摘要:

European patients with human immunodeficiency virus type 1 (HIV-1) infection have been reported to have lower liters of anti-p24 antibody than Central African HIV seropositive patients. Recently, black HIV positive patients in the United States were reported to be more likely to have detectable anti-p24 antibodies, less p24 antigenemia, and higher combined serum immu-noglobulins than white HIV positive patients. We measured individual total serum immunoglobulins in 853 HIV positive patients (94% male; 58% white and 42% black) on their initial medical evaluation and compared them with CD4+T-cell counts. Blacks had notably higher IgG levels (p = 0.001) across the entire spectrum of CD4+T-cell counts. Serum IgM levels were slightly higher in blacks. IgA levels were not significantly different between the races, although the trend (p = 0.006) was toward higher levels in whites. We also measured these three serum immunoglobulins in 60 HIV seronegative, healthy blood donors (30 black and 30 white). In this control group, blacks had statistically higher IgG and IgA levels than whites. A review of the literature prior to the HIV/aquired immune deficiency syndrome epidemic also supports the view that racial differences in IgG levels are not specific for HIV infection. We speculate that racial differences in humoral immunity, independent of geography or strain of HIV, may account for differences in anti-HIV antibody levels and HIV antigenemia.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Because little was known about the prevalence of neurological complications of human immunodeficiency virus type 1 (HIV-1) infection in Africa, we conducted a cross-sectional study among consecutive admissions to the internal medicine wards of Mama Yemo Hospital in Kinshasa, Zaire. Of the 196 patients studied, 104 (53%) were HIV-1 seropositive, of whom 50 (48%) had stage 3 and 49 (47%) had stage 4 HIV-1 infection according to the provisional WHO staging criteria for HIV infection. Neuropsychiatric abnormalities were present in 43 (41%) of 104 HIV-1-seropositive patients. Of the HIV-1-seropositive patients, 9 (8.7%; 95% confidence interval, 4–16%) were diagnosed as having possible HIV-1-associated dementia complex, 1 (1%) as having possible HIV-1 myelopathy, and 3 (2.7%) as having possible HIV-1-associated minor cognitive/motor disorder. Definitive diagnoses could not be made because there were no facilities for neuroimaging and neuropathology. Meningitis caused by cryptococcus was diagnosed in six (5.6%) and byMycobacterium aviumin two (2%) of the HIV-1 seropositive patients. Acute onset hemiplegia, believed to be due to stroke, was present in four (4%) of the HIV-1-seropositive patients. The prevalence of other central nervous system opportunistic infections and mass lesions, especially toxoplasmic encephalitis, could not be assessed. In this population of Zairian inpatients, the prevalence of neurological complications of HIV-1 infection was similar to that observed in industrialized countries among patients with advanced HIV disease.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The purpose of this study was to compare the efficacy and safety of dapsone and trimethoprim/sulfamethoxazole in the primary prophylaxis ofPneumocystis cariniipneumonia (PCP) in patients infected with the human immunodeficiency virus (HIV) and having <200 CD4-positive cells per ml. This was a prospective, randomized, open-label study, using dapsone (100 mg p.o.) or trimethoprim/sulfamethoxazole (160 mg/800 mg p.o.) daily. Patients who developed toxicity requiring discontinuation were offered to cross over to the other study drug. They continued in the study until development of toxicity or documented PCP. Eighty-six patients were enrolled; 47 were randomized to receive dapsone and 39 to receive trimethoprim/sulfamethoxazole. Discontinuation of initial study drug occurred in 33 of the dapsone group and 25 of the trimethoprim/sulfamethoxazole group. Rash was the most common reason for discontinuation. Ten patients crossed over from dapsone to trimethoprim/ sulfamethoxazole (4 successfully), and 11 patients crossed over from trimethoprim/sulfamethoxazole to dapsone (6 successfully). During 1,638 patient-months of observation (862 for dapsone and 776 for trimethoprim/sulfamethoxazole), one episode of PCP developed in each group. Both dapsone and trimethoprim/sulfamethoxazole are efficacious for the prophylaxis of PCP in HIV-infected persons with <200 CD4-positive cells per ml, but are each associated with significant toxicity. Development of toxicity to one dlrug does not invariably predict toxicity to the other.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We describe the clinical and epidemiological characteristics of human immunodeficiency virus (HIV) infection in patients >55 years of age at the time of diagnosis and make comparisons with younger HIV-infected patients. Patients were selected by stratification according to age (>55 years and <40 years) from a large cohort, and information was obtained by review of charts. Three samples of younger patients were used for general comparison (sample 1), for analysis of progression to acquired immunodeficiency syndrome (AIDS) (sample 2), and for analysis of survival after AIDS (sample 3). We identified 33 patients >55 years of age (30 men and 3 women). The mean age was 60.1 years (range, 55–72). Risk factors included homosexual/bisexual, 22 (67%); blood products, seven (21%); heterosexual, two (6%); and unknown risk, two (6%). HIV encephalopathy tended to be more common in the older group, while Kaposi's sarcoma was more common in younger controls. Older patients more frequently acquired HIV infection via transfusion of blood or blood products (p < 0.005), were more likely to have AIDS at presentation (p < 0.001), progressed to AIDS more rapidly (p< 0.002), and had higher mortality rates (p < 0.001). Transfusion of blood or blood products is an important mode of acquisition of HIV in patients >55 years of age. HIV infection has a more rapid and aggressive course in older patients.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Cytomegalovirus retinitis in the human immunodeficiency virusinfected patient currently requires almost daily and lifelong parenteral ganciclovir therapy. Self-preparation of ganciclovir is not an option in the majority of patients with decreased visual acuity or poor muscle coordination. Therefore, based on current stability data, patients usually receive a 5-day supply of reconstituted drug. This requirement is unfortunately associated with poor patient compliance. If the extended stability of ganciclovir was known, then more efficient regimens for outpatient therapy could be formulated. This study was designed to determine the stability of reconstituted ganciclovir between 7 and 28 days. Ganciclovir diluted with normal saline or 5% dextrose in water to final drug concentrations of 5 or 10 mg/ml was evaluated for stability by highpressure liquid chromatography under different conditions of storage. Samples were stored at both 4°C and – 20°C in polyvinyl chloride bags and at 4°C in ADFuse syringes. Ganciclovir remained stable under these conditions for 28 days. On the basis of these data, we have recommended that patients receive a 2-week supply of reconstituted ganciclovir for parenteral outpatient therapy. We have observed high levels of patient compliance with this regimen and no unexpected progression of retinitis over a 5-month period in three patients who received the drug in this fashion.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Thirteen isolates of human immunodeficiency virus type 1 (HIV-1) obtained in coculture with peripheral blood lymphocytes were tested for in vitro susceptibility to zidovudine (ZDV). Seven isolates were obtained from patients who had never been treated with ZDV and six from patients receiving the drug. The seven isolates from untreated patients and four of six from treated patients were susceptible to ZDV. The two isolates from the patients treated for the longest periods were resistant to the drug. The presence of mutations at critical positions of the reverse transcriptase gene was investigated by direct sequencing of polymerase chain reaction (PCR)-amplified DNA and four isolates were found to be mutants. An isolate from an untreated patient showed a change at residue 70 of the reverse transcriptase and an isolate from a patient treated for 4 months showed a change at residue 67. A change at residue 215 was found only for the two drug-resistant isolates, which correlated with the results obtained by Larder et al. using isolates from MT-2 cell cocultures. These results suggest that any HIV isolate provided by conventional coculture could be confidently tested for ZDV susceptibility in order to study the emergence of resistance during long-term therapy.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

To assess the incidence and time trends of human immunodeficiency virus (HIV) infection among intravenous drug users (IVDUs) and to evaluate the opportunities for prevention, we studied IVDUs recruited from 23 drug dependence treatment centers in Milan and Northern Italy. Participants were screened for HIV antibodies, and seronegative subjects were enrolled. A preventive intervention, based on counseling and HIV antibody testing, was done, and participants were invited to the centers for follow-up visits. We enrolled 1,532 subjects between 1 January 1987 and 31 October 1990, and we observed 901 subjects for an average of 15.9 months. Forty-one cases of HIV infection occurred, giving a seroconversion rate of 6.1% in 1987, 4.1% in 1988, 2.2% in 1989, and 1.6% in 1990. HIV prevalence decreased from 54% in 1986 to 49% in 1989. Incidence rates were higher in areas with high prevalence. During follow-up, 35 to 55% of the subjects stopped injecting heroin intravenously altogether, and those who did not stop decreased the frequency of syringe sharing. This is probably the reason for the decline in seroconversion rates, while the apparent decline in prevalence may be due to the entry of new seronegative individuals and/or to differential withdrawal of HIV-positive individuals from the IVDU population to the heterosexual (non-IVDU) population.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

In this article, we present the preliminary results of a study on sexual networks in a homosexual community in Iceland. The network data are transformed into a mixing matrix, which suggests that the pattern of sexual contact within the community is disassortative (i.e., sexual contacts occur largely between individuals of disparate sexual activity levels). The implications for the spread of human immunodeficiency virus (HIV) in the community are assessed by comparison with epidemics generated by proportionate and assortative (like with like) mixing, using a mathematical model of HIV transmission. The potential magnitude of the epidemic associated with the data is shown to be larger than both proportionate and assortative alternatives, although the early rate of growth is lower for the mixing matrix implied by the data. The assumptions made concerning behavioural changes triggered by alterations in population structure as a consequence of AIDS-induced mortality do not significantly alter the shape of the predicted epidemic. The problems in data acquisition and interpretation are discussed.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Antibodies were determined against five synthetic peptides (epitopes) of HIV-1 p17 in the sera of an immunologically and clinically well-characterized cohort (N = 292) of HIV-1 seronegative and HIV-1 seropositive high-risk homosexual men, HIV-1 seropositive i.v. drug abusers (IVDA), and AIDS patients. The synthetic peptides, representing the entire HIV-1 p17 protein sequence were: HGP-33 (aa 1–33), HGP-19 (aa 34–52), HGP-35 (aa 51–85), HGP-30 (aa 85–114), and HGP-17 ala (aa 114–131). The presence of one or more peptide-specific antibodies in the sera of all of the HIV-1 p17-positive subjects indicated that all five peptides contain B-cell epitopes. No antibodies were found in the sera of heterosexual controls, HIV-1 seronegative high-risk men, or asymptomatic HIV-1 seropositive but p17 antibody-negative study subjects. Significant differences in antibody recognition profiles to the peptide epitopes were found among the various study groups. A significantly higher proportion of HIV-1 seropositive IVDA had antibodies specific to HGP-17 ala (aa 114–131), HGP-35 (aa 51–85), and HGP-33 (aa 1–33) compared to the HIV-1 p17-positive asymptomatic homosexuals. The epitope-specific antibody responses reflected the clinical status of the HIV-1-infected study subjects, and declined to nondetectable levels as the patient progressed to ARC/AIDS. This decline preceded by several months the reduction in the antibody titer against the intact HIV-1 p17 and p24 proteins. Thus, the antibody response against specific HIV-1 p17 epitopes might be a better prognostic indicator than the total antibody response against the native HIV-1 p17 protein.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Two features of simian immunodeficiency virus (SIV) infection are emphasized: a transitory decrease in CD4 T cells in the first 2 weeks of infection followed by CD8 T-cell rise, and immune cell activation occurring by 4 weeks and persisting throughout the illness. The short-term changes included a fall in CD4 T cells by 2 weeks with partial recovery by 4 weeks and a CD8 rise that starts at 2 weeks. Subsequent characterization of CD4 T cells showed reduced expression of HLA-DR and CD25 (IL-2 receptor alpha chain) antigens later in SIV infection. Immune cell activation is evident in increased serum levels of neopterin and soluble CD8 antigen. Serum β2-microglobulin changes are less marked. Activation of CD8 T cells is reflected by increased percentages of cells expressing HLA-DR antigen. The B-cell numbers increased late in the course of SIV infection. Increased expression of the CD78 (Leu 21) activation phenotype was also seen in some monkeys. The immune activation changes (serum neopterin levels) induced by SIV infection in rhesus macaques appear to be associated with duration of illness, although the number of monkeys observed until death were too few for conclusive data. Thus, immune activation as well as T-cell deficiency may reflect significant immunopathogenic processes in SIV-induced disease.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID