Acquired Immune Deficiency Syndrome Diagnosis Research Articles

Improved Algorithm-Based Magnetic Resonance Images Combined with Computed Tomography in the Diagnosis of Acquired Immune Deficiency Syndrome Combined with Spinal Tuberculosis

This study aimed to analyze the diagnostic value of magnetic resonance imaging (MRI) combined with computed tomography (CT) based on the improved algorithm for acquired immune deficiency syndrome (AIDS) combined with spinal tuberculosis, so as to provide an effective reference theory for the clinical application of imaging diagnosis. The ResNet and Inception network structure were combined to form an improved convolutional neural grid classification (CNGC) algorithm. The improved algorithm was applied to AIDS patients with spinal tuberculosis to evaluate its diagnostic effect and value. 50 patients with AIDS and spinal tuberculosis and 50 patients with spinal tumors were selected for MRI and CT scans. The results showed that the accuracy, specificity, and sensitivity of the improved ResNet-Inception algorithm were much higher than those of the ResNet18 and GoogLeNet algorithms. In addition, compared with the training losses of ResNet18 and GoogLeNet algorithms that converged after 700 times, the ResNet-Inception algorithm only required 350 times to achieve convergence. Based on the improved ResNet-Inception algorithm, the false positive rate (FPR) of AIDS combined with spinal tuberculosis in imaging examinations was about 4%, which was greatly lower than that of the other two traditional algorithms ( P < 0.05 ). It can be seen that the improved ResNet-Inception algorithm was more valuable than traditional algorithms for MRI combined with CT in the diagnosis of AIDS combined with spinal tuberculosis and showed great clinical value for the diagnosis of the disease and the differential diagnosis of spinal tumors.

Acquired immune deficiency syndrome (AIDS) and late presentation in Poland - data from Test and Keep in Care (TAK) Polska project.

Late presentation (LP) at HIV diagnosis is associated with worse prognosis and an increase in the number of new infections. We analyse the proportion of patients diagnosed late and factors related to LP in Poland in 2016-2017. Data were obtained from 13 out of 17 HIV centres in Poland from 2016 and 2017, including date of diagnosis, age, sex, transmission route, anti-hepatitis C virus (anti-HCV), Venereal Diseases Research Laboratory (VDRL) antibodies, AIDS diagnosis, baseline HIV viral load and CD4 count. Out of 1522 patients, 88.9% were male with median age of 33.6years. Men who have sex with men (MSM) comprised 69.4% of all new infections, heterosexual route of transmission (HTX) 18.2% and injecting drug use (IDU) 4.7%. Late presenters comprised 44.8% of the study group. Factors associated with LP were female sex [odds ratio (OR) = 1.5, 95% confidence interval (95% CI): 1.09-2.08], older age (OR = 1.59, 95% CI: 1.42-1.79 per decade), route of transmission (HTX: OR = 1.96, 95% CI: 1.50-2.56; IDU: OR = 3.17, 95% CI: 1.92-5.37), positive HCV results (OR = 1.90, 95% CI: 1.23-2.95) and syphilis diagnosis (OR = 2.06, 95% CI: 2.29-3.31). Adjusting for these factors, the only independent factors associated with LP were age (OR = 1.52, 95% CI: 1.35-1.71) and route of transmission (HTX: OR = 1.73, 95% CI: 1.23-2.44; IDU: OR = 2.24, 95% CI: 1.25-4.10). Late presentation in Poland follows European trends. A total of 44.8% of all newly diagnosed patients in Poland continue to present late or at the AIDS stage. Independent factors associated with LP/AIDS were older age, IDU and HTX. Patients from these groups should be targeted to improve early diagnosis and medical care.

Semiparametric regression analysis of doubly censored failure time data from cohort studies

Doubly censored failure time data occur when the failure time of interest represents the elapsed time between two events, an initial event and a subsequent event, and the observations on both events may suffer censoring. A well-known example of such data is given by the acquired immune deficiency syndrome (AIDS) cohort study in which the two events are HIV infection and AIDS diagnosis, and several inference methods have been developed in the literature for their regression analysis. However, all of them only apply to limited situations or focus on a single model. In this paper, we propose a marginal likelihood approach based on a general class of semiparametric transformation models, which can be applied to much more general situations. For the implementation, we develop a two-step procedure that makes use of both the multiple imputation technique and a novel EM algorithm. The asymptotic properties of the resulting estimators are established by using the modern empirical process theory, and the simulation study conducted suggests that the method works well in practical situations. An application is also provided.

