Human Immunodeficiency Virus Carriers Research Articles

India: HIV banks

The professional blood donor organizations in Bombay, India, face difficulties, since many donors have become infected with the human immunodeficiency virus (HIV). Professional donors meet more than half of the demand from hospitals for blood. More than 5 million liters of blood are bought every year at an annual cost of more than 29 million pounds. The government suspended the manufacture of blood products, and a blood screening program was launched, yet up to 95% of donated blood is unsafe. In a WHo study, it was disclosed that 80% of Bombay's blood sellers are infected with HIV, and 1/3 of them show signs of AIDS or AIDS-related complex. India is expected to have 250,000 HIV carriers and at least 60,000 cases of AIDS by 1995. Medical organizations like the Indian Health Organization (IHO) and the WHO are educating blood donors and prostitutes about AIDs and are promoting safe sex. An IHO team consisting of a doctor, social worker, and health educator regularly visits the district of Bombay where 200,000 prostitutes ply their trade. Team members distribute literature, organize slide shows, and hand out free condoms to prostitutes and their clients.

Rehabilitation dimensions of AIDS: a review.

With the spread of human immunodeficiency virus (HIV) infection and of the acquired immune deficiency syndrome (AIDS), many rehabilitation professionals are faced with new challenges. This report covers two basic problems that are becoming common in rehabilitation practice: the management of the patient who suffers from disability resulting from HIV infection or AIDS, and the management of the traditional rehabilitation patient who may coincidentally be infected with HIV. Common manifestations of HIV infection and associated secondary infections and neoplasms are discussed, as well as are the complications of current medical treatments. This report also explores specific neurologic and musculoskeletal disorders and the fatigue associated with AIDS. In addition, potential approaches to rehabilitation management are evaluated, and consideration is given to the management of the asymptomatic HIV carrier. The differences between HIV infection in adults and children are explored, and the social implications of HIV rehabilitation are discussed. After consideration of the basic pathophysiology of infection and the modes of transmission, the significance and ethics of serologic testing are examined, and the concept of universal precautions is described. The paper concludes with a discussion of the use of safe sex practices by the disabled population.

The socio-cultural context of the transmission of HIV in Thailand

At a global level there are considerable differences between regions in the levels of prevalence, and rate of transmission, of the Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS). Furthermore there are differences between regions in the social and demographic characteristics of HIV carriers/AIDS sufferers (e.g. heterosexuals, homosexuals, injecting drug users, infants). It is notable that Asia has generally lagged behind other regions in the spread of HIV. However recently Thailand has acknowledged rapidly increasing levels of infection. This paper is structured in terms of three broad sections. (1) An outline of some basic epidemiological principles concerning the transmission of HIV which help account for the regional variations in prevalence; (2) a description of the emerging awareness of HIV as a public health problem within Thailand; (3) a review of the social characteristics of HIV carriers in Thailand, interpreted by reference to the wider social context, chiefly in terms of; the commercial sex industry/sexual lifestyles, international tourism, and injecting drug dependency. Reference is also made to impressions of the personal response of individuals learning of their HIV seropositive status. A brief comment compares the sexual culture and sex industry in Thailand to that of other South East Asian countries (most notably the Philippines). The paper highlights the importance of considering the particular social and historical factors which shape and sustain the transmission of HIV within a particular country.

Determinants of condom use among French heterosexuals with multiple partners.

In September 1988, a sample of French individuals between 18 and 49 years of age, who reported more than one sexual partner in the past six months and who considered themselves heterosexuals (n = 1088), were interviewed at home about risk perception of human immunodeficiency virus (HIV) transmission, sexual behavior, and condom use. Systematic or occasional use of condoms during the previous 12 months was reported by 46.9 percent of respondents. Among condom users, 38.7 percent declared they had never used condoms before the last 12 months, fear of acquired immunodeficiency syndrome (AIDS) rather than contraception being the main motivation of these recent users. Multivariate analysis indicates that voluntary testing for HIV, average or more than average fear of sexually transmitted diseases (STDs), and knowledge of HIV carrier in personal relations are associated with condom use.

Risk Reduction through Testing, Screening and Infection Control Precautions: With Special Emphasis on Needlestick Injuries

Transmission of the hepatitis B virus (HBV) and human immunodeficiency virus (HIV) pose substantial risks to institutional healthcare employees working with blood. While the risk of contracting hepatitis B in the hospital setting is much greater than the probability of acquiring HIV, the cost of treating the acquired immunodeficiency syndrome (AIDS)--if it develops--is much greater in both dollars and human suffering. In addition to the risks posed by the presence of HIV infection in the hospital increase daily. By the end of 1990, one of every 14 hospitalized patients will be an HIV carrier. Of all hospital-related injuries to employees, the highest percentage (35%) is caused by needlestick/"sharps" punctures. Over a 12-month period, approximately 18,000 hepatitis cases reportedly have been caused by needlestick accidents. After nurses, housekeeping personnel--victims of incorrectly disposed needles--are most at risk. Nurses incur 58% of needlesticks when needles are broken, cut or recapped. Currently, there are products on the market specifically designed to eliminate contact with needles. These cartridge-needle safety units allow for only one-time use, thus doing away with the possibility of recapping. Initial expenditures for new equipment are well worthwhile; the implementation of revised safety precautions are not only worthwhile but also required by law. The dollar costs imposed on hospitals by accidental transmission of bloodborne diseases include tests for the employee, treatment, outpatient visits and wages. One pilot study prevention program conducted in an 800-bed hospital resulted in a 53% reduction in needlestick injuries.

A Controlled Study of Early Neurologic Abnormalities in Men with Asymptomatic Human Immunodeficiency Virus Infection

Although neurologic complications are frequent in the acquired immunodeficiency syndrome, their incidence and progression in early human immunodeficiency virus (HIV) infection remain controversial. The goal of this study was to assess neurologic manifestations in asymptomatic carriers of HIV. We studied 29 HIV-seropositive homosexual men and 33 seronegative homosexual controls by means of neurologic and neuropsychological examinations, magnetic resonance imaging (MRI), and electrophysiologic tests (electroencephalography, multimodal evoked-potential tests, and otoneurologic tests). After six to nine months, the tests were repeated in 27 seropositive men and 30 controls. The investigators were blind to the serologic status of the subjects. The seropositive subjects had a mean CD4+ lymphocyte count of 635 X 10(6) per liter. Neurologic and neuropsychological examination, MRI, and measurements of pattern visual evoked potentials did not show significant differences between the two groups. The latencies of the median-nerve somatosensory evoked potentials were slightly prolonged in the seropositive men. The initial electroencephalogram was judged abnormal in 8 of 27 of the seropositive subjects (30 percent) as compared with none of the controls, with a slowing of fundamental activity, anterior spread [corrected] of alpha rhythm, subnormal reactivity, and unusual anterior theta activities. These findings were confirmed by computerized spectral analysis. The second electroencephalogram was abnormal in 10 of 25 of the seropositive men (40 percent). The otoneurologic evaluation identified abnormalities in the central auditory or vestibulo-ocular pathways in 34 percent of the seropositive men (10 of 29), as compared with 6 percent of the controls (2 of 33), on the first examination and in 44 percent (12 of 27) and 7 percent (2 of 30), respectively, on the second examination. Altogether, electrophysiologic abnormalities were found in 67 percent of the seropositive men (18 of 27) and 10 percent of the controls (3 of 30) (P less than 0.00005). In persons with asymptomatic HIV infection, electrophysiologic tests may be the most sensitive indicators of subclinical neurologic impairment. Electrophysiologic abnormalities are far more common in asymptomatic carriers of HIV than in controls and tend to progress over time.

Interference with human immunodeficiency virus (HIV) replication by CD8+ T cells in peripheral blood leukocytes of asymptomatic HIV carriers in vitro

A long asymptomatic period is one of the characteristics of human immunodeficiency virus (HIV) infection, despite its fatal consequences. Antiviral defense in HIV-infected individuals controls viral replication during this period. In the present study, we demonstrate that peripheral blood leukocytes (PBL) of asymptomatic HIV-1 carriers, following exogenous HIV-1 infection in vitro, do not support viral replication. These cells do not produce detectable amounts of reverse transcriptase or accumulate unintegrated proviral DNA. This is a striking contrast to the behavior of HIV-1-infected PBL of seronegative individuals, which produce large amounts of RT and unintegrated DNA. Such resistance to HIV-1 replication is not seen in PBL of patients with advanced disease. Since the binding of HIV-1 to CD4 molecule is not impaired in PBL of asymptomatic carriers, the interference with HIV replication must occur after the stage of virus binding. PBL lose their resistance when CD8+ lymphocytes are removed. In addition, these PBL are not resistant to an exogenous infection with HIV-2. These observations suggest that certain populations of CD8+ lymphocytes of asymptomatic HIV-1 carriers operate on the target cells in PBL to block viral replication in an HIV-1-specific manner. Such CD8+ lymphocyte-mediated interference with HIV replication could play an important role in the maintenance of the period of disease latency.

Course and prognosis of human immunodeficiency virus-associated nephropathy

Patients infected with the human immunodeficiency virus (HIV) have been described to have an unusual form of renal disease known as HIV-associated nephropathy. This condition is characterized by severe proteinuria, rapid progression to renal insufficiency, and a morphologic pattern of focal segmental glomerulosclerosis (FSGS) on renal biopsy. Despite increasing awareness of this entity, the epidemiology and clinical course of HIV-associated nephropathy are not yet well defined. We therefore decided to study HIV-infected patients with this biopsy-proven pattern of focal sclerosis. Using life-table analysis, we evaluated the clinical features and course of 26 patients with HIV infection and biopsy-proven FSGS and compared them with those in 24 subjects with HIV infection who had no glomerular disease at autopsy. The group with FSGS had a higher percentage of blacks (96% versus 46%) and intravenous drug abusers (42% versus 17%), and had a higher mean serum creatinine level (5.4 mg/dL versus 1.0 mg/dL) than the group of HIV-infected subjects without glomerular disease. At the time of diagnosis of FSGS, six patients had clinical acquired immunodeficiency syndrome (AIDS), eight had AIDS-related complex (ARC), and 12 patients had no evidence of AIDS or ARC. The progression to end-stage renal disease for all patients was rapid, with a median time to dialysis of 10.9 weeks. Duration of patient survival was dependent upon the stage of HIV infection at the time of diagnosis of renal disease. Patients who presented with AIDS had a median survival of 1.9 months, compared to a median survival of 3.6 months for those with ARC and 9.7 months for initially asymptomatic HIV carriers (p less than 0.05). Fifteen patients either presented with or developed AIDS during the course of the study, and all died as a consequence of their immunodeficiency. Survival curves from the diagnosis of AIDS to death were similar in the group with HIV-associated nephropathy (7.3 weeks) compared to the control AIDS group without renal disease (6.9 weeks). Our data indicate that FSGS associated with HIV infection can occur before other manifestations of AIDS, is more common in blacks and in intravenous drug abusers, and is rapidly progressive to uremia. Patient survival is dependent upon the stage of HIV infection. These findings may prove useful in devising more effective strategies for the care of this growing patient population.

Human immunodeficiency virus and the cardiac surgeon: A survey of attitudes

The decision to operate on carriers of the human immunodeficiency virus (HIV) who need an urgent cardiac operation is difficult. There is a lack of knowledge about the effect of the presence of HIV on operative risk, about the effect of cardiopulmonary bypass on the progression of HIV infection to acquired immunodeficiency syndrome (AIDS), and about the risk to the cardiac surgical team of operating on 1 or more HIV carriers. This lack of knowledge is exacerbated by the strict regulations surrounding testing. We polled the board-certified cardiac surgeons in the United States on their willingness to perform open cardiac procedures on HIV carriers and AIDS patients. Fifty-three percent of the surgeons responded. Two thirds of them will operate on HIV carriers who need an urgent cardiac operation but regard the presence of AIDS as a contraindication to cardiopulmonary bypass. This is presumably a medical judgment. Those who will not operate on HIV carriers are apparently motivated by fear rather than moral judgments concerning the patients. Virtually all surgeons want to be able to test “high-risk” patients, and a substantial majority would test all patients.

NOTIFICATION OF HIV CARRIERS: POSSIBLE EFFECT ON UPTAKE OF AIDS TESTING

Passing of the AIDS Prevention Bill , which demands the notification of human immunodeficiency virus (HIV) carriers, seems imminent in Japan. Its effect on people's willingness to be tested for the HIV antibody was assessed among heterosexual subjects (students, office workers) and groups at high risk of the acquired immunodeficiency syndrome (AIDS) (prostitutes, homosexual males) by means of a questionnaire. More than 70% of the 811 students and 509 workers replied that, if notification became mandatory, they would agree to be tested but 10% of the males and 17% of the females in these two groups would prefer testing at institutes not complying with the clause; all 198 prostitutes said that they would be prepared to undergo testing but 35% of them would prefer to go to non-complying clinics; 45% (410) of 902 homosexual males replied that they would refuse testing, and 65% of those who would agree to be tested (492) would prefer to go to non-complying clinics. These findings strongly suggest that when the bill is passed the greater the self-perceived risk of HIV infection the poorer will be the uptake of AIDS testing. Hence the bill would be counterproductive in the surveillance of potential HIV carriers.

The clinical spectrum of renal disease associated with human immunodeficiency virus.

A nephrology consultation was called on 100 adult patients of 1,635 (6.1%) patients with human immunodeficiency virus (HIV) infection seen between 1982 and 1987 at the University of Miami/Jackson Memorial Medical Center. Renal disease was observed in all groups of patients with a risk factor for HIV infection with a lesser incidence, however, among homosexuals. Intravenous drug (IVD) use and possibly race appear to be important factors in the development of renal complications. Renal disease was the dominant clinical feature in eight asymptomatic HIV carriers and in 34 patients with AIDS-related complex (ARC) who had not developed the opportunistic infections and/or malignancies associated with acquired immunodeficiency syndrome (AIDS). Ninety-one percent of consultations were requested for evaluation of proteinuria and/or renal failure. Nephrotic range proteinuria, in excess of 3 g/24 h, was present in 52 patients, and was less prevalent in homosexuals than in other groups at risk. Renal failure (serum creatinine greater than or equal to 5 mg/dL), initially present in 32 patients, eventually developed in 69 and improved in only 18 of them. A renal biopsy, obtained for work-up of nephrotic syndrome (22 patients) or renal insufficiency (3 patients), uncovered a picture of focal and segmental glomerulosclerosis in all 25 instances. Overall, 76 patients are dead, seven are lost to follow-up, and 17 are alive, of whom eight (four HIV carriers, two patients with ARC, and two with AIDS) are on maintenance hemodialysis with a mean survival time of 217 days.

Replication of human immunodeficiency virus in two T-cell lines and their application as antigens for immunofluorescence.

Two T-cell lines, TALL-1 and CCRF-CEM, were infected with human immunodeficiency virus (HIV), strain LAV, to explore the time course of the appearance of various virus specific antigens, and to establish an antibody assay system by indirect immunofluorescence (IF). These cells were infected with LAV at two different input multiplicity of infection (MOI). Antigens were tested by Western blot analysis (WB) and IF. Antigens for WB were extracted from the infected cells at various times after infection, but pooled sera of American HIV carriers could not recognize gp41 or gp160. Antigen expression was highest in CCRF-CEM, but, as the antigen for IF, TALL-1 infected at the MOI of 8.0 was the most suitable 7 days after infection, because it includes a fairly large number of uninfected cells, which served as the internal control.

Efficacy of an immunoglobulin preparation from HIV carriers in preventing HIV replication in vitro.

Immunoglobulin samples (HIV-Ig) were prepared by cold ethanol fractionation of human plasma containing antibody against human immunodeficiency virus (HIV). The ability to prevent viral spreading was studied using either human T-cell leukemia virus type I (HTLV-I)-carrying MT-4 cells or in a coculture system using MOLT-4 cells and virus-producing MOLT-4/HIV HTLV-IIIB cells. Treatment of HIV-infected MT-4 cells with HIV-Ig effectively blocked the appearance of antigens of HIV and the virus-induced cytopathic effect. HIV-Ig blocked multinucleated giant cell formation in the MOLT-4 and MOLT-4/HIV HTLV-IIIB coculture system.

The challenge of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) in women and children

Physicians in the field of reproductive health care have a special interest in reducing the incidence of human immunodeficiency virus (HIV) infection in women and their offspring. The majority of women with acquired immunodeficiency syndrome (AIDS) acquired infection through needle sharing. Sexual transmission of HIV appears to be less effective than transmission of other sexually transmitted diseases. The risk of male-to-female transmission from an infected partner has been estimated at 7-21%. The risk of perinatal transmission from the infected mother to her infant is far higher, however--at least 65%. There is also evidence that the immunosuppression of pregnancy may accelerate progression to AIDS in asymptomatic HIV carriers. In the absence of a vaccine or effective treatment, prevention of AIDS requires education about safe behaviors. A sizable decrease in the rate of transmission of HIV could occur if persons considered whether their partner might be infected before initiating sexual contact. Prevention of pediatric AIDS depends on the prevention of infection in women and the prevention of transmission from infected women. Women infected with HIV should be advised to avoid pregnancy and given highest priority for family planning services. Since many infected women are asymptomatic, HIV antibody testing is the only reliable way to determine whether a woman is actually infected. Such testing, however, should be limited to women believed at risk of HIV infection. Prenatal testing, if done early, can allow more options in the management of pregnancy, yet studies have found that women with positive HIV antibody tests do not elect to terminate their pregnancies at a higher rate than women whose test results are negative.

Efficacy of an Immunoglobulin Preparation from HIV Carriers in Preventing HIV Replication in vitro

Immunoglobulin samples (HIV-Ig) were prepared by cold ethanol fractionation of human plasma containing antibody against human immunodeficiency virus (HIV). The ability to prevent viral spreading was studied using either human T-cell leukemia virus type I (HTLV-I)-carrying MT-4 cells or in a coculture system using MOLT-4 cells and virus-producing MOLT-4/HIV(HTLV-IIIb) cells. Treatment of HIV-infected MT-4 cells with HIV-Ig effectively blocked the appearance of antigens of HIV and the virus-induced cytopathic effect. HIV-Ig blocked multinucleated giant cell formation in the MOLT-4 and MOLT-4/HIV(HTLV-IIIb) coculture system.

AIDS, psychiatry, and the law.

As clinical concerns are evolving about the treatment of psychiatric patients who have AIDS or are carriers of the human immunodeficiency virus (HIV) ( 1 ,2), a related set of legal issues is being raised by involvement of these persons with the mental health system. To date, in mental health law as in other areas of AIDS-related law, it is easier to frame the questions than to provide definitive answers (3,4). There is clearly value, however, in beginning to consider the dilemmas. With public concern growing about persons with positive HIV blood tests recklessly transmitting the virus, the legitimacy of using the mental health system for their detention will become an issue of increasing debate. The issue is already being discussed among emergency mental health personnel, though only one published account could be found of an HIV carrier confined to a psychiatric hospital for the purpose of quarantine (5,6). Will more facilities be forced to fill this role? Demands for psychiatric hospitalization of HIV-positive persons who engage in promiscuous sexual

Hypertrichosis of the Eyelashes in Acquired Immunodeficiency Syndrome

To the Editor.— The skin is one of the target organs of the acquired immunodeficiency syndrome (AIDS) virus, and many are the mucocutaneous manifestations of the disease.1,2Most of these manifestations are brought on by a reduction in cellular immunity (fungus and virus infections). Kaposi's sarcoma and a seborrheiclike dermatitis also manifest themselves on the skin in cases of AIDS. Recently, we have had three patients, two with Fig 1.—Patient 1. Lateral view. Hypertrichosis is more evident in eyelashes. AIDS, and the third, a carrier of the human immunodeficiency virus (HIV), who developed hypertrichosis of the eyelashes. We could not relate this phenomenon to their medication or to the infections. Therefore, we propose hypertrichosis of the eyelashes as a cutaneous manifestation of AIDS. Report of Cases.— Case1.—A 27-year-old man, who was a drug addict and HIV carrier, and who had been receiving treatment since August 1986 for tuberculosis