Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The epidemiology of tuberculosis in this country is changing because of a combination of biological and social factors. The recent use of DNA fingerprinting of Mycobacterium tuberculosis using restriction-fragment-length polymorphism analysis has suggested that nearly one-third of new cases of tuberculosis being reported in a large metropolitan city is a result of recent infection. The immunosuppression of individuals with the human immunodeficiency virus and the prevalence of multiple drug-resistant tuberculosis has resulted in a renewed interest in the epidemiology and prevention of this disease. To determine the magnitude of the problem in the U.S. Navy enlisted population, a computer search of more than one million inpatient hospitalization records from January 1980 to December 1994 was performed. Total first hospitalization rates for all cases of tuberculosis during this period ranged from 2.2 per 100,000 person-years at risk in white females to 27.5 per 100,000 person-years in males, race "other" (includes mostly Filipinos and Asian-Americans). First hospitalization rates across all cases of tuberculosis declined during this period from a high of 8.7 per 100,000 in 1980 to a low of 2.2 per 100,000 in 1994.
Mil Med 1998 Feb
PMID:Hospitalization rates of tuberculosis in U.S. Navy enlisted personnel: a 15-year perspective. 950 95

It is appropriate to study sexual risk behaviors among ship- and shore-based active duty Navy women. Morbidity and mortality associated with sexually transmitted diseases and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), the increasing number of HIV/AIDS cases among heterosexual women, and the limited information regarding Navy women's sexual health are justification for identifying the determinants of sexual risk behavior(s) among this group of women of childbearing age. This study provides an integrated perspective in which demographic characteristics, motivation, problem-solving, self-esteem, and sexual risk behaviors are used to explore determinants of sexual risk behavior among ship- and shore-based Navy women. The subjects in the study (N = 165) consisted of 53 (32.5%) African-American and 88 (54%) white women whose average age was 26.89 years (SD = 6.10 years); the remaining 13.5% were from four other ethnic/racial groups. Sexual risk behaviors were defined as having more than one sex partner (n = 68) and the partner not using a condom (n = 75). Single women whose partners did not use condoms were observed to have lower self-esteem scores than single women whose partners used condoms (t = 3.37, df = 70.85, p = 0.001). A knowledge of the factors that influence sexual risk behavior(s) will provide direction for the development of interventions to reduce risk.
Mil Med 1998 Apr
PMID:Mary J. Nielubowicz Award. Sexual risk behaviors among ship- and shore-based Navy women. 957 73

A paper-and-pencil questionnaire was administered to 1,377 U.S. Army troops from rapid deployment units at Fort Bragg, North Carolina. This yielded 1,368 surveys available for analysis. The primary goal of the survey was to evaluate this group's experience with the Army human immunodeficiency virus (HIV) education program and to determine their level of HIV risk behaviors as related to participation in the Army's HIV education program. Seventy-seven percent of the respondents (1,052 of 1,368) reported receiving some HIV education from the Army. Of those, 55% (578 of 1,052) reported receiving 1 hour of education within the past year. Soldiers of Asian, Native American, and "other" race/ethnicity, and to a lesser extent, Hispanic background, were more likely to report receiving no HIV education compared with whites and African Americans. Self-reported receipt of HIV education did not strongly differentiate individuals in their partner selection or in key sexual risk behaviors in which they engaged.
Mil Med 1998 Oct
PMID:Human immunodeficiency virus (HIV) education and HIV risk behavior: a survey of rapid deployment troops. 979 42

In the future, U.S. military forces will be faced with opposing forces that have chemical and biological weapon capabilities. Although drugs used against these agents would be an ideal solution to protecting soldiers, the ability to test their efficacy in humans is limited by several ethical and technical problems: (1) the high risk of toxicity to volunteers; (2) the risk of delayed side effects in the volunteers; and (3) the inability to extrapolate effects against sublethal doses to efficacy against lethal doses. The Food and Drug Administration (FDA) relies on safety and efficacy data in humans, making approval for these types of drugs difficult. An alternative approach for regulatory approval would be to use surrogate markers. Surrogate markers are biochemical or physiologic measurements that demonstrate the direct effect of the drug. Surrogate markers, such as CD4 counts and viral RNA levels, have been used recently in the anti-human immunodeficiency virus drug approval process with success. A drug development program using surrogate markers must meet several criteria, including demonstrated efficacy in animal models, correlation between efficacy and the surrogate marker, a link between the surrogate marker and the pathophysiology and toxicologic effects of the agent, and the ability to produce the surrogate marker in humans. This article illustrates the use of drug-induced methemoglobin as a surrogate marker for protection against cyanide intoxication. Safety issues regarding this class of drugs would also have to be pursued aggressively during and after their use by military forces. Demonstrating that the drug satisfies these criteria would be a platform for approval by the FDA. The guidelines mentioned above should be an acceptable approach for FDA approval, scientific researchers, medical practitioners, and the soldiers using these drugs.
Mil Med 1998 Nov
PMID:Use of surrogate markers for drugs of military importance. 981 32

A cost-effectiveness analysis of syphilis screening was performed. Strategies included no screening, universal testing at military entrance processing stations, universal testing at basic training centers, and contracting centralized screening. Probabilities derived from data retained on recruit applicants from 1989 through 1991 (N = 1,588,143) and from the published literature were used. Cost estimates were derived from costs incurred by the military and costs projected from implementing new strategies. Sensitivity analyses were performed. Modifying the existing contract for human immunodeficiency virus screening to include syphilis screening would maximize the effectiveness of screening at a cost to the Department of Defense of $9.52 per additional year of service received. The no-screening option was significantly more cost-saving than the current method of testing. Syphilis is rare and treatable, and individuals with syphilis will be identified by other means in many cases. Syphilis screening of recruit applicants at the military entrance processing stations should cease, saving the military $2,541,000 per year.
Mil Med 1999 Aug
PMID:Cost-effective syphilis screening in military recruit applicants. 1045 69

Highly active antiretroviral therapy (HAART) has been recommended for human immunodeficiency virus (HIV)-positive patients with a detectable viral load; it typically consists of two reverse transcriptase inhibitors combined with a protease inhibitor. In 1996, Madigan Army Medical Center began offering HAART to HIV-positive patients with a detectable viral load. We retrospectively reviewed the records of our HIV patients before and after the initiation of HAART to determine the impact of HAART on hospitalizations, mortality, and outpatient pharmacy expenditures. Comparing 1997 with 1994 and 1995, we found a greater than 700% increase in the average expenditure on antiretroviral agents after institution of HAART. At the same time, we found a dramatic reduction in hospitalizations and nontraumatic mortality. Therefore, the increase in expenditures on antiretroviral agents may be offset by a reduction in hospitalizations and mortality.
Mil Med 1999 Sep
PMID:Reduction in human immunodeficiency virus patient hospitalizations and nontraumatic mortality after adoption of highly active antiretroviral therapy. 1049 28

A survey was conducted to evaluate military human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) policies and programs in 119 countries. Ninety-eight percent of the 62 respondents provide prevention education, 95% in group settings but only 53% individually. Predeployment briefings are more common than postdeployment briefings. Condoms are promoted more often than provided. Seventy-eight respondents report some form of mandatory HIV testing, and 58% perform mandatory recruit testing, with recruitment denied to HIV-positive individuals in 17%. Counseling accompanies mandatory testing less than voluntary testing. In-service care for AIDS patients is universal. Many military prevention programs can be improved through postdeployment briefings and proactive interventions involving education, condom distribution, and counseling combined with testing. Mandatory testing is often inconsistent with stated goals, and AIDS care policies may strain military budgets. Testing based on cost-benefit assessments may increase efficiency in military HIV control. Military budgets may benefit from greater civil-military cost sharing in AIDS care.
Mil Med 2000 Feb
PMID:International military human immunodeficiency virus/acquired immunodeficiency syndrome policies and programs: strengths and limitations in current practice. 1070 66

