摘要:

This study examines the risk of developing cytomegalovirus (CMV) retinitis as a function of the duration and degree of CD4+lymphocyte depletion. A retrospective analysis of 135 persons infected with the human immunodeficiency virus (HIV) was performed. Kaplan-Meier estimates for the percentage of patients developing CMV retinitis during the 27-month study period were calculated. Twenty-six patients were diagnosed as having CMV retinitis. In 14 of these patients, T cell phenotyping was done within the 3 months preceding diagnosis. The mean CD4+lymphocyte count for these patients was 15.6 cells/mm3(range, 2–33/mm3). At 27 months, the percentage of patients developing CMV retinitis with baseline CD4+lymphocyte counts of 0–50, 51–100, and 101–250 cells/mm3was 41.9%, 26.3%, and 14.7%, respectively (log-rank test, p = 0.003). The odds ratio for developing CMV retinitis for those with baseline CD4+lymphocyte counts of 0–50 cells/mm3compared with those with CD4+lymphocyte counts of 101–250 cells/mm3was 4.62 (p= 0.002). Twenty-four patients had CD4+lymphocyte counts of ≤50 cells/mm3for an average of 13.1 months prior to diagnosis. Twenty-two patients had an acquired immune deficiency syndrome (AIDS)-defining illness diagnosed for an average of 18.0 months prior to the onset of retinitis. CMV retinitis is most likely to develop in patients with AIDS when the CD4+lymphocyte count is =≤50 cells/mm3.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

In order to determine the most sensitive method for the early detection of HIV infection, polymerase chain reaction (PCR) and serology were compared using matched peripheral blood mononuclear cells (PBMC) and serum samples taken sequentially at 3-month intervals on 17 HIV seroconverters. All samples from the time of enrollment in the study to the time of seroconversion were studied. [There were only two of the 17 cases where PCR and antigen positivity preceded EIA detectable seroconversion.] Initially, one of these cases was found to be PCR positive 11 months prior to seroconversion, however DNA fingerprinting techniques indicated that the early positive specimen did not belong to the subject in question. In a single subject, PCR was negative at the time of serologic evidence of infection but was positive at the next sampling 3 months later. In the remaining 14 cases, PCR was positive at the same sample time as full or partial seroconversion as determined by three EIA screening tests and Western blot. EIA antibody screen tests showed variability in detection of early HIV antibodies. We found no evidence for prolonged HIV infection prior to seroconversion. PCR offers little if any advantage over serology in the early detection of HIV infection in adults.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The p24 antigen is only detectable in a minority of asymptomatic HIV infected individuals, which is in part felt to be secondary to immune complex formation with p24 antibody. We sought to determine if the recovery of p24 antigen could be enhanced by an acidification procedure in an attempt to dissociate p24 antibody-antigen complexes. We tested 291 HIV antibody positive serum samples in duplicate, comparing the standard Coulter p24 Antigen Assay with the same assay which was modified by pretreating samples for 60 min with 1.5Mglycine (pH 1.85) and then neutralizing the sample with 1.5MTris (pH 9.0). Using the assay cutoff (∼7.8 pg/ml), the standard assayed sera and the acid pretreated sera were positive in 65/291 (22.3%) and 167/291 (57.4%) of the samples, respectively. This difference between procedures was statistically significant (p< 0.0001) by McNemar χ2. There was also a statistically significant difference between Walter Reed stages for p24 antigen quantification by ANOVA (p < 0.0001). We have demonstrated that the detection of p24 antigen may be significantly enhanced by acid pretreatment of sera which dissociates immune complexed antigen. We have also shown significant differences exist between Walter Reed stages for quantitative p24 antigen levels. Enhanced detection of p24 antigen may be important prognostically and may allow for the monitoring of antiretroviral therapy.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

One hundred forty-nine patients of private physicians in Toronto, Canada, who were positive for human immunodeficiency virus (HIV), medically stable, and had CD4 cell counts of <700 cells/mm3participated in a randomized, double-blind trial of placebo versus low-dose (50 U) versus high-dose (100 U) oral interferon-α. Treatment allocation was balanced according to baseline CD4 cell count and history of prior antiviral therapy. Patients were observed at 4 and 8 weeks for assessment of adverse events and several measures of disease status, including CD4 cell count, β2-microglobulin, weight, and Karnofsky score. We detected neither short-term benefits nor adverse effects from oral interferon-α therapy.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Nutritional status and food intake of HIV + and HIV – homosexual men that were free from enteric pathogens were compared. Food intake (7-day weighed record), anthropometry, and D-xylose excretion were measured in 44 patients (9 HIV – 35 HIV +). HIV + patients were found to be thinner, based on anthropometric measurements of skinfold thickness (p< 0.05) and percentage body fat [p< 0.05), and they also tended to be lighter than the HIV – patients. No differences were observed in the arm muscle mass or the food intake of the two groups. In the HIV+ patients, regression analysis was used to correlate changes in nutritional status with progression of the disease, using CD4+lymphocyte count as a measure of severity. A decrease in CD4 count positively correlated with a decrease in weight (r= 0.48,p< 0.01), body mass index (r= 0.41,p< 0.05), and arm muscle area (r= 0.42,p< 0.01). Energy intake (r= 0.67,p< 0.01), serum albumin (r= 0.52,p< 0.01), and D-xylose excretion (r= 0.57,p< 0.0001) also positively correlated with CD4 count. Multiple regression analysis revealed a relationship between CD4 count, weight, and energy intake, indicating that as the disease progresses, a decline in weight is seen parallel to a reduction in food intake. These data indicate that changes in body composition and nutritional status are present throughout the stages of HIV disease, though no causal relationships can be interpreted from this study. The initial changes appear to be due to loss of fat stores, as determined by anthropometry. As the disease progresses, there is a reduction in lean body mass, a reduced food intake, and a breakdown in intestinal mucosal integrity.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The human immunodeficiency virus establishes an intimate interaction with the immune system. The virus can use cytokines, such as tumor necrosis factor-α (TNF-α) and interleukin-1 (II-1), to regulate its own expression by modifying the normal immunoregulatory network. We demonstrate that mRNA of the cytokine TNF-α from peripheral blood mononuclear cells is overexpressed in virtually all patients with AIDS who do not have active opportunistic infections compared with uninfected volunteers (p< 0.0001). This overexpression correlates with elevated mRNA levels of the recently discovered GRO (p< 0.05), a cytokine involved in the inflammatory response.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Since 1987, the annual increases of AIDS incidence among homosexual and bisexual men have slowed but the increases among other risk groups have continued unabated. Although indirect evidence suggests the incidence change is related to medical care for HIV disease delaying the onset of AIDS, other explanations are also possible. To examine the incidence change from a different perspective, we classified the residents of Philadelphia (PA, U.S.A.) with AIDS by the per capita income of their census tracts of residence. AIDS incidence increased steadily in the lowest income tercile, showed continuing but smaller increases after 1987 in the middle tercile, and was level after 1987 in the highest income tercile. The relationship between income and changes of incidence persisted after stratification on race or mode of infection with HIV. Income was associated with private medical insurance at the time of diagnosis of AIDS (59% privately insured in the highest income tercile, 24% in the lowest) and with median survival after a diagnosis of AIDS (467 days in the highest tercile of income, 359 days in the lowest). These observations are consistent with a medical treatment benefit that reaches the highest tercile of income and does not reach the lowest one.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We sought to track recent changes in AIDS incidence and prevalence in the city of Philadelphia (PA, U.S.A.) using morbidity and mortality data reported to the health department. We stratified the data by the mean per capita income in census tracts where people with AIDS resided. Estimates made without adjustment for the time lag between events and their entry into the database undercount both recent AIDS diagnoses and recent AIDS deaths. Therefore, we used a previously published method to adjust for the lag in reporting diagnoses and developed a method to adjust for the lag in reporting deaths. We calculated prevalent cases as the difference between cumulative cases and cumulative deaths. Between 1988 and 1990, annual AIDS incidence per 100,000 Philadelphia residents increased by 21% (from 25.9 to 31.4) and AIDS prevalence per 100,000 population increased by 62% (from 30.2 to 48.8). AIDS prevalence increased 113% (from 29.8 to 63.6) in low-income tracts, 88% (from 27.8 to 52.3) in middle-income tracts, and 14% (from 32.5 to 37.2) in high-income tracts. The 62% increase in AIDS prevalence and the shift toward people in poorer neighborhoods imply a need for public funding for AIDS care that is far larger than would be suggested by the general 21% increase in AIDS incidence over the same period.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Critical to understanding the spread of the human immunodeficiency virus via needle sharing among drug users is theinfectivity, i.e., the conditional probability of infection given injection with a shared, contaminated syringe. A simple mathematical model was constructed that relates infectivity to the prevalence of infection in needles used by drug users, the mean shared injection frequency among drug users, the probability that a needle is disinfected prior to use, and the mean AIDS incubation time. Three of these parameters have been estimated using data from the New Haven, Connecticut legal needle exchange program. Using the polymerase chain reaction to test for the presence of HIV proviral DNA in a sample of returned needles, we determined that 67.5% were HIV positive. We were able to estimate shared injection rates and disinfection rates from surveys of drug users enrolled in the needle exchange and our syringe tracking system. Current estimates of the mean AIDS incubation time are available in the literature. Our model implies that the probability of infection per injection with a contaminated syringe equals 0.0067, which is slightly higher than the transmission probabilities of 1/300 to 1/200 estimated from needlestick studies, and a factor of 3 higher than estimates of the probability of HIV transmission per vaginal sex act from an infected man to an uninfected woman.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The relationships between previous HIV counseling and testing and sexual behavior were examined among injecting drug users in Bangkok. Six hundred one i.v. drug users (IVDUs) were recruited from drug treatment programs in November of 1989. A standardized interview on AIDS risk behavior was administered and a blood sample was collected for HIV testing of the 601 people. Fifty-six percent reported that they had not been previously tested (NPT), 15% had previously tested positive (PT + ), and 29% had previously tested negative (PT —). Previous testing was associated with higher levels of safer sex and contraception with primary partners: 56% of the PT+ people with regular partners reported using condoms at least some of the time with that partner, compared with 28% of the PT- and only 20% of the NPT people. Similarly, 89% of the PT+ and 72% of the PT- people, compared with 59% of the NPT people, reported practicing some form of contraception with regular partners. The results strongly support the utility of HIV counseling and testing as a method of reducing heterosexual and perinatal HIV transmission among IVDUs in Bangkok.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID