Search PubMed⌕ Search

Biomedical subjects

G Maartens

Publications and source records attributed to G Maartens.

At least 19 recordsLinked to original sources
PubMed2003

Plasma vitamin A and zinc levels in HIV-infected adults in Cape Town, South Africa.

A cross-sectional study of 132 adults attending an HIV clinic in Cape Town, South Africa, was conducted to determine predictors of low plasma vitamin A and Zn levels. No patients were on antiretroviral therapy. The possible confounding effect of the acute-phase response was controlled by including C-reactive protein levels in multivariate analysis and by excluding active opportunistic infections. Retinol levels were low (<1.05 micromol/l) in 39 % of patients with early disease (WHO clinical stages I and II) compared with 48 and 79 % of patients with WHO stage III and IV respectively (P<0.01). Plasma Zn levels were low (<10.7 micromol/l) in 20 % of patients with early disease v. 36 and 45 % with stage III and IV disease respectively (P<0.05). C-reactive protein levels were normal in 63 % of subjects. Weak, positive associations were found between CD4+ lymphocyte count and plasma levels of retinol (r 0.27; 95 % CI 0.1, 0.43) and Zn (r 0.31; 95 % CI 0.25, 0.46). Multivariate analysis showed the following independent predictors of low retinol levels: WHO stage IV (odds ratio 3.4; 95 % CI 2.1, 5.7) and body weight (odds ratio per 5 kg decrease 1.15; 95 % CI, 1.08, 1.25), while only body weight was significantly associated with low Zn levels (OR per 5 kg decrease 1.19; 95 % CI 1.09, 1.30). CD4+ lymphocyte count <200/microl was not significantly associated with either low retinol or Zn levels. In resource-poor settings, simple clinical features (advanced disease and/or weight loss) are associated with lowered blood concentrations of vitamin A and/or Zn. The clinical significance of low plasma retinol and/or Zn levels is unclear and more research is required to establish the role of multiple micronutrient intervention strategies in HIV disease.

Adult↗
PubMed2002

Opportunistic infections associated with HIV infection in Africa.

HIV-associated infections in sub-Saharan Africa differ markedly in their incidence from those in industrialized countries. Tuberculosis is the commonest cause of morbidity and mortality. Enteric pathogens such as microsporidiosis commonly cause disease as access to safe water is limited. Pneumocystis carinii pneumonia, which is the commonest opportunistic infection in industrialized countries, is uncommon in adults with HIV infection. This remains unexplained because P. carinii pneumonia is common in Black African HIV-infected children. Cytomegalovirus and Mycobacterium avium complex, which only occur in severely immune-suppressed individuals, are seldom found. One reason may be that survival after conversion to AIDS is relatively short in Africa. Patients often die before they develop severe immune suppression. Recently, prophylactic cotrimoxazole treatment was shown to be effective in symptomatic HIV-infected adults in Africa. Tuberculosis preventive therapy is also effective in Africa, at least in the medium term. It is hoped that these two affordable interventions will become available to large numbers of patients identified in voluntary counselling and testing centres.

AIDS Serodiagnosis↗
PubMed2002

Tuberculosis should not be considered an AIDS-defining illness in areas with a high tuberculosis prevalence.

OBJECTIVE: To assess the prognosis of human immunodeficiency virus (HIV) associated tuberculosis in a high tuberculosis prevalence setting. METHODS: Survival and subsequent AIDS-defining illnesses (ADI) of patients with tuberculosis were compared with patients remaining tuberculosis-free in a prospective cohort study in two university-affiliated adult HIV clinics in Cape Town. RESULTS: Tuberculosis without prior or simultaneous ADI was diagnosed in 141 patients. CD4+ T-lymphocyte count was >200 cells/microl in 67% of the incident tuberculosis cases. Survival in tuberculosis patients was comparable to that of patients with oral hairy leukoplakia and/or oral candidiasis (median = 23.6 vs. 27.8 months respectively; P = 0.59, adjusted hazard ratio [AHR] = 0.87; 95%CI 0.63-1.58), and better than in patients with AIDS (median = 11.5 months; P < 0.001, AHR = 2.37; 95% CI 1.93-4.66). Subsequent ADI were less frequent in tuberculosis than in AIDS patients (AHR = 0.36; 95%CI 0.23-0.58). Survival of patients with pulmonary or extra-pulmonary tuberculosis was similar (P = 0.32). CONCLUSION: Tuberculosis in HIV-infected patients from areas endemic with tuberculosis occurs across a wide spectrum of immune suppression and has a considerably better prognosis than other ADI. Inclusion of tuberculosis in the clinical case definition of AIDS in such areas should be reconsidered.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Initiating co-trimoxazole prophylaxis in HIV-infected patients in Africa: an evaluation of the provisional WHO/UNAIDS recommendations.

OBJECTIVE: To evaluate the proposed WHO/UNAIDS criteria for initiating co-trimoxazole prophylaxis in adult HIV-infected patients in Africa [WHO clinical stages 2--4 or CD4 count < 500 x 10(6) /l or total lymphocyte count (TLC) equivalent]. DESIGN: Observational cohort study of 5-year follow-up. SETTING: Adult HIV clinics, University of Cape Town, South Africa. METHODS: Effect of prophylactic low dose co-trimoxazole (480 mg per day or 960 mg three times per week) on survival and morbidity was assessed in patients stratified by WHO clinical stage, CD4 T-lymphocyte count or TLC. Patients receiving antiretroviral therapy were excluded. RESULTS: Co-trimoxazole reduced mortality [adjusted hazard ratio (AHR), 0.56; 95% confidence interval (CI), 0.33--0.85; P > 0.001] and the incidence of severe HIV-related illnesses (AHR, 0.52; 95% CI, 0.38--0.68; P < 0.001) in patients with evidence of advanced immune suppression on clinical (WHO stages 3 and 4) or laboratory assessment (TLC < 1250 x 10(6)/l or CD4 count < 200 x 10(6)/l). No significant evidence of efficacy was found in patients with WHO stage 2 or CD4 count 200--500 x 10(6)/l/TLC 1250--2000 x 10(6)/l. If we had applied the WHO/UNAIDS recommendations 88.3% of our patients would have received co-trimoxazole prophylaxis at their initial clinic visit. CONCLUSION: Co-trimoxazole in HIV-infected adults from an area in which Pneumocystis carinii pneumonia is uncommon demonstrated a survival benefit consistent with previous randomized trials. Further studies are needed to assess the optimal time of commencement of prophylaxis, as widespread co-trimoxazole use will lead to increasing antimicrobial resistance to other major pathogens in Africa.

AIDS-Related Opportunistic Infections↗
PubMed2001

Association between tuberculosis and HIV disease progression in a high tuberculosis prevalence area.

SETTING: Adult human immunodeficiency virus (HIV) clinics affiliated to the University of Cape Town, South Africa. OBJECTIVE: To assess the impact of tuberculosis on HIV-1 disease progression in an area with high tuberculosis prevalence and minimal antiretroviral therapy use. DESIGN: Prospective patient cohort study. METHODS: Age, race, risk status, CD4+ T-lymphocyte count, history of AIDS, prophylactic co-trimoxazole and antiretroviral therapy were controlled for in a time-dependent Cox proportional hazards regression model. RESULTS: Tuberculosis fulfilling the case definition developed in 158/609 patients in the 5-year observation period. Tuberculosis was associated with an increased risk of AIDS (adjusted risk ratio [RR] = 1.60, 95% confidence interval [CI] 1.08-2.41; P = 0.02) and death (adjusted RR = 2.16, 95% CI 1.29-3.59; P = 0.003). In a stratified analysis, the increased mortality associated with tuberculosis was observed only in patients with CD4+ T-lymphocyte count > 200 cells/microliter and in those without AIDS at baseline. CONCLUSION: The onset of tuberculosis in HIV-infected patients is associated with an increased risk of AIDS and death. Although a causal link cannot be established in an observational study, our findings support the view that prolonged immune activation induced by tuberculosis leads to prolonged increased HIV replication and consequent accelerated disease progression.

AIDS-Related Opportunistic Infections↗
PubMed2001

AIDS in Africa--survival according to AIDS-defining illness.

OBJECTIVE: Evaluation of prognostic significance of the type of AIDS-defining illness (ADI) and performance status in a cohort of AIDS patients. DESIGN, SETTING, SUBJECTS, OUTCOME MEASURES: A retrospective analysis of 280 patients with AIDS, as defined by the proposed World Health Organisation (WHO) clinical staging system, who attended two Cape Town-based HIV clinics between 1984 and 1997. Patients were stratified according to the type of initial ADI. Survival associated with each opportunistic event was determined by Kaplan-Meier analysis. Cox proportional hazard analysis was used to determine relative risk for death associated with three strata of ADI. RESULTS: Median survival associated with various initial ADIs varied from less than 3 months (encephalopathy and wasting), to over 2 years (extrapulmonary tuberculosis and herpes simplex virus infection). This effect of ADI on outcome was most striking in patients with relatively preserved CD4 counts (CD4 > 50/microliter). A performance status score 4 predicted 50% mortality at 1 month, irrespective of co-morbidity. CONCLUSION: The type of ADI is an important determinant of survival, particularly in patients with preserved CD4 counts. The stratification of patients by type of ADI and performance status may be useful in the management of patients with advanced HIV infection in resource-limited environments.

AIDS Dementia Complex↗
PubMed2001

Predictors and prognostic value of oral hairy leukoplakia and oral candidiasis in South African HIV-infected patients.

BACKGROUND: Oral hairy leukoplakia and oral candidiasis diseases (OHL/OC) are common clinical manifestations of HIV/AIDS. Sparse literature exists from resource-limited countries on their incidence and impact on HIV-infected patients. OBJECTIVE: To determine the predictors and prognosis of OHL/OC in HIV-infected patients. METHODS: Patients were drawn from a cohort established in 1992 and prospectively followed until 1997 in the adult HIV clinics, University of Cape Town. Cox hazards regression models were fitted to determine the predictors of OHL/OC, and the association between OHL/OC and progression to AIDS and death. RESULTS: 218 patients presenting with OHL/OC at their initial clinic visit were excluded. 205/772 patients developed OHL/OC (27.8 cases/100 years). White ethnicity (hazard ratio [HR] = 1.73, 95% CI 1.23-2.33), CD4+ count < 200 cells/(L (HR = 2.55, 95% CI 1.89-3.45), total lymphocyte count < 1250 cells/(L (HR = 1.72, 95% CI 1.28-2.31) and WHO stage 3 or 4 (HR = 2.61, 95% CI = 1.93-3.53) where variables predictive of increased hazard to developing OHL/OC. OHL/OC were independently associated with hazard of AIDS (HR = 3.65, 95% CI 1.89-6.69) and death (HR = 2.12, 95% CI 1.47-4.34). CONCLUSIONS: The presence of OHL/OC in HIV-infected patients provides important prognostic information, and can be used as a cost-effective tool for screening patients in therapeutic interventions in resource-limited settings.

AIDS-Related Opportunistic Infections↗
PubMed2000

Risk factors for developing tuberculosis in HIV-1-infected adults from communities with a low or very high incidence of tuberculosis.

OBJECTIVE: To estimate the incidence rate of tuberculosis in HIV-1-infected adults resident in a region with a high tuberculosis prevalence and to identify clinical and laboratory parameters associated with increased risk of developing tuberculosis. METHODS: Adult patients going to the University of Cape Town HIV clinics between January 1986 and May 1996. The following variables were assessed for the risk of developing tuberculosis: ethnicity, employment and education status, World Health Organization (WHO) clinical stage, erythrocyte sedimentation rate (ESR), CD4+ count, and total lymphocyte count. Tuberculin skin test data were not available. RESULTS: There were 198 prevalent and 144 incident cases of tuberculosis in the cohort of 1206 patients. The incidence rate of tuberculosis risk was 10.4/100 person years. WHO clinical stages 3 and 4 (risk ratio [RR], 3.4; 95% confidence interval [CI], 1.8-6.4), ESR >75 mm/hour (RR, 3.5; CI, 1.8-6.5) and being a member of a high-prevalence tuberculosis community (RR, 2.5; CI, 1.2-5.1) were independently associated with the risk of developing tuberculosis. CONCLUSIONS: HIV-infected adults in Cape Town are at high risk of developing tuberculosis irrespective of tuberculin skin testing. The risk increases markedly with HIV disease progression. Patients at extremely high risk can be identified on the basis of demographic and clinical features. Such individuals would be suitable for targeted tuberculosis prophylaxis.

Adult↗
PubMed2000

Thalidomide-induced antigen-specific immune stimulation in patients with human immunodeficiency virus type 1 and tuberculosis.

Thalidomide, which inhibits monocyte tumor necrosis factor (TNF)-alpha production and costimulates T cells, was tested for immune modulation in patients with human immunodeficiency virus (HIV) infection and tuberculosis (TB) in a placebo-controlled study. Thalidomide therapy resulted in increased levels of plasma interleukin (IL)-2 receptor, soluble CD8, interferon-gamma, and IL-12, indicating immune stimulation. TNF-alpha levels were not reduced. Thalidomide treatment increased CD4+ and CD8+ T cell counts and lymphocyte proliferation to purified protein derivative. Immune stimulation was not associated with an increase in plasma HIV levels. In vivo, a thalidomide dose-dependent costimulatory effect on T cell proliferation and HIV replication was observed after stimulation with antigens or anti-CD3, respectively. Thalidomide-induced increased viral replication in CD4+ T cells was abrogated by adding back autologous CD8+ T cells. Thus, in the presence of thalidomide, antigen-specific immune responses in vitro and in patients with HIV/TB were enhanced.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Diagnosing HIV-associated tuberculosis: reducing costs and diagnostic delay.

SETTING: University-affiliated hospital in South Africa. OBJECTIVE: To assess the time to diagnosis and the yield and laboratory cost of diagnostic procedures in human immunodeficiency virus (HIV) associated tuberculosis. DESIGN: Cohort study. PATIENTS: Adult HIV-infected patients with newly-diagnosed tuberculosis admitted over a 2-year period. RESULTS: A total of 141 admissions fulfilled the case definition. Sputum smear yield (43% overall) correlated strongly with chest radiograph appearance but not with CD4+ lymphocyte count. Sputum smear yield was approximately 40% per sample sent, resulting in a high cumulative yield when > or = three samples were sent. Smear of sputum or wide needle lymph node aspirates were the most cost-effective diagnostic methods. Significant diagnostic delay occurred in sputum smear-negative patients. Most patients with sputum smear-negative tuberculosis had either pleural effusions or lymphadenopathy. Lymph node biopsy had a high diagnostic yield even in patients with symmetrical nodes, but was under-utilised in this group. There was unnecessary expenditure on cultures, with many patients having several positive cultures. CONCLUSION: Repeated sputum smear examination produces a high cumulative yield in HIV-associated tuberculosis. Considerable savings in laboratory utilisation and bed occupancy would have been made if a streamlined diagnostic approach with greater use of lymph node aspirate and early pleural or lymph node biopsy had been followed.

Adult↗