摘要:

ObjectiveTo assess the frequency with which HIV-seropositive patients treated with corticosteroids develop cytomegalovirus (CMV) disease.DesignRetrospective case-controlled study.MethodsAll 130 patients receiving systemic corticosteroids over a 20-month period at the HIV Unit, Westminster Hospital, London, UK were reviewed for the development of clinical CMV disease within 28 days. The incidence of CMV disease in this group was compared with that in a cohort admitted during the same period, which was matched for admission diagnosis, HIV risk group, antiretroviral therapy and CD4 lymphocyte subset count (± 20%) at admission.ResultsEleven of the 130 patients given corticosteroids developed CMV disease within 28 days, compared with two patients in the case-controlled cohort. All patients who developed CMV disease had a CD4 count < 50 x 106/l on admission.ConclusionThe use of corticosteroids in patients with advanced immunosuppression due to HIV infection should be reviewed carefully in view of the possible increased incidence of CMV disease.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo describe death attributed to severe hepatomegaly and macrovesicular steatosis without inflammation or necrosis in HIV-seropositive patients without AIDS.PatientsPatients from the AIDS Clinical Trials Group (ACTG) Adverse Reactions and the Food and Drug Administration's (FDA) Spontaneous Report databases.ResultsSix fatal and two non-fatal cases in which no known cause of hepatic steatosis could be found were identified. With one possible exception, none of the six fatal cases had a diagnosis of AIDS and all were in reasonable nutritional status (as indicated by weight and/or serum albumin); the majority were mildly to moderately overweight. All had received at least 6 months of antiretroviral therapy, and all had gastrointestinal complaints without other non-hepatic abdominal pathology. At least three out of the six had no history of progressively abnormal liver function tests until a few weeks prior to the onset of symptoms and subsequent death. Further investigation of the FDA and ACTG databases identified two similar but non-fatal cases in which abnormalities resolved after cessation of antiretroviral therapy.ConclusionsThe cases described represent a degree of hepatic abnormalities that has not been reported previously in HIV-seropositive patients, and are probably an underestimate of actual incidence, since patients with possible etiologies of liver disease were excluded from the clinical history, laboratory, microbiologic, or histologic examination. The etiology of hepatic disease may be associated with antiretroviral therapy, HIV, or an unidentifiable infection, and requires further investigation.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo determine what proportion of blood transfusions given in Mwanza Region, Tanzania could be avoided.MethodsA total of 1029 patients who received a blood transfusion in one of eight hospitals were analysed. Two sets of criteria for avoidable blood transfusions were determined, on the basis of a literature review.ResultsThe following percentages of blood transfusions in five groups of patients were found to be avoidable: operated patients, 8–24%; pregnant women, 8–10%; children aged under 5 years, 31–52%; children aged 5–14 years, 23–25%; and adults, 16–25%. Overall, 23–39% of blood transfusions were avoidable. At least 75% of all avoidable blood transfusions were to children aged under 5 years.ConclusionsThe largest reduction of blood transfusions can be achieved in children aged under 5 years, especially in infants aged less than 1 year. Following this study, blood transfusion prescribers drew up provisional guidelines on blood transfusions, which have been introduced in all hospitals in Mwanza Region. An evaluation study has been carried out and is being analysed.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveMonitoring HIV infection in sentinel populations of sexually transmitted disease (STD) patients in several geographical areas. This paper describes the main characteristics of the study populations and compares HIV seropositivity rates within and between networks in different subgroups: homo-/bisexuals, intravenous drug users (IVDU) and non-IVDU heterosexuals.DesignHIV testing is performed with informed consent in most networks. It is mandatory for STD patients in Hungary, while the English and Welsh, Scottish and French networks use unlinked anonymous testing.SettingEighteen networks in 17 European countries are participating in the study. The networks usually consist of STD or dermato-venereology clinics.PatientsPatients presenting at any of the clinic sites with a new episode of one or more of a selected list of 12 STD were eligible for the study. This study recorded a total of 36827 STD episodes, registered between June 1990 and December 1991. HIV test results were known for 33004 (89.6%) of the patients.ResultsHIV seropositivity rates were usually much higher for the homo-/bisexual and IVDU patients than for the non-IVDU heterosexuals. However, HIV-seropositive patients were found among non-IVDU heterosexuals in all but the Czech network.ConclusionThis Concerted Action has successfully launched an HIV sentinel surveillance programme among STD patients in 17 European countries using a standard methodology.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectivesTo assess the prevalence of and risk factors associated with HIV infection in European female sex workers, particularly sexual risk factors.DesignMulticentre cross-sectional study performed in nine European countries.MethodsFemale sex workers voluntarily enrolled between September 1990 and November 1991. Face-to-face interviews were conducted in various settings (health care, prostitute organizations, outreach) to collect information on over 150 behavioural, health and sociodemographic variables. Enrollment of intravenous drug users (IVDU) was limited to a maximum of 25% of the total sample. The HIV-1 and HIV-2 antibody status of blood or saliva samples was tested using enzyme-linked immunosorbent assay and confirmed by Western blot.ResultsEight hundred and sixty-six (91.6%) of the 945 interviewees provided blood (n = 824) or saliva (n = 42) samples. HIV seroprevalence was 5.3% [44 HIV-1-positives and two HIV-2-positives (from Lisbon)] overall, 31.8% (35 out of 110) in IVDU and 1.5% (11 out of 756) in non-IVDU [odds ratio (OR), 31.6;P< 0.001]. Lack of condom use (P= 0.002, test for trend) and previous ulcerative sexually transmitted disease (OR, 3.6;P= 0.06) were associated (on logistic regression) with HIV infection in both IVDU and non-IVDU. Previous hepatitis B (OR, 13.8;P= 0.02) and needle-sharing (OR, 4.1;P= 0.04) were associated with HIV infection in IVDU, and low education level (P= 0.02, test for trend), previous transfusion (OR, 9.1;P= 0.003), origin from sub-Saharan Africa (OR, 5.4;P= 0.05) and use of petroleum-based lubricants (OR, 15.2;P= 0.001) in non-IVDU.ConclusionsHIV prevalence remains relatively low among non-IVDU prostitutes in Europe. While intravenous drug use remains the most important risk factor for HIV, petroleum-based lubricants (used by 10% of women in this study) may be a risk factor for HIV among European female sex workers; over 80% of those interviewed always used condoms with clients.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo investigate the relationship between heterosexual behaviors associated with HIV infection and ethnicity, sex, and intravenous drug use.MethodsSubjects were recruited from Bellevue Hospital Center, New York City between 1986 and 1989, and interviewed about sexual behaviors and intravenous drug use. Analyses were based on 1561 black, white, or Hispanic individuals who reported having sexual contact with a member of the opposite sex.ResultsTwenty-seven per cent of the study population were black, 43% Hispanic, and 31% white. Blacks were more likely than whites or Hispanics to have initiated sexual intercourse at an early age, and to have had a sexually transmitted disease. Sex with a female drug user was more common among white men, and contact with a prostitute more frequent among Hispanic men. Among the women, Hispanics had fewer sexual risk factors overall than whites or blacks. Use of barrier contraceptives was uniformly low across all ethnic groups. Intravenous drug use was significantly associated with sexual risk-taking. Women were more likely than men to have an intravenous drug-using (IVDU) sexual partner.ConclusionsThe large prevalence of high-risk sexual practices observed in this study emphasizes the continuing need to target AIDS prevention programs at those at highest risk of heterosexually transmitted HIV: racial minorities, IVDU, and their sexual partners.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo measure developments in survival patterns among United Kingdom adult AIDS cases.DesignA follow-up survey of cases reported voluntarily to the national surveillance schemes was undertaken to obtain up-to-date information on vital statusMethodsAll reporting clinicians who had a current AIDS patient not known to have died whose AIDS-defining illness was diagnosed before the end of September 1990 were contacted. A total of 3984 cases were included in the analysis.ResultsAn extra third of deaths other than those reported through routine channels were ascertained by follow-up. Median survival for patients diagnosed before and after the end of 1986 increased from 15 to 18 months for men who had sex with men presenting with Kaposi's sarcoma, from 10 to 19 months for other men who had sex with men and from 7 to 16 months for all others. Improvement in survival was greatest in the first 3 months. One-third of patients have been surviving 2 years or more. Factors observed with independent effects on improved survival are recent diagnosis, younger age and larger cumulative AIDS case load of reporting centre. HIV encephalopathy and other central nervous system symptoms may be associated with poorer survival.ConclusionsSurvival patterns have been changing and generally improving. Average survival for very recent cohorts tends to be underestimated because longer survival has been observed in patients for whom there is a longer delay between AIDS diagnosis and report to the Communicable Disease Surveillance Centre. Information on mortality is improved by active follow-up.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo describe the epidemiology of patients with AIDS in Vellore region, Southern India.Design and methodsSixty-one patients with AIDS were diagnosed and treated between July 1987 and June 1992. Information on their demographic characteristics and probable modes of acquiring HIV infection was collected at interviews with them and their spouses.ResultsThere was a progressive increase in the number of patients seen over the 5 years. The mean ages of the 51 men and the 10 women were 33 and 29 years, respectively. Of the 44 patients from our district (population, 5 million), 28 were from Vellore town and 10 from rural areas. Forty-seven (92%) men had frequently used prostitutes. Of the women, four were prostitutes, one had had multiple sex partners and five had not had extramarital sexual contact. One man and one woman had no other risk factor except blood transfusion. Thirty-one (51%) patients had died by August 1992.ConclusionThe AIDS epidemic in this region is in its early ascending phase, with a doubling time of approximately 1 year. Most men with AIDS were infected by heterosexual contact with prostitutes, while some women were prostitutes themselves. Together with the male-to-female ratio of 5:1, these results suggest that the male population at risk has sex with a much smaller population of female prostitutes, constituting the major chain of transmission. HIV infection is occurring in both urban and rural populations.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectivesTo examine gay men's patterns of self-disclosure of HIV seropositivity to friends, lovers, relatives and colleagues; to assess the effects of disclosure; and to identify reasons for not disclosing to particular individuals.DesignLongitudinal questionnaire survey of gay men.MethodsA total of 163 HIV-positive men participating in the AIDS Behavioral Research Project, a longitudinal study of San Francisco gay men, completed questionnaires about their self-disclosure patterns, health status, and psychological well-being.ResultsHIV-positive men were most likely to disclose their status to lovers and closest gay friends. Asymptomatic men were less likely to disclose to relatives and colleagues than symptomatic men. Friends and lovers were rated as responding more helpfully than relatives and colleagues. Men who perceived their significant others as responding more helpfully were less depressed and anxious currently and 1 year later. A variety of reasons were given for not disclosing, including not wanting to worry others, fear of discrimination, fear of disrupting relationships, and emotional self-protection.ConclusionWhile disclosure can have advantages for both HIV-positive individuals and their significant others, HIV-positive individuals must be assured that the benefits of doing so will outweigh the potential costs.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID