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

In a prospective cohort of 2,647 human immunodeficiency virus type 1 (HIV-1) seropositive homosexual men enrolled in Baltimore, Chicago, Los Angeles, and Pittsburgh, 891 developed clinical acquired immunodeficiency syndrome (AIDS) between June 1984 and January 1992. Cox proportional hazards models were used to examine temporal trends in survival after AIDS for specific diagnoses, controlling for level of immunosuppression at diagnosis, age, race, and geographic location. Median survival time following AIDS onset increased from 11.6 months in 1984-1985 to 19.5 months in 1988-1989; for those diagnosed in 1990-1991, the median survival time dropped to 17.2 months. Trends in improved survival were diagnosis-specific. Survival after Pneumocystis carinii pneumonia consistently improved from 1984 to 1991 (p < 0.001). Compared with men diagnosed in 1984-1985, those diagnosed with P. carinii pneumonia in 1990-1991 had one-tenth the hazard of dying. For men with > or = 100 helper T-lymphocytes (CD4+ cells) when diagnosed with Kaposi's sarcoma, the relative hazards (95% confidence intervals) of dying after Kaposi's sarcoma were 0.8 (0.42-1.60) in 1986-1987, 0.7 (0.34-1.58) in 1988-1989, and 0.6 (0.19-1.61) in 1990-1991 compared with those diagnosed before 1986. Men with < 100 CD4+ cells when diagnosed with Kaposi's sarcoma did not demonstrate a consistent change in their subsequent survival. After a nonsignificant (p > 0.05) initial improvement in prognosis, there has not been a significant improvement in survival for men who presented with other opportunistic infections. Observed increases in overall survival probably relate to improved treatment of patients who develop P. carinii pneumonia. Limited improvement in survival following other AIDS diagnoses indicates the need for developing effective treatment against these diseases.
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PMID:Changes in survival after acquired immunodeficiency syndrome (AIDS): 1984-1991. 790 22

Since initial reports emerged of an association between recreational drug use and high-risk sexual behaviors in gay men, there has been interest in studying this relationship for its relevance to behavioral interventions. Reported here are the longitudinal patterns of alcohol and recreational drug use in the Chicago Multicenter AIDS Cohort Study (MACS)/Coping and Change Study (CCS) of gay men. A pattern of decreasing drug use over 6 years was observed that paralleled a decline in high-risk sexual behavior (i.e., unprotected anal intercourse). In contrast, alcohol consumption tended to be more stable over time, and to show no relationship to sexual behavior change. Men who combined volatile nitrite (popper) use with other recreational drugs were at highest risk both behaviorally and in terms of human immunodeficiency virus-1 (HIV) seroconversion throughout the study. Popper use also was associated independently with lapse from safer sexual behaviors (failure to use a condom during receptive anal sex). Use of other recreational substances showed no relationship to sexual behavior change patterns, and stopping popper use was unrelated to improvement in safer sexual behavior. When popper use and lapse from safer sex were reanalyzed, controlling for primary relationship status, popper use was associated with failure to use condoms during receptive anal sex among nonmonogamous men only. These findings suggest an association between popper use and high-risk sexual behavior among members of the Chicago MACS/CCS cohort that has relevance to HIV prevention intervention efforts.
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PMID:Recreational drugs and sexual behavior in the Chicago MACS/CCS cohort of homosexually active men. Chicago Multicenter AIDS Cohort Study (MACS)/Coping and Change Study. 791 May

We analyzed data from a multisite study of 1,063 gay or bisexual men attending sexually transmitted disease clinics to evaluate factors predicting failure to disclose human immunodeficiency virus (HIV) risk behaviors to clinic staff and the extent of such failure. We compared data from a brief screening assessment on unprotected anal and oral sex with data on the same behaviors from a subsequent detailed interview. We also compared behavioral data from screening and the interview with data on diagnoses of rectal gonorrhea abstracted from medical charts. Of 523 men reporting unprotected anal sex at interview, 29% failed to report this behavior at screening. Men failing to disclose unprotected anal sex were also less likely to disclose engaging in unprotected oral sex. Among men reporting no unprotected anal sex, either at screening or interview, 1.6% were diagnosed with rectal gonorrhea. Logistic regression analyses comparing men who did and did not disclose at screening having engaged in unprotected anal sex showed that men who failed to disclose reported greater involvement in gay organizations, greater perceived peer support for condoms, fewer episodes of unprotected anal sex in the last four months, and lower rates of substance abuse treatment. Our data suggest that men who failed to disclose may have lower risk levels, and may be more integrated into the gay community. Brief interviews, as opposed to detailed ones, also may underestimate incidence of unsafe sex. Where feasible, HIV risk assessment and counseling and laboratory screening should be routinely provided to all clinic attendees, regardless of self-reports.
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PMID:Failure to disclose HIV risk among gay and bisexual men attending sexually transmitted disease clinics. 791 36

To provide an estimate of the seroprevalence of human immunodeficiency virus (HIV) in a representative sample of the U.S. household population, serum samples from participants in the third National Health and Nutrition Examination Survey (NHANES III) were tested for HIV antibody. The testing was performed anonymously on 5,430 individuals 18-59 years old from phase 1 of NHANES III conducted from 1988 to 1991. Twenty-nine individuals were HIV positive. The total weighted prevalence was 0.39%. The population estimate of infected individuals was 547,000, with a 95% confidence interval of 299,000-1,020,000 infected persons. Black participants were four times more likely to be HIV positive than white/other individuals and three times more likely than Mexican Americans. Men were three times more likely to be infected than women. Higher nonresponse to the survey and to phlebotomy was observed in young white men; therefore these data provide a conservative estimate of HIV infection in the general household population. This estimate does not include individuals who do not live in households and who may be at higher risk of infection, such as persons in penal institutions, the homeless, or certain hospitalized patients.
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PMID:The seroepidemiology of human immunodeficiency virus in the United States household population: NHANES III, 1988-1991. 793 86

The success of efforts to prevent continued transmission of the human immunodeficiency virus (HIV) and to increase compliance with HIV prophylactic interventions among homosexual and bisexual men will depend in part on health care professionals' understanding of and ability to establish linkages with these men. In order to recruit men into a research project and an educational program, staff at the Pitt Men's Study, an epidemiological investigation of HIV infection, developed a process described here as "brokering," which was based on community organizing and marketing principles. Brokering is a dynamic process by which researchers and public health professionals exchange goods and services with formal and informal leaders of the gay community in order to establish strong, long-term linkages. To date, this process yielded 2,989 homosexual and bisexual recruits into the study, which began in 1983. After 8 years, 79% of those still alive continue to return for follow-up. While recruitment techniques will need to vary from city to city, the importance of establishing linkages with the local indigenous leadership remains of major importance.
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PMID:Brokering: a process for establishing long-term and stable links with gay male communities for research and public health education. 802 44

Men attending four Seattle gay bars were asked to complete a self-administered questionnaire including measures of sexual behavior, perceptions of peer norms in the area of sexual safety, personal human immunodeficiency virus (HIV) risk estimate, and knowledge and use of a variety of acquired immunodeficiency syndrome (AIDS) prevention services. Twenty-nine percent of the sample reported engaging in unprotected anal intercourse at least once during the 2 months before the survey. Differences in peer norm perceptions, age, HIV risk estimate, and intent to be sexually safe in the future were found between those engaging in unprotected anal intercourse and those not reporting unprotected anal intercourse. No significant differences were found in level of education, use of AIDS prevention services, and whether or not a person had been tested for HIV. Implications for prevention programs are discussed.
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PMID:Risk behavior for HIV transmission among gay men surveyed in Seattle bars. 804 57

Clinical trials have shown that the prophylactic use of zidovudine and aerosolized pentamidine (or other antibiotics used as prophylaxis against Pneumocystis carinii pneumonia) in acquired immunodeficiency syndrome (AIDS)-free human immunodeficiency virus (HIV)-infected persons delays the development of AIDS, but the effectiveness of such therapy in general use in the population still remains largely undocumented. To help answer this question, the authors estimate the effectiveness of this therapy in a population-based cohort of HIV-infected homosexual and bisexual men in San Francisco. The authors use a continuous-time Markov process to model the decline of CD4+ T-lymphocytes (T4-cells) measured in cells/microliter in HIV-infected persons. The model partitions the HIV (type 1) infection period into six progressive T4-cell count intervals (stages), followed by a seventh stage: AIDS diagnosis. The authors use maximum likelihood methods to fit the model to the observed transitions for 428 HIV-infected men during June 1984 to March 1991, from the San Francisco Men's Health Study. Since zidovudine was not widely used before 1988, the model has a component that controls for calendar time-related biases. The fitted model provides statistical estimates and confidence intervals for measuring therapy effectiveness. The authors estimate that prophylactic therapy reduces the progression rate from stage 4 (T4-cell count, 350-499) to stage 5 (T4-cell count, 200-349) by a factor of 0.26 (95% confidence interval (CI) -0.22 to 0.55); from stage 5 to stage 6 (T4-cell count < 200) by a factor of 0.33 (95% CI 0.04-0.54); and from stage 6 to 7 (AIDS) by a factor of 0.62 (95% CI 0.47-0.73). In addition, therapy started by an HIV-infected person in stage 4 is estimated to reduce the risk of developing AIDS by a factor of 0.83 (95% CI 0.46-0.94) at 6 months and 0.68 (95% CI 0.35-0.89) at 24 months after entering stage 4. Therapy started by HIV-infected persons in more advanced stages is estimated to reduce the risk of developing AIDS by factors ranging from 0.70 (95% CI 0.39-0.90), early in stage 5, to 0.28 (95% CI 0.14-0.45), late in stage 6. Thus, the prophylactic use of zidovudine and pentamidine in routine medical care has a strong, consistent, and significant effect in slowing the clinical course of HIV infection in a population-based cohort.
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PMID:Effect of routine use of therapy in slowing the clinical course of human immunodeficiency virus (HIV) infection in a population-based cohort. 810 Jun 82

The acquired immunodeficiency syndrome (AIDS) results from infection with the human immunodeficiency virus (HIV). The time of infection is generally unknown since transmission usually occurs during the course of repeated sexual contacts or needle sharing. Brookmeyer and Gail describe the biases that may arise in survival analyses using the recruitment time rather than the unknown infection time as the origin in prevalent cohorts of HIV-infected individuals. We apply a non-parametric hazard estimator, introduced by Nielsen, that assumes the hazard of an AIDS diagnosis depends upon the unknown time of infection solely through the value of possibly multidimensional markers of HIV-disease progression such as CD4+ T lymphocyte cell counts. Essentially, we estimate the hazard for a specific marker value y by dividing the number of occurrences among subjects with marker measurements in a neighbourhood of y by the total risk time in that neighbourhood. We present this estimator, which relies upon kernel estimator techniques to produce a smooth estimate, within a counting process framework. We apply this method to marker data from the San Francisco Men's Health Study.
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PMID:Marker-dependent hazard estimation: an application to AIDS. 810 Oct 12

Men with advanced human immunodeficiency virus (HIV) disease have a high prevalence of anal human papillomavirus (HPV) infection and potentially precancerous anal disease. To characterize prevalence of and risk factors for anal HPV infection and anal cytologic abnormalities, 37 HIV-positive and 28 HIV-negative participants in the San Francisco General Hospital Cohort Study were studied. A questionnaire was administered, followed by an anal examination consisting of two consecutive anal swabs for cytology and HPV DNA hybridization, and anoscopy with biopsy of visible lesions. Ten of 28 (36%) HIV-negative men and 19 of 37 (51%) HIV-positive men had anal HPV infection (p = 0.32). Risk factors for anal HPV infection included HIV positivity with a CD4 count < 200/mm3 (p = 0.03) and a history of smoking (p = 0.03). Abnormal anal cytology was found in 2 of 26 (8%) HIV-negative men and 10 of 36 (28%) HIV-positive men with cytology adequate for interpretation (p = 0.09). Risk factors for abnormal anal cytology included HIV positivity with a CD4 count < 200/mm3 (p = 0.006) and current smoking (p = 0.03). We conclude that the risk of development of anal disease and HPV infection was highest among HIV-positive men with a CD4 count of < 200/mm3, and that smoking may play a role in the pathogenesis of anal disease.
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PMID:Risk factors for anal human papillomavirus infection and anal cytologic abnormalities in HIV-positive and HIV-negative homosexual men. 817 44

We reviewed the features of patients with human immunodeficiency virus (HIV) infection, whose only way of acquisition was heterosexual contacts, analyzing differences with others risk groups. Epidemiological features (age, gender, family situation, socioeconomic status and sexual behavior), clinical manifestations immunological status, and evolution of 40 patients with HIV infection through heterosexual contact are studied, and compared with others risk groups. All were attended in our center from 1985 to October 1991; 15 were in stage IV. Along the study period, the proportion of heterosexual patients has steadily increased to represent 40% on total number of acquired immunodeficiency syndrome (AIDS) cases diagnosed in 1991. This study allow to establish two groups of patients depending on the gender. All men had had occasional sexual contacts with prostitutes, most had no stable partner, they mainly were between their fourth and sixth decade of life, and they were stable partners of seropositive patients or prostitutes, they had an averaged age significantly lower than men, and they were diagnosed in earlier stages. Two groups with different features can be established among the patients infected through heterosexual contacts. Men are adults, and acquired HIV infection through contacts with prostitute; they are diagnosed in late phases of the disease. On the contrary, women are younger, with no homogeneous patterns of behavior and they are diagnosed in earlier stages. Complications throughout the evaluation were similar in the heterosexual and in the other groups.
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PMID:[Epidemiologic and clinical characteristics and clinical course of the HIV positive patient infected by heterosexual transmission]. 823 77


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