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Biomedical subjects

C Chintu

Publications and source records attributed to C Chintu.

At least 19 recordsLinked to original sources
PubMed1999

HIV-1 seroprevalence in Zambian patients with acute diarrhea: a community-based study.

The seroprevalence of HIV-1 in sub-Saharan African patients with diarrhea in the community remains largely unknown. We present the findings of a 2-month study that we undertook to ascertain the seroprevalence of HIV-1 in Zambian patients presenting with acute diarrhea in a community-based health center. A total of 256 patients with diarrhea and 140 apparently healthy controls was seen. Of the patients with diarrhea, 161 were < 16 years old and 95 were adults. Most children with diarrhea were < 6 years old (147 of 161; 91%). Overall, 81 of 256 (32%) patients with diarrhea were HIV-1-seropositive. When results from children < 18 months old and possibly having maternal anti-HIV-1 antibodies were excluded, 64 of 172 (37%) patients with diarrhea were HIV-seropositive. Rates of HIV-1 seropositivity for patients with diarrhea were significantly higher than were rates for diarrhea-free controls (p < .001 for both the total population; odds ratio [OR], 95% confidence interval [CI], 1.42 < 2.48 < 4.35) and population > 18 months old (OR, 95% CI, 1.54 < 2.90 < 5.49). Among children between 18 months and 5 years old, 14 of 63 (22%) were HIV-1-seropositive compared with 8 of 62 (13%) without diarrhea (p > .05, not significant). Moreover, 49 of 95 (52%) adults with acute diarrhea were HIV-1-seropositive compared with 10 of 44 (23%) healthy adult controls (p < .003; OR, 95% CI, 1.51 < 3.62 < 8.87). No significant differences were found in HIV-1 seroprevalence rates between males and females in all age groups. These data show a close association between acute diarrhea and HIV seropositivity in Zambian adults in the community.

Acute Disease↗
PubMed1999

The effects of BCG immunization and human immunodeficiency virus infection on dual skin test reactions to purified protein derivative and Mycobacterium avium sensitin among adults in Zambia.

SETTING: University hospital in Lusaka, Zambia. OBJECTIVE: To determine the effects of childhood bacille Calmette-Guerin (BCG) immunization and human immunodeficiency virus (HIV) infection on dual skin test reactions to purified protein derivative (PPD) and Mycobacterium avium sensitin (MAS) in a developing country. DESIGN: Descriptive cross-sectional study. RESULTS: Dual skin testing was performed on 112 adults, 58 HIV-positive and 54 HIV-negative. Forty-seven (42%) of 112 had PPD reactions > or =10 mm and 52 (46%) had MAS reactions > or =10 mm. PPD reactions > or =10 mm were present in 30 (63%) of 48 BCG-positive subjects compared to 17 (27%) of 64 BCG-negative subjects (P<0.001). Nineteen (33%) of 58 PPD or MAS skin test positive subjects were PPD dominant, 15 (26%) were MAS dominant, and 24 (41%) were non-dominant. MAS dominant and non-dominant reactions were significantly reduced in HIV-positive subjects, and non-dominant reactions were increased in BCG-positive subjects. CONCLUSIONS: Childhood BCG immunization is associated with PPD reactions > or =10 mm among adults. Reduced PPD reaction rates in HIV-positive adults appear to be due to a loss of BCG-induced PPD reactivity. Prior infection with M. avium complex is detectable in a significant proportion of adults in a developing country.

Adult↗
PubMed1998

Seroprevalence of human herpesvirus 8 among Zambian women of childbearing age without Kaposi's sarcoma (KS) and mother-child pairs with KS.

The seroprevalence of human herpesvirus 8 (HHV-8) among a group of Zambian women of reproductive age and among mother-child pairs in which either one of them has Kaposi's sarcoma (KS) was determined. A cross-sectional group of 378 pregnant women was randomly recruited into the study, and 183 (48.4%) had HHV-8 antibodies. Among the human immunodeficiency virus (HIV)-1-infected women, 51.1% were HHV-8-seropositive, whereas of HIV-1-negative women, 47.3% were HHV-8-seropositive. In addition, 21 women index patients with KS and 5 young children index patients with KS were studied. All children with KS had mothers who were HHV-8-seropositive, while not all children whose mothers had KS were infected with HHV-8. Our study suggests that there is a high HHV-8 seroprevalence among Zambian women, and the rate is almost the same in HIV-1-positive and -negative women. This high seroprevalence may be a contributing factor toward the increased frequency of KS in this population.

Adolescent↗
PubMed1998

Human immunodeficiency virus-associated diarrhea and wasting in Zambia: selected risk factors and clinical associations.

A significant association was observed among human immunodeficiency virus (HIV)-positive adult cases in Lusaka, Zambia compared with HIV-negative controls for chronic diarrhea (68% versus 22%; P < 0.05), weight loss (54% versus 30%; P < 0.05), lymphadenopathy (44% versus 15%; P < 0.05), and skin eruption (33% versus 7%; P < 0.05). Among the HIV-positive children, a higher proportion had clinical evidence of tuberculosis when compared with HIV-negative children (8% versus 1%; P < 0.05). The study demonstrated an association between weight loss in HIV-positive adults and children and chronic diarrhea (odds ratio [OR] = 12.7, 95% confidence interval [CI] = 6.4-25.5; P < 0.001), persistent cough (OR = 7.2, 95% CI = 2.9-14.5; P < 0.001), and an age of 31-45 years (OR = 3.8, 95% CI = 1.8-8.3; P < 0.01). The factors associated with mortality in HIV positive patients included chronic diarrhea (OR = 7.4, 95% CI = 1.6-34; P < 0.01), and lymphadenopathy (OR = 3.89, 95% CI = 1.2-12.2; P < 0.04).

Adolescent↗
PubMed1995

Influence of HIV epidemic on the incidence of Kaposi's sarcoma in Zambian children.

Acquired immunodeficiency syndrome-associated Kaposi's sarcoma (KS) is well documented in adults. However, very little information is available about KS in the pediatric age group. A retrospectively study was undertaken at the University Teaching Hospital (UTH), Lusaka, Zambia, to define the incidence and clinical profile of KS in Zambian children over the last 13 years and to determine the influence, if any, of the current human immunodeficiency virus (HIV) epidemic on the pattern of pediatric KS. All the histopathological records from 1980 to 1992 were reviewed and all cases of KS along with the total number of malignancies, both in children and adults, were analyzed. Along with this, 17 of 23 case files of pediatric KS patients treated at the UTH since 1984 were retrieved and clinical details recorded. Of a total of 915 cases of KS, 85 (9.25%) were in children < 14 years of age. The age ranged from 7 months to 14 years, with an average of 5.62 years; the male/female ratio was 1.76:1. A significant increase in the incidence of pediatric KS has been recorded since 1987 (p < 0.001). This coincides with the advent of the HIV epidemic in the country. The disease was aggressive and fulminant in pediatric patients. More than 80% HIV seropositivity was detected. Children with blood transfusion-related HIV infection had cutaneous or lymphocutaneous disease, indicating that the mode of acquisition of HIV infection may influence the clinical appearance of KS. Thus, HIV-associated KS in children is becoming a common entity in Zambia. An urgent prospective epidemiologic study is needed to address this problem in HIV-affected regions.

Adolescent↗
PubMed1995

HEp-2 cell-adherent Escherichia coli in patients with human immunodeficiency virus-associated diarrhea.

Diarrhea occurs commonly in African human immunodeficiency virus (HIV) infections. A case-control (HIV-positive vs. -negative) study of adults with diarrhea was done in Lusaka, Zambia, to determine the prevalence of intestinal infection by HEp-2 cell-adherent Escherichia coli. Adherent E. coli were more common in HIV-positive patients with acute diarrhea than among HIV-negative controls (60% vs. 33%) and were found significantly more often in HIV-positive patients with chronic diarrhea than among HIV-negative controls with chronic diarrhea (79% vs. 17%, P < .002). Adherent strains were found significantly more often among HIV-positive patients (69%) than in 22 asymptomatic subjects (36%, P < .02). The HEp-2 cell adherence of the E. coli strains did not show a common pattern. Adherent bacteria were also observed in colonic biopsies from 32% of Zambians with chronic diarrhea who underwent endoscopy. Adherent E. coli may be an important cause of HIV-associated diarrhea in Zambia.

Acute Disease↗
PubMed1995

Intestinal parasites in HIV-seropositive Zambian children with diarrhoea.

We undertook a study over a period of 9 months to define the frequency of parasitic infections in hospitalized children with diarrhoea between the ages of 15 months and 5 years. Every alternate day, mothers of all children admitted with diarrhoea between 09.00 hours and 12.00 hours to one of the wards of the Department of Pediatrics and Child Health of the University Teaching Hospital (UTH) in Lusaka, Zambia, were interviewed for enrollment of their children into the study. A total of 178 children with diarrhoea were enrolled in the study. Of these 44 (25 per cent) were HIV seropositive and 134 (75 per cent) were seronegative for HIV. Out of 44 HIV-seropositive patients, 20 (45 per cent) had acute diarrhoea and 24 (55 per cent) had chronic diarrhoea. Of the 134 HIV-seronegative patients, 68 had acute diarrhoea (51 per cent) and 66 (49 per cent) had chronic diarrhoea. At least one intestinal parasite was found in 34 out of the 178 children enrolled. The commonest parasites identified were Ascaris and Cryptosporidia. No associations were identified between parasite isolation and the following: age, sex, or socio-economic status. Cryptosporidium spp. was isolated from 6 out of 44 (14 per cent) HIV-seropositive children, while 8 out of 134 (6 per cent) seronegative children had the parasite (P = 0.01). HIV-seropositive children with chronic diarrhoea had significantly higher cryptosporidium identification rates than those HIV-seropositive children with acute diarrhoea [5 out of 24 (21 per cent) patients with chronic diarrhoea compared to 1 out of 20 (5 per cent) patients with acute diarrhoea; (P > or = 0.01)].(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Opportunistic Infections↗
PubMed1995

Impact of the human immunodeficiency virus type-1 on common pediatric illnesses in Zambia.

The seroprevalence of HIV-1 and in-patient mortality in children with common pediatric illnesses was studied. Between October 1990 and July 1991 at the Department of Paediatrics and Child Health, University Teaching Hospital (UTH), Lusaka, Zambia, mothers of all pediatric admissions were interviewed and counselled for enrollment of their children into the study. Of a total of 1323 children seen, 1266 children (600 female and 666 male) were enrolled into the study. Pneumonia (28 per cent), malaria (24 per cent), malnutrition (18 per cent), and diarrhoea (10 per cent) constituted over 80 per cent of the total admission diagnoses. Tuberculosis (5 per cent) was the fifth commonest cause of admission (61 out of 1266 children). A total of 354 out of the 1266 (28 per cent) children were found to be seropositive for HIV-1 compared to a seroprevalence rate of 9 per cent in children attending accident and emergency for traumatic injuries (P=0.001). High HIV-1 seroprevalence rates were found in children with tuberculosis (69 per cent), malnutrition (41 per cent), pneumonia (28 per cent). and diarrhoea (24 per cent). The overall mortality in hospital among HIV-seropositive children (19 per cent) was significantly higher than those who were HIV-seronegative (9 per cent) (P = < 0.0001).

AIDS-Related Opportunistic Infections↗
PubMed1995

Childhood cancers in Zambia before and after the HIV epidemic.

Human immunodeficiency virus (HIV) related cancers in children are not as common and as well described as in adults. An HIV epidemic has been prevalent in Zambia since 1983-1984. To study the effect of the epidemic on the epidemiology of cancers in children a retrospective study was undertaken at the University Teaching Hospital (UTH), Lusaka, Zambia. All the histopathological records from 1980 to 1992 were reviewed and all cases of cancers in children less than 14 years of age were analysed. In order to define the effect of the HIV epidemic, the epidemiological features of various childhood cancers occurring before (during the years 1980-1982) and after (during the years 1990-1992) the onset of the HIV epidemic were compared. A significant increase in the occurrence of total childhood cancers was found. This is mostly due to a highly significant increase in the incidence of paediatric Kaposi's sarcoma (p = 0.000016), which is causally related to HIV infection, and a significant increase in the incidence of retinoblastoma (p = 0.02), which has an unknown relation to HIV infection. Though not yet statistically significant, there has also been a gradual and sustained increase in the incidence of non-Hodgkin's lymphoma, nasopharyngeal carcinoma, and rhabdomyosarcoma. There has been a significant reduction in the incidence of Burkitt's lymphoma. A prospective in depth epidemiological study of HIV related childhood cancers in Africa is urgently needed.

Adolescent↗
PubMed1994

Human immunodeficiency virus type-1 infection in Zambian children with tuberculosis: changing seroprevalence and evaluation of a thioacetazone-free regimen.

SETTING: This study was conducted at the Department of Paediatrics and Child Health, University Teaching Hospital (UTH), in Lusaka, Zambia. OBJECTIVES: To monitor the seroprevalence of HIV type-1 in children with tuberculosis and to evaluate the response to anti-tuberculosis therapy using a thioacetazone-free treatment regimen. DESIGN: A prospective cross-sectional study of all consecutive newly diagnosed cases of TB in children from 1 month-15 years of age seen at the University Teaching Hospital (UTH) in Lusaka, Zambia between 1 October 1991 and 31 May 1992. RESULTS: 120 children with a clinical diagnosis of tuberculosis and 167 controls were enrolled in the study. The overall HIV type-1 seroprevalence rate in children with tuberculosis was 55.8% (67/120) compared to 9.6% (16/167) amongst the control group (P < 0.0001: odds ratio = 11.50; 95% CI = 5.99-22.7). Common clinical presentations among children with TB were bronchopneumonia (45/162), miliary TB (30/162) and tuberculous lymphadenopathy (21/33). There were no significant differences in clinical presentation of TB between the HIV-negative and HIV-positive groups. The follow-up of those patients with tuberculosis was poor, with only 65 patients (55%) returning to the clinic for scheduled appointments after discharge. All the 16 patients who died did so within 60 days of discharge from hospital; all of them were seropositive for HIV. There were no deaths among the HIV-negative group. Despite the exclusion of thioacetazone from the treatment regimen, cutaneous reactions occurring within 8 weeks of commencing treatment were observed in 7 of the 65 (11%) patients, 2 of whom developed fatal Stevens-Johnson syndrome. All 7 patients were seropositive for HIV-1. CONCLUSIONS: The seroprevalence rate of HIV type-1 among children with tuberculosis in Lusaka continues to rise; careful monitoring of anti-TB therapy (even in regimens excluding thioacetazone) for potentially lethal side effects should be carried out.

Adolescent↗
PubMed1994

Intestinal secretory IgA immune response against human immunodeficiency virus among infected patients with acute and chronic diarrhea.

Diarrhea is common in patients infected with the human immunodeficiency virus (HIV) in Africa. There has been speculation that HIV itself may cause some of the enteropathy seen. The intestinal secretory IgA (sIgA) response was used to evaluate HIV intestinal infections in Zambian patients with acute and chronic diarrhea. sIgA was extracted from stool specimens and evaluated by an ELISA. Seven (58%) of 12 HIV-positive patients with acute diarrhea and 25 (69%) of 36 HIV-positive patients with chronic diarrhea showed an sIgA response to HIV p24, compared with 1 of 10 HIV-positive patients without diarrhea (P < .025 for acute and P < .001 for chronic diarrhea). The mean duration of diarrhea was significantly longer in patients showing an anti-p24 response. An sIgA response to HIV antigens occurs commonly in infected patients with diarrhea and may provide further evidence of an etiologic role of HIV in the diarrhea associated with AIDS.

Acute Disease↗