摘要:

ObjectiveTo compare the clinical and laboratory features of visceral leishmaniasis (kala-azar) in HIV-infected and non-infected subjects, and to determine the presence of Leishmania amastigotes in circulating leukocytes using peripheral blood smears.PatientsTwenty-eight HIV-infected and six HIV-negative adult patients diagnosed as having kala-azar presenting at one institution over a 7-year period.MethodsRetrospective review of clinical charts and re-examination of peripheral blood smears.ResultsThere were no significant differences in the clinical presentation and laboratory features of HIV-positive and HIV-negative patients. However, Leishmania amastigotes were observed in circulating leukocytes in eight out of the 17 available peripheral blood smears (15 from HIV-infected patients). All eight individuals presenting with Leishmania in peripheral blood leukocytes were HIV-positive.ConclusionsDirect visualization of Leishmania amastigotes in leukocytes on peripheral blood smears enabled the diagnosis of kala-azar in a high proportion [eight out of 15 (53%)] of our HIV-infected patients.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveThe treatment-free incubation period distribution was estimated from data obtained from a cohort of homo/bisexual men in Amsterdam.DesignParticipants in a cohort study that started in Amsterdam at the end of 1984 were seen at 3− or 6-monthly intervals. The analysis excluded time since the start of zidovudine treatment (given to 27 individuals) and no cohort member received primary Pneumocystis carinii pneumonia prophylaxis (i.e., before AIDS diagnosis) before February 1990.MethodsBoth HIV-positive (n = 269) and HIV-seroconverted (n = 79) homosexual men were included in this study. Of these, 68 developed AIDS before February 1990. The unobserved dates of seroconversion were obtained by multiple imputation. The incubation period distribution was estimated from these data by direct Kaplan—Meier analysis and by using parametric Weibull and gamma distributions (including a parameter describing the probability of never progressing to AIDS). Our results are compared with published estimates of progression to AIDS from other homo/bisexual cohort studies.ResultsBoth the Weibull and the gamma distributions provide equally good empirical descriptions of the incubation period distribution for up to 7 years postseroconversion, but the estimated gamma distribution (median, 9.2; mean, 10.2; percentage AIDS at 7 years, 33%) should be preferred beyond that time, due to a slowing of the hazard rate. There is insufficient information to be able to estimate accurately the probability of never progressing to AIDS.ConclusionsThe time-dependent pattern of HIV incidence should be considered in the analysis of prevalent cohort studies. Our results are in agreement with other homo/bisexual cohort studies, and will be valuable for future comparison with and understanding of the epidemiological consequences of clinical treatment that delays the onset of AIDS.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo evaluate changes in cognition in a selected group of asymptomatic homosexual/bisexual men over a 3-year period.Patients and methodsSixty HIV-infected (Centers for Disease Control stage II) subjects and 60 controls (individually matched for age and years in education) were administered neuropsychological tests evaluating attention, language, memory, logic and visuo-motor abilities. None of the patients had a history of alcohol or drug abuse, and all received the baseline cognitive evaluation within 18–24 months of seroconversion.ResultsThe HIV-infected subjects differed from controls in only one of the six memory tests (P< 0.01). Follow-up evaluation after 18 and 36 months (available for 51 and 36 subjects, respectively) demonstrated a significant deterioration in visuo-motor ability (P< 0.01) only in subjects who had progressed to AIDS, without signs or symptoms of central nervous system involvement.ConclusionsThe data suggest that cognitive alterations in asymptomatic stages of HIV infection are in most subjects minor and do not develop. Percentage rates of CD4 lymphocyte decline appear to be significantly related to deterioration in visuo-motor abilities.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo evaluate the effectiveness of relapse prevention (RP) and brief intervention (BI) in reducing HIV risk-taking behaviours among injecting drug users (IDU) enrolled in methadone programmes. The hypotheses tested were: (1) that a six-session RP programme would be more effective in reducing HIV risk-taking behaviours than a one-session BI and a non-intervention control condition (C); and (2) that Bl would be more effective in reducing HIV risk-taking behaviours than C.DesignClients of methadone programmes were randomly assigned to either RP, Bl, or C. Follow-up occurred 6 months after pre-intervention assessment and was conducted by independent research assistants who were not aware of subjects' group allocations.SettingConfidential assessment interviews and interventions generally took place at the methadone unit treating the subject.ParticipantsNinety-five IDU enrolled in methadone programmes. Study entry criteria were: injection of any drug in the 6 months before the day of pre-intervention assessment; literacy in English; agreement to HIV-antibody testing for research purposes; and no known diagnosis of a serious mental illness. Eighty subjects were contacted successfully for a 6-month follow-up.InterventionsThe RP intervention was a six-session programme. Each 60–90-min session was conducted individually. The Bl was a one-session motivational interview lasting 60–90 min, accompanied by a self-help booklet.Main outcome measuresAll subjects were administered the Drug Use Scale and HIV Risk-Taking Behaviour Scale of the Opiate Treatment Index and consented to the collection of a capillary blood sample for HIV-antibody testing at pre-intervention assessment and follow-up. At follow-up, the Highest HIV Risk-Taking Behaviour Scale, collateral reports from subjects' sexual partners pertaining to the previous month and urinalysis results for the month before follow-up were collected.ResultsCompliance with interventions was good. Correspondence of self-reports with urinalysis and collateral reports was satisfactory. There were no significant differences between groups in risk-taking behaviours during the month before follow-up. However, there was evidence of a lower rate of needle-risk behaviour (sharing and cleaning) during the heaviest risk-taking month since pre-intervention assessment in the group given RP. There were no indications that Bl was of greater benefit than the usual methadone treatment and neither intervention appeared to reduce sexual risk behaviour.ConclusionsThe results are cautiously interpreted as showing that individual RP programmes decrease the level of needle-risk behaviour during relapse episodes, but further research is required to replicate this finding.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo assess the maintenance of safe sexual practice. (We use the term ‘safe’ sex throughout the paper, since ‘safe’ is the term adopted by the Australian National Committee on AIDS.)DesignMaintenance was assessed by comparing sexual behaviour with both regular and casual partners reported in a 1986/1987 survey (time 1) with behaviour reported in a second survey in 1991 (time 2).MethodThe 145 homosexually active participants were a non-clinical sample recruited in 1986/1987 by advertisement and followed-up in 1991. A structured questionnaire was administered at both times. Items included questions about the nature of the men's sexual relationships and their sexual practices.ResultsOur findings indicate that the majority of men had sustained safe sex practices. HIV prevention strategies adopted included condom use, avoidance of anal intercourse and negotiated safety (i.e., the negotiated practice of unprotected anal intercourse within regular partnerships of concordant serostatus).ConclusionsNegotiated safety is not the same as relapse.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectivesTo assess the extent to which condoms are used effectively in commercial heterosexual intercourse. Data on the number of condoms that had broken or slipped off, the sexual technique during which this had occurred and the perceived cause of failure were collected. The use of non-water-soluble lubricants and of non-fortified condoms during anal intercourse, and the demand for a greater variety of condom sizes were also examined.Subjects and methodsOne hundred and twenty-seven female prostitutes and 91 male clients from different parts of The Netherlands were interviewed face-to-face between July 1990 and March 1991.ResultsOf those who used condoms during vaginal intercourse, 49% of the prostitutes had experienced condom breakage in the previous 6 months, and 16% of the clients in the previous 12 months. The breakage rate was 0.8% for prostitutes and 1.5% for clients. Condom quality was seldom reported as the cause; breakage was generally attributed to human factors, such as rough or prolonged intercourse, incorrect handling of the condom or the use of insufficient lubricant. Prostitutes also identified penis size as a cause. Condoms slipping off before or after ejaculation was reported less frequently than breakage. Thirteen per cent of clients and 36% of prostitutes expressed a need for either smaller or larger condoms. Of the prostitutes, 9% used oil or vaseline as a lubricant.ConclusionsIn view of the low rate of condom failure in heterosexual prostitution in The Netherlands, the potential spread of HIV by this means is small. The use of a greater variety of condom sizes may further reduce the failure rate. Few prostitutes remain ignorant about the adverse effects of oil-based lubricants on condoms.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectivesTo determine the effect of counselling on condom use by prostitutes.DesignCohort study.SettingField-based study in The Gambia.ParticipantsThirty-one (12 HIV-positive and 19 HIV-negative) prostitutes.InterventionsPost-test HIV counselling.Main outcome measuresLevels of condom use.ResultsOverall, counselling had no effect on condom use.ConclusionsScarce resources should be directed towards providing condoms in bars rather than counselling.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo estimate the seroincidence of HIV-1 infection in the general adult population of Kigali, Rwanda.DesignRepeated standarized cross-sectional studies.SettingTwo urban prenatal clinics.PatientsA total of 4486 consecutive pregnant women consulting in 1989 and 1990.Main outcome measuresPrevalence of HIV-1 antibodies.ResultsHIV seropositivity increased by 3–5% annually over this period, indicating that it has not reached a plateau in this sentinel population. The percentage infection rates, calculated using two complementary methods, were 26.2–30.7% in 1990. Extrapolating these results to the general population of Kigali, we estimate that 2300–3800 new infections in young women and 3600–6100 new infections in young men occur annually among the total population of 350000 in Kigali.ConclusionsA new HIV infection occurred in an adult every 50–90 min, on average, in Kigali during 1989–1990, while every 6–7 h a baby with maternally acquired HIV infection was born. Our HIV surveillance system, which is based on prenatal sentinel posts, is a useful tool for monitoring the progression of the HIV epidemic in Kigali.

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

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID