摘要:

This article reports on a study of medical costs of intravenous drug users (IVDUs) with acquired immune deficiency syndrome (AIDS) in Brooklyn, NY, U.S.A. Sociodemographic and clinical data as well as information on medical resource use was gathered for 38 IVDUs with AIDS, all of whom belonged to minority racial/ethnic groups and were covered by Medicaid insurance. Data obtained through patient interviews and review of medical records indicated that the sample had mean annual medical charges of $33,002 per patient per year. Average inpatient charges were $24,171, with an average of 1.13 hospitalizations and 38.5 days of in-hospital care. Significantly more in-hospital care and higher inpatient changes on average were noted among patients who did not have a stable housing environment. Outpatient charges averaged $8,831, with 80% for pharmaceuticals. This estimate of medical charges and resource use, one of the first developed in a cohort of nonwhite individuals with i.v. drug use as a risk factor for human immunodeficiency virus infection, is about one third less than recent estimates reported from studies of cohorts of white homosexual men.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

To answer questions related to the usefulness of premarital testing for human immunodeficiency virus type 1 (HIV-1), two “blinded” or “nonlinked” HIV-1 serosurveys were done in New Jersey, a state with a high incidence of AIDS, on blood specimens submitted for a premarital serologic test for syphilis. The first survey involved premarital blood specimens submitted to the New Jersey Department of Health laboratory for the year starting September 1987. The second survey involved premarital specimens submitted to five private or hospital clinical laboratories in the spring of 1989, of which approximately 1,000 consecutive premarital specimens from each laboratory were sent to the Department of Health laboratory for HIV-1 testing. Of 4,247 specimens tested in the 1987–1988 survey, 21 (0.49%) were positive for antibodies to HIV-1, while among 4,696 specimens in the 1989 survey, 29 (0.62%) were positive. When the survey results were weighted by the number of marriages by geographic regions of the state, the weighted premarital HIV-1 seroprevalence was 0.55% for the 1987–1988 survey and 0.62% for the 1989 survey. The male/female ratio of positive tests was 2.7:1 in 1987–1988 and 1.6:1 in 1989. Of the 8,943 specimens in both surveys, 5 (0.06%) gave an indeterminate immunoblot result, compared with 50 positive results. These percentages of premarital HIV-1 infections are much higher than earlier estimates and reports and are of the same magnitude as recently reported blinded premarital HIV-1 testing elsewhere. Results of this magnitude support a recommendation in New Jersey of voluntary HIV-1 counseling and testing for marriage applicants.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

To evaluate determinants of the prevalence of human T-cell leukemia virus type I (HTLV-I) antibody positivity in an endemic region, Miyazaki Prefecture, Japan, demographic and serologic data were collected on 7,055 individuals consecutively seen at Miyazaki City Health Promotion Center between September 1983 and December 1984. The overall HTLV-I seroprevalence was 8.5%; age and gender distributions of HTLV-I antibody positivity were consistent with previous findings for endemic populations. The prefecture could be divided into two geographic areas based on seroprevalence: high prevalence (12.1%) in the southwest and medium prevalence (6.6%) for the rest of the prefecture. Current occupation in fishing, forestry, or livestock raising significantly correlated with HTLV-I seropositivity [relative risk (RR) = 3.0, 2.5, 2.0, respectively]; farming also was associated but only in the medium prevalence region (RR = 1.3;p= 0.06). For a subset of 157 HTLV-I-positives and 175 negative controls screened for antibodies to the toxoplasmosis organisms, toxoplasma exposure was not significantly associated with HTLV-I infection. In this endemic Japanese population, both geographic and sociologic factors characterized the distribution of HTLV-I seroprevalence, reflecting transmission patterns and historical duration of the infection.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A seroepidemiological study was conducted, during 1988 and 1989, of mother-child pairs living in The Gambia (West Africa) in order to determine the distribution of the human immunodeficiency viruses type 1 (HIV-1) and type 2 (HIV-2). Specimens were obtained from 931 children (age range, 14–17 months) and 923 mothers (age range, 14–47 years) using village-based cluster samples; the children are participating in The Gambia Hepatitis Intervention Study (GHIS), a large-scale HBV vaccination program. Large numbers of indeterminate Western blot patterns were observed among the mothers, mainly for HIV-1 antibodies; HIV-1 infected subjects were not found, whereas an HIV-2 seroprevalence rate of 0.75% was observed. The children born to the seven HIV-2 positive women were seronegative for HIV-2 antibodies, and none of the children showed HIV-2 or HIV-1 seropostitivity.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Twenty-nine human immunodeficiency virus type 2 (HIV-2) seropositive women identified in a cross-sectional study in Bissau in 1987 participated in a follow-up study in 1988, where each was matched for age and marital status with two HIV-2 seronegative women. Detailed information about all pregnancies was obtained. The HIV-2 seropositive women and their controls had similar mean numbers of pregnancies, live children, children who died, and abortions. The HIV-2 seropositive women did not have a greater risk of having had an abortion or a child who died than did the HIV-2 seronegative women. No difference in survival was seen between children born to HIV-2 seropositive and HIV-2 seronegative women. The H/S-ratios and CD4 numbers were lower in the seropositive group, but none had values lower than 0.4 and 0.4 x 109/L, respectively. Seven prospectively observed children born to HIV-2 seropositive mothers showed no sign of infection. The lack of evidence of transmission of HIV-2 from mother to child is suggested to be due to the absence of marked immunodeficiency in this random sample of the general population.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Better markers are needed to monitor the efficacy of antiretroviral drugs in persons infected with human immunodeficiency virus (HIV). We investigated the effects of zidovudine (ZDV) and dideoxycytidine (ddC) on the presence of unintegrated HIV-1 DNA in peripheral blood mononuclear cells (PBMCs) from AIDS patients. DNA was extracted from PBMCs and separated into low molecular weight (unintegrated) and high molecular weight (integrated) chromosomal fractions. These DNA fractions were then amplified by a quantitative polymerase chain reaction (PCR) and the amount and percentage of unintegrated HIV DNA were determined. Very high levels of unintegrated HIV DNA were found in AIDS patients not receiving treatment with ZDV or ddC (median = 95% unintegrated HIV DNA). In contrast, most patients who had received 4 or more weeks of antiretroviral therapy had lower levels of unintegrated HIV DNA (median = 30% unintegrated HIV DNA for patients receiving ZDV). Paired samples taken from five patients before and after therapy showed a striking reduction in the percentage of unintegrated HIV DNA. The decrease in the proportion of unintegrated HIV DNA in AIDS patients was due to both a reduction in the copy number of unintegrated HIV DNA and an increase in the copy number of integrated HIV DNA. Thus, measurements of unintegrated and integrated HIV DNA may be useful in providing objective assessments of the effectiveness of antiretroviral therapies.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

