Acquired Immune Deficiency Syndrome Deaths Research Articles

Gene Silencing: A Novel Approach and Suppression of HIV-1 Gene

In today’s era, AIDS (Acquired immune deficiency syndrome) has been changed from a death sentence to a manageable chronic disease after usage of antiretroviral therapy (ART). Although, according to NACO 2015 and UNAIDS 2017, there was a 54% decline in AIDS death from 2007 to 2015 and an overall 32% decline in new HIV infection (80,000 in 2016). It is still one of the leading causes of death. UNAIDS (2017) reported 2.1 million (1.324 billion) people living with HIV in India and with a ranked third in the world.

The Cumulative Impact of Harm Reduction on the Swiss HIV Epidemic: Cohort Study, Mathematical Model, and Phylogenetic Analysis.

BackgroundHuman immunodeficiency virus (HIV) transmission among injecting drug users (IDUs) is increasing in the United States due to the recent opioid epidemic and is the leading mode of transmission in Eastern Europe.MethodsTo evaluate the overall impact of HIV harm reduction, we combined (1) data from the Swiss HIV Cohort Study and public sources with (2) a mathematical model expressed as a system of ordinary differential equations. The model reconstructs the national epidemic from the first case in 1980 until 2015. Phylogenetic cluster analysis of HIV-1 pol sequences was used to quantify the epidemic spillover from IDUs to the general population.ResultsOverall, harm reduction prevented 15903 (range, 15359–16448) HIV infections among IDUs until the end of 2015, 5446 acquired immune deficiency syndrome (AIDS) deaths (range, 5142–5752), and a peak HIV prevalence of 50.7%. Introduction of harm reduction 2 years earlier could have halved the epidemic, preventing 3161 (range, 822–5499) HIV infections and 1468 (range, 609–2326) AIDS deaths. Suddenly discontinuing all harm reduction in 2005 would have resulted in outbreak re-emergence with 1351 (range, 779–1925) additional HIV cases. Without harm reduction, the estimated additional number of heterosexuals infected by HIV-positive IDUs is estimated to have been 2540 (range, 2453–2627), which is equivalent to the total national reported incidence among heterosexuals in the period of 2007 to 2015.ConclusionsOur results suggest that a paramount, population-level impact occurred because of the harm reduction package, beyond factors that can be explained by a reduction in risk behavior and a decrease in the number of drug users over time.

Cause-Specific Life Expectancies After 35 Years of Age for Human Immunodeficiency Syndrome-Infected and Human Immunodeficiency Syndrome-Negative Individuals Followed Simultaneously in Long-term Cohort Studies, 1984–2008

Parametric and semiparametric competing risks methods were used to estimate proportions, timing, and predictors of acquired immune deficiency syndrome (AIDS)-related and non-AIDS-related mortality among individuals both positive and negative for the human immunodeficiency syndrome (HIV) in the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS) from 1984 to 2008 and 1996 to 2008, respectively. Among HIV-positive MACS participants, the proportion of deaths unrelated to AIDS increased from 6% before the introduction of highly active antiretroviral therapy (HAART) (before 1996) to 53% in the HAART era (P < 0.01); the median age of persons who died from non-AIDS-related causes after age 35 years increased from 49.0 to 66.0 years (P < 0.01). In both cohorts during the HAART era, median ages at time of non-AIDS-related death were younger for HIV-positive individuals than for comparable HIV-negative individuals (8.7 years younger in MACS (P < 0.01) and 7.6 years younger in WIHS (P < 0.01)). In a multivariate proportional cause-specific hazards model, unemployment (for non-AIDS death, hazard ratio (HR) = 1.8; for AIDS death, HR = 2.3), depression (for non-AIDS death, HR = 1.4; for AIDS death, HR = 1.4), and hepatitis B or C infection (for non-AIDS death, HR = 1.8, for AIDS death; HR = 1.4) were significantly (P < 0.05) associated with higher hazards of both non-AIDS and AIDS mortality among HIV-positive individuals in the HAART era, independent of study cohort. The results illuminate the changing face of mortality among the growing population infected with HIV.

Sudden Cardiac Death in Patients With Human Immunodeficiency Virus Infection

The aim of this study was to determine the incidence and clinical characteristics of sudden cardiac death (SCD) in patients with human immunodeficiency virus (HIV) infection. As the HIV-infected population ages, cardiovascular disease prevalence and mortality are increasing, but the incidence and features of SCD have not yet been described. The records of 2,860 consecutive patients in a public HIV clinic in San Francisco between April 2000 and August 2009 were examined. Identification of deaths, causes of death, and clinical characteristics were obtained by search of the National Death Index and/or clinic records. SCDs were determined using published retrospective criteria: 1) the International Classification of Diseases-10th Revision, code for all cardiac causes of death; and (2) circumstances of death meeting World Health Organization criteria. Of 230 deaths over a median of 3.7 years of follow-up, 30 (13%) met SCD criteria, 131 (57%) were due to acquired immune deficiency syndrome (AIDS), 25 (11%) were due to other (natural) diseases, and 44 (19%) were due to overdoses, suicides, or unknown causes. SCDs accounted for 86% of all cardiac deaths (30 of 35). The mean SCD rate was 2.6 per 1,000 person-years (95% confidence interval: 1.8 to 3.8), 4.5-fold higher than expected. SCDs occurred in older patients than did AIDS deaths (mean 49.0 vs. 44.9 years, p = 0.02). Compared with AIDS and natural deaths combined, SCDs had a higher prevalence of prior myocardial infarction (17% vs. 1%, p < 0.0005), cardiomyopathy (23% vs. 3%, p < 0.0005), heart failure (30% vs. 9%, p = 0.004), and arrhythmias (20% vs. 3%, p = 0.003). SCDs account for most cardiac and many non-AIDS natural deaths in HIV-infected patients. Further investigation is needed to ascertain underlying mechanisms, which may include inflammation, antiretroviral therapy interruption, and concomitant medications.

A comparison of ad hoc methods to account for non-cancer AIDS and deaths as competing risks when estimating the effect of HAART on incident cancer AIDS among HIV-infected men

Objective To compare three ad hoc methods to estimate the marginal hazard of incident cancer acquired immune deficiency syndrome (AIDS) in a highly active antiretroviral therapy (1996–2006) relative to a monotherapy/combination therapy (1990–1996) calendar period, accounting for other AIDS events and deaths as competing risks. Study Design and Setting Among 1,911 human immunodeficiency virus (HIV)-positive men from the Multicenter AIDS Cohort Study, 228 developed cancer AIDS and 745 developed competing risks in 14,202 person-years from 1990 to 2006. Method 1 censored competing risks at the time they occurred, method 2 excluded competing risks, and method 3 censored competing risks at the date of analysis. Results The age, race, and infection duration adjusted hazard ratios (HRs) for cancer AIDS were similar for all methods (HR ≈ 0.15). We estimated bias and confidence interval coverage of each method with Monte Carlo simulation. On average, across 24 scenarios, method 1 produced less-biased estimates than methods 2 or 3. Conclusions When competing risks are independent of the event of interest, only method 1 produced unbiased estimates of the marginal HR, although independence cannot be verified from the data. When competing risks are dependent, method 1 generally produced the least-biased estimates of the marginal HR for the scenarios explored; however, alternative methods may be preferred.

A New Application of Spatiotemporal Analysis for Detecting Demographic Variations in AIDS Mortality: An Example from Florida

The purpose of the present study was to characterize, geographically and temporally, the patterns of acquired immune deficiency syndrome (AIDS) death disparity in 67 Florida jurisdictions, and to determine if the detected trends varied according to age, race, and sex. The space-time scan statistic proposed by Kulldorff et al was used to examine the excess AIDS deaths that occurred between 1987 and 2004. Results were geographically referenced in maps using EpiInfo and EpiMap made available by the Centers for Disease Control. Miami-Dade and the nearby counties including Broward, Martin, and Palm Beach are the most likely clusters (observed/expected: 1505.16) with temporal dimension (also called cluster's age) persisting from 1996 to the present. Union county had the longest cluster for the cluster period 1987-1998, but not for 1999-2004. African-Americans contributed to more clusters compared with whites. Time trends indicated that AIDS mortality peaked in 1995 and then sharply dropped until 1998, when the decrease stopped. By accounting for the temporal dimension of disease clustering, the present study revealed the persistence of geographic clusters, which is not often provided by other geographic detection methods. These findings may be informative for medical resource allocation and better focus public health intervention strategies for AIDS care.

Pediatric viral human immunodeficiency virus type 1 RNA levels, timing of infection, and disease progression in African HIV-1-infected children.

To describe plasma human immunodeficiency virus type 1 (HIV-1) RNA levels in African HIV-1-infected children in relation to the timing of infection and disease progression. A retrospective cohort study was conducted of 80 children who were born to HIV-1-positive mothers and clinically followed from birth to 18 months of age in the ANRS 049 Ditrame project, Abidjan, Côte d'Ivoire (West Africa). The diagnosis and timing of pediatric HIV-1 infection were determined prospectively according to HIV-1 DNA polymerase chain reaction results. A total of 364 HIV-1 RNA viral load (VL) measurements were assessed retrospectively. Kaplan-Meier analyses and proportional hazards models were used to evaluate the prognostic value of pediatric VL and covariates for HIV disease progression or death. Mean initial positive VL was significantly lower among children who were infected in utero (4.94 log10/mL, n = 12) than in children who were infected later (5.6-6.1 log10/mL, n = 68). In the first 6 months after diagnosis, HIV-1 RNA levels peaked (> or =6 log10/mL), regardless of timing of infection. Then, a slow decline (overall slope, -0.076 log10 copies/mL/mo) was observed until 18 months of age. A 1 log10 higher value of the pediatric peak VL (risk ratio [RR]: 1.85; 95% confidence interval [CI]: 1.0-3.44) and of the maternal VL at delivery (RR: 1.90; CI: 1.16-3.12) were independently associated with an increased risk of rapid progression to acquired immune deficiency syndrome (AIDS) or death at 18 months of life (23 AIDS diagnoses and 31 deaths). Disease progression or death was more rapid for girls than for boys (RR: 2.26; CI: 1.39-4.96). In Africa, pediatric HIV-1 RNA levels are very close to those described in industrialized countries and seem to be predictive of AIDS stage or death, as in industrialized countries. With antiretroviral therapy becoming more widely available, the early identification and monitoring of pediatric HIV disease remains of paramount importance in Africa.

Measures of Mortality in the Study of Individuals Infected with the Human Immunodeficiency Virus in the UK Haemophilia Population

Summary Two statistical issues that have arisen in the course of a study of mortality and disease related to the human immunodeficiency virus (HIV) in the haemophilia population of the UK are discussed. The first of these concerns methods of standardization for age and it is shown that, when the mortality of HIV-infected individuals with different severities of haemophilia are compared, an analysis based on the ratio of observed to national expected deaths suggests that mortality in HIV-infected individuals depends on the severity of their haemophilia. This conclusion is inappropriate and mortality in HIV-infected individuals is, in fact, similar regardless of severity of haemophilia. The second part of the paper discusses the effect of using various end points for studies of survival and progression of HIV-related disease. In the present example it was possible to calculate relative survival in HIV-infected individuals, i.e. survival after correcting for mortality expected in the absence of HIV infection. An analysis based on absolute survival gave a very similar picture of the effect of age at infection to an analysis based on relative survival, whereas an analysis based on the time to diagnosis of acquired immune deficiency syndrome (AIDS) underestimated the effect substantially and the possible alternative end point of time to AIDS or HIV-related death was shown to be subject to considerable misclassification error.

DANE, Barbara O. and Carol LEVINE, eds., AIDS AND THE NEW ORPHANS: Coping with Death

DANE, Barbara 0. and Carol LEVINE, eds., AIDS AND THE NEW ORPHANS: Coping with Death. West Port, CT: Auburn House, 1994, 158pp., $17.95 softcover. Since the AIDS (Acquired Immune Deficiency Syndrome) appeared on the scene in late 1970s, it has been treated often as a political and moral issue because it was initially viewed as a disease of the gay and lesbian people who were suspected to be intravenous drug users, and in many ways outcasts. The most disappointing aspect of this situation has been that for several years the people who suffered from this disease, which still remains incurable, were stigmatized and their suffering continues. In AIDS and the New Orphans. by Dane and Levine, the authors fill a void by putting together recent research in nine articles by scholars who have focused their recent attention on grief, death and bereavement. These include not only those who contacted AIDS but also those whose loved ones are also infected or suffered from the death of the loved ones, thus leaving behind orphans who have no one to care for. Thus the title of the book, The New Orphans. To accomplish this end, of exploring the coping strategies of the new orphans, Dane and Levine obtain support from other contributors to the book. Dane introduces the subject of grieving in the time of AIDS, death and bereavement with relevant history and extent of the disease supported by figures with cross-national, racial and ethnic comparisons, and the number of U.S. children and youth involved in the bereavement process. To an extent surprising and also gratifying for an edited book, that the authors of the nine contributions were quite self-disciplined in addressing the issues of coping with death, in many instances illustrating distress and grief through case reports. By seeking to analyze, Dane focuses on the concept of death in Western culture suggesting that the denial of AIDS death is culturally constructed. Such a denial is further necessitated because AIDS death is especially stigmatizing. She challenges the antiquated view that fear of death has no meaning to children; on the contrary, children are capable of a wide range of grief responses. In the next chapter, Kenneth Doka examines the role of religion and spirituality and their relationship to AIDS and resultant grief in the lives of the children. The following two chapters by Karolynn Siegel and Barbara Freund and by Luis Zayas and Kathleen Romano, explore the natural reactions and feelings of unfairness marked by guilt and anguish among latency-age children and adolescents, respectively. Although the book does not include chapters on all major minority groups, it does includ a chapter on the Latino community by Esther Chachkes and Regina Jennings, and another on Black American communities by Penelope Johnson-Moore and Lucretia Phillips. …

Using death certificates to estimate the completeness of AIDS case reporting in Ontario in 1985-87

Abstract The completeness of AIDS (acquired immune deficiency syndrome) case reporting in Ontario was assessed by reviewing all AIDS death certificates compiled by the Registrar General between Jan. 1, 1985, and Dec. 31, 1987. Several demographic variables were used to match death certificates with cases reported to the provincial AIDS registry. The completeness of case reporting was then estimated by examining the ratio of reported deaths of patients with AIDS to the total number of deaths reviewed. The estimated completeness of case reporting was 81.1% in 1985, 71.5% in 1986 and 75.4% in 1987; the overall rate for 1985-87 was 75.2%. The difference in the completeness of case reporting from year to year was not statistically significant. There was a significant increase from 1985 to 1986 in the proportion of unreported cases in people who had never been married (p less than 0.02). Reporting was not associated with the patient's age, sex, occupation or place of residence. The deficiency in AIDS case reporting could adversely affect the long-term planning of health care resources and the development of programs to prevent and control the spread of AIDS.

AIDS deaths in the UK—How complete are the figures?

A study was carried out to investigate the extent of non-reporting of Acquired Immune Deficiency Syndrome (AIDS) as a cause of death within Riverside Health District and amongst district residents who died outside the district in 1986 and 1987. 44 deaths were certified as due to AIDS or HIV infection; a further 98 cases were identified from a research database, from Hospital Activity Analysis data or from death notifications where the age and certified cause of death indicated that AIDS was the most probable cause of death. Thus, the total number of deaths identified, 142, was over three times the number certified. The first 124 of the deaths thus identified were cross-checked by the Communicable Diseases Surveillance Centre against deaths voluntarily notified to them as being due to AIDS. It was found that 23 (19%) of the deaths had not been notified to the CDSC. We conclude that there is considerable non-certification of AIDS as a cause of death, and considerable non-notification of AIDS deaths, whether certified as such or not, to the CDSC.

Protestors hit FDA for AIDS drug policies

Protesting the criminally inadequate response of the Food & Drug and the Reagan in general to the urgent need for drugs to combat AIDS (acquired immune deficiency syndrome), hundreds of angry demonstrators from across the U.S. last week besieged FDA's headquarters outside Washington, D.C. Chanting 42,000 dead today— Where was the FDA? Release the drugs now, No more red tape, Let us choose, We die—they do nothing, and We're gonna seize control, some 600 activists, by police count, launched a daylong series of civil disobedience actions around the 18-story building. Intensively covered by the media, the protestors crossed police barriers, blocked streets, set off smoke bombs, occupied the roof over the main entrance, and put up signs proclaiming Federal Death Administration and The government has blood on its hands—One AIDS death every half hour. Prominent were photographs of President Reagan labeled He kills me and AIDSGATE, and of Vice President George B...

AIDS IN UGANDA

The village of Kasensero in southern Uganda has probably suffered more than any other in Africa and possibly the entire world from the ravages of Acquired Immune Deficiency Syndrome (AIDS). Since 1983 most likely 1/4 of the villages inhabitants have died of the village term for AIDS because the victims slowly waste away before they die. The survivors at least those of a sexually active age most likely also are carriers of the AIDS virus human immunodeficiency virus (HIV) and most likely in another 4 years they also will be dead. A visit was made to this village in 1986 and again in 1987. Thus far there are no treatments and the people continue to die. In Gwanda the small town up the road from Kasensero a record book showed that in the 6 months since August 1986 just 37 of the 66 deaths had been ascribed to Slim averaging out at about 3 AIDS deaths a fortnight. This means that 1% of Gwandas 8000 population are dying of the disease in a year yet the death rate has dropped dramatically in the last year. Various explanations were offered for the reduction in the death rate but none seemed adequate. The epidemic of AIDS has reinforced the communitys inherent leaning towards fatalism and religiosity. Sexual activity is the principle source of infection in the area because nearly all recorded victims are either in the 16-45 sexually active age range or are the young children of infected parents. Yet fear and superstition continue in both Kasensero and Gwanda. Some insist that mosquitoes and other blood-sucking insects were spreading the disease. Others identify a major headache problem in the area. Some believe that they suffer from chronic dysentery or from a long-untreated sexually transmitted disease and not from Slim. Misinformation is understandable given the wide range of physical symptoms that may be exhibited. Most of the victims showed the classic local symptoms of chronic diarrhea severe weight loss and stomach-ache. Some showed other symptoms like appetite loss swelling of the lymph glands and persistent coughing. Although disease has spread to most of the regions of Uganda the rates of infection elsewhere are not nearly as high as along the Kasensero-Kyotera-Masaka-Kampala axis. Compared to other African nations Ugandas attitude to its AIDS problem has been refreshingly open since Yoweri Museveni took power in January 1986. The Ministry of Health is focusing its efforts on educating the public about the risks of sex in an effort to limit the spread of the disease.

AIDS fatalities in Hamburg (status: February 1985)--legal medicine aspects

The registration of patients with acquired immune deficiency syndrome (AIDS) and AIDS deaths is centralized for medical research. A short review of the epidemiological state of AIDS in Hamburg is given (situation as of February 1985), and the autopsy results of seven postmortem examinations are referred to. Kaposi's sarcoma was seen in four patients and opportunistic infections in all cases, especially as a result of Pneumocystis carinii and cytomegalovirus. Due to the constellation of groups with an increased risk of acquiring AIDS--homosexual males, intravenous drug abusers and prostitutes--forensic implications have to be expected.