摘要:

SummaryThe objective of this study was to determine if clinical signs, symptoms, laboratory variables, and use of therapeutic or prophylactic agents have prognostic associations with survival after diagnosis of clinical AIDS. A total of 2,168 homosexual men, seropositive for human immunodeficiency virus type 1 (HIV-1) participated in a longitudinal cohort study of the greater metropolitan areas of Baltimore, Maryland, Washington, D.C., Chicago, Illinois, Pittsburgh, Pennsylvania, and Los Angeles, California, U.S.A.the Multi-center AIDS Cohort Study (MACS). Variables within 6 months prior to AIDS diagnosis included age, CD4+lymphocyte counts, hemoglobin, and self-reported thrush, fever, anti-retroviral therapy (ART) beginning prior to AIDS onset, and ART beginning after AIDS (as a time-dependent covariate) were analyzed as mutually exclusive categories, as was prophylaxis forPneumocystis cariniipneumonia (PCP). Univariate and multivariate survival models of time from AIDS to death were fit. In univariate analysts, younger age, higher counts of CD4+lymphocytes, hemoglobin, and absence of thrush or fever prior to AIDS onset were associated with longer survival after AIDS. Those who began ART within 3 months after AIDS onset had longer median survival (1.75 years), from 3 months after AIDS, when compared with those who began ART prior to AIDS (1.18 years). This comparison is not influenced by the bias that those who survive longer have a greater likelihood to subsequently receive ART. Prophylaxis for PCP beginning after AIDS onset was also associated with longer post-AIDS survival when compared with beginning prophylaxis prior to AIDS or never using prophylaxis. In multivariate-analysis, age <37 years at AIDS onset, higher hemoglobin level, and higher CD4+lymphocyte count remained prognostically beneficial for survival after AIDS (relative hazards 0.78, 0.91 per g/dL and 0.80 per 100 cells x 106/L, respectively). When PCP prophylaxis and ART were started only after AIDS onset (considered as time-dependent covariates, they reduced the hazard of death by 40% and 50%, respectively. The hazard of death after AIDS was 26% lower in those using ART prior to AIDS than in those never using ART (p= 0.095). Clinical variables such as younger age, higher hemoglobin level, and higher CD4+count are prognostically beneficial for survival after AIDS. Pre-AIDS ART and pneumocystis prophylaxis are presently the standard of care in treating those with HIV-1 infection and have been shown to delay the onset of AIDS. Survival after AIDS onset was longer for men who received pre-AIDS ART compared with those who never received ART, but it was shorter in the former group than in those initiating ART after AIDS. This finding suggests a transient beneficial effect from ART that is not completely attenuated at AIDS in the pre-AIDS ART recipient.

ISSN:0894-9255    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryA cross-sectional study of stable monogamous couples, recruited from 16 clinical and surveillance centers in Italy between 1987 and 1992, was carried out to investigate the risk factors of woman-to-man sexual transmission of human immunodeficiency virus (HIV). The male partners of all HIV-infected women attending the centers were invited to participate in the study. Of the 275 male partners who were tested for HIV and interviewed with use of a structured questionnaire, 51 were excluded because they had other possible risk factor for HIV infection, no established risk factor was found in the index case, or they had stopped engaging in sexual intercourse. Fourteen of the 224 men (6.3%) were seropositive for HIV. At logistic regression, the highest risks of transmission were for men practicing peno-anal intercourse [odds ratio (OR), 4.6; 95% confidence interval (Cl), l.CV-22.2] and for men whose partner had acquired immune deficiency syndrome (AIDS) or a CD4+lymphocyte count of ≤400/mm3. No seropositive men were observed among those who were aware of the woman's HIV seropositivity since the beginning of the relationship or were partners of a zidovudine-treated woman. The results suggest that the risk factors described in man-to-woman and man-to-man HIV sexual transmission also operate in woman-to-man transmission.

ISSN:0894-9255    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryTo identify risk factors for HIV infection among women not known to be members of high-risk groups in Dar-es-Salaam, Tanzania, and assess associations between contraceptive use and HIV infection, we conducted a cross-sectional case-control study at three representative family planning clinics. Between February 1991 and June 1992, we enrolled 2,285 women; women were interviewed using a structured questionnaire, and specimens were collected for laboratory diagnosis of HIV and other sexually transmitted diseases (STDs). The overall HIV prevalence was 11.5% (95% CI: 10.2–12.8). Other prevalent STDs included gonorrhea (4.2%), trichomoniasis (14.3%), candidiasis (11.5%), and syphilis (2.5%). HIV seroprevalence was significantly lower among younger women and women in nonpolygamous marriages. HIV risk increased with both women's education and male partner's education. Number of sex partners in the last 5 years was positively associated with HIV risk; however, among HIV-seropositive women, the median number of sexual partners was only two. For married women with only a single partner, their risk increased significantly if their husbands had other partners. The risk of HIV infection was higher among subjects with STDs, although only significantly so for gonorrhea (OR 1.95, 95% CI: 1.10–3.45). After controlling for known and potential risk factors, the risk of HIV infection was significantly increased among women who had ever used an intrauterine device (IUD) (OR 2.50, 95% CI: 1.35–4.64). Use of other contraceptives, including oral contraceptives, was not-significantly associated with HIV infection. Our findings confirm that HIV and STDs are a major public health problem among women in Dar-es-Salaam. Prospective data are needed to confirm the association between HIV and the use of an IUD. Interventions involving both women and men are urgently needed to reduce further spread of HIV/STDs in this population.

ISSN:0894-9255    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryBetween November 1990 and January 1991, status of human immunodeficiency virus (HIV) infection was assessed for 522 men and 484 women attending the Comprehensive Health Centre in Kingston, Jamaica, for a new sexually transmitted disease (STD) complaint. Prevalence of HIV type 1 (HIV-1) infection was 3.1% (31 of 1,006), a tenfold rise in seroprevalence in 4.5 years. Nineteen of 517 (3.7%) heterosexual men, 3 of 5 (60%) homosexual/bisexual men, and 9 of 484 (1.9%) women were infected with HIV. In heterosexual men, factors associated with HIV infection after age adjustment included present complaint of genital ulcer [odds ratio (OR) 7.3; 95% confidence interval (CI) 1.4–72], past history of genital ulcer (OR, 4.3; CI, 1.4–12), positive MHATP syphilis serology (OR, 3.4; CI, 1.1–10), sex with a prostitute in the past month (OR, 3.8; CI, 1.1–11). Three or more sex partners in the month prior to complaint (OR, 3.6; CI, 1.0–12), and bruising during sex (OR, 4.0; CI, 1.4–13). On multiple logistic regression analysis, independent associations with HIV infection were shown for bruising during sex (OR, 3.0; CI, 1.1–8.3), positive MHATP syphilis serology (OR, 3.2; CI, 1.1–9.5), and history of genital ulcer (OR, 2.9; CI, 1.0–8.0). Among women, history of “bad blood” (syphilis) (OR, 6.6; CI, 1.4–30), self-perception of high risk for acquired immune deficiency syndrome (AIDS) (OR, 8.6; CI, 0.9–108), positive gonorrhea culture (OR 12; CI 2.1–72), HTLV-1 seropositivity (OR, 5.7; CI, 0.9–29), history of stillbirth (OR, 7.6; CI, 1.3–43), and current abnormality of the cervix (OR, ∞; CI, 1.7-∞) were associated with HIV infection. Conditions giving rise to a disruption of the genital epithelium in men such as bruising (trauma) with sex and genital ulcers may facilitate HIV transmission from women to men while inflammation of the cervix (e.g., gonorrhea) may facilitate male-to-female HIV transmission.

ISSN:0894-9255    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0894-9255    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0894-9255    

出版商:OVID    

年代:1994

数据来源: OVID