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

Epidemiologic studies involving HIV (human immunodeficiency virus) antibody testing create ethical dilemmas, particularly about notifying asymptomatic seropositive subjects. Four study designs address this problem: mandatory notification, optional notification, anonymous testing, and blind testing. No single design consistently optimizes the trade-off between valid and ethical research. Each strategy differs substantially from the others in its effect on response rates, bias, ability to perform longitudinal studies, numbers of subjects who learn their test results, and the number of subjects counseled about HIV risk reduction. Both local institutional review boards and potential subjects of study (and their sexual partners) should participate in decisions regarding the conduct of sensitive AIDS (acquired immunodeficiency syndrome) research.
 ...
PMID:To tell or not to tell: the ethical dilemmas of HIV test notification in epidemiologic research. 281 69

Before December, 1986, all public human immunodeficiency virus (HIV) testing in Oregon was done using names confidentially. Since December, clients have been offered the option of either anonymous or confidential testing. Clients choosing anonymous testing still received pre-test counseling, but were identified only by number. Demographic and risk factor data were collected, and a self administered questionnaire investigated opinions regarding anonymous testing. There was a sharp increase in the number of individuals seeking testing, from 363 first-time clients in the 3 1/2 months preceding anonymous testing to 1250 in the 3 1/2 months after the change (50% increase). 29% of clients indicated that they would not have come without anonymity, although 11% of these chose confidential testing. Of those who would have come without anonymity, 46% chose anonymity. This was most marked among homosexual men, 49% of whom would not have been tested without anonymity. Anonymous testing is strongly implicated as causing these changes, as there was no sharp increase in the number of people coming for testing in Colorado or California. Neither actual nor perceived antibody status was associated with the choice of anonymous or confidential testing. In the 3 1/2 months after anonymous testing was available 85 seropositive individuals were identified, versus 36 in the 3 1/2 months before. 95% of the client who tested positive after the change (81/85) were gay, and 48% (39/81) would not have come without anonymous testing. Thus, anonymous testing attracted homosexual men who would not have been tested confidentially and resulted in the identification of twice as many seropositive individuals as before.
 ...
PMID:Trial of anonymous versus confidential human immunodeficiency virus testing. 289 84

The potential spread of the human immunodeficiency virus (HIV) to childbearing women in areas of high acquired immunodeficiency syndrome (AIDS) endemicity is a major public health concern. As a private institution providing obstetric care to such a population of women, we undertook an anonymous HIV cord blood serosurvey to estimate the number of childbearing women at our institution at risk for perinatal transmission of the virus and to assess the success of our voluntary screening program to identify seropositive women. Between November 1987 and January 1988, cord blood samples from all clinic deliveries were analyzed for the presence of HIV antibody. For each sample obtained, the mother's age and site of prenatal care were known. Overall, 2.7% (six of 224) of the samples tested were seropositive; two of the 34 samples (5.9%) from teenage mothers were seropositive. All positive samples were from women who received prenatal care; none were identified through a voluntary screening program based on patient self-acknowledged risk-behavior assessment. This confirms that risk factor history elicited by personal interview is not a reliable screening tool for initiating HIV antibody counseling and testing. The high seropositive rate in teenagers is disturbing and needs further assessment.
 ...
PMID:Umbilical cord blood serosurvey for human immunodeficiency virus in parturient women in a voluntary hospital in New York City. 291 24

A random, stratified sample of 2601 adult Australians from all states and territories was interviewed about knowledge of the acquired immunodeficiency syndrome (AIDS). After the interview, an anonymous questionnaire on the prevalence of practices that are associated with risk of human immunodeficiency virus (HIV) infection was left with the respondents; 60.2% of these questionnaires were returned. Data from this survey suggest that the prevalences of male homosexual behaviour, prostitute contact and lesbian contact are substantially lower than were estimated previously. Men with homosexual experience were significantly more prevalent in the more populous states, but the majority of other risk factors--intravenous drug abuse, male respondents' contact with prostitutes, transfusion of blood or blood products during 1980-1985 and heterosexual contact--showed few significant associations with geographical, occupational or marital status. Intravenous drug abusers were significantly younger, and heterosexual contact was associated with age for both male and female respondents. No significant differences were found in the prevalence of homosexual contact among single, married and previously-married men, although the prevalence of homosexual contact was lower in married men. The results of the study are discussed in terms of targeting preventive campaigns and assessing the future potential for the spread of HIV infection.
 ...
PMID:Prevalence of risk factors for human immunodeficiency virus infection in the Australian population. 317 93

Nine hundred fifty-five of 1,384 (69 per cent) gay and bisexual men enrolled in a prospective study of the natural history of human immunodeficiency virus (HIV) infection who reported engaging in anal intercourse in the past six months were surveyed about condom use practices for both insertive (IAI) and receptive anal intercourse (RAI). The following results were obtained: 23 per cent of the men reported that they always used condoms for IAI and 21 per cent for RAI; 32 per cent sometimes used condoms for IAI; 28 per cent sometimes used condoms for RAI; 45 per cent never used condoms for IAI; and 50 per cent never used condoms for RAI. Multiple logistic regression analysis revealed that the following variables were associated with both insertive and receptive condom use: condom acceptability; a history of multiple and/or anonymous partners in the past six months, and the number of partners with whom one is "high" (drugs/alcohol) during sex. Knowledge of positive HIV serostatus was more strongly associated with receptive than with insertive use. Condom use is a relatively complex health-related behavior, and condom promotion programs should not limit themselves to stressing the dangers of unprotected intercourse.
 ...
PMID:Variables influencing condom use in a cohort of gay and bisexual men. 326 81

