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Biomedical subjects

C P Hudson

Publications and source records attributed to C P Hudson.

At least 19 recordsLinked to original sources
PubMed2003

Community-based trials of sexually transmitted disease treatment: repercussions for epidemiology and HIV prevention.

This paper reviews the scientific basis for trials exploring the relation between sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) infection in Mwanza in the United Republic of Tanzania and Rakai and Masaka in the Republic of Uganda. The importance of a study's location and explanations for the divergent results of these trials are discussed. The modest effect on STDs seen in the trial of syndromic management in Mwanza, in contrast to the 38% reduction in the incidence of HIV, casts doubt on the underlying hypothesis that treating STDs alone slows the transmission of HIV-1. According to the Piot-Fransen model, the trial in Rakai, which offered treatment of STDs to all subjects irrespective of symptoms ("mass" treatment), should have been more effective both in reducing the prevalence of STDs and the incidence of HIV. However, the Rakai trial was stopped because there was no difference in the incidence of HIV between the intervention and control arms. If Mwanza is seen as the trial that needs explaining, another paradigm becomes relevant. In rural East Africa, where all trials have been conducted, networks of concurrent sexual partnerships are a source of infection with both STDs and HIV. Because of their shorter latency periods, STDs may prompt attendance at a clinic before the early signs of HIV-1 infection appear. Part of the management of STDs is to recommend abstinence or the consistent use of condoms until treatment is completed. This recommendation may cover the earliest period of viraemia during primary HIV-1 infection. This paradigm appears to explain the results from Mwanza and Rakai, emphasizing behavioural aspects of syndromic management.

Adolescent↗
PubMed2002

Stage of the epidemic and viral phenotype should influence recommendations regarding mother-to-child transmission of HIV-1.

This article argues for a new approach to use of nevirapine in the prevention of vertical transmission of HIV-1. Existing antenatal surveillance should be strengthened to plan geographical allocation, and subsequent evaluation, of a "nevirapine plus" programme. As the epidemic evolves the programme should also and, ideally, care should be tailored to individual women. Underpinning this approach is evidence that a more virulent viral phenotype appears in many patients with advanced HIV-1 infection. This phenotype will become more common at the population level as the epidemic progresses. As efficacy of zidovudine correlates with viral phenotype, and use of the drug may alter phenotype, there is an urgent need for a replacement that is safe to use with nevirapine.

Anti-HIV Agents↗
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↗
PubMed1997

Severe primary HIV-1 infection among black persons in Barbados.

Descriptions of primary HIV-1 infection have so far been based on Caucasians living in industrialized nations. Due to studies of leptospirosis in the predominantly black population of Barbados, serum was available for patients admitted with acute febrile illnesses to the Queen Elizabeth Hospital (QEH). By searching the medical records of 510 adult patients with known HIV-1 infection we identified 10 patients who had stored serum from an admission for an acute febrile illness that predated or coincided with their first HIV-1-positive test. Serological testing confirmed primary HIV-1 infection in 9 and was suggestive in the 10th patient. The clinical features of these 10 patients were in keeping with previous descriptions of primary HIV-1 infection but differed from leptospirosis cases seen at the QEH. One patient died during his seroconversion illness and another died 3 months after seroconversion. The findings suggest that severe primary HIV-1 infection could be a relatively uncommon occurrence, that the condition may be misdiagnosed, and that cases may not occur until the AIDS epidemic is established.

Barbados↗