Sexually transmitted diseases (STDs) and their sequelae are responsible for significant human and economic costs. Military personnel are one of many core populations at increased risk for acquiring STDs. This study was designed to assess primary care physician/practitioner compliance with secondary screening recommendations and reporting practices of STDs in a military setting. Data from approximately 27,000 covered lives from the Naval Hospital and the Naval Air Station Branch Medical Clinic in Jacksonville, Florida, were used in this analysis. Because chlamydia is the most prevalent STD, laboratory results indicative of infection with chlamydia from July 1 to December 31, 1996, were used as a marker of a patient population requiring additional (secondary) STD screening. Patients with laboratory-confirmed chlamydia infection were identified using the Composite Health Care System. The medical records of these index cases were then analyzed for the presence of laboratory test results of human immunodeficiency virus (HIV), rapid plasma reagin, and hepatitis B virus (HBV) within 6 months of a positive chlamydia test. To assess compliance with mandated reporting of particular STDs, total laboratory-confirmed cases of chlamydia, syphilis, and HBV were compared with total cases reported to the Office of Preventive Medicine at the Bureau of Medicine and Surgery, U.S. Navy, during a 1-year period from July 1, 1996, to June 30, 1997. In 32% of chlamydia cases, no additional laboratory tests for HIV, syphilis, or HBV were obtained within 6 months. Fourteen percent of chlamydia cases were reported to the Office of preventive Medicine. Compliance with screening for multiple STDs after the identification of a single STD should be improved. In addition, better methods for reporting cases of STDs should be implemented.
Mil Med 2000 Jun
PMID:Sexually transmitted disease screening and reporting practices in a military medical center. 1087 Mar 66

Systems for the staging of individuals with human immunodeficiency virus type 1 (HIV-1) infection were developed 15 years ago. Subsequently, assays for quantitating HIV-1 RNA and immunophenotyping of lymphocyte subsets have been developed and validated. The utility of these assays for improved staging in early disease was evaluated in 256 HIV-infected adults (52% minority) with CD4 counts > or = 400 cells/microL followed in U.S. military medical centers before the highly active anti-retroviral therapy era. HIV viral load (RNA) was quantitated; the frequencies of select CD4+ immunophenotypes were determined in 112 subjects. The results were analyzed in relation to three outcome measures: death, first acquired immunodeficiency syndrome-defining opportunistic infection, and CD4 count < or = 200 cells/microL. Serum RNA level and CD4 count were each found to be predictive of all three outcomes. In addition, increases in the T-cell subsets CD28-CD4+ and CD29+CD26-CD4+ were found to be independently predictive of more rapid progression. The classification of early-stage HIV patients is improved by the quantitation of both viral RNA and T-lymphocyte subsets.
Mil Med 2001 Jul
PMID:Clinical prognosis of patients with early-stage human immunodeficiency virus (HIV) disease: contribution of HIV-1 RNA and T lymphocyte subset quantitation. 1146 26

Blastomycosis is a fungal infection acquired via inhalation of Blastomyces dermatitidis. The majority of cases occur in central, southeastern, and mid-Atlantic areas of the United States. We report the case of a 42-year-old veteran infected with the human immunodeficiency virus who presented in E1 Paso, Texas, with a dry cough, fever, and recent weight loss. We review the clinical and epidemiologic features of blastomycosis. Diagnostic criteria and pharmacologic management are discussed. Active duty personnel are at high risk of exposure to B. dermatitidis. Military providers should maintain an index of suspicion for blastomycosis in endemic and nonendemic regions.
Mil Med 2001 Nov
PMID:Acquired immunodeficiency syndrome-related blastomycosis in an unusual geographic location. 1172 16


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