摘要:

ObjectiveTo estimate the frequency of acute retroviral syndrome associated with HIV infection among injecting drug users (IDU), and to determine the extent to which acute retroviral syndrome predicts a faster rate of progression to AIDS and immunosuppression in this population.DesignProspective study of HIV seroconverters (median follow-up, 50.5 months).SettingSixteen clinical centres throughout Italy established to study the natural history of HIV infection.PatientsThree hundred and ninety-one IDU for whom the date of HIV seroconversion was established with a 9-month precision.Main outcome measures and methodsIncidence of acute retroviral syndrome with signs and symptoms that included fever (temperature >38°C) occurring within 6 months prior to the time of first positive HIV test, progression to AIDS, crude and adjusted relative hazard of AIDS using survival analysis techniques, and trajectories of CD4+ cell counts using a piece-wise linear regression model incorporating the degree of dependency of within-person measurements.ResultsOf 391 HIV seroconverters, 39 (10.0%) were diagnosed with acute retroviral syndrome. During follow-up, 13 seroconverters with acute retroviral syndrome and 24 asymptomatic seroconverters developed AIDS. The Kaplan-Meier estimates for the cumulative AIDS incidence during 4.5 years of follow-up were 26.8 and 6.5%, respectively; the relative hazard of developing AIDS for acute retroviral syndrome was 5.59 (95% confidence interval, 2.79–11.20) after adjustment for age, sex and year of seroconversion. Although CD4+ level within the first year from seroconversion was similar, the rate of CD4+ cell decline after 1 year from seroconversion was faster in individuals with acute retroviral syndrome than in those without this syndrome (P< 0.001).ConclusionsAmong HIV-infected IDU, a distinct acute retroviral syndrome is apparent and associated with a faster rate of clinical progression to AIDS and HIV-related immunosuppression.

ISSN:0269-9370    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveTo describe and quantify changing AIDS incidence trends in New York City.MethodsData on 44400 AIDS cases diagnosed and reported between 1981 and 1992 were analyzed among demographic and HIV transmission categories. Data were grouped into 10-year birth cohorts by sex, race/ethnicity, and mode of HIV transmission. AIDS incidence and rates of change, as well as changes in median age at diagnosis, were analyzed for persons born between 1920 and 1969.ResultsDeclining AIDS incidence between 1989 and 1992 was only observed among white men who have sex with men (MSM) born prior to 1960 and among minority MSM born prior to 1940. Between 1989 and 1992 the highest rate of increase in AIDS incidence was observed among female injecting drug users (IDU) and persons born after 1960. Median age at diagnosis increased during the study period by 1 year among white MSM, by 2 years among minority MSM, by 7 and 6 years among male and female IDU, respectively, and by 5 years among women infected through heterosexual contact.ConclusionsThese findings suggest that early HIV infection dynamics of the AIDS epidemic were differentially related to age, sex, and transmission category, which resulted in the diffusion of infection from older to younger cohorts and from men to women. The continuing increase in AIDS incidence among the 1960s cohort suggests that the future growth of the epidemic will be dependent upon infection patterns of younger birth cohorts.

ISSN:0269-9370    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectivesTo identify factors associated with effective AIDS behavior change among injecting drug users (IDU) in different national settings.DesignCross-sectional surveys of IDU, with determination of HIV status. Trends in city HIV seroprevalence among IDU also used to validate effectiveness of behavior change.Setting and participantsSubjects recruited from drug-use treatment programs and outreach efforts in Bangkok, Thailand (n = 601), Glasgow, Scotland (n = 919), New York City, USA (n = 2539), and Rio de Janeiro, Brazil (n = 466).ResultsEvidence for the effectiveness of self-reported risk reduction was available for all cities. Univariate followed by multiple logistic regression analyses were used to identify factors associated with self-reported AIDS behavior change. Separate analyses were conducted for each city. Talking about AIDS with drug-using friends was significantly associated with behavior change in all four cities. Talking with sex partners about AIDS, educational level, knowing that someone can be HIV-infected and still look healthy, and having been tested previously for HIV were each significantly associated with behavior change in three of the four cities.ConclusionsDespite the substantial differences in these national settings, there were common factors associated with effective risk reduction. In particular, risk reduction appears to occur through social processes rather than through individual attitude change. HIV prevention programs need to explicitly incorporate social processes into their work.

ISSN:0269-9370    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveTo estimate the proportion of outpatient visits that could be managed at a primary-care level, by World Health Organization (WHO) clinical staging.DesignProspective, descriptive study. Six medical doctors in a tertiary hospital HIV ambulatory clinic recorded clinical diagnoses, WHO clinical staging and their recommendation regarding the appropriate level of care for each outpatient seen.Setting and study populationAll HIV-infected patients attending a public-sector, urban, South African, referral and teaching hospital HIV outpatient clinic between September and November 1992.ParticipantsThere were 238 visits by 148 patients during the study period.ResultsOf 238 visits, 165 (69.3%) were deemed suitable for treatment at the primary-care level. After allowing for contradictory responses, at least 141 visits (59.2%) could be appropriately treated at the primary-care level. Although all six doctors assessed more than half of their visits as suitable for primary care, there were significant differences among them. In total, 83 visits (34.8%) needed a medical specialist, and 45 (18.9%) required tertiary-care facilities. Of all the visits, 58 (24.9%), 51 (21.9%), 60 (25.8%) and 64 (27.4%) were classified as WHO stages 1, 2, 3 and 4, respectively. For these stages, 55 (94.8%), 38 (74.5%), 42 (70.0%) and 26 (40.5%) visits, respectively, were suitable for treatment at a primary-care facility.ConclusionsMany of the outpatient visits to this outpatient specialist clinic could have been safely cared for at a primary-care level. As the severity of the disease increases, there is a decrease in the proportion of patients that can be treated at a primary-care level.

