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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We conducted a pilot study of potential sources of incorrect laboratory reports of human immunodeficiency virus type 1 testing using blind proficiency testing. Sets of three serum samples, including one serum sample with negative reactions in antibody tests, one serum sample with positive reactions, and one that gave false-positive results with certain testing kits, were sent as routine patient specimens to testing laboratories. Half the laboratories reported the serum sample positive for human immunodeficiency virus antibodies as "indeterminate"; one laboratory rendered a final positive report without supplemental testing. On the report forms, the actual laboratory results were often obscured and intermingled with information, sometimes incorrect, such as identifying the agent as "HTLV-III" (human T-cell lymphotropic virus type III) and advising that a test with positive results is evidence of exposure to the virus. Many of these reports have the potential to confuse, rather than to enlighten, the requesting physician.
JAMA
PMID:Reporting the results of human immunodeficiency virus testing. 258 92

We reviewed 92 published and unpublished studies of the prevalence of infection with the human immunodeficiency virus (HIV) among intravenous drug users (IVDUs) in the United States. Human immunodeficiency virus seroprevalence among IVDUs in drug treatment programs in the United States ranged from 0% to 65%. Seroprevalence was highest in the Northeast (10% to 65%) and Puerto Rico (45% to 59%); lower in the South Atlantic (7% to 29%) and in the metropolitan areas of Atlanta, Ga (10%), Detroit, Mich (7% to 13%), and San Francisco, Calif (7% to 13%); and 5% or less in other areas of the West, the Midwest, and the South. Among IVDUs seen in drug treatment programs, risk of infection was not associated with gender or age but was associated with black and Hispanic ethnicity, male homosexual orientation, and certain intravenous drug-use practices. Cross-sectional and cohort studies indicated increases in seroprevalence of between 0% and 14% per year among IVDUs in treatment. We estimated that between 61,000 and 398,000 IVDUs in the United States were infected with human immunodeficiency virus, or 5% to 33% of the IVDU population. High rates of infection among IVDUs in treatment in the Northeast indicate the potential for rapid spread in regions where rates are currently low. An urgent need exists to monitor human immunodeficiency virus infection levels and trends more widely and to develop effective programs to reduce the further spread of human immunodeficiency virus infection among IVDUs.
JAMA 1989 May 12
PMID:Prevalence of HIV infection among intravenous drug users in the United States. 265 32

The promise of early intervention in the course of human immunodeficiency virus (HIV) disease to slow or prevent its progression to AIDS has far-reaching implications for health care in the United States. Medical advances could bring tens of thousands of asymptomatic seropositive individuals into the health care system. The demand for HIV testing, counseling, laboratory monitoring, medications, and overall primary health care will be great, particularly among previously underserved groups such as intravenous drug users and the urban poor. Treatment of HIV positive patients could cost as much as $5 billion per year, and would require a major financial commitment from all levels of government as well as from the private sector. The authors call for rational planning for early intervention in HIV disease to avoid the crisis-driven policy making that has characterized the AIDS epidemic until now.
JAMA 1989 Sep 15
PMID:Economic and policy implications of early intervention in HIV disease. 229 77

The development of measles vaccination recommendations for immunodeficient children infected with human immunodeficiency virus requires assessment of disease risk and the risks and benefits of vaccination. Measles in 4 such children resulted in 3 severe pneumonias and 1 death despite previous immunization in 2. Antibody to measles as determined by enzyme-linked immunosorbent assay was present in 3 (12.5%) of 24 children studied retrospectively and developed in only 2 (25%) of 8 children immunized and followed up prospectively. The sera of 9 of 24 children had antibody when tested by sensitive hemagglutination inhibition. Measles developed in 2 of 6 children who had negative enzyme-linked immunosorbent assay results and positive hemagglutination inhibition results. No adverse consequences of measles immunization were detected. Although the immunogenicity of measles vaccine in children infected with human immunodeficiency virus was low and vaccine failure occurred, the apparent safety provides the rationale for immunization in the face of a potentially fatal disease. Since neither documented immunization nor low-level antibody guaranteed immunity to measles, we recommend passive postexposure immunoglobulin prophylaxis for all children infected with human immunodeficiency virus.
JAMA 1989 May 05
PMID:Measles and measles immunity in children infected with human immunodeficiency virus. 270 10

Serum immunoreactive erythropoietin (SIE) and hemoglobin levels were measured in 152 patients infected with the human immunodeficiency virus. Anemia was present in 18% of asymptomatic patients who tested positive for the human immunodeficiency virus, 50% of patients with a condition related to the acquired immunodeficiency syndrome (AIDS), and 75% of patients with AIDS. The mean SIE level for untreated AIDS patients (26.2 +/- 2.4 mU/mL) was greater than for patients who tested positive for human immunodeficiency virus or patients with an AIDS-related condition but not outside the normal range for SIE (4 to 26 mU/mL), and the incremental increase in SIE level for a given decline in hemoglobin level was much less in AIDS patients than in patients with uncomplicated iron deficiency anemia. Forty-two patients were treated with zidovudine, and the hemoglobin level fell 10 g/L or more in 48%. In contrast to the untreated patients, however, the mean SIE level rose 10-fold to 214 mU/mL, and the incremental change in SIE level for a given decline in hemoglobin level was markedly increased. In the zidovudine-treated patients, erythrocyte mean corpuscular volume also rose significantly from a mean of 88.1 fL to 102 fL. However, in only 1 patient was there a corresponding increase in reticulocytes and in none was there amelioration of anemia. The data indicate that SIE level is inappropriately low in anemic AIDS patients. The ability of these patients to produce erythropoietin is intact and can be expressed with zidovudine therapy. However, even very high levels of SIE fail to stimulate erythropoiesis adequately.
JAMA 1989 Jun 02
PMID:Serum immunoreactive erythropoietin in HIV-infected patients. 271 42

The prevention of human immunodeficiency virus (HIV) infection during international travel is gaining increased attention. In this report, a 32-year-old man acquired the HIV following a motor vehicle accident in Rwanda. During the accident the patient received multiple lacerations and was covered with the blood of similarly injured and bleeding passengers. This exposure through lacerated skin to the blood of persons with a high probability of being infected with HIV demonstrates an unusual mode of transmission and emphasizes the importance of HIV prevention during travel and of motor vehicle safety.
JAMA 1989 Jun 09
PMID:HIV infection following motor vehicle trauma in central Africa. 271 64

Decisions to terminate or continue pregnancy among human immunodeficiency virus (HIV) seropositive (+) and seronegative (-) intravenous drug users in a New York City methadone maintenance treatment program were examined to determine the effect of knowledge of HIV status on decisions about pregnancy in HIV infected and at-risk women. All women were informed of their HIV antibody status prior to 24 weeks gestation. In retrospective interviews, seropositive women who terminated pregnancy cited fear of AIDS for themselves or their infants as an important factor in their decision. However, pregnancy termination for both HIV+ and HIV- women was best predicted by a prior history of elective abortion, whether the pregnancy was unplanned, and whether the woman reported feeling sad or scared upon learning she was pregnant. Desire for a child and religious beliefs were reported as the main reasons to continue pregnancy by both groups.
JAMA
PMID:Knowledge of HIV antibody status and decisions to continue or terminate pregnancy among intravenous drug users. 272 3

During a 1-year period of study at two plasma collection centers, 7 of 35,000 plasma donors seroconverted to the human immunodeficiency virus (HIV) and had stored plasma samples that predated or antedated the seroconversion period. From each donor, three to eight plasma samples that had been collected at 2- to 7-day intervals were tested for IgG and IgM antibodies to HIV with enzyme immunoassays, Western blot testing, and radioimmunoprecipitation assays. The presence of an HIV viremic phase was demonstrated by the infectivity of plasma on normal, phytohemagglutinin-stimulated peripheral blood mononuclear cells and by the detection of HIV antigen. In 5 of these donors, HIV antigen was detected prior to or simultaneously with IgG to HIV; these HIV-antigen-positive samples overlapped an IgM immune response. The disappearance of detectable HIV antigen, and to a lesser extent plasma infectivity, was concurrent with the development of an IgG immune response. Although the improved sensitivity of a recombinant DNA-derived anti-HIV screening assay shortened the "window period" between initial HIV infection and antibody detection, HIV antigen and plasma HIV viremia were the only markers of HIV infection for several days in 2 donors. These results demonstrate that HIV plasma viremia and antigenemia occur prior to seroconversion in healthy plasma donors.
JAMA 1989 Jul 07
PMID:Markers of HIV infection prior to IgG antibody seropositivity. 273 26

In a study to assess the impact of the human immunodeficiency virus epidemic on The Johns Hopkins Hospital Emergency Department, we found 152 (6.0%) of 2544 consecutive patients to have human immunodeficiency virus infection, an absolute increase of 0.8% from the previous year. Of the 57 patients with a known history of infection, 49.1% had no insurance vs 36.0% of seronegative patients. Infected patients were three times more likely to be admitted as seronegative patients. Overall, health providers followed universal precautions during 44.0% of interventions. In patients with profuse bleeding, adherence fell to 19.5%. The most common reasons given by providers for not following precautions were insufficient time to put on protective attire and interference with procedural skills. We conclude that the human immunodeficiency virus epidemic has a major impact on emergency services and that strategies need to be developed for appropriate use of emergency resources and also for maximizing provider protection.
JAMA 1989 Jul 28
PMID:Human immunodeficiency virus infection in emergency department patients. Epidemiology, clinical presentations, and risk to health care workers: the Johns Hopkins experience. 273 54

There is marked debate by physicians and policymakers regarding the creation of regionalized acquired immunodeficiency syndrome (AIDS) centers. A central issue is whether outcomes of care, particularly mortality, differ as a function of hospital experience with patients with AIDS. We evaluated the experience of 257 patients with AIDS and Pneumocystis carinii pneumonia treated at 15 California hospitals between October 1986 and October 1987. An overall 15.2% in-hospital mortality rate was observed. However, a markedly lower in-hospital mortality rate was observed in the group of patients treated at hospitals that had a high level of experience with patients with AIDS (greater than or equal to 30 human immunodeficiency virus-related discharges per 10,000 hospital discharges) relative to the group treated at hospitals with less experience (less than 30 human immunodeficiency virus-related discharges per 10,000 hospital discharges): 12% vs 33%. Other factors significantly associated with in-hospital mortality included intensive care unit use, admission from an emergency department or through an interhospital transfer, and a history of hospitalizations. A logistic regression model indicated that, after controlling for severity indicators, AIDS experience remained significantly related to mortality. Our findings suggest that policymakers should consider three options: creating regional AIDS centers, implementing policies that promote a rapid but carefully monitored increase in experience of low-volume hospitals with human immunodeficiency virus-infected individuals, or providing highly focused educational efforts at low-AIDS-experience facilities. Without such policy initiatives, differences in mortality rates like those we have found might persist as cases of AIDS begin to occur in every area of the country.
JAMA 1989 May 26
PMID:The relation between hospital experience and in-hospital mortality for patients with AIDS-related PCP. 278 7


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