摘要:

Fifty-eight of 89 serum samples (65.17%) from HIV-1-infected individuals at various disease stages contain antibodies that react with a platelet peptide located in the cytoplasmic domain of integrin β3, glycoprotein GPIIIa (aa749-761; sequence DRKEFAKFEEERA). Rabbit polyclonal antibodies raised against the synthetic platelet peptide also react with the structurally homologous HIV-1 gp41-derived peptide (EKNEQELLELDKW(A)) and bind to a Western blot band with molecular weight corresponding to HIV-1 gp41. These findings point to molecular mimicry between HIV-1 and a human membrane protein found in platelets and other cells that could be of pathologic consequence.

ISSN:1077-9450    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Coinfections with HIV-1 and HTLV-I or HTLV-II have been associated with unique immunophenotypes and an increased risk for development of neurodegenerative conditions. These findings may result from an increased HTLV-I or II viral burden in dually infected individuals. To investigate this possibility, HTLV-I/II tax/rex messenger RNA and viral antigen expression in peripheral blood mononuclear cells (PBMCs) were measured in 37 HTLV-I- or HTLV-II-infected subjects with or without HIV-1 coinfection. Tax/rex messenger RNA was detected in 14 of 24 PBMC samples from dually infected subjects, compared with only 1 of 13 PBMC samples from singly infected subjects (58% versus 7%;p< .003). The reverse transcription-polymerase chain reaction (RT-PCR) assay correlated with HTLV-I/II viral antigen detection in PBMC cultures but not with HIV-1 viral load levels in plasma. These findings may provide clues regarding the pathophysiologic consequences of HIV/HTLV-I and HIV/HTLV-II coinfections.

ISSN:1077-9450    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Thirty-three patients referred to a wasting clinic were evaluated to assess whether levels of HIV RNA were related to the magnitude of prior weight loss. Their median RNA level was 46,887 gene copies/ml (range, <200-510,070 gene copies/ml) at the time of referral. Patients had lost 10.5 ± 6.4 kg over 461 ± 304 days. RNA levels were correlated with the absolute amount and percentage of weight lost as well as the difference in body mass index (BMI) at the prior maximal and minimal recorded weights (r= 0.7, 0.67, 0.69;p= .0001 for the comparisons). The magnitude of these changes increased across strata of HIV RNA levels (p≤ .004), previously defined as associated with increasing risk for disease progression. The other parameter that could be associated with weight loss was the CD4 lymphocyte count (r= −0.43;p= .01). Low levels of testosterone and measures of body cell mass, fat free mass, or fat mass within 6 weeks of the RNA level could not be related to weight loss, change in BMI, or RNA levels. Thirty-two of the patients had chronic, relentless weight loss; in 15 of these subjects, no apparent secondary opportunistic complications were associated with weight loss or gastrointestinal symptoms to impair energy intake. Levels of HIV replication appear to be causally related to the magnitude of weight loss in some patients with wasting.

ISSN:1077-9450    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objectives:To quantify spontaneous and activation-induced apoptosis in peripheral blood mononuclear cells (PBMC) of HIV-infected patients and to look for correlations between PBMC apoptosis levels, stages of HIV disease, CD4 count, and plasma viral load.Study Populations:75 consecutive inpatients and outpatients infected with HIV (mean CD4 count, 202 ± 182 × 106/L; mean plasma viral load, 4 ± 1.29 log10RNA copies/ml) and a control group composed of 18 healthy, HIV-negative adults.Methods:Spontaneous apoptosis was detected at the single-cell level by direct incorporation of fluorescein-deoxyuridine triphosphate (dUTP) in PBMC DNA strand breaks. Activation-induced apoptosis was determined after in vitro stimulation with anti-CD3 antibodies and interleukin-2 (IL-2).Results:Spontaneous apoptosis was low in patients and controls, whereas activation-induced apoptosis was significantly higher in HIV-infected patients (5.22 ± 4.32% versus 2.46 ± 1.77%, respectively;p= .009). The degree of activation-induced apoptosis was positively correlated with the plasma viral load (r= 0.29;p= .029) and negatively correlated with the CD4 count (r= −0.37;p= .0009). Although activation-induced apoptosis was significantly higher in patients fulfilling AIDS criteria, it did not differ significantly between patients with an acute AIDS-defining event and those with stable disease.Conclusion:Susceptibility of PBMC to apoptosis in HIV-1-infected patients is correlated to the plasma viral load and the stage of the disease.

ISSN:1077-9450    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective:A 4-month observational cohort study was performed to compare the performance of one health maintenance organization (HMO) with two fee-for-service (FFS) systems in Boston, Massachusetts in treating 255 patients with AIDS.Main Outcome Measures:Total 4-month costs; cost subcomponents, including inpatient, outpatient, home care, and zidovudine costs; functional status (difficulties with activities of daily living); and satisfaction with care.Results:Compared with FFS patients, HMO patients were better educated, more often white, less often on Medicaid, and more often reported homosexual or bisexual behaviors as HIV risk factors (all factors,p= .001). Both groups had similar duration of AIDS, baseline hemoglobin levels, and leukocyte counts. Total 4-month costs at the HMO were significantly lower than those in the FFS settings ($4799 U.S. versus $8540 U.S.;p= .013), as were outpatient costs ($1131 U.S. versus $1614 U.S.;p= .001), after adjustment for sociodemographic factors, baseline functioning, main HIV risk factor, and other clinical variables. Adjusted physical functioning (p= .32) and patient satisfaction (p= .82). were similar between systems.Conclusions:The HMO had significantly lower total costs without any observable decrement in functional outcomes or patient satisfaction. The largest component of these cost savings came from reduced spending on inpatient care, but the HMO also spent less on outpatient and home care. Better coordination of care at the HMO may have been responsible for these lower costs.

ISSN:1077-9450    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Although enthusiasm for measuring health-related quality of life (HRQL) in clinical trials exists, information is limited on the meaning of scores. We examined the relation between scores from the 34-item Medical Outcomes Study HIV Health Survey (MOS-HIV) and the more detailed HIV Overview of Problems-Evaluation System (HOPES) using the responses of 318 HIV-infected outpatients being treated in Los Angeles and Baltimore. With the HOPES problem statements as independent variables, statistically significant predictors of the variation in MOS-HIV scores for the Physical Function, Mental Health, and Energy/Fatigue scales were identified using stepwise regression. Approximately 60% to 70% of the variation in each of the scores was explained by five to seven different HOPES problem statements, with a single item explaining 47% to 59% of the variation. We created illustrative profiles for each of the three MOS-HIV scales using the HOPES items identified in the regressions. Independent of the scale, persons scoring in the top MOS-HIV quartile tended to report few if any problems, whereas a decline in score to the next quartile was characterized by functional difficulties (e.g., "HIV interferes with work"). The onset of specific problems might trigger further evaluation and potential intervention from health care providers to help maintain patient functioning.

ISSN:1077-9450    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

While CD4+T-cell counts in the blood of HIV-infected individuals gradually decrease, there is a parallel increase in the number of blood CD8+T cells such that the total number of T cells remains essentially constant for several years(1). The basis and significance of this phenomenon are not known. Based on a statistical analysis of longitudinal T-cell counts from the Transfusion Safety Study (TSS) database and on theoretical considerations, we evaluate several alternative models, including versions of the "blind homeostasis" (BH) hypothesis(1-3). At issue is the nature of the homeostatic regulation of lymphocytes and its apparent failure in HIV infection. The most plausible explanation for the conservation of total blood T-cell numbers while subset ratios change is that CD4+and CD8+T cells compete for a limited access to the blood compartment. Such interaction between the subsets implies, in particular, that changes in the number of CD4+T cells occurring in other tissues cannot be reliably inferred from those observed in the blood. We reiterate propositions made earlier(4)that much of the apparent "depletion" of CD4+lymphocytes during the asymptomatic phase of HIV infection may be attributed to redistribution between the tissues and the blood compartment.

ISSN:1077-9450    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The peripheral blood of 41 Yaruro and Guahibo Indians from Venezuela was examined for HTLV antibodies and DNA. Twenty-five samples (61%) were found to be infected with HTLV-IIB. The sensitivities of the serologic and DNA polymerase chain reaction (PCR) analyses were 80% and 96%, respectively. Epidemiologic studies supported both sexual and perinatal transmission of the virus. Sequence analyses of the HTLV-IIB strains from these Indians indicate that they are unique relative to HTLV-II detected in other groups of humans. HTLV-IIB-G2 isolated from a Guahibo Indian is the most divergent HTLV-IIB strain relative to the prototype HTLV-II NRA.

ISSN:1077-9450    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We assessed factors associated with women's attitudes toward HIV test results in gynecology clinics in Abidjan, Côte d'Ivoire. HIV testing was systematically offered to nonpregnant women attending two gynecology clinics in Abidjan. Individual pretest counseling was performed by trained midwives. Posttest counseling was given 2 weeks later to women who wished to know their HIV test results. HIV testing was offered to a total of 1482 women, of whom 1401 (94.5%) agreed to be screened. The prevalence of HIV infection was 21.3%. Of the women who participated, 10% failed to return. Youth, low educational level, and absence of genital infection were findings individually associated with failure by participants to return for their test results. Among the 1242 women who returned, 13.7% did not wish to know the results of their HIV test. A positive HIV test result, being native to Côte d'Ivoire, a high educational level, and knowing the existence of the asymptomatic stage of HIV infection were factors independently associated with declining to know the HIV test result. In conclusion, women who declined to know their HIV test results presented a specific profile at the time of HIV testing. This information can be used to improve pretest counseling and the efficacy of future HIV screening programs.

ISSN:1077-9450    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This study was designed to assess HIV risk behaviors, HIV seroprevalence, and tuberculosis (TB) infection in shooting gallery managers in Puerto Rico. The subjects were 464 injection drug users (IDUs), of whom 12.5% reported managing shooting galleries. The median frequency of drug injection was higher in shooting gallery managers than in nonmanagers. A trend was observed for purified protein derivative (PPD) reactivity to increase according to the length of time spent as a gallery manager, but this trend was not statistically significant. However, anergy rates increased significantly with increase in the number of months spent as shooting gallery manager (p= .021). Multivariate analyses showed that IDUs reporting shooting gallery management experience of ≥25 months were more likely to be infected with HIV. Prevention programs need to emphasize strategies to protect the health of shooting gallery clients and, in particular, shooting gallery managers. Additional studies are required to determine effective strategies for reducing the risk of HIV and TB infection in shooting galleries.

ISSN:1077-9450    

出版商:OVID    

年代:1998

数据来源: OVID