As the second largest group of persons to have been infected with human immunodeficiency virus (HIV), and the most likely to transmit HIV to heterosexual partners in the United States and Europe, iv drug users will play an increasingly important role in the future of the AIDS epidemic. This paper reviews five emerging critical issues regarding HIV infection among iv drug users. In epidemiology, rates of drug injection and anonymous sharing of injection equipment appear related to rapid spread of HIV among iv drug users, while heterosexual transmission from iv drug users appears to have been occurring at a relatively slow but constant rate. Data exist that support a gender-related cofactor and a continuing drug injection cofactor, but mechanisms for these potential cofactors have not been determined. Besides frank AIDS, HIV infection also appears to lead to epidemic-level increases in a variety of fatal infections among iv drug users. Several studies of prevention show active risk reduction among iv drug users, but new methods are urgently needed to increase amount of risk reduction.
 ...
PMID:HIV infection and intravenous drug use: critical issues in transmission dynamics, infection outcomes, and prevention. 328 Dec 19

Results of voluntary, anonymous human immunodeficiency virus (HIV) antibody testing and counseling offered to all patients attending a sexually transmitted disease (STD) clinic showed that men who refused testing were 5.3 times more likely to be infected than men who accepted testing, and that male homosexuals and black and Hispanic men who refused testing were even more likely to be infected than their counterparts who accepted testing. The prevalence of HIV infection in persons refusing HIV testing was determined in a retrospective, blinded study using stored serum specimens originally drawn for syphilis testing. It is recommended that HIV testing and counseling should be routinely offered to STD clinic patients; male STD clinic patients who refuse voluntary HIV testing should be counseled about reducing their risk for HIV transmission.
 ...
PMID:Comparison of HIV-antibody prevalence in patients consenting to and declining HIV-antibody testing in an STD clinic. 339 98

To determine the prevalence of unsuspected human immunodeficiency virus (HIV) infection in critically ill emergency patients, we examined the anonymous serum samples of 203 critically ill or severely injured patients with no history of HIV infection. We found that six (3%) were seropositive for HIV antibody by both enzyme-linked immunoassay and Western blot analysis. All seropositives were trauma victims between the ages of 25 and 34 years, representing 16% of the trauma patients in that age group (n = 37). All seropositives were actively bleeding, and all required multiple invasive procedures. History of intravenous drug abuse was not discriminating in identifying potential seropositives. We conclude that infection-control precautions are indicated for both emergency department personnel and prehospital care providers (such as paramedics, police officers, and fire fighters) when caring for bleeding patients, whether or not previous suspicion of HIV infection exists.
 ...
PMID:Unsuspected human immunodeficiency virus in critically ill emergency patients. 357 58

We report on the first four years (1990-93) of a survey within the national HIV prevalence monitoring programme. The survey's objective is to monitor the prevalence of infection with the human immunodeficiency virus (HIV) in pregnant women in London and elsewhere in England. The survey--based in forty centres that offer antenatal care in London, Greater Manchester, West Yorkshire, and adjacent non-metropolitan areas--uses repeated cross sectional serosurveillance for anti-HIV-1 and 2 and the unlinked anonymous test method on blood left over from specimens collected for antenatal screening for immunity to rubella. The seroprevalence of HIV-1 ranged from 0.007% (1 in 14,530) in non-metropolitan areas, to 0.011% (1 in 8790) in metropolitan areas outside London, and 0.23% (1 in 440) in London. Evidence of HIV-2 infection was found in only four specimens, in London (1 in 50,300). The seroprevalence of HIV-1 in London varied more than tenfold between centres, from 0.03% (1 in 3190) to 0.51% (1 in 200). The highest prevalence of infection was in London in women aged between 20 and 30 (0.30%; 1 in 335). The seroprevalence in London centres rose from 0.18% in 1990 (1 in 560) to 0.26% in 1993 (1 in 390) and the rise was significant in all age groups. If voluntary confidential HIV testing (with counselling) among pregnant women in England were to be promoted, its cost effectiveness would be greater if focused on particular centres that provide antenatal care in London.
 ...
PMID:Survey of human immunodeficiency virus infection among pregnant women in England and Wales: 1990-93. 752 76

An anonymous survey of 149 resident doctors was conducted to estimate the extent of accidental exposures to blood and body fluids of patients over a one-year period. There was a total of 1142 exposures. Ninety-three percent of respondents reported one or more exposure incident(s). Analysis of events and procedures leading to accidental exposures revealed that recapping needles was involved in 17%, suturing accounted for 14%, setting up intravenous lines 11%, cuts with scalpel 9% and phlebotomy 9%. Surgical residents had a threefold greater risk of exposure compared with medicine residents. No trend was found for accidental exposures by level of residency training. Seventy-four percent of the residents used universal precautions 50% or less of the time. Only half of the doctors could recall formal instruction on correct course of action after exposure and 5% of them had as undergraduates hepatitis B vaccine prior to the commencement of venepuncture duties. All but one of the residents' exposures were not reported to the Staff Medical Services Department. The doctor who reported was neither tested for hepatitis B virus or human immunodeficiency virus nor was he properly treated. Only 5 (4.6%) of the contaminating patients were evaluated serologically for their status of these viruses. These data emphasize the need for increased efforts toward improved early and continuing education, prevention and correct management of accidental exposures to blood or body fluids of patients by resident doctors in Nigeria. No recent study exists that exclusively addresses this problem in doctors in tropical Africa.
 ...
PMID:Self-reported incidence of accidental exposures to patients' blood and body fluids by resident doctors in Nigeria. 756 70


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>