       Document 0181
 DOCN  M9650181
 TI    AIDS in Africans living in London.
 DT    9605
 AU    O'Farrell N; Lau R; Yoganathan K; Bradbeer CS; Griffin GE; Pozniak AL;
       Department of Genitourinary Medicine, Guy's Hospital, London.
 SO    Genitourin Med. 1995 Dec;71(6):358-62. Unique Identifier : AIDSLINE
       MED/96164964
 AB    OBJECTIVES--To investigate the presentation of HIV infection and AIDS
       amongst Africans diagnosed with AIDS living in London.
       METHODS--Identification of all AIDS cases of African origin attending
       four HIV specialist centres in South London--Guy's, King's, St George's
       and St Thomas' Hospitals--up to March 1994, by retrospective review of
       case notes of all HIV positive patients. RESULTS--Of 86 patients (53
       women, 33 men) studied, 59 (69%) were from Uganda. The most frequent
       AIDS-defining diagnoses were: Pneumocystis carinii pneumonia (PCP) 21%,
       tuberculosis (TB) 20% (extrapulmonary TB 14%, pulmonary TB 6%), cerebral
       toxoplasmosis 14%, oesophageal candida 13%, cryptococcal meningitis 11%,
       wasting 6%, herpes simplex infection > 1 month 5%, Kaposi's sarcoma 5%,
       other 6%. Cytomegalovirus retinitis was diagnosed in one case. Late
       presentation was common; 70% were diagnosed HIV positive when admitted
       to hospital. The diagnosis of AIDS was coincident with a first positive
       HIV test result in 61%. The mean CD4 counts at both HIV and AIDS
       diagnoses were similar in both men and women: 87 x 10(6)/l and 74 x
       10(6)/l in men and 99 x 10(6)/l and 93 x 10(6)/l in women respectively.
       Overall, TB 21 (24%) (extrapulmonary TB 12, pulmonary TB 9) was either
       the AIDS-defining diagnosis or was detected within three months of this
       event. Sixty-two per cent of TB cases were diagnosed within twelve
       months of entry to the UK compared to 34% of all other AIDS cases. The
       prevalence of STD was very low; genital herpes was the commonest STD:
       17% of the women, 9% men; 28% of the men and 11% of the women tested had
       a positive TPHA test. In cases known to be HIV-positive prior to an AIDS
       diagnosis, 41% took prophylaxis for PCP and 45% had taken zidovudine
       (ZDV). Forty two of the study participants had 89 children: 59 of these
       children had mothers in the study. Overall, 37 (42%) of the children had
       lost at least one parent at the time of data assessment.
       CONCLUSIONS--PCP and TB were the most common initial AIDS-defining
       diagnoses. The majority of TB cases were diagnosed within 12 months of
       entry to the UK. An AIDS-defining diagnosis was the first manifestation
       of HIV-related illness in the majority of patients. Because of late
       presentation to medical services, access to treatments for HIV infection
       and prophylaxis against opportunistic infections was limited. Extending
       the role of clinics and staff into the community might facilitate both
       earlier presentation and access to services. Future provision of local
       services will need to be sensitive to the requirements of individuals
       from different cultures and backgrounds.
 DE    Acquired Immunodeficiency Syndrome/DRUG THERAPY/*ETHNOLOGY  Adult
       Africa/ETHNOLOGY  Antiviral Agents/THERAPEUTIC USE  Female  Human  HIV
       Infections/DIAGNOSIS  London/EPIDEMIOLOGY  Male  Middle Age  Pneumonia,
       Pneumocystis carinii/DIAGNOSIS/PREVENTION & CONTROL  Retrospective
       Studies  Tuberculosis/DIAGNOSIS  Zidovudine/THERAPEUTIC USE  JOURNAL
       ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

