摘要:

To assess the completeness of human immunodeficiency virus (HIV) reporting among hospital inpatients whose records listed diagnostic codes for HIV infection but who did not meet the 1987 AIDS case definition, we conducted a statewide hospital study of admissions between January 1, 1986 and December 31, 1990. Of the 396 HIV-infected hospital inpatients identified, 313 (79%) had been reported to the State HIV Registry. HIV reporting was less complete for patients who were older and/or were blood product recipients. Of the 313 reported patients, 189 (60%) had been reported prior to their first hospital admission. Temporal improvements were noted in the completeness of HIV reporting among the hospital patients (1986: 65%; 1987: 81%; 1988: 64%; 1989: 82%; 1990: 86%; Chi square for linear trend 9.6, p < 0.01) and prior to their first hospital admission (1986: 31%; 1987: 34%; 1988: 49%; 1989: 64%; 1990: 72%; Chi square for linear trend 26.6; p < 0.01). Women were more likely than men to be reported prior rather than during or after their first hospital admission (71% vs. 55%; p < 0.01). Of the 155 patients with CD4+T-lymphocyte test results, 41 had CD4+counts <200 mm3and met the 1993 but not the 1987 AIDS case definition. In South Carolina most (79%) diagnosed, hospitalized, HIV-infected patients had been reported to the State HIV Registry, with improvements in reporting occurring over time. Findings suggest that the 1993 AIDS case definition will improve our ability to monitor severe morbidity related to HIV.

ISSN:0894-9255    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

This study sought to quantify HIV-related deaths among persons not classified as having AIDS, in an area where AIDS incidence among injecting drug users (IDUs) is high. Death certificates of persons who were aged 25–44 years at death, died in 1987 in two New Jersey counties, and had certain infectious conditions were compared with names in the AIDS Registry. Hospital and/or Medical Examiner records were reviewed for nonmatching cases. Cases were considered as confirmed HIV infection if there was laboratory evidence of such infection and as suggestive HIV infection if the decedent had oral thrush or a combination of certain other clinical findings were present. Of 412 deaths meeting the above criteria, 165 (40.0%) were in the AIDS Registry. We investigated 205 of the remainder; of these, 7.3% were found to have AIDS, 21.5% had confirmed HIV infection without AIDS, and 15.1% had suggestive HIV infection. This increased the HIV-related mortality in excess of deaths due to AIDS in this age group by 9.2% for confirmed HIV infections and 15.6% for both confirmed and suggestive HIV infections, with deaths among IDUs increasing 12.3% for confirmed HIV infections and 18.9% for both confirmed and suggestive HIV infections. Thus, in addition to AIDS indicator diseases, a variety of other infectious conditions can lead to death in HIV-infected persons, particularly in IDUs; however, the extent of such deaths may be less than previously described.

ISSN:0894-9255    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A high percentage of HIV-1-infected infants and children in Romania are coinfected with hepatitis B virus. Little information is available on the impact of concurrent hepatitis B infection on the course of HIV-1 infection. We conducted a prospective cohort study over 1 year in a group of 68 HIV-1-infected infants and children to determine whether hepatitis B surface antigenemia, neopterin, and β2-microglobulin (B2M) predicted death. Among the 44 hepatitis B surface antigen-positive (HBsAg+) subjects at enrollment, 13 (30%) died during 1 year of follow-up. In comparison, two of 24 (8%) HBsAg-negative subjects died (RR = 7.7; p = 0.05). Higher initial serum concentrations of neopterin and B2M were negatively associated with survival. After stratifying by baseline clinical evidence of HIV-related disease, survival was negatively associated with HBsAg+status (p = 0.04) in 33 children in stage P-2, adjusting for age, serum neopterin, and serum B2M levels. The results of this study suggest that serum neopterin is a marker for severity of clinical illness and that HBsAg+status increases the mortality rate among children with clinical evidence of HIV infection.

ISSN:0894-9255    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Much confusion exists about federal regulations governing the enrollment of prisoners in experimental clinical trials. Given the high prevalence of HIV infection in certain incarcerated populations, the issues surrounding clinical trials need clarification. A review of the history of prisoners as human subjects and current federal regulations regarding research on prisoners is provided. Experience at two New York State Designated AIDS Centers with inmates and experimental drug trials is described. Guidelines for enrollment of inmates in clinical trials are presented.

ISSN:0894-9255    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Although CD4 positive lymphocyte counts are important predictors of clinical events in persons infected with human immunodeficiency virus (HIV), little is known about their predictive value for survival. We analyzed CD4 counts obtained regularly since 1983 with regard to survival in a multi-center cohort study of 921 HIV-infected hemophiliacs of whom 177 have died. Dates of seroconversion were determined from stored serum samples. Cumulative mortality and actuarial survival rates were calculated from the first time the mean of two consecutive CD4 counts decreased from levels of >500 to 200–499, 100–199, 50–99, and <50 cells/μl. The death rate per 100 patient years of observation was 0.87 (95% CI 0.27, 1.47) for those with CD4 counts of >500 cells/μl and increased progressively to 26.23 (95% CI 21.29, 31.17) for those with CD4 counts of <50/μl. HIV-related deaths occurred in 50 of 58 who died with CD4 counts of <300/μl compared to 0 of 6 who died with CD4 counts of >500/μl. The median CD4 count most proximal to death was 39.5 (range, 1–945). The 10-year actuarial estimate of survival from seroconversion was 77.3 ± 2% for 546 persons who seroconverted at age >18 years compared to 90.5 ± 2% for 375 persons who seroconverted at age <18. Survival decreased at each CD4 level to a median of 27 months at CD4 counts of 50/μl. At each CD4 level, younger patients survived longer than older patients. In this cohort, death was 32 times more frequent with very low CD4 counts (<50 cells/μl) compared to high CD4 counts (>500 cells/μl). However, among those with very low CD4 counts, survival was much longer than had previously been described and younger age at seroconversion was a positive prognostic factor at all CD4 levels.

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