Maternal virus load and perinatal human immunodeficiency virus type 1 subtype E transmission, Thailand. Bangkok Collaborative Perinatal HIV Transmission Study Group

To determine the rate and risk factors for human immunodeficiency virus (HIV)-1 subtype E perinatal transmission, with focus on virus load, pregnant HIV-infected women and their formula-fed infants were followed prospectively in Bangkok. Of 281 infants with known outcome, 68 were infected (transmission rate, 24.2%; 95% confidence interval, 19.3%-29.6%). Transmitting mothers had a 4.3-fold higher median plasma HIV RNA level at delivery than did nontransmitters (P<.001). No transmission occurred at <2000 copies/mL. On multivariate analysis, prematurity (adjusted odds ratio [AOR], 4.5), vaginal delivery (AOR, 2.9), low NK cell percentage (AOR, 2.4), and maternal virus load were associated with transmission. As RNA quintiles increased, the AOR for transmission increased linearly from 4.5 to 24.8. Two-thirds of transmission was attributed to virus load>10,000 copies/mL. Although risk is multifactorial, high maternal virus load at delivery strongly predicts transmission. This may have important implications for interventions designed to reduce perinatal transmission.     

Psychological distress and neuropsychological complications of HIV infection and AIDS.

AIDS, whether real or threatened, poses a radical challenge to the psychological, social, and practical adaptation of individuals at various stages of human immunodeficiency virus (HIV) disease. The challenge arises from multiple sources, including disease progression, social discrimination, bereavement, pressure for life-style change, and neurological impairment associated with HIV brain infection. The consequences of this challenge to people with HIV infection, AIDS-related complex, AIDS, and AIDS dementia complex are reviewed. The potential for both personal crisis and personal growth in response to this challenge is highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of potent antiretroviral therapy on time to AIDS and death in men with known HIV infection duration. Multicenter AIDS Cohort Study Investigators

CONTEXT: Time to development of acquired immunodeficiency syndrome (AIDS) and time to death have been extended with the increased use of combination therapy and protease inhibitors. Cohort studies following up persons with human immunodeficiency virus (HIV) infection in periods characterized by different therapies offer the opportunity to estimate therapy effectiveness at the population level. OBJECTIVE: To assess the effectiveness of self-reported, long-term potent antiretroviral therapy in a cohort of 536 men whose duration of HIV infection was known (seroconverters). DESIGN: Cohort study. The cohort was compared for time to development of AIDS and time to death in 1984 to 1990, 1990 to 1993, 1993 to July 1995, and July 1995 to July 1997 when the major treatments were no therapy, monotherapy, combined therapy, and potent antiretroviral therapy, respectively. Survival analysis methods with time zero set as the date of seroconversion and incorporating staggered entries into each period were used. Mean CD4 cell change, stratified by infection duration, was determined for each period using a random effects model. SETTING: The Multicenter AIDS Cohort Study (MACS) in 4 urban areas (Baltimore, Md; Chicago, III; Los Angeles, Calif; and Pittsburgh, Pa). PARTICIPANTS: A total of 5622 men who were 18 years or older were enrolled into MACS. Of the 5622, there were 2191 HIV-positive individuals at enrollment. Of the 3431 men who were HIV-negative, 536 were observed to seroconvert and were followed up for up to 13 years. The group of 536 who seroconverted constituted the study population. MAIN OUTCOME MEASURES: Time from seroconversion to development of AIDS and to death and change in CD4 cell count. RESULTS: A total of 231 seroconverters developed AIDS, and 200 men died. Using 1990 to 1993 as the reference period, the relative hazard of AIDS was 1.04 (95% confidence interval [CI], 0.73-1.48) during 1993 to July 1995 and 0.35 (95% CI, 0.20-0.61) during July 1995 to July 1997. Relative hazards of death were 0.87 (95% CI, 0.58-1.31) and 0.62 (95% CI, 0.38-1.01 ) for the same periods. The relative time (the factor by which times are contracted or expanded) to development of AIDS was 0.97 (95% CI, 0.86-1.09) for 1993 to July 1995 and 1.63 (95% CI, 1.40-1.89) for July 1995 to July 1997. Relative survival time for 1993 to July 1995 was 1.01 (95% CI, 0.91-1.12) and for July 1995 to July 1997 was 1.21 (95% CI, 1.07-1.36) relative to 1990 to 1993. The rate of CD4 cell count decline in July 1995 to July 1997 was significantly lower (P<.05) compared with the previous 2 periods. CONCLUSIONS: In the calendar period when potent antiretroviral therapy was introduced, the time to development of AIDS and time to death were extended, and rate of CD4 cell count decline was arrested.     

Sensitivity and specificity of a rapid whole-blood assay for D-dimer in the diagnosis of pulmonary embolism

BACKGROUND: Patients with suspected pulmonary embolism often have nondiagnostic lung scans and may present in circumstances where lung scanning is unavailable. Levels of D-dimer, a fibrin-specific product, are increased in patients with acute thrombosis; this may simplify the diagnosis of pulmonary embolism. OBJECTIVE: To determine the sensitivity and specificity of a whole-blood D-dimer assay in patients with suspected pulmonary embolism and in subgroups of patients with low pretest probability of pulmonary embolism or nondiagnostic lung scans. DESIGN: Prospective cohort. SETTING: Four tertiary care hospitals. PATIENTS: 1177 consecutive patients with suspected pulmonary embolism. MEASUREMENTS: All patients underwent an assessment of pretest probability by use of a standardized clinical model, a D-dimer assay, ventilation-perfusion lung scanning, and bilateral compression ultrasonography. Patients in whom pulmonary embolism was not initially diagnosed were followed for 3 months. Accordingly, patients were categorized as positive or negative for pulmonary embolism. RESULTS: Of the 1177 patients, 197 (17%) were classified as positive for pulmonary embolism. Overall, the D-dimer assay showed a sensitivity of 84.8% and a specificity of 68.4%. In 703 patients (3.4%) with a low pretest probability of pulmonary embolism, the likelihood ratio associated with a negative D-dimer test result was 0.27, resulting in a posterior probability of 1.0% (95% CI, 0.3% to 2.2%). In 698 patients with nondiagnostic lung scans (previous probability, 7.4%), the likelihood ratio associated with a negative D-dimer test result was 0.36, resulting in a posterior probability of 2.8% (CI, 1.4% to 4.8%). CONCLUSIONS: A normal D-dimer test result is useful in excluding pulmonary embolism in patients with a low pretest probability of pulmonary embolism or a nondiagnostic lung scan.     

Preventing HIV infection in infants and children by reducing perinatal HIV transmission: review of efficacy and preliminary cost evaluation. South Carolina Pediatric AIDS Advisory Committee

We present the genotype distribution of the CYP1A1 gene in a sample of over 300 subjects of various ethnic origins. Genotypes are presented as composites of eight possible alleles, taking into account the three major polymorphisms, including a recently described African-American-specific MspI RFLP. A new nomenclature system is presented for clarifying the various haplotypes. Interesting interracial differences in allelic frequencies and admixture rates were observed for the three polymorphisms. Because of the importance of the CYP1A1 gene (which encodes the aromatic hydrocarbon hydroxylase) as a biomarker of genetic susceptibility to environmental carcinogens such as polycyclic aromatic hydrocarbons, these data may provide a useful reference for future studies of relationships between CYP1A1 genotype and disease susceptibility.     

Tympanometric detection of middle ear effusion in infants and young children

Tympanometry, a test of middle ear status new to clinical pediatrics, was carried out on 280 subjects, 10 days through 5 years of age. The tympanograms obtained were compared with otoscopic findings and, in 107 of the subjects, with findings at myringotomy. Seven distinct tympanometric curve types were identified and defined, based on their degree of correlation with the presence or absence of middle ear effusion. In subjects 7 months of age and older, curves suggesting normal (high) tympanic membrane compliance in combination with atmospheric or near-atmospheric middle ear air pressure were rarely associated with effusion. Conversely, curves suggesting low tympanic membrane compliance were highly correlated with the presence of effusion. Curves suggesting intermediate compliance or reduced middle ear air pressure were also correlated with effusion, but the degree of correlation was dependent on the shape of the curve. In infants less than 7 months of age, many of the ears with effusion had "normal" tympanograms, presumably because external auditory canal walls in such infants tend to be highly distensible. Tympanometry is a simple, rapid, atraumatic, valid, and objective test, easily administered by paraprofessional personnel. Its use can result in improved detection of middle ear effusion and other middle ear abnormalities, and also appears to promote improvement in diagnostic acumen.     

Neuromuscular function in HIV infection: analysis of a placebo-controlled combination antiretroviral trial. AIDS Clinical Group 175/801 Study Team

OBJECTIVE: To determine the frequency of peripheral neuropathy and myopathy in HIV-infected subjects enrolled in a combination antiretroviral treatment trial. DESIGN AND METHODS: AIDS Clinical Trial Group (ACTG) protocol 175 was a multicenter, double-blind, placebo-controlled, clinical trial. A total of 2467 subjects were randomized to one of four single or combination regimens, containing zidovudine (ZDV), didanosine (ddl), zalcitabine (ddC), and their respective placebos. Site investigators reported peripheral neuropathy, and the diagnosis of distal symmetrical neuropathy (DSP) was established by the study authors. Myalgia, muscle weakness and creatine phosphokinase (CPK) were prospectively assessed in a subset of the antiretroviral-naive cohort (n = 1067). RESULTS: Of 222 site diagnoses of neuropathy, 109 (49%) were DSP. There was a significant difference between treatment arms for rate of DSP and time to first grade 2 or higher DSP (ZDV-ddC, 6%; ZDV, 4%; ZDV-ddl, 4%; ddl, 3%; P = 0.029). Age and Karnofsky score were significant predictors of DSP. Fifty-six (54%) out of 104 patients with DSP remained on study medication at full (n = 29) or reduced (n = 27) dose within 6 months of developing neuropathy. There was no significant difference between treatment arms in the rate of myalgia or muscle weakness. The median CPK of subjects on ZDV-ddC was significantly higher than other study treatments, although CPK levels did not correlate with symptoms of myopathy. Only six subjects were diagnosed with myopathy during the study (one ZDV-ddl, one ZDV-ddC, and four ddl). CONCLUSIONS: DSP and myopathy may occur with current dosing regimens of combination antiretroviral therapy, and should be diagnosed using stringent criteria. ZDV-ddC was associated with the highest rate of DSP, although features of myopathy were not significantly different between treatment regimens.     

Early detection of cognitive decline in higher cognitively functioning older adults: Sensitivity and specificity of a neuropsychological screening battery.

The sensitivity and specificity of a neuropsychological screening battery designed to determine early cognitive decline in the high functioning elderly are presented. The battery is composed of 4 standard neuropsychological tests assessing cognitive domains commonly effected in early stages of CNS disease. Initial validation data were gathered by applying cutoff scores derived from published or submitted normative data to test data on 2 groups of elderly, higher cognitively functioning individuals: a sample of 45 elderly individuals diagnosed with 1 of 5 target disorders, and a sample of 61 independent elderly. Cutoff scores were identified that produce high rates of correct classification and a range of sensitivity and specificity. The suggested neuropsychological test battery classifies Ss as having a high, moderate, or low probability of cognitive impairment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HIV knowledge and stigmatization of persons with AIDS: Implications for the development of HIV education for young adults.

A group of 660 undergraduates and 596 clinical and counseling psychologists completed a battery of questionnaires about AIDS. Both groups knew moderate amounts of AIDS general information and prevention information and reported moderately positive attitudes toward AIDS patients. Also, both groups felt fairly invulnerable to HIV infection; neither group had much direct experience with HIV-infected patients. For both samples, degree of homophobia was the best predictor of stigmatizing attitudes toward persons with AIDS. Implications for program development and professional practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing HIV infection and AIDS in children and adolescents: Behavioral research and intervention strategies.

This article focuses on pediatric and adolescent AIDS. Literature is reviewed on the incidence of AIDS in various age groups, highlighting differences in demographic patterns among pediatric, adolescent, and adult AIDS cases. Behaviors that increase the likelihood that a child or adolescent will contract AIDS, as well as prevention strategies that target the prevention of human immunodeficiency virus (HIV) infection, are discussed. Finally, recommendations are made for social science research directed toward altering behavior associated with HIV. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceptions of AIDS susceptibility among minority and nonminority women at risk for HIV infection.

272 women sampled from mass transit waiting areas in an urban center completed anonymous surveys of AIDS-related risk behavior, perceptions of susceptibility, and knowledge. Variable patterns of HIV risk behaviors were identified, with 22% of women reporting high-risk behavior. Perceptions of susceptibility were associated with an interaction between ethnicity and level of risk; nonminority women at high risk reported greater concern about AIDS than did minority women at high risk, who did not differ from women at low risk. With an array of life problems and inaccurate information about HIV transmission, minority women were found to be at continued risk for AIDS-related behavior. Implications for culturally sensitive and relevant AIDS prevention efforts are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The safety of Bacille Calmette-Guérin vaccination in HIV infection and AIDS

Health promotion and prevention are critical elements of public health programs designed to improve health status and extend life chances. The pattern of mortality and morbidity in rural Australia suggests a particularly important role for health promotion and preventive measures in country areas. However, the importance of preventive health measures and how people access health-related information is not well understood. This study examines which sources of health-related information are most valued by rural residents and whether the importance attributed to different sources varies according to age, sex and geographic location. The results demonstrate the overwhelming importance of the general practitioner and pharmacist in provision of preventive health information for all rural people. There is a need to ensure that the work carried out by all those involved with health promotion is closely integrated with that of rural general practitioners.     

The work of clinical nurse specialists (HIV/AIDS) in areas with a low prevalence of HIV infection

Organ level-targeting of anticancer drugs or other relating stimuli to tumor tissues and their circumstances is important in cancer therapy. The successful targeting results in the greater antitumor effect and the lower numerous side effects. Application of a magnet from the outside of body is a useful tool to increase the targeting efficacy. In this review paper, targeting technology utilizing magnetic microparticulate system for cancer therapy was introduced and the future on the magnetic targeting system was augured.     

Sensitivity to indirect contacts with other persons: AIDS aversion as a composite of aversion to strangers, infection, moral taint, and misfortune.

College students and their parents rated their willingness to wear sweaters previously worn by a target person described as having AIDS, another infectious illness (tuberculosis), a misfortune (maimed in automobile accident), moral taint (convicted murderer), or simply as a healthy but unknown man. Parallel ratings were obtained with respect to beds slept in or automobiles previously owned by the same set of target persons. Results indicated that there are strong individual differences in sensitivity to 4 sources of aversion to indirect interpersonal contagion: infection, misfortune, immorality, and unfamiliarity. Individual sensitivity to any one of these sources predicts sensitivity to the others (rs in the .30s). Aversion to indirect contact with a person with AIDS (by sweater, bed, or car) includes all 4 sources of aversion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Antiretroviral therapy for HIV infection in 1996. Recommendations of an international panel. International AIDS Society-USA

We report on a retrospective study evaluating infectious morbidity associated with totally implantable venous access devices (TIVAD) (Port-A-Cath) in HIV-infected patients. This study of 84 consecutive HIV-infected patients requiring 89 TIVAD between January 1990 and October 1993 was performed in the Department of Infectious Diseases H?pital de l'Institut Pasteur, Paris, France. The total number of catheter days was 11,595. Eighteen of 89 patients with TIVAD (20%) were infected, causing 25 infectious events (25/89: 28%) among 17 different patients (17/84: 20%). The infection rate was 0.22 per 100 catheter days. Mean onset of infection was 82 days. Twenty microorganisms were isolated: Staphylococcus aureus in eight cases (40%), coagulase-negative Staphylococcus in six cases (30%), Streptococcus D faecalis in one case; Gram-negative bacilli were found in five cases (25%). All patients received an intravenous antibiotherapy combined with a local lock treatment in eight cases. Nine TIVAD removals were performed. One death was related to the TIVAD infection. No additional predisposing factor for infection was identified other than the implied condition of the HIV infection. The population and material in this study were homogeneous. The TIVAD infection rate was comparable to other published reports. Prospective evaluation comparing tunneled catheter and TIVAD in HIV-infected patients is needed.     

HIV infection and isosporiasis. Presentation of a case

Tear lactoferrin concentration was measured by ELISA technique and followed in 30 patients undergoing cataract surgery. On the first day following surgery, there was a significant decrease in tear lactoferrin concentration followed by a gradual return to the initial values during the postoperative observation period of 7 days. There was an inverse linear relationship between tear lactoferrin concentration and the tear secretion rate measured by a modified Schirmer I test (1 min) suggesting a constant lactoferrin secretion by the tear glands. Since lactoferrin has known antibacterial and anti-inflammatory effects, the results may contribute to further understanding of the microbial vulnerability or resistance of the eye following surgical procedures.     

Risk factors for cervical presence of human papillomavirus DNA among women at risk for HIV infection. DIANAIDS Collaborative Study Group

Teleost retinas adapted to light show numerous spinules invaginated in the cone pedicles whereas darkness induces a reduction in the number of spinules. Horizontal cells show nematosomes whose size decreases as the number of spinules increases. We have investigated the involvement of actin filaments in spinule formation, by using cytochalasin D through intraocular injection into an eye. The ultrastructural analysis reveals that cytochalasin D impairs spinule formation and nematosome-size reduction in both treated and contralateral untreated retinas.