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South Afr Polit Econ Mon. 1994 Jun;7(9):5-8.
The scourge of HIV and AIDS in Africa.

Goncalves F.

PIP: International assistance for prevention of HIV infections has been requested jointly by the Southern African Frontline States and the Global Coalition for Africa. Sub-Saharan Africa has had more AIDS victims than anywhere else in the world. Over 8 million of the estimated 13 million HIV-positive adults worldwide are in sub-Saharan Africa, where transmission is primarily through heterosexual sex. The World Health Organization (WHO) estimates that 71% of cases worldwide are transmitted by heterosexual sex, 7% through injections or drug use, 5% by blood transfusion, and 15% through homosexual behavior. In Uganda, an estimated 1 out of every 6 adults is HIV-positive. The expectation by WHO is that 10-15 million children worldwide will lose both or at least one parent to AIDS by the year 2000. An extreme example was of a Ugandan grandmother who had lost 6 children to AIDS and cared for her 25 grandchildren. The consequences are far reaching. there is the cost of funerals, which many poor can not afford; there are orphans, lack of caretakers or overwhelmed caretakers, loss of productive workers, and drains on health services. There is contention about the extent of the AIDS incidence is Sub-Saharan Africa; some would argue that many deaths are due to endemic diseases. However, one consequence of the presence of the HIV virus is the damage to the immune system response to any disease. The actual cause of an AIDS death may be pneumonia, tuberculosis, or any other illness. The male high risk group is comprised of males aged 20030 years, away from home, a possible history of sexually transmitted disease, and contact with prostitutes. The female high risk group is comprised of single mothers aged 18025 years, with a history of sexually transmitted disease, and engaged in commercial sex. Lack of condom use is linked to alcohol consumption. An estimated 25% of patients attending sexually transmitted disease clinics in South Africa have HIV infections. In 1993, Tanzania had southern Africa's highest incidence of reported cases (37,719), followed by Zambia (29,734), Malawi (29,194), and Zimbabwe (25,332). AIDS has become so widespread that many feed a sense of hopelessness and engage in careless sexual behavior, seeking out teenage girls believed to be HIV-free. The high level of poverty in Africa makes AIDS difficult to combat.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12287761&dopt=Abstract

Contracept Fertil Sex (Paris). 1994 Jan;22(1):15-21.
[AIDS and the obstetrician-gynecologist]

[Article in French]

Henrion R.

PIP: This work provides current information and recommendations concerning prenatal care and treatment of seropositive women. The influence of pregnancy on HIV infection is difficult to assess because of the need to dissociate effects of the natural development of the illness from those possibly aggravated by pregnancy. It now appears that pregnancy is deleterious primarily in women who have AIDS or a significant immune deficit. Affects of HIV infection on the fetus related to the virus itself, to the immune deficit, and to thrombopenia have been described. Complications related to the virus vary from country to country. Secondary infections in a mother with a compromised immune system may affect the infant, while complications related to thrombopenia have been very rare. It is not yet known at what moment of pregnancy infection of the fetus by the mother is most likely to occur, but much evidence exists of infection at some moment before birth. There is some evidence that over 70% of infections occur late in pregnancy, although earlier infection has been demonstrated. Infection during delivery and breast feeding have also been demonstrated. The frequency of maternal-fetal transmission is variable in different countries. It was 14.4% in the most recent European collaborative survey, 20% in the French survey, 20 to 25% in the US, and 35% or over in Africa. Mothers at advanced stages of disease are more likely to infect their infants. Some 20% of infected infants are gravely ill from birth, while another large group begins to become ill at around six months and follows a course similar to that of adults. Women who already have AIDS are usually under the care of a physician at the start of pregnancy. In most cases, the mother is asymptomatic. A complete physical examination should be performed including CD4 and CD8 lymphocyte count and related tests. The HIV status of the partner should be assessed, as should the ability of the couple to raise a child. The choice of whether to proceed with the pregnancy must be made by the mother. In France, over 50% of HIV positive mothers choose to continue their pregnancies. AZT treatment should begin if the level of CD4 lymphocytes is less than 200. Treatments to prevent opportunistic infection should be administered. Prenatal diagnosis of HIV infection is theoretically possible but difficult to carry out. The woman's HIV status should be reassessed every two or three months as the pregnancy progresses. It is not yet known whether cesarean delivery can lessen the risks of perinatal transmission. Labor and delivery are not affected by the infection. Fetal lesions should be scrupulously avoided. The woman's lower genital tract may be disinfected every four hours of labor and immediately before delivery with a solution of benzalkonium chloride 0.1%. The infant should be thoroughly cleansed of all traces of maternal blood and the cord disinfected before any skin-piercing procedure is performed. Breast feeding is contraindicated in Europe but not in developing countries at this time. Pregnancy is formally discouraged in seropositive women, but as a practical matter it is often impossible to prevent a young woman from seeking a desired pregnancy.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12287766&dopt=Abstract

AIDS Anal Afr. 1995 Mar-Apr;5(2):2.
AIDS research receives a much-needed stimulus.

[No authors listed]

PIP: Recent breakthroughs in research on acquired immunodeficiency syndrome (AIDS) have brought human immunodeficiency virus (HIV) vaccines and antiviral drugs closer to realization. A group of sex workers in Gambia have been found to be immune to HIV. In the US, it has been discovered that a fierce battle is conducted by the body's immune system during the asymptomatic stage of the disease, and scientists are searching for drugs that delay the onset of AIDS. According to Professor Robin Weiss of the Institute for Cancer Research, AIDS research is progressing at a more rapid rate than other areas of study, such as cancer and multiple sclerosis. The public and media frustration with the continuing astronomical spread of HIV should be directed at solving a social problem, rather than a scientific one.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12288601&dopt=Abstract

AIDS Action. 1995 Feb;(27):6.
HIV and AIDS: fact not myth. Epidemiology update.

[No authors listed]

PIP: In 1983 when HIV was isolated, researchers believed that the virus destroyed the immune system. This was difficult to prove, however, because the immune system is able to fight off the virus for many years until it is finally weakened in some as yet undetermined way. AIDS is the name given to the collection of illnesses that take advantage of the body's inability to defend itself. Many of these illnesses are common, but more and more infected individuals are suffering from multiple chronic illnesses which are difficult to treat, more middle-aged and young adults are dying from tuberculosis, and rare immune-deficiency illnesses are becoming more common. These illnesses and deaths were linked with HIV when a study in Uganda found that people between age 13 and 44 years who tested HIV-positive were up to 60 times more likely to die in the next 2 years than those who were HIV-negative. HIV statistics are incomplete because, although tests are now accurate, many measurements are obtained anonymously through surveillance of blood donors, patients at sexually transmitted disease clinics, and prenatal women. Many people with AIDS fear stigmatization and do not seek health care. The World Health Organization has used the most reliable reports available to estimate that 13-15 million people are living with HIV or AIDS.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12288723&dopt=Abstract

World Watch. 1994 Jul-Aug;7(4):31-4.
Why don't we stop tuberculosis?

Platt AE.

PIP: Many people think of tuberculosis (TB) as a disease of the past of no current concern to modern society. This is not the case. Despite the medical establishment's ability to treat and cure TB, the disease has reemerged to assume the position as the leading killer worldwide among infectious or communicable diseases. TB threatens more people than AIDS, cholera, dengue fever, and other infectious diseases combined. Accordingly, the World Health Organization (WHO) declared a global state of emergency against TB in 1993. In 1993, 2.7 million people died from TB and another 8.1 million were infected. Worldwide, an estimated 1.7 billion people had inert TB infections. The current TB epidemic is expected to worsen, especially in the developing world due to the evolution of multi-drug-resistant strains and the emergence of AIDS which compromises human immune systems and makes them more susceptible to infectious diseases. By the year 2000, the global incidence of TB is expected to increase to 10.2 million cases per year, an increase of 36% over 1990's 7.5 million cases. 75% of the increase can be traced to poor TB control programs, population growth, and the advancing age of the population, while the remaining 25% is attributed to the interaction between the TB virus and HIV. More than 95% of TB cases reported in 1990 were in the developing world, with an estimated two thirds in Asia; India accounted for 2.1 million cases. Developing countries have a disproportionate number of cases because AIDS is spreading quickly, health services are inadequate, and little money is available for treatment. WHO points out that adherence to the complete and inexpensive drug regimen of rifampicin, isoniazid, pyrazinamide, and ethambutol every day for six to eight months could reduce the rate of TB transmission and cut the number of TB deaths in half over the next ten years. Worldwide early treatment could prevent almost 12 million deaths over the next decade and save large amounts of money. Moreover, global monitoring by WHO and regional health nongovernmental organizations to identify and diagnose TB must be combined with sufficient infrastructure and resources, such as vaccines, medicines, trained health personnel, and clinics. Funding for research and prevention and treatment programs is essential.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12288930&dopt=Abstract

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