Showing papers in "AIDS in 1993"
TL;DR: Non-ulcerative STD were risk factors for sexual transmission of HIV-1 in women, after controlling for sexual exposure, and offered an important additional strategy for the prevention of HIV/AIDS.
Abstract: There is only a small probability that HIV-1 will be transmitted via any single sexual contact. The risk of transmission however during such an act may be greatly increased by the presence of ulcerative genital sexually transmitted disease (STD). Little evidence is published on whether infection with non-ulcerative STD facilitates the transmission of HIV-1. The authors therefore investigated whether treatable STD enhanced the sexual transmission of HIV-1 in a cohort of female prostitutes in Kinshasa Zaire. 431 initially HIV-1-seronegative women were followed prospectively in this nested case-control study for a mean duration of two years in monthly STD check-ups and three-monthly HIV-1 serology. The 68 women who seroconverted were compared against the 126 women who remained HIV-1-seronegative for the incidence of STD and sexual exposure during the presumed period of HIV-1 acquisition. There was a 9.8% annual incidence of HIV-1 in this cohort of subjects. Seroconverters were of mean age 24.6 years compared to 26.8 years for the HIV-seronegative women. During the period of HIV-1 acquisition cases had a much higher incidence of gonorrhea chlamydial infection and trichomoniasis and engaged in unprotected sex with clients and partners more frequently than controls. After controlling for sexual exposure by multivariate analysis adjusted odds ratio for seroconversion were 4.8 for gonorrhea 3.6 for chlamydial infection and 1.9 for trichomoniasis. Genital ulcers were more frequent in cases than controls but much less common than other STD. These findings therefore suggest that non-ulcerative STDs were risk factors for the sexual transmission of HIV-1 in these women. Such STD may be a considerable population-attributable risk in the transmission of HIV-1 worldwide given the high prevalence of non-ulcerative STDs in some populations.
1,183 citations
TL;DR: In this population, HIV-positive adults present to hospital with advanced disease associated with high mortality, and the three major underlying pathologies (TB, toxoplasmosis and bacteraemia) are either preventable or treatable.
Abstract: HIV disease is epidemic in Africa but associated mortality underlying pathology and CD4+ T-lymphocyte counts have not previously been evaluated in a representative study. Such data help to determine the management of HIV-positive people. Both HIV-1 and HIV-2 infections are prevalent in Cote dIvoire and the pathology of HIV-2 infection in Africa is unclear. Consecutive adult medical admissions to a large city hospital in Cote dIvoire were studied in 1991 and a sample of HIV-positive deaths autopsied. Of 5401 patients evaluated 50% were HIV-positive; 38% of these died with a median survival of 1 week. At autopsy (n=294 including 24% of HIV-positive deaths in hospital) tuberculosis (TB) bacteremia (predominantly Gram-negative rods) and cerebral toxoplasmosis caused 53% of deaths. TB was seen in 54% of cadavers with AIDS-defining pathology and Pneumocystis pneumonia in 4%. The median CD4+ T-lymphocyte counts in those who died was /1. Compared with HIV-1 positives patients with HIV-2 positivity had a greater frequency of severe cytomegalovirus infection HIV encephalitis and cholangitis. In this population HIV-positive adults present to hospital with advanced disease associated with high mortality. The 3 major underlying pathologies (TB toxoplasmosis and bacteremia) are either preventable or treatable. TB is an underestimated cause of the slim syndrome in Africa. The patterns of pathology in HIV-2 positive patients suggest a more prolonged terminal course compared with HIV-1. There is an urgent need for attention towards the issues of therapy and care for HIV disease in developing countries. (authors)
567 citations
TL;DR: The genetic variation among HIV-1 isolates is more extensive than previously appreciated and at least seven distinct HIV- 1 genotypes can be identified.
Abstract: ObjectiveTo determine the extent of genetic variation among internationally collected HIV-1 isolates, to analyse phylogenetic relationships and the geographic distribution of different variants.DesignPhylogenetic comparison of 70 HIV-1 isolates collected in 15 countries on four continents.MethodsTo
375 citations
TL;DR: The authors' findings indicate that the majority of men had sustained safe sex practices, and HIV prevention strategies adopted included condom use, avoidance of anal intercourse and negotiated safety.
Abstract: Objective To assess the maintenance of safe sexual practice. (We use the term ‘safe’ sex throughout the paper, since ‘safe’ is the term adopted by the Australian National Committee on AIDS.) Design Maintenance was assessed by comparing sexual behaviour with both regular and casual partners reported in a 1986/1987 survey (time 1) with behaviour reported in a second survey in 1991 (time 2). Method The 145 homosexually active participants were a non-clinical sample recruited in 1986/1987 by advertisement and followed-up in 1991. A structured questionnaire was administered at both times. Items included questions about the nature of the men's sexual relationships and their sexual practices. Results Our findings indicate that the majority of men had sustained safe sex practices. HIV prevention strategies adopted included condom use, avoidance of anal intercourse and negotiated safety (i.e., the negotiated practice of unprotected anal intercourse within regular partnerships of concordant serostatus). Conclusions Negotiated safety is not the same as relapse.
278 citations
TL;DR: These findings support both a biphasic natural history and the suggestion that the broad range in HIV disease progression rates may be the result of several independent factors interacting in a variety of combinations.
Abstract: Objective:To identify and characterize individuals with long-term HIV-1 infection who have experienced little or no progressive CD4+ T-cell loss during follow-up.Patients and methods:The rate of CD4+ T-cell loss (CD4 slope) was determined for each of the 290 participants in the San Francisco Men's H
258 citations
TL;DR: In conclusion, a large body of new information on the biology and immunology of T. gondii has accumulated in the past several years due to the advent of AIDS and the increased funding made available to researchers interested in opportunistic infections in this patient population.
Abstract: In conclusion, a large body of new information on the biology and immunology of T. gondii has accumulated in the past several years. Much of this is due to the advent of AIDS and the increased funding made available to researchers interested in opportunistic infections in this patient population. These scientific advances have led to a better understanding of the process by which Toxoplasma infects mammalian host cells, molecular biology and biochemistry of the parasite, antigenic structure and immune response to the infection and approaches to be adopted for drug design and therapeutic strategies. Thus, it is through such recognition of the importance of understanding the basic science of an opportunistic pathogen that such advances can be realized.
241 citations
TL;DR: Examining gay men's patterns of self-disclosure of HIV seropositivity to friends, lovers, relatives and colleagues found that men who perceived their significant others as responding more helpfully were less depressed and anxious currently and 1 year later.
Abstract: ObjectivesTo examine gay men's patterns of self-disclosure of HIV seropositivity to friends, lovers, relatives and colleagues; to assess the effects of disclosure; and to identify reasons for not disclosing to particular individuals.DesignLongitudinal questionnaire survey of gay men.MethodsA total o
225 citations
TL;DR: Among HIV-infected patients in whom the tuberculin skin test is negative, the risk of developing active TB is sufficient to consider prophylaxis if the CD4 count falls below 400 $$ 106/l, at least in those patients with skin anergy living in high-risk geographical areas such as Spain.
Abstract: ObjectiveTo evaluate the risk of developing active tuberculosis (TB) in a cohort of HIV-1 -infected patients.MethodsProspective longitudinal follow-up of 839 HIV-infected patients, of whom 505 (60%) were parenteral drug users and 269 (32%) homosexual men. Tuberculin skin tests were performed at base
177 citations
TL;DR: Differences in viral load between individuals infected with HIV-2 and those infected withAIDS could partly account for reported differences in the pathogenicity of the two viruses.
Abstract: Objective To determine circulating viral load in HIV-2-infected individuals. Methods Viral load was determined in 40 HIV-2-infected adults using standardized quantitative cell and qualitative plasma viraemia assays. We also tested for proviral HIV-2 DNA using single and nested polymerase chain reaction (PCR) in fresh lymphocytes from 27 subjects. The results were compared, on the basis of the CD4+ lymphocyte count, with our published data for HIV-1 infection. Results HIV-2 was isolated from peripheral blood mononuclear cells (PBMC) from 19 individuals and plasma from four patients. The rate of cell and plasma viraemia positivity correlated with the CD4+ cell count and HIV-2 virus load increased as the CD4+ cell count fell. The cellular HIV-2 load in the patients with a CD4+ count 500 x 10(6)/l, HIV-1 and HIV-2 were undetectable in plasma and HIV-1 was isolated from PBMC in significantly more cases than HIV-2. By single PCR, amplification were positive in 14 out of 27 subjects and there was a correlation between positivity and CD4+ cell count. By nested PCR, only four of the 27 subjects, all with a high CD4+ count, remained negative. Conclusions Differences in viral load between individuals infected with HIV-2 and those infected with HIV-1 could partly account for reported differences in the pathogenicity of the two viruses.
177 citations
TL;DR: Even in the earliest stage of HIV-1 infection a small group of individuals at high risk for rapid progression to AIDS can be recognized by the clinical presentation of primary HIV infection, the presence of HIV p24 antigenaemia and the absence of a serological response to HIV core protein.
Abstract: OBJECTIVE: To determine whether at the time of HIV-1 seroconversion rapid progressors to AIDS and a low CD4+ count can be distinguished by the clinical presentation of primary HIV-1 infection and serological and immunological characteristics. DESIGN: Prospective cohort study on HIV-1 infection in homosexual men. SETTING: The Municipal Health Service, Amsterdam, The Netherlands. SUBJECTS: One hundred and eight men who seroconverted for HIV-1 during follow-up. MAIN OUTCOME MEASURES: Progression to AIDS and progression to a CD4+ lymphocyte count < 200 x 10(6)/l. RESULTS: Symptomatic primary HIV infection with fever and skin rash, absence of anti-HIV core and transient HIV p24 antigenemia were independent predictors of progression to AIDS at the time of HIV-1 seroconversion. A low CD4+ count immediately after seroconversion and the calendar year were independent predictors of progression to a low CD4+ count at the time of HIV-1 seroconversion. CONCLUSIONS: Even in the earliest stage of HIV-1 infection a small group of individuals at high risk for rapid progression to AIDS can be recognized by the clinical presentation of primary HIV infection, the presence of HIV p24 antigenaemia and the absence of a serological response to HIV core protein.
TL;DR: A common methodology was developed and can now be applied to all studies with sufficient follow-up and comparisons made between transmission rates, essential for assessing determinants of transmission and for the development of a common approach for the evaluation of interventions aimed at reducing or interrupting MTCT of HIV.
Abstract: PURPOSE: In the last 8 years, numerous cohort studies have been conducted to estimate the rate of mother-to-child transmission (MTCT) of HIV. Many of these have faced problems in data collection and analysis, making it difficult to compare transmission rates between studies. This workshop on methodological aspects of the study of MTCT of HIV-1 was held in Ghent (Belgium) in February 1992. STUDY SELECTION AND DATA EXTRACTION: Fourteen teams of investigators participated, representing studies from Central (five) and Eastern Africa (three), Europe (two), Haiti (one) and the United States (three). A critical evaluation of the projects was carried out, under four headings: (1) enrollment and follow-up procedures, (2) diagnostic criteria and case definitions, (3) measurement and comparison of MTCT rates and (4) determinants of transmission. RESULTS OF DATA ANALYSIS: Reported transmission rates ranged from 13 to 32% in industrialized countries and from 25 to 48% in developing countries. However, no direct comparisons could be made because methods of calculation differed from study to study. Based on this review, a common methodology was developed. Agreement was reached on definitions of HIV-related signs/symptoms, paediatric AIDS and HIV-related deaths. A classification system of children born to HIV-1-infected mothers according to their probable HIV infection status during the first 15 months of life, allowed the elaboration of a direct method of computation of the transmission rate and of an indirect method for studies with a comparison group of children born to HIV-seronegative mothers. This standardized approach was subsequently applied to selected data sets. CONCLUSIONS: The methodology can now be applied to all studies with sufficient follow-up and comparisons made between transmission rates. This step is essential for assessing determinants of transmission and for the development of a common approach for the evaluation of interventions aimed at reducing or interrupting MTCT of HIV.
TL;DR: The increased prevalence of ASIL seen among immunosuppressed HIV-seropositive men may be the result of both a non-specific increase in productive HPV infection and HIV-induced immune alterations of HIV-related neoplasia.
Abstract: Objective: To examine and quantify the association between anal squamous intraepithelial lesions (ASIL), anal human papillomavirus (HPV) infection and immunosuppression among HIV-seropositive and HIV-seronegative homosexual men.Design: Cross-sectional study among homosexual men presenting at a commu
TL;DR: The cases described represent a degree of hepatic abnormalities that has not been reported previously in HIV-seropositive patients, and are probably an underestimate of actual incidence.
Abstract: Objective To describe death attributed to severe hepatomegaly and macrovesicular steatosis without inflammation or necrosis in HIV-seropositive patients without AIDS. Patients Patients from the AIDS Clinical Trials Group (ACTG) Adverse Reactions and the Food and Drug Administration's (FDA) Spontaneous Report databases. Results Six fatal and two non-fatal cases in which no known cause of hepatic steatosis could be found were identified. With one possible exception, none of the six fatal cases had a diagnosis of AIDS and all were in reasonable nutritional status (as indicated by weight and/or serum albumin); the majority were mildly to moderately overweight. All had received at least 6 months of antiretroviral therapy, and all had gastrointestinal complaints without other non-hepatic abdominal pathology. At least three out of the six had no history of progressively abnormal liver function tests until a few weeks prior to the onset of symptoms and subsequent death. Further investigation of the FDA and ACTG databases identified two similar but non-fatal cases in which abnormalities resolved after cessation of antiretroviral therapy. Conclusions The cases described represent a degree of hepatic abnormalities that has not been reported previously in HIV-seropositive patients, and are probably an underestimate of actual incidence, since patients with possible etiologies of liver disease were excluded from the clinical history, laboratory, microbiologic, or histologic examination. The etiology of hepatic disease may be associated with antiretroviral therapy, HIV, or an unidentifiable infection, and requires further investigation.
TL;DR: Complement activation by HIV envelope glycoproteins was found to be mediated by the binding of MBP to carbohydrates on natural envelope protein produced in virus-infected cells, as well as on glycosylated recombinant envelope proteins produced in insect cells.
Abstract: ObjectiveRetroviruses can activate the complement system in the absence of antibodies, and the purpose of this study was to examine whether the serum collectin, mannan-binding protein (MBP), could mediate such complement activation.DesignVirus envelope proteins gp120 and gp110 from HIV-1 and HIV-2 w
TL;DR: Backloading can be a route of HIV transmission among IDU and should be incorporated into risk-factor studies and HIV transmission modeling, and many IDU who avoid other high-risk drug-injection practices may overlook the risk of backloading.
Abstract: Background:In syringe-mediated drug-sharing (backloading), injecting drug users (IDU) use their syringes to mix drugs and to give measured shares to other IDU by squirting drug solution into the syringes of other IDU. Backloading has been discussed as a potential HIV risk factor, but its role as an
TL;DR: Serologic results corroborated previous findings, in a smaller subset of samples, of an apparent segregation of viral subtypes by mode of transmission, suggesting two separate HIV-1 epidemics in Thailand.
Abstract: A simple synthetic enzyme immunoassay (EIA) for serotyping HIV-1 specimens from Thailand based on gp120 V3 loop peptide was developed and tested on 188 sera from 4 regions of the country. There are 2 major known gene variants of HIV-1 in Thailand designated genotype A and B. The peptide EIA was tested on 61 sera that had been characterized by polymerase chain reaction and DNA sequencing. The EIA was then tested on 188 sera from high risk groups collected in the northern northeastern central and southern regions in mid-1991. The PND-A assay was 86% sensitive and 96% specific; the PND-B assay was 96% sensitive and 92% specific. The EIAs showed 100% predictive values when sera known to be reactive to only HIV A or B were tested. In the series there were also 8 sera reactive to both A and B and 40 not reactive to either variant. Excluding dual and non-reactors 92% of patients with sexual high risk factors had HIV-1 type A and 76% of those with IV drug use history had type B. The results suggest that 2 HIV-1 epidemics have occurred in Thailand an initial wave in 1988 among IV drug users and a later wave centered among prostitutes and their clients.
TL;DR: Changes in the distribution of thymocyte subsets suggests a role for thymic involvement in the pathogenesis of HIV-1 infection in neonates.
Abstract: Objective:To determine the impact of HIV-1 infection on thymocyte development, and the role of thymic infection on the pathogenesis of neonatal HIV-1 infection.Design and methods:The consequences of thymic infection by HIV-1 were examined by comparative histologic and molecular analyses of an asympt
TL;DR: MRI is more sensitive than CT for detecting white matter abnormalities and zidovudine may improve symptoms and prolong survival in patients with ADC, which rarely developed with continued zidvudine use in this study.
Abstract: OBJECTIVE: To assess the clinical presentation and course of the AIDS dementia complex (ADC). DESIGN: Retrospective study of a consecutive series of symptomatic HIV-1-infected patients [Centers for Disease Control and Prevention (CDC) stages IVA, B, C and D] evaluated for neurological symptoms between 1982 and 1992. SETTING: An academic referral centre for AIDS. PATIENTS: A total of 536 symptomatic HIV-1-infected patients evaluated for neurological symptoms between 1982 and 1992. INTERVENTIONS: Zidovudine treatment, which was introduced in The Netherlands on 1 May 1987 for patients with severe symptoms of HIV infection (CDC stages IVA, B, C and D). MAIN OUTCOME MEASURES: Diagnosis of ADC and CD4 cell count, clinical features, neuropsychological abnormalities, computed tomography (CT) and magnetic resonance imaging (MRI) abnormalities, cerebrospinal fluid (CSF) findings and course in patients with ADC. RESULTS: ADC was diagnosed in 40 out of 536 (7.5%) immunosuppressed, neurologically symptomatic HIV-1-infected patients in CDC stage IV, and was the AIDS-defining illness in six. The mean CD4 cell count of the 40 patients with ADC was 109 x 10(6)/l. Neuropsychological abnormalities in 15 out of 17 patients tested were in accordance with subcortical dementia. On CT scan of the brain, 70% showed no or only mild cortical atrophy. MRI was more sensitive than CT scan for detecting white matter abnormalities (73 versus 35%; P = 0.02). CSF examination showed mononuclear pleocytosis in 25%, protein level increase in 55%, and HIV-1 p24 core protein in 38% (13 out of 34). The mean survival was 6.7 months in the 40 ADC patients, but 4 months in 20 patients who had never used zidovudine, compared with 14.8 months in 10 patients who started zidovudine after they were classified as having ADC (P < 0.001). Three of these 10 patients improved remarkably, and two slightly, after starting zidovudine. ADC developed after discontinuation of zidovudine in nine patients. Only one patient developed ADC while receiving 600 mg zidovudine. CONCLUSIONS: MRI is more sensitive than CT for detecting white matter abnormalities. To date, there is no specific or sensitive CSF marker for ADC. Zidovudine may improve symptoms and prolong survival in patients with ADC, which rarely developed with continued zidovudine use in our study.
TL;DR: This study will contribute to conventional practitioners' understanding of those unconventional explanations and therapies for HIV infection that many patients find relevant and meaningful and should be aware of their patients' interest in participating in decisions about their treatment.
Abstract: Objective: To investigate the extent of recourse to alternative therapies among 184 HIV-positive patients who continued to attend conventional medical clinics. The study describes the specific alternative therapeutic modalities that were more commonly sought by our respondents, and provides data on
TL;DR: It is demonstrated that fetal T cells can be primed to HIV env determinants in utero, suggest that HIV-specific TH immunity may be protective in newborns, and provide a possible means for identifying newborns who are at risk for HIV infection.
Abstract: ObjectiveTo study a possible correlate of protection in mother-to-infant transmission of HIV infection. In particular, to determine whether lack of HIV-specific T-helper (TH) function as indicated by HIV and non-HIV antigen-stimulated interleukin (IL)-2 production of mother and/or newborn peripheral
TL;DR: Examination of cognitive function in patients at various stages of HIV infection indicates that there is a steady increase in the prevalence of neurobehavioral abnormalities associated with stage of infection and the pattern of abnormality also varies with disease stage.
