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Biomedical subjects

A S Latif

Publications and source records attributed to A S Latif.

At least 19 recordsLinked to original sources
PubMed2000

Report of sexually transmitted diseases by HIV infected men during follow up: time to target the HIV infected?

OBJECTIVES: To compare the rate of self reported sexually transmitted diseases (STDs) among HIV infected men with men who remained HIV negative during follow up of a Harare male factory cohort. METHODS: Male factory workers were offered enrolment and behavioural data were collected at entry then every 6 months, along with HIV testing. Self report of STDs was used to calculate incidence per 100 person years. Cox proportional hazards models examined independent risk factors for STDs, with hazard ratios (HRs). RESULTS: At entry 20% of men were HIV infected and 11% reported STDs in the previous year. A total of 2777 (82%) of 3383 men enrolled were followed at least once. Compared with men who remained HIV negative, seroconverters had the highest incidence of STDs (16.8 per 100 person years; IRR = 3.3, 95% CI = 2.5-4.3); men enrolled HIV positive also reported higher STD incidence (14.5 per 100 person years, IRR = 2.8; 95% CI 2.3-5.5). Among HIV positive men, the only independent risk factor for report of urethral discharge was history of multiple partners (HR = 10, 95% CI 1.4-73.2). CONCLUSION: HIV positive men reported threefold higher incidence of STDs than HIV negative men, many related to high risk sexual behaviour.

Adult↗
PubMed2000

Quality of life evaluation in patients with HIV-I infection: the impact of traditional medicine in Zimbabwe.

OBJECTIVES: To evaluate the impact of phytotherapy (traditional medicine) in persons with HIV infection and to assess the quality of life of those persons with respect to HIV disease progression, including sociodemographic characteristics. DESIGN: A community based open label non-intervention and uncontrolled cohort study. SETTING: Blair Research Institute Clinic. SUBJECTS: A total of 105 HIV infected persons at various stages of HIV infection. Seventy-nine percent were on phytotherapy (PT) and 21% on conventional medical care (CMC). MAIN OUTCOME MEASURES: (a) Assessment of quality of life of HIV infected persons on phytotherapy using the WHOQol instrument, and (b) assessment of quality of life of those persons in relation to the HIV disease progression using CD4 cell counts and viral load as measure of disease progression. METHODS: We interviewed 105 patients with various stages of HIV-I infection in a community based cohort study from June 1996 to May 1998, in Harare. The 96 (91.4%) asymptomatic and six (8.6%) symptomatic patients underwent regular physical examinations and had blood drawn for laboratory tests at the baseline afterwards at three month intervals over a period of two years. RESULTS: The mean (s.d.) age was 34.9 (7.3) years; 64.4% were women and 60.3% were married. In multi variate analyses, age was significantly correlated with the level of independence domains (p = 0.032), whereas, gender was significantly correlated with social relationships' domains (p = 0.034). The type of treatment received was significantly correlated with spiritual domains (p = 0.045). Proportions of scores on five domains measuring different aspects of quality of life for patients on phytotherapy were much lower than those on conventional therapy (p < 0.0001, for all variables). CONCLUSION: Our data support the role of phytotherapy in improving the quality of life of HIV-I infected patients, yet its pharmacological basis is unknown. The WHOQol instrument is a good measure of quality of life for patients with HIV infection.

Adolescent↗
PubMed1999

Prevalence and incidence of herpes simplex virus type 2 infection among male Zimbabwean factory workers.

Stored sera from a cohort of 2397 male factory workers in Harare, Zimbabwe, were screened for herpes simplex virus type 2 (HSV-2)-specific antibodies, to estimate the prevalence and incidence of genital herpes infection and to assess the relation between HSV-2 and human immunodeficiency virus (HIV) acquisition. The prevalence of HSV-2 at enrollment was 39.8%. Correlates of HSV-2 seropositivity were HIV seropositivity, marital status, history of sexually transmitted disease (STD), older age, and higher income. The incidence of HSV-2 seroconversion during follow-up was 6.2/100 person-years. Correlates of HSV-2 seroconversion were enrollment while HIV-positive or seroconversion during follow-up, reported genital ulcer, history of STD, and number of sex partners. No evidence was found that HSV-2 infection was more likely to precede HIV or vice versa. HSV-2 and HIV seropositivity are strong markers for high-risk sexual behavior. Improved interventions targeted to populations in which the incidence of either viral infection is high are needed.

Adolescent↗
PubMed1999

Risk factors for gonococcal and chlamydial cervical infection in pregnant and non-pregnant women in Zimbabwe.

OBJECTIVE: To identify demographic, behavioural and clinical characteristics of symptomatic and asymptomatic women with gonococcal and/or chlamydial cervicitis a study was conducted among women attending antenatal clinics and primary care clinics in Harare, Zimbabwe. DESIGN: Cross sectional study. SETTING: Primary care clinics and antenatal clinics in Harare. SUBJECTS: 467 women with vaginal discharge and 1,189 asymptomatic pregnant women. MAIN OUTCOME MEASURES: Behavioural and clinical correlates of gonococcal and chlamydial cervical infection. RESULTS: The mean age of symptomatic women was 26.11 +/- 6.84 years (range: 15 to 52 years) and that of asymptomatic pregnant women was 24.67 +/- 5.43 years (range: 15 to 45 years). Gonococcal and/or chlamydial cervical infection was found in 69 of 1,189 (5.8%) pregnant women and in 77 of 467 (16.5%) non-pregnant women. Logistic regression analysis identified the following predictors of gonococcal or chlamydial infection in women with vaginal discharge: being separated from the partner for a month or more (p = 0.002), having had sex with a new partner in the last three months (p = 0.002), current use of condoms (p = 0.011), and the finding on examination of a purulent vaginal discharge (p = 0.004). Amongst these women an increasing educational level was inversely associated with cervical infection (p = 0.007). Amongst asymptomatic pregnant women the following were identified as predictors of cervical infection: the patient admitting to having a vaginal discharge on direct questioning (p = 0.004), and the finding of a purulent vaginal discharge on examination (p = 0.001). CONCLUSIONS: Amongst symptomatic and asymptomatic women certain behavioural factors and some clinical findings are associated with cervical gonococcal or chlamydial infection. Women with multiple partners and with partners who are currently using condoms with them and those women with a purulent vaginal discharge are likely to be infected. The age and marital status of subjects was not associated with cervical infection. These findings are useful in providing appropriate care for women with overt or minimal symptoms.

Adolescent↗
PubMed1999

Alcohol consumption in HIV-I infected persons: a study of immunological markers, Harare, Zimbabwe.

OBJECTIVE: To examine the effect of alcohol use in relation to the age, gender and plasma levels of HIV-I RNA and CD4 cells count in HIV-I infected persons as a prognostic indicator for the disease progression to AIDS. DESIGN: A community based cohort study. SETTING: The study was conducted at the Blair Research Institute Clinic from June 1996 to May 1998. SUBJECT: We interviewed 105 volunteers, at a baseline and then followed them up on a three monthly basis. They underwent physical examinations and had blood drawn for laboratory tests. AUDIT Core was used to gain an indication of how much dependence there was on alcohol by patients in relation to demographic and immunological variables. MAIN OUTCOME MEASURES: Frequency of alcohol use and HIV-I disease progression to AIDS using viral loads and CD4 cells counts as measures of immune impairment. RESULTS: The volunteers had a mean (s d) age of 34.9 (7.3) years. Prevalence of alcohol use was 30.5% (n = 34.95% CI = 21.7 to 39.3). Most of the patients with CD4 cells count less than 200 mm3 did not use alcohol (p = 0.023) by the six months follow ups. There were no significant mean differences between users and nonusers of alcohol regarding the levels of both plasma viremia and CD4 cells count. CONCLUSION: Our finding is consistent with previous findings that found no relationship between alcohol use in persons with HIV-I infection and progression of disease to AIDS.

Adult↗
PubMed1999

Haematologic features of the human immunodeficiency virus (HIV) infection in adult Zimbabweans.

OBJECTIVE: To describe the haematologic features of the HIV infection in adult Zimbabweans and compare the features in the different clinical stages of the disease. DESIGN: Descriptive cross sectional study. SETTING: Parirenyatwa Hospital, a tertiary and referral medical centre in Harare, and the blood donor clinics of the Blood Transfusion Service in Harare. SUBJECTS: Patients attending HIV outpatients clinics or receiving inpatient care at Parirenyatwa Hospital and asymptomatic persons donating blood at the BTS Harare. MAIN OUTCOME MEASURES: Full blood counts and bone marrow cell counts and morphology. RESULTS: Blood cytopenia was found in 47.5% of adults with HIV infection. The most frequent abnormalities were lymphopenia (31.5%); anaemia (30.8%); neutropenia (29.6%); thrombocytopenia (24.7%); eosinophilia (23.5%) and leucopenia (11.7%). Frequency of anaemia in the AIDS and symptomatic groups (43.4% and 24.5% respectively) was greater than in the carriers (6.7%), while the frequency of other cytopenias and of eosinophilia was about the same in all groups. There was also a general lack of association between the severity of haematologic abnormalities and the clinical stage of the disease. CONCLUSION: Severe haematologic changes occur frequently in HIV infection and AIDS but routine full blood count may not be helpful in the monitoring of the disease or the prediction of onset of AIDS.

Adolescent↗
PubMed1998

Syndromic management of sexually transmitted diseases. Part 2--The management of genital discharge.

In men urethral discharge is commonly caused by Neisseria gonorrhoeae and Chlamydia trachomatis. Both organisms cause an acute anterior urethritis and infected men usually present with symptoms of urethritis. A proportion of men with urethral infection may remain asymptomatic. Amongst women the common cause of vaginal discharge is vaginitis caused by Trichomonas vaginalis, Candida albicans and anaerobic bacterial infection (bacterial vaginosis). However, cervicitis caused by N. gonorrhoeae and C. trachomatis also causes vaginal discharge. Cervicitis is the more serious cause of vaginal discharge as the aetiologic agents may lead to infection ascending above the internal os of the cervix resulting in pelvic inflammatory disease and other complications.

Algorithms↗
PubMed1998

Syndromic management of sexually transmitted diseases. Part 4--The management of lower abdominal pain in women.

The symptom of lower abdominal pain in women is extremely common and does not always indicate the presence of serious illness. However, women with certain serious conditions such as pelvic inflammatory disease (PID), acute appendicitis, ectopic pregnancy and other complications of pregnancy may present initially with this symptom. Therefore, in managing women with lower abdominal pain care should be taken to exclude any serious condition before dismissing the patient. PID is a condition in which there is infection of the reproductive tract of women above the internal os of the cervix. This usually occurs as a result of an ascending cervical infection caused by Neisseria gonorrhoeae, Chlamydia trachomatis and anaerobic bacteria. The immediate and long term effects of PID include salpingitis, pelvic abscess, peritonitis, infertility and predisposition to tubal ectopic pregnancy. Women with lower abdominal pain should be assessed carefully and if PID is the cause they should be treated for gonococcal, chlamydial and anaerobic bacterial infection. Other gynaecological and surgical causes of lower abdominal pain and the immediate complications of PID require urgent referral to a specialist. PID is associated with significant morbidity and mortality.

Abdominal Pain↗
PubMed1998

Impact of HIV counselling and testing on HIV seroconversion and reported STD incidence among male factory workers in Harare, Zimbabwe.

OBJECTIVES: To assess the impact of HIV counselling and testing on HIV seroconversion and incidence of reported sexually transmitted diseases (STDs) among male factory workers in Harare, Zimbabwe. DESIGN: Prospective, observational study among men recruited to participate in a future workplace based AIDS prevention intervention. METHODS: Participants provided STD histories and blood for HIV antibody testing at enrolment and six month intervals during visits to factories. Participants received HIV test results, post test counselling, and free STD services at the project clinic. RESULTS: Between March 1993 and June 1995, 2,414 men were enrolled with 85% follow up. Overall HIV sero-incidence was 2.60 per 100 person-years; the incidence of reported STDs was 10.19 per 100 person-years. Men who obtained their HIV test results had significantly higher HIV sero-incidence and incidence of reported STDs compared to men who did not obtain their results (IRRs: 1.87, 3.47, respectively). Among men who obtained their HIV test results, a non-significant 40% decrease in HIV sero-incidence was observed after obtaining test results compared to before obtaining results (p = 0.18). The incidence of reported STDs, however, increased by 30% after obtaining HIV test results (p = 0.10). CONCLUSIONS: Decreased HIV sero-incidence in the face of increased reported STD incidence suggests that timely treatment of STDs may decrease the risk of acquiring HIV even in the absence of behaviour change. In populations with high rates of HIV and STDs, the greatest benefit of HIV counselling and testing may be achieved by simultaneously offering STD screening and treatment services.

AIDS Serodiagnosis↗
PubMed1997

Antimicrobial resistance in gonococci isolated from patients and from commercial sex workers in Harare, Zimbabwe.

The objective is to compare antibiotic resistance amongst gonococci isolated from different patient groups in Harare, Zimbabwe. Antimicrobial susceptibilities of Neisseria. gonorrhoeae were determined by disc sensitivity tests. The MICs for penicillin, kanamycin, ceftriaxone, norfloxacin and ciprofloxacin were determined using E-test strips. There were 147 isolates from symptomatic men, 47 isolates from symptomatic women, 29 isolates from asymptomatic women and 41 isolates from female commercial sex workers. A total of 119 (45%) isolates were PPNG and 23 (16%) non-PPNG isolates had a penicillin MIC > 0.64 mg/l. Over 90% of isolates were resistant to TMP/SMX and 16% were resistant to tetracycline. Resistance was uncommon against kanamycin (6%), erythromycin (2%) or ceftriaxone ( < 1%). For kanamycin, the MIC90 was 32 mg/l, for ceftriaxone the MIC90 was < 0.032 mg/l for non-PPNG and < 0.064 mg/l for PPNG. For norfloxacin and ciprofloxacin the MIC90 was < 0.064 mg/l for both PPNG and non-PPNG. Isolates from the commercial sex workers showed a significantly increased prevalence of PPNG, of penicillin-tolerant non-PPNG and of tetracycline resistance. Four of the 41 isolates from sex workers showed multiple resistance (to penicillin, TMP/SMX, tetracycline and kanamycin) compared to 1/223 isolates from other groups (OR = 24.0). Antimicrobial resistance is common amongst gonococci in Harare, especially with isolates from commercial sex workers. In order for STD treatment to be implemented as an effective strategy in HIV control, continued monitoring of resistance patterns is essential.

Anti-Bacterial Agents↗
PubMed1997

Peripheral neuropathy in individuals with HIV infection in Zimbabwe.

Peripheral neuropathy is associated with HIV infection. The prevalence and types of peripheral neuropathy encountered in a randomly-selected HIV infected African population at different stages of disease were investigated. HIV positive individuals were categorized into 1 of 3 groups: asymptomatic, symptomatic and AIDS. HIV negative individuals formed the control group. Nerve conduction data were obtained using standard electrophysiological procedures and CD4+ levels were measured. The type of neuropathy was determined from the history, clinical presentation and electrophysiological abnormalities. The prevalence of peripheral neuropathy was 44%: subclinical neuropathy (SCN) accounted for 56%, acute inflammatory demyelinating polyneuropathy (AIDP) for 15% and distal symmetrical polyneuropathy (DSPN) for 22% of cases of neuropathy. SCN was found in all categories whereas AIDP predominated in the symptomatic category and DSPN in individuals with AIDS. The pattern and frequency of neuropathies seen in our African population is similar to that reported from other continents.

Adult↗
PubMed1997

HIV seroconversion among factory workers in Harare: who is getting newly infected?

OBJECTIVE: Zimbabwe, like other countries in sub-Saharan Africa, is experiencing a rapidly growing HIV/AIDS epidemic. It is crucial to determine risk events and socio-demographic characteristics associated with incident infections in order to tailor prevention messages accordingly. A cohort was established among factory workers with the objectives of estimating HIV incidence, seroprevalence, correlates of infection and subsequently evaluating the impact of prevention interventions. SETTING: 40 factories in Harare, Zimbabwe. DESIGN AND METHODS: HIV seroindicence [total new infections over person time (years) follow up] was estimated in a longitudinal cohort of male factory workers before and during a randomised peer education intervention. Correlates of seroconversion were identified using Cox regression analysis. RESULTS: Of 2,992 subjects enrolled there were 129 seroconversions during 1993 to 1996 follow up, yielding a 2.96 per 100 person year (PY) seroconversion incidence (95% CI = 2.47 to 3.52). Reporting a genital ulcer during follow up (Hazard ratio [HR] = 4.9, p = 0.001) having multiple sexual partners (HR = 1.9, p = 0.04), having a urethral discharge (HR = 2.1, p = 0.001), being single (HR = 2.3, p = 0.001), widowed or married but not residing with wife were independent factors significantly associated with risk of HIV seroconversion. CONCLUSIONS: Incidence of HIV identified in this economically productive sector is unacceptably high, and, disturbingly, is increasing in some age groups. Although the impact of the present intervention remains to be evaluated, the high incidence of HIV infection, points to the need for a more aggressive prevention effort in the general population.

Adult↗
PubMed1994

The association of tuberculosis and HIV infection in Harare, Zimbabwe.

SETTING: The tuberculosis (TB) service responsible for all TB treatment in Harare, Zimbabwe. OBJECTIVES: (1) To determine HIV seroprevalence among TB patients and controls. (2) To compare clinical and demographic characteristics of HIV-infected and uninfected TB patients. DESIGN: Cohort study. Entry criterion: TB diagnosed during the 18 month study period. Assessment included HIV serology. Matched community controls were HIV serotested. RESULTS: In 1434 TB patients tested, HIV seroprevalence was 48% in men and 44% in women, peaked in the 25-34 year age group and was higher than in controls (relative risk [RR] = 3.1, 95% confidence interval [CI] = 2.6-3.7). In adults, seroprevalence was 34%, 49% and 58% in successive 6 month periods. A history of entry of prior TB treatment was less common in the HIV-seropositive (RR = 0.57, CI = 0.37-0.88). In adults, tuberculin negativity, TB at 2 sites, lymph node, pericardial and miliary TB, hilar adenopathy and pleural effusion were significantly more common in HIV-seropositive patients; cavitation and upper lobe involvement were significantly less frequent. Pulmonary TB and sputum smear positivity had similar frequencies in the 2 groups. CONCLUSION: HIV was strongly and increasingly associated with TB in Harare and altered the clinical and radiologic features of TB. Failed standard TB treatment in HIV-infected individuals contributed minimally to new cases of TB.

AIDS-Related Opportunistic Infections↗
PubMed1993

HIV and other sexually transmitted diseases at a rural hospital in Zimbabwe.

OBJECTIVE: To define the epidemiological characteristics of STD patients attending an outpatient clinic in rural Zimbabwe, to examine the aetiologic agents causing infection and to determine their relationship with HIV infection. SUBJECTS: 319 men and 146 women, making a sample of about 7% all patients attending an STD clinic during the 3 month study period. Microbiological data were collected from 104 men and 72 women selected randomly from these. Pregnant women were excluded and patients who had received antibiotics within the previous 14 days were excluded from the microbiology sub-sample. SETTING: An outpatient STD clinic at a District Hospital on a major truck route about 300 km north of the capital, Harare. METHODS: All new patients attending the clinic during a 3 month period were enrolled for clinical and epidemiological investigations using a standard procedure. Specimens for microbiological investigation were taken from every second patient seen on the first three days of each week. RESULTS: The typical patient was male (m:f ratio 2.2) aged 20-29 years (68% patients), not married (56% men) and in paid employment (66% men vs. 27% for the district). In men the most common presenting feature was genital ulceration, while in women, discharges were more common. Genital warts were noted frequently in both sexes. In the sub-sample examined microbiologically, H ducreyi was isolated from 46% ulcers clinically diagnosed as chancroid, and motile spirochaetes were detected in 25% painless ulcers. Neither of these were detected in ulcers in women, but HSV antigen was found as frequently in ulcers from men (19%) as from women (17%). In patients with genital discharges, gonococcal infection occurred in 64% men and 17% women, while T vaginalis was isolated from 39% women and only 8% men. Over 60% gonococcal isolates were PPNG, and 18% showed in vitro resistance to tetracycline. Yeasts, mainly C albicans were isolated from 42% women with a discharge and 25% women with ulcers. In men the presence of yeasts was associated with superficial ulceration and itchiness of the glans. Positive HIV-1 serology was found in 64% patients. There was no statistical association with current genital ulcers, though there was an association with previous STD episodes and particularly with serological evidence of syphilis. Apart from yeasts, there was no association between positive HIV-1 serology and the presence of pathogens in the genital tract. CONCLUSIONS: The high prevalence of HIV-1 antibodies in STD patients in Karoi suggests integration of STD and AIDS control programmes to be a necessity. Since paid employment was a common feature of both STD clinic attendance and HIV-1 seropositivity, these programmes may be effectively directed through the work place.

Adolescent↗