History Of Human Immunodeficiency Virus Research Articles

Prevalence of antibodies to hepatitis C virus in populations at low and high risk for sexually transmitted diseases in Rio de Janeiro.

In order to investigate the sexual transmission of the Hepatitis C Virus (HCV), the prevalence of specific antibodies in populations at high and low risk for sexually transmitted diseases (STDs) was evaluated. The population at low risk for STDs was composed of persons who voluntarily donated blood at the Hospital Universitário Clementino Fraga Filho (HUCFF) between July and November, 1990 (n = 2494). The population at high risk for STDs was drawn from an ongoing study on the natural history of Human Immunodeficiency Virus (HIV) infection (n = 210, 187 with sexual risk factors for HIV infection). All samples were screened using a first generation ELISA. Repeat reactive samples were then tested in a second generation RIBA. For all ELISA positive samples, two sex and age-matched ELISA negative controls were selected. Data pertaining to the presence of antibodies to the Hepatitis B core antigen (anti-HBC antibodies) and to Treponema pallidum were abstracted from the medical records. The prevalence of RIBA 2 confirmed HCV infection among the blood donors was 2.08%, which is well above the reported prevalence in similar populations from developed western countries. Among the HIV infected homosexuals, the encountered prevalence was 7.96% (p < 0.0005). For the whole group with sexually acquired HIV infection, the prevalence was 8.02% (p < 0.000005). Anti-HBc antibodies were more frequently present in anti-HCV RIBA-2 confirmed positive blood donors than in controls (p < 0.001). 33.3% of the HCV-positive blood donors and 11.04% controls were found to be anti-HBc positive (p < 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)

Human immunodeficiency virus-related conditions in children and adults with hemophilia: rates, relationship to CD4 counts, and predictive value

To further elucidate the natural history of human immunodeficiency virus (HIV) infection, we studied intermediate HIV-related conditions occurring before acquired immunodeficiency syndrome (AIDS) in a prospectively observed multicenter cohort of 738 HIV-infected persons with hemophilia. We analyzed the frequency in adults and children of common HIV-related conditions and the relative risk of AIDS after occurrence of these conditions, controlling for age at seroconversion and the percentage of CD4+ lymphocytes. Thrombocytopenia was the most frequently observed condition with cumulative incidences of 43% +/- 7% in adults and 27% +/- 6% in children and adolescents by 10 years after seroconversion. Oral candidiasis, fever, weight loss, and non-AIDS pneumonia were two to four times more common in adults than children, whereas herpes zoster risk was similar in the two age groups. HIV- related conditions were infrequent during the first 4 years of infection, particularly in children. With the exception of thrombocytopenia, mean CD4 counts were less than 350 cells/microL at the onset of the conditions. The relative hazard of AIDS after oral candidiasis was 18 in children and 3.8 in adults. Relative hazard in adults was also increased after persistent fever (10), weight loss (3.2), and non-AIDS pneumonia (2.2). Herpes zoster and thrombocytopenia were not significantly associated with AIDS in either age group. We conclude that intermediate HIV-related conditions occur more frequently in adults than in children with hemophilia. Persistent fever is the strongest predictor of AIDS in adults, whereas oral candidiasis is the strongest predictor in children. These findings should facilitate the design and conduct of clinical trials as well as the management of HIV- infected children and adults.

Mortality risks in gay men with human immunodeficiency virus infection and cognitive impairment.

We obtained data from 111 gay men who entered a longitudinal study of the natural history of human immunodeficiency virus (HIV) without clinical evidence of acquired immunodeficiency syndrome (AIDS), and examined them regularly over a 36-month period. Using a Cox proportional-hazard regression model to compare cumulative risk of mortality in subjects with and without cognitive impairment and several putative risk factors present at baseline, we found that the mortality risk ratio (RR) associated with poor neuropsychologic test performance was significantly increased (RR = 2.9; 95% confidence interval [CI], 1.1 to 7.8), and increased further (RR = 4.1; 95% CI, 1.3 to 12.5) when adjusted for other factors associated with mortality (a history of a disturbance in movement or gait, CD4-lymphocyte and red blood-cell counts, and age). A significant increase in symptoms related to cognitive impairment and gait, a decline in neuropsychologic test performance, and declines in CD4-lymphocyte and red-cell counts occurred over the study period. A second model was constructed to adjust for changes in CD4-lymphocyte and red-cell counts, age, medical stage, and motor symptoms over the study period, but the mortality RR for poor neuropsychologic test performance at baseline changed very little (RR = 4.7; 95% CI, 1.5 to 14.9). We conclude that the presence of cognitive impairment, manifest by poor neuropsychologic test performance in both asymptomatic and symptomatic gay men with HIV infection, is associated with a significantly increased risk of death. This effect progresses in parallel with the immunologic and systemic effects of HIV.

Human Immunodeficiency Virus Infection in North American Women

This study was designed to define the epidemiology and natural history of human immunodeficiency virus (HIV) infection in women in Rhode Island. Two hundred women referred to Brown University physicians from 1986 through 1990 were evaluated at 3-to-6-month intervals for 12 to 60 months. All received antiretroviral therapy and prophylaxis against opportunistic infections when indicated on the basis of CD4 lymphocyte counts. Major findings included: 1) rapid shift of dominant mode of transmission from intravenous drug sharing to heterosexual route; 2) significant gender-specific differences in clinical presentation; 3) increased frequency of cervical dysplasia in women infected via intravenous needle sharing; 4) no definite gender-specific differences in progression of HIV infection; 5) enormous societal impact of HIV infection in women. Principal conclusions are: 1) rapid change to predominantly heterosexual HIV transmission can occur in North America, with serious societal impact; 2) gender-specific clinical features can lead to earlier diagnosis of HIV infection in women; 3) HIV infection in women does not pursue an inherently more rapid course than that observed in men.

Natural History of Human Immunodeficiency Virus Infection

The natural history of human immunodeficiency virus (HIV) infection is marked by a progressive deterioration of the host immune system and a concomitant increase in host viral burden. The rationale for major HIV disease staging systems is discussed in light of this natural history. The need for early diagnosis and treatment of HIV-infected patients is underscored by the prolonged phase during which patients are simultaneously asymptomatic and infectious. Clinical, immunologic, and virologic markers of disease stage, progression, and response to therapy will require continuing refinement as we better understand the pathobiology of HIV disease.

Medical Aspects of Care for the Person with Advanced Acquired Immunodeficiency Syndrome (AIDS): A Palliative Care Perspective

The classification and natural history of human immunodeficiency virus (HIV) infection is outlined briefly, followed by a detailed consideration of the prognostic factors that form the basis for effective medical communication and decisionmaking in palliative care. The broad clinical spectrum of AIDS and selected management problems are discussed, including palliation by control of oppportunistic infections, neuropsychiatric disorders (including AIDS-related dementia) and safety in the use of corticosteroids. The article ends with consideration of when to stop specific AIDS-related treatments in advanced disease.

Seroconversion to human immunodeficiency virus (HIV) in hemophiliacs. Relation to lymphadenopathy.

The authors studied the natural history of human immunodeficiency virus (HIV) exposure in 187 hemophiliacs followed for an average of 45 months. Overall, 55 percent developed antibody specific for HIV and 21 percent developed persistent generalized lymphadenopathy. Most patients seroconverted sometime between early 1982 and the end of 1984. Four patients developed acquired immune deficiency syndrome (AIDS) and four seropositive patients developed idiopathic thrombocytopenia (ITP). One of the four patients who developed AIDS and three of the four with ITP had preexisting lymphadenopathy. None of the 10 patients with lymphadenopathy or the 20 asymptomatic patients was seropositive for human T-lymphotropic virus, type I. Although seropositivity and lymphadenopathy have been found in many of the authors' patients, few have developed clinical disease that can be related to HIV infection.

