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J Bogaerts

Publications and source records attributed to J Bogaerts.

At least 55 records · Page 3Linked to original sources
PubMed1992

Confidential HIV testing and condom promotion in Africa. Impact on HIV and gonorrhea rates.

OBJECTIVE: We evaluated the impact of human immunodeficiency virus (HIV) testing and counseling on self-reported condom and spermicide use and on corresponding HIV seroconversion and gonorrhea rates in urban Rwandan women. DESIGN: Prospective cohort study with 2 years of follow-up, comparison of outcome variables before and after an intervention, and condom use measured in a control group that did not receive the intervention. SETTING: Outpatient research clinic in Kigali, the capital of Rwanda. PARTICIPANTS: One thousand four hundred fifty-eight childbearing women, 32% of whom were infected with HIV, were enrolled in a prospective study in 1988, and followed at 3- to 6-month intervals for 2 years. Follow-up was available for 95% of subjects at year 1 and 92% at year 2. INTERVENTIONS: An acquired immunodeficiency syndrome (AIDS) educational videotape, HIV testing and counseling, and free condoms and spermicide were provided to all participants and interested sexual partners. MAIN OUTCOME MEASURES: Self-report of compliance with condom-spermicide use and observed incidence of HIV and gonorrhea. RESULTS: Only 7% of women reported ever trying condoms before the intervention, but 22% reported condom use with good compliance 1 year later. Women who were HIV-positive were more likely to adopt condom use than HIV-negative women (36% vs 16%; P < .05). Independent predictors of condom use, both in HIV-positive and in HIV-negative women, included HIV testing and counseling of the male partner, having a nonmonogamous relationship, and believing condoms were not dangerous. Human immunodeficiency virus seroconversion rates decreased significantly (from 4.1 to 1.8 per 100 person-years; P < .04) in women whose partners were tested and counseled. The prevalence of gonorrhea decreased substantially (13% to 6%; P < .05) among HIV-positive women, with the greatest reduction among condom users (16% to 4%; P < .05). CONCLUSION: A confidential HIV testing and counseling program was associated with increased use of condoms and reduced rates of gonorrhea and HIV in urban Rwandan women. The lack of risk reduction in HIV-negative women whose partner's serostatus was unknown was of concern. Interventions that promote HIV testing and counseling for both members of a couple should be considered in other high-prevalence areas.

AIDS Serodiagnosis↗
PubMed1992

Effect of serotesting with counselling on condom use and seroconversion among HIV discordant couples in Africa.

OBJECTIVE: To determine whether HIV testing and counselling increased condom use and decreased heterosexual transmission of HIV in discordant couples. DESIGN: Prospective study. SETTING: Kigali, the capital of Rwanda. SUBJECTS: Cohabiting couples with discordant HIV serology results. MAIN OUTCOME MEASURES: Condom use in the couple and HIV seroconversion in the negative partners. RESULTS: 60 HIV discordant couples were identified, of whom 53 were followed for an average of 2.2 years. The proportion of discordant couples using condoms increased from 4% to 57% after one year of follow up. During follow up two of the 23 HIV negative men and six of the 30 HIV negative women seroconverted (seroconversion rates of 4 and 9 per 100 person years). The rate among women was less than half that estimated for similar women in discordant couples whose partners had not been serotested. Condom use was less common among those who seroconverted (100% v 5%, p = 0.01 in men; 67% v 25%, p = 0.14 in women). CONCLUSIONS: Roughly one in seven cohabiting couples in Kigali have discordant HIV serological results. Confidential HIV serotesting with counselling caused a large increase in condom use and was associated with a lower rate of new HIV infections. HIV testing is a promising intervention for preventing the spread of HIV in African cities.

AIDS Serodiagnosis↗
PubMed1992

Predictors of mortality among HIV-infected women in Kigali, Rwanda.

OBJECTIVE: To better characterize the natural history of disease due to human immunodeficiency virus (HIV) infection in African women. DESIGN: Prospective cohort study over a 2-year follow-up period. PARTICIPANTS: A total of 460 HIV-seropositive women and a comparison cohort of HIV-seronegative women recruited from prenatal and pediatric clinics in Kigali, Rwanda in 1988. MEASUREMENTS: Clinical signs and symptoms of HIV disease, AIDS, and mortality. MAIN RESULTS: Follow-up data at 2 years were available for 93% of women who were still alive. At enrollment, many seropositive women reported symptoms listed in the World Health Organization (WHO) clinical case definition of AIDS, but these were nonspecific and often improved over time. The 2-year mortality among HIV-infected women by Kaplan-Meier survival analysis was 7% (95% CI, 5% to 10%) overall, and 21% (CI, 8% to 34%) for the 40 women who fulfilled the WHO case definition of AIDS at entry. In comparison, the 2-year mortality in women not infected with HIV was only 0.3% (CI, 0% to 7%). Independent baseline predictors of mortality in seropositive women by Cox proportional hazards modeling were, in order of descending risk factor prevalence: a body mass index of 21 kg/m2 or less (relative hazard, 2.3; CI, 1.1 to 4.8), low income (relative hazard, 2.3; CI, 1.1 to 4.5), an erythrocyte sedimentation rate exceeding 60 mm/h (relative hazard, 4.9; CI, 2.2 to 10.9), chronic diarrhea (relative hazard, 2.6; CI, 1.1 to 5.7), a history of herpes zoster (relative hazard 5.3; CI, 2.5 to 11.4), and oral candida (relative hazard, 7.3; CI, 1.6 to 33.3). Human immunodeficiency virus disease was the cause of death in 38 of the 39 HIV-positive women who died, but only 25 met the WHO definition of AIDS before death. CONCLUSIONS: Human immunodeficiency virus disease now accounts for 90% of all deaths among child-bearing urban Rwandan women. Many symptomatic seropositive patients may show some clinical improvement and should not be denied routine medical care. Easily diagnosed signs and symptoms and inexpensive laboratory tests can be used in Africa to identify those patients with a particularly good or bad prognosis.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Cryptococcal meningitis associated with acquired immunodeficiency syndrome (AIDS) in African patients: treatment with fluconazole.

Cryptococcal meningitis associated with acquired immunodeficiency syndrome (AIDS) is particularly common in tropical Africa. This could be explained by the dramatic increase in the number of human immunodeficiency virus (HIV) infections and the high prevalence of Cryptococcus neoformans var. neoformans in the domestic and general environment of HIV-positive and AIDS patients Meningoencephalitis is the usual and dominant clinical feature of cryptococcal infection in AIDS patients and 'slim disease', tuberculosis and candidiasis are the most common opportunistic infections associated with cryptococcal meningitis. In a group of 64 African patients with AIDS and cryptococcosis treatment with a daily dose of 400 mg fluconazole (FCA) during the acute phase showed a clinical cure in 63% of the evaluable patients. Mycological response to treatment with negative culture was found in 76% of our patients (at day 60-90). The overall tolerance of FCA was excellent. This treatment was also used successfully for relapse of cryptococcal meningitis.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Pulmonary tuberculosis in Kigali, Rwanda. Impact of human immunodeficiency virus infection on clinical and radiographic presentation.

The aim of the present study was to compare the clinical and radiographic presentation as well as the therapeutic outcome of pulmonary tuberculosis (PT) in adult patients with and without human immunodeficiency virus type 1 (HIV-1) infection in Kigali, Rwanda. Over a 17-month period 59 consecutive patients with bacteriologically and/or histopathologically documented PT were enrolled. Of these, 48 (81%) patients were HIV seropositive. Among these, 35 fit the WHO clinical criteria for AIDS (WHOCCA) at the time of admission. Significant differences were found between the HIV-seropositive and HIV-seronegative groups of patients: fever (85 versus 36%; p less than 0.001), tuberculin skin test anergy (69 versus 0%; p less than 0.01), mediastinal and/or hilar adenopathies (31 versus 0%; p = 0.05), and pleural effusion (43 versus 9%; p less than 0.05) were more frequently encountered in the HIV-seropositive group, and upper lobe infiltrates (55 versus 16%; p less than 0.02) and cavitation (91 versus 39%; p less than 0.003) were more often seen in the HIV-seronegative group. However, HIV-seropositive patients not meeting WHOCCA were less frequently anergic (0 versus 100%; p less than 0.001) and feverish (53 versus 97%; p less than 0.01) and more often had cavitation (69 versus 28%; p less than 0.02) and less often mediastinal and/or hilar adenopathies (7 versus 40%; p less than 0.04) compared with HIV-seropositive patients meeting WHOCCA. Under antituberculosis treatment, clearance of fever was slower in HIV-seropositive compared with HIV-seronegative patients, and among the HIV-seropositive group it was slower in those fitting WHOCCA.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1992

Two-year incidence of tuberculosis in cohorts of HIV-infected and uninfected urban Rwandan women.

To determine the prevalence of Mycobacterium tuberculosis infection and the incidence of tuberculosis in HIV-infected and uninfected urban Rwandan women, 460 HIV-positive and 998 HIV-negative childbearing women were recruited from pediatric and prenatal care clinics and were enrolled in a prospective study in 1988 and followed for 2 yr. Tuberculin testing was administered 12 to 18 months after enrollment. Fifty-three percent of HIV-negative women had positive tuberculin tests (induration > or = 10 mm), with higher rates among older women and among women who had received BCG vaccine. Only 21% of HIV-positive women had positive tuberculin tests, with no relationship to BCG vaccine. Follow-up was available for 93% of subjects. Tuberculosis was diagnosed in 20 HIV-positive women and in two HIV-negative women. Features associated with an increased risk of tuberculosis among HIV-positive women included: age > or = 30, body mass index in the lowest quartile, low income, erythrocyte sedimentation rate > 75, positive tuberculin test, and chronic cough, chronic fever, and weight loss. Among Rwandan women who are infected with HIV, approximately half of those who are infected with M. tuberculosis do not have positive tuberculin tests. The rate ratio for development of tuberculosis among HIV-positive women was 22 (95% CI, 5 to 92). New algorithms are needed to improve the early detection of tuberculosis among HIV-positive patients in Africa.

AIDS Serodiagnosis↗
PubMed1992

Evaluation of the cryptococcal antigen test as a diagnostic tool of AIDS-associated cryptococcosis in Rwanda.

To evaluate the latex test, two different retrospective studies were undertaken. A positive culture for Cr. neoformans was used as the golden standard of active cryptococcal infection. 439 sera selected at random sent to the NSP laboratory for screening of HIV antibody were tested as well as--71 CSF from patients with meningeal symptoms sent to the laboratory of the Centre Hospitalier de Kigali. In total, two discrepancies were found: two CSF samples from ancient cases of cryptococcosis under treatment were positive with the latex test and negative by culture. If it stands to reason that the antigen test cannot differentiate between active and inactive cryptococcal diseases, the persistence of small amounts of soluble antigens in a CSF implies that the patient must remain under surveillance, a relapse being very frequent in AIDS patients. As a conclusion, the latex test is a fast, easy to perform and quite reliable test for the diagnosis of cryptococcosis.

AIDS-Related Opportunistic Infections↗
PubMed1991

Increased frequency of infection after open reduction of fractures in patients who are seropositive for human immunodeficiency virus.

In a prospective study of 214 patients who had elective extensive operations for fractures, we compared the relative frequencies of postoperative infections in the seventeen patients who were seropositive for human immunodeficiency virus and had associated clinical symptoms, in the twenty-six patients who were seropositive and had no associated clinical symptoms, and in the 171 patients who were seronegative. The relative frequency of postoperative infection was significantly higher in patients who were seropositive and had associated clinical symptoms (four of seventeen) than in patients who were seronegative (eight of 171) (Fisher exact test, p = 0.01). In all patients who were seropositive and had a postoperative bacterial infection, treatment with antibiotics was effective. The results of this study suggest that people who are seropositive for human immunodeficiency virus and have associated symptoms are at increased risk for postoperative infection.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Treatment of gonococcal conjunctivitis with a single intramuscular injection of cefotaxime.

Between 25% and 50% of children in African countries are exposed to Neisseria gonorrhoeae at birth and are at risk of developing gonococcal ophthalmia neonatorum. The problem is aggravated by the emergence of penicillinase-producing strains of N. gonorrhoeae (PPNG). Twenty-one children (9 boys, 12 girls, mean age 13 days) presenting with gonococcal conjunctivitis were identified during a 47-month period. Nineteen children received a single im injection of 100 mg/kg cefotaxime (maximum dose 1 g) without topical antibiotic therapy. One neonate with concurrent otitis media was treated with cefotaxime for five days and a 17-month old girl received two im injections because of the severity of her symptoms. Eight patients (38%) had received previous antibiotic therapy (penicillin im and/or tetracycline eye ointment). Twelve isolates of N. gonorrhoeae were found to be PPNG strains. At three to seven day follow-up examination all 21 patients were clinically cured without residual eye damage. Cefotaxime offers an effective first line treatment for gonococcal ophthalmia neonatorum in areas where there is a high prevalence of PPNG strains. The advantages of a single-dose treatment over multidose regimens in terms of compliance and cost are discussed.

Cefotaxime↗
PubMed1990

Multiresistant Salmonella typhimurium systemic infection in Rwanda. Clinical features and treatment with cefotaxime.

Children with multiresistant Salmonella typhimurium (MRST) systemic infections, in total 246, were diagnosed during the study period. Of these, 220 had MRST without metastatic focal infections and 26 had metastatic focal infections (including 12 patients with meningitis). The median age of the children was 10 months. Diarrhoeal disease, measles and severe malnutrition were the most frequent causes of admission. Fever was found in 99% and diarrhoea in 72% of the patients, with respiratory symptoms in 72%. In 199 (81%) of the patients, the MRST infection was considered to be hospital-acquired. Of the 246 children, 159 were treated with cefotaxime. In this group, 16 of 152 patients died (10.5%). However, of the 87 children who did not receive cefotaxime, 64 died (74%). Relapses occurred in 4% of the patients with bacteraemia treated with cefotaxime. Our study confirms the high efficiency of cefotaxime in treating severe systemic infections with MRST.

Adolescent↗
PubMed1990

Characterization, in vitro susceptibility, and clinical significance of CDC group HB-5 from Rwanda.

From June 1984 until July 1988, CDC group HB-5 isolates were recovered from the exudates of genital ulcers in 25 of 675 (3.6%) patients (204 women, 471 men) in Kigali, Rwanda. Among a group of 145 men presenting with urethritis but without genital ulcers, a positive culture for HB-5 of a specimen from the coronal groove of the penis of only 1 man (0.7%) was found. During the same period, the organism was not obtained in cultures of vaginal specimens from 838 women without genital ulcer disease. The main biochemical characteristics of the isolated microorganisms included weak oxidase positivity, catalase negativity, indole positivity, reduction of nitrate to nitrite, acid production from D-glucose and fructose, and H2S production. A total of 75% of the organisms were susceptible to penicillin G. beta-Lactamase production was detected by the chromogenic cephalosporin test in a quarter of the strains. This study confirms that HB-5 can be found in the genital tract. HB-5 was associated with genital ulcer disease in Rwanda. However, its etiologic role in patients with this condition remains unclear.

Drug Resistance, Microbial↗
PubMed1989

Treatment of adult gonococcal keratoconjunctivitis with oral norfloxacin.

We evaluated the efficacy of oral norfloxacin in 15 patients with culture-proven gonococcal eye disease caused by Neisseria gonorrhoeae. The first seven patients received 1,200 mg of oral norfloxacin for three consecutive days. The other eight patients were each treated with a single oral dose of 1,200 mg of norfloxacin. All control cultures were negative, and there was no progression of the corneal lesions after treatment was initiated. No adverse effects were observed. The results of this study suggested that a single dose of oral norfloxacin may be a valuable alternative to the currently recommended treatment regimens for gonococcal eye disease because it combines high efficacy and low toxicity with low cost and excellent patient compliance.

Administration, Oral↗