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participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



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Respiratory Tract Infection in HIV-1-Infected Adults in Nairobi, Kenya [Mwachari, CW., et al. JAIDS 2001;27:365]: The authors evaluated the WHO algorithm for managing respiratory tract infections in HIV-infected adults in Nairobi. The algorithm consists of sputum microscopy for AFB and pulmonary auscultation for evidence of a respiratory tract infection, with x-rays in those with rales. Patients with evidence for TB by AFB stain or chest x-ray are treated for tuberculosis. Those with rales by auscultation without x-ray evidence of tuberculosis are treated with ampicillin; if there is no improvement in three days, they are treated with TMP-SMX, which is given for five days. For study purposes, sputum was examined for bacteria after liquefication with dithiothreitol, CD4 cell counts were performed, and chest x-rays were taken. The results showed 497 cases of respiratory tract infections, including 177 cases of pneumonia, and 420 with acute bronchitis. Important outcome findings are summarized below:

  • The positive predictive value of rales based on chest x-ray was 77% (81/105 with clinically suspected pneumonia cases).
  • The incidence of pneumonia was 500/1000 patient-years.
  • The mortality attributed to respiratory tract infections was 13 patients, including 2% of those with pneumonia.
  • Tuberculosis was found in 32 episodes and M. tuberculosis was the most common pathogen identified.
  • S. pneumoniae was recovered in only nine cases of pneumonia (3%).
  • All mycobacteria were M. tuberculosis.
  • Analysis of patients with pneumonia showed 52% responded to ampicillin, 14% responded to TMP-SMX and 32% required non-protocol antibiotics, usually erythromycin.
  • Six patients required hospitalization and were treated with intravenous antibiotics, usually penicillin.

Comment: The results of this study are especially important in light of escalating interest in HIV care in Africa. The differences in the management, recommendations and experience are striking when compared with those advocated by the IDSA, ATS and the CDC.
posted 8/10/2001





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