摘要:

ObjectiveTo evaluate the presence of autonomic nervous system (ANS) involvement in HIV-positive drug users.DesignWe investigated 37 HIV-positive (and 18 HIV-negative controls) intravenous heroin users who were without symptoms and signs of autonomic or peripheral neuropathy.MethodsThe patients were clinically and immunologically assessed and subjected to a battery of five cardiovascular reflex function tests.ResultsThe tests revealed ANS involvement in 22 HIV-positive subjects but only in one HIV-negative subject. Immunoglobulin (Ig) G and C1q immune complex levels were significantly higher in HIV-positive subjects with severe cardiovascular reflex function tests alteration compared to those with normal tests. In a follow-up of 17 HIV-positive subjects, nine presented deteriorated reflexes in the tests and higher IgG immune complex levels.ConclusionsThe results confirm that, by using sufficiently sensitive tests, signs of preclinical autonomic neuropathy can frequently be found in HIV-positive intravenous heroin users, as previously observed in homosexual patients, and suggest the existence of an HIV-related autoimmune pathogenesis. Early diagnosis of ANS involvement could be important, since the presence of autonomic dysfunction could increase the risk of cardiorespiratory arrest during invasive procedures.

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

SubjectsThree HIV-infected patients with active pulmonary non-disseminated tuberculosis and normal chest radiograph at clinical presentation and during follow-up are reported. Patients had cough and fever but no other specific symptoms. Löwenstein cultures of specimens from bronchoalveolar lavage in two cases and induced sputum in one yieldedMycobacterium tuberculosis.ConclusionsThe diagnosis of tuberculosis in HIV-infected patients depends greatly on clinical suspicion by the physician, because of its atypical presentation. Failure to perform appropriate diagnostic tests in HIV-infected patients who present with suspected pulmonary disease will result in underdiagnosis and undertreatment of tuberculosis.

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveThis study was designed to assess the significance of HIV-related oral lesions in predicting the rate of progression to AIDS.DesignCohorts were investigated prospectively, and oral examinations were performed by clinicians trained in the diagnosis of oral lesions.Setting: We studied three existing cohorts of homosexual and bisexual men in San Francisco, California, USA.ParticipantsOf the HIV-infected men who received standardized oral examinations (n = 791), 603 were eligible for analysis of baseline examinations and 448 for analysis of follow-up examinations.Main outcome measuresWe determined time from presence of oral lesion at baseline or follow-up examination, or from participant self-reported history of the lesion, to diagnosis of AIDS.ResultsUsing proportional hazard regression and stratifying by CD4 lymphocyte count at the time of baseline oral examination, we found that the rate of development of AIDS was increased among men with hairy leukoplakia [relative hazard, 1.8; 95% confidence interval (CD, 1.2–2.7], oral candidiasis (relative hazard, 7.3; 95% CI, 3.1–17.3), and both lesions (relative hazard, 3.1; 95% CI, 1.6–6.1) compared with men with normal findings. On follow-up examination, stratifying for CD4 count, the rate of progression to AIDS was similar for those with hairy leukoplakia compared with those with oral candidiasis. The progression rate from oral candidiasis to AIDS was faster from presence on baseline examination than from presence on follow-up examination or from self-reported history of the lesion.ConclusionThe presence of oral candidiasis and/or hairy leukoplakia on baseline examination confers independent prognostic information and should be incorporated into HIV-staging schemes.

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo assess whether routinely collected data from partner notification for HIV infection could be used to study HIV epidemiology. The issues addressed were measures of contact patterns and behaviour change, variables influencing transmission risks, and indications of HIV incidence.DesignWe collected anonymous questionnaire data from all partner notifications performed from seropositive patients diagnosed in Sweden between 1 January 1989 and 30 June 1990.MethodA structured questionnaire was completed by the physician or counsellor interviewing newly diagnosed seropositive patients and counselling their reported partners. The questions focused on temporal and behavioural aspects of all contacts between index patients and partners.ResultsQuestionnaires were completed for 365 of the 403 (91%) index patients diagnosed during the study period, for 350 of the 390 (90%) located partners, and for 274 of the 297 (92%) relationships where results of HIV testing were known for index patient and partner. Seropositive individuals diagnosed in 1989 or later reported less risk behaviour than those diagnosed earlier. Risk of transmission in sexual contact increased when the infectious partner developed symptoms of HIV infection. Anal intercourse was found to be approximately twice as infectious as vaginal, and transmission risk from a seropositive insertive partner approximately twice as high as from a receptive. The total HIV incidence in Sweden appears to be declining, as does the number of newly diagnosed infected homosexual men.ConclusionCarefully collected data acquired from a partner notification programme are well suited to describe and follow the epidemiology of HIV infection.

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectivesTo test the efficacy of reaction time measures derived from cognitive psychology as measures of subclinical cognitive slowing in individuals with HIV-1 infection.DesignCognitive slowing is the primary deficit in AIDS dementia. One measure of cognitive slowing is decision-making speed, the discrepancy between simple and choice reaction times, which represents an index of central information processing time.MethodsNineteen HIV-seropositive and 13 control subjects performed a detection and decision task in a reaction time procedure. All subjects were administered measures of simple and choice reaction time, a control measure of rate of verbal encoding, and measures of psychological distress.ResultsCompared with controls, both symptomatic and asymptomatic HIV-seropositive subjects had significantly longer decision times, but performed the control task of rate of encoding normally. Simple reaction times correlated significantly with depression scores, but choice reaction times were unrelated to psychological distress.ConclusionsThe results support mental slowing as the initial cognitive disturbance of HIV-1 infection and emphasize potential use of reaction times as markers of central nervous system involvement in HIV-1 infection.

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo identify predictors of treatment outcomes in methadone maintenance programs and to determine whether HIV counseling and testing influenced these outcomes.DesignRetrospective record review.SettingFour methadone maintenance programs in four cities in Connecticut, USA.ParticipantsFive hundred and ninety-four clients, who began treatment over an 18-month period and for whom records were available, took part.InterventionsHIV counseling and testing.Main outcome measuresRisk of treatment discontinuation and persistent in-treatment illicit drug use.ResultsThe most important predictor of treatment discontinuation and of persistent in-treatment illicit drug use was self-reported pre-treatment cocaine use. After controlling for this and demographic risk factors, clients who received initial HIV counseling, when compared with clients who did not, had a similar 12-month discontinuation risk (54 versus 59%;P= 0.08) but were less likely to show persistent illicit drug use (46 versus 53%;P= 0.01). Among counseled entrants who were tested for HIV antibodies, those receiving positive results had a 12-month discontinuation risk similar to those receiving negative results (50 versus 52%), but more often showed persistent illicit drug use (57 versus 44%), although this difference may have been due to chance (P= 0.28). The majority of clients who discontinued treatment did so because they were discharged for non-compliance with clinic rules, usually for failing to pay fees.ConclusionsHIV counseling and testing do not have a substantial adverse effect on methadone treatment outcomes. In the clinics under study, failure to pay clinic fees was an important factor contributing to discontinuation of treatment.

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo assess the representativeness of drug use treatment samples for measuring HIV seroprevalence among injecting drug users (IDU) in community settings.DesignSeroprevalence was determined in two cross-sectional, convenience samples including an unlinked survey of IDU entrants to all publicly-funded drug-treatment programs and a survey of community-recruited IDU.MethodsUnconditional logistic regression [odds ratio (OR)] was used to calculate unadjusted and adjusted OR to measure the association between HIV seropositivity and site of recruitment.ResultsBetween 1988 and 1989, 25% of 870 community-recruited IDU were seropositive, compared with 13% of 671 entrants to drug-treatment programs. This twofold risk of HIV seropositivity among community-recruited IDU remained after adjustment for sample differences in gender, race-ethnicity, and age group (adjusted OR, 2.09; 95% confidence interval, 1.58–2.78).ConclusionsThese results suggest the importance of extending HIV surveillance outside of drug-treatment facilities. Active serologic surveillance may be feasible by coupling recent saliva and fingerstick sampling techniques with existing community outreach education efforts.

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID