Diagnoses of HIV-1 and HIV-2 in England, Wales, and Northern Ireland associated with west Africa

OBJECTIVES: To describe HIV diagnoses, including those of HIV-2 infection, made in England, Wales, and Northern Ireland (E,W&NI) among those probably infected in west Africa, and to consider whether there is evidence for ongoing heterosexual transmission within the United Kingdom. METHODS: Reports of new HIV diagnoses received at the Communicable Disease Surveillance Centre were analysed. Individuals probably infected in west Africa and those infected through heterosexual intercourse within the United Kingdom by a heterosexual partner infected in west Africa were included. RESULTS: Between 1985 and 2003 inclusive, 1324 individuals diagnosed and reported with HIV had probably been infected in west Africa, with 222 diagnoses made in 2003. 917 (69%) were HIV-1 infected and 52 (6%) HIV-2 or HIV-1/HIV-2 co-infected. For 355 (27%) the HIV type was not reported. The proportion of HIV-2 and HIV-1/HIV-2 infections varied by country of infection (p<0.001): ranging from the Gambia (11.7%-15.2%) to Nigeria (0.7%-1.0%). A further 130 individuals were probably infected through heterosexual intercourse within the United Kingdom by a heterosexual partner infected in west Africa. 89 (68%) were HIV-1 infected and three (2%) HIV-2 infected or HIV-1/HIV-2 co-infected. For 38 (29%) HIV type was not reported. CONCLUSION: The number of people infected with HIV in west Africa and diagnosed in E,W&NI has increased in recent years, and there is evidence of heterosexual transmission within the United Kingdom from people infected in west Africa. While numbers of HIV-2 diagnoses remain relatively low, an appreciable proportion of people infected in some west African countries and diagnosed in the United Kingdom may be HIV-2 positive, with implications for prognosis and treatment.     

Epidermolysis bullosa in Northern Ireland

Cases of epidermolysis bullosa (EB) diagnosed in Northern Ireland during a 23-year period (1962-84) were identified from dermatology clinic files, paediatric hospital notes and cases known by general practitioners. A total of 48 confirmed new cases of EB were diagnosed during the screening period. This involved 31 families, with identification of 36 further cases. The distribution of incident EB subtypes was: simplex 31 (65%), junctional 1 (2%), dystrophic 12 (25%) and acquisita 4 (8%). The incidence rate of new cases of EB diagnosed per year is 1.4/million and prevalence of all forms estimated at 32/million. The prevalence of simplex, junctional and dystrophic forms is 28, 0.7 and 3/million, respectively.     

Industrial dermatitis in Northern Ireland

Industrial injuries and disablement benefits paid for industrial dermatitis (PD 42) in Northern Ireland are analyzed by age, industry and substance responsible. The most significant trend is a decrease in the number of cases due to cement and an increase in the number of nickel cases.     

Case Reports Ulcer due to Mycobacterium ulcerans in Northern Ireland

We report a patient who presented to our service in June 1981 with an extensive ulcer involving his left elbow which eventually proved to be due to Mycobacterium ulceram. This case underlines the necessity of good history taking with respect to foreign travel and a high index of clinical suspicion when faced with unusual lesions in a multiracial society.     

Trends in undiagnosed HIV-1 infection among attenders at genitourinary medicine clinics, England, Wales, and Northern Ireland: 1990-6

OBJECTIVE: To describe trends in seroprevalence of undiagnosed HIV-1 infection among attenders at 15 genitourinary medicine clinics in England, Wales, and Northern Ireland between 1990 and 1996. METHOD: Prospective, cross sectional sentinel serosurvey. Unlinked anonymous testing of remnant serum drawn for routine syphilis screening. RESULTS: In 1996, the seroprevalence of undiagnosed HIV-1 infection was 5% in homosexual men, 0.48% in heterosexual men, and 0.33% in heterosexual women. Between 1990 and 1996, there was a significant linear decrease in the seroprevalence of undiagnosed HIV-1 infection among homosexual and bisexual men within and outside London (p < 0.0001; p = 0.0141), equivalent to yearly decreases of 7.65% and 10.73% respectively. However, seroprevalence among homosexual and bisexual men under 25 years of age did not decline either inside or outside London. Seroprevalence among heterosexual men declined outside London (p < 0.005), equivalent to an average annual decrease of 14.54%. There was a significant increase among male heterosexuals inside London (p < 0.05) equivalent to a 8.09% increase per annum. Seroprevalence over time was unchanging among female heterosexuals both inside and outside London. Seroprevalence was significantly higher among those who injected drugs than those who did not report injecting in the following groups: homosexual and bisexual males within London (p < 0.005), male heterosexuals both within and outside London (p < 0.05; p < 0.05) and female heterosexuals within London (p < 0.05). CONCLUSIONS: The study highlights a significant burden of undiagnosed HIV-1 infection more than 15 years since the HIV epidemic began. Methods of offering HIV testing need to be reassessed to extend the practice of routinely testing for HIV in GUM clinics. HIV transmission among young homosexual and bisexual men continues. The contrasting trends between homosexual and bisexual men, injecting drug users, and heterosexuals attending GUM clinics indicate these groups should be considered separately. The substantial HIV seroprevalence in each group indicates that they should be priorities for targeted HIV prevention.     

HIV-1抗体阳性者的免疫印迹带型分析

目的 分析江门市HIV-1抗体阳性者流行病学特征及其抗体蛋白免疫印迹试验(WB)带型特征,为艾滋病防治工作提供科学依据。方法 运用免疫印迹试验、流式细胞术检测2018-2019年江门市新确诊的HIV-1感染者外周血中的HIV抗体、CD4⁺T淋巴细胞,结合该人群的人口学特征进行统计分析。结果 214例HIV-1抗体阳性者中,男156例(72.90%),女58例(27.10%);平均年龄(44.70±14.00)岁;CD4⁺T淋巴细胞≤350个/μL的占68.69%。WB带型以次全带为主,缺失条带类型以p55和p17为主。不同性别间的WB带型仅p55的检出率差异有统计学意义(χ²=4.41,P=0.036)。在不同途径感染人群间gp41(χ²=16.31,P<0.01)、p51(χ²=8.75,P=0.013)的抗体检出率差异均有统计学意义。不同免疫水平的人群间WB带型gp41(χ²=9.26,P=0.010)、p24(χ²=5.3...     

Thirteen-year retrospective study of Bowen''s disease in Northern Ireland

In a retrospective study we measured the incidence of internal malignancy in patients diagnosed as having Bowen's disease, in Northern Ireland, between 1970 and 1983. Data on 157 patients were obtained from hospital notes, death certificates, the Northern Ireland Cancer Registry and the patients' general practitioners. There was a preponderance of females with Bowen's disease with a female to male ratio of 2.8:1. The incidence of internal malignancy was significantly greater in patients with Bowen's disease than that expected for the general population, suggesting that these patients should be screened for occult malignancy. Patients with multiple areas of Bowen's disease did not appear to be more at risk of internal malignancy than those with a single lesion.     

Chlamydia trachomatis prevalence in men in the mid-west of Ireland

OBJECTIVES: To estimate the prevalence of chlamydia infection in young men in the Mid-Western Health Board Region of Ireland, and to determine risk factors for its acquisition. METHODS: Consecutive men attending orthopaedic clinics (OPD), and a university sports arena (UL) were recruited to a chlamydia prevalence study. All men aged 17-35 who had been sexually active and had not passed urine in the last hour were eligible. Information about chlamydia was given, informed consent obtained, and a self administered questionnaire was completed. A first void urine (FVU) was collected and tested by ligase chain reaction (LCR). RESULTS: 82% (207/252) of men from OPD, and 60% (186/310) from UL participated. 6.3% (13/207) from the OPD and 5.4% (10/186) from UL tested LCR positive, giving an overall prevalence of 5.9% (23/393). Proved risk factors for chlamydial positivity were: (1) more than one sexual partner in previous 6 months, (2) more than eight lifetime sexual partners, (3) current symptoms (dysuria or discharge). No statistical significance was found for age, condom use, smoking, days since last sexual intercourse and previous GUM clinic attendance. No statistically significant difference to cost effective prevalence of 6% was shown. CONCLUSIONS: A 5.9% prevalence of Chlamydia trachomatis was found which is cost effective to screen and treat. Non-invasive screening of men in the community was possible. Numbers of sexual partners and current symptoms were significant risk factors. Since only 25% of men in this laboratory were diagnosed with chlamydia outside the GUM clinic, compared with 59% of women, it is important that community screening of men is promoted.     

Mercury allergy in a contact dermatitis clinic in Northern Ireland

441 consecutive patients (294 female, 147 male) with suspected contact dermatitis were patch tested to the European standard series, mercury metal (1% pet.). ammoniated mercury (1% pet.), and mercuric chloride (0.1% aq.), 14 patients (3.2%), 12 of whom were female, showed a positive response to 1 or more mercury compounds: none reacted to mercuric chloride alone. Primary sensitization was most likely due to either inoculation with vaccines containing merthiolate preservatives or amalgam dental restorations. Mercury allergy was of historical clinical relevance in only 2 pa I rents, both women who developed gingivostomatitis following insertion of amalgam dental fillings. 1 of these women subsequently developed allergic contact dermatitis from contact lens solutions, shampoos and cosmetics which contained mercury preservatives. On the basis of these findings, we recommend patch testing with both metallic mercury and ammoniated mercury in patients with suspected mercury allergy.     

Prevalence of gallstones in patients with erythropoietic protoporphyria in Northern Ireland

Erythropoietic protoporphyria (EPP) is characterized by increased red cell protoporphyrins, which are excreted solely in the bile. Since gallstones are thought to be more prevalent in EPP, all 17 patients in Northern Ireland known to have EPP had abdominal ultrasound scanning and tests of liver function. Asymptomatic gallstones were detected in one patient, an 11-year-old girl. Liver function was normal in all patients.     

Incidence of herpes genitalis in Northern Ireland in 1973-83 and herpes simplex types 1 and 2 isolated in 1982-4.

During 1973 - 83 there was a pronounced rise in the number of new cases of herpes genitalis in Northern Ireland. This study of 127 patients with herpes genitalis shows that 30% had herpes simplex virus type 1 (HSV 1) and 70% had herpes simplex virus type 2 (HSV 2) infections. Of 41 sexual contacts who attended, only seven had herpes genitalis (caused in each case by HSV 2); another patient had a history of genital lesions, and one other of oral lesions, but HSV was not isolated from either patient. None of the other sexual contacts had a history of oral or genital infection. Of 31 women with herpes genitalis who consented to undergoing cervical cytology, five had atypical changes (all had primary herpes genitalis). Of these, four were infected with HSV 1 and one with HSV 2.     

HIV-1 incidence and HIV-1 associated mortality in a cohort of urban factory workers in Tanzania.

OBJECTIVE--To determine HIV-1 incidence and HIV-1 associated mortality in a prospective cohort study. To determine whether the cohort is suitable for studies aiming to determine the impact of interventions on HIV-1 incidence. METHODS--The study population was a cohort of 1772 urban factory workers (1478 men and 294 women) in northwest Tanzania. The study took place from October 1991 to September 1993. Outcome measures were HIV-1 seroconversion and death. RESULTS--HIV-1 incidence was 1.2 (95% CI 0.7-2.0) per 100 person-years (pyr). Crude annual mortality was 4.9 per 100 pyr in those with and 0.3 in those without HIV-1 infection, giving an age and sex adjusted mortality ratio of 12.9 (95% CI 5.4-30.7). Of all deaths, 62% were attributable to HIV-1 infection. CONCLUSION--HIV-1 infection was a major public health problem, being the major cause of death in this adult population. At an HIV-1 incidence of 1.2 per 100 pyr, a large cohort size would be required to evaluate the impact of interventions on HIV-1 incidence.     

AIDS and prevalence of antibody to human immunodeficiency virus (HIV) in high risk groups in Thailand.

Since September 1984, six cases of acquired immune deficiency syndrome (AIDS) and 11 cases of AIDS related complex (ARC) have been reported in Thailand. All people with AIDS were homosexual or bisexual men; two were Thai and the rest were European or American. Nine of the 11 people with ARC were homosexual or bisexual men, one was the female sexual partner of a man with AIDS, and one was a Thai man who had lived in the United States of America for several years, but denied having had any homosexual contact. Nine of the 11 people with ARC were Thai. In a survey in April 1985 at a resort area near Bangkok, antibodies to human immunodeficiency virus (HIV) (confirmed by western blot) were detected in 2.4% of 127 homosexual men and none of 77 female prostitutes. In a more extensive survey in October 1985, antibodies were detected in 0.8% of 720 homosexual men, but none of 2880 female prostitutes or 309 sexually active heterosexual men. HIV has been introduced into Thailand primarily by homosexual transmission. The public health policy of Thailand concerning AIDS is discussed.     

P24 antigen detection, viral isolation, DNA-PCR and in vitro antibody production for the diagnosis of HIV-1 latent infection in heterosexual women at high risk for HIV-1 infection.

INTRODUCTION--The report of the existence of at-risk seronegative subjects, latently infected with HIV-1 and producing "in vitro" HIV-1 specific antibodies, prompted the authors to evaluate extensively twenty-five heterosexual HIV-1 seronegative women at high risk for HIV-1 infection. MATERIAL AND METHODS--The capability of peripheral blood mononuclear cells from such subjects to produce "in vitro" HIV-1 specific antibodies after pokeweed-mitogen stimulation, was studied. Silent HIV-1 infection was investigated by HIV-1 DNA PCR, viral isolation and serum p24 Ag detection at entry and after 6 and 12 months. RESULTS--Three seroconversions took place within 12 months, but no HIV-1 infections were found in the absence of detectable serum anti HIV-1 antibodies, even in subjects who apparently produced such antibodies in vitro. The antibodies produced in vitro by the seronegative women studied appeared of narrow specificity, reacting mainly with gp 160/120 envelope glycoproteins. CONCLUSIONS--A strong concordance was found between the serological status and the other markers for HIV-1 infection, suggesting that the phenomenon of HIV-1 "latent infection" is a very rare event, if it occurs at all. Seronegative women sexually exposed to the virus may produce in vitro anti HIV-1 antibodies of narrow specificity in the absence of other signs of infection and this phenomenon might be related to an anamnestic response to the virus.     

Trends of HIV-1 and HIV-2 prevalence among pregnant women in Guinea-Bissau, West Africa: possible effect of the civil war 1998 1999

Objectives

Sentinel surveys in Bissau, the capital of Guinea‐Bissau, have shown low prevalence of HIV‐1 but high HIV‐2 prevalence before 1998. Guinea‐Bissau experienced a civil war in 1998–1999. To examine specifically the trends of HIV prevalence from antenatal surveys in Bissau, Guinea‐Bissau in 1987–2004, and whether the civil war in 1998–1999 could have an effect on HIV prevalence levels after the conflict.

Methods

Since 1987, anonymous HIV testing in delivering women has been performed at the maternity clinic, Simão Mendes National Hospital, Bissau, as part of the national sentinel surveillance programme. Consecutive sampling was performed for approximately 3 months between September and December each year. Serological analyses were performed at the National Public Health Laboratory in Guinea‐Bissau.

Results

A total of 20 422 women were tested for HIV between 1987 and 2004. The total HIV‐1 prevalence increased from 0.0% in 1987 to 4.8% in 2004 and the total HIV‐2 prevalence decreased from 8.3% in 1987 to 2.5% in 2004. The HIV‐1 prevalence increased from 2.5% in 1997 to 5.2% in 1999, but stabilized in subsequent years.

Conclusions

There was a significant increase in HIV‐1 prevalence in the years 1987–2004 and a significant decline in HIV‐2 prevalence over the same period. The civil war in 1998–1999 may have sparked HIV‐1 transmission, as HIV‐1 prevalence more than doubled between 1997 and 1999, but there is no evidence of a long‐term effect on the trends of HIV‐1 or HIV‐2 prevalence.