ISSN:0269-9370    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveTo assess the current patterns of HIV transmission in Los Angeles County and determine if AIDS surveillance data accurately reflect these patterns.DesignRecords-based cohort study.MethodsThe demographic and HIV risk characteristics of persons considered to be recently infected with HIV (CD4+ count >700×106/I) were determined and compared with the characteristics of persons meeting the Centers for Disease Control and Prevention (CDC) 1993 AIDS case definition. Data were obtained for patients with HIV infection enrolled from four HIV outpatient clinics and analyzed between August 1991 and July 1993.ResultsThe patient cohort included 1857 persons with HIV infection; 1096 (59.1%) met the CDC 1993 AIDS case definition and 134 (7.2%) had a CD4+ lymphocyte count >700×106/I. The median CD4+ count for the group presumed to be recently infected was 809×106/I. Persons considered recently infected with HIV were more likely than those meeting the AIDS case definition to be female (26.1 and 14.5%, respectively;P< 0.001), black (28.4 and 18.2%, respectively;P= 0.001), or male homosexual injecting drug users (IDU; 6.7 and 3.4%, respectively;P=0.05). After controlling for confounding variables by logistic regression, persons recently infected were more likely to be female [adjusted odds ratio (OR), 3.4; 95% confidence interval (CD, 1.8–6.5;P< 0.001], black (adjusted OR, 1.6; 95% CI, 1.1–2.5;P=0.02) or male homosexual IDU (adjusted OR, 2.4; 95% CI, 1.1–5.2;P=0.02) than persons with AIDS.ConclusionsOur results suggest that the HIV epidemic in Los Angeles County is currently advancing into different subpopulations and indicate that the current patterns of HIV transmission in the County are not fully reflected in standard AIDS surveillance activities. However, our data must be interpreted cautiously because of potential selection and misclassification biases. These findings illustrate the benefits of alternative surveillance mechanisms in detecting important changes in HIV transmission and defining groups at risk, especially in jurisdictions without HIV reporting.

ISSN:0269-9370    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveTo estimate the prevalence of HIV-1 infection among adult and young offenders admitted to remand facilities in the province of Ontario, Canada, by using a design that reduces volunteer bias.MethodsA study using a modified anonymous HIV-surveillance design was conducted with urine specimens routinely collected from male and female entrants to all Ontario jails, detention and youth centres between February and August 1993. Information on sex, age, and history of injecting drug use was also collected. Urine was screened using a modified commercial HIV enzyme-linked immunosorbent assay kit and confirmed using a modified in-house Western blot assay.ResultsData were obtained on 10530 adult men, 1518 adult women, 1480 young male offenders, and 92 young female offenders. Urine specimens were available for 88% of new entrants. Of the entrants, 1 % (n = 163) refused to have their urine used for research. Refusals were not associated with history of injecting drug use. Overall rates of HIV-1 infection were 1 % for adult men, 1.2% for adult women, and 0% for young offenders. Both the rates of infection and prevalence of injecting drug use varied across facilities and geographic regions. Overall, 13% of adult men, 20% of adult women, 3% of young male offenders, and 2% of young female offenders reported a history of injecting drug use. Rates of infection were highest among self-reported injecting drug users. Rates of HIV were 3.6% for adult men and 4.2% for adult women who injected compared with 0.6 and 0.5%, respectively, for non-injecting drug users.ConclusionsThe use of unlinked left-over specimens is an important tool for measuring HIV-prevalence rates and should be encouraged. The results indicate that HIV rates are much higher among those entering prisons than in the general population. The pattern of HIV in Ontario prisons is similar to that reported in Europe and the United States. We are optimistic that these data will stimulate much needed efforts towards education and health promotion, and open the door to further research in Canadian prisons.

ISSN:0269-9370    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveTo assess self-disclosure of HIV-positive serostatus to family, friends, and intimate lovers among asymptomatic and symptomatic men who varied in length of time since HIV-seropositive diagnosis. Additionally, the study assessed the anticipated and actual interpersonal consequences of disclosure.MethodsA multiethnic sample of 684 men with HIV/AIDS completed self-administered questionnaires at two HIV-outpatient clinics in Los Angeles. The cross-sectional analysis stratified the men by time since testing HIV-seropositive and symptomatic status. Disclosure to six significant others (intimate lover, close friend, mother, father, sister, brother) was examined in univariate and multivariate analyses.ResultsMen recently diagnosed HIV-seropositive (within 2–4 months) were more likely to have informed intimate lovers and friends than family members; disclosure to father was extremely low. Disclosure was generally lower among asymptomatic than symptomatic men; 21% of asymptomatic men who had tested HIV-seropositive in the previous year had not informed any of the six significant others considered in the study. Disclosure rates were higher among men diagnosed less recently. The interpersonal reactions of those informed were more favorable than the reactions non-disclosers anticipated; however, both actual and anticipated reactions were generally supportive.ConclusionMany asymptomatic men inform few or no significant others of their HIV infection in the first few months after HIV diagnosis. Given the generally supportive reactions reported, HIV-seropositive men should be encouraged, when appropriate, to inform family, friends, and intimate lovers of their serostatus.

ISSN:0269-9370    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:1995

数据来源: OVID