Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The Italian Seroconversion Study (ISS) involves 16 major HIV-treatment centers across Italy and about 1,200 individuals. These individuals were HIV-negative less than 2 years before the first positive test and seroconverted between 1980 and 1994. The majority were infected through i.v. drug use (56%), male-to-male sex (25%), and heterosexual contact (7%). For each end point, crude and adjusted relative hazards were calculated using standard survival techniques such as Kaplan-Meier curves, log-rank test, and Cox proportional hazards regression models. Autoregression models were used to describe CD4 cell reductions. Objectives were as follows: to estimate HIV disease progression rates; to assess whether there are differences in the rate of development of severe immunosuppression, AIDS, and death according to age, gender, and exposure category; to identify co-factors and predictors of disease progression; and to evaluate the clinic-based population "effect" of antiretroviral treatment. The risk for developing AIDS among individuals in the ISS cohort was less than 50% by 10 years after HIV seroconversion. Using univariate analysis, more rapid progression was found for older individuals than for younger individuals and for homosexual men compared with those in other exposure categories. No difference between men and women was observed. After adjusting for age, differences among exposure groups disappeared. Individuals with a history of acute HIV disease were more likely to develop AIDS than other seroconverters. Co-infection with HCV and HTLV-II did not accelerate progression to AIDS. The cumulative incidence of receiving pre-AIDS therapy within 7 years of seroconversion was 49.2% (95% CI 45.3-53.0). The relative hazards of developing AIDS in patients who started treatment with zidovudine (AZT) monotherapy was 0.57 (0.36-0.91) and 0.92 (0.64-1.33) within the first year and after 1 year from AZT initiation, respectively. The effect was greater among homosexual men than among i.v. drug users. In conclusion, incident cohort studies may provide accurate information on incubation time and co-factors for disease progression. Observational studies may also provide useful information about the effect of treatment at the community level, which may complement the results of clinical trials.
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PMID:Determinants of progression to AIDS in HIV-infected individuals: an update from the Italian Seroconversion Study. 958 45

Few studies have addressed the relation between serum vitamin A level and HIV disease progression. Thirty HIV-infected women in Rwanda were studied over a time span of 26 to 99 months. Fourteen subjects seroconverted and died of HIV-related disease at a mean of 44 months (range, 26-69 months) after their first HIV-positive test and were termed "rapid progressors," (RPs). A comparison group of 16 "slow progressors" (SPs) were HIV-positive at the time of their first HIV serology and had asymptomatic HIV infections at a mean of 96 months (range, 93-99 months) after their first HIV serology. Baseline mean serum retinol values were the same in RPs and SPs: 0.65 + 0.08 mmol/L versus 0.67 + 0.09 micromol/L (p = .7). Lower serum retinol levels were observed in RPs compared with SPs for the second and third measurements, obtained at a median of 12 and 24 months past baseline: 0.51 + 0.07 mmol/L versus 0.76 + 0.14 mmol/L (p = .3) and 0.44 + 0.09 mmol/L versus 0.64 + 0.08 mmol/L (p = .08), respectively. Median retinol levels for the third sample measurement were similar in RPs with lower viral load (LVL) and SPs (0.49 mmol/L and 0.52 mmol/L, respectively) compared with only 0.19 mmol/L in RPs with higher viral load (HVL; p = .02). A trend toward decreasing serum retinol levels and increasing HIV-1 RNA viral load was observed at the third sample measurement (p = .04). Subjects with LVL, higher serum retinol levels (> or =0.70 mmol/L), or both had more favorable rates of survival than subjects with HVL, low serum retinol levels (<0.70 mmol/L), or both. Although sample size does not permit definitive conclusions, this study demonstrates an association of high HIV load, rapid progression, and low serum retinol late but not early in disease progression.
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PMID:Serum retinol and HIV-1 RNA viral load in rapid and slow progressors. 970 54

A randomized, controlled, clinical trial was conducted to examine the impact of a semistructured, 10-week, once weekly, 90-min/session bereavement support group intervention on immunological, neuroendocrine, and clinical health status in human immunodeficiency virus type 1-seropositive (HIV-1+) and HIV-1-seronegative (HIV-1-) homosexual men, compared to a standard of care control condition. A total of 119 homosexual men (74 HIV-1+ and 45 HIV-1-) were assessed at baseline, 10 weeks, and 6 months follow-up. At the 6-month follow-up assessment, the intervention groups exhibited significant beneficial effects compared to controls on changes in CD4 cell, total T-lymphocyte, and total lymphocyte counts, when baseline levels, antiretroviral medication use, CDC stage of disease, and other potentially confounding factors were accounted for. There was no statistically significant effect on the CD4/CD8 ratio or on the CD8 cell count. The effect on CD4 cell count was associated with group attendance and with changes in plasma cortisol level. Plasma cortisol levels decreased significantly among intervention subjects, compared to controls. A significantly reduced number of health care visits over the 6-month follow-up period among the intervention subjects supported the clinical relevance of the immunological changes observed for both HIV-1+ and HIV-1- individuals. These results indicate that behavioral interventions may have salutary immunological and clinical health effects following bereavement among HIV-1-infected individuals. The effect in HIV-1- individuals suggests that this bereavement support group intervention might have similar salutary effects in the general population. Potential effects of such interventions on clinical HIV disease progression are of interest and should be studied.
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PMID:A bereavement support group intervention is longitudinally associated with salutary effects on the CD4 cell count and number of physician visits. 960 95

Few studies have addressed the relation between serum vitamin A levels and HIV disease progression. Thirty HIV-infected women in Rwanda were studied over a time span of 26 to 99 months. Fourteen subjects seroconverted and died of HIV-related disease at a mean of 44 months (range, 26-69 months) after their first HIV-positive test and were termed "rapid progressors," (RPs). A comparison group of 16 "slow progressors" (SPs) were HIV-positive at the time of their first HIV serology and had asymptomatic HIV infections at a mean of 96 months (range, 93-99 months) after their first HIV serology. Baseline mean serum retinol values were the same in RPs and SPs: 0.65 + 0.08 micromol/L versus 0.67 + 0.09 micromol/L (p = .7). Lower serum retinol levels were observed in RPs compared with SPs for the second and third measurements, obtained at a median of 12 and 24 months past baseline: 0.51 + 0.07 micromol/L versus 0.76 + 0.14 micromol/L (p = .3) and 0.44 + 0.09 micromol/L versus 0.64 + 0.08 micromol/L (p = .08), respectively. Median retinol levels for the third sample measurement were similar in RPs with lower viral load (LVL) and SPs (0.49 micromol/L and 0.52 micromol/L, respectively) compared with only 0.19 micromol/L in RPs with higher viral load (HVL; p = .02). A trend toward decreasing serum retinol levels and increasing HIV-1 RNA viral load was observed at the third sample measurement (p = .04). Subjects with LVL, higher serum retinol levels (> or =0.70 micromol/L), or both had more favorable rates of survival than subjects with HVL, low serum retinol levels (<0.70 micromol/L), or both. Although sample size does not permit definitive conclusions, this study demonstrates an association of high HIV load, rapid progression, and low serum retinol late but not early in disease progression.
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PMID:Serum retinol and HIV-1 RNA viral load in rapid and slow progressors. 959 54

The effect of pregnancy on disease progression and survival in HIV-infected women was investigated through a systematic literature review and meta-analysis of the results of eligible studies. The literature search identified seven studies--all prospective cohort analyses--on this topic published in 1983-96. The summary odds ratios (ORs) for adverse maternal outcomes related to HIV infection were as follows: maternal death, 1.8 (95% confidence interval (CI), 0.99-3.3); HIV disease progression, 1.41 (95% CI, 0.85-2.33); progression to an AIDS-defining illness, 1.63 (95% CI, 1.00-2.67); and fall of CD4 cell count to below 200, 0.73 (95% CI, 0.17-3.06). Sensitivity analyses indicated HIV progression during pregnancy was significantly more common in developing countries (OR, 3.71; 95% CI, 1.82-7.75) than developed countries (OR, 0.55; 95% CI, 0.27-1.11) as well as in studies of high methodological quality (OR, 3.71; 95% CI, 1.82-7.57) compared with low-quality studies (OR, 0.55; 95% CI, 0.27-1.11). When studies attempted to control for confounding factors by matching or restriction techniques, there was less progression of HIV disease, but this was not statistically significant. Although this meta-analysis suggests that pregnancy in HIV-positive women may be associated with at least small increases in risk of adverse maternal outcomes, further large-scale observational studies of pregnant and nonpregnant HIV-infected women with long-term follow-up are required. Data on immune function should be available before pregnancy to facilitate determination of the effect of pregnancy on immune status.
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PMID:The effect of pregnancy on survival in women infected with HIV: a systematic review of the literature and meta-analysis. 974 74

The predictive value of HIV-1 phenotype in peripheral blood mononuclear cell (PBMC) coculture and the relation among viral phenotype, viral load, and CD4+ T-cell count were examined in two studies. In study A, 132 HIV-1-infected individuals were examined retrospectively for the relation between the result of their initial HIV cultivation in PBMC coculture and survival rate 6 years later. In study B, 176 patients were examined since 1994 for markers of HIV disease progression. HIV-1 phenotype was determined by PBMC cocultivation, viral load by NASBA HIV RNA QT System, and CD4+ T-cell count by flow cytometry. In study A, the percentage of survival for patients with initial negative virus culture was significantly higher (95%) than in patients with nonsyncytia-inducing (NSI) isolates (78%) and syncytia-inducing (SI) isolates (21%) (P < 0.05 and P< 0.0001, respectively). When SI phenotype was subdivided into moderately cytopathogenic and highly cytopathogenic, significant differences in the rate of survival between these subgroups could be observed (45% vs. 14%; P < 0.05). In study B, progression from negative virus culture to the isolation of NSI variants was associated with increasing viral load (P < 0.0001) but did not affect CD4+ T-cell count significantly (P> 0.07), whereas the switch from NSI to SI virus was accompanied by significant decline of CD4+ T-cells (P < 0.0001) but no change in viral load (P > 0.21). Thus, isolation and phenotyping of HIV represents an additional striking predictive marker for progression of HIV infection.
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PMID:Role of HIV-1 phenotype in viral pathogenesis and its relation to viral load and CD4+ T-cell count. 978 95

The influence of major surgery on HIV disease progression and decline in CD4+ cell count was evaluated in 23 seropositive haemophilia patients. 24 HIV-infected patients served as non-operated controls. In addition, 32 age-matched seronegative subjects were included. The follow-up time was up to 5 years. During the course of the study, eight of the operated (35%) and 11 of the non-operated (48%) subjects developed HIV-related symptoms (P=0.267). The relative risk for developing HIV-related symptoms after surgery was 0.60 (95% CI 0.25; 1.48). A significant decline in CD4+ cell counts was observed in both the surgery (4.0 x 10(6)/l/month, 95% CI 2.0; 6.0 x 10(6), P=0.001) and the non-surgery (4.0 x 10(6)/l/month, 95% CI 2.0; 6.0 x 10(6), P=0.004) seropositive subgroup, but no difference between the two subgroups was seen (P=0.793). HIV (6.0 x 10(6)/l/month, 95% CI 2.1; 9.9 x 10(6), P=0.0005) but not surgery (-1.0 x 10(6)/l/ month, 95% CI -3.0; 0.96 x 10(6), P=0.647) was an independent predictor for the decline in CD34+ cell count. No interaction effect was observed between HIV infection and surgery (P=0.361). The annual amount of factor concentrate used for regular replacement therapy did not influence the decline in CD4+ cell count (P=0.492). We conclude that major surgery may be considered in symptom-free HIV-seropositive haemophilia patients, with CD4+ cell counts > or = 0.20 x 10(9)/l under similar premises as for seronegative subjects.
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PMID:Major surgery seems not to influence HIV disease progression in haemophilia patients. 979 82

Risk testing for HIV serostatus is unlikely to detect more than 20% of HIV-positive pregnant women. Of the 11 pregnant women discovered to be HIV-infected at Port Moresby General Hospital in Papua New Guinea in 1994-95, only four had more than two sexual partners since 1992 and none was an intravenous drug user. The deleterious effect of pregnancy on HIV disease progression appears to be small but variable, with more serious effects in the later stages of disease. The risk of vertical transmission increases when viral loads are high, the general maternal condition is poor, and delivery is preterm. In developing countries, where HIV-infected pregnant women are likely to be malnourished and to have concomitant infections such as malaria and tuberculosis, the risks of preterm labor, small-for-gestational age infants, and chorioamnionitis are increased. HIV-related gynecologic conditions such as pelvic inflammatory disease, vulvovaginal candidiasis, and cervical neoplasia may be resistant to treatment and tend to recur. Pregnancy prevention through effective contraceptive methods such as Depo-Provera and tubal ligation may be more important to HIV-infected women than prevention of viral transmission, especially when both partners are seropositive.
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PMID:HIV infections in obstetrics and gynaecology. 979 61

Study objectives were to evaluate the safety and immunogenicity of three HIV recombinant glycoproteins in HIV-infected infants and children between 1 month and 18 years of age with asymptomatic (P-1) infection. Using Chiron rgp 120 (SF-2) 15 or 50 microg; MicroGeneSys rgp 160 (IIIB) 40 or 320 microg; Genentech rgp120 (MN) 75 or 300 microg; or adjuvant control (Alum or MF-59), children were randomized to a double-blind, placebo-controlled, dose-escalating study of vaccine administered intramuscularly at entry and 1, 2, 3, 4, and 6 months later. No adverse events were attributed to study vaccines. Between 30% and 56% of volunteers exhibited a lymphoproliferative response as defined in terms of stimulation index (SI) to vaccine antigens; 65% of vaccinees but none of placebo recipients exhibited moderate or strong responses after enzyme immunoassay to HIV specific antigens. CD4 cell counts and quantitative HIV culture did not differ significantly among vaccine and control groups, nor were differences found among groups in HIV disease progression. The rgp160 and gp120 subunit vaccines were safe and immunogenic in this population.
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PMID:Safety and immunogenicity of HIV recombinant envelope vaccines in HIV-infected infants and children. National Institutes of Health-sponsored Pediatric AIDS Clinical Trials Group (ACTG-218). 985 58

The prevalence of GB virus C (GBV-C) infection is high in human immunodeficiency virus (HIV)-infected persons. However, the long-term consequences of coinfection are unknown. HIV-positive persons with a well-defined duration of infection were screened on the basis of their GBV-C/hepatitis G virus (HGV) RNA status and studied. GBV-C/HGV viremia was observed in 23, who carried the virus over a mean of 7.7 years. All parameters (survival, CDC stage B/C, HIV RNA load, CD4 T cell count) showed significant differences in terms of the cumulative progression rate between persons positive and negative for GBV-C/HGV RNA. When GBV-C/HGV RNA-positive and -unexposed subjects were matched by age, sex, baseline HIV RNA load, and baseline CD4 T cell count, HIV disease progression appeared worse in GBV-C/HGV RNA-negative subjects. The carriage of GBV-C/HGV RNA is associated with a slower progression of HIV disease in coinfected persons.
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PMID:Carriage of GB virus C/hepatitis G virus RNA is associated with a slower immunologic, virologic, and clinical progression of human immunodeficiency virus disease in coinfected persons. 1006 72


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