Acquired immunodeficiency syndrome and human immunodeficiency virus infection in Bujumbura, Burundi

In the first seroepidemiological survey in Burundi in 1984, only 59 acquired immunodeficiency syndrome (AIDS) cases were recognized. We report here clinical surveillance of AIDS cases in the 4 hospitals in Bujumbura during a 4-month period in 1986. The project was combined with a seroprevalence study of pregnant women in the 6 dispensaries in Bujumbura. 258 AIDS patients were recorded. 16% of the 925 pregnant women were seropositive for human immunodeficiency virus (HIV). The clinical characteristics of 120 adult AIDS patients were similar to those reported in Kinshasa or Kigali. From demographic findings we presume that the major mode of HIV transmission in Bujumbura is by sexual contact. The results of this study formed the starting point of prevention activities against AIDS in Burundi.     

Effective inactivation of human immunodeficiency virus with chlorhexidine antiseptics containing detergents and alcohol

The antiseptics 4% chlorhexidine gluconate detergent formulation containing 4% isopropyl alcohol (Hibiclens/Hibiscrub) and 0.5% chlorhexidine gluconate in 70% isopropyl alcohol with emollients (Hibistat/Hibisol) efficiently inactivated human immunodeficiency virus (HIV) produced in cell culture within 15 seconds. These antiseptics were completely effective at 1:100 and 1:5 dilutions, respectively. Therefore, use of these products according to the manufacturer's instructions (i.e. undiluted) for routine disinfection of hands following contact with HIV-contaminated materials, as well as immediate disinfection of abrasions or cuts exposed to HIV, should have significant protective effects.     

Tuberculosis, human immunodeficiency virus infection, and malnutrition in Burundi.

In order to compare the nutritional status of tuberculosis (TB) patients who were human immunodeficiency virus (HIV)-seropositive with those who were seronegative, we carried out a cross-sectional anthropometric and biochemical assessment, together with bioelectrical impedance analysis (BIA) of the nutritional status of TB patients hospitalized in the Department of Internal Medicine, Bujumbura University Hospital, Burundi, East Africa. Of the 65 TB patients (33 pulmonary, 6 extrapulmonary, and 26 disseminated TB), 50 (76.9%) were HIV-seropositive (HIV+). When assessed according to anthropometric, BIA, and biochemical variables, HIV+ TB patients had more pronounced malnutrition than HIV- patients. Similar results were obtained when the comparison was restricted to patients with only pulmonary TB: HIV+ patients were more malnourished than HIV- patients. The results according to anthropometric measurements were: weight loss (13.5% of HIV- patients versus 26.4% of HIV+ patients, P = 0.005), body mass index (18.6 versus 15.1, P = 0.003), fat free mass (FFM) (13.9 versus 11.9, P < 0.01), and body fat (BF) (4.55 versus 3.71, P = 0.03) expressed per unit height2. BIA showed that the difference in FFM between HIV- and HIV+ TB pulmonary patients was mostly due to a decrease in body cellular mass. Measurements of albumin, prealbumin, and transferrin showed a marked decrease in all three markers in HIV+ TB pulmonary patients. The nutritional status of HIV+ patients with disseminated versus pulmonary TB was similar. The nutritional status of HIV+ TB patients is far worse than that of HIV- TB patients. In such patients, anthropometry underestimates the degree of malnutrition because it does not account for the water component of FFM. Nutritional status should be assessed and nutritional intervention should be provided in an attempt to improve the prognosis of TB patients, especially those who are infected by HIV.     

Screening for human immunodeficiency virus

Screening for human immunodeficiency virus (HIV) antibodies as a means of preventing both the progress and spread of acquired immunodeficiency syndrome (AIDS) is problematic in terms of efficacy, effectiveness, and ethics. The few desired effects are mostly offset by greater and more certain undesirable effects on individuals and society.     

