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

Highly sensitive assays that quantitate human immunodeficiency virus type 1 (HIV-1) RNA may be valuable for clinical research and the treatment of HIV-1-infected patients. In this study we evaluated the reproducibility and accuracy of the first-generation branched DNA (bDNA-1.0) signal amplification assay under conditions that are relevant to routine use in a clinical context. We show that the bDNA-1.0 assay was able to discern two- to three-fold changes in plasma HIV-1 RNA levels as significant. Reverse transcription coupled to polymerase chain reaction (RT-PCR) was less reproducible and required a 3.7- to 5.8-fold change in plasma HIV-1 RNA levels to be statistically significant. The accuracy of the bDNA-1.0 assay in RNA quantitation was not affected by HIV-1 genotypic variation or by the presence of hemoglobin, bilirubin, lipemia, or any of a dozen therapeutic drugs. Using the bDNA-1.0 assay, we show that HIV-1 RNA levels in plasma specimens were stable when stored at -80 degrees C and were able to withstand at least three freeze-thaw cycles without significant loss. We also examined the performance of an ultrasensitive bDNA assay with improvements to the signal amplification technology. The ultrasensitive bDNA assay displayed a quantitation limit of approximately 500 RNA Eq/ml, yet maintained a dynamic quantitation range up to 1.6 x 10(6) RNA Eq/ml. Like the bDNA-1.0 assay, the ultrasensitive bDNA assay was not affected by HIV-1 genotype variability.
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PMID:Performance characteristics for the quantitation of plasma HIV-1 RNA using branched DNA signal amplification technology. 755 11

Monze Hospital is a 250-bed hospital located in the southern province of Zambia. In 1991 overall seroprevalence of HIV was about 15.9% among the hospital's blood donors. The usual procedure was to interview and weigh the donor, measure his or her hemoglobin concentration, and then to collect the blood. Blood was tested for HIV with HIVChek or another rapid test or by ELISA. The cost of testing was dependent on which HIV test was available at the time. A rapid test such as HIVChek was preferred but the price was high. The alternative was an ELISA such as the Wellcozyme ELISA. The total cost of collection of 1 unit of blood was about $11.76 when HIVChek was used, when ELISA was used, the cost of 1 unit was $9.69. For the 1073 units transfused in 1991, 1276 units had to be tested and 203 were rejected. About 2/3 of units were screened by HIVChek and 1/3 by ELISA. The approximate cost of blood collection was $14,128, of which HIV tests accounted for $4745, 33.6% of the total. About 16% of units were discarded because of HIV positivity, and the costs of this wastage brought the total cost per usable unit to an average of $12.82. A minimum of 11.4 of the 1073 units transfused were probably infected but were not detected by screening. Of these about 8 units would have caused new infections. Therefore, 150 infections were prevented by screening and the cost of HIV screening per infection prevented was $31.62. About 59% of infections prevented would have been in children no more than 5 years old and 31% in women. The cost of HIV screening was $4745, an annual expenditure of $0.03 per person. The cost of HIV screening per year of healthy life saved was $1.32. The cost to the health services of treating HIV disease in the 2 years before death was about $110.60 per person. The cost of screening blood in 1991 was estimated at $4745. Thus, the benefit/cost ratio was 3.5/1.
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PMID:Benefits of HIV screening of blood transfusions in Zambia. 765 6

The implication of blood in HIV and other viruses transmission has invigorated the research for finding a fluid able to replace blood as regards its oxygen-carrying properties. In this work, the specifications of a potential substitute are first defined. Then, the means to be developed in order to match these specifications at best are precise. Afterwards, a possible oxygen-carrier, the hemoglobin-dextran-BTC conjugate, is described.
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PMID:[Extracted hemoglobins as oxygen transporters: proposal of a hemoglobin-dextran-benzenetetracarboxylate conjugate]. 768 13

To determine the effect of asymptomatic human immunodeficiency virus (HIV) infection on the risk of complications and outcomes in women undergoing gynecological surgical procedures, retrospective analysis was performed of 62 asymptomatic HIV-infected women who underwent gynecological procedures. One hundred forty seronegative women who had similar procedures during the same time period served as controls. Procedures included tubal sterilization, hysterectomy, and diagnostic laparotomy. The following variables were compared: length of hospital stay, age, blood loss, white blood cell count, hemoglobin, and hematocrit. Laboratory parameters were compared pre-and postoperatively, as well as between the study and control groups. Race and parity were similar in both groups. HIV-infected women were younger (mean: 25 years versus 31 years) than controls. Length of hospital stay was similar. Blood loss was higher in the HIV-infected group than controls. (318 cc versus 122 cc) Differences in white blood cell counts, hematocrits, and febrile morbidity were insignificant. Asymptomatic HIV infection has minimal effect on the outcome of elective gynecologic surgery. The younger age of the HIV-infected women reflects the demographics of HIV infection and sterilization reflects the desire to prevent perinatal transmission.
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PMID:Gynecological surgical outcomes among asymptomatic human immunodeficiency virus-infected women and uninfected control subjects. 772 3

Starting in 1988, 72 patients with advanced human immunodeficiency virus (HIV) infection were enrolled in a phase I study of didanosine at the National Cancer Institute. Beginning in 1992, patients with decreases in CD4 cell counts could switch to a combination of zidovudine and didanosine. The estimated median survival for all patients was 28 months (95% confidence interval, 23-46). However, for patients whose entry CD4 cell counts were 100-300/mm3, the estimated 4-year survival was 80%. Baseline CD4 and CD8 cell counts, hemoglobin, lymphocytes, sedimentation rates, diagnosis of AIDS, and fever were significant predictors of overall survival. Principal toxicities were pancreatitis and peripheral neuropathy; no new toxicities were seen with extended didanosine treatment that had not been observed in shorter-term studies. This 5-year follow-up shows that didanosine can be tolerated for > 4 years in some patients with advanced HIV infection and may have particular long-term utility in patients with moderately advanced immunosuppression.
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PMID:Five-year follow-up of a phase I study of didanosine in patients with advanced human immunodeficiency virus infection. 775 92

Over an 18-month period, from October 1991 through early 1993, a study was carried out in two phases in the pediatric wards of the Eldoret District Hospital to document infant and child morbidity and mortality in the Uasin Gishu district and parts of several surrounding districts in western Kenya. Patient discharge summaries and ward registers were analyzed for age, sex, diagnosis, length of hospitalization, and outcome. There were a total 4720 pediatric admissions over the period. The most frequent 20 diseases were identified and their respective case fatalities were calculated. 74.5% of the admissions were due to only four diseases: malaria (33.0%), pneumonia (26.8%), gastroenteritis (10%), and measles (7.6%). Malaria was responsible for only 9 (9.1%) of all deaths. The disease specific mortality rate for malaria was 2.2%, 11th among the top 15 diseases. 20 (20.4%) out of a total of 98 deaths were due to pneumonia. Measles was becoming less important as a cause of morbidity because of immunization: in 1991, over 20 cases/per month were admitted, but by 1993 only 6.5 cases/month were admitted, a decrease of 68%. Neonatal tetanus was responsible for 43.2% of neonatal mortality during the 18 months. In addition, 47 infants and children had severe anemia (hemoglobin 4.0 gm%); 8 (17%) of these children died despite emergency blood transfusions. The overall mortality rate in the hospital during the study was 8.2%, which compares with 9.6% reported in Tanzania in 1987. 61 (64.9%) deaths occurred within 24 hours of hospitalization owing to delay in seeking medical care. In a 1988 study in Harare, 201 (43.7%) of 460 deaths occurred within the first 24 hours of admission. Furthermore, during February through June 1992, 29 of 57 children under 2 years of age admitted for gastroenteritis tested positive for HIV antibodies. A retrospective review of the ward register also showed that in 20% of the admissions the outcome was not recorded, in 25% the length of stay could not be determined, and for 8.3% the age of the patient was not recorded.
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PMID:Paediatric morbidity and mortality at the Eldoret District Hospital, Kenya. 779 68

To determine the effect of zidovudine (ZDV) on the pharmacokinetic disposition of recombinant soluble CD4 immunoglobulin G (rCD4-IgG) and to evaluate the safety and preliminary activity of concurrent administration of ZDV with rCD4-IgG, we undertook an open-label, dose-escalating, 12-week study. The regimens of intravenous rCD4-IgG and oral ZDV we used were (a) 300 micrograms/kg rCD4-IgG twice per week and 300 mg ZDV per day, (b) 300 micrograms/kg rCD4-IgG twice per week and 600 mg ZDV per day, (c) 1,000 micrograms/kg rCD4-IgG twice per week and 300 mg ZDV per day, (d) 1,000 micrograms/kg rCD4-IgG twice per week and 600 mg ZDV per day, and (e) 3,000 micrograms/kg rCD4-IgG twice per week and 300 mg ZDV per day. Subjects were recruited from three AIDS clinical trials units. Forty-one patients with HIV infection who had CD4 cell counts < or = 500 cells/mm3 and < 120 days of previous ZDV therapy participated. Pharmacokinetic interactions were assessed with the second regimen. Mean calculated peak serum rCD4-IgG concentrations were 5.47 micrograms/ml with ZDV and 8.28 micrograms/ml without ZDV, with serum half-lives of 34.2 and 32.0 h, respectively. Antibodies to rCD4-IgG were not detected. Seven episodes of severe adverse events occurred in five patients: one episode each of severe nausea, fever, or abnormal liver function tests and four episodes of severe neutropenia. Mean hemoglobin and neutrophil counts decreased, and mean platelet counts increased in all regimens, but there were no significant differences among regimens, rCD4-IgG dose, or ZDV dose.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Combination therapy with recombinant human soluble CD4-immunoglobulin G and zidovudine in patients with HIV infection: a phase I study. 783 98

