摘要:

Objectives:To address the impact of highly active antiretroviral therapy (HAART) on the incidence and outcome of patients with HIV-related lung cancer.Design and subjects:Patients with HIV-related lung cancer were identified from a prospective HIV data base of 8400 patients diagnosed between 1986 and 2001. Patients diagnosed with HIV-related lung cancer before 1996 were in the pre-HAART cohort whereas the remainder were in the post-HAART cohort.Methods:The incidence of HIV-related lung cancer in the pre- and post-HAART cohorts was compared with the age and sex-matched population of south east England. Clinicopathological features, treatments and outcomes were also recorded.Results:The incidence of HIV-related lung cancer increased from 0.8 (95% CI 0.2–3.2)/105patient-years follow-up in the pre-HAART era to 6.7 (95% CI 3.1–13.9)/105patient-years follow-up in the post-HAART era. The age and sex-matched incidence of lung cancer in south east England was 0.75 (95% CI 0.63–0.87)/105patient-years, suggesting that HIV-related lung cancer only occurred more frequently in the post-HAART era (relative risk 8.93, 95% CI 4.92–19.98). The patient characteristics and outcomes were similar in the pre- and post-HAART eras, although the time interval between testing HIV positive and developing HIV-related lung cancer was longer in post-HAART patients.Conclusion:In this study HIV-related lung cancer occurred more frequently in the post-HAART era, when compared with the HIV-negative population. Unfortunately, the outcome of these patients remains poor despite HAART.

ISSN:0269-9370    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objective:To examine temporal variation in the effects ofCCR5-Δ32andCCR2-64Ichemokine receptor gene polymorphisms on HIV-1 disease progression.Design:Pooled analysis of individual patient data from 10 cohorts of HIV-1 seroconverters from the United States, Europe, and Australia.Methods:We studied HIV-1 seroconverters of European (n = 1635) or African (n = 215) ancestry who had been genotyped forCCR5-Δ32andCCR2-64I. We used Cox proportional hazards models with time-varying coefficients to determine whether the genetic protection against AIDS (1987 case definition) and death varied with time since seroconversion.Results:Protection against AIDS conferred byCCR5-Δ32held constant at a 31% (RH 0.69, 95% CI 0.54, 0.88) reduction in risk over the course of HIV-1 infection, whereas protection against death held constant at a 39% reduction in risk (RH 0.61, 95% CI 0.45, 0.88). When the period from AIDS to death was isolated, the survival benefit ofCCR5-Δ32diminished 2 years after AIDS. Protection against AIDS conferred byCCR2-64Iwas greatest early in the disease course. Compared with individuals withoutCCR5-Δ32orCCR2-64I, individuals with one or two copies ofCCR2-64Ihad a 58% lower risk of AIDS during the first 4 years after seroconversion (RH 0.42, 95% CI 0.23, 0.76), a 19% lower risk during the subsequent 4 years (RH 0.81, 95% CI 0.59, 1.12), and no significant protection thereafter.Conclusion:The protection against AIDS provided byCCR5-Δ32is continuous during the course of infection. In contrast, the protection provided byCCR2-64Iis greatest early in the course of infection.

ISSN:0269-9370    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objective:To assess the influence of maternal HIV status and orphanhood on child mortality and physical well-being.Design:Retrospective cohort study with > 10 years of follow-up.Methods:From population-based surveys in Karonga District, Malawi in the 1980s, 197 individuals were identified as HIV-positive. These individuals and 396 HIV-negative individuals matched for age and sex, and their spouses and offspring, were sought in 1998–2000.Results:All but 11 of the index individuals were traced, identifying 2520 offspring; of these, 1106 offspring were included in analyses. Among those with HIV-positive mothers, mortality was 27% [95% confidence interval (CI), 17–38] in infants (1–30 days), 46% (95% CI, 34–58) in those under 5 years and 49% (95% CI, 38–61) in those under 10 years. The corresponding figures for those with HIV-negative mothers were 11% (95% CI, 8–13), 16% (95% CI, 13–19) and 17% (95% CI, 14–20). Death of HIV-positive mothers, but not of HIV-negative mothers or of fathers, was associated with increased child mortality. Among survivors who were still resident in the district, neither maternal HIV status nor orphanhood was associated with stunting, being wasted, or reported ill-health.Conclusions:Mortality in children under 5 years is much higher in children born to HIV-positive mothers than in those born to HIV-negative mothers. With 10% of pregnant women HIV-positive, we estimate that approximately 18% of under-5 deaths in this population are attributable to HIV. Most of the excess is attributable to vertical transmission of HIV. Our findings suggest that, in terms of physical well-being, the extended family in this society has not discriminated against surviving children whose parents have been ill or have died as a result of HIV/AIDS.