230 The natural history of human immunodeficiency virus (HIV) infection in screened HIV positive USAF personnel: A preliminary report

230 The natural history of human immunodeficiency virus (HIV) infection in screened HIV positive USAF personnel: A preliminary report

Delayed hypersensitivity skin testing and anergy in a population of gay men

Anergy is almost universal among patients with the acquired immunodeficiency syndrome (AIDS). To determine the prevalence and correlates of anergy in a population at risk for AIDS, we performed skin tests in 1120 gay men who were enrolled in a prospective study of the natural history of human immunodeficiency virus (HIV) infection. Anergy, defined as no induration to any of four intradermal antigens, was present in 12%. Individually, no induration was detected in response to tetanus toxoid (41%), mumps (28%), candida (47%), and trichophyton (72%). Anergy was strongly associated with the presence of antibody to HIV and with a reduced number of T helper lymphocytes, but not independently with generalized lymphadenopathy, the number of reported male sexual partners in the previous 2 years, the number of T suppressor lymphocytes, or with high titers of antibodies to cytomegalovirus. Nine percent of HIV antibody-negative subjects and 20% of antibody-positive subjects were anergic; anergy is not specific for serologically documented HIV infection in this population. Skin testing with only tetanus toxoid, candida, and mumps antigens may be sufficient to detect anergy. In the presence of HIV antibody, the ability of anergy to predict progressive immunodeficiency remains to be determined.

Immunohistology of persistent generalized lymphadenopathy. Evidence for progressive lymph node abnormalities in some patients.

Immunohistologic analysis of cellular changes in serial lymph node biopsies of eight patients with persistent generalized lymphadenopathy (PGL) syndrome was performed and correlated with clinical and laboratory findings to better determine the natural history of human immunodeficiency virus (HIV) infection. The authors observed decreased follicle size and area in the second biopsies of six of the eight patients, associated in some with increased numbers of B-cells in medullary regions (four of eight) and more involuted follicles (four of eight). Five cases showed progressively increased paracortical areas in the second biopsies, with increased numbers of T-cytotoxic/suppressor cells and decreased T-helper cells. Seven of the patients also had a progressive loss of T-helper cells in the peripheral blood. These findings provide tissue and peripheral blood evidence for progressive immunologic deterioration in some patients with PGL.

Marketing strategies for recruiting gay men into AIDS research and education projects.

Recruiting gay and bisexual men into AIDS-related research and education programs will become increasingly common as federal, state and local funds become available. The Pitt Men's Study, a study of the natural history of Human Immunodeficiency Virus (HIV) infection, developed a recruitment strategy based on marketing principles. These techniques allowed the study to target particular gay and bisexual groups for inclusion. 1718 gay and bisexual men were recruited. Non-whites and unemployed men were targeted and recruited in numbers comparable to their representation in the larger community.

NATURAL HISTORY OF HUMAN IMMUNODEFICIENCY VIRUS INFECTION IN ZAIRE

The natural history of human immunodeficiency virus (HIV) infection in Zaïre was determined by identifying in October, 1984, 125 seropositive hospital personnel without signs or symptoms and 145 age and sex matched seronegative controls from the same population. Between July, 1985, and February, 1986, 67 seropositives, including 38 men and 29 women, and 113 seronegatives were interviewed and examined by an observer who did not know their serological status. The acquired immunodeficiency syndrome (AIDS) had developed in 1 seropositive and no seronegatives (rate difference, 1·3/100 person-years [py]; 95% confidence interval 0-3·3/100 py); AIDS-related complex or generalised lymphadenopathy had developed in 8 seropositives (12%) and 1 seronegative (1%) (rate ratio, 13·2; 95% confidence interval 1·3-134·6); and minimal lymphadenopathy had developed in 19 seropositives (28%) and 8 seronegatives (7%) (rate ratio, 3·9; 95% confidence interval 1·8-8·4). These data provide the first estimates for rates of progression to AIDS or AIDS-related conditions among healthy HIV seropositive heterosexual adults. Rates observed in this study are similar to those reported in US or European homosexual or bisexual men.