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

To develop a model for predicting acquired immunodeficiency syndrome (AIDS) morbidity in San Francisco, Calif, through June 1993, we combined annual human immunodeficiency virus seroconversion rates for homosexual and bisexual men and for heterosexual intravenous drug users with estimates of the cumulative proportion of the population with AIDS by duration of human immunodeficiency virus infection and with estimates of the size of the at-risk populations. We projected AIDS mortality by applying Kaplan-Meier estimates of survival time following diagnosis to the projected number of cases. The median incubation period for AIDS among homosexual and bisexual men infected with the human immunodeficiency virus was estimated to be 11.0 years (mean, 11.8 years; 95% confidence interval, 10.6 to 13.0 years). The model projects 12,349 to 17,022 cumulative cases of AIDS in San Francisco through June 1993, with 9,966 to 12,767 cumulative deaths.
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PMID:Projections of AIDS morbidity and mortality in San Francisco. 230 86

Mutations were made by recombinant DNA techniques in an infectious molecular clone of the human immunodeficiency virus San Francisco isolate 2 (HIVSF2) [formerly the prototype isolate of the acquired immunodeficiency syndrome-associated retrovirus (ARV-2)]. The effect of these changes on the replicative and cytopathologic properties of the virus was studied by transfecting modified virus clones into cultured human cells. Mutations in the gag, pol, env, and tat regions precluded virus replication and cytopathology in lymphoid cells. A mutation in orf-A dramatically reduced but did not abolish virus replication. Mutant viruses with deletions in the orf-B region were highly cytopathic and replicated to approximately 5-fold higher levels than wild-type virus. They also produced approximately 5-fold more viral DNA in infected lymphoid cells than did wild-type virus. Thus, the orf-B region may function to down-regulate virus replication. This mutational analysis of the HIVSF2 genome is a means of assessing genes regulating viral replication and cytopathology.
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PMID:Mutational analysis of the human immunodeficiency virus: the orf-B region down-regulates virus replication. 243 56

Between 1978 and 1980, 359 hepatitis B seronegative homosexual and bisexual men were recruited from the San Francisco municipal sexually transmitted disease clinic for hepatitis B vaccine trials. Of the 359 participants, 320 (89%) consented to have their stored blood samples tested for human immunodeficiency virus antibodies. The prevalence of human immunodeficiency virus infection in these 320 vaccine trial participants rose from 0.3% in 1978 to 50.9% in 1988. The annual incidence of human immunodeficiency virus infection showed that seroconversion peaked in 1980-1982, dropped significantly in 1983, and has remained low. Men less than 30 years old on entry into the study seroconverted earlier in the epidemic and had higher incidence rates than men 30 years or older (p = 0.07). No statistical difference in seroconversion rates was found for other demographic variables. Using a Kaplan-Meier survival curve of the cumulative proportion of men without acquired immunodeficiency syndrome by duration of human immunodeficiency virus infection, an estimated 39% (95% confidence interval 27%-51%) will develop acquired immunodeficiency syndrome within 9.2 years of infection. Cox proportional hazard stepwise analysis showed no correlation between age at seroconversion, race, or year of seroconversion and progression to acquired immunodeficiency syndrome.
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PMID:Prevalence, incidence, and progression of human immunodeficiency virus infection in homosexual and bisexual men in hepatitis B vaccine trials, 1978-1988. 253 43

Acquired immunodeficiency syndrome (AIDS)-related services offered by San Francisco General Hospital (SFGH); programs to protect employees who are at occupational risk for infection with human immunodeficiency virus (HIV); and the legal, ethical, and economic implications of such infection are discussed. Support from public officials, health-care professionals, and the community has enabled SFGH to develop an extensive program of AIDS-related services. The program consumes 10% of SFGH's budget and was responsible for treating 1693 patients between January 1981 and June 1988. The hospital has two internationally recognized units dedicated to the care of AIDS patients. Many of the medical and support departments at SFGH contribute expertise directly; clinical and basic research are also conducted. Other services sponsored by the hospital include HIV testing and counseling; special training for physicians and nurses; assisting patients with finances, housing, and home care; emotional support; and community education. Expenses per patient are lower at SFGH than nationally because of contributions from the private and public sectors, but costs are not fully recovered. Hospital employees are protected by a body substance precautions program, a comprehensive needle-stick program, mandatory reporting and evaluation of all exposures, and enrollment in a study to document seroconversions. Confidentiality and compensation remain major concerns. San Francisco General Hospital has a model program of caring for patients with AIDS and protecting its workers, but the issue of compensating those employees who do become infected with HIV has not yet been resolved.
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PMID:Multidisciplinary response of San Francisco General Hospital to the AIDS epidemic. 253 64

The economic cost of the acquired immunodeficiency syndrome (AIDS) in San Diego County, California, is forecast to increase from $103 million in 1986 to between $502 and $743 million in 1991, rising at a minimum average annual rate of 30% after adjusting for inflation. A greater emphasis on outpatient care and the use of new therapies that increase life expectancy by reducing the frequency and severity of morbidity will decrease the future annual cost of treatment but will have a small effect on total economic costs because of substantial foregone earnings by persons with AIDS. Estimating the economic impact of this disease provides valuable information for formulating effective strategies to treat AIDS patients, to provide education for limiting the spread of the human immunodeficiency virus, and to achieve other health objectives.
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PMID:Assessing the economic impact of AIDS in local communities. Current and projected costs for San Diego County. 258 88

Transmission of the human immunodeficiency virus (HIV) and other blood-borne viruses in hospitals is discussed, and the infection control system and worker protection and education plan at San Francisco General Hospital (SFGH) are described. The acquired immunodeficiency syndrome (AIDS) epidemic has led to increased concern about occupationally acquired infections in health-care workers. As the number of HIV-infected persons increases, so does the risk of infection. Occupationally acquired HIV infection of health-care workers occurs principally in nurses, phlebotomists, and laboratory technicians through accidental subcutaneous injection of contaminated blood; splashing of blood onto open skin lesions, the eyes, and mucous membranes represents another route of exposure. The risk of infection from a single needle-stick exposure to HIV-infected blood is about 0.4%. Other blood-borne viruses to which employees are vulnerable include hepatitis B virus and human T-cell lymphotropic viruses, which may cause leukemia and lymphoma. SFGH has a comprehensive infection control system. Specimen containers are enclosed in transparent secondary containers, the worker is encouraged to wear protective clothing when necessary, and specific needle-stick precautions are promoted. There is also a health-care worker protection and education plan. The employee health services department provides immunizations, keeps records on accidental exposures, and operates a hot line. The education committee disseminates educational materials and arranges lectures. Infection control and education provide simple but effective measures for protecting hospital employees against HIV and other occupationally acquired infections.
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PMID:Infection of the health-care worker by HIV and other blood-borne viruses: risks, protection, and education. 261 Feb 20

As the epidemic of the acquired immunodeficiency syndrome (AIDS) expands, the prevalence of the human immunodeficiency virus (HIV) infection in health care environments will increase and health care workers in many locations are likely to be at increased risk for exposure. The Fifth Annual Advances in Occupational Cancer Conference, held in December 1988 in San Francisco, addressed occupational HIV infection. Symposium participants concluded that the risk of HIV infection for health care workers is low but not zero. Implementation of universal blood and body fluid precautions was agreed to as an appropriate method of preventing exposure to HIV, especially for preventing needlestick accidents. Current standards for hospital waste disposal were judged to be adequate to prevent transmission of HIV, and confidential testing for HIV antibody in health care workers with follow-up counseling was recommended where indicated. It was also agreed that the risk of occupational exposure to HIV does not free health care workers from the responsibility to provide care to infected persons.
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PMID:Occupational infection with human immunodeficiency virus (HIV). Risks and risk reduction. 264 24

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.
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PMID:Prevalence of HIV infection among intravenous drug users in the United States. 265 32

In this review, available human immunodeficiency virus (HIV) seroprevalence data are presented for United States women attending clinics related to reproductive health and for women in other settings. At family planning clinics, prenatal clinics, and in delivery room settings (cord blood testing), studies that have not targeted women at high risk for HIV infection have shown prevalence rates ranging from 0-4.3%. Higher rates (greater than 1%) have been observed in more urban areas--Newark, New York City, Baltimore, Miami, and San Juan; rates at settings outside these areas have generally been below 1%. Filter-paper testing for maternal HIV antibodies from neonatal heel-stick specimens has been conducted statewide in Massachusetts and New York; prevalence rates were 0.3% in Massachusetts in 1987, and 0.2% in upstate New York and 1.3% in New York City in 1987-1988. Prevalence rates of female military applicants and female blood donors are below 0.03% and 0.1%, respectively, and have been relatively stable over time. Where age data are available, prevalence rates are near 0 in women below age 20 years, are higher for young adult and early middle-aged women, and decline thereafter. Studies have also been conducted using blood samples from women undergoing premarital testing for syphilis serology, from women attending sexually transmitted disease clinics and drug treatment centers, and from patients at sentinel hospital sites. Information on the prevalence of HIV infection in United States women is useful to identify specific populations at risk for HIV infection and to target and evaluate education and prevention efforts.
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PMID:Review of human immunodeficiency virus infection in women in the United States. 268 15

Note from Dr. Merle A. Sande--Health care workers are at risk of acquiring human immunodeficiency virus (HIV) infection subsequent to accidental sticks with needles contaminated with blood from infected patients. The risk is small but real. Postexposure management is critically important, but few solid data are available. Can zidovudine (AZT, azidothymidine) prevent infection? How soon after exposure must the drug be given? At what dosage? For how long? Two leading authorities were asked to discuss this problem and to offer recommendations. Both have developed programs in their institutions, Dr. David K. Henderson at the Warren Grant Magnuson Clinical Center at the National Institutes of Health and Dr. Julie L. Gerberding at the University of California, San Francisco.
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PMID:Prophylactic zidovudine after occupational exposure to the human immunodeficiency virus: an interim analysis. 276 Apr 86


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