Regional differences in alcohol consumption, alcohol addiction and drug use among Swedish adults

Introduction: Alcohol consumption and drug use, as well as alcohol- and drug-related problems, vary considerably in different regions in Sweden, and between men and women of different ages. AIM: The aim of the present study was to examine the regional, gender and socioeconomic distribution of risk consumption of alcohol, alcohol dependency and drug use in a random sample in Sweden. Material and METHODS: In both May 2003 and 2004, 7200 gender-stratified adults (a total of 14,400), randomly selected from 12 regions in Sweden, were contacted by mail, and asked to fill out an enclosed questionnaire. The questionnaire concerned use of alcohol, alcohol-related problems, and use of illicit drugs. RESULTS: Heavy alcohol consumption and cannabis use were more frequent in the south of Sweden than in the north, and the further north, the lower the frequency. Alcohol and drug use decreased with age, and was higher for men than for women. On average, 11.5% of all men and 5.0% of all women consumed alcohol intensively at least weekly, 8.6% of men and 4.5% of women had a generally high alcohol consumption, 4.1% of men and 2.5% of women were alcohol addicted, and 2.9% of men and 1.3% of women had used cannabis during the last 12 months. CONCLUSIONS: High alcohol consumption and use of illegal drugs seem to be more prevalent in those parts of Sweden that are closer to the European continent. In our opinion, this might be an effect of the closeness to other European countries with lower prices for alcohol, less strict alcohol control policies, and higher availability of drugs. Consideration of regional, gender and age differences in problems related to alcohol and drugs seem to be important in the planning and development of preventive activities.     

人类免疫缺陷病毒相关神经认知功能障碍的研究进展

目前抗反转录病毒治疗(ART)明显改善了HIV感染者的预后,但是HIV相关神经认知功能障碍(HAND)逐步成为影响HIV感染者预后的严重并发症,此文对HAND的临床表现、致病机制、诊断和治疗进行综述,以期为临床治疗提供参考.     

Nutrition in paediatric human immunodeficiency virus infection

The nutritional condition of children with human immunodeficiency virus (HIV) infection continues to be a problem both in developed and developing countries. HIV-infected children grow below normal standards in both height and weight when compared with HIV-exposed non-infected children. These patterns persist over time. It is possible that acute infectious episodes and increased HIV viral burden contribute to decrements in all growth variables. Potential aetiologies for abnormal growth include inadequate dietary intake, gastrointestinal malabsorption, increased energy utilization and psycho-social problems. It is likely that all these factors contribute to the growth problems of these children to some extent. With the development of protease inhibitor anti-retroviral therapy and highly-active anti-retroviral treatment regimens, children with HIV infection in developed countries are living longer with a chronic illness. New nutritional problems have arisen with the development of the fat redistribution syndrome or lipodystrophy. Emerging problems are now being recognized, with the development of insulin resistance and truncal obesity which may potentially lead to premature cardiovascular disease.     

Illicit alcohol consumption and neuropathy--a preliminary study in Sri Lanka

AIMS: To compare the effects on peripheral and autonomic nerve functions of Sri Lankan illicitly distilled alcohol consumption versus legal spirit consumption. METHODS: Peripheral nerve conduction and autonomic nerve functions were assessed in 40 healthy control subjects and two groups of chronic heavy drinkers: 41 illicit spirit drinkers and 17 legal spirit drinkers. RESULTS: Lower-limb motor and sensory nerve conduction parameters were affected in both groups of alcoholics. When compared with controls, in illicit spirit drinkers the mean heart rate indexes of all parasympathetic tests were lower while in legal spirit drinkers the heart rate response to standing was affected. There were no differences in the results of the above tests when the two groups of heavy drinkers were compared. CONCLUSIONS: Though chronic alcoholism results in peripheral and autonomic nerve damage, the damage caused by consumption of illicitly distilled spirit is not worse than the damage caused by consumption of legal spirits.     

Nutrition and immune function in human immunodeficiency virus infection

The triad of human immunodeficiency virus (HIV) infection, nutritional status and immune function are intimately related, each factor having effects on the others. The dominant effect in this three-way relationship is the effect of HIV infection on nutritional status, an effect which, until the advent of potent anti-retroviral drugs, has been manifest primarily as wasting. Recently, more complex metabolic abnormalities have become apparent, particularly fat redistribution syndromes, hyperlipidaemia and hypercholesterolaemia. For the converse effect, the effect of nutritional state on HIV disease progression, there is good evidence that clinical outcome is poorer in individuals with compromised nutrition. However, the beneficial effects of nutritional support have been more difficult to demonstrate. For macronutrients, effective macronutrient supply improves survival in severely-malnourished individuals and may have beneficial effects in less-severely-affected individuals. Micronutrient deficiencies appear to be involved in modifying clinical HIV disease and may also be associated with enhanced mother-to-child transmission of virus, particularly in developing countries. Intervention trials in this setting are currently under way. In conclusion, the interaction of HIV infection and nutrition is of great importance not just because of the major impact that HIV infection has on nutritional state, but also because strategies to improve nutritional status, both quantitatively and qualitatively, may have a beneficial effect on the clinical and immunological course of the disease.     

