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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

HIV disease, once considered an acute disease with a 100% mortality rate but a very short symptomatic stage, has begun to emerge as a preventable, treatable, chronic disease. Interactions between patients, dentists, and physicians are essential to gain the information necessary to provide appropriate dental care for both short-term and long-term survivors. The prognosis and survival time of the dental patient may influence treatment protocols and necessitate modified dental procedures. Certain clinical and laboratory parameters, which may be useful indicators of disease progression, need to be recognized by the dental clinician. These parameters include systemic signs, symptoms, and serologic data as well as intraoral manifestations associated with HIV disease. Although a perfect classification system for progression of HIV disease does not exist, trends among larger cohorts may enable health care providers to estimate the prognosis and survival of HIV-infected patients on an individual basis. This article presents clinical and laboratory parameters that indicate HIV disease progression. Providers who care for HIV-infected patients need to consider these parameters to establish an appropriate and flexible treatment plan based on changes in the patient's medical status.
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PMID:Evaluation of prognosis and survival of the HIV-infected patient. 140 7

Much has been learned about the pathogenesis and natural history of AIDS over the past decade. The causative agent is now known to be a human retrovirus that selectively infects CD4 lymphocytes and monocyte/macrophages. The structure, genetic composition, and major proteins of HIV have been identified, and its basic pathophysiology defined. Antibody tests have been developed to screen for HIV infection, and antiretroviral agents devised for its treatment. The viral and host factors that protect against HIV infection and modulate its course, once established, remain to be clarified. HIV infection produces a chronic disease characterized by a primary syndrome, clinical latency period, and manifestations of increasing immunosuppression. It encompasses a wide clinical spectrum ranging from the absence of symptoms to the presence of life-threatening opportunistic diseases. Clinical and laboratory predictors of disease progression have been identified. Neither of the published classification systems for HIV has gained widespread acceptance by the medical community. Staging of patients based on the management implications of their CD4 lymphocyte count is perhaps of greatest practical value to the clinician.
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PMID:Pathogenesis, natural history, and classification of HIV infection. 159 91

The article proposes that the clinical case definition for Acquired Immunodeficiency Syndrome in Africa is an unworkable concept, with the wrong definition, incorrect validation, improper use, and consequently is a poor surveillance tool. The definition was proposed by the World Health Organization in 1986 to satisfy the use in countries with limited diagnostic resources, and resources for serological testing. Critical review until now of this procedure was lacking. Currently serological testing is available and of high quality. It does not seem justifiable to continue using a provisional surveillance definition. Abandoning this classification procedure may also lead to the focus on problems other than opportunistic infections and AIDs. Clinical surveillance is important, but as well morbidity and mortality need monitoring. It is argued that the definition is an unworkable concept because patients with underlying immunosuppression disorders such as AIDs can not be easily distinguished from chronic disease patients; i.e., pulmonary tuberculosis, renal failure, uncontrolled diabetes, or diarrhea with weight loss. Clinical accuracy is insufficient. It is the wrong definition because pulmonary tuberculosis with a persistent cough cannot be distinguished for those HIV positive and those not. There is inconsistency in the WHO clinical definition and the Centers for Disease Control definitions of AIDs. The incidence of tuberculosis in countries with unmodified clinical case definitions may contribute to an inflated number of AIDs cases. The wrong standards were used to validate the WHO definition in evaluative studies. The reference sensitivity ranges indicate that the definition is insensitive to identifying seropositive patients. Also, the HIV status of patients does not equate with AIDs. Although designed for surveillance, the clinical case definition is used by doctors for individual patient management. Labeling a patient as having AIDs, when he is HIV negative, leads to negative consequences. Researchers compare African AIDs data with North American data with imprecise and noncomparable definitions. As a surveillance tool in countries with a fragmentary or without a vital registration system, it is an inaccurate tool. Alternatives to obtaining data about the spread and impact of HIV are cluster sampling, hospital surveillance of selected populations, anonymous testing of pregnant women or patients in sexually transmitted disease clinics. In Nairobi, a necropsy survey found that 16% had AIDs but 38% were HIV positive.
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PMID:What use is a clinical case definition for AIDS in Africa? 173 1

This article addresses ethical and legal issues related to the HIV epidemic. The author discusses individual and utilitarian schools of philosophy, and identifies philosophical issues in relationship to the stage of HIV infection that the client is experiencing. Prevention strategies and nursing interventions for three levels of prevention are also presented. HIV infection is now accepted as a chronic disease, which is characterized by different stages. Nursing intervention focused on prevention can be related to the stage of infection.
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PMID:Examining the ethical and legal issues generated by the HIV epidemic. 187 34

