Combining HIV and AIDS surveillance: an experience from an Italian region

BACKGROUND: Surveillance systems based on the reporting of AIDS cases do not provide a completely up to date picture of the trend of the HIV epidemic, stressing the need for systems based on the diagnosis of HIV infection. However, implementation of these systems has been hindered by low feasibility, poor access to HIV testing, and problems related to confidentiality. The advantages and disadvantages of the two systems and of combined use were explored by comparing and integrating information from AIDS and HIV testing registries in a region of Northern Italy. METHODS: Linkage of AIDS and HIV testing registries allowed the annual number of incident and prevalent infections to be calculated. For linked cases, concordance of exposure category was determined. RESULTS: Up to the end of 1995, 2186 AIDS cases and 5306 HIV-positive individuals were diagnosed. Linkage identified 1212 individuals reported to both registries. From 1990 to 1995, annual AIDS incidence steadily increased, while incidence of new HIV diagnoses decreased. The AIDS-to-AIDS-free ratio among those infected decreased from 1:5.6 in 1989 to 1:4.2 in 1995. The proportion of women and noninjecting drug users was higher among AIDS-free cases than among AIDS cases. The concordance of the exposure category was high (K = 0.70; 95% CI: 0.67-0.74), but it varied by exposure category; the highest concordance was for injecting drug users. CONCLUSIONS: Integrated use of the information provided by these surveillance systems allowed us to better understand and foresee the AIDS epidemic dynamics. The data also suggested that the reliability of information on exposure category may vary among categories.     

The HIV-epidemic in Norway 1996--mainly heterosexual transmission

Up to 1996, a total of 1,537 individuals had been reported as having HIV infection in Norway (population 4.3 million). 511 of these had developed AIDS and 410 had died from AIDS. 223 persons had acquired HIV heterosexually. Less than a fifth of these had acquired the infection from persons who themselves had been infected with HIV heterosexually in Norway. Named testing of pregnant women, recruits and blood donors confirms the limited spread of HIV. We estimate that the annual incidence of heterosexually acquired HIV infection has remained at 20-30 for the last ten years. Earlier prognoses for the epidemic in Norway were grossly erroneous, mainly owing to lack of knowledge about the factors determining the spread of HIV. Given the low rate of transmission of the virus and the sexual behaviour of Norwegians, there was never any real danger of a large heterosexual HIV epidemic in this country. The future efforts to combat the epidemic should focus on maintaining features that make Norwegian society less vulnerable to HIV.     

AIDS and severe HIV disease: combined predictions for the United Kingdom to 1999

The number of HIV infections prevalent in the United Kingdom (UK) at the end of 1994 have been estimated. Estimates of the future annual incidence and prevalence of AIDS and severe HIV disease have been calculated for the UK by combining recently published projections for Scotland with projections produced for England and Wales adjusted to account for Northern Ireland. The number of HIV infections prevalent in the UK at the end of 1994 was estimated to be about 23,000, 36% of them undiagnosed. It was estimated that 52% of prevalent infections were in homo/bisexual men, and 32% were in people exposed through heterosexual intercourse. Between 2100 and 2190 new cases of AIDS are expected to be reported in the UK each year from 1995 to 1999. It is predicted that a 30% rise in the number of cases exposed through heterosexual intercourse and a 17% rise in cases who inject drugs will be balanced by a 7% fall in cases among homo/bisexual men. Prevalent AIDS cases in the UK are expected to rise by 15%, from 3740 at the end of 1995 to 4290 at the end of 1999. The number of people expected to be living with severe HIV disease, including AIDS, will also rise by about 15%, from 7545 at the end of 1995 to 8650 at the end of 1999.     

HIV/AIDS development in Denmark and Sweden. Are there differences?

