HIV-seropositive Persons Research Articles

People living with HIV infection who attend and do not attend support groups: a pilot study of needs, characteristics and experiences.

People living with Human Immunodeficiency Virus (HIV) confront a myriad of stressors over the course of their infection. Social support groups offer a means of addressing the support needs of people living with HIV. In the present study, 34 persons who had attended HIV support groups and 29 who had not attended groups completed measures of distress, coping, and social connectedness, and participated in open-ended interviews concerning their support group experiences. Results showed that those who attended support groups knew they were HIV-seropositive for a longer time, reported less emotional distress, and had more social contact than did non-attenders. However, non-attenders endorsed avoidant coping strategies to a greater extent. Analyses showed that time since testing positive accounted for differences between groups in social connectedness but not differences in anxiety, depression, or avoidance coping. Thus, HIV-seropositive persons become socially reconnected with time, but individuals with avoidant coping styles experience greater emotional distress and are unlikely to seek support groups. A sizeable proportion of people with HIV may therefore need supportive interventions, particularly nearer to the time that they test HIV-seropositive.

A community support group for HIV-seropositive drug users: is attendance associated with reductions in risk behaviour?

Although support groups for HIV-seropositive persons are a potential source of emotional support and information, there has been little assessment of such groups as to their role in changing risk behaviour for transmission. The present study combines observations from over 52 group sessions with baseline and follow-up interview data to assess changes in sex and drug behaviour among seropositive drug users participating in an ongoing group for African Americans. The sample of 100 adults was recruited from drug treatment centres and from the community in Atlanta, Georgia. At the 6-month interview, frequency of group attendance was associated mainly with healthier drug behaviour, the topic most frequently discussed by members. Findings suggest that training for support group facilitators needs to target two areas for technology transfer: successful strategies for reducing both high-risk sex and drug behaviour and methods for introducing these behavioural change tools into a setting designed for socio-emotional support. We conclude that community support groups are an untapped opportunity for low-cost prevention services.

IgA and IgG antibodies to distinct serotypes of Mycobacterium avium in HIV seropositivity and AIDS

IgA and IgG antibodies to cytoplasmic and secreted antigens of serotypes 4 and 8 of Mycobacterium avium and the percentage of agalactosyl immunoglobulin (%Gal[0]) were measured by ELISA in groups of blood donors, HIV seronegative persons, HIV seropositive persons with CD4+ cell counts >300/mm3 and AIDS patients co-infected with M.avium. No differences were found between the control groups, but HIV seropositive persons were distinguished by their increased %Gal[0] (p<0.001) and increased IgA titre (p<0.05) to secreted antigens of both serotypes of M. avium. Patients going on to develop aviumosis differed from other HIV-positive individuals, having more IgA to secreted antigens of serotype 8 (p<0.03) and more IgG to secreted antigens of both serotypes (p<0.0001), IgA titres fell to both types of antigen from serotype 4 (p<0.01) and sonicate antigen of serotype 8 (p<0.001) and IgG fell to the secreted antigens of serotype 4 (p<0.03). On interpretation of these observations that antibody profiles to M. avium might be used to identify healthy persons at special risk of developing HIV seropositivity, and to identify persons with early AIDS who are likely to develop aviumosis.

Pentoxifylline therapy in HIV seropositive subjects with elevated TNF

Tumor necrosis factor-α (TNF-α) is thought to induce cachexia in subjects infected with human immunodeficiency virus (HIV), and it has been suggested that HIV-seropositive patients would benefit from treatment with pentoxifylline, a known suppressor of TNF-α production. The purpose of the present study was to examine how pentoxifylline at a dose of 800 mg thrice daily would influence the cellular immune system in HIV-seropositive persons with elevated TNF-α. Six HIV-seropositive subjects with elevated amounts of TNF-α in plasma at least at two occasions were included in an open, controlled, randomized, cross-over study consisting of a 6 week treatment period and a 6 week control period. Blood samples were collected before and at the end of each period. Pentoxifylline treatment did not influence the concentration of plasma-TNF-α, subpopulations of blood mononuclear cells, the proliferative responses nor the natural killer (NK), and lymphokine activated killer (LAK) cell activities. Furthermore, pentoxifylline treatment did not influence the weight, temperature, well being, or tiredness of the subjects. However, the patients frequently reported gastrointestinal side effects. In vitro, however, pentoxifylline at suprapharmacological concentrations inhibited the blood mononuclear cell (BMNC) proliferative responses, NK, and LAK cell activities.

Characterization of Streptococcus pneumoniae from human immunodeficiency virus--seropositive patients with acute and recurrent pneumonia.

Thirty-two isolates of clinically significant Streptococcus pneumoniae from 11 human immunodeficiency virus (HIV)-seropositive patients with single or multiple episodes of pneumonia were characterized by antibiotic susceptibility testing, serotyping, ribotyping, and repetitive extragenic palindromic polymerase chain reaction (REP-PCR). The isolates comprised 10 serotypes, 12 ribotyping patterns, and 12 REP-PCR patterns. There was close but not absolute correlation between techniques. By combining these characterization methods, 14 strains were identified. Five strains were found in > 1 patient, suggesting their frequent occurrence in this population. Two isolates of different serotype from 1 patient were highly related by ribotyping and REP-PCR, suggesting possible in vivo serotype change. Acute infection was associated with single strains or coinfection by distinct strains. Recurrent pneumonia was identified as relapse with the same strain or reinfection with new strains. The molecular characterization of pneumonococci from HIV-seropositive persons refines our understanding of pneumonococcal infection in these patients.

Peripheral gamma delta T-cell populations in HIV-infected individuals with mycobacterial infection.

Previous studies have suggested that gamma delta T cells can be increased in HIV-1-seropositive individuals, although characterization of gamma delta T cell subtypes and correlation with clinical status of these patients have not been performed. We investigated groups of HIV-seropositive persons to determine the prevalence of elevated levels of gamma delta T cells and whether any gamma delta T cell subtypes were preferentially expressed. Since a large proportion of human gamma delta T cells appear to be reactive to proteins encoded by mycobacteria, we also examined our patients for the incidence of mycobacterial infection. Our results show that a significant number of HIV-positive patients have an elevated number of gamma delta T cells in their peripheral blood as compared to normal controls. HIV-seropositive patients with clinical or laboratory evidence of mycobacterial infection had statistically significant increases in the percentage and total numbers of gamma delta T cells over the HIV-positive persons without mycobacterial infection. An examination of the subtypes of gamma delta T cells revealed that certain subtypes such as V gamma 9+ and V delta 2+ T cells were preferentially elevated in the mycobacteria-positive patients. These results suggest that an increased number of gamma delta T cells in HIV-positive patients is most often seen in the setting of an opportunistic mycobacterial infection and that specific gamma delta T cell subtypes are stimulated under these conditions. The role of these increased number of gamma delta T cells in HIV-associated disease is unclear but is likely a component of the response and degree of host resistance to this organism.

Elevated IgE level in relationship to nutritional status and immune parameters in early human immunodeficiency virus–1 disease

Elevation of IgE has been associated with T-cell dysregulation and with the occurrence of opportunistic infections in patients with acquired immunodeficiency syndrome. The precise cause of IgE overproduction during the early stages of human immunodeficiency virus (HIV)–1 disease, however, has not been established. In light of reports demonstrating that IgE production may be affected by vitamin E levels in an animal model, we evaluated nutritional status in relationship to plasma IgE levels and immune parameters in 100 asymptomatic HIV-1–seropositive and 42 HIV-1–seronegative homosexual men. Approximately 18% of the HIV-1–seropositive population demonstrated biochemical evidence of plasma vitamin E deficiency (<5 μg/ml). Subsequent analysis of available samples indicated a dramatic elevation of IgE levels (308 ± 112 IU/ml) in vitamin E–deficient seropositive subjects ( n = 9) as compared with age and CD4-matched HIV-1–seropositive persons with adequate vitamin E levels ( n = 16, 118.1 ± 41.1 IU/ml) and significantly lower levels (59.5 ± 15.7 IU/ml) in HIV-1–seronegative men ( n = 20, p = 0.01). This effect, which was independent of CD4 cell count, did not appear to be influenced by atopic or gastrointestinal parasitic disease. The low plasma vitamin E levels were related at least in part to dietary intake ( r = 0.552, p = 0.01), suggesting that supplementation may be warranted in HIV-1–infected persons in whom vitamin E deficiency develops. Analysis of covariance revealed a strong relationship between IgE levels and CD8 cell counts ( p < 0.006), and between IgE level and vitamin E deficiency ( p < 0.039). Although nutritional deficiency is unlikely to be the principal cause of immunoglobulin dysregulation in HIV infection, these results demonstrate that vitamin E deficiency may play a contributory role in IgE elevation during the early stages of disease. (J A LLERGY C LIN I MMUNOL 1995;95:886-92.)

Rapid culture and quantitation of human immunodeficiency virus type 1 from patient cells without the use of mitogen-stimulated donor cells.

We report the development of a rapid, sensitive virus culture method for direct quantitation of human immunodeficiency virus (HIV) in peripheral blood mononuclear cells (PBMCs). This new method involves culturing 10(7) PBMCs from HIV-seropositive persons in 10 ml of medium containing phorbol 12-myristate 13-acetate and interleukin-2. Both agents stimulate cell activation and hence viral replication. Cell-associated virus and free virus are quantitated by a commercially available HIV p24 antigen capture enzyme immunoassay. Detection of cell-associated p24 antigen by flow cytometry was less sensitive than by the enzyme immunoassay. In this preliminary study, HIV was detected in 20 of 23 HIV-seropositive patients and in none of the 11 HIV seronegative low-risk individuals. One HIV-seronegative person with Guillain-Barré syndrome following high-risk activity was found to be rapid-HIV-culture positive. The overall sensitivity and specificity were 87 and 100%, respectively. By comparing the quantity of virus produced in infected cells with the amount of virus produced in chronically infected U1 monocytes and ACH-2 lymphocytes stimulated with phorbol 12-myristate 13-acetate and interleukin-2, the approximate number of infected cells per sample is calculated. In the same patient specimens, quantitation of the number of HIV infected cells by the HIV rapid-culture method correlated with the results of the 21-day cell dilution coculture assay (correlation coefficient r = 0.5; 95% confidence interval, 0.07 to 0.77). Advantages of the rapid HIV culture include no requirement for donor PBMCs or change of media, shortened culture time, and the ability to detect p24 viral antigen from cell-associated virus for quantitation of viral load.

Dysregulation of cytokine expression in monocytes from HIV-positive individuals

Because HIV may alter the production of inflammatory factors produced by monocytes, the expression of tumor necrosis factor alpha (TNF-alpha), tissue factor (TF), interleukin (IL)-1 beta, and IL-6 was evaluated in 47 HIV-seropositive persons and seronegative control subjects. RNA was extracted from freshly isolated lipopolysaccharide (LPS)-stimulated or unstimulated monocytes. Cytokine and TF expression was quantitated by dot blot hybridization or a reverse transcription polymerase chain reaction (RT-PCR). A significant depression of TF mRNA was observed in LPS-stimulated monocytes (66% less in AIDS, 20% less in AIDS-related complex (ARC), and 0% less in asymptomatic patients), whereas normal responses were observed for TNF-alpha, IL-1 beta, and IL-6. When constitutive expression was measured in unstimulated monocytes by RT-PCR, a differential pattern was also observed. TNF-alpha and IL-1 beta were positive in 85% of asymptomatic persons, compared with only 27% of ARC and 42% of AIDS patients. Expression of IL-6 was observed in lower proportions, 27-30%, with no significant differences among disease states. All samples were negative for TF. Thus, the regulation of inflammatory molecules is differentially altered in individuals with HIV infection. TF is preferentially down-regulated, compared with TNF-alpha, IL-1 beta, and IL-6, in LPS-stimulated monocytes as patients progress to AIDS. TNF-alpha and IL-1 beta are preferentially up-regulated, compared with IL-6 and TF, in unstimulated monocytes in asymptomatic persons, with a loss of up-regulation as patients progress to AIDS.

Oral hairy leukoplakia: pathogenetic aspects and significance of the lesion.

Oral hairy leukoplakia in HIV-seropositive persons is considered as a highly serious sign and places the patient in the AIDS-related complex group according to the classification recommended by the Centers for Disease Control. Epstein-Barr virus (EBV) is thought to be the cause. Based on the investigation of 14 of our own cases and a review of the literature, we conclude that so called hairy leukoplakia does not have a specific histopathologic pattern. Identical lesions can be caused by fungus infection, or biting and other kinds of mechanical irritation. Both fungal infection and EBV infection have been proven in a high percentage of the lesions. However, EBV has been found also in apparently normal oral mucosa. This questions the assumption that the virus is the cause of the lesions. In our investigation the presence of "hairy leukoplakia" did not reflect the clinical status of the patient. The best indicator of the clinical status was the T-lymphocyte subset CD4+ number in the peripheral blood. It appears that low CD4+ counts, candidiasis and the presence of replicating EBV in the epithelial cells are parallel markers of increasing immunodeficiency.

Correlation between anti-V3 peptide and neutralizing antibodies in plasma from HIV-1 infected individuals resident in Brazil.

A study was conducted of the reactivity of 85 plasma samples from HIV-1 seropositive persons living in Brazil. Five HIV-1 plasma samples had synthetic peptides from the V3 region isolates (IIIB, MN, SC, WMJ-2, and RF). There was a low reactivity (59%) with HIV-1 isolate MN derived PND peptides, while most studies report a 90% or higher reactivity. Brazilian HIV-1 seropositive sera had lower reactivity with MN isolate PND peptides than sera from other countries. Researchers used 5 HIV-1 MN isolate PND peptides from other sources to analyze the same plasma to confirm the study's results. The HIV-1 MN isolate PND peptides had different amino acid sequences, but all had the GPGR top of the V3 loop. 52% of the Brazilian plasma recognized V3 peptides, 55% for 48 peptides, 56% for C52 peptides, and 49% for C53 pep tides. Only 27% of the Brazilian plasma recognized the C54 peptide. There was considerable overlapping reactivity, however. For example, 65% of the V3 MN reactive plasma also recognized the C52 MN peptide and the C53 MN peptide. The overlap between C52 MN and C53 MN was 69%. These findings suggest that, in the Brazilian study population, at least 2 different anti-MN-PND antibody specificities directed against amino acid sequences including the GPGR top of the V3 loop exist (an epitope including PNY[NKRKRIHIGPGR] and the epitope including [KRKRIHIGPGR]AFY). 86% of the plasma reacted with at least 20% of the MN PND peptides, which equals reactivities in other studies. 96% of the Brazilian plasma were positive for neutralizing antibodies based on overlap of peptide recognition and HIV-1 MN isolate neutralization (titers = 1:100-1:52,600). Recognition of the V3 loop of the HIV-1 MN isolate in sera from HIV-1 positive persons in Brazil has two different antibody specificities. Most of the Brazilian plasma recognize the N terminal arm, which consists of the GPGR top of the V3 loop.

