Acquired Immunodeficiency Syndrome Victims Research Articles

Répercussions biopsychosociales du Sida et pistes d’intervention et de recherche

The acquired immunodeficiency syndrome (AIDS) is a world wide health problem of exceptional magnitude with considerable effect in many areas : individual, social, economic, demographic and cultural. Current literature clearly indicates the emotional impact of the losses occasionnée by those suffering from this fatal disease. There include strong anxiety, fear, anger powerlessness and hopelessness. To this psychological distress is added isolation of AIDS victims. The negative reaction of society contributes to discrimination and stigmatization of these victims. AIDS may be seen as a personnal tragedy which often spells the collapse of family life. The psychosocial repercussions of this disease require intervention and further research with respect to the many unresolved problems generated by this syndrome.

HIV-I Induced Destruction of Neocortical Extracellular Matrix Components in AIDS Victims

Neurological dysfunction is not uncommon in patients suffering from acquired immunodeficiency syndrome (AIDS) and, when manifested, intimates involvement of the central nervous system. Here, the human immunodeficiency virus (HIV) infects preferentially microglial cells, which thereby release substances known to interfere with neuronal function. One class of agents set free in this manner are proteases; these degrade certain components within, and thereby undermine the integrity of, the extracellular matrix (ECM) compartment, which plays a vital role in cell-to-cell communication. We wished to ascertain whether the ECM compartment is indeed disrupted in the brains of AIDS victims. We examined the neocortical areas of 27 AIDS autopsy cases, including 9 with diagnosed HIV-encephalopathy (HIVE); 8 HIV-seronegative cases with various types of brain lesion, including viral infections, were also included in this study. HIV-antigens and DNA were identified by use of immunohistochemistry andin situhybridization, and ECM components by lectin staining and immunohistochemistry. Of the 27 AIDS cases examined, each of the 9 with HIVE was completely devoid of labeled ECM components; 8 of the 18 without HIVE had incurred substantial losses, and only 2 manifested a normal complement of constituents within this compartment. With respect to stratal and topographic variations, layers II and III were less affected than layers V to VII, as was the frontal cortex relative to other areas. These findings confirmed our expectations of the brain's ECM undergoing degradation following HIV infection, and these changes may well underlie the neurological disturbances manifested in AIDS patients.

Living With AIDS

The worldwide pandemic of the acquired immunodeficiency syndrome (AIDS), which was first manifest a scant 10 to 12 years ago, has assumed a kaleidoscope of identities. In one short decade, the name of the disease progressed from gay-related immune disease (GRID), to HTLV-III (human T-cell lymphotropic virus type III) infection, to HIV (human immunodeficiency virus) infection, and its stages of development added yet further acronyms: ARC (AIDS-related complex) and AIDS itself. Some of these terms, though obsolete, have become enshrined in the language of bureaucracy, which defines eligibility for social services and entitlement. The terminology of the AIDS social movement in the United States has also evolved. Social activists have rejected the pity and dependency that they believe are embodied in such terms as "AIDS victims" or even "AIDS patients." They prefer terms of empowerment and the neutral "people with AIDS" (PWAs). They eschew "innocent victims," often employed when describing

Attitudes, knowledge, experience and behaviour related to HIV and AIDS among Zimbabwean social workers

A recent study of Samuels & Boyle (1989) examined knowledge, attitudes, and behaviours of social service team members in Newham, East London in relation to HIV and AIDS. This study extends theirs to investigate social workers, both experienced and in training, in Harare, Zimbabwe, Whilst overall, there appear to be high levels of knowledge and positive attitudes displayed by these social workers, detailed examination of their responses shows gaps in knowledge and ambivalent attitudes and behaviours. These issues should be addressed when planning AIDS training courses.

AIDS and the lung. Introduction.

Damage to the immune system induced by the human immunodeficiency virus (HIV) leads to a spectrum of opportunistic infections of which the lung is the most common site. In Europe and North America, pneumocystis carinii pneumonia is the presenting symptom in 64% of cases of acquired immunodeficiency syndrome (AIDS) and occurs at some point in 80% of AIDS victims. This infection is less common in Africa, where tuberculosis is the predominant opportunistic infection. Other AIDS-related lung infections that are gaining in prevalence include pneumonia due to pyogenic bacteria, pulmonary infection with Mycobacterium tuberculosis, and lymphoid interstitial pneumonitis. In addition, there is evidence that the lung may be extensively involved in Kaposi's sarcoma. Given the importance of the lung as a site for AIDS-related opportunistic infections, respiratory physicians will be required to become more involved in the diagnosis and management of AIDS cases.

Knowledge, attitudes and practices concerning AIDS in Ugandans

A survey of the knowledge, attitudes and practices of 3928 Ugandans concerning AIDS was done in two semi-rural communities in August 1987. Eighty-eight per cent of the respondents knew that AIDS could be acquired from other people and that having multiple sexual partners was high-risk behaviour. There were, however, many incorrect beliefs about HIV transmission, including belief in transmission by insect bites (37%), witchcraft (22%) and casual contact with ill people (21%). AIDS was believed to be curable by 15% of the respondents. As part of the survey, blood was obtained from 3907 (99%) participants; 421 (10.8%) had antibody to HIV-1 by enzyme-linked immunosorbent assay (ELISA) and females were more likely to be infected than males (12.5 versus 8.8%, relative risk 1.42). Factors significantly associated with HIV infection on univariate analysis include multiple sexual partners, sexually transmitted diseases (STDs), injections, and being female. Stratified analysis of a history of STDs in people who were monogamous still showed an association with HIV infection. Information about the AIDS epidemic is reaching the Ugandan population; however, changes in behaviour are slower to follow.

Rapid spread of HIV infection in a rural district in Central Africa

Although recent reports suggest a high prevalence of human immunodeficiency virus (HIV) infection in Central Africa few data are available about the prevalence of infection in rural areas. In this study serum samples were collected between 1983-86 from 610 people in a rural district of North Uganda (East Acholi). In addition during 1986 serum specimens were collected from 50 tuberculosis patients and from 54 patients whose clinical profile was suggestive of acquired immunodeficiency syndrome (AIDS). The prevalence of HIV antibodies among outpatients tested in 1986 subdivided by sex and possible risk factors were as follows: males 13.6%; females 14.0%; pregnant women 12.5%; patients with sexually transmitted diseases 16.9%; and soldiers 16.5%. HIV infection was confirmed in 45 out of 54 sera obtained from suspected AIDS patients and 22 of these patients had died within 2 months of diagnosis. Chronic diarrhea and weight loss were the primary symptoms in AIDS victims. 22 of the 45 AIDS patients identified reported more than 5 sexual partners in the last 2 years and 17 had made at least 1 trip to South Uganda during this time. Of the 50 tuberculosis patients screened 5 (10%) were positive for the HIV antibody. Overall these findings suggest that HIV infection is spreading very rapidly in a rural district of Central Africa even among healthy people.

Acquired Immunodeficiency Syndrome in Urban Brazil

This article contributes to the cross‐cultural understanding of Acquired Immunodeficiency Syndrome (AIDS) through a detailed examination of the AIDS epidemic in contemporary Brazil. Since 1983, when the first verified case was reported there, the number of AIDS victims has grown rapidly enough to place Brazil high on the list of countries with the largest number of confirmed cases. Yet the pace of this epidemic has received relatively little attention from either the international community or the Brazilian government. In addition, the model used for understanding the transmission of the disease has been developed in the rather different social and cultural contexts of Western Europe and the United States. This article draws on the author's research on Brazilian sexual culture and suggests its relevance for understanding the transmission of AIDS in Brazil. It calls for a more active and culturally appropriate response to the disease in Brazil, as well as for an increasingly sophisticated understanding of cultural differences that influence the AIDS epidemic internationally.

Dealing with AIDS and fear: would you accept cookies from an AIDS patient?

Acquired immunodeficiency syndrome (AIDS) has engendered a crisis of fear among the public and health professionals alike. In addition to the myriad anxieties that generally accompany dying and death, AIDS patients must deal with numerous additional fears. In rushing to treat the physiologic aspects of AIDS, health professionals have generally failed to provide adequate support systems to deal with the emotional needs of dying AIDS patients. Health professionals must now move rapidly to develop support systems based on a realistic understanding of the fears and the other powerful emotions confronted by AIDS victims. Such systems must permit AIDS patients to give meaning to their adversity.

The Initial Impact of AIDS on Public Health Law in the United States—1986

The impact of acquired immunodeficiency syndrome (AIDS) on public health is just beginning to be felt. Initial state reporting requirements have expanded to attempts to control the spread of the disease through limiting activities such as school attendance and identifying carriers by screening tests. Federal statutory authority has also been invoked. Liability for, and compensation of, AIDS victims who contracted the disease from blood transfusions, organ transplantation, or sexual activity may have a significant impact on health personnel and public health policy. Breaches of confidentiality could result in increased bias against AIDS victims and carriers, who are already experiencing discrimination in employment, housing, health care, insurance, and funeral arrangements. It is unlikely that AIDS-related legal matters will be resolved quickly.