Abstract: Objective: To examine cognitive function in patients at various stages of HIV infection, and to determine the nature and severity associated with stage of illness.Design: Subjects were administered an extensive battery of neuropsychological tests.Subjects: Two hundred and thirty-three HIV-1 -infecte
TL;DR: The low variation between the HIV-1 sequences from randomly chosen individuals from high-risk cohorts in two Indian states suggests a rapid and recent spread of HIV and, possibly, introduction of the virus by the same route, most probably heterosexual transmission.
Abstract: The authors report their findings from the analysis of nucleotide sequences derived from the env region of four HIV-1 strains in an attempt to gain molecular insights into different HIV-1 strains present in Maharashtra and Goa India. HIV-1 was isolated from 22 patients from Bombay and one from Goa. The subjects were mainly prostitutes. The molecular analysis of the env region encompassed all variable domains of the external glycoprotein gp120. Genomic DNA from cultured cells infected with each of the four Indian HIV-1 strains independently was amplified by polymerase chain reaction (PCR). PCR fragments were cloned and sequenced and a phylogenetic tree constructed. All four Indian HIV-1 sequences were found to be closely related to each other with the closest related sequence being from a South African isolate HIV-1 (NOF) with an homology of 85-87%. In the phylogenetic tree the Indian and South African HIV-1 sequences cluster together and constitute a subtype different from the North American/European Central African Uganda/Rwanda and Northern Thailand subtypes. The viruses of this subtype are characterized by an additional potential N-glycosylation site C-terminal to the CD4-binding domain. HIV is spreading rapidly in India most probably through heterosexual sexual intercourse. Consideration must be given to the existence of these varied HIV-1 strains when developing a vaccine.
TL;DR: Drug toxicity, assessed in 25 enrolments, was well-tolerated with little renal, hepatic or haematological toxicity and AmBisome is well-Tolerated and may be an effective formulation in the treatment of cryptococcosis.
Abstract: Objective To determine the safety and efficacy of liposomal amphotericin B (AmBisome) in the primary treatment of AIDS-associated cryptococcosis. Design A Phase II, multicentre, European, non-comparative, open study to assess the use of AmBisome in 23 patients (26 enrolments) with cryptococcosis. Dose requirements, mycological response and toxicity were documented. Setting Hospital-based HIV units. Patients Twenty-three HIV-1-seropositive patients. Results Drug toxicity, assessed in 25 enrolments, was well-tolerated with little renal, hepatic or haematological toxicity. Eighteen out of 23 (78%) enrolments responded clinically. Nineteen enrolments had cryptococcal meningitis: sterilization of spinal fluid was achieved in 12 out of the 18 (67%) who were mycologically evaluable. Fourteen out of the 19 (74%) responded clinically. Conclusion AmBisome is well-tolerated and may be an effective formulation in the treatment of cryptococcosis.
TL;DR: The pattern of HIV-2 infection in this rural community has similarities to that found in urban Bissau, and prevalence in both areas peaks in older subjects than in HIV-1 foci, supporting previous suggestions that HIV- 2 is not a recent introduction to Guinea-Bissau and that it is less pathogenic and less readily transmitted than HIV- 1.
Abstract: ObjectivesTo determine the prevalence of HIV infection and its relationship to age, sex and other factors.Design and settingCross-sectional survey of a rural community in Guinea-Bissau.MethodsQuestionnaire-administration and screening of sera from subjects aged >m; 15 years.ResultsOf the 2770 subjec
TL;DR: Young men in the general population in northern Thailand are at high risk for HIV-1 infection via sex with female prostitutes; STD are highly associated with HIV- said to be immediate goals of HIV control programs.
Abstract: This study sought to determine risk factors for HIV-1 infection in young men in northern Thailand. This cohort of 1115 young men were selected by lottery for conscription and at enrollment into this prospective study data were collected from a self-administered questionnaire and serologic testing. The overall HIV-1 infection rate was 6.9%; however the rate was 15.3% among the 387 (34.7%) men who had been living in the upper north subregion of Thailand compared with 2.5% for the remaining 728 men (p < 0.001). A history of sex with female prostitutes was reported by 74.7% of men and increased frequency of this type of sex was highly associated with HIV-1 infection and a history of sexually transmitted disease (STD) symptoms (chi square for trend p < 0.001). In stratified and multivariate analyses however history of STD symptoms reported by 42.5% of the cohort was most strongly associated with HIV-1 infection. Only 42.8% of men who reported sex with prostitutes had used condoms more than half the time. Young men in the general populations in northern Thailand are at high risk for HIV-2 infection via sex with female prostitutes; STDs are highly associated with HIV-2 infection. Increasing condom use and controlling STD should be immediate goals of HIV control programs.
TL;DR: This study demonstrates that health of the index, anal intercourse and bleeding as a result of intercourse are the major determinants of sexual transmission of HIV to women in couples.
Abstract: OBJECTIVE: Since heterosexual transmission of HIV in the United States is occurring at an increasing rate, especially among black and Hispanic couples and those in which one member has a history of intravenous drug use, we sought to study the heterosexual transmission of HIV in couples. DESIGN: Multiple logistic regression analysis of risks for HIV infection in female partners. METHODS: We enrolled 158 non-intravenous drug user (IVDU) steady heterosexual partners of HIV-infected individuals (indexes) in this study. Of these, 93% were women, 54% were Hispanic whites, 23% were black and 65.6% were partners of IVDU. RESULTS: In a multiple logistic regression analysis of risks for HIV infection in female partners, the strongest predictors of transmission were AIDS or AIDS-related complex (ARC) in the index [adjusted odds ratios (OR), 16.81; P < 0.001 and 12.53; P = 0.003, respectively], a history of anal intercourse (adjusted OR, 10.81; P < 0.001) and bleeding as a result of intercourse (adjusted OR, 4.90; P < 0.05). Female-to-male transmission was detected in seven out of 11 couples at risk. Ethnicity, number of episodes of vaginal intercourse, number of other sexual partners and history of sexually transmitted infections were not significantly associated with transmission to women. CONCLUSION: Our study demonstrates that health of the index, anal intercourse and bleeding as a result of intercourse are the major determinants of sexual transmission of HIV to women in couples.
TL;DR: These data provide strong epidemiologic evidence that indiscriminate injections with contaminated needles and syringes were responsible for HIV transmission in this population of abandoned Romanian infants and children.
Abstract: Objective:To determine risk factors for HIV infection among abandoned Romanian infants and children living in a public institution.Methods:A cross-sectional study was conducted in June 1990 among 101 children between 0 and 4 years of age living in an orphanage. Orphanage and hospital records were re
TL;DR: The association between HIV wasting syndrome and injecting drug use, and the significant racial/ethnic and geographic differences in prevalence of this AIDS diagnosis may reflect differences in diagnostic and reporting practices and/or access to medical care.
Abstract: OBJECTIVE To describe the characteristics of individuals > or = 13 years of age with HIV wasting syndrome in the United States and US territories. DESIGN Retrospective review of national AIDS case surveillance data. METHODS Data for the 147,225 individuals with AIDS reported to the Centers for Disease Control from 1 September 1987 to 31 August 1991 were reviewed. The frequency of HIV wasting syndrome and its association with demographic and exposure category variables and with other AIDS-indicator diseases were assessed. RESULTS A total of 10,525 (7.1%) had wasting syndrome as the only AIDS-indicator condition, and 15,726 (10.7%) had wasting syndrome plus at least one other AIDS-indicator condition. Patients with wasting syndrome as the only AIDS diagnosis were more likely to be female, to be black or Hispanic, and to have a mode of HIV exposure reported as injecting drug use, heterosexual contact, or transfusion/hemophilia. The proportion of AIDS patients reported with wasting syndrome varied by geographic distribution, ranging from 11% in the northeastern United States to 47% in Puerto Rico. The association between HIV wasting syndrome and Hispanic ethnicity was due to the much higher prevalence of wasting syndrome reported in Puerto Rican AIDS patients. The other AIDS-indicator conditions most strongly associated with wasting syndrome were isosporiasis, pulmonary candidiasis, esophageal candidiasis, HIV encephalopathy, chronic mucocutaneous herpes simplex, and coccidioidomycosis. CONCLUSIONS The association between HIV wasting syndrome and injecting drug use, and the significant racial/ethnic and geographic differences in prevalence of this AIDS diagnosis may reflect differences in diagnostic and reporting practices and/or access to medical care.