Serum HIV-1 p24 levels and body weight measurements before and after 4 weeks of diethylcarbamazine treatment given to HIV-1 seropositive persons

Previous reports suggest that diethylcarbamazine citrate (DEC) could be useful in the treatment of retroviral, bacterial, and fungal infections [1]. In an additional experiment, DEC (25 mg by mouth twice daily) was administered concurrently with oral Zidovudine (20 mg/kg twice daily, later changed to 10 mg/kg, then 15 mg/kg oral Videx twice daily) to a chronically FeLV-infected 18-month-old female domestic shorthair cat (cat S). FeLV serum p27 levels were lowered (by a factor of 10) with no apparent adverse effects or notable changes in serum alanine aminotransferase and creatinine levels, and a weight gain of 0.5 kg was noted over 4 months. Another study indicated that 1 month of oral DEC (10 mg/kg day -~) given to 12 FeLV-infected cats did not significantly alter serum alanine aminotransferase and

Oral carriage of candida in healthy and HIV-seropositive persons

The prevalence of oral colonization with Candida species was studied in 28 HIV-seropositive and 28 healthy persons. Candida was cultured from 75% and 68% of HIV-positive and control persons, respectively, with a significantly higher density carriage in the HIV-seropositive group. Positive smears were seen in 39% of all patients. Candida albicans was the most frequently isolated species with Biotype 1 accounting for 56% of the isolates. Resistance to antifungal agents was seen in Candida strains isolated from both groups.

A Screening Test for Subtle Cognitive Impairment Early in the Course of HIV Infection

The authors report on the use of the Rey-Osterrieth Complex Figure Copy (ROC) and Memory (ROM) test as a bedside screening measure of cognitive impairment in 67 HIV-seropositive persons (43 men, 24 women). HIV-seropositive individuals scored significantly worse than 49 HIV-seronegative matched individuals (33 men, 16 women) in the control group on the ROC (P = 0.045, effect size = 0.39), but not on the ROM test. The scores did not correlate with stage of HIV infection, CD4a cell counts, cerebrospinal fluid parameters, or measures of affective state. No gender effects on performance were noted. It is concluded that while cognitive deficits may occur early in asymptomatic HIV disease, the ROC/ROM test as the authors used it is not a useful screening tool for clinicians. The study also suggests that the growing number of HIV-positive women should be included in neuropsychological studies of early HIV disease.

Tuberculin and anergy testing in HIV-seropositive and HIV-seronegative persons. Pulmonary Complications of HIV Infection Study Group.

To determine the prevalence and predictors of reactivity to tuberculin purified protein derivative (PPD) and skin test anergy in patients with human immunodeficiency virus (HIV) infection and in HIV-seronegative controls. Cross-sectional analysis of baseline data from a prospective, multicenter study of pulmonary complications of HIV infection. Community-based cohort of persons with and without HIV infection. A total of 1171 HIV-seropositive patients without AIDS (841 homosexual men, 274 intravenous drug users, and 56 women with heterosexually acquired infection); 182 HIV-seronegative persons (125 homosexual men and 57 intravenous drug users). Delayed-type hypersensitivity response to tuberculin PPD, trichophytin, mumps, and Candida antigens; T-lymphocyte subsets. The prevalence of tuberculin PPD reactivity was higher among intravenous drug users than among homosexual men, in both HIV-seronegative (19.1% compared with 6.8%, P = 0.03) and HIV-seropositive persons (15.1% compared with 2.5%, P < 0.001). Among HIV-infected patients, the prevalence of tuberculin reactivity varied directly and that of anergy inversely with the absolute CD4 lymphocyte count. Prevalences were 1% and 72%, respectively, in patients with fewer than 200 CD4 cells/mm3, and 8.4% and 25.5%, respectively, in those with 600 CD4 cells/mm3 (P < 0.001 for both comparisons). Patients with HIV infection and fewer than 400 CD4 lymphocytes/mm3 had a lower prevalence of PPD reactivity than HIV-seronegative controls (2.7% compared with 10.0%, P < 0.001). The strongest predictors of tuberculin reactivity were intravenous drug use, black race, a previous positive PPD test result, and a history of Calmette-Guérin bacillus vaccination. The strongest predictor of anergy was HIV seropositivity. The response to delayed-type hypersensitivity antigens depends on immune status. The value of PPD and anergy testing in HIV-seropositive patients depends on the ability of such testing to predict subsequent tuberculosis, which is imprecisely known. Until more data or better methods are available, these tests should be done as early as possible in the course of HIV infection.

Molecular investigation of human immunodeficiency virus (HIV) infection in a patient of an HIV-infected surgeon.

Recall of patients who had been treated by a human immunodeficiency virus (HIV)-infected surgeon uncovered 1 previously unknown HIV-seropositive person. Nucleotide sequencing of the gag gene and maximum likelihood phylogenetic analysis were used to investigate the relationships among sequences from the surgeon, the patient, and an anonymous blood donor from whom the patient had received blood products. The likelihoods of all possible pathways of transmission linking these persons were estimated. On these data, transmission from the surgeon to the patient was significantly less likely than from the blood donor to the patient. It is concluded that none of the recalled patients were infected by the surgeon.

Human Immunodeficiency Virus Counseling, Testing, Referral, and Partner Notification Services

The Centers for Disease Control and Prevention (Atlanta, Ga) annually provides more than +100 million in funding to states, territories, and cities for the provision of human immunodeficiency virus (HIV) counseling, testing, referral, and partner notification (CTRPN) services. Given the size of this expenditure, it is important to consider the net benefits of this program activity. We compared the economic costs and benefits of publicly funded HIV CTRPN services. Standard methods for cost-benefit analysis were used. A societal perspective was employed. Major assumptions used in the base-case analysis included the following: (1) without public funding, the HIV CTRPN services would not be provided; (2) for every 100 HIV-seropositive persons identified and reached by CTRPN services, at least 20 new HIV infections are averted; and (3) for every +100 spent on direct and indirect costs of CTRPN services, approximately another +60 is spent on the ancillary costs of alerting people to HIV issues and CTRPN service availability. Sensitivity analyses were performed to explore the robustness of base-case results to these and other changes in model assumptions. Under base-case assumptions, the combined direct, indirect, and ancillary costs of the CTRPN program in 1990 dollars were +188,217,600. At a 6% discount rate, the estimated economic benefits of this expenditure are +3,781,918,000. The resultant benefit-cost ratio is 20.09. Sensitivity analyses showed that the benefit-cost ratio is greater than 1 for all considered cases. This cost-benefit analysis strongly suggests that publicly funded CTRPN services result in a net economic gain to society.

Evaluation of two new neuropsychological tests designed to minimize cultural bias in the assessment of HIV-1 seropositive persons: A WHO study

Evaluation of two new neuropsychological tests designed to minimize cultural bias in the assessment of HIV-1 seropositive persons: A WHO study

Evaluation of two new neuropsychological tests designed to minimize cultural bias in the assessment of HIV-1 seropositive persons: A WHO study

In the course of the preparatory work for the WHO cross-cultural study on the neuropsychiatric aspects of HIV-I infection, two new neuropsychological tests (the WHO/UCLA Auditory Verbal Learning Test and the Color Trails 1 & 2) were developed. The evaluation of these tests was performed at four sites, two in developed and two in developing countries. The data obtained suggest that the tests are more culture fair than others currently used to assess the same functional domains, that they are sensitive to HIV-1-associated cognitive impairment, and that this sensitivity "holds" across different cultures.

Gastro-intestinal involvement in Mycobacterium avium intracellulare infection of patients with HIV

In a study of 866 faecal specimens from 437 persons, Mycobacterium avium-intracellulare (MAI) was isolated from 14.8% patients with AIDS and 1.3% patients with symptomatic HIV infection but not from any HIV seronegative or asymptomatic HIV seropositive persons. These data support the hypothesis that the gastro-intestinal tract is the portal of entry for MAI and confirm that MAI infection is a manifestation of late-stage HIV disease. Positive faecal cultures correlated well with disseminated disease. The use of faecal cultures for early diagnosis is therefore recommended.