ISSN:0269-9370    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

As part of an ongoing prospective study of seropositive homosexual men in Vancouver, Canada, a seroprevalent cohort of 246 subjects (i.e. duration of infection unknown) and a seroincident cohort of 102 subjects (i.e. duration of infection known) were followed a median of 63 and 45 months, respectively. Follow-up with validation utilizing record linkage with the Canadian Federal Centre for AIDS registry revealed 58 and nine cases of AIDS in the seroprevalent and seroincident cohorts, respectively, through July 1988. These data yield product limit estimates of the cumulative progression rates to AIDS at 60 months of 23.0% for the seroprevalent cohort, 13.0% for the seroincident cohort, and 21.0% for the combined groups. Univariate analyses revealed the following to be statistically and clinically significant predictors of AIDS progression: low CD4 counts, low CD4/CD8 ratios, elevated immune complexes, elevated immunoglobulin G (IgG) and immunoglobulin A (IgA) levels, and low platelet counts. Cox regression revealed that elevated IgA levels, low CD4 counts, elevated immune complexes, two or more symptoms, and more than 20 male sexual partners in high-risk areas in the 5 years prior to enrolment were independent predictors of progression to AIDS over the subsequent 5 years. A multivariate risk function based on the latter five variables delineated low-, medium- and high-risk groups whose 5-year progression rates to AIDS were 6.7, 15.6 and 64.4%, respectively. The high-risk group contained 75% of all subjects who progressed to AIDS. Only 6% of the high-risk group would have qualified for zidovudine therapy under current guidelines at the beginning of the observation period. A simplified, more widely applicable function based only on IgA, immune complexes, lymphocyte counts, and symptoms delineated groups whose 5-year progression rates to AIDS were 6.9, 18.8 and 56.4%, respectively. Our data suggest that such models may have much greater predictive value than simplistic rules based on CD4 count alone. Further development and testing of such prediction rules should be encouraged so that we may better delineate those infected persons most likely to benefit from interventions at an early stage in their infection.

ISSN:0269-9370    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Factors influencing the outcome of disease were analysed in 289 adults presenting with AIDS in Barcelona, Spain from January 1986 (31 cases) to December 1987 (258 cases). One hundred and fifty-four (53.3%) were parenteral drug addicts and 100 (34.6%) were male homosexuals. Ninety-six (33.2%) presented with tuberculosis, 148 (51.2%), with other opportunistic infections, 34 (11.7%) with Kaposi's sarcoma, and the remaining 11 with a lymphoma. By February 1988, 144 (49.8%) of the 289 had died, with an actuarial survival probability of 46.7% at 2 years (40.7%–52.7%, 95% confidence interval). The factors selected by the multivariate analysis as independently worsening the prognosis were: having been diagnosed as having AIDS before 1986, being more than 45 years old, not being a parenteral drug addict and presenting with an opportunistic infection other than a tuberculosis or with a malignancy.In conclusion, some factors influencing the prognosis for AIDS patients are very dependent upon the geographical area of the series.

ISSN:0269-9370    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

To define the rate of HIV infection and associated risk factors among heterosexual partners of HIV-infected individuals, 80 partners and 77 index cases were examined for clinical, behavioural and virological variables. The study population included 61 male and 16 female index cases, of whom 40 were European and 37 African. Multiple sexual partners in central Africa was the risk factor for HIV infection in 83%.The overall infection rate among the contact cases was 45%, 53% among female partners and 13% among male partners (P< 0.001).Variables significantly associated with HIV infection in the partners included advanced clinical stage (AIDS-related complex or AIDS), a low concentration of T4 lymphocytes and African nationality of the index case, young age of the partner, and more than 50 instances of sexual contact with the index cases.In a logistic regression analysis, a low concentration of T4 lymphocytes, clinical stage ARC/AIDS and African nationality of the index case but not number of sexual contacts, remained as independent risk factors for HIV transmission.Our data indicate that there is a significant biological heterogeneity in sexual transmission of HIV and that advanced clinical stage and severe T cell depletion of the index case are major determinants of infectivity.

ISSN:0269-9370    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Future heterosexual spread of HIV will in part depend on the efficiency of transmission from men to women and from women to men. We studied seventy-eight female sexual partners of men infected with HIV and 18 male sexual partners of infected women. Participants were interviewed concerning sexual practices, use of contraception and other risk factors for HIV infection. Fifteen out of 78 (19.2%) female partners and one out of eighteen (5.5%) male partners were seropositive for HIV antibody. All couples had practised vaginal intercourse. Seropositive female partners did not differ significantly from seronegative partners with regard to length of relationship, number of acts of vaginal intercourse, other sexual practices, stage of clinical disease in the index case, or numbers of other sexual partners in the last five years. In two women, seroconversion was documented after one act of unprotected sexual intercourse. The majority of infected female partners (eight out of 15) had sexual relationships with men who were asymptomatic and did not practise anal intercourse. Biological factors such as variability in infectivity of the index case and susceptibility of the contact, as well as behavioural variables may be important in determining transmission.

ISSN:0269-9370    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The relationship between HIV seroprevalence and the proportion of uncircumcised males in African countries is examined to determine whether circumcision practices play a role in explaining the large existing variation in the sizes of African HIV epidemics. A review of the anthropological literature yielded estimates of circumcision practices for 409 African ethnic groups from which corresponding national estimates were derived. HIV seroprevalence rates in the capital cities were used as indicators of the relative level of HIV infection of countries. The correlation between these two variables in 37 African countries was high (R = 0.9;P< 0.001). This finding is consistent with existing clinic-based studies that indicate a lower risk of HIV infection among circumcised males.

ISSN:0269-9370    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Eighteen out of 19 women who were clinically well but infected by HIV showed abnormalities of the lower genital tract. Seven patients had intraepithelial neoplasia, histologically verified in five, involving the cervix in four, the vulva in three and the perineum in one. Lesions (clinical and/or subclinical) compatible with human papillomavirus (HPV) infection were identified in these women, as well as in 10 out of the other 11 women infected with HIV. Disease at more than one site was detected in half of the patients and would have remained covert in more than half, had colposcopy not been undertaken.Women with HIV infection are at high risk of harbouring HPV and of developing lower genital tract neoplasia.

ISSN:0269-9370    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

In order to clarify whether HIV-1 core andenvantigens are destroyed during pepsin treatment, used previously for detecting HIV-1 core andenvantibodies hidden in circulating immune complexes, purified recombinantenvand core antigen preparations were treated with pepsin. Core antigen was found to be extremely sensitive to this enzyme. By contrast, the antigenicity of the purifiedenvantigen was not destroyed and was even increased after pepsin treatment, performed under identical conditions. These findings suggest that after pepsin digestion the core-anti-core immune complexes do not reconstitute because of the loss of antigenicity of the core antigen. By contrast, the lack of binding after neutralization to theenvantigen of the F(ab‘)2fragment of the anti-envantibody, cleaved by pepsin from the immune complexes, is probably due to other factors.

ISSN:0269-9370    

出版商:OVID    

年代:1989

数据来源: OVID