Switch of predicted HIV-1 tropism in treated subjects and its association with disease progression.

Dynamics of human immunodeficiency virus type 1 (HIV-1) tropism after antiretroviral therapy (ART) initiation and their association with disease progression are poorly investigated.This was a cohort study on subjects from the ICONA cohort receiving ART with persistently detectable (PD) or persistently undetectable (PU) viral load (VL) and with stored plasma or peripheral blood mononuclear cell (PBMC) samples at 2 time-points (T1, T2) after ART initiation. HIV-1 co-receptor tropism was determined by V3-loop sequencing and the geno2pheno algorithm. A switch in viral tropism was defined if the tropism classification at T2 differed from that observed at T1. Time to disease progression, defined as the occurrence of a new acquired immune deficiency syndrome (AIDS)-defining event/death from T2, was also evaluated.One hundred ninety-five patients were analyzed (124 PD, 71 PU). Over a median follow-up of 22.6 (19.8–28.1) months, PD and PU patients showed similar rates (95% confidence interval) of switch to a non-R5 virus [PD: 6.9 (3.7–11.2)/100-person-years of follow-up (PYFU); PU: 8.0 (3.4–14.5)/100-PYFU; P = 0.63] and of switch to a R5 virus [PD: 15.4 (7.3–26.4)/100-PYFU; PU: 8.1 (2.5–16.7)/100-PYFU; P = 0.38]. Switch to non-R5 virus was predicted by nadir CD4+ before T1.Twenty-two (18%) PD and 4 (6%) PU subjects experienced disease progression (P = 0.02). The risk of disease progression was independently associated with a switch in co-receptor tropism (adjusted hazard ratio = 4.06, 95% CI: 1.20–13.80, P = 0.03) as well as age, AIDS diagnosis, nadir CD4+ before T2, current CD4+, and VL.Switch of HIV-1 tropism under ART occurs in both directions, with similar rates in subjects with PD or PU VL and it might be predictive of future unfavorable clinical outcome.

CD4 quantification based on magneto ELISA for AIDS diagnosis in low resource settings

The Acquired Immune Deficiency Syndrome (AIDS) affects the life of millions of people around the world. Although rapid and low cost screening tests are widely available for the diagnosis of HIV infection, the count of CD4+ T lymphocytes remains a drawback in the areas mostly affected by the HIV, being this control imperative for assessing the deterioration of the immunological system and the progression towards AIDS, when the counting of cells falls down 200cellsμL−1. This paper describes a high-throughput, simple and rapid method for CD4+ T lymphocytes quantification, directly in whole blood, based on a magneto ELISA. The CD4 cells are separated and preconcentrated from whole blood in magnetic particles, and labeled with an enzyme for the optical readout performed with a standard microplate reader. The magneto ELISA is able to reach the whole CD4 counting range of medical interest, being the limit of detection as low as 50 CD4+ cells per μL of whole blood, without any pretreatment. This method is a highly suitable alternative diagnostic tool for the expensive flow cytometry at the community and primary care level, providing a sensitive method but by using instrumentation widely available in low-resource settings laboratories and requiring low-maintenance, as is the case of a microplate reader operated by filters.

The AIDS epidemic in south Florida: black non-Hispanics in our communities remain increasingly vulnerable

We compared demographic variables of individuals in Miami-Dade County, Florida, USA, with Acquired Immune Deficiency Syndrome (AIDS) during two time periods (1993 - 1995 and 2009 - 2011). Incidence and mortality-related data were explored in this observational study. Tests of significance were performed to identify differences or associations between selected groups. A correlation analysis was conducted to identify relationships between AIDS diagnosis and socioeconomic indicators. We observed a reduction in the number of new AIDS cases reported and AIDS-related mortality. Nonetheless, AIDS is still disproportionately affecting the black non-Hispanic population. Black non-Hispanic women remain particularly vulnerable to the disease. A positive correlation between AIDS diagnosis and poverty rate and the lack of health insurance, and a negative correlation between AIDS diagnosis and education level were identified. Though the actual number of AIDS cases is declining in this region, it continues to disproportionately affect the poorer, less well educated communities. Despite the availability of improved medication, people in these communities remain particularly vulnerable.

Cost effectiveness of liposomal doxorubicin vs. paclitaxel for the treatment of advanced AIDS–Kaposi’s sarcoma

Objective:Epidemic Kaposi’s sarcoma (KS) is one of the most common acquired immune deficiency syndrome (AIDS) defining malignancies, a disease with stigmatized clinical features that characterizes the diagnosis of AIDS. This study aims to perform a cost-effectiveness analysis between liposomal doxorubicin and paclitaxel in treating AIDS-KS.Methods:A 21 week decision tree analysis was created using a hospital perspective to compare treatment patterns with liposomal doxorubicin and paclitaxel. All costs were calculated in 2011 US dollars and obtained from an academic treatment center. Acquisition costs were obtained from public estimates using wholesale acquisition cost (WAC). Effectiveness was estimated based on a Phase 3 study of liposomal doxorubicin and paclitaxel (Von-Roenn et al.). Adverse events (AEs) associated with treatment and not the disease were included in the analysis. One-way sensitivity analysis was performed to test the robustness of the results.Results:Cost minimization analysis showed that treatment with liposomal doxorubicin was $18,125 whereas paclitaxel costs $12,347. After accounting for response rate, the results showed that liposomal doxorubicin costs $39,403 versus $21,661 for paclitaxel. This study has some limitations. Clinical data were derived from different clinical trials. In addition, many assumptions were made.Conclusion:Paclitaxel is dominant due to its lower acquisition cost and high response rate. Acquisition cost of liposomal doxorubicin and paclitaxel are significantly different. After accounting for all the factors that contribute to cost and response rate, paclitaxel is more cost effective than liposomal doxorubicin.

Sociostructural Correlates of AIDS Progression for African American Women Living with Diagnoses of HIV Infection in the District of Columbia

Background: Among women living with HIV infection in the District of Columbia (DC), African American women are disproportionately affected, comprising > 90% of reported cases. Sociostructural exploration of local HIV epidemics among African American women has been understudied. We explored sociostructural correlates of health for HIVinfected African American women in DC to inform local HIV prevention and intervention efforts. Methods: HIV surveillance data from the District of Columbia Department of Health for African American women living with HIV were reviewed. We analyzed data for sociostructural correlates for progressing to acquired immune deficiency syndrome (AIDS) (CD4 counts < 200 cells/ml) among African American women. Data were analyzed using SAS 9.2 and mapped by census tracts using ArcGIS. Results: Of 4,619 women living with HIV, 4,204 (91%) were African American; 3,050 (72.5%) had census tract information available and were included. Median age at diagnosis was 36.6 years. Among these 3,050 African American women, 1,814 (59.4%) had ever progressed to AIDS, 1,109 (36.4%) had CD4 counts < 200 cells/μl (AIDS) at most recent clinical visit, and 208 of 1,109 (18.8%) had progressed to AIDS within 12 months of their HIV diagnosis (late testers). Women who progressed to AIDS had a higher probability of being diagnosed at private facilities compared with public facilities (PR=1.1, 95% CI=1.1-1.3) and of being exposed through injection drug use (IDU) compared to being exposed through heterosexual contact (PR=1.3, 95% CI=1.2-1.5). In multivariate and geomapping analyses, poverty, education levels and census tracts were not associated with an AIDS diagnosis. Conclusion: Progression to AIDS is prevalent among HIV-infected African American women in DC. Increased, early routine HIV screening and intensified treatment efforts with African American women living with HIV infection in DC, regardless of socioeconomic status, are warranted, to improve outcomes and decrease disparities.

The effect of combined polymorphisms in chemokines and chemokine receptors on the clinical course of HIV-1 infection in a Brazilian population

Polymorphisms in genes that encode chemokines or their receptors can modulate susceptibility to human immunodeficiency virus (HIV) infection and disease progression. The objective of this study was to assess the frequency of polymorphisms CCR5-Δ32, CCR2-64I, CCR5-59029A and SDF1-3'A and their role in the course of HIV infection in a Southern Brazilian population. Clinical data were obtained from 249 patients for an average period of 6.4 years and genotypes were determined by standard polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism. Survival analyses were conducted for three outcomes: CD4+ T-cell counts below 200 cells/µL, acquired immune deficiency syndrome (AIDS) or death. The frequency of the polymorphisms CCR5-Δ32, CCR2-64I, CCR5-59029A and SDF1-3'A were 0.024, 0.113, 0.487 and 0.207, respectively. CCR5-Δ32 was associated with a reduction in the risk for CD4+ T-cell depletion and with an increased risk for death after AIDS diagnosis. CCR2-64I was associated with a reduction in the risk for developing AIDS. SDF1-3'A was also associated with decreased risk for AIDS, but its effect was only evident when CCR2-64I was present as well. These results highlight the possibility of using these markers as indicators for the prognosis of disease progression and provide evidence for the importance of analysing the effects of gene polymorphisms in a combined fashion.

Development and Evaluation of a Complementary and Alternative Medicine Use Survey in African-Americans with Acquired Immune Deficiency Syndrome

The purpose of the current study was to develop and evaluate the psychometric properties of a culturally- and stage-of-disease-appropriate measure of complementary and alternative medicine (CAM) use among a population of African-American individuals with acquired immune deficiency syndrome (AIDS) using a mixed-method design. Data were collected in two phases. In phase 1, qualitative data were used to refine an existing CAM measure for the specific study population in the present study. In phase 2, this refined instrument was implemented in a larger sample. The resulting numeric data were analyzed to evaluate the psychometric properties of the revised CAM instrument. Data were collected from patients who were receiving care from the infectious disease clinic of a large, public, urban hospital in the Southeastern United States. Patients were eligible to participate if they (1) were receiving their care from the clinic, (2) had an AIDS diagnosis, (3) were identified as African-American, (4) were > or =21 years of age, (5) spoke English, and (6) were not cognitively impaired. Focus groups in phase 1 were conducted with a semistructured focus group guide. Participants also completed a basic sociodemographic survey. Phase 2 participants used programmed laptops to answer questions about their CAM use and several sociodemographic questions. Information from the focus groups prompted some substantive revisions in the already-existing CAM survey. The revised instrument had satisfactory face validity and adequate test-retest reliability (r = 0.79). Furthermore, the instrument factored in a manner that was interpretable and consistent with prior findings. In order for human immunodeficiency virus health care providers to provide the best care to their patients, they need to be informed about the types and frequency of CAM use among their patients. This can be accomplished by methodologically developing CAM instruments, rigorously implementing and assessing these instruments, and then disseminating the findings to researchers and practitioners.

Clinical audit: virological and immunological response to combination antiretroviral therapy in HIV patients at a Sydney sexual health clinic

Bigge Park Centre (BPC) is a sexual health clinic located in a socially disadvantaged area in Southwest Sydney. This served as a retrospective clinical audit, documenting patient demographics, identifying factors associated with virological, immunological and discordant responses, evaluating the centre's ability in HIV control and investigating changes in practice from 1996 to 2007. Data including age, gender, ethnicity, mode of transmission, hepatitis co-infection, prior acquired immune deficiency syndrome (AIDS)-defining-illness, HIV-1 RNA and CD4+cell counts of patients on combination antiretroviral therapy (CART) for treatment of HIV with at least 1-year follow up at the BPC were analysed. Results were compared with other cohorts in medical literature. BPC manages HIV patients from diverse backgrounds. Sequential monotherapy was associated with poor virological control, lower CD4+cell recovery and discordant response. When patients who had sequential monotherapy were excluded, Caucasian race, high viral load at 1 month and triple-NRTI (nucleoside reverse transcriptase inhibitor) regimen were associated with lack of virological control. Lower baseline viral load and triple-NRTI regimen were associated with lower CD4+cell recovery. Lower baseline CD4+cell count and prior diagnosis of AIDS were associated with discordant response. Virological control and CD4+cell recovery achieved were comparable to that documented in medical literature. There was no significant change over time in terms of timing of CART initiation, attainment of immunological response or virological control since the late 1990 s. HIV control achieved at the BPC was comparable to that reported in medical literature. Enhancement of strategies to promote screening and improve adherence as well as performance of HIV resistance assessment and avoidance of triple-NRTI therapy will likely improve patient care.

Factors Associated with the Occurrence of AIDS-Related Non-Hodgkin Lymphoma in the Era of Highly Active Antiretroviral Therapy: Aquitaine Cohort, France

High grade non-Hodgkin lymphoma (NHL) remains the most common Acquired Immune Deficiency Syndrome (AIDS)-associated neoplasia and an important cause of mortality in people living with human immunodeficiency virus (HIV) infection in industrialized countries in the era of highly active antiretroviral therapy (HAART). A case-control study was implemented in a large cohort of HIV-infected patients. Case patients had newly diagnosed NHL, and control subjects were matched for CD4(+) cell count, calendar period, sex, and length of follow-up. Variables associated with a decreased risk of NHL were the use of HAART during follow-up for at least 6 months (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.21-0.98), receipt of a diagnosis of AIDS before the censoring date (OR, 0.37; 95% CI, 0.18-0.76), and undetectable level of HIV RNA during follow-up (OR, 0.34; 95% CI, 0.15-0.77). The use of antiherpetic drug for at least 6 months was associated with a nonsignificant decreased risk of NHL (OR, 0.40; 95% CI, 0.11-1.44; P=.16). In multivariate analysis, variables significantly associated with a decreased risk of NHL were the use of HAART for at least 6 months during follow-up (OR, 0.37; 95% CI, 0.16-0.87) and receipt of an AIDS-related diagnosis before the censoring date (OR, 0.44; 95% CI, 0.21-0.93). Age, transmission group, hepatitis B and C coinfections, CD4(+) and CD8(+) cell count nadir, and previous history of herpes virus infection were not associated with an increased risk for NHL. The use of HAART for at least 6 months was associated with a decreased risk of NHL, whereas uncontrolled HIV RNA load may be associated with an increased risk. The role of antiherpetic drugs needs further investigation.

Attitudes of cardiothoracic surgeons in the UK to human immunodeficiency virus.

A survey was carried out into attitudes of cardiothoracic surgeons in the UK to human immunodeficiency virus type 1 (HIV-1) infection associated with clinical situations that would normally have been managed surgically with low operative mortality rates and long median survival times. The survey response rate was 72.4 per cent. In patients with acute valvular insufficiency or with continuing angina despite maximal medical therapy (unstable angina) who were HIV-1 antibody positive, 75.8 and 80.8 per cent, respectively, of surgeons would operate. If the patient had end-stage infection, acquired immune deficiency syndrome (AIDS), 29.7 per cent and 34.7 per cent, respectively, would consider surgical intervention. When asked to perform simple procedures such as open lung biopsy or pleurectomy on a patient with AIDS, more than half of surgeons would operate (52.2 and 65.6 per cent respectively). In patients with operable carcinoma of the lung and asymptomatic HIV-1 infection 52.3 per cent would operate. This fell to 15.0 per cent if the patient had a diagnosis of AIDS. The majority of surgeons (77.2 per cent) felt patients should have an HIV-1 antibody test before operation and this rose to 95.6 per cent if patients were in a high-risk group; 60.2 per cent of surgeons had changed their surgical practice to reduce the risks of blood-borne infection.

Recurrent corneal erosion (RCE) secondary to lattice dystrophy in a patient with acquired immune deficiency syndrome (AIDS)

We present a case of an Acquired Immune Deficiency Syndrome (AIDS) patient with recurrent erosion (RCE) secondary to lattice corneal dystrophy. As a human immunodeficiency virus (HIV)-infected patient becomes more immunocompromised, the ocular surface defense mechanisms may be compromised. Lattice dystrophy, RCE, and modifying approaches to the management of RCE in an HIV-positive or AIDS patient are reviewed. A 49-year-old man presented with RCE. His ocular history included lattice corneal dystrophy OU, recurrent corneal erosion O.S., and herpes simplex virus keratitis O.S. Systemic history included hepatitis C and HIV infection with a diagnosis of AIDS with secondary Pneumocystis carinii pneumonia. Viral load was 35533 HIV-RNA (ribonucleic acid) molecules/ml of plasma and CD4 lymphocyte count 99 cells/mm3. Acuities were O.D. 20/80 and O.S. 20/50. The abrasion was treated with cycloplegia and bacitracin/polymyxin B ointment q.i.d. O.S. and it resolved in 3 days. Management of lattice dystrophy with secondary RCE in an AIDS patient requires that the clinician be familiar with the patient's immune status. As the CD4 count declines and the viral load increases, the patient is at higher risk for opportunistic anterior segment infections. Clinicians need to monitor these patients closely for potential complicating ocular sequelae of AIDS such as herpes zoster ophthalmicus, herpes simplex keratitis, fungal/bacterial keratitis, and keratoconjunctivitis sicca. Our patient responded well to antibiotic therapy and cycloplegia. The importance of daily monitoring of immunocompromised patients is emphasized.

Association of AIDS and Bipolar Mania with Rapid Progression to Dementia and Death

Neuropsychiatric complications of human immunodeficiency virus (HIV) infection or acquired immune deficiency syndrome (AIDS) may present clinically as acute or chronic organic brain syndrome, or mimic functional psychiatric diseases. Among such psychiatric diseases, mania tends to occur with increased frequency after the onset of AIDS. We report a case in which manic manifestations were noted before the diagnosis of AIDS. The patient had no past or family history of mood disorders, but had risk factors for HIV infection. He had a rapid downhill course from initial manic symptoms to depression, dementia and then death within 10 months. Such rapid cognitive deterioration into AIDS dementia after mania is consistent with previous reports. Cases like this will become more common with spread of the AIDS pandemic in Asian regions, including Taiwan. Clinicians should be mindful of HIV infection/AIDS as a differential diagnosis in patients with manic episodes and risk factors for HIV infection.

Prevalence of Antiretroviral Drug Resistance Mutations in Chronically HIV-Infected, Treatment-Naive Patients: Implications for Routine Resistance Screening before Initiation of Antiretroviral Therapy

The prevalence of drug resistance among persons with newly acquired human immunodeficiency virus (HIV) infection is well documented. However, it is unclear to what extent these mutations persist in chronically infected, treatment-naive patients. Prevalence of and factors associated with genotypic drug resistance were analyzed retrospectively in a subset of 491 chronically HIV-infected, antiretroviral-naive patients enrolled at 25 cities in the Terry Beirn Community Programs for Clinical Research on Acquired Immune Deficiency Syndrome (AIDS) Flexible Initial Retrovirus Suppressive Therapies trial during 1999-2001. Resistance was defined on the basis of the International AIDS Society 2003 definition, as well as the presence of additional mutations at codons 215 (C/D/E/S) and 69 (A/N/S) in the pol gene. Prevalence of mutations was estimated by use of techniques for stratified random samples. Logistic regression models were used to determine factors associated with resistance. Among the 491 chronically HIV-infected patients (mean CD4 cell count, 269 cells/mm(3); 31% of patients had a prior AIDS diagnosis), 57 (11.6%) had >or=1 resistance mutation, resulting in an estimated prevalence for the cohort of 10.8% (95% confidence interval [CI], 9.5%-12.1%). The prevalence was 8.8% if the 118I mutation was excluded. By drug class, the estimated prevalence of mutations conferring resistance to nucleoside reverse-transcriptase inhibitors was 7.8%, and the prevalence was 3.0% for nonnucleoside reverse-transcriptase inhibitors and 0.7% for protease inhibitors. In a multiple logistic regression analysis, non-Hispanic white subjects were twice as likely than African American subjects to have resistance (odds ratio [OR], 2.1; 95% CI, 1.1-4.1; P=.03), and there was a 40% increase per year in prevalence of mutations by later year of enrollment (OR, 1.4; 95% CI, 1.0-2.1; P=.05). These results demonstrate the persistence of drug resistance mutations in chronically HIV-infected patients and an increasing prevalence of resistance over time, and they support genotyping of virus at baseline for chronically HIV-infected patients.

Quimioterapia associada à terapia anti-retroviral de alta eficácia no tratamento dos linfomas não-Hodgkin agressivos relacionados à Síndrome da Imunodeficiência Adquirida

Linfoma não-Hodgkin é uma das complicações oncológicas mais freqüentes em portadores da Síndrome da Imunodeficiência Adquirida (AIDS). Em outros países, após a introdução da terapia anti-retroviral de alta atividade (HAART), a queda na incidência dos linfomas agressivos sistêmicos ficou aquém das expectativas, embora a sobrevida destes pacientes tenha triplicado. No Brasil, pouco se conhece a respeito do comportamento clínico e da sobrevida dos pacientes com linfoma e AIDS na era pós-HAART. O objetivo deste estudo foi avaliar retrospectivamente 25 pacientes com linfoma e AIDS, tratados com a associação de quimioterapia e HAART. Em concordância com a literatura, a maior parte dos pacientes era do sexo masculino - 20 (80%), com mediana de idade de 39 anos. Houve predomínio do subtipo histológico Difuso de Grandes Células B - 13 (52%), de pacientes em estádios avançados - 15 (60%), com envolvimento extranodal - 22 (88%) e com sintomas B - 18 (72%). O diagnóstico prévio de AIDS observado em 14 (56%) foi superior em nossa casuística em relação ao descrito por outros autores. Cinqüenta e dois por cento dos pacientes obtiveram RC, com SLD e SG em três anos de 54% e 42%, respectivamente e mediana de SG de 15 meses. Toxicidade hematológica e infecções foram freqüentes, porém nenhum óbito foi relacionado à sua ocorrência. Concluímos que o tratamento combinado com quimioterapia e HAART é factível em pacientes brasileiros, podendo propiciar uma sobrevida global similar à descrita por alguns grupos internacionais, com um perfil aceitável de toxicidade.

The evolving mode of presentation of HIV-infected patients to health services of northern Spain: 1985 through December 1999.

To evaluate the mode in which human immunodeficiency virus (HIV)-infected patients have had their first contact with the health services throughout time as well as their demographic and immunologic features, all 1,076 adult HIV-infected patients seen at our institution were grouped by the year of presentation. The patients' age and gender, the mode of presentation (admitted through the emergency department or seen at the outpatient clinic), and the presence of acquired immune deficiency syndrome (AIDS)-defining conditions and CD4 counts at the time of presentation were analyzed. The patients' age at presentation and the rate of female patients increased throughout time (p < 0.001, and p = 0.01, respectively). There was a progressive decline in the proportion of patients who were hospitalized until the mid-1990s (p < 0.0001), followed by a rise during the subsequent years (p = 0.04). This U-shaped curve was opposite to that of CD4 counts, which was ascending until 1994 (p = 0.04), to decline progressively later (p = 0.1). Patients whose first contact with the hospital was through admission had lower CD4 counts (p = 0.007), and higher rates of AIDS diagnosis throughout time (p < 0.0001). We conclude that some features of HIV-infected patients at the time of their first contact with the health services are changing over time, such as older age, increasing numbers of women, and higher degrees of immunosuppression. These findings seem to reflect the increasing number of patients unaware of their past risk factors, and should be considered for the development of strategies targeted to this population in order to allow earlier detection of their infection.

HIV/AIDS and Older Adults: The Invisible Ten Percent

Human Immunodeficiency Virus (HIV) was first identified as the virus that causes AIDS (Acquired Immune Deficiency Syndrome) in 1983. Much information has come forward about this complex, elusive, and devastating illness since then. The HIV virus is transmitted via the exchange of certain bodily fluids: blood, semen, and vaginal secretions, exchanged during sexual intercourse; injection drug use; and, in very rare cases today, blood transfusions. Infected mothers can also transmit HIV to their nursing infants via breast milk. The HIV virus replicates itself in an infected individual billions of times a day. It does so by attaching itself to and taking over certain white blood cells (CD4 cells, also known as'T cells), thereby insidiously destroying the body's immune defense system. We have learned to develop treatments that inhibit or manage this cloning activity. Although these treatments do not result in a cure for HIV, they have so far helped many (though not all) infected individuals live longer and often (though not always) healthier lives. It is important to note that HIV/AIDS is not confined to so-called groups. In the past, HIV/AIDS has been erroneously perceived as a gay men's disease because in the United States it first surfaced in the gay community and wiped out almost a generation of this population. It is now known that risk behaviors promote transmission of the virus and that these behaviors are practiced by people of all sorts, including heterosexual men and women (Emlet, 1997). There appears to be much information yet to learn about HIV/ AIDS before a cure is discovered, a goal that has eluded scientists and researchers in the medical profession for more than two decades. In fact, the closer they appear to get, the further they seem to be from this goal. We now approach the third decade of the AIDS epidemic; yet apparently there is one particular aspect of HIV/AIDS we have chosen to deny: age is no barrier. What has been ignored from the outset is what Emlet (1997) calls a hidden population of older persons (persons aged 50 and above) who have been and are being infected in significant numbers. The Centers for Disease Control and Prevention (CDC) (1999) reports that as of June 1999, 75,266 people in the United States aged 50 and above have contracted AIDS, more than 10% of all AIDS cases in the United States (Figure 1). Almost 11,000 were women and more than 20,000 over the age of 60. In New York City, the epicenter of the epidemic in the United States, the numbers are even more dramatic. Older adults in metropolitan New York account for close to 13 percent of all AIDS cases; and in Manhattan that number is nearing 15 percent (New York City Department of Health, 1999). This is also the case in parts of Florida such as Dade and Palm Beach Counties, where there are many retirees, as well as in other densely populated urban areas of the country (Puleo, 1996). Emphasis must be placed on the fact that new AIDS cases are rising faster among this age group than any other; (Saag et al., 1998). New AIDS cases in persons aged 50 and above rose by 22 percent in the five years from 1991 to 1996, while the increase in that same period for persons 13 to 49 was only 9 percent (CDC, 1998)-that's more than double the increase. Another surprising figure surfaced in 1994 when Stall and Catania (1994) determined that by the early 1990s older adults accounted for the highest percentage of heterosexual transmission of HIV/AIDS among all age groups (10%). Prior to 1985, such transmission was virtually unheard of in this cohort. These figures represent persons with AIDS diagnoses only, not individuals that are simply HIV-positive. An HIV-positive test result indicates the presence of HIV-fighting antibodies in the bloodstream; people who are HIV-positive can remain so for a decade or more without any visible signs or symptoms. They have not yet contracted any opportunistic infections (OIs), seen their T-cell counts drop to below 200, or exhibited any of the other indicators which would give them a diagnosis of AIDS. …

The attitudes and attributions of student nurses: do they alter according to a person's diagnosis or sexuality and what is the effect of nurse training?

The threat of an AIDS (acquired immune deficiency syndrome) epidemic in the early 1980s saw the emergence of strong negative attitudes from both the public and health care professionals alike. Certain 'high risk' groups in society, who were considered as susceptible to the disease, homosexuals and intravenous drug users in particular, became the victims of prejudice and discrimination. More recent research has indicated a possible shift to a more positive orientation, although the findings are far from conclusive. In this current study, the Prejudicial Evaluation and Social Interaction Scale (PESIS) was administered to four separate cohorts of student nurses approximately a year apart in training (n = 192). Each cohort was divided into four groups, each one completing the PESIS after reading a version of a vignette that described either a person with AIDS or leukaemia, and who was either homosexual or heterosexual. The design therefore allowed for within-group and between-group comparisons. Overall the results showed that the student nurses held positive attitudes although they reported a significantly greater prejudice towards AIDS. No significant differences were found for sexual orientation. Additionally significantly greater levels of blame and responsibility were associated with the person with AIDS, but again there was no effect for sexual orientation. The findings suggest that a slightly more negative attitude continues to be associated with a diagnosis of AIDS but no longer with homosexuality. No effect across cohorts was noted either, student nurses being as positive at the beginning of training as at the end. Some of the limitations of PESIS and the difficulties of attitude assessment in general are discussed and future areas of research are identified.