Skip to main content
PMC home page
American Journal of Public Health logoLink to American Journal of Public Health
. 1993 Oct;83(10):1385–1389. doi: 10.2105/ajph.83.10.1385

Clinical research, prophylaxis, therapy, and care for HIV disease in Africa.

K M De Cock 1, S B Lucas 1, S Lucas 1, J Agness 1, A Kadio 1, H D Gayle 1
PMCID: PMC1694848  PMID: 8214225

Abstract

By the end of the century, citizens of resource-poor countries will constitute 90% of the world's human immunodeficiency virus (HIV)-infected people. Clinical management of such persons in developing countries has been neglected; most AIDS research has concentrated on epidemiology, and donor agencies have generally invested in the prevention of HIV infection. The heavy burden of HIV disease in Africa requires that care for AIDS be addressed, and prevention and care should be seen as interrelated. Prevention and treatment of tuberculosis, the commonest severe infection in persons with AIDS in Africa, illustrate this interrelationship. We outline priorities for applied research on the management of HIV disease in a resource-poor environment, and discuss prophylaxis, therapy for opportunistic diseases, terminal care, and use of antiretroviral therapy. Research should define the standard of care that can realistically be demanded for HIV disease in a resource-poor environment. Research and public health programs for AIDS in developing countries must address AIDS care and attempt to reduce the widening gap between interventions available for HIV-infected persons in different parts of the world.

Full text

PDF
1385

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abouya Y. L., Beaumel A., Lucas S., Dago-Akribi A., Coulibaly G., N'Dhatz M., Konan J. B., Yapi A., De Cock K. M. Pneumocystis carinii pneumonia. An uncommon cause of death in African patients with acquired immunodeficiency syndrome. Am Rev Respir Dis. 1992 Mar;145(3):617–620. doi: 10.1164/ajrccm/145.3.617. [DOI] [PubMed] [Google Scholar]
  2. Barnes P. F., Bloch A. B., Davidson P. T., Snider D. E., Jr Tuberculosis in patients with human immunodeficiency virus infection. N Engl J Med. 1991 Jun 6;324(23):1644–1650. doi: 10.1056/NEJM199106063242307. [DOI] [PubMed] [Google Scholar]
  3. Blatt S. P., Lucey C. R., Butzin C. A., Hendrix C. W., Lucey D. R. Total lymphocyte count as a predictor of absolute CD4+ count and CD4+ percentage in HIV-infected persons. JAMA. 1993 Feb 3;269(5):622–626. [PubMed] [Google Scholar]
  4. Cameron D. W., Simonsen J. N., D'Costa L. J., Ronald A. R., Maitha G. M., Gakinya M. N., Cheang M., Ndinya-Achola J. O., Piot P., Brunham R. C. Female to male transmission of human immunodeficiency virus type 1: risk factors for seroconversion in men. Lancet. 1989 Aug 19;2(8660):403–407. doi: 10.1016/s0140-6736(89)90589-8. [DOI] [PubMed] [Google Scholar]
  5. De Cock K. M., Soro B., Coulibaly I. M., Lucas S. B. Tuberculosis and HIV infection in sub-Saharan Africa. JAMA. 1992 Sep 23;268(12):1581–1587. doi: 10.1001/jama.268.12.1581. [DOI] [PubMed] [Google Scholar]
  6. Fischl M. A., Richman D. D., Hansen N., Collier A. C., Carey J. T., Para M. F., Hardy W. D., Dolin R., Powderly W. G., Allan J. D. The safety and efficacy of zidovudine (AZT) in the treatment of subjects with mildly symptomatic human immunodeficiency virus type 1 (HIV) infection. A double-blind, placebo-controlled trial. The AIDS Clinical Trials Group. Ann Intern Med. 1990 May 15;112(10):727–737. doi: 10.7326/0003-4819-112-10-727. [DOI] [PubMed] [Google Scholar]
  7. Gilks C. F., Brindle R. J., Otieno L. S., Simani P. M., Newnham R. S., Bhatt S. M., Lule G. N., Okelo G. B., Watkins W. M., Waiyaki P. G. Life-threatening bacteraemia in HIV-1 seropositive adults admitted to hospital in Nairobi, Kenya. Lancet. 1990 Sep 1;336(8714):545–549. doi: 10.1016/0140-6736(90)92096-z. [DOI] [PubMed] [Google Scholar]
  8. Goodgame R. W. AIDS in Uganda--clinical and social features. N Engl J Med. 1990 Aug 9;323(6):383–389. doi: 10.1056/NEJM199008093230605. [DOI] [PubMed] [Google Scholar]
  9. Harris J. E. Improved short-term survival of AIDS patients initially diagnosed with Pneumocystis carinii pneumonia, 1984 through 1987. JAMA. 1990 Jan 19;263(3):397–401. [PubMed] [Google Scholar]
  10. Katabira E. T., Wabitsch K. R. Management issues for patients with HIV infection in Africa. AIDS. 1991;5 (Suppl 1):S149–S155. [PubMed] [Google Scholar]
  11. Moore R. D., Hidalgo J., Sugland B. W., Chaisson R. E. Zidovudine and the natural history of the acquired immunodeficiency syndrome. N Engl J Med. 1991 May 16;324(20):1412–1416. doi: 10.1056/NEJM199105163242006. [DOI] [PubMed] [Google Scholar]
  12. Schopper D., Walley J. Care for AIDS patients in developing countries: a review. AIDS Care. 1992;4(1):89–102. doi: 10.1080/09540129208251623. [DOI] [PubMed] [Google Scholar]
  13. Serwadda D., Katongole-Mbidde E. AIDS in Africa: problems for research and researchers. Lancet. 1990 Apr 7;335(8693):842–843. doi: 10.1016/0140-6736(90)90946-3. [DOI] [PubMed] [Google Scholar]
  14. Volberding P. A., Lagakos S. W., Koch M. A., Pettinelli C., Myers M. W., Booth D. K., Balfour H. H., Jr, Reichman R. C., Bartlett J. A., Hirsch M. S. Zidovudine in asymptomatic human immunodeficiency virus infection. A controlled trial in persons with fewer than 500 CD4-positive cells per cubic millimeter. The AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases. N Engl J Med. 1990 Apr 5;322(14):941–949. doi: 10.1056/NEJM199004053221401. [DOI] [PubMed] [Google Scholar]
  15. Wachter R. M. AIDs, activism, and the politics of health. N Engl J Med. 1992 Jan 9;326(2):128–133. doi: 10.1056/NEJM199201093260209. [DOI] [PubMed] [Google Scholar]
  16. Wallis R. S., Vjecha M., Amir-Tahmasseb M., Okwera A., Byekwaso F., Nyole S., Kabengera S., Mugerwa R. D., Ellner J. J. Influence of tuberculosis on human immunodeficiency virus (HIV-1): enhanced cytokine expression and elevated beta 2-microglobulin in HIV-1-associated tuberculosis. J Infect Dis. 1993 Jan;167(1):43–48. doi: 10.1093/infdis/167.1.43. [DOI] [PubMed] [Google Scholar]
  17. Yarchoan R., Venzon D. J., Pluda J. M., Lietzau J., Wyvill K. M., Tsiatis A. A., Steinberg S. M., Broder S. CD4 count and the risk for death in patients infected with HIV receiving antiretroviral therapy. Ann Intern Med. 1991 Aug 1;115(3):184–189. doi: 10.7326/0003-4819-115-3-184. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES