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Biomedical subjects

P Piot

Publications and source records attributed to P Piot.

At least 163 records · Page 9Linked to original sources
PubMed1989

Vaccination against hepatitis B in homosexual men. A review.

Homosexual men are at increased risk for infection with hepatitis B virus (HBV). Both plasma-derived and recombinant deoxyribonucleic acid vaccines have been shown to induce long-standing protective immunity in this population. However, non-responders and weak responders to HBV vaccine have recently become a problem among homosexual men because of an impaired antibody response due to previous infection with human immunodeficiency virus. In addition, human immunodeficiency virus infection predisposes persons to the development of a HBV carrier state following HBV infection. Vaccination still remains the most effective tool for preventing hepatitis B in homosexual men, although recent behavioral changes have apparently resulted in a decreased incidence of HBV infection among this group.

Clinical Trials as Topic↗
PubMed1989

Female to male transmission of human immunodeficiency virus type 1: risk factors for seroconversion in men.

To determine the frequency and risk factors for female to male sexual transmission of human immunodeficiency virus type 1 (HIV-1), a prospective study was carried out in 422 men who had acquired a sexually transmitted disease (STD) from a group of prostitutes with a prevalence of HIV-1 infection of 85%. The initial seroprevalence of HIV among the men was 12%. 24 of 293 (8.2%) initially seronegative men seroconverted to HIV-1. Newly acquired infection was independently associated with frequent prostitute contact (risk ratio 3.2, 95% confidence interval 1.2-8.1), with the acquisition of genital ulcer disease (risk ratio 4.7, 95% confidence interval 1.3-17.0), and with being uncircumcised (risk ratio 8.2, 95% confidence interval 3.0-23.0). 96% of documented seroconversions occurred in men with one or both of the latter two risk factors. In a subgroup of 73 seronegative men who reported a single prostitute sexual contact, the frequency of HIV-1 infection was 8.2% during 12 weeks of observation. No man without a genital ulcer seroconverted. A cumulative 43% of uncircumcised men who acquired an ulcer seroconverted to HIV-1 after a single sexual exposure. These data indicate an extremely high rate of female to male transmission of HIV-1 in the presence of STD and confirm a causal relation between lack of male circumcision, genital ulcer disease, and susceptibility to HIV-1 infection.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Evaluation of two enzyme immunoassays for detection of human immunodeficiency virus antigen in African and European sera.

The performance of two HIV antigen enzyme immunoassays (EIAs), the HTLV-III antigen EIA (Abbott) and the Innotest HIV antigen EIA (Innogenetics), was assessed using 276 HIV-1 antibody positive and 42 HIV antibody negative sera from European and African individuals. On the initial screening 16% (51/318) of the sera were reactive in the Abbott EIA and 21.4% (68/318) in the Innotest EIA. The Innotest detected significantly more confirmed HIV antigen positive sera (55/58, 94.6%) than the Abbott EIA (41/58, 70.7%). The presence of free detectable HIV antigen in African and European sera was strongly associated with the clinical classification CDC IV and with low p24 antibody levels.

Africa↗
PubMed1989

The association of tuberculosis and HIV infection in Burundi.

AIDS and tuberculosis (TB) are both endemic in Bujumbura, Burundi. An 11% failure rate to standard antituberculosis treatment (n = 173) was observed at the Tuberculosis Treatment Center of Bujumbura (CATB) in 1985-1986. All resistant cases (n = 19) were HIV seropositive. Among 328 consecutive cases with tuberculosis at the CATB during a 3 month period in 1986, 54.5% were HIV seropositive, which is five times higher than the prevalence in the general population in Bujumbura. More female patients than male cases were HIV antibody positive (62 versus 49%, respectively; p less than 0.02). Persistent weight loss, cough, and an anergic tuberculin test were more common in the HIV-seropositive group. Among 48 household members of HIV-seropositive patients with tuberculosis, 6 (12.5%) new cases of tuberculosis were identified, compared with none among 28 household members of HIV-seronegative patients with tuberculosis (odds ratio, 3.8; 95% confidence interval, 0.43-33.2). HIV infection is a new risk factor for tuberculosis in Africa, and HIV-infected cases of tuberculosis may be more infectious than HIV-negative patients. The AIDS epidemic may drastically complicate the diagnosis, management, and control of tuberculosis in populations in which both infections are endemic.

Adolescent↗
PubMed1989

Advanced immunodeficiency as a risk factor for heterosexual transmission of HIV.

To define the rate of HIV infection and associated risk factors among heterosexual partners of HIV-infected individuals, 80 partners and 77 index cases were examined for clinical, behavioural and virological variables. The study population included 61 male and 16 female index cases, of whom 40 were European and 37 African. Multiple sexual partners in central Africa was the risk factor for HIV infection in 83%. The overall infection rate among the contact cases was 45%, 53% among female partners and 13% among male partners (P less than 0.001). Variables significantly associated with HIV infection in the partners included advanced clinical stage (AIDS-related complex or AIDS), a low concentration of T4 lymphocytes and African nationality of the index case, young age of the partner, and more than 50 instances of sexual contact with the index cases. In a logistic regression analysis, a low concentration of T4 lymphocytes, clinical stage ARC/AIDS and African nationality of the index case but not number of sexual contacts, remained as independent risk factors for HIV transmission. Our data indicate that there is a significant biological heterogeneity in sexual transmission of HIV and that advanced clinical stage and severe T cell depletion of the index case are major determinants of infectivity.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Epidemiologic aspects of infections due to Neisseria gonorrhoea in Belgium].

In the context of a surveillance programme for communicable diseases in Belgium, a network of microbiological laboratories has, since February, 1983, made weekly registrations of a number of pathogenic agents, among them, N. gonorrhoeae. Some epidemiological characteristics of N. gonorrhoeae in Belgium are discussed. Although only a portion of Belgian laboratories participate in the programme, the total of cases registered from 1983 through 1986 was 2 to 5 times greater than obtained through the notifiable diseases reporting system. More than 75% of the cases registered concerned those between 20 and 39 years of age, with a maximum for the 20-29-year age group. In 1985, 82% of the diagnoses were based on one culture alone (or one + ELISA); in 1986, this percentage was only 66%.

Adolescent↗
PubMed1989

Sexually transmitted diseases and Chlamydia trachomatis in women consulting for contraception.

To study the frequency of genital infections in women consulting their family doctor for contraception, 248 women (median age 23 years) were examined for a range of genital microorganisms. The prevalence of clue cells, Candida albicans and Trichomonas vaginalis were 21.0%, 12.9% and 2.0%, respectively. Neisseria gonorrhoeae was isolated in only one case, whereas Chlamydia trachomatis was found in 6.3% of women. A specific clinical picture for an infection with C. trachomatis in women was not seen. Given the prevalence of over 5% for C. trachomatis and the absence of typical signs and symptoms in infected women, screening for this organism is recommended in women requesting an intrauterine contraceptive device, to prevent complications such as pelvic inflammatory disease and their sequelae.

Adolescent↗
PubMed1989

Cutaneous delayed-type hypersensitivity in patients with human immunodeficiency virus infection in Zaire.

Cutaneous delayed-type hypersensitivity (DTH) reactions were assessed by the CMI-Multitest (Merieux, Lyon, France) in patients with different stages of human immunodeficiency virus (HIV) infection in Kinshasa, Zaire. Skin tests were read after 48-72 h. A reaction to an antigen was considered positive if there was induration of greater than 2 mm. Cutaneous anergy occurred more often in HIV-seropositive patients than in healthy controls (p less than 0.001) and was most prevalent in patients with advanced HIV illness. HIV-seropositive patients with a positive tuberculin reaction were more likely to have active tuberculosis (TB) than HIV-seropositive patients without a positive tuberculin reaction (p less than 0.001). Therefore, a TB diagnosis should be pursued in HIV-seropositive patients with a positive tuberculin reaction.

Adult↗
PubMed1989

Epidemiology and control of gonococcal ophthalmia neonatorum.

From a public health point of view gonococcal ophthalmia neonatorum (GCON) is important as it can rapidly lead to blindness. The frequency of GCON is determined by the prevalence of maternal gonococcal infection. In most industrialized countries the prevalence of gonorrhoea in pregnant women is less than 1%; in developing countries the rates are between 3% and 15%, more than 50% being due to penicillinase-producing Neisseria gonorrhoeae strains (PPNG). The rate of transmission from mother to newborn is between 30% and 50%. Strategies for the control of GCON include: (1) prevention of gonococcal infection in women of childbearing age, (2) detection and treatment of gonococcal infection in pregnant women, (3) eye prophylaxis in the newborn at birth, and (4) diagnosis and treatment of GCON. Eye prophylaxis by the instillation immediately after birth of either 1% silver nitrate eye drops or 1% tetracycline eye ointment is very effective. This reduces the GCON incidence by 80% to 95% and is highly cost-effective, particularly in high-risk settings.

Adult↗
PubMed1988

Risk factors for infection with human immmunodeficiency virus among European expatriates in Africa.

The pattern of cases of AIDS in Belgium suggests that Europeans infected with human immunodeficiency virus (HIV) acquired the infection in Africa. The prevalence of infection was assessed in Belgian advisers and European expatriates and risk factors for infection defined in a case-control study of expatriate men. Fifteen (1.1%) of 1401 Belgian advisers working in Africa and 41 (0.9%) of 4564 European expatriates living in Africa, were positive for antibody to HIV in a voluntary screening programme in Belgium. Among subjects with antibody to HIV the ratio of men to women was 3:1. These subjects did not have a history of intravenous drug abuse or blood transfusion and only one was homosexual. In a case-control study of 33 expatriate men who had antibody to HIV and 119 controls the men with antibody reported significantly more female sexual partners, who were more commonly local; and significantly more sexual contact with prostitutes in Africa. They had a significantly higher prevalence of history of sexually transmitted disease and had received significantly more injections by unqualified staff in Africa during the previous five years. No specific sexual practices were associated with having antibody to HIV. After multivariate analysis sexual contact with local women (adjusted odds ratio 14.7; 95% confidence interval 2.81 to 76.9), sexual contact with prostitutes (adjusted odds ratio 10.8 (1.6 to 71.9), and injections by unqualified staff (adjusted odds ratio 13.5 (3.7 to 49.8) remained independent risk factors for infection. European expatriates in Africa were at increased risk from infection with HIV and were a means of introducing HIV into the heterosexual population in Europe. Transmission from women to men by vaginal intercourse seemed to be the most probable route of infection.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Human immunodeficiency virus infection among men with sexually transmitted diseases. Experience from a center in Africa.

Heterosexual transmission of the human immunodeficiency virus (HIV) appears to occur readily in Africa but less commonly in North America and Europe. We conducted a case-control study among men attending a clinic for sexually transmitted diseases in Nairobi to determine the prevalence of HIV infection and the risk factors involved. HIV antibody was detected in 11.2 percent of 340 men who enrolled in the study. Reports of nonvaginal heterosexual intercourse and homosexuality were notably rare. Recent injections and blood transfusions were not associated with HIV infection. Travel and frequent contact with prostitutes were associated with HIV seropositivity. Men who were uncircumcised were more likely to have HIV infection (odds ratio, 2.7; P = 0.003), as were those who reported a history of genital ulcers (odds ratio, 7.2; P less than 0.001). A current diagnosis of genital ulcers was also associated with HIV seropositivity (odds ratio, 2.0; P = 0.028). Multivariate analysis revealed an independent association of genital ulcers with HIV infection in both circumcised and uncircumcised men. Uncircumcised men were more frequently infected with HIV, regardless of a history of genital ulcers. Our study finds that genital ulcers and an intact foreskin are associated with HIV infection in men with a sexually transmitted disease. Genital ulcers may increase men's susceptibility to HIV, or they may increase the infectivity of women infected with HIV. The intact foreskin may operate to increase the susceptibility to HIV.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Prophylaxis of gonococcal and chlamydial ophthalmia neonatorum. A comparison of silver nitrate and tetracycline.

We evaluated the use of silver nitrate drops and tetracycline ointment for the prophylaxis of ophthalmia neonatorum in a controlled trial involving 2732 newborns in Nairobi, Kenya. The overall rates of prevalence of intrapartum maternal gonococcal and chlamydial infection were 6.4 and 8.9 percent, respectively. After prophylaxis with silver nitrate, the incidence rates of gonococcal, chlamydial, and nongonococcal, nonchlamydial ophthalmia neonatorum were 0.4, 0.7, and 6.2 percent, respectively, whereas after prophylaxis with tetracycline, the rates were 0.1, 0.5, and 4.5 percent. The attack rates of gonococcal ophthalmia neonatorum in newborns exposed to Neisseria gonorrhoeae at birth were 7.0 percent in those receiving silver nitrate and 3.0 percent in those receiving tetracycline (95 percent confidence interval for the difference in rates, -3.4 to 11.4 percent). As compared with historical controls, the incidence of gonococcal ophthalmia neonatorum decreased 83 percent among infants treated with silver nitrate and 93 percent among those treated with tetracycline. Failure of prophylaxis was associated with postpartum maternal endometritis (P = 0.05). Among newborns exposed to maternal infection with Chlamydia trachomatis, chlamydial conjunctivitis developed in 10.1 percent given silver nitrate and in 7.2 percent given tetracycline (95 percent confidence interval for the difference in rates, -4.7 to 10.5 percent), yielding reductions in the incidence of chlamydial ophthalmia of 68 and 77 percent, respectively, as compared with the historical controls. We conclude that tetracycline is as effective as silver nitrate in preventing gonococcal ophthalmia neonatorum.

Chlamydia Infections↗