摘要:

ObjectiveTo determine whether there is a simple relationship between body weight or body surface area (BSA) and serum zidovudine pharmacokinetic parameters in patients receiving oral zidovudine.DesignSingle-dose, pharmacokinetic study.PatientsFifty-three asymptomatic and symptomatic HIV-infected men (CD4+ cell count < 500 × 106/l) participated in the study. Results of renal function and haematology tests were within normal limits and all hepatic function tests were up to three times the upper limit of normal. Patients received 200 mg oral zidovudine and serial blood samples were collected for 4h (18 patients) or 8 h (35 patients). Serum zidovudine concentrations were measured by high-performance liquid chromatography (12 patients) or radioimmunoassay (41 patients). Pharmacokinetic parameters were calculated by non-compartmental methods. The relationships between body weight or BSA and maximum serum concentration (Cmax), area under the concentration-time curve (AUC), apparent serum clearance (CL/F), and apparent terminal volume of distribution (VZ/F) were determined by simple least-squares linear regression.ResultsThere were no significant relationships between either body weight or BSA and Cmax, AUC, VZ/F (corrected for weight), and clearance (P> 0.07;R2< 0.06 for all comparisons). A significant positive association between VZ/F, uncorrected for weight, and either weight (P= 0.011;R2= 0.121) or BSA (P= 0.022;R2= 0.098) was observed. The interindividual coefficients of variation of CL/F and VZ/F values were only marginally reduced when the parameters were corrected for weight (31.3 versus 30.8% and 28.0 versus 26.0%, respectively).ConclusionsThere is little or no linear association between either body weight or BSA and observed serum zidovudine concentrations following administration of 200 mg zidovudine in adult male patients who are within 20% of their ideal weight.

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectiveTo analyse the influence of age at seroconversion and sexual exposure group on the progression of HIV disease.DesignThis multicentre prospective cohort study involved 443 subjects whose date of HIV infection was known to within ±1 year. Individuals whose sexual behaviour was exclusively heterosexual after HIV infection constituted the heterosexual group (n = 131). AIDS-free survival was compared with that of men (n = 312) infected through homosexual sex and who continued homosexual activity after HIV infection. They constituted the homosexual group.MethodsThe end-point was the onset of an AIDS-defining illness listed in the 1987 revised Centers for Disease Control and Prevention (CDC) criteria. Using the Kaplan-Meier method, AIDS-free survival curves were plotted for three age categories ( < 20, 20–39, >40 years). A Cox model was used to quantify the effect of age and to assess the influence of exposure group on AIDS onset after adjustment for age. Because of the high incidence of Kaposi's sarcoma (KS) among homosexual men, a disease that can be an early AIDS-defining illness, multivariate analysis was performed with and without consideration of the occurrence of KS.ResultsPatients aged ≥40 years at seroconversion progressed more rapidly to AIDS than younger patients (P< 0.006). When age was fitted as a continuous variable and adjusted for exposure group, the relative risk of developing AIDS by any time after seroconversion was 1.34 for a 10-year increase difference [P= 0.03; 95% confidence interval (Cl), 1.03–1.77]. After adjustment for age, the relative risk of developing AIDS (CDC criteria) was 2.42 (P= 0.008; 95% Cl, 1.18–4.97) among the homosexual men (AIDS cases, n = 56). All cases of KS (n = 19) involved the homosexual group. Excluding KS as a first manifestation of AIDS, homosexual or bisexual subjects had a risk of AIDS of 1.92 (P=0.07; 95% Cl, 0.92–4.03) compared with heterosexual subjects.ConclusionsThe risk of AIDS increases with age at seroconversion. The more rapid progression towards AIDS in the homosexual group than in the heterosexual group persisted after adjustment for age. Further studies are required to determine the possible role of repeated exposure to HIV or other pathogens acquired sexually.

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectiveTo estimate the age-specific relative risk of progression from HIV seroconversion to onset of AIDS in hemophiliacs and homosexual men.DesignProspective follow-up data from HIV seroconversion to AIDS was analyzed for hemophiliacs in the Multicenter Hemophilia Cohort Study and for homosexual men in the International Registry of Seroconverters. Follow-up was censored at 1 July 1987 to obtain natural history estimates unaffected by therapies that were widely used after this date. The age-specific relative hazard of progression was estimated using nonparametric proportional hazards models and the baseline hazard function was described using spline models.ResultsAmong the 373 children and adults with hemophilia and the 1020 adult homosexual men, each 10-year increment in age at seroconversion was associated with a 1.6− and 1.4-fold increase in the hazard of progression, respectively. The effect of age was highly significant among hemophiliacs. The magnitude of the effect was consistent in different cohorts of homosexual men, although it was not nominally significant. Furthermore, there was a significant increase (1.9-fold higher) in progression rates among homosexual men above rather than below 35 years of age at seroconversion. After adjusting for age, progression rates among hemophiliacs were significantly slower, possibly because Kaposi's sarcoma was rare. In both groups, the annual hazard rate increased during the first 5 years after seroconversion, but broad confidence limits prevented us from establishing hazard trends beyond this time.ConclusionsEstimates of the aggregate incubation time distribution were substantially shorter in older compared with younger individuals. The increasing risk with age was similar in hemophiliacs and homosexual men, suggesting that age is an endogenous host factor. These findings can be incorporated into newly developed backcalculation models to estimate HIV infection incidence by age group from age-specific AIDS surveillance data.

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectiveTo describe the dynamics of the HIV-1 epidemic in childbearing women in Kinshasa, Zaïre, by estimating incidence from serial seroprevalence studies.MethodsIn 1986 and 1989, 5937 and 4623 pregnant women, respectively, were screened for HIV-1 in Kinshasa. We estimated age-specific incidence from two seroprevalence surveys by using a birth-year cohort analysis and adjusting for differences in mortality and fertility between HIV-1-infected and uninfected women. Mortality and fertility data were measured in a cohort of women recruited from the survey in 1986 and followed until 1989.ResultsWhile the overall HIV-1 seroprevalence changed little (5.8% in 1986 and 6.5% in 1989;P=0.17), the prevalence increased in birth-year cohorts of women under 25 years of age in 1989 from 3.2 to 6.2% (P< 0.001), but decreased for women above 25 years of age from 6.9 to 6.7% (P= 0.7). In addition, new HIV infections between 1986 and 1989 were balanced by a higher mortality and lower fertility observed in HIV-infected women. After adjusting for these effects, we estimated an overall 3-year cumulative HIV-1 incidence of 2.8 per 100 uninfected women [95% confidence interval (Cl), 1.4–4.2]. The highest incidence, 5.7 per 100 (95% Cl, 3.5–8.0), was in women aged 20–24 years in 1989.ConclusionDespite an overall relatively stable HIV-1 prevalence in childbearing women in Kinshasa between 1986 and 1989, approximately 40% of all HIV-1 infections detected in the 1989 survey occurred between 1986 and 1989, and 60% occurred in women under 25 years of age in 1989.

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectiveTo compare occurrence of clinical symptoms, physical examination findings and hematologic variables in male and female HIV-seropositive injecting drug users (IDU) with similar CD4+ lymphocyte counts.MethodWe interviewed and examined 118 female and 444 male AIDS-free HIV-seropositive IDU for clinical signs and symptoms. HIV serology and T-lymphocyte subset evaluations were performed. Comparisons were analyzed by Mantel-Haenszel procedures.ResultsIn this population, median age for men was 35 years versus 33 years for women; median CD4 cell count was 490 × 106/l for men versus 480 × 106/l for women. The overall frequency of oral candidiasis increased as CD4 cell count decreased, but did not vary by sex. Recent history of genital herpes was more frequent (P< 0.05) in women than men, but this difference was not significant on physical examination. Symptoms of diarrhea, fatigue, weight loss, shortness of breath, presence of enlarged posterior cervical lymph nodes did not vary by CD4 cell count or sex, and no strong interactions were evident. Although absolute values of hematocrit were higher (P< 0.001) and platelet count lower (P< 0.001) in HIV-seropositive men than women, distributions of hematocrit and platelet count by sex were similar for HIV-seropositive participants and HIV-seronegative controls.ConclusionOur data on IDU prior to a diagnosis of AIDS suggest that constitutional signs and symptoms are generally similar among men and women early in HIV infection. Additional follow-up is needed to determine whether differential rates of signs and symptoms by sex appear with progression of HIV infection.

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectivesTo determine HIV seroconversion rates among female commercial sex workers (CSW) in Chiang Mai, Thailand.DesignA three-round multi cross-sectional study was used at approximately 3-month intervals.MethodsIn December 1989, 38 brothels (60%) in Chiang Mai were randomly selected. All 518 female CSW in the brothels were interviewed about their sociodemographics, sexual practices, condom use, history of sexually transmitted diseases (STD) and other risk factors. Blood was tested for Venereal Disease Research Laboratory (VDRL)-reactivity and HIV-1 antibody. The same brothels, which were all still operating, were revisited in March and July 1990 and 431 and 320 CSW, respectively, were interviewed and blood-tested. Pelvic examination, cervical, urethral and rectal cultures for gonococcus were added to the study in March 1990, although rectal culture was dropped from the study in July 1990.ResultsThere were 5.2% [95% confidence interval (Cl), 4.1–10.6] and 3.6% (95% Cl, 1.5–5.4) per woman-month HIV seroconversion rates for the December-March and March-July periods, respectively. Of the CSW, 71.6–77.0% reported histories of at least one STD. Condom-use rates among these CSW were reported to be 85.8–91.8%. High rates of positive cervical (11.2–12.3%) and urethral (8.8–11.4%) cultures for gonococcus were also found in the CSW.ConclusionsThe fact that high HIV seroconversion rates and high STD prevalence rates occur despite high rates of reported condom use suggests that more aggressive education programs are needed in Thailand.

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectiveTo compare the development rate of new AIDS-defining diseases between 566 women and 1988 men with AIDS who were infected with HIV via the same routes (mainly by sharing drug injecting equipment and heterosexual sex).DesignInformation on patient follow-up after AIDS diagnosis was obtained by retrospectively reviewing case notes.MethodsThe 2554 men and women were followed from the time of AIDS diagnosis as part of the multicentre AIDS in Europe study, which examined AIDS cases diagnosed at 52 centres in 17 European countries between 1979 and 1989. Incidence of AIDS-defining diseases and demographic variables were recorded for all patients and CD4 lymphocyte count at the time of AIDS diagnosis for approximately half the patients.ResultsOnly toxoplasmosis andherpes simplexvirus ulceration showed statistically significant differences in occurrence rate between women and men [relative risks (RR), 1.51 and 3.44; 95% confidence interval (Cl), 1.51 1.09–2.08 and 3.44 1.92–6.23, respectively] which remained after adjusting for imbalances in other variables. For both diseases, the additional absolute rate in women was approximately three per 100 person-years at risk. Survival after AIDS diagnosis was also similar between the two sexes (RR, 0.96; 95% Cl, 0.86–1.08).ConclusionThere appears to be little difference between women and men in the clinical course of AIDS.

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectiveTo evaluate the extent to which 'high-risk' sexual behaviour is influenced by awareness of partners' HIV status among gay men.DesignStructured interviews and collection of saliva samples for anonymous linked testing for HIV-1 antibodies.SettingGenitourinary medicine clinics and the gay community.SubjectsMen (n = 677) who reported sexual contact with another man in the last 5 years.ResultsThe majority of respondents (63%) had had an HIV-antibody test. Analysis of data showed that in 15% of the respondents' 1380 partnerships, HIV status was known by both parties. However, the majority of partnerships involved only safe sex. Only 26% of the partnerships in which unprotected penetrative anal sex had occurred involved mutual knowledge of HIV status and was most likely to occur with regular rather than non-regular/casual partners. Logistic regression revealed that this latter association could not be explained in terms of mutual HIV status knowledge.ConclusionsDespite widespread HIV testing, the majority of gay men engaging in high-risk sex are unaware of their partner's HIV status.

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectiveTo assess the frequency of CD4+ T-lymphocyte depletion in selected populations in West Africa and to determine whether an association exists between AIDS-like illnesses and CD4+ T-lymphocytopenia in HIV-negative individuals.DesignRetrospective review of databases and prospective case-control study.SettingProjet RETRO-CI, an AIDS research project in Abidjan, Côte d'lvoire, a University Hospital and tuberculosis treatment and maternal and child health centres in Abidjan.MethodsWe conducted a retrospective review of CD4+ T-lymphocyte counts performed between 1991 and 1992 on hospitalized medical patients, outpatients with tuberculosis, and women participating in a study of HIV-1 and HIV-2 mother-to-child transmission. A prospective case-control study was conducted in 1992 to examine the relationship between HIV-negative CD4+ T-lymphocyte depletion and wasting syndrome (wasting and chronic diarrhoea and/or chronic fever).ResultsIn the retrospective data review, CD4+ T-lymphocyte counts < 300 × 106/l were found in 9.6% of 115 HIV-negative hospitalized patients, in 4.2% of 312 ambulatory tuberculosis patients, and in 0.4% of 263 healthy women after delivery. In the case-control study, no association was found between CD4+ T-lymphocyte depletion in HIV-negative individuals and the presence of wasting syndrome. Increased mortality in HIV-negative individuals was associated with wasting but not with reduced CD4+ T-lymphocyte counts. In contrast, a trend existed for increased mortality with increasingly severe CD4+ T-lymphocyte depletion in HIV-positive patients. Tuberculosis was the most frequently proven or suspected diagnosis in HIV-negative individuals with wasting and CD4+ T-lymphocytopenia.ConclusionsIn the absence of HIV infection, CD4+ T-lymphocytopenia is uncommon ( < 1%) in West African asymptomatic individuals but is more frequent in those with tuberculosis (4%) and hospitalized patients (10%). CD4+ T-lymphocytopenia in HIV-negative individuals was not associated with wasting syndrome or increased mortality. There was no evidence for frequent, clinically relevant immune deficiency other than that associated with HIV infection.

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID