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

We studied the rates of and factors associated with self-reported prior human immunodeficiency virus (HIV) testing in adult patients visiting an emergency department (ED) in the Bronx, New York City. A total of 1,744 consecutive noncritical adult medical emergency patients responded to a standardized interview administered by ED physicians. The interview included questions pertaining to demographic characteristics, prior HIV testing, and HIV risk behaviors. On multivariate analysis, female gender, younger age, history of weight loss, injecting drug use (IDU), syphilis, and genital herpes were all associated with increased reported prior testing rates. Race (i.e., black race) was an independent predictor of increased rates among male subjects; comparatively low rates were reported by patients with a first language other than English, patients lacking medical insurance, and highly sexually active, nonblack men. Increased HIV testing rates were reported by subjects with recognized HIV risk behaviors in a New York City ED population; however, substantial proportions of subjects at risk had not been tested. Programs of HIV testing and counseling need to include older, uninsured, and non-English-speaking segments of the population who engage in high-risk behaviors.
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PMID:Rates of and factors associated with self-reported prior HIV testing among adult medical patients in an inner city emergency department in the Bronx, New York City. 898 12

A multiplex polymerase chain reaction (M-PCR) assay for Haemophilus ducreyi, Treponema pallidum, and herpes simplex virus (HSV) was compared with clinical and standard laboratory methods for the diagnosis of genital ulcer disease (GUD) in 105 patients; 36% were human immunodeficiency virus (HIV)-seropositive. Chancroid (80%), syphilis (8%), and genital herpes (8%) were the most frequent diagnoses. H. ducreyi and HSV were isolated from ulcers of 43% and 18% of patients, respectively; in 35%, all cultures were negative and the laboratory diagnosis indeterminate. M-PCR detected H. ducreyi, T. pallidum, and HSV in 56%, 23%, and 26% of patients, respectively; (no definitive diagnosis, 6%). The proportion of patients with more than one agent was 4% by culture and 17% by M-PCR (P = .002). Resolved sensitivities of M-PCR for H. ducreyi and HSV cultures were 95% and 93%, respectively. The sensitivities of H. ducreyi and HSV cultures were 75% and 60%, respectively. HSV, detected in 47% of specimens from HIV-infected versus 16% from HIV-uninfected patients (P < .001), may be emerging as a more frequent cause of GUD.
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PMID:Comparison of clinical diagnosis and standard laboratory and molecular methods for the diagnosis of genital ulcer disease in Lesotho: association with human immunodeficiency virus infection. 904 29

The presence of human papillomavirus (HPV) DNA in esophageal brushings from human immunodeficiency virus (HIV)-seropositive hosts was investigated in a cross-sectional study. Oral and esophageal brushings from individuals scheduled for esophagogastroscopy (53 HIV-positive and 61 age-matched HIV-negative patients) were tested for the presence of HPV DNA by a consensus L1 polymerase chain reaction assay. HPV DNA was detected in esophageal brushings of 9 (17%) of the 53 HIV-seropositive patients and 0 of the 61 HIV-negative individuals. HPV-16 DNA was the most frequently detected. No proliferative mucosal lesion was noted in individuals with HPV-positive esophageal brushings. Cytological smears were done for 6 of the 9 patients with HPV-positive esophageal brushings, and epithelial atypia was recorded for 1. HIV infection and a history of genital herpes were strong independent predictors of HPV, suggesting that HPV is transmitted sexually in the esophagus.
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PMID:Human immunodeficiency virus infection is a major risk factor for detection of human papillomavirus DNA in esophageal brushings. 914 28

Viral sexually transmitted diseases (STDs) are a major health problem for women. Over many years the incidence of these infections has increased steadily to epidemic proportions. These infections not only cause short-term morbidity but also have been associated with significant long-term morbidity and mortality. This paper focuses on two of the most common viral STDs-Genital Herpes Simplex Virus (HSV) infection and Human Immunodeficiency Virus (HIV) infection of the female. The steady increase in the incidence of HIV infection and subsequent adult immunodeficiency disease (AIDS) among women requires health care providers to assume an active role in detection and treatment in order to avoid transmission, to protect the health of women with HIV/AIDS, and to reduce the risk of maternal-fetal (vertical) transmission. Because treatment with zidovudine has been shown to reduce vertical transmission, routine offering of HIV testing is currently recommended for all pregnant women. The approach to testing nonpregnant patients, i.e., the choice between selective screening or routine testing, rests with the individual clinician. Testing large numbers of patients within a practice may be facilitated by the availability of an oral antibody testing system. The sensitivity and specificity of the oral test is equivalent to blood testing. Serum and oral specimens are tested by enzyme-linked immunosorbent assays (ELISA) and confirmatory Western blot assays specifically designed for use with oral samples. Controversies in diagnosis as well as the most updated treatments for these infections are discussed.
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PMID:Diagnosis and treatment of viral STDs in women. 916 Feb 21

We offered standardized gynecologic examinations to consecutive women admitted to an AIDS-designated inpatient medical service; 65 (97%) of 67 women consented to the examination. The median CD4+ T lymphocyte count was 54/mm3. Only 9% of the women were admitted for primary gynecologic or genitourinary diagnoses; however, on evaluation, 83% of these women had gynecologic disease. The overall prevalences of vaginitis, cervical dysplasia, genital condylomata, genital herpes, and pelvic inflammatory disease were 51%, 45%, 23%, 20%, and 5%, respectively. Unexpected findings included adenovirus infection and foscarnet-associated genital ulcerations (two cases each). For predicting disease, gynecologic symptoms had a sensitivity of 76% and a positive predictive value of 95% but a negative predictive value of only 41%. Our results document the high prevalence of comorbid gynecologic disease among women infected with human immunodeficiency virus (HIV). Because of the inability to fully predict disease by symptom history, it is imperative that comprehensive gynecologic evaluation be offered routinely to all HIV-infected women hospitalized for acute medical illnesses.
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PMID:High prevalence of gynecologic disease among hospitalized women with human immunodeficiency virus infection. 931 65

The frequency and anatomic location of subclinical and symptomatic herpes simplex virus (HSV) shedding were evaluated among human immunodeficiency virus (HIV)-negative HSV-2-seropositive men who have sex with men (MSM). Eight men attended a research clinic daily for 30 days for a detailed genital examination and anoscopy with colposcopy to detect herpes lesions. HSV cultures were obtained daily from four sites (perianal, urethral, penile shaft, and oral) at home and the research clinic. Signs and symptoms of genital herpes were recorded by the participants and clinician. Three (37.5%) of the men shed HSV. Overall, the 8 men shed HSV on 5.5% of days cultures were obtained and shed subclinically on 2.7% of days. All HSV shedding was perianal or rectal; only 1 symptomatic recurrence, concurrent with an external perianal lesion, was detected by anoscopy. Subclinical HSV shedding was frequent among HIV-negative MSM, and anoscopy with colposcopy did not increase the detection rate of rectal HSV lesions or shedding.
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PMID:Herpes simplex virus shedding among human immunodeficiency virus-negative men who have sex with men: site and frequency of shedding. 980 24

Recent evidence suggests that sexually transmitted diseases (STDs) enhance the transmission of human immunodeficiency virus (HIV) type 1. In 143 HIV-infected women enrolled in a university-based longitudinal HIV clinic over 16 months (mean), the STD point prevalence was examined at enrollment and the cumulative prevalence was calculated at follow-up. At enrollment, 35 women (25%) had > or = 1 STD. These included trichomoniasis in 16 women (11%); syphilis, 9 (6%); genital herpes, 8 (6%); gonorrhea, 5 (4%); chlamydia, 5 (4%); genital warts, 2 (1%); and pelvic inflammatory disease (PID), 1 (1%). STDs were found in 55 (42%) of the 125 patients who returned for at least one follow-up visit: trichomoniasis in 23 (18%); genital herpes, 20 (12%); gonorrhea, 9 (7%); syphilis, 7 (6%); genital warts, 7 (6%); chlamydia, 5 (4%); and PID, 4 (3%). Despite counseling at both enrollment and follow-up, these women had a very high cumulative prevalence of STDs, indicating persistent high-risk sexual behavior.
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PMID:Sexually transmitted disease acquisition among women infected with human immunodeficiency virus type 1. 980 54

A study conducted at the Centre Medico-Social de Bilyogo, a primary health clinic located in an area of Nyamirambo, Kigali (Rwanda), where prostitution is widespread, assessed the frequencies of the causes of genital ulcer disease. Out of 1057 consecutive genital ulcer patients tested in 1986-88, 57% of men and 80% of women were infected with HIV-1. The most frequent laboratory diagnoses were chancroid (27%), syphilis (19%), and genital herpes (19%) among men and syphilis (35%), genital herpes (23%), and chancroid (20%) among women. During follow-up in 1990-92, HIV-1 seroprevalence increased sharply among men of all ages and women under 30 years of age. HIV-1 seropositivity had no effect on the clinical presentation of ulcers or on the time required for ulcer healing. Advanced immunodeficiency, diagnosed among 12% of HIV-positive patients, was significantly associated with increasing age and genital herpes.
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PMID:Genital ulcers in a primary health clinic in Rwanda: impact of HIV infection on diagnosis and ulcer healing (1986-1992). 986 86

Genital herpes is a common, distressing infection which, due to increasing incidence world-wide, has become a prominent public health issue over recent years, even throughout the decade of human immunodeficiency virus (HIV). Since the late 1970's, the prevalence of herpes simplex virus type 2 (HSV-2) infection has increased by approximately 30 percent in the US. The number of sufferers world-wide is currently estimated at approximately 86 million people. New serological methods based on the detection of type-specific antibodies to herpes simplex virus (HSV) glycoproteins have clarified issues concerning the true incidence of genital herpes, the modifying effect of prior HSV-1 infections, the changing proportions of HSV-1 genital herpes, and the importance of asymptomatic shedding. Patients' ignorance of their diagnosis along with the occurrence of atypical symptomatology and asymptomatic viral shedding of HSV all contribute to the transmission of genital herpes. Genital ulcer disease, of which genital herpes is the most common cause in developed countries, is an important risk factor in the acquisition and transmission of human immunodeficiency virus (HIV) infection and has contributed to the spread of this disorder. Risk factors for genital herpes HSV-2 are strongly related to lifetime number of sexual partners, number of years of sexual activity, male homosexuality, black race, female gender and a history of previous sexually transmitted diseases (STD). Understanding the epidemiology of genital herpes is of great importance in limiting the spread of this STD. In this review, we summarise current knowledge related to the epidemiology of genital herpes.
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PMID:Epidemiology of genital herpes - recent advances. 1021 Jul 81

Stored sera from a cohort of 2397 male factory workers in Harare, Zimbabwe, were screened for herpes simplex virus type 2 (HSV-2)-specific antibodies, to estimate the prevalence and incidence of genital herpes infection and to assess the relation between HSV-2 and human immunodeficiency virus (HIV) acquisition. The prevalence of HSV-2 at enrollment was 39.8%. Correlates of HSV-2 seropositivity were HIV seropositivity, marital status, history of sexually transmitted disease (STD), older age, and higher income. The incidence of HSV-2 seroconversion during follow-up was 6.2/100 person-years. Correlates of HSV-2 seroconversion were enrollment while HIV-positive or seroconversion during follow-up, reported genital ulcer, history of STD, and number of sex partners. No evidence was found that HSV-2 infection was more likely to precede HIV or vice versa. HSV-2 and HIV seropositivity are strong markers for high-risk sexual behavior. Improved interventions targeted to populations in which the incidence of either viral infection is high are needed.
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PMID:Prevalence and incidence of herpes simplex virus type 2 infection among male Zimbabwean factory workers. 1051 4


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