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Query: UMLS:C0019693 (HIV)
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From 1981 through 1990, 100,777 deaths among persons with acquired immunodeficiency syndrome (AIDS) were reported to CDC by local, state, and territorial health departments; almost one third (31,196) of these deaths were reported during 1990. During the 1980s, AIDS emerged as a leading cause of death among young adults in the United States. By 1988, human immunodeficiency virus (HIV) infection/AIDS had become the third leading cause of death among men 25-44 years of age and, by 1989, was estimated to be second, surpassing heart disease, cancer, suicide, and homicide (Figure 1). In 1988, HIV infection/AIDS ranked eighth among causes of death among women 25-44 years of age (Figure 2); in 1991, based on current trends, HIV infection/AIDS is likely to rank among the five leading causes of death in this population (1).
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PMID:Mortality attributable to HIV infection/AIDS--United States, 1981-1990. 189 57

Poly(ADP-ribose)polymerase is a chromatin-bound enzyme which is activated by free DNA ends and is therefore stimulated by a variety of DNA-damaging agents. The enzyme transfers the ADP moiety of NAD to nuclear proteins to create protein-bound ADP-ribose polymers. Under conditions favouring an accelerated poly(ADP-ribose) polymer formation, the enzyme may exhaust cellular NAD pools. At the same time, or shortly thereafter ATP levels drop and cell viability eventually declines. As a series of chemical and physical agents which may play a role in activating latent HIV-1 infection or favouring HIV-1 replication, have a DNA-damaging activity, we investigated the behaviour of poly(ADP-ribose)polymerase activity in various types of HIV-1-infected cells. The results obtained show that HIV-1-infected cells to possess an increased poly(ADP-ribosol)ating activity together with an accentuated fragmentation of cellular DNA which are associated with the time course of HIV-1 replication. These data give circumstantial support to the hypothesis that a NAD-depdendent cellular suicide response to DNA damage, could play a role in the death of HIV-1 infected cells. In this respect, the impared immunocompetence of HIV-1-infected patients could bear some resemblance to immune attribution that sometimes accompanies some inborn errors affecting DNA precursor metabolism and DNA integrity.
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PMID:Increased poly(ADP-ribose)polymerase activity in cells infected by human immunodeficiency virus type-1. 190 73

In 1986, a national survey was carried out in France among 4846 drug abusers attending specialised agencies and treatment centres. Data are analysed and compared with the results of a previous study in 1972. Most French drug abusers are men (74%) ranged in age from 20 to 29 years (68%). Data suggest increasing problems with heroin (69%), cocaine (13%), solvents (5%), alcohol (26%) and multiple drug dependence. Women are younger, they have attempted suicide more often than men but have been incarcerated half as often. Concerning drug abuse trends, women appear to use increasingly sedatives in combination with other drugs. Partial data concerning HIV seropositivity reveal a rate of 48% among drug abusers having been tested.
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PMID:Drug addicts attending specialised institutions: towards a drug addiction data bank? 202 59

Of 3450 women tested for antibodies to human immunodeficiency virus HIV-1 and HIV-2 between September 1985 and July 1989, 61 were positive (1.8%). Twenty-seven of these (44%) were presumed to have acquired their HIV infection by heterosexual contact and 23 (38%) were intravenous drug addicts. In geographical origin, 23 (38%) of the patients were from the UK and 19 (31%) from Africa. Amongst these 61 women, 2 (3%) have since died, one committed suicide and one was suspected of committing suicide.
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PMID:Risk factors of female HIV-seropositive patients attending the clinic for sexually transmitted diseases at St Mary's Hospital, London. 204 8

Histologic studies supplemented by in situ hybridization for human immunodeficiency virus type 1 (HIV-1), Epstein-Barr virus, cytomegalovirus, and human herpesvirus type 6 were performed on tissues obtained from the autopsy of six patients who died either by homicide or suicide shortly after learning of their seroconversion. Except for mild nonspecific lymphoid tissue reactions, no lesions were noted that would indicate HIV-1 infection. DNA from all viruses was detected in some lymphoid cells. The amount of DNA for Epstein-Barr virus, cytomegalovirus, and human herpesvirus type 6 corresponded to that observed for clinically occult latent infection. Lymphoid cells carrying HIV-1 DNA were even less frequent. Cells positive for HIV-1 were noted in the lamina propria of the large intestine in three male homosexuals and in one female prostitute. The cells were arranged similar to antigen-presenting cells. The present findings are consistent with current theories regarding the pathogenesis of HIV-1-associated disease.
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PMID:Search for early lesions following human immunodeficiency virus type 1 infection. A study of six individuals who died a violent death after seroconversion. 215 81

