Showing papers by "Irving F. Hoffman published in 2004"

Frequent detection of acute primary HIV infection in men in Malawi

Abstract: Acute (antibody-negative) HIV infection is associated with high transmission potential but is rarely recognized. Design: Cross-sectional study. We examined the prevalence and predictors of acute HIV infection among 1361 consecutive male outpatients attending sexually transmitted disease (STD; n = 929) and dermatology (n = 432) clinics in Lilongwe Malawi. Serum specimens negative for HIV antibodies were screened by HIV RNA PCR using a highly specific pooling/resolution testing algorithm. Five-hundred and fifty-three men (40.6%) were HIV antibody positive and 24 (1.8%) had acute HIV infection; 23 of 24 acutely infected men were from the STD clinic where they represented 4.5% of all HIV antibody-negative men and 5.0% of all HIV infections. HIV RNA levels for acutely infected men were significantly higher [median (interquartile range) 6.10 (5.19–6.54) log/10 HIV RNA copies/ml] than for 58 HIV antibody-positive men [4.42 (3.91–4.95) log/10 copies/ml; P < 0.0001]. The factor most strongly associated with acute HIV infection was STD clinic attendance: (odds ratio 15.2; 95% confidence interval 2.04–113.0). In multivariate analysis considering only STD patients factors associated with acute HIV infection included inguinal adenopathy genital ulceration and age 24–26 years the age stratum associated with peak incidence of HIV infection among Malawian men. Traditional HIV antibody tests alone are not sufficient to exclude HIV infection among men with acute STD in Malawi due to a surprising proportion of acute HIV infections in this population. Alternative screening methods are required for diagnosis of acute HIV infection; such screening could be important for research and for prevention of the sexual transmission of HIV in select populations. (authors)

Nonoxynol-9 100 mg gel: multi-site safety study from sub-Saharan Africa.

Abstract: The objectives were to evaluate the safety of 100 mg nonoxynol-9 (N-9) gel a vaginal microbicide on the genital mucosa of women from Malawi and Zimbabwe in preparation for a phase III efficacy study. HIV-uninfected women (180) were enrolled and randomized to either N-9 or placebo gel and instructed to insert gel into the vagina twice daily for 14 days. Follow up examinations were conducted at 7 and 14 days. The number of adverse events in the N-9 gel group was higher than in the placebo group (40% versus 13%; P < 0.01). Reported number of any genital symptoms was significantly higher in the N-9 group (38% N-9 13% placebo; P = 0.01). The number of total epithelial disruptions was higher in the N-9 group (20% versus 3%; P < 0.01); however the number of genital ulcers and abrasions in the N-9 group was low (2% and 3% respectively) and not different from that in the placebo group (1% and 2% respectively). N-9 gel 100 mg caused a significant increase in the rate of genital symptoms and epithelial disruptions compared with placebo. The clinical significance of these epithelial disruptions is unknown. Although these findings alone were not sufficient to cancel the planned phase III study when considered together with the negative results from the COL-1492 effectiveness trial of 52.5 mg N-9 gel the decision was made to cancel the planned phase III trial of 100 mg N-9 gel. (authors)

The Use of Specimens from Various Genitourinary Sites in Men, to Detect Trichomonas vaginalis Infection

Abstract: Variations in estimates of prevalence of trichomoniasis in men may reflect true differences in the burden of disease but are also affected by the performance of diagnostic methods and the type of specimen tested. In this study, men were evaluated at baseline and at follow-up, to evaluate syndromic management of urethritis and the effects of human immunodeficiency virus and trichomoniasis, in Lilongwe, Malawi. First-void urine specimens and urethral swabs were obtained at enrollment, for Trichomonas vaginalis culture; semen specimens were also obtained at follow-up. The sensitivities of testing methods using urine specimens and urethral swabs were equal; 67% of cases were identified by use of either specimen, and, in 47% of cases, both specimens tested positive. When semen specimens were included, all 3 specimens tested positive in only 19% of cases. Semen was the most sensitive single specimen, and, in 25.6% of cases, only semen specimens tested positive. Thus, prevalence of T. vaginalis infection in men is underestimated if only 1 specimen is tested.

Trichomoniasis in men and HIV infection: Data from 2 outpatient clinics at Lilongwe Central Hospital, Malawi

Abstract: Background. Little is known about the epidemiologic profile of trichomoniasis in men and its relationship to human immunodeficiency virus (HIV) infection. Among men presenting for care for symptomatic sexually transmitted infections (STIs) in Malawi, trichomoniasis is not considered for first-line treatment. Methods. We conducted a cross-sectional survey of 1187 men attending either a dermatology or STI outpatient clinic in the capital of Malawi. Men were interviewed, and the etiologies of the STIs were determined. Results. At the STI clinic ( men), we identified 150 men (20%) with Trichomonas vaginalis infection, n p 756 358 men (47%) with HIV infection, and 335 men (44%) with Neisseria gonorrhoeae infection. At the dermatology clinic ( men), we identified 54 (13%), 118 (27%), and 2 (0.5%) men, respectively. At both clinics, a lower n p 431 education level and reporting never having used a condom were predictive of T. vaginalis infection. Only at the dermatology clinic was older age associated with infection, and only at the STI clinic were marital, genital ulcer disease, and HIV-infection status associated with T. vaginalis infection. At the STI clinic, urethral symptoms attributable to trichomoniasis were more severe among HIV-positive men than among HIV-negative men. Conclusions. Given its high prevalence and the increased risk for HIV transmission, T. vaginalis infection should be reconsidered for inclusion in the Malawi STI-treatment regimen for men.