National surveillance data from Denmark and Sweden were analyzed for trends in the incidence of HIV and AIDS. By the end of 1995, the cumulative number of AIDS cases was higher in Denmark than in Sweden, but since the annual incidence was still increasing in Sweden and slightly decreasing in Denmark, the Denmark:Sweden ratio of the overall annual AIDS incidence has decreased since 1992, and so has this ratio of incidence among homo/bisexual men. The cumulative number of acquired infections was estimated to be higher in Denmark than in Sweden, although the bi-annual proportional increase in incidence from 1987 to 1993 was higher in Sweden than in Denmark. In both countries, the annual number of new identified HIV infections among homo/bisexual men has become stable, although the Denmark:Sweden ratio has decreased since 1990. In conclusion, the national epidemiological data do not indicate that the Swedish strategy has been more effective than the Danish in preventing new HIV infections.     

Trends in HIV seroprevalence, AIDS and prevention policy among intravenous drug users and men who have sex with men, before and after 1990 in Austria

This study reports for the first time on secular trends in human immunodeficiency virus (HIV) infection and AIDS, and possible associations with prevention policy in Austria. We analysed HIV seroprevalence and AIDS cases among intravenous drug users (IDU) and men who have sex with men (MSM). In this study we found a diminished rate of increase in new cases of AIDS and a decline in HIV seroprevalence among IDU but not among MSM. Among clients visiting HIV counselling and testing centres in Austria between 1987 and 1990, seroprevalence among IDU was estimated at 27.9% as compared to 19.6% between 1990 and 1992 (odds ratio (OR): 0.62; 0.45-0.85). Among MSM corresponding prevalence for these two periods was 12.1% and 10.9%, respectively, which was not a significant decline. In the period 1990 to 1994, the increase in AIDS cases per half-year levelled off for IDU (incidence rate ratio (IRR) :1.00; 0.99-1.01) but to a lesser extent among MSM (IRR: 1.01; 1.01-1.02). The most effective prevention policy intervention was considered to be the national Methadone Maintenance Program (MMTP), started in 1987, and the provision of sterile injection equipment. We observed that in the recent period there was a decline in the frequency of attendance among young (less than 28 years of age) MSM at counselling centres (OR: 1.27; 95 % CI: 1.08-1.49), accompanied by the observation that the rate of seroprevalence among this group did not decline. This is in contrast to young IDU where attendance did not decline but seroprevalence did. Although inference is limited from cross sectional studies, we argue for a reoriented and effectively monitored HIV prevention policy focused on young MSM.     

Development of an astrocytic response to lesions of the spinal cord in the North American opossum: an immunohistochemical study using anti-glial fibrillary acidic protein

OBJECTIVE: To describe the incidence of the acquired immunodeficiency syndrome (AIDS) in Australia between 1982 and 1991. DESIGN: State and Territory Health Departments notified new diagnoses of AIDS to the National AIDS Registry. Information reported for each case included sex, date of birth, date of AIDS diagnosis, presumed mode of exposure to the human immunodeficiency virus (HIV), and illness(es) on which the diagnosis of AIDS was based. RESULTS: To the end of March 1992, 3,160 cases of AIDS were reported as having been diagnosed between 1982 and the end of 1991. The cumulative incidence per head of population was about twice as high in New South Wales as in Australia as a whole. Over 97% of cases were in men, of whom 91% were adults or adolescents reporting homosexual contact. In women, 40% of cases were acquired through receipt of blood, blood products or tissue. The annual incidence of AIDS rose sharply until about 1988, but the annual rates of increase slowed in subsequent years. This trend was also apparent in cases acquired through sexual contact between men. In other exposure groups, numbers of cases were much smaller and trends less apparent. However, there was no indication of a similar levelling in AIDS incidence, except among blood transfusion recipients, in whom incidence may be declining. CONCLUSION: Transmission of HIV among people with AIDS in Australia has been overwhelmingly attributed to sexual contact between men. The annual incidence of cases attributed to sexual contact between men appears to be stabilising.     

Russia: sex, drugs, and AIDS and MSF

The first case of HIV infection in Russia was detected in 1987, there have since been 142 million HIV tests in the country, and 196 and 1535 new HIV cases were reported in 1995 and 1996, respectively. By 2000, the Ministry of Health forecasts that there will be 800,000 HIV-positive people in the country. It is culturally accepted in Russia to use drugs intravenously. There has been a rapid rise in the number of IV drug users in Russia, with an estimated 100,000 users in Moscow forming an important core group for HIV transmission, and similar numbers of users in Leningrad, Kalinigrad, and Rostov. Russian IV drug users are mainly aged 15-25 years who lead regular lives, attend school, and socialize freely with non-users, including having sexual relationships. Such behavior among IV drug users facilitates the rapid spread of HIV to the rest of society. Ketamine is popular among schoolchildren, who inject it intramuscularly, while homemade IV drugs also abound. High levels of IV drug use, a health system in a state of collapse, a growing incidence and prevalence of sexually transmitted diseases (STDs), and government inexperience with the HIV epidemic mean that an HIV epidemic in Russia is inevitable. Medecins Sans Frontieres has launched an HIV prevention campaign together with the government.     

Incidence and risk factors of the association of AIDS and tuberculosis in Spain

BACKGROUND: Incidence of tuberculosis in persons coinfected with HIV is very high. The aim of this study was to determine the risk factors for tuberculosis in AIDS patients in Spain. PATIENTS AND METHODS: A study was carried into AIDS cases (1993 European AIDS case definition) over 12 years old, diagnosed in Spain in 1994. A comparison was run between cases with tuberculosis and the remaining reported AIDS cases on the register, by sex, age, transmission category and prison record. Multiple logistic regression was used to assess the independent effect of each variable, with the adjusted odds ratio (ORa) and their 95% confidence intervals. RESULTS: Annual incidence of AIDS and tuberculosis comorbidity was 8.9 per 100,000 inhabitants. Multivariate analysis revealed that tuberculosis in AIDS patients appeared with higher frequency in: males (ORa = 1.4; CI 95%, 1.3-1.6); the 13-29 age group (ORa = 1.3; CI 95%, 1.1-1.5) and the 30-39 year old group (ORa = 1.1; CI 95%, 1.0-1.3), injecting drug users (IDU) (ORa = 1.4; CI 95%, 1.2-1.6), and those patients with a prison record (ORa = 2.1; CI 95%, 1.9-2.4). CONCLUSIONS: In Spain, male AIDS patients, under age 40 years with a prison record and IDU have a higher risk of tuberculosis. Control measures for tuberculosis should therefore be intensified among these patients.     

Personal social networks and HIV status among women on methadone

This objective of this study was to examine the association between a women's HIV status and specific (IDUs) characteristics of her social networks with respect to (1) number of injection drug users (2) number of drug partners and (3) number of HIV-positive contacts in her personal networks, after controlling for the respondent's demographic characteristics and drug use. Participants were recruited through posted announcements in three methadone clinics in Harlem, New York City. Individuals were considered eligible if they were enrolled as patients in one of the clinics for at least three months. A social network questionnaire modeled after the General Social Survey network section was developed by the investigators. Face-to-face interviews were conducted by trained interviewers and included demographics, drug use, self-reported HIV status of the woman and her network members, and the social network structures. Univariate analyses found that HIV-positive and HIV-negative women had different network profiles. HIV-positive women were more likely to associate with a higher number of current drug users, injection drug users, injection drug users who were HIV-positive, drug partners, drug partners who used injection drugs, and drug partners who were HIV-positive. Multivariate analyses indicated that HIV-positive respondents were more likely to associate with HIV-positive network members than their HIV-negative counterparts. The findings suggest that to better understand the spread of HIV among female drug users and to design more effective HIV/AIDS prevention programmes, efforts should move beyond focusing on individual attributes to address the contextual dynamics of social networks.     

The AIDS epidemic among Spanish drug users: a birth cohort-associated phenomenon

OBJECTIVES: In Spain the number of new acquired immunodeficiency syndrome (AIDS) cases among injection drug users continues to rise. The time trend up to 1994 has been analyzed, with special attention paid to the different generations. METHODS: The source for injection drug use-related cases was the Spanish AIDS Register. Independent analyses of annual specific rates were run for each sex with the use of an age-period-cohort log-linear model. RESULTS: After adjustment for age and year of diagnosis, AIDS incidence related to injection drug use is associated with specific birth cohorts. Rising values are observed in the successive generations born during the 1950s, peaking in men born in 1962 and women born in 1964. In subsequent cohorts, there is a marked falloff in incidence for both sexes, but this decline is seen to halt in men from the 1972 birth cohort onwards. The overall period effect is upward, yet the trend flattens in the last years. There is a pronounced age effect with maximum values in men and women at ages 29 and 27, respectively. CONCLUSIONS: It is essential to urge avoidance of risk behaviors in new generations.     

Lower prevalence and incidence of HIV-1 syncytium-inducing phenotype among injecting drug users compared with homosexual men

OBJECTIVE: To study the prevalence, incidence and predictive value for progression to AIDS of the HIV-1 syncytium-inducing (SI) phenotype in HIV-infected injecting drug users (IDU) compared with HIV-infected homosexual men. DESIGN: Two prospective cohort studies on HIV-1 infection among IDU and homosexual men. METHODS: HIV-infected IDU (n = 225) and homosexual men (n = 366) without AIDS were studied from March 1989 through December 1993. Data on laboratory markers, including the presence of SI variants, demographics, behavioural characteristics and clinical events were collected at every visit. RESULTS: At baseline, SI variants were detected in 4% of IDU and 17% of homosexual men. During the study period 18 IDU and 68 homosexual men switched from non-SI to SI phenotype (4-year cumulative incidence, 14.6 and 28.4%, respectively) before AIDS diagnosis. Among participants with a documented date of HIV infection the cumulative incidence of SI was lower among IDU than homosexual men (4-year cumulative incidence, 6.2 and 20.7%, respectively). At AIDS diagnosis, 21% of all AIDS cases among IDU had the SI phenotype compared with 54% among homosexual men. In both risk groups an accelerated CD4 decline was found after the non-SI-to-SI switch. The SI phenotype appeared to be a predictor of AIDS (multivariate relative hazard, 5.33), independent of CD4 cell count and p24 antigen at baseline. In the multivariate time-dependent analysis, the relative hazard of SI phenotype decreased considerably, which is consistent with the hypothesis that the effect of SI phenotype on progression to AIDS is mediated by CD4 cell count. CONCLUSION: The SI phenotype is associated with accelerated CD4 decline and progression to AIDS in both risk groups. The remarkable lower prevalence and incidence of the SI phenotype among IDU may implicate a difference in pathogenesis and natural history of HIV infection linked to transmission group.     

Sequences in the ligand-binding domains of the human androgen and progesterone receptors which determine their distinct ligand identities

A cross-sectional survey was undertaken to describe risk-taking behaviors and to assess the knowledge and risk perception of HIV and AIDS among young males aged 18 to 29 years in 82 villages in Longchuan, Yunnan, China, in 1994. Information on demographic, behavioral, and drug-using factors, and knowledge of HIV transmission and prevention, and risk perception was collected using an interviewer-administered anonymous questionnaire. A total of 1,548 individuals were interviewed and 433 drug users, including 52 nonsharing injectors and 140 sharing injectors, were identified. Over half the individuals scored 0 on HIV knowledge, but knowledge was greater among nonsharing drug injectors. Most drug injectors had initiated drug injection after 1990. The reported incidence continues to increase in all three major ethnic groups. Sharing of equipment was common (73%) among injectors. Drug users were four times more likely to have had premarital or extramarital sex, but condoms were used by only 2.5%. Thus, factors promoting spreading of HIV are common in this area. We recommend that a community-based intervention program, targeting both young men and women, be implemented and evaluated in Longchuan as soon as possible.     

Discontinuation of treatment with IFN-beta leads to exacerbation of experimental autoimmune encephalomyelitis in Lewis rats. Rapid reversal of the antiproliferative activity of IFN-beta and excessive expansion of autoreactive T cells as disease promoting mechanisms

BACKGROUND: It is important for HIV/AIDS control programmes to determine population knowledge on AIDS in order to develop appropriate Information, Education and Communication (IEC) messages. The objectives of our study were to determine the seroprevalence of HIV and syphilis among pregnant women, female prostitutes and long-distance truck drivers and to evaluate knowledge, attitudes, beliefs, and practice (KABP) with respect to the HIV/AIDS epidemic in these three groups in Burkina Faso. METHODS: We performed three cross-sectional serosurveys including face-to-face interviews on KABP between October 1994 and February 1995 in three population groups. RESULTS: Overall, 1,294 pregnant women, 236 long-distance truck drivers and 426 female prostitutes were recruited. HIV seroprevalence was 8% (95% Confidence Interval (CI): 6.6-9.6) among pregnant women, 18.6% (95% CI: 13.9-24.2) among long-distance truck drivers and 58.2% (95% CI: 53.4-62.9) in female prostitutes. The prevalence of syphilis was 2.5%, 9.3% and 15%, respectively. Most pregnant women (98%), long-distance truck drivers (96%) and female prostitutes (98%) had already heard of AIDS. However, the level of knowledge of HIV transmission routes, of risk factors for HIV transmission and of available preventive measures was very low. Consequently, 41% of pregnant women, 40% of long-distance truck drivers and an alarming 61% of female prostitutes reported that they did not feel themselves at risk for HIV. In each group, high levels of knowledge on AIDS were associated with increased awareness of AIDS risk and the adoption of preventive behaviours. Level of education was associated with knowledge of AIDS and condom use. However, in the 12 months preceding the surveys, condom use was very low among pregnant women (0.1%), long-distance truck drivers (18%) and among female prostitutes (42%). CONCLUSIONS: These results indicate that HIV is widespread in Burkina Faso and that there is an urgent need to develop and evaluate HIV prevention strategies in the general population and among core groups such as female prostitutes and long-distance truck drivers. Interventions must include information campaigns, condom promotion and distribution, and sexually transmitted diseases control.     

Seroconversion for human herpesvirus 8 during HIV infection is highly predictive of Kaposi's sarcoma

BACKGROUND: The finding of antibodies against human herpesvirus 8 (HHV-8) is associated with the occurrence of Kaposi's sarcoma in persons infected with HIV. However, the predictive value of HHV-8 antibodies for Kaposi's sarcoma in HIV infection is unknown. METHODS: The Amsterdam Cohort Studies on HIV infection and AIDS started in 1984 for homosexual men and in 1985 for injecting drug users. Serum samples from 1459 homosexual men and 1167 drug users were tested for antibodies to recombinant HHV-8 lytic-phase capsid (ORF65) antigen and latent-phase nuclear (ORF73) antigen. Individuals were retrospectively identified as HHV-8-positive or HHV-8-negative at enrolment or HHV-8 seroconverter during the study. Kaposi's sarcoma-free survival time was compared between HIV-infected men who were positive for HHV-8 at enrolment and those who later seroconverted for HHV-8. Hazard ratios were estimated for Kaposi's sarcoma, lymphoma, and opportunistic infection according to the HHV-8 serostatus. RESULTS: The incidence of HHV-8 seroconversion among drugs users was 0.7 per 100 person-years based on 31 seroconversions, whereas an incidence of 3.6 was found among homosexual men based on 215 seroconversions. The hazard ratio for Kaposi's sarcoma was 3.15 (95% CI: 1.89-5.25) in HIV-infected individuals if HHV-8 antibodies were present either at enrolment or at HIV seroconversion. In HIV-infected persons who later seroconverted to HHV-8, Kaposi's sarcoma developed more rapidly: hazard ratio of 5.04 (95% CI: 2.94-8.64), an additional risk of 1.60 (95% CI: 1.01-2.53; P = 0.04). Time-dependent adjustment for CD4+ cell count and HIV RNA had no impact on the additional risk, although the CD4+ cell count was an independent risk factor for Kaposi's sarcoma. HHV-8 infection did not increase the risk of AIDS-related lymphoma or opportunistic infections. CONCLUSIONS: The incidence of HHV-8 infection is higher in homosexual men than in drug users. The presence of HHV-8 antibodies in HIV-infected persons increases the risk of Kaposi's sarcoma. Among HIV-infected persons, those who subsequently seroconvert for HHV-8 are at highest risk. These results strongly confirm the causal role of HHV-8 in Kaposi's sarcoma and emphasize the clinical relevance of HHV-8 seroconversion before and after the HIV infection.     

Prevention indicators for evaluating the progress of national AIDS programmes

Major interventions to reduce HIV transmission involve increasing knowledge about preventing HIV transmission for sustained behavioral changes; and enhancing the control of sexually transmitted diseases (STD), which increase the probability of HIV transmission. Activities have also been developed to prevent the transmission of HIV by blood, donor selection, and more rational use of transfusions. Behavioral changes among injecting drug users have also been promoted. Recommendations are made for the evaluation of AIDS programs, focusing on prevention of sexual transmission of HIV, and outlining the approach developed by the Global Program on AIDS (GPA; Geneva, Switzerland) for use by national programs. Based on the feasibility, accuracy, reliability and validity of the quantitative assessment of programs, 10 indicators of progress and outcomes of prevention activities have been developed by GPA. These include indicators of population knowledge regarding preventive practices, reported sexual behavior and use of condoms in the general population, STD service evaluation, and indicators of program impact. The latter are measured through the reported STD incidence in the general male population, and syphilis and HIV prevalence in women. The four methods are proposed for measuring the 10 core prevention indicators (PI). Five PIs are measured during a population survey: reported knowledge of preventive practices (PI-1), condom availability at peripheral level (PI-3), reported frequency of nonregular sexual partners (PI-4), reported condom use during nonregular sexual encounters (PI-5), and reported STD incidence among men (PI-9). Condom availability at central level (PI-2) is assessed through key-informant interviews with major distributors. Structured health facility surveys allow assessment of the appropriateness of STD case management (PI-6 and PI-7). A serosurvey among antenatal clinic attenders aged 15-24 years allows the measurement of HIV and syphilis seroprevalence in that population (PI-8 and PI-10). GPA recommends that such surveys be repeated after a period of 1 to several years.     

Harm reduction and street-based program: looking into Nepal

In August 1991 the Lifesaving and Lifegiving Society (LALS) became the first nongovernmental organization in Nepal to work with injecting drug users (IDUs) to reduce the harm caused by drugs in order to prevent HIV/AIDS. Its mission is to provide education, counseling, and primary health care, as well as bleach, sterile water, condoms, and new needles and syringes to IDUs to lower their risk of acquiring blood-borne diseases. An evaluation of the program found that the prevalence of HIV infection among IDUs who were in regular contact with the program from 1991 to 1994 was 1.6%. No new cases of HIV infection were detected among participants in either 1993 or 1994. Though a harm reduction program is expensive to implement and sustain in Nepal, through its nonjudgmental, noncoercive, and confidential philosophy, LALS has engaged drug users into recovery and given them a platform by which they are able to address their concerns in a public forum.     

Declining seroprevalence in a very large HIV epidemic: injecting drug users in New York City, 1991 to 1996

OBJECTIVES: This study assessed recent trends in HIV seroprevalence among injecting drug users in New York City. METHODS: We analyzed temporal trends in HIV seroprevalence from 1991 through 1996 in 5 studies of injecting drug users recruited from a detoxification program, a methadone maintenance program, research storefronts in the Lower East Side and Harlem areas, and a citywide network of sexually transmitted disease clinics. A total of 11,334 serum samples were tested. RESULTS: From 1991 through 1996, HIV seroprevalence declined substantially among subjects in all 5 studies: from 53% to 36% in the detoxification program, from 45% to 29% in the methadone program, from 44% to 22% at the Lower East Side storefront, from 48% to 21% at the Harlem storefront, and from 30% to 21% in the sexually transmitted disease clinics (all P < .002 by chi 2 tests for trend). CONCLUSIONS: The reductions in HIV seroprevalence seen among injecting drug users in New York City from 1991 through 1996 indicate a new phase in this large HIV epidemic. Potential explanatory factors include the loss of HIV-seropositive individuals through disability and death and lower rates of risk behavior leading to low HIV incidence.     

Comparison between the lactulose/mannitol and 51Cr-ethylenediaminetetraacetic acid/14C-mannitol methods for intestinal permeability. Frequency distribution pattern and variability of markers and marker ratios in healthy subjects

OBJECTIVE: To determine the most efficient approach to the diagnosis of infective endocarditis (IE) in febrile parenteral drug users (PDUs) and evaluate possible effects of human immunodeficiency virus (HIV) infections or acquired immunodeficiency syndrome (AIDS) on susceptibility to IE and final outcome. DESIGN: A prospective study of appropriate patients admitted on 149 random sampling days during a 14-month period and review of past experience with IE, HIV, and AIDS admissions to hospital. SETTING: An urban university hospital. PATIENTS: Prospectively, 121 febrile PDUs plus an additional 16 found to have IE on nonsampling days during the study period. Retrospectively, all PDUs with IE from 1985 to 1991 and all patients with HIV infections with or without AIDS from July 1990 through December 1991. MEASUREMENTS: Physical examination, hemograms, urinalysis, blood cultures (plus other body fluids when indicated), echocardiography, laboratory testing for HIV status. MAIN RESULTS: Five categories of patients were identified: I. Infective endocarditis (n = 16); II. Other infections with bacteremia (n = 21); III. Bacteremia with unidentified source of infection (n = 14); IV. Infections without bacteremia (n = 52); V. Fever of unknown origin (n = 18). Physical findings and standard laboratory testing did not differentiate Group I from any of the other diagnostic categories. Adding additional IE cases from nonstudy days brought the total to 32. Vegetations were found on echocardiography in 94%; blood cultures, available in 30 of 32 instances, were all positive. HIV or AIDS status was not found to alter susceptibility to IE or influence mortality. While hospital admissions for HIV and especially AIDS have continued to increase among PDUs, the number of cases of IE has decreased since 1988 to 1989. CONCLUSIONS: Based on the high incidence of blood culture positivity and the sensitivity of echocardiography in detecting vegetations in IE, a simple algorithm has been developed for the initial diagnostic management of febrile PDUs admitted with the possible diagnosis of IE. HIV infection, with or without full-blown AIDS, does not appear to affect the incidence or outcome of IE among these patients. Current practices among PDUs may be effecting a decline in IE but not HIV infections.     

Pelvic lymph node dissection can be curative in patients with node positive bladder cancer

To determine the incidence of cryptococcosis and its risk factors among human immunodeficiency virus (HIV)-infected persons, population-based active surveillance was conducted in four US areas (population, 12.5 million) during 1992-1994, and a case-control study was done. Of 1083 cases, 931 (86%) occurred in HIV-infected persons. The annual incidence of cryptococcosis per 1000 among persons living with AIDS ranged from 17 (San Francisco, 1994) to 66 (Atlanta, 1992) and decreased significantly in these cities during 1992-1994. Among non-HIV-infected persons, the annual incidence of cryptococcosis ranged from 0.2 to 0.9/100,000. Multivariate analysis of the case-control study (158 cases and 423 controls) revealed smoking and outdoor occupations to be significantly associated with an increased risk of cryptococcosis; receiving fluconazole within 3 months before enrollment was associated with a decreased risk for cryptococcosis. Further studies are needed to better describe persons with AIDS currently developing cryptococcosis in the era of highly active antiretroviral therapy.     

Investigation of mortality among HIV-infected intravenous drug users in Ruili region of Yunnan province

The investigation of death condition of HIV infected intravenous drug users (IVDU) was conducted with a retrospective cohort study in Ruili city of Yunnan province from 1989-Oct to 1993-Oct, the deaths among 395 HIV+ IVDUs add up to 61 and the mortality is 15.4%, which has significant difference compared to the death level of control cohort composed by 192 HIV- IVDUs (add up to 18). The relative risk of death is 1.6 (95% confidence interval 1.0-2.5). After classified by the cause of death, it was found that both maintain high accidence mortality caused mainly by narcotism, violence and suicide. But in death group caused by diseases, the mortality of HIV+ IVDU (8.4%) is much higher than HIV- IVDU (3.1%) (95% confidence interval 1.2-6.1). We also compared non-AIDS mortality between HIV+ and HIV- IVDU according to data of HIV/AIDS surveillance which showed 2 patients died of AIDS in HIV+ IVDU. The difference is also significant (13.8% in HIV+, but 7.9% in HIV- IVDU) and the relative risk is 1.7 (95% confidence interval 1.0-2.8). The results indicated that the lever of reported AIDS cases were probably lower than that of actual AIDS cases existing.