ISSN:0269-9370    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objective:To evaluate two methods for estimating HIV prevalence among the general female population of reproductive age by adjusting data observed among antenatal clinic (ANC) attendees.Methods:We adjusted the HIV prevalence among ANC attendees in Fort Portal (Uganda; 1994–1995), Mwanza municipality (Tanzania; 1990–1991), rural Mwanza (Tanzania; 1991–1993), Mposhi district (Zambia; 1994), Chelston (Lusaka, Zambia; 1994, 1996 and 1998) and Ndola (Zambia; 1998), using firstly a method that accounts for differences in age-specific fertility by HIV serostatus and secondly a method that accounts for differences in HIV prevalence by fertility risk category and parity.Results:The non-adjusted HIV prevalence among ANC attendees underestimates the prevalence among the general female population by 8.0% in Chelston in 1998 and by between 20.7% and 31.9% in all other cases. The adjusted prevalence obtained using the first method underestimates the prevalence among the general female population by about 0.5% in Fort Portal and Mposhi; it overestimates that observed in Chelston in 1994 and 1996 by about 3.5%, and that observed in Ndola, urban Mwanza and rural Mwanza, by 6.5%, 10.6% and 12.8%, respectively. The second method (applied for only four sites) provides an overestimate of 7.0% in Chelston in 1994 and an underestimate of 3.8% and 2.1% in Ndola and rural Mwanza, respectively. Both adjustment methods overestimate the 1998 prevalence in Chelston, producing less accurate estimates than the non-adjusted data.Conclusions:The HIV prevalence among women in the general population could be estimated fairly accurately by these methods in settings with mature epidemics.

ISSN:0269-9370    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objective:To investigate determinants of breastmilk RNA viral load among HIV-infected South African women, with particular attention to infant feeding mode and subclinical mastitis.Design:Observational, longitudinal study.Methods:Information on current infant feeding practice and a spot milk sample from each breast were obtained from 145 HIV-infected lactating women at 1, 6 and 14 weeks postpartum. The sodium/potassium (Na+/K+) ratio in milk was taken as an indicator of subclinical mastitis. The association between milk RNA viral load and maternal and infant characteristics was investigated using uni- and multivariate models.Results:Milk viral load was below the limit of detection of the HIV RNA assay (< 200 copies/ml) in 63/185 (34.1%), 73/193 (37.8%) and 68/160 (42.5%) of samples at 1, 6 and 14 weeks, respectively. Multivariate models predicted between 13 and 26% of variability in milk viral load in the first 14 weeks. Low blood CD4 cell count (< 200 × 106cells/l) during pregnancy and raised milk Na+/K+ratio were significantly associated with raised milk RNA viral load at all times, but there were no consistent associations between infant feeding mode and RNA viral load in milk. There was a non-significant trend for the six infants known to be infected postnatally, compared with the 88 infants who remained uninfected, to have been exposed to breastmilk of higher viral load at each time point.Conclusions:Breast milk HIV RNA viral load in the first 14 weeks of life varied; high levels were associated with subclinical mastitis and severe maternal immunosuppression. Multivariate models had limited predictive value for milk RNA viral load, illustrating the multiple contributors to viral load.

ISSN:0269-9370    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objective:To examine the influence of environmental-structural factors in promoting consistent condom use (CCU) among female sex workers (FSW) and their regular paying partners in the Dominican Republic.Methods:A cross-sectional survey was conducted with 288 FSW recruited from 41 sex establishments in Santo Domingo from March to June 1998. Sex workers were asked about their sexual behavior, self-efficacy at negotiating safe sex, perceived intimacy with their most recent regular paying partner, and the physical, social and policy environment of the establishment where they worked. Factor and reliability analysis were utilized to develop aggregate measures for self-efficacy (Cronbach's Alpha 0.60), intimacy (Cronbach's Alpha 0.80), and environmental-structural support (Cronbach's Alpha 0.72).Results:Controlling for sociodemographic characteristics of participants in multivariate analyses, environmental-structural support for condom use and HIV/sexually transmitted infection (STI) prevention was a significant predictor of CCU (OR 2.16; CI 1.18–3.97) among FSW and their regular paying partners. Safe sex self-efficacy (OR 2.80; CI 1.31–5.97) and low perceived intimacy with the most recent regular paying partner (OR 7.20; CI 3.49–14.83) were also significantly associated with CCU in multivariate analysis.Conclusion:Environmental-structural support for condom use and HIV/STI prevention is a significant predictor of CCU among FSW in the context of regular paying partnerships. Environmental-structural factors, in addition to relational and individual cognitive factors, should be assessed and addressed by behaviorally guided theory, research and interventions related to HIV/STI prevention and female sex work.

ISSN:0269-9370    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objectives:We sought to identify risk factors for infection with the Kaposi's Sarcoma-associated herpesvirus (KSHV) among pregnant women and to examine a reported association of KSHV with injecting drug use (IDU) and hepatitis C virus (HCV) infection.Design:Cross-sectional evaluation of questionnaire data and KSHV and HCV seroprevalence in the Women and Infants Transmission Study.Methods:In sera collected from HIV-1-infected pregnant women (n = 887) and, at age 12 months, their offspring (n = 900) at six sites in the USA and Puerto Rico, KSHV and HCV antibodies were detected with sensitive and specific enzyme immunoassays. Risk of KSHV was estimated by the unadjusted and adjusted odds ratio (ORadj) and 95% confidence interval (CI). The geographic referent sites were Chicago and Boston.Results:Forty-seven (5.3%) of the women and three (0.3%) of the infants were KSHV seropositive. In univariate and multivariate analyses, KSHV in the women was associated with enrollment in Puerto Rico, Houston or Brooklyn (ORadj,4.3; 95% CI, 1.8–10.4) or Manhattan (ORadj,9.8; 95% CI, 3.7–25.6); non-completion of high school (ORadj,1.8; 95% CI, 0.9–3.4); the number of sexually transmitted diseases (ORadj,1.4; 95% CI, 1.0–1.9 per disease); and especially with IDU and HCV infection (ORadj,3.5; 95% CI, 1.5–7.9).Conclusions:Transmission of KSHV by blood inoculation may be highly inefficient, but our data support the hypothesis that it does occur. Large formal studies to evaluate whether KSHV transmission occurs via transfusion are needed to inform decisions regarding screening volunteer blood donors to protect the blood supply.

ISSN:0269-9370    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objective:To investigate the prevalence ofPneumocystis cariniiin consecutive HIV-positive patients with suspected pulmonary tuberculosis (PTB) attending a university hospital in Ethiopia.Methods:A PCR forP. cariniiand an indirect immunoflorescence (IF) assay were performed on expectorated sputum samples from: 119 HIV-1-positive patients with negative smears and sputum cultures forMycobacterium tuberculosis; 96 HIV-1-positive patients with culture-verified PTB; and 97 HIV-negative patients with negative mycobacterial cultures and 72 HIV-negative patients with culture-verified PTB, serving as controls. Outcome of PCR and IF were compared with the chest radiographic (CXR) and initial clinical diagnosis.Results:In the HIV+PTB− group,P. cariniiwas found in 10.9% by IF, 8.4% by single PCR (sPCR) and 30.3% by nested PCR (nPCR). In the HIV+PTB+ group, 3.1% wereP. cariniipositive by IF and sPCR and 13.5% by nPCR. All IF- and sPCR-positive samples were nPCR positive. In the HIV−PTB+ and HIV−PTB− groups, 4.2% and 3.1% were nPCR positive, respectively. Six out of eight HIV+PTB− patients with CXR suggestingP. cariniipneumonia (PCP) were IF and/or nPCR positive forP. carinii.In the IF-positive and nested PCR-positive HIV+PTB− patients more than one-third were interpreted as PTB by CXR whereas only one patient was diagnosed with clinical PCP.Conclusions:P. cariniiis prevalent in HIV-positive PTB suspects, suggesting that PCP may be an important, but not well recognized, differential diagnosis. Our findings have implications for treatment and primary prophylaxis for PCP in Ethiopia.

ISSN:0269-9370    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:2003

数据来源: OVID