Recent psychoneuroimmunologic findings have suggested that it may be useful to evaluate the influence of behavioral factors on immune functioning and disease progression among human immunodeficiency virus-Type 1 (HIV-1) infected individuals. Behavioral interventions with immunomodulatory capabilities may help restore competence and thereby arrest HIV-1 disease promotion at the earliest stages of the infectious continuum. Evidence describing benefits of behavioral interventions such as aerobic exercise training on both psychological and immunological functioning among high-risk HIV-1 seronegative and very early stage seropositive gay men is presented. The HIV-1 infection is cast as a chronic disease for which early immunomodulatory behavioral interventions may have important physical and psychological impact.
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PMID:Psychoneuroimmunology and HIV-1. 218 Oct 3

HIV infection is now perceived as the end stage of a chronic disease that is spreading most rapidly among blacks and Hispanics. The politics of the HIV epidemic in the 1980s were dominated by four interacting factors: fear and fascination; who had the disease and to whom it seemed to be spreading; the endemic problems of United States social policy; and the impact on policy of advances in scientific knowledge. This paper analyzes the political history of each of these factors and describes the dominant policies of the federal government and the states regarding HIV in the areas of surveillance, prevention, research, and financing. Four uncertainties will have a profound influence on the future politics of the HIV epidemic: how the states and the federal government will address the general problems of paying for the care of people with chronic diseases and providing access to care for the uninsured and the underinsured; the number and distribution of the sexual behaviors that transmit infection with HIV and the effectiveness of policies to persuade people to modify these behaviors; precisely who uses addictive drugs and the effectiveness of measures to change their behavior; and the natural history of the virus.
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PMID:Chronic disease and disadvantage: the new politics of HIV infection. 221 29

Although most babies born to women with HIV will not develop AIDS, many health professionals and segments of the public object when these women will not forgo pregnancy. Such a view fails to consider fully the cultural, political, and socioeconomic contexts in which seropositive women make reproductive choices. HIV infection is only one of many conditions of chronic disease that can be passed from a woman to her fetus, and should not be singled out as a target for coercive policies. Rather, government and society have an obligation to empower women to protect themselves against HIV infection in the first place, and to offer them options for self-esteem and achievement independent of reproduction.
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PMID:HIV and childbearing.1. Uncertain risks and bitter realities: the reproductive choices of HIV-infected women. 226 22

Financing health care for persons with HIV infection is an increasing burden on states and their taxpayers. The major problems of state policy in the 1990s are how to organize and finance both early detection of infection and preventive drug treatment for persons without symptoms and how to provide a full range of health and social services for infected persons whose life expectancy is unknown. This article first describes the shift in the perceptions of HIV infection from a plague to a chronic disease and the implications of this shift for state government. Then it places the history of financing for health care in the context of general health care financing policy during the past decade. Next it describes the history of state action to finance care for HIV infection, especially the use of of Medicaid Waivers, problems of state financing for expensive prescription drugs, and state initiatives, especially in California, Michigan, New Jersey and New York. Finally, the article presents seven policy questions that states should consider in deciding what, if any, legislation or regulations to enact in order to organize treatment and pay some or all of the costs of care for persons with HIV infection.
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PMID:Financing health care for persons with HIV infection: guidelines for state action. 228 48

Virtually only researchers from developed countries have done studies of risk factors for acute respiratory infections (ARIs) since these countries have an infrastructure that can support large multidimensional epidemiologic studies while developing countries do not. Yet results from these countries studies are not always relevant to developing countries since risk factor exposures in developing countries. For example, the predominant problem in developing countries is that ARIs in children is that ARIs in children 5 years old often result in death whereas in developed countries morbidity predominates. Based on studies in developed countries, there is plenty of evidence that strong associations exist between ARIs and chronic disease in adults, direct and passive smoking, and breast feeding. Thus policy need not request additional studies to base proper changes in public health policy. Yet researchers do need to collect more data on the associations between ARIs and HIV infections, low birth weight, and other possible risk factors. In fact, some are now examining relationships between ARIs and malnutrition, vitamin A supplementation, and indoor air pollution in developing countries. Some of the more important issues in developed countries are the links between maternal antibody levels and passive immunity in infants, the links between air pollution and ARIs, and the reasons for a rise in pneumonia in the aged. Another area that scientists need to explore is the association between respiratory infection (especially between 1-12 months old) and subsequent ARI. Further epidemiologists should standard data collection methods in both developed and developing countries. For example, the chronic respiratory questionnaire of the American Thoracic Society can serve as a model for acute symptom questionnaires.
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PMID:The epidemiology of acute respiratory infections in children and adults: a global perspective. 228 16

The disorder, benign transient hyperphosphatasia, has been defined previously as a condition occurring in a normal child with spontaneous, transient elevation of alkaline phosphatase. We report three cases of hyperphosphatasia in patients with congenital HIV infection and underlying liver disease which appear to satisfy the criteria for benign transient hyperphosphatasia despite the presence of chronic disease. These three children, when compared with three normal children with transient hyperphosphatasia exhibited similar patterns of change in serum alkaline phosphatase. Extreme elevation of serum alkaline phosphatase in HIV infected patients does not of itself suggest alterations in clinical status nor indicate the need for extensive evaluation.
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PMID:Benign transient hyperphosphatasia and HIV infection. 278 57


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