HIV-positive Individual Research Articles

On the recent sharp increase in HIV detections in Cuba

Contact tracing has been debated as a control measure for HIV/AIDS ever since the emergence of the global HIV pandemic. In Cuba the Partner National Notification Programme has been tracing sexual contacts of known HIV-seropositive individuals since 1986. Data in 1996 have shown an increase in the number of HIV-positive contacts. To see whether this sharp increase indicates an actual increase in the HIV-positive population the number of HIV-infected individuals infected through sexual contact was estimated using the HIV seroprevalence data of the Partner Notification Programme as a seroprevalence result from a random sampling of the sexually active population in Cuba. Overall results show that in agreement with the seroprevalence data there is an increase in the number of HIV-positive individuals in the country since 1996. However the increase is consistent with the previous increase in the first half of the decade.

HIV infection and aging: enhanced Interferon- and Tumor Necrosis Factor-alpha production by the CD8+ CD28- T subset

BackgroundT cells from HIV+ and aged individuals show parallels in terms of suppressed proliferative activity and interleukin-2 (I1-2) production and an increased number of CD8+ CD28- T cells. In order to compare cytokine production from T cells from these two states, CD4+ and CD8+ T cells from HIV+ aged, and normal young donors (controls) were monitored for cytokine production by flow cytometry, quantitative PCR and ELISA upon activation by PMA and anti-CD3. In addition, the CD8+ T cell subsets CD28+ and CD28- from the HIV+ and the aged groups were evaluated for cytokine production by flow cytometry, and compared with those from young controls.ResultsFlow cytometric analysis indicated that CD8+ T cells from both HIV+ and aged donors showed an increase of approximately 2–3 fold over controls in percentage of cells producing inflammatory cytokines IFN-γ and TNF-α. Similar analysis also revealed that the production of interleukins-4,6 and 10, production was very low (1–2% of cells) and unchanged in these cells. Quantitative PCR also showed a substantial increase (4–5 fold) in IFN-γ and TNF-α mRNA from HIV+ and aged CD8+ T cells, as did ELISA for secreted IFN-γ and TNF-α (2.3–4 fold). Flow cytometric analysis showed that the CD8+ CD28- T cell subset accounts for approximately 80–86% of the IFN-γ and TNF-α production from the CD8+ subset in the aged and HIV+ states. The CD4+ T cell, while not significantly changed in the HIV+ or aged states in terms of IFN-γ production, showed a small but significant increase in TNF-α production in both states.ConclusionsOur data appear compatible with physiologic conditions existing in HIV+ and aged individuals, i.e. elevated serum levels and elevated CD8+ T cell production of IFN-γ and TNF-α. Thus, the capacity for increased production of cytokines IFN-γ and TNF-α in the aged individual by the dominant CD8+ CD28- subset may have a profound influence on the clinical state by aggravating inflammatory pathologies such as rheumatoid arthritis, and possibly Alzheimer's disease and Crohn's disease. In AIDS, these cytokines may contribute to wasting and cachexia. We theorize that the predominant phenotypic change to the cytotoxic CD8+ CD28- T cell subsets in both the HIV+ and the aged states may reflect a natural "endpoint" in CD8+ T cell differentiation induced after a lifetime of immune activity (toward viruses, etc) in the aged, and after a massive accelerated response to HIV in the HIV-positive individual.

Paediatric AIDS--related linear gingival erythema: a form of erythematous candidiasis?

Three vertically HIV-infected children showed, in addition to oral candidiasis, HIV-gingivitis, which healed on antimycotic treatment. The intense linear gingival erythema of a fourth child was also clinically evaluated as a possible form of erythematous oral candidiasis. Direct microscopic examination of material from the gingival lesions of the latter disclosed yeast cells and hyphae. Subsequent culture, biochemical and serological tests identified the yeast as Candida dubliniensis. As the patient was on long-term prophylaxis with fluconazole, ketoconazole was administered and led to a good clinical response. This is the first report implicating this new Candida species as a pathogen in linear gingival erythema in a HIV-positive individual. The case reports presented provide evidence that linear gingival erythema may be of candidal origin. Further clinical and laboratory observations are required to establish whether this condition constitutes a variant of erythematous candidiasis associated with paediatric HIV infection.

HIV, empowerment and the sick role: an investigation of a contemporary moral maze

Through examination of a number of interview transcripts conducted with individuals living relatively long-term with an HIV-positive diagnosis, this paper explores the implicitly morally loaded dimension of the interview situation. In particular, we are concerned with the way in which a specific sample of HIV-positive individuals orient both to ‘the sick role’ and to an ‘empowerment discourse’ which challenges that role, and how they negotiate the contradictory and morally problematic situation that this places them in. It is argued that the moral dilemmas encountered, oriented to and accounted for by the HIV-positive individual in the interview situation cannot be reduced to issues of individual morality but must be understood in terms of the ill-defined social space occupied by HIV-positive individuals in contemporary society.

Primary non-Hodgkin's lymphoma of the cranial vault

We present a case of primary B-cell, large-cell, lymphoma of the skull vault in a 50-year-old HIV-positive male, who presented with a history of unilateral headache and a swelling on the scalp. Primary non-Hodgkin's lymphoma of the skull is rare, with only ten such cases in adults previously described. We suggest that this is the second reported case in an HIV-positive individual.

An empirical examination of the implications of assortative matching on the incidence of HIV

Using data from The San Francisco Home Health Study (SFHHS), this paper analyzes the degree to which the incentives to avoid HIV infection result in infection-dependent (assortative) matching patterns based on HIV status. The incidence implications induced by such matching are compared to infection independent matching, an implicit assumption in canonical models within epidemiology. We estimate that an HIV-positive individual is more than twice as likely as an HIV-negative individual to have an HIV-positive partner, and that this results in a decrease in HIV incidence of about one-third compared to the predictions implied by standard epidemiological models.

Prophylaxis for tuberculosis in Europe--ongoing research.

The incidence of tuberculosis (TB) in patients with human immunodeficiency virus (HIV) infection has increased in recent years, raising issues regarding preventive therapy for TB in this high-risk patient population. To determine if an HIV-positive individual is at risk for reactivation of latent infection, testing with purified protein derivative (PPD) is recommended; however, many people with impaired cell-mediated immunity due to HIV are anergic. Strategies regarding PPD testing and criteria for HIV-positive patients are presented. Isoniazid has been the accepted drug for use as prophylaxis for TB in immunocompetent patients, and there is evidence that isoniazid is also effective in HIV-positive, PPD-positive patients. Data from efficacy and feasibility trials and the risks and benefits of preventive therapy with isoniazid are discussed. Because of toxicity and compliance problems with isoniazid, there is a continuing need for development of alternative therapies. The results of some preliminary studies of newer therapies are presented here.

A qualitative evaluation of HIV and AIDS education to senior school children in Lothian Region, Scotland

In response to the high incidence of HIV and AIDS in Lothian Region Scotland the Education Department has funded a development team to work in the schools. The main focus of this team is a conference day aimed at 15-16-year-old school pupils run by external facilitators. The day comprises an educational input a question-and-answer session role playing and a plenary session led by an HIV positive individual. This paper evaluates the programme using qualitative methods at three schools. The views of the pupils were sought using focus groups both before and after the conference day. The programme was well received giving pupils the opportunity to raise personal issues surrounding HIV and AIDS. In general the pupils were well informed about the subject but lacked confidence in their knowledge and their ability to implement safer sex practices. This conference day appears to have underlined the importance of HIV and AIDS in the pupils lives and clarified related issues. It is a good model of practice. (authors)

Appetite and Nutrition in Relation to Human Immunodeficiency Virus (HIV) Infection and Acquired Immunodeficiency Virus Syndrome (AIDS)

Why are we interested in what people with human immunodeficiency virus (HIV) infection and acquired immunodeficiency virus syndrome (AIDS) eat? Interest in what people with HIV infection and AIDS eat focuses on the possibility that by consuming a certain type of diet, or by ingesting a certain amount of a particular nutrient, the HIV-positive individual can live longer. This is not an unreasonable suggestion since there is a popular belief that evidence exists for an ‘anti-heart disease diet’, so why not an ‘anti-AIDS diet’?

Appetite and nutrition in relation to human immunodeficiency virus (HIV) infection and acquired immunodeficiency virus syndrome (AIDS)

Why are we interested in what people with human immunodeficiency virus (HIV) infection and acquired immunodeficiency virus syndrome (AIDS) eat? Interest in what people with HIV infection and AIDS eat focuses on the possibility that by consuming a certain type of diet, or by ingesting a certain amount of a particular nutrient, the HIV-positive individual can live longer. This is not an unreasonable suggestion since there is a popular belief that evidence exists for an ‘anti-heart disease diet’, so why not an ‘anti-AIDS diet’?

Management of splenic abscess in immunocompromised children

Splenic abscess is an infrequent complication in the immunocompromised patient. Six patients underwent splenectomy for presumed splenic abscess from 1987 to 1991. Chemotherapy altered the immune system of four patients; the human immunodeficiency virus (HIV) rendered the other two vulnerable to infection. Five presented with fever but none had leukocytosis; only one exhibited palpable splenomegaly; three had abdominal pain. Cultures documented systemic infection in all but one, an HIV-positive individual. Respiratory embarrassment was the indication for surgery in one patient. In five cases the decision for surgical intervention was made after computed tomography (CT) indicated the presence of multiple splenic lesions and systemic antibiotics failed to resolve the fevers. CT additionally showed hepatic and/or renal microabscesses in four patients. Signs and symptoms experienced preoperatively resolved with splenectomy in all six patients. No additional surgery was required for the patients with extrasplenic abscesses. Surgical pathology determined that three spleens had fungal and two had mycobacterial abscesses. The other was shown to be a spindle cell sarcoma; no abscess was present. This patient had preoperative blood cultures positive for mycobacteria, and the same organism was recovered from retroperitoneal nodes sampled at the time of splenectomy for the sarcoma. Follow-up indicates that no patients experienced surgical complications or sequelae related to their splenic pathology. Splenectomy is necessary and effective in treating splenic abscesses in immunocompromised patients and is appropriate for diagnosis as well as therapy.

HIV in the oral cavity: virus, viral inhibitory activity, and antiviral antibodies: a review.

Although it is generally assumed that HIV transmission does not occur through casual oral contact, persistent reports in the literature and the well-documented case of the Florida dentist (Ou et al., 1992) have served to elevate concerns and interest about the possibility of oral transmission of HIV. The literature suggests that: (1) the presence of infectious virus in the oral cavity is an uncommon event; (2) PCR data indicate that HIV sequences may be present in the oral cavity at reasonably high frequency--further studies are warranted; (3) saliva appears to contain potent anti-HIV activity that may be responsible for the low oral virus titer; and (4) oral secretions are a reliable source for monitoring anti-HIV antibodies. It is clear that the oral cavity will remain a focus for HIV research, in terms of both viral transmission/pathogenesis and for noninvasive diagnosis of the HIV-positive individual.

Analysis of disease progression from clinical observations of US Air Force active duty members infected with the human immunodeficiency virus: distribution of AIDS survival time from interval-censored observations

A non-parametric estimator of the AIDS survival time (after developing AIDS) is computed for the AIDS data set from the US Air Force (USAF). Survival times are unobservable. They are censored by the screening mechanism. The Armstrong Laboratory's Epidemiologic Research Division maintains data on over 954 active duty US Air Force (USAF) individuals who tested positive for human immunodeficiency virus (HIV) antibodies. Many have been clinically evaluated seven times since 1986. The HIV-positive individual is classified in seven stages of the disease complex as time progresses. Exact times of transition from one stage to the next are unknown. It is known that transition occurred between two consecutive evaluations. The aim of this study is to analyse distributions of the times that individuals spend in each stage of the HIV disease complex. We will discuss methods used to obtain non-parametric estimators of the distribution of times that individuals spend in stage 6. Finally, it is hoped to model the median time spent in each stage of the disease. This, along with incidence and separation data, will allow the prediction of the impact of HIV disease on USAF individuals and medical care systems.

HIV Testing, Counseling Improved Condom Use Among Rwandan Couples

According to a study in Rwanda of 53 couples in which 1 partner tested positive for the human immunodeficiency virus (HIV) and the other tested negative condom use increased markedly within 1 year after counseling. The rate of seroconversion among HIV-negative women in this group was less than 50% of that in a larger group of comparable women whose partners had not been tested. Among 1258 women in cohabiting unions who were screened for HIV in 1988 at the Centre Hospitalier de Kigali 420 had partners who also requested testing. 60 couples had discordant results and 53 of these were enrolled in a prospective study to determine the effect of HIV testing and counseling on risk-reduction behavior and transmission. Couples viewed a video about AIDS and HIV risk prevention stressing condoms as the most effective preventive method and baseline data were collected. Participants were tested once every 2 weeks during the first 3 months by enzyme-linked immunosorbent assay confirmed by Western blot. Among 60 discordant couples only 3% of the women and 7% of the men had previously used condoms; after 1 year 57% of discordant couples were using condoms compared with 16% of the women whose partners were not tested. 2 of the 23 men (who never used condoms) who initially tested negative for HIV seroconverted during follow-up yielding a seroconversion rate of 3.8/100 person-years. Of the 30 HIV-negative women 6 seroconverted yielding a rate of 9.5/100 person-years. The estimated seroconversion rate among women whose partners were not tested was 22/100 person-years. Among those who seroconverted during follow-up there was 1 transmission/286 unprotected contacts among HIV-negative men and 1/350 among women. Thus in Rwanda the risk of HIV transmission in one act of intercourse with an HIV-positive individual is no greater than that seen in Western countries.

Molecular and biochemical analyses of human immunodeficiency virus type 1 vpu protein.

We have performed a detailed analysis of the biochemical properties of the human immunodeficiency virus (HIV) type 1 vpu gene product to elucidate its function during virus replication. Our data suggest that vpu is posttranslationally modified by phosphorylation, since a 16-kilodalton phosphoprotein can be specifically immunoprecipitated with both a serum from an HIV-positive individual (HIV-positive serum) and a vpu-specific antiserum. In contrast, our results suggest that vpu is not glycosylated, even though the protein contains a potential glycosylation site. In vitro translation studies demonstrated that vpu is cotranslationally integrated into microsomal membranes, suggesting that vpu is an integral membrane protein. While vpu was found in significant quantities in virus-producing cells, the protein could not be detected in cell-free culture fluids and is therefore most likely not viron associated. Processing of viral precursor proteins was unaffected by the absence of vpu, and no differences were detected in the protein compositions of wild-type and mutant virions. However, virus release from cultures producing vpu-defective virus was found to be delayed, resulting in the intracellular accumulation of viral proteins. Our data suggest that vpu has a function in the release of virus particles from infected cells.