In this chapter, we have suggested that neurobehavioral phenomena in HIV-infected individuals can be usefully grouped according to underlying pathogenesis. Neurogenic phenomena are those that result from direct involvement of the brain either by HIV-1 (primary neurogenic disorder) or from opportunistic infection, neoplasia, or side effects of treatment (secondary neurogenic disorder). These phenomena should be distinguished from disturbances resulting from a second pathogenetic mechanism--the psychogenic disorders. We define psychogenic disorders as those that reflect primarily psychological responses to knowledge of HIV infection and/or progression of disease, and resultant of social ramifications. In proposing the neurogenic and psychogenic groupings, we do not intend to harken back to antique "mind-body" distinctions. We recognize fully that diseases of the brain can and do cause disturbances in mood, thought, and behavior, and that preexisting psychogenic disturbances might, in fact, be substantially worsened by onset of such neuropathology. Nevertheless, for the sake of clarity and also of determining appropriate treatment, we feel that the distinction we propose is a heuristically useful one. Challenges that lie ahead include defining more precisely the incidence and natural course of HIV-associated neurogenic disorder. Although there is little doubt that CDC IV individuals have higher prevalence of both subclinical and clinical "organic mental" symptomatology, the time of onset and rate of progression of such changes are not understood. At present, it seems likely that early in the course of HIV infection, the CNS is spared; at some point, however, rate of neuropsychiatric abnormality probably increases, and this may not be directly related to progression of the immunological aspect of the disease. In regard to psychogenic phenomena, it is clear that anxiety syndrome can occur as a direct product of knowledge of HIV serostatus and may be exacerbated by progression of disease. It is possible also that some subgroups of HIV + individuals (e.g., military samples) may be at heightened risk for suicide. These observations pose challenges for focused intervention with these groups. Accumulating data both on neurogenic and psychogenic phenomenology underscore also the importance of conceptualizing HIV infection in neurobehavioral as well as immunologic-virologic terms.
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PMID:Neurogenic and psychogenic behavioral correlates of HIV infection. 218 17

The health of health care workers is mentioned in the early occupational health literature but the significance of these populations in occupational health has only recently received widespread attention. The health care industry now employs about 5% of the national workforce and, despite its size and the multiplicity of its occupational hazards, little systematic enquiry has taken place to quantify these risks. The occupational health services available to health service staff are often rudimentary. Current health concerns include evidence that the mortality experience of subgroups is not as favourable as for comparable socio-economic groups. Specific areas of concern are occupational exposures to biological agents such as HIV and hepatitis B, pharmaceutical products, allergens, violence, electromagnetic fields and chemical carcinogens. Psychosocial factors and excessive hours of work may, in part, explain the high suicide rates experienced by some subsections of the workforce. New initiatives to investigate and monitor this complex working environment are clearly needed.
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PMID:The health of health care workers. The Ernestine Henry lecture 1990. 221 74

Personal and familial psychopathological histories and information about early losses were collected and the results of the locus of control test and tests for psychological responses were determined for a series of ninety-two HIV-infected subjects (58 drug addicts; 26 homosexuals; 8 heterosexuals, partners of drug addicts). A higher percentage of drug addicts reported past histories of attempted suicide than the homosexuals. Early loss events were more frequent for homosexuals than for drug addicts. There was a higher psychopathological risk for asymptomatic HIV seropositivity in homosexuals, drug addicts who had attempted suicide, subjects that acknowledged that they have serious illness and subjects with external coping mechanisms rather than internal.
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PMID:Psychopathologic features among drug addicts and homosexuals with HIV infection. 226 90

Ninety injection drug users (61 males, 29 females) attending the Addiction Research Foundation Clinical Institute completed an anonymous, self-administered questionnaire about their knowledge, attitudes and behaviour regarding Human Immunodeficiency Virus (HIV) infection. Sixty-two percent had used drugs for more than five years; 61% used primarily heroin, 20% cocaine. Needle sharing was common: 76% within 5 years, 37% within the preceding month, although 87% named needle sharing as a risk factor for HIV infection. Current needle sharers could not be distinguished from former sharers on selected demographic, attitudinal or knowledge variables. Twenty percent of respondents had been HIV tested (all negative); 88% reported willingness to be tested. Thirteen percent would consider suicide or resume heavy drug use in response to a positive test; 19% were uncertain about their response. There may be a risk of serious harm to IDUs who are tested in the absence of excellent counselling and support services.
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PMID:AIDS-related knowledge, attitudes and behaviour in injection drug users attending a Toronto treatment facility. 231 Oct 50

The human immunodeficiency virus (HIV) epidemic has created a multidimensional crisis that is challenging the health care system. Individuals with or without risk behaviors have anxieties about acquired immunodeficiency syndrome (AIDS) and need support and counseling. Once symptoms of HIV infection develop, crisis intervention and support need to be integrated into ongoing medical care. A biopsychosocial approach enables persons with AIDS to develop strategies for coping, to improve adherence, and to prevent transmission and suicide. Persons with AIDS are confronted with severe illnesses, neuropsychiatric disorders, discrimination, and death. Each person deserves the best medical and psychologic care available and the services of other disciplines where indicated. Caregivers, anxious about contagion, are devastated by the complexity, severity, and multiplicity of the illnesses that comprise AIDS and the lack of adequate resources to combat the epidemic. AIDS is a paradigm of a medical illness that requires a biopsychosocial approach. Psychiatric sequelae complicate the HIV epidemic, affecting both the uninfected and infected. The psychiatric manifestations of the uninfected include anxiety, phobia, factitious disorder, delusions, and Munchausen's AIDS. Psychiatric disorders associated with HIV infection include organic mental disorders, substance abuse disorder, affective disorders, adjustment disorders, anxiety disorders, and personality disorders. The consultation-liaison (C-L) psychiatrist is in a unique position to clarify and treat the psychiatric complications and to provide leadership for multidisciplinary programs. The biopsychosocial approach enables persons with HIV infection, their loved ones, and caregivers to meet the challenges of the HIV epidemic with compassion, optimism, and dignity.
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PMID:Biopsychosocial approach to the human immunodeficiency virus epidemic. A clinician's primer. 240 16


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