Risk of AIDS to Health Care Workers

This article reviews evidence on the risk of acquired immunodeficiency syndrome (AIDS) to health workers and suggests guidelines for the clinical care of AIDS patients. No health worker in the world has yet contracted AIDS from a patient. However seroconversion to human T-lymphotropic virus type III (HTLV-III) has occurred in a small number. A serologic study of 1758 US health workers who had direct contact with AIDS patients found HTLV-III antibodies in the blood of 26 (1.5%) but 23 of these workers were in another high-risk group for AIDS (homosexual men). Similar studies in San Francisco and London that included large numbers of health workers who sustained needlestick injuries while working with AIDS patients have failed to detect seroconversion. A further study of the siblings children and parents of 39 adult AIDS victims also found no evidence of infection suggesting that AIDS does not occur by casual contact. HTLV-III appears to be less communicable than the hepatitis B virus which health service staff have contracted from infected blood. It is recommended that when a patient known to be positive for HTLV-III is admitted to the hospital all specimens from that patient should be labelled with a biohazard sticker. Specimens should be handled and processed in the same way as those from hepatitis B patients. Staff should wear gloves and a plastic apron when attending to these patients. Although isolation is not necessary it is unwise to place patients with HTLV-III in the same ward with patients who are immunocompromised for other reasons given the risk of 2-way transmission of infection. Finally every effort should be made to maintain confidentiality and lists of HTLV-III-positive patients should not be displayed.

Acquired immunodeficiency syndrome: impact and implication for the neurological system.

Acquired immunodeficiency syndrome (AIDS) has reached epidemic proportions throughout the world. Because at least 40% of AIDS victims are neurologically symptomatic, the neuroscience nurse must be prepared to care for increasing numbers of these patients. This article will define the syndrome, identify risk groups, and discuss the possible etiology. An explanation of the immune system will facilitate understanding of AIDS and its impact on the neurological system. The role of the nurse will be considered, with emphasis on the psychosocial implications of the syndrome for its victims.

Malignancies in the AIDS patient: natural history, treatment strategies, and preliminary results.

Almost 40% of the 3000 US patients with acquired immunodeficiency syndrome (AIDS) have a malignancy at the time of reporting, and the incidence of AIDS patients who develop a malignancy during the course of the disease may be 65-70%. 2 types of malignancies have been noted with increased frequency in AIDS victims: Kaposi's sarcoma and malignant lymphomas. About 35% of all AIDS patients and 50% of homosexual or bisexual victims have developed Kaposi's sarcoma, and those with coincident opportunistic infection have 2.5 times the mortality of those without such infection. There are 2 essential features to the histopathology of Kaposi's sarcoma: 1) vascular proliferation and 2) spindle-shaped neoplastic cells in a network of reticulin fibers that appear to be of endothelial origin. The treatment of the epidemic form of Kaposi's sarcoma has not been successful, and the projected 2-year survival is only 30%. The causes of death in the majority of such patients are overwhelming opportunistic infections, especially cytomegalovirus and Pneumocystis carinii, and irreversible cachexia and wasting. Interferon therapy has had a beneficial effect in patients with disease limited to skin, with T4/T8 ratios over 0.5, and without a prior history of opportunistic infection; however, there is no evidence that interferon exerts any beneficial effects on the underlying immune defects. An aggressive 6-drug combination chemotherapy regimen has been tried on patients whose tumors appeared to be life-threatening and was effective in controlling the Kaposi's sarcoma, but again did not appreciably alter immune parameters. Several other approaches to the treatment of epidemic Kaposi's sarcoma are under evaluation, including gamma interferon, interleukin-2, and plasmapheresis. Patients who develop malignant lymphomas require combined treatment with central nervous system radiation and systemic combination chemotherapy. There is no evidence that the antitumor responses obtained in AIDS-related malignancies translate into survival advantages to the AIDS victim.

Acquired immunodeficiency syndrome in infants.

Acquired immunodeficiency syndrome (AIDS) was first believed to be confined to male homosexuals. 1-4 Subsequently, the same syndrome has been seen among intravenous (IV) drug users, 5 Haitians, 6 hemophiliacs 7,8 and other recipients of blood products, and, more recently, in female sexual partners of patients with AIDS. 9 This ever broadening spectrum of AIDS victims has raised the possibility of a causative transmissible agent(s). The discovery of a condition similar to AIDS in infants and their mothers 10,11 is probably the most important step in elucidating the dissemination of the disease to the heterosexual population. Early in 1982, my colleagues and I described what we believed to be the first five infants with an AIDS-like disease. 10 Since then, the number of cases rose to seven by July 1982, 11 13 by January 1983, 12 and 26 by July 1983. We identified these children in the Bronx, a borough of

Neurological complications now characterizing many AIDS victims

As more and more cases of the mysterious acquired immunodeficiency syndrome (AIDS) are being diagnosed ( JAMA [MEDICAL NEWS] 1982;248:1423-1431), medical researchers are developing a clearer picture of its clinical course. According to the Centers for Disease Control, Atlanta, as of Nov 19, 744 AIDS cases had been reported for the United States, with 287 deaths. So far, 54 cases have been reported from foreign countries. Among the latest findings are neurological complications in large numbers of AIDS patients, many of whom are homosexuals and/or intravenous drug abusers. At UCLA School of Medicine, neurological involvement is seen in three of every four AIDS patients, says Sandra L. Horowitz, MD, now of St Vincent's Hospital, Worcester, Mass. According to her, the complications tend to arrive late and to be quite devastating in Southern California victims. During the recent American Neurological Association (ANA) meetings in Washington, DC, Carolyn Britton, MD, of Columbia University