To investigate the influence of HLA specificities on the rate of progression and outcome of human immunodeficiency virus (HIV) infection, we performed (a) a case-control study in 1989–1990 of HIV-seropositive individuals stratified by both risk behavior and ethnic background, (b) a longitudinal cohort study of HIV-infected male homosexuals enrolled in 1981–1982, and (c) an analysis of individuals with a diffuse infiltrative CD8 lymphocytosis syndrome. In the case-control study, there was a significantly higher frequency of HLA-B35 among intravenous drug users, but not homosexuals, who developed illnesses meeting the case definition for AIDS compared with asymptomatic HIV-positive controls, regardless of ethnic status. In the longitudinal study, HLA-B35-positive homosexuals had a significantly increased rate of progression to AIDS and decreased survival over a 7-year period compared with those without this specificity. Finally, there was a significantly decreased frequency of HLA-B35 in individuals with the diffuse infiltrative lymphocytosis syndrome, a clinically and genetically distinctive disorder occurring in HIV infection in which a low rate of progression to opportunistic infections was found. The high rate of salivary and lacrimal gland lymphoma in this group suggests that there is dissociation between the presence of HLA-B35 and the development of particular AIDS-defining conditions. We conclude that HLA-B35 is a risk factor for more rapid progression to AIDS, particularly opportunistic infections and Kaposi's sarcoma, operating in groups with high rates of newly acquired HIV infections such as New York City male homosexuals in 1981–1982, and intravenous drug users in 1989–1990. We interpret the absence of HLA-B35 as a statistically significant risk factor for HIV disease progression in homosexuals at present to be a result of modified high-risk behavior patterns and consequent diminution in seroconversion rates among this group, leading to a selective attrition through death of HLA-B35-positive individuals from the present pool of HIV-infected homosexuals.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Lactoferrin, lysozyme, interferon, and neopterin levels were determined in parotid saliva from 44 individuals with different clinical stages of human immunodeficiency virus (HIV) infection and 19 HIV-seronegative controls. The secretory output of individual components was calculated according to the fluid flow rate. No parotid interferon activity was found in any of the HIV-infected subjects or controls, and no significant differences in parotid lysozyme or neopterin outputs were observed. The lactoferrin output was significantly decreased in HIV-seropositive subjects in parallel with their markedly reduced parotid secretory IgA output. This combined deficiency of parotid lactoferrin and secretory IgA may well contribute to the frequent oral infections seen in subjects with HIV infection.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Quantification of human immunodeficiency virus (HIV) proviral DNA in peripheral blood mononuclear cells (PBMC) was performed in 13 HIV-seropositive asymptomatic individuals during 10–24 months by polymerase chain reaction amplification of multiple half-log dilutions of cellular DNA. At enrollment, subjects had a geometric mean titer of 100 copies of HIV provirus per 106PBMC (mean ± SD, 2 ± 0.9 log10). In four untreated individuals there was no significant change in provirus levels during a mean period of 13.3 months. In eight patients treated with zidovudine (ZDV) and human recombinant interleukin 2 (rIL-2), HIV provirus copies declined to 13 per 106cells (1.1 ± 0.8 log10) at the end of the first course of ZDV and rIL-2 at week 20 (p < 0.01), and to 40 per 106cells (1.6 ± 0.9 log10) after 12 months of treatment (p < 0.04). Subsequent courses, which included 12 weeks of ZDV alone or 4 weeks of IL-2 alone, did not significantly change the already depressed provirus copy numbers. Proviral copy number also remained depressed during drug-free “washout periods” between courses. Finally, we observed a return to a geometric mean of 400 copies per 106cells (2.6 ± 0.3 log10) a mean of 7.9 months after discontinuation of therapy. Measurement of changes in HIV provirus should provide a direct marker for defining antiviral activity of drugs, biologics, and combination therapy.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Neuropathic complaints were frequently observed in a Phase I study of dideoxyinosine (ddI) in 44 patients with AIDS and AIDS-related complex. Ten patients (23%) were thought to have a ddI-related peripheral neuropathy. The symptoms were primarily sensory, and there was limited motor involvement. The sensory symptoms improved in all patients with discontinuation of ddI. Some patients tolerated reintroduction of ddI at lower doses without significant recurrence of the neuropathic symptoms. Although the neuropathy was usually seen in patients taking higher doses of ddI than used in current treatment protocols, clinicians must be aware of this potential toxicity as more human immunodeficiency virus-infected patients are being treated with ddI.

ISSN:0894-9255    

出版商:OVID    

年代:1992

数据来源: OVID