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 48,410 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

By using routinely collected data and results from research studies at the Infectious Diseases Hospital (IDH), Nairobi, we have begun to determine the scale of the increase in resource utilisation and treatment costs for tuberculosis control services caused by the HIV epidemic. New cases of tuberculosis registered annually at the IDH rose 61%, from 447 in 1985 to 720 in 1990. HIV seroprevalence among patients with tuberculosis rose from 7.5% in 1986 to 42% in 1990. The inpatient mortality rate rose from 8.4% in 1985 to 16.8% in 1989, but fell to 13.5% in 1990. HIV-positive patients were admitted to hospital on 2 or more occasions more often than HIV-negative patients (Relative risk (RR) = 2.46, 95% confidence intervals (CI), 1.1-5.7), but average duration of admission was similar for the 2 groups. Significantly more HIV-positive patients were prescribed antibiotics, antifungal agents, antidiarrhoeal agents, analgesics and corticosteroids than HIV-negative patients. Microbiological investigations, apart from those for tuberculosis, were performed more commonly among HIV-positive patients (RR = 2.0, 95% CI 1.0-4.2). Using this data, the average cost of ideal drug therapy, including antituberculosis drugs and treatment for intercurrent infections and other complications, was estimated using 1992 prices (ECHO, Coulsdon Surrey, UK). The costs were US$16.62 and US$32.94 for HIV-negative patients using 'standard' therapy (2STH/10TH) and short course therapy (2SHRZ/6TH) respectively, and US$41.18 for HIV-positive patients using a short-course regimen without thiacetazone (2EHRZ/6EH). The HIV epidemic is causing both an increase in the numbers of patients requiring treatment and an increase in the average cost of treatment per patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The impact of HIV on resource utilization by patients with tuberculosis in a tertiary referral hospital, Nairobi, Kenya. 821 80

One hundred and six HIV-positive drug users were tested with a two-tone auditory evoked potential (AEP) task and a small battery of neuropsychological tests, to examine the relationship between the latency of the P300 component (P3) of the AEP, intellectual function, mood and drug use. Principal components analysis revealed a significant correlation between P3 latency and the first principal component (r = -0.43, P < 0.001). Varimax rotation generated three orthogonal components which we interpreted as intellectual performance, memory, and mood. Intellectual performance and self-reported mood were individually correlated with P3 latency, but memory was not (r = -0.36, P < 0.001; r = 0.23, P < 0.05; and r = -0.18, NS, respectively). Subjects with symptomatic HIV disease had a higher correlation between P3 latency and intellectual performance than subjects with asymptomatic HIV disease and, among patients with symptomatic HIV disease, poorer memory was associated with a lower CD4 count. Opiate or benzodiazepine consumption did not correlate with poor intellectual performance, memory, or self-rated mood in our sample. These results indicate that there is a relationship between AEP latency and neuropsychological measures of intellectual function, and that it is influenced by subjective mood. Surprisingly, declared current drug use has no discriminable effect on these relationships.
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PMID:The Edinburgh cohort of HIV-positive drug users: the relationship between auditory P3 latency, cognitive function and self-rated mood. 823 68

In England between November 1989 and February 1991, 917 new female patients at a department of genitourinary medicine (GUM), a family planning clinic (FPC), and an abortion clinic, all in inner London, completed a questionnaire so researchers could examine sexual behavior and HIV risk behavior between these women and to determine the effect of ethnic origin and socioeconomic status on these behaviors. 25.3% of GUM women and 25% of women at the abortion clinic did not use any contraception. The median numbers of sexual partners in the last 1-2 years and 4-6 years were essentially the same in all 3 groups (1.5-2.0 and 6.8-11.1, respectively). 54.8-68.9% of the women had had sexual intercourse with a nonregular sexual partner in the last 12 months. Few (10.4-17.1%) always used a condom with their regular partners. The percentage who always used a condom with nonregular partners was also low (31.3-39.7%). 18.6-23.9% of the women had at least 1 major HIV risk behavior. Age at first intercourse was younger in women of lower socioeconomic class than those of higher class (17.39 years vs. 18.04 years; p 0.0001). Whites had more lifetime sexual partners (10.34 vs. 5.18; p = 0.02) and were more likely to have practiced fellatio and anal sex (p 0.0001 and p 0.05) than did Afro-Caribbean women. Whites were more likely to have had a history of genital herpes (4.6% vs. 1%; p 0.02) and to have had sex with an IV drug user (6.9% vs. 1.5%; p = 0.005) than Afro-Caribbean women. Yet, Afro-Caribbean women were more likely to have at least 1 HIV risk behavior than Whites (29.5% vs. 21.4%; p = 0.01), almost entirely because they had had intercourse with a man from Sub-Saharan Africa. These findings suggest that staff at FPCs and abortion centers should provide women advice on sexually transmitted diseases and HIV infection and that staff at GUM clinics need to offer contraception advice. The 3 clinical disciplines must be integrated so women can receive more comprehensive sexual health services.
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PMID:A comparison of sexual behaviour and risk behaviour for HIV infection between women in three clinical settings. 828 97

A series of protease inhibitors bearing constrained unnatural amino acids at the P2-position and novel heterocycles at the P3-position of compound 1 (Ro 31-8959) were synthesized, and their in vitro enzyme inhibitory and antiviral activities were evaluated. Replacement of P2-asparagine of compound 1 with (2S,3'R)-tetrahydrofuranylglycine resulted in improvement in enzyme inhibitory as well as antiviral potencies (compound 23). Interestingly, incorporation of (2S,3'S)-tetrahydrofuranylglycine at the P2-position proved to be less effective. The resulting compound 24 was 100-fold less potent than the 2S,3R-isomer (compound 23). This stereochemical preference indicated a hydrogen-bonding interaction between the tetrahydrofuranyl oxygen and the residues of the S2-region of the enzyme active site. Furthermore, replacement of P3-quinolinoyl ligand of 1 with various novel heterocycles resulted in potent inhibitors of HIV proteases. Of particular interest, compound 2 with (2S,3'R)-tetrahydrofuranylglycine at P2 and pyrazine derivative at P3 is one of the most potent inhibitors of HIV-1 (IC50 value 0.07 nM) and HIV-2 (IC50 value 0.18 nM) proteases. Another important result in this series is the identification of compound 27 in which the P2-P3-amide carbonyl has been removed. The resulting compound 27 has exhibited improvement in antiviral potency while retaining the enzyme inhibitory potency similar to compound 1.
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PMID:Potent HIV protease inhibitors: the development of tetrahydrofuranylglycines as novel P2-ligands and pyrazine amides as P3-ligands. 836 Aug 74

Opportunistic lung infections and malignancies are life-threatening complications in HIV-positive patients. In 72 HIV-positive patients the role of different non-invasive tests such as lung function tests, blood gas analysis, 67 gallium scanning and epithelial lung clearance with 99m Tc-DTPA for the management of these patients was prospectively studied. For all non-invasive tests the mean values of patients with pulmonary complications (n = 25) differed significantly from those of asymptomatic HIV-positive patients (n = 47) (p < 0.001). In 10 patients presenting with acute Pneumocystis carinii pneumonia, 99m Tc-DTPA clearance rates and 67 gallium uptake differed significantly before and after therapy (4.80 +/- 1.23%/min vs 2.47 +/- 0.72%/min and 2.15 +/- 0.42 vs 1.39 +/- 0.18, respectively). Follow-up after therapy revealed different time courses of these tests for normalization. A significant inverse correlation was found between DLCO and 99m Tc-DTPA lung clearance (r = -0.90, p < 0.001, n = 35). A diffuse homogeneous 67 gallium uptake is not diagnostic for PCP, the same pattern was found in a patient with lymphoid interstitial pneumonitis and in patients with CMV pneumonitis; these patients also had accelerated epithelial lung clearance rates. 67 gallium (6/6) was superior to 99m Tc-labelled immunoglobulin G (3/6) for detection of PCP. The 3 patients with Kaposi sarcoma of the lung had negative 67 gallium scans, but positive 201 thallium scans and increased 99m Tc-DTPA clearance rates.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Contribution of nuclear medicine to management of pulmonary complications in patients with acquired immune deficiency]. 838 18

Even before the onset of the HIV epidemic, studies reported large variations in the protective effect of BCG against TB. The current HIV/AIDS epidemic has increased the incidence of tuberculosis in many countries in sub-Saharan Africa. Thus, local estimates of the effectiveness of BCG are needed which take prevalence of HIV into account for planning strategies for vaccination and TB control programmes. A case control study was conducted in Lusaka, Zambia. The study included 116 TB cases and 154 hospital controls. Eighty-eight per cent of controls had BCG scars compared to 77 per cent of the cases. BCG was not associated with TB in HIV positive children (OR 1.0, 95 per cent CI 0.2, 4.6). However, there was 59 per cent protective effect (OR 0.41, 95 per cent CI 0.18, 0.92) in HIV negative children. The results also suggest an eight times higher risk of TB in HIV positive children.
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PMID:HIV, BCG and TB in children: a case control study in Lusaka, Zambia. 841 15

Thyroid function and regulation were studied in 14 consecutive male outpatients with asymptomatic human immunodeficiency virus (HIV) infection (CDC II/III, n = 8) or AIDS (CDC IV, n = 6) who were free of concomitant infections and hepatic dysfunction, and in eight healthy, age- and weight-matched male controls. Blood was sampled every 10 minutes over 24 hours for measurement of thyrotropin (TSH). Thereafter, thyroid hormones and TSH responsiveness to thyrotropin-releasing hormone (TRH) were measured. Triiodothyronine (T3) and thyroxine (T4) did not differ between HIV-infected patients and controls, but HIV patients had lower thyroid hormone-binding index ([THBI] HIV patients, 1.01 +/- 0.02; controls, 1.11 +/- 0.03; P < .02), free thyroxine (FT4) index (94 +/- 3 v 110 +/- 4, P < .01), FT4 (11.8 +/- 0.4 v 14.3 +/- 0.4 pmol/L, P < .01), and reverse triiodothyronine (rT3) values (0.18 +/- 0.01 v 0.26 +/- 0.02 nmol/L, P < .001) and higher thyroxine-binding globulin ([TBG] 20 +/- 1 v 16 +/- 1 mg/L, P < .02) values. Mean 24-hour TSH levels were increased in HIV patients (2.39 +/- 0.33 v 1.44 +/- 0.16 mU/L, P < .05), associated with increased mean TSH pulse amplitude and TSH responsiveness to TRH. No differences were observed between asymptomatic HIV-seropositive and AIDS patients. In conclusion, there is a hypothyroid-like regulation of the pituitary-thyroid axis in stable HIV infection, which differs distinctly from the euthyroid sick syndrome in non-HIV-nonthyroidal illnesses.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hypothyroid-like regulation of the pituitary-thyroid axis in stable human immunodeficiency virus infection. 849 9

To compare AIDS-defining conditions in women and men, US adult AIDS cases diagnosed between January 1988 and June 1991 and reported to the Centers for Disease Control and Prevention through June 1992 were examined. For most AIDS-defining conditions, the prevalence was similar for women and men when differences in race/ethnicity and mode of transmission were accounted for. Pneumocystis carinii pneumonia was the most prevalent condition (> 50%) regardless of gender, race/ethnicity, or mode of transmission. By logistic regression analysis, among injection drug users, conditions reported significantly more frequently in women than in men include esophageal candidiasis (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.40-1.62), herpes simplex virus (HSV) disease (OR, 1.68; CI, 1.46-1.94), and cytomegalovirus (CMV) disease (OR, 1.43; CI, 1.18-1.73). More knowledge of the interrelationships in women between HIV infection and secondary opportunistic infections, including candidiasis and sexually transmitted disease (e.g., HSV and CMV) is needed.
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PMID:Gender differences in reported AIDS-indicative diagnoses. 851 33

The finding that severe measles occurs in immunized as well as nonimmunized human immunodeficiency virus (HIV)-infected individuals suggests that both immunologic memory and the initial response to measles may be impaired by HIV infection. That the initial response is affected was supported by the finding that post-measles immunization titers of HIV-infected babies were significantly lower (p = 0.01) than those of normal babies. Poor immunologic memory was evidenced in HIV-infected children by lower titers than in normal children (p < 0.001) and by a continuing decline in measles antibody that was not arrested by reimmunization. Impaired memory appeared to be associated with defective avidity maturation. HIV-infected babies and infants or children had a significantly lower avidity index (AI) than age-matched normal children (p < 0.01). HIV-infected adults, who were infected with HIV following infection with measles, did not have AI values significantly different from normal adults (p = 0.18) but had significantly greater values than did HIV-infected babies and children (p < 0.01). Thus, in contrast to infants and children who were infected with HIV before measles immunization, the adult immune response to measles was less affected.
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PMID:Abnormalities of measles antibody response in human immunodeficiency virus type 1 (HIV-1) infection. 854 33

To meet the needs of primary care physicians caring for patients with HIV infection, we developed a knowledge-based medical record to allow the on-line patient record to play an active role in the care process. These programs integrate the on-line patient record, rule-based decision support, and full-text information retrieval into a clinical workstation for the practicing clinician. To determine whether use of a knowledge-based medical record was associated with more rapid and complete adherence to practice guidelines and improved quality of care, we performed a controlled clinical trial among physicians and nurse practitioners caring for 349 patients infected with the human immuno-deficiency virus (HIV); 191 patients were treated by 65 physicians and nurse practitioners assigned to the intervention group, and 158 patients were treated by 61 physicians and nurse practitioners assigned to the control group. During the 18-month study period, the computer generated 303 alerts in the intervention group and 388 in the control group. The median response time of clinicians to these alerts was 11 days in the intervention group and 52 days in the control group (PJJ0.0001, log-rank test). During the study, the computer generated 432 primary care reminders for the intervention group and 360 reminders for the control group. The median response time of clinicians to these alerts was 114 days in the intervention group and more than 500 days in the control group (PJJ0.0001, log-rank test). Of the 191 patients in the intervention group, 67 (35%) had one or more hospitalizations, compared with 70 (44%) of the 158 patients in the control group (PJ=J0.04, Wilcoxon test stratified for initial CD4 count). There was no difference in survival between the intervention and control groups (P = 0.18, log-rank test). We conclude that our clinical workstation significantly changed physicians' behavior in terms of their response to alerts regarding primary care interventions and that these interventions have led to fewer patients with HIV infection being admitted to the hospital.
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PMID:A clinical trial of a knowledge-based medical record. 859 71


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