Effects of chronic alcohol drinking on receptor-binding, internalization, and degradation of human immunodeficiency virus 1 envelope protein gp120 in hepatocytes.

Although alcohol drinking increases susceptibility to human immunodeficiency virus (HIV) infection, possible mechanisms underlying the effects of alcohol are not yet known. Since the HIV envelope protein gp120 plays a key role in progression of HIV infection, the aim of the present study was to evaluate the toxicity and degradation of gp120 in hepatocytes isolated from liver of alcohol-preferring rats drinking either 15% ethanol in water or pure water for 70 days. The hypothesis was that alcohol drinking augmented the toxicity, but suppressed degradation of gp120. Hepatocytes from water-drinking rats (C-cells) or ethanol-drinking rats (Et-cells) were treated with laptacystin, anti-CD4 antibodies, CCR5 antagonist, or mannose, followed by [(125)I]gp120 or native gp120. At predetermined intervals, control (C) and ethanol exposed (Et) cells were analyzed for toxicity and degradation of gp120. In C-cells, [(125)I]gp120 binding and internalization peaked within 5-45 min and remained elevated for up to 10h and then decreased gradually. In Et-cells, [(125)I]gp120 binding peaked comparably to C-cells, but the binding remained to the peak level throughout the experimental period. C-cells exhibited the lysosomal/ubiquitin-mediated degradation of intracellular gp120, resulting in released gp120 fragments into the incubation medium that suppressed gp120-CD4 binding, improved cell viability, and inhibited gp120-induced apoptosis. Ethanol drinking suppressed gp120 degradation in and release of gp120 fragments from hepatocytes. The incubation medium of Et-cells did not suppress gp120-CD4 binding or the gp120-mediated apoptosis in hepatocytes. Thus, chronic alcohol drinking augmented the adverse effects of gp120 possibly by suppressing its degradation in hepatocytes. The present observation also suggests that a number of CCR5 or ubiquitin-based therapeutic drugs may not be effective in suppressing HIV infection in alcohol-drinking subjects.     

Ethical issues in nutrition and human immunodeficiency virus.

Ethical dilemmas often arise in the provision of healthcare. In view of the advances in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) medical management since the late 1990s, many of the challenges and ethical dilemmas encountered by healthcare professionals have changed from terminal or end-of-life issues to long-term management issues. This article presents 5 case scenarios on common ethical issues faced by those providing nutrition care to people living with HIV/AIDS and addresses key questions to ask in the ethical deliberative process. Ethical dilemmas surrounding the use of complementary and alternative medicine, providing aggressive nutrition support, dealing with third-party payers for supplement reimbursement, and managing patients with mental health disorders and substance abuse issues are discussed, with possible solutions presented from an ethics point of view.     

受血者受血前HIV、HBV、 HCV、梅毒感染及其重叠感染研究

目的研究受血者受血前人免疫缺陷病毒（HIV）、乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）、梅毒感染及其重叠感染现状与特点。方法对2007年10月-2008年6月间某院需输注血制品的9694例患者进行检测;采用酶联免疫吸附试验检测血清HBV标志物、血清抗HCV,双抗原夹心酶联免疫法检测血清抗HIV和梅毒抗体。结果9694例受血者受血前血清HBV标志物阳性1549例（15．98％）,抗HCV阳性59例（0．61％）,抗HIV阳性34例（0．35％）,梅毒抗体阳性495例（5．11％）。重叠感染者中,HBV与HCV57例（0．59％）,HBV与梅毒94例（0．97％）,HCV与梅毒3例（0．03％）;血清抗HIV阳性患者中,重叠感染HBV13例（0．13％）,HCV10例（0．10％）,梅毒4例（0．04％）;HIV、HBV和HCV重叠,HIV、HBV和梅毒重叠感染各2例（1．08％）,HIV、HBV、HCV和梅毒重叠感染1例（0．54％）。结论部分受血者在受血前就已有感染,特别是HBV和梅毒的感染率较高。对受血者于受血前进行全面检查不仅可避免相关医疗纠纷,还可为患者治疗和医务人员的职业防护提供帮助。