87 newly diagnosed pulmonary tuberculosis (PTB) patients at the Infectious Diseases Hospital, Nairobi, Kenya, were recruited into the study. Only patients with acid fast bacilli on stained smears of expectorated sputum were considered to have PTB. Cases were presumed PTB when a negative sputum smear was obtained in a patient with clinical and radiographic features consistent with PTB. Heparinized peripheral venous blood from each patient was tested for antibodies to HIV-1 with the Dupont HTLV 111 and the Wellcozyme Diagnostics ELISA. Only samples seropositive with both ELISAs were considered HIV-1 seropositive. T-lymphocyte subpopulation was separated from mononuclear cells by centrifugation on a Ficoll-Hypaque gradient. There were approximately equal numbers of males and females (25 males and 24 females) in the HIV-1 negative group but as many as 26 males compared to 12 females in the HIV-1 positive group. The sex ratio in the HIV-1 negative was M/F; 1:0.96 and M/F; 1:0.5 in the HIV-1 positive group. The mean age of patients with HIV-1 (33.4 +or- 7.22) was significantly higher than those without HIV-1 (28.70 +or- 11.20; p0.001). The overall prevalence of HIV-1 was 44%; higher in men (30%) than in women (14%). The hemoglobin (12.0 +or- 2.6 gm HIV-1 negative; 12.0 +or- 1.4.0 gm HIV-1 positive) and total lymphocyte counts (2451.6 +or- 1036.7/cubic mm HIV-1 negative; 2020.9 +or- 1258.6/cubic mm HIV-1 positive) were not significantly different between the 2 groups. However, the white blood cell count was significantly higher in HIV-1 seronegative group (7273.5 +or- 4700/cubic mm) than in the HIV-1 seropositive group (5094.8 +or- 3494/cubic mm); p0.05). Patients with HIV-1 presented more often with lymphadenopathy, diarrhea and weight loss, whereas cough and fever were as common in HIV-1 positive as HIV-1 negative patients. Even though CD3, CD4, and CD8 counts were significantly lower in HIV-1 positive patients, the ratio of CD4/CD8 was not significantly different between the 2 groups.
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PMID:Clinical and immunological markers in Kenyan pulmonary tuberculosis patients with and without HIV-1. 783 58

Patients with HIV infection frequently develop clinically significant anemia, either as a manifestation of the HIV or as a result of therapy with medications such as zidovudine. Therapy with recombinant human erythropoietin can increase hemoglobin levels in these patients, decreasing transfusion requirements and improving some aspects of the quality of life. Once erythropoietin therapy is started, it is important to monitor patients carefully for the development of iron deficiency and erythrocytosis.
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PMID:The clinical application of recombinant erythropoietin in the HIV-infected patient. 785 17

The prevelance of IDA in industrialized countries has declined in recent decades, but there has been little change in the worldwide prevalence. IDA is currently estimated to affect more than 500 million people. Recent studies have indicated that anemia per se, the most common manifestation of iron deficiency, is less important from a public health standpoint than liabilities associated with tissue iron deficiency. The most important of the latter are an impairment in psychomotor development and cognitive function in infants and preschoolers, a deficit in work performance in adults, and an increase in the frequency of low birth weight, prematurity, and perinatal mortality in pregnancy. There have been several recent advances in combatting nutritional iron deficiency. One of the major problems has been in distinguishing iron deficiency from other causes of anemia seen epidemiologically such as malaria, HIV infection, chronic inflammation, hemoglobinopathies, and protein energy malnutrition. When combined with serum ferritin and hemoglobin determinations, the serum transferrin receptor assay is a valuable addition in epidemiologic surveys because it provides a quantitative measure of functional iron deficiency and it distinguishes true IDA from the anemia of chronic disease. The most difficult challenge is to develop effective methods of supplying iron to large segments of a population. Supplementation with iron tablets is suitable for only brief periods of need such as during pregnancy. The poor compliance with existing supplementation programs is believed to be due mainly to the gastrointestinal side effects of oral iron which can be eliminated by the use of a gastric delivery system. The most effective long-term strategy is to increase the intake of bioavailable iron in the diet. The customary approach has been to fortify a food staple such as wheat, rice, sugar, or salt, and thereby increase the iron intake of the entire population. However, because of concerns about the risk of cancer and heart disease in individuals with high iron stores, there is an increasing reluctance to supply iron to individuals who do not require it. A more effective strategy is to fortify food vehicles that are targeted to segments of the population at greatest risk of iron deficiency such as infants and school children. Because of the strong inhibitory properties of diets in regions of the world where iron deficiency is most prevalent, the use of NaFeEDTA has important advantages for food fortification.
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PMID:Iron deficiency: the global perspective. 788 26


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