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

Qualitative and quantitative methods were combined to evaluate the process and outcome of an AIDS prevention program for sex workers in the San Francisco Bay area. 182 women and 43 of their male, noncommercial, steady partners participated in the study over the period July 1, 1989 - June 30, 1990. Mean age was 30 years, 74.2% of women were Black, 16.5% White, and 5.5% Latina. Data were collected for health status, sexual activity, drug use, and serological status for HIV, syphilis, and hepatitis B. Open-ended interviews were conducted and ethnographic field notes taken. The study revealed that while sex workers may fell at risk for HIV and AIDS, perceived risk stems mostly from sex with clients and not from husbands or boyfriends. Condoms are used in this sample far more frequently with clients than with steady partners. Efforts should therefore be made to increase condom use among steady partners. The study also found former sex worker field staff indigenous to the neighborhood and population to be highly effective in recruiting participants and disseminating information. Moreover, these workers became role models for positive behavior change. Combining evaluative approaches proved more effective in determining how to best reach sex workers regarding AIDS risk reduction messages than could either approach independently.
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PMID:Hey girlfriend: an evaluation of AIDS prevention among women in the sex industry. 156 72

Tuberculous infection of the oesophagus is rare. This is confirmed by our present review of cases managed in our teaching hospitals over a period of 18 years which uncovered only 11 patients. The main presentation is that of dysphagia whose algorithm of investigation should seek to differentiate tuberculosis from carcinoma, the more common cause of this symptom. Of the 11 patients, 9 presented with dysphagia while 2 had haemorrhage; 7 had an abnormal plain chest radiograph, of whom 4 had a mediastinal mass lesion (3 were lymphadenopathy and one an abscess). All but one had an abnormal radio-contrast oesophagogram, including a mediastinal sinus in two and a traction diverticulum in another two. The mainstay of investigation was oesophagoscopy through which diagnostic biopsy material was obtained in half of the patients. In the other half diagnosis was by either biopsy of associated mediastinal (3) or cervical (1) lymph node masses or by acid fast bacilli positive sputum (1). The diagnosis was established post-mortem in one patient. Treatment was primarily non-operative with standard anti-tuberculosis drug therapy. Two patients underwent a diagnostic thoracotomy and one a drainage of mediastinal abscess together with resection and repair of oesophago-mediastinal sinus during the early part of the series. Outcome of management was very rewarding in 9 patients and death occurred in 2 patients, one of whom had his anti-tuberculosis drug therapy interrupted by severe hepatitis B virus infection. The other death occurred in a patient whose haemorrhage from an aorta-oesophageal fistula was not established ante-mortem. It is recommended that when biopsy material of the oesophagus is unobtainable or non-diagnostic in patients with dysphagia, especially with an abnormal chest radiograph or human immunodeficiency virus infection, effort should be made to obtain biopsy material from associated lymph nodes, even by thoracotomy if necessary, or culture of biopsy from the radiologically abnormal part oesophagus and sputum for mycobacteria, in order to establish the diagnosis of this rare but eminently treatable cause of dysphagia. Clinicians should be aware of tuberculosis of the oesophagus as a possible cause of haematemesis in patients with otherwise unexplained upper gastrointestinal haemorrhage.
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PMID:Oesophageal tuberculosis: a review of eleven cases. 157 Feb 50

To investigate the prevalence of four blood-borne viruses among a cohort of haemodialysis (HD) patients in Japan, hepatitis B surface antigen (HBsAg), antibody to hepatitis C virus (anti-HCV), antibody to human T-cell lymphotropic virus type-I (anti-HTLV-I), and antibody to human immunodeficiency virus type-1 (anti-HIV-1) were studied in the sera from 393 consecutive HD patients and in the sera from 786 age- and sex-matched healthy individuals from the general population (controls). The prevalence of anti-HCV and anti-HTLV-I was significantly higher in HD patients than in the controls (17.8% vs. 1.1% and 3.8% vs. 0.5%), but the prevalence of HBsAg showed no significant difference. No patients or controls were positive for anti-HIV-1. In HD patients with no history of blood transfusion, anti-HCV was detected in only one (2.1%) of 48 patients undergoing HD treatment for less than 3 years, and there was no significant difference between the prevalence of anti-HCV in these patients and in the controls. In HD patients who had received blood transfusion, anti-HTLV-I was detected in only one (1.0%) of 103 patients undergoing HD treatment for less than 3 years, and there was no significant difference between the prevalence of anti-HTLV-I in these patients and in the controls. These findings suggest that in recent years, the risk of HCV transmission by routes other than blood transfusion in HD patients is low, and that of HTLV-I transmission by transfusion is very low or non-existent.
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PMID:Prevalence of four blood-borne viruses (HBV, HCV, HTLV-I, HIV-1) among haemodialysis patients in Japan. 157 19

To investigate the prevalence of hepatitis C virus infection in two risk groups, stored serum samples from treated haemophiliacs and intravenous drug users were tested for anti-HCV by both anti-C-100 based and second generation ELISAs (Abbott and Ortho) followed by testing in two confirmatory immunoblot assays that incorporate core as well as other non-structural antigens (Innogenetics LIA and Chiron RIBA-HCV test). Clear evidence of HCV infection was found in all but one of 78 haemophiliacs treated with non-virus inactivated clotting factor concentrates, but in none exposed only to super dry heat-treated concentrates. Only four samples gave rise to conflicting serological results between the four tests, two of these occurred in patients with advanced HIV related disease and almost certainly reflected loss of humoral immunity associated with disease progression, and the others occurred in the only two patients tested who were chronic carriers of hepatitis B infection and may reflect an interaction between the two viruses. Comparison of anti-C-100 versus second generation tests in immunocompetent drug users revealed a false negative rate of 20% using C-100 alone, indicating the advantage of using second generation assays for detection of past or current HCV infection. Of all of the antigens used in the confirmatory assay, positive sera showed strongest and most frequent reactivity with the C22 and C33c proteins (Ortho RIBA).
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PMID:Use of several second generation serological assays to determine the true prevalence of hepatitis C virus infection in haemophiliacs treated with non-virus inactivated factor VIII and IX concentrates. 158 Dec 36

The generation of memory B cells in response to vaccination with a baculovirus-derived recombinant gp160 candidate AIDS vaccine, VaxSyn HIV-1, was investigated in 12 healthy human volunteers who were immunized with VaxSyn HIV-1, hepatitis B vaccine, or alum adjuvant alone on days 1, 28, 180, and 540. Peripheral blood mononuclear cells were collected pre- and post-immunization and cultured unstimulated or with pokeweed mitogen (PWM), VaxSyn HIV-1 (rgp160), or HIV-1 lysate (iHIV-1) for 7 days before polyclonal and HIV-1-specific IgG production in culture supernatants (SNs) were measured. No differences were seen in the spontaneous or PWM-induced IgG production in SN from vaccinees and controls. Only vaccinee SN contained higher-than-normal levels of polyclonal IgG after stimulation with either rgp160 or iHIV-1, especially after the second and third booster immunizations on days 180 and 540, respectively. There were also contemporaneous increases in HIV-1-specific antibody in SN of all vaccinees, albeit at different time points throughout the study. We conclude that VaxSyn HIV-1 induces antigen-specific B-cell responses with the generation of memory B cells in vivo that can be reactivated in vitro to deliver an anamnestic response.
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PMID:B-cell activation and differentiation by HIV-1 antigens among volunteers vaccinated with VaxSyn HIV-1. 161 72

A cross-sectional seroepidemiologic study was carried out between 1985 and 1990 in 1,567 heterosexual intravenous drug users who had been seen at the AIDS Regional Reference Center in Palermo, Italy, to evaluate the rate of human immunodeficiency virus type 1 (HIV-1) seroprevalence in this group and its long-term trend. Sixty serum samples collected from drug users in 1980 and 1983, before the founding of the Center (1985), were tested as well. Some demographic and behavioral risk factors were studied in a subgroup of intravenous drug users enrolled in 1985, 1987, and 1990 for their possible association with HIV-1. These factors were also studied in relation to hepatitis B virus infection, since both viruses share the same modes of spread. These drug users had a higher prevalence of markers for hepatitis B virus than of HIV-1 antibodies, and the prevalence rates in sera collected declined over time for both infections. The presence of both antibodies to HIV-1 and markers for hepatitis B virus was independently associated with the age of the drug user, the duration of drug use, and the year of serum collection. Antibodies to HIV-1 were observed more frequently in females than in males. No relation was found between education or employment status and the presence of HIV-1 antibodies or hepatitis B virus markers. Although new HIV-1 infections still occur, the decline in seroprevalence observed at the end of the 1980s might be related to modifications in social behavior among newer drug users, partial exhaustion of the susceptible population, and increasing risk awareness in more experienced users.
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PMID:The changing pattern of human immunodeficiency virus type 1 infection in intravenous drug users. Results of a six-year seroprevalence study in Palermo, Italy. 162 37

We report the development of severe hepatotoxicity in a patient on zidovudine therapy who received 3.3 g of acetaminophen in less than 36 hours. Three days later, the patient's serum aspartate aminotransferase level was 5,724 U/L, alanine aminotransferase was 3,124 U/L, lactate dehydrogenase was 12,675 U/L, alkaline phosphatase was 84 U/L, and total bilirubin was 20 mumol/L. These values substantially improved over the ensuing 4 days. Serologic results for hepatitis B, hepatitis A, and cytomegalovirus were all negative. The pattern and time sequence of transaminase elevation in this patient are consistent with acute acetaminophen hepatotoxicity, especially since zidovudine-induced hepatotoxicity is described as producing cholestasis rather than acute hepatitis. We hypothesize that our patient's susceptibility to acetaminophen-dependent hepatotoxicity may have been augmented by competitive utilization of glucuronidation by other drugs such as zidovudine and/or trimethoprim-sulfamethoxazole with subsequent increased cytochrome P450-dependent metabolism of acetaminophen. Additionally, due to malnutrition and/or to human immunodeficiency virus infection per se, our patient may have had decreased hepatic reserves of glutathione with which to conjugate the toxic acetaminophen product of the P450 system. Although severe acetaminophen-associated hepatotoxicity has not previously been reported in patients receiving zidovudine, we suggest that clinicians be aware of this potential interaction and counsel malnourished patients, especially those with concomitant hepatic disease, to exercise caution when taking both these medications.
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PMID:Severe hepatotoxicity in a patient receiving both acetaminophen and zidovudine. 836 34

Five (0.74%) of 678 women delivering in 1985 at a tertiary referral hospital for high-risk pregnancies and 16 (1.34%) of 1198 women visiting an urban prenatal obstetrics clinic in 1986-1987 had serologic evidence of human immunodeficiency virus type 1 (HIV-1) infection. Unlinked testing (removal of personal identifiers from the blood specimen and the epidemiologic data sheet) of residual serum from hepatitis B virus serologic testing was used. Neither age, marital status, payor status, nor serologic markers of hepatitis B virus infection was useful in identifying women at risk for HIV-1 infection. As a result of these data, we have initiated a program in which counseling is offered to all women and testing for those who consent. Unlinked testing of women who refuse consent is performed for epidemiologic purposes. This will allow us to continue to plan for health care resource needs and to track the course of the epidemic in various subgroups of pregnant women.
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PMID:Seroprevalence of human immunodeficiency virus type 1 among pregnant women. 162 22

The risk of Theatre Staff becoming infected from blood borne viruses such as HIV and Hepatitis B is steadily increasing. Sir David Cox's report (1988) predicted that the number of people infected with HIV by the end of 1987 would be between 20,000 and 50,000. Although these predictions are now thought to be more accurately estimated between 12,000 and 26,000, the number of people developing Aids is still expected to rise at an alarming rate. The precautions taken within the Theatre Department to reduce this risk are becoming transparently inadequate. It is no longer sufficient--or acceptable practice--to only be vigilant in avoiding blood contamination if the patient falls within a certain 'high risk' category. A happily married, middle aged woman may also be a virus carrier, particularly considering the long dormancy the HIV virus can exhibit before being detectable. It must be assumed that everyone is a potential carrier and the same precautionary measures taken for every patient, regardless of their past history, or present appearance.
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PMID:The swab rack--an outdated ritual. 162 36

It goes without saying that the members of any professional group are more likely to modify their behavior if they are provided with logical, rational reasons to enact the suggested change. In the mid 1980s, health care providers, including dental personnel, were advised to adopt universal precautions and to alter their infection control habits with minimal justification, apart from the general unease and paranoia surrounding AIDS. Therefore, it is understandable that some practitioners would react with scepticism to the idea that their traditional infection control techniques were less than adequate, while others would overwhelmingly embrace the new recommendations in the misguided belief that personal, patient, staff and family safety would be enhanced. This predictable confusion is epitomized by the dentist who "sterilizes" extraction forceps by immersing them in alcohol for 10 minutes, versus the dentist who wears gloves, mask and disposable gown to conduct a recall examination. And if dentists are perplexed, it is clear that their staffs are equally, if not more confused, since they are exposed to the exaggerated claims and counter claims of sales agents. The microbes encountered in dental practise, apart from the hepatitis B virus, pose no significant risk to dental personnel or their patients, and the danger of hepatitis B transmission is reduced most effectively by vaccination. In reality, the genesis of dentistry's current emphasis on infection control resides entirely with HIV disease. But there is no credible clinical evidence to suggest that HIV infection is transmitted via dental treatment. Indeed, it may be theorized that for such a transmission to occur, the blood stream of the susceptible recipient would have to be invaded directly by a pathogenic inoculum of the virus--an unlikely event in the normal practise of dentistry. Under such circumstances, infection control practises should ignore the danger of HIV transmission, but concentrate on: Sterilization of all surgical and invasive instruments to protect patients from potential cross-infection. All dental staff receiving hepatitis B vaccinations. Dental staff wearing gloves, especially while performing intraoral procedures with blood release, and handling used instruments, to protect them from direct contact with potential pathogens. Working in a clean environment, in which blood spills and splatters are removed mainly for esthetic reasons. Such measures reflect the actual potential for disease transmission, as it exists in dentistry. They are justified and economical, and will be implemented by concerned but knowledgeable dental staff.
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PMID:Concerns regarding infection control recommendations for dental practice. 151 56


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