摘要:

We evaluated and compared four staging classification systems for HIV infection in a population-based cohort: (1) a staging based on prodromal clinical criteria; (2) the Walter Reed Staging Classification (WRSC); (3) the immunologie staging system (ISS), and (4) a simple staging based on oral disease and CD4+ T-cell depletion. The staging systems were applied to 386 HIV-infected men in the San Francisco Men's Health Study cohort who did not have AIDS at the baseline examination. After 48–56 months of follow-up the cumulative incidence of AIDS and the cumulative mortality by stage was determined for each staging. Unlike the other systems, the WRSC could not classify a substantial proportion of HIV-infected men (51.9%). The WRSC and ISS include one or more stages which did not appear to be associated with a prognosis substantially different from that of adjacent stages. The simplified staging system based on CD4 + T-cell depletion and oral disease may be the most effective of the systems studied. A more complete understanding of the pathophysiology during the evolution of HIV infection will be required to define a more detailed staging of this disease.

ISSN:0269-9370    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

To determine the relationships between individuals' baseline T-cell subsets, their rates of change with time, and AIDS-free survival time, data were collected at 6-monthly intervals from 379 HIV-seropositive homosexual Sydney men, of whom 31 developed AIDS during the 3-year observation period. Both CD4% and rate of change of CD4% in an individual had significant prognostic value in determining AIDS-free survival time. Compared with subjects whose CD4% remained stable, subjects whose CD4% dropped by 7% or more in a year had a relative hazard of 35.1 (95% confidence interval = 11.7–105.6,P< 0.001) of developing AIDS. Increasing CD4% had a significant protective effect, reducing the risk of developing AIDS. CD4%, CD4 cell count and CD4:CD8 ratios showed steeper declines in subjects who were later diagnosed with AIDS than in those who remained AIDS-free. The rates of immunological change in AIDS-free seroconverters and seropositives were similar, despite indeterminate differences in durations of infections. In the multivariate Cox regression analysis, baseline CD4%, the rate of change of CD4%, and baseline lymphocyte count were associated with AIDS-free survival time. Baseline CD4% had greater prognostic value than baseline CD4 cell count. Baseline CD8%, baseline CD8 count, their rates of change and their mean square errors were not independently significant in this analysis. These findings are important for clinicians monitoring HIV infection in an individual and for entry criteria and monitoring procedures in clinical trials. They also have implications for resource-poor settings; prognosis based on CD4% can be made with a flow cytometer without a full blood count. Data were collected before zidovudine was available and thus reflect the natural history of HIV infection.

ISSN:0269-9370    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

During 1989, 316 members of a cohort of homosexual men were tested for HIV-specific DNA by the polymerase chain reaction (PCR) using a pair of gag-region primers. Of 125 HIV-seronegative subjects, 123 (98.4%) were PCR-negative while 158 (82.7%) of 191 HIV-seropositive subjects were PCR-positive. Fewer of the 33 subjects who were seropositive and PCR-negative were at Centers for Disease Control (CDC) stage IV than the seropositive, PCR-positive subjects (6 versus 25%;P= 0.030). The seropositive, PCR-negative group had higher median CD4 counts (640 versus 490 ± 106cells/I;P= 0.006), higher CD4: CD8 ratios (0.92 versus 0.64;P= 0.004), lower immunoglobulin (Ig) G levels (1290 versus 1645 mg/dl; P = 0.002), lower IgA levels (168 versus 251 mg/dl;P< 0.001), and lower C1q binding activity (8 versus 14%; P = 0.010) than the seropositive, PCR-positive subjects. The median rate of CD4 cell decline in the 3 years preceding the PCR sample was less marked in the seropositive, PCR-negative group than the seropositive, PCR-positive group (—58 versus — 77 ± 106cells/I per year; P = 0.028). To control for duration of infection, we restricted the analysis to the subgroups of 11 seropositive, PCR-negative subjects and 34 seropositive, PCR-positive subjects who had seroconverted earlier in the cohort study. Both subgroups had similar durations of infection, yet the same pattern of differences persisted. Moreover, despite a median of 51 months since seroconversion, the seropositive, PCR-negative subgroup had CD4 counts and antecedent rates of CD4 cell decline that were similar to those of the 123 seronegative, PCR-negative homosexual controls who were not infected with HIV. We conclude that PCR can identify a group of HIV-infected people with very low levels of proviral DNA who demonstrate slower progression of the effects of HIV.

ISSN:0269-9370    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The exact frequency of HIV-associated thrombocytopenia (TCP), defined as platelet count <150 ± 109/1, was studied in 435 symptom-free HIV-seropositive individuals. At the baseline control, 23 (5.5%) had TCP. TCP individuals had a significantly lower mean CD4 lymphocyte count than the non-TCP individuals. During a mean follow-up of 30 months, 79 out of the 435 individuals (18%) had TCP at least once. During the study period, only 1% of our patients had a platelet count <50 ± 109/1. TCP was more frequent in intravenous drug users than in other risk groups. A spontaneous normalization of platelet count was observed in more than 50% of TCP individuals.

ISSN:0269-9370    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

To investigate the interval between HIV-1 infection and the development of clinical AIDS among Italian patients with congenital coagulation disorders, a national cohort study was undertaken in 1988. Information was collected both retrospectively and prospectively on 499 HIV-1-positive patients enrolled in an ongoing national registry of patients with congenital coagulation disorders. Two methods were used to estimate each patient's seroconversion date: the mid-point between the last negative (either known or estimated) and the first positive test, and the median under a Weibull distribution, which was assumed to fit seroconversion data. The two methods of estimating the seroconversion time yielded similar results. The actuarial incidence of AIDS was estimated using the Kaplan-Meier survival analysis at 12.8% (95% confidence interval = 9.7–15.9) over 7 years for Italian haemophiliacs. Progression appears to be slow in the first 5 years after the infection, and to rise steadily thereafter. A strong association between faster progression and older age at seroconversion was found. Zidovudine-treated individuals seem to have a slower progression than untreated individuals, after controlling for CD4, but there was no association between progression and type and severity of the congenital disorder.

ISSN:0269-9370    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

To assess changes in mortality in Abidjan since the development of the AIDS epidemic, we compared official city mortality statistics and hospital fatality rates in 1983, before AIDS was recognized in Abidjan, with those in 1988. Review of records in the city's major hospitals showed that fatality rates (deaths per 1000 admissions) in adult medical patients increased by 54% between 1983 and 1988, with increases of 106 and 98% in men 20–29 and 30–39 years of age, respectively, and 199 and 42% in women of the same age ranges. Mortality rates in surgical patients showed little change, while in children they declined. Over the same period, official mortality statistics for the city showed reduced mortality rates in children and women 20–29 years of age, but an increase in mortality rates of 54% in men 20 years of age and older, and of 28% in women aged 30 years and older. HIV infection may be a major cause of the increased adult mortality documented in hospital and city records, and jeopardizes improved survival from preventive measures such as maternal and child health services.

ISSN:0269-9370    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

From October 1987 to June 1988, we attempted to determine the prevalence of HIV infection among patients hospitalized with tuberculosis and the extent of immunosuppression among those tuberculosis patients infected with HIV. Of 178 consecutive patients, 18–65 years of age, who were hospitalized with newly diagnosed, previously untreated tuberculosis, 46% (82 out of 178) had clinical or serological evidence of HIV infection, 30% (54 out of 178) were HIV-seronegative, and 24% (42 out of 178) could not be assessed for the presence of HIV infection. Among the HIV-seropositive patients without an AIDS-defining diagnosis by non-tuberculous criteria, the median CD4 lymphocyte (CD4) count was 133 ± 106cells/l (range: 11–677 ± 106); among the HIV-seronegative patients, the median CD4 count was 613 ± 106cells/l (range: 238–1614 ± 106; P < 0.001). Among the HIV-seropositive patients, those with disseminated tuberculosis (median CD4 = 79 ± 106cells/l) and those with pulmonary tuberculosis who had radiographic evidence of mediastinal or hilar adenopathy (median CD4 = 45 ± 106cells/l) had the most severe CD4 depletion, whereas those with localized extrapulmonary tuberculosis (median CD4 = 242 ± 106cells/l) and those with pulmonary tuberculosis without adenopathy (median CD4 = 299 ± 106cells/l) were less severely immunosuppressed. Of the 178 patients, 6% (11 out of 178) were infected with strains ofMycobacterium tuberculosisresistant to both isoniazid and rifampin.

ISSN:0269-9370    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Since 1985, a population of over 1000 predominantly HIV-positive female prostitutes residing in a low-income area of Nairobi, has been enrolled in a sexually transmitted disease (STDVHIV control programme. The major elements of the programme include the diagnosis and treatment of conventional STD, and the promotion of condom use to prevent the transmission of HIV and other sexually transmitted infections. Using estimates of numbers of HIV-seropositive prostitutes, numbers of sexual contacts, susceptibility of clients to HIV, HIV transmission efficiency, rates of condom use and the basic reproductive rate of HIV infection in Kenya, we estimate that the programme is responsible for preventing between 6000 and 10000 new cases of HIV infection per year among clients and contacts of clients. The total annual operating cost of the programme is approximately US$77000 or between US$8.00 and US$12.00 for each case of HIV infection prevented. Programmes to reduce the transmission of HIV and other sexually transmitted infections which are targeted at high-frequency STD transmitters, such as prostitutes, can be effective and relatively inexpensive to undertake. More such programmes should be developed and evaluated in different settings.

ISSN:0269-9370    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Lymphocytes or lymphoblastoid cells that have been infected by HIVin vitroor exposed to its envelope glycoprotein (gp120) show abnormal inositol polyphosphate-mediated signal transduction and associated defects in calcium regulation. Such cells behave as though they were chronically activated and fail to respond to further activating signals. We now show that similar changes are seen in lymphocytes obtained from HIV-infected subjects at various stages of infection, despite the fact that only a minority of such cells are infected. Furthermore, the defect in the phosphatidylinositol hydrolysis pathway in lymphocytes obtained from AIDS patients reverses after treatment with zidovudine, in parallel with improvements in phytohaemagglutinin-induced proliferative response and interferon-γ production.

ISSN:0269-9370    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The diagnosis of syphilis is frequently dependent upon the results of serological tests, but the reliability of syphilis serology in patients with HIV-1 infection has been questioned. We examined specific antibody toTreponema pallidum(TP) using the TP haemagglutination (TPHA) and fluorescent treponemal antibody-absorption (FTA-ABS) tests in AIDS patients and HIV-antibody-negative controls with a history of syphilis. Tests were carried out on two sera separated by an interval of at least 3 years from each patient. Twelve out of 29 AIDS patients compared with four out of 29 controls showed significant falls in titres of specific antibody as measured by the TPHA, FTA-ABS, or by both the TPHA and FTA-ABS (P= 0.02). Furthermore, in three out of 29 (10%) of the AIDS patients with past syphilis infections both the TPHA and FTA-ABS became non-reactive. We conclude that negative specific serology does not exclude a past syphilis infection in patients with AIDS.

ISSN:0269-9370    

出版商:OVID    

年代:1991

数据来源: OVID