Human Immunodeficiency Virus Serologic Status Research Articles

Bloodborne Pathogens: CAN YOU BECOME INFECTED FROM YOUR OLDER PATIENT?

1. Exposure to bloodborne pathogens in the workplace creates acute anxiety in health care workers (HCWs); however, HCWs are at a greater risk for contracting the hepatitis B virus (HBV) than for contracting the human immunodeficiency virus (HIV). 2. A postexposure management program (PEMP) provides an education of the risk of infection and risk-reduction techniques; a mechanism for assessment of the source patient's risk factors and for obtaining source patient HBV and HIV serologic status; a setting in which the HCW can be periodically and confidentially tested for HIV antibody; and a formal assessment of the HCW for AZT chemoprophylaxis. 3. As in other areas of nursing practice, it is possible to be exposed to potentially infectious body fluids when caring for older patients. It is important that health care providers protect themselves with hepatitis B immunization and decrease exposure risk by the rigorous practice of universal precautions with patients in all age groups.

Effects of HIV infection on the serologic manifestations and response to treatment of syphilis in intravenous drug users.

To describe the effects of human immunodeficiency virus (HIV) infection on the serologic manifestations and response to treatment of syphilis in intravenous drug users. Cohort study of intravenous drug users. Medical clinic in a hospital-based methadone maintenance treatment program in New York City. Fifty patients with syphilis, of whom 31 were HIV seropositive and 19 HIV seronegative. Serologic tests for syphilis and clinical manifestations. Stage of syphilis at presentation was not associated with HIV serologic status. No unusual or fulminant manifestations of early syphilis or neurosyphilis were noted among HIV-seropositive cases. Maximum nontreponemal titers were higher among HIV-seropositive (median, 1:128) than among HIV-seronegative (median, 1:32) patients with syphilis (P = 0.05); this difference was present only among patients with first-episode syphilis. All 26 evaluable, HIV-seropositive patients treated for syphilis responded appropriately, including 13 patients given standard or less-than-standard doses of penicillin. Seven of 43 patients (16%) showed reversion to negative treponemal antibody assay results after treatment for syphilis; this finding was not associated with HIV infection, CD4 count, or stage of syphilis. Low nontreponemal titer was weakly associated with treponemal test reversion. Infection with HIV did not alter the stage at presentation, clinical course, serologic manifestations, or response to treatment of syphilis in this cohort of intravenous drug users.

A comparison of the nutritional beliefs of human immunodeficiency virus (HIV) seropositive and seronegative homosexual men

One‐hundred and eighty‐eight HIV‐seropositive (index cases) and 45 HIV‐seronegative (controls) homosexual men completed a questionnaire to assess their nutritional beliefs and practices, their psychosocial characteristics and information sources. Most individuals, irrespective of their HIV serological status, perceived the need to change their diet. Dietary changes were those which would be perceived as healthy by the general population, for example, a low‐fat, high‐fibre diet. Most HIV‐seropositive individuals believed that vitamin and mineral supplements were especially important for their health and this was mirrored in their relative increased use of these substances compared to controls. Dietetic advice was not effective in terms of reported changes in dietary practice.This work shows that although dietetic advice could be important in the management of HIV infection, in terms of altering dietary intake to promote weight gain, current practice needs to be reviewed in an attempt to improve efficacy. These results highlight the need to consider psychological characteristics when monitoring dietary compliance.

Painful Gingivitis May Be an Early Sign of Infection with the Human Immunodeficiency Virus

Anecdotal reports have suggested that painful gingivitis may be associated with infection due to the human immunodeficiency virus (HIV). Twenty patients who presented to the emergency department with a chief complaint of gum pain were evaluated for HIV infection, CD4/CD8 T lymphocyte profiles, complete blood cell counts and differentials, and lymphocyte function (response to mitogenic stimulation). Seven of the 20 patients (35%) were seropositive for HIV. Three of the seven HIV-seropositive patients were unaware of their HIV infection until tested in this study (with use of an ELISA and western blotting). The HIV-seropositive patients were significantly older than the HIV-seronegative patients (31.4 +/- 3 years and 24 +/- 1 year, respectively). Two of the seven HIV-seropositive patients presented with severe CD4 lymphocyte depletion. The other five HIV-seropositive patients presented with CD4 lymphocyte counts of 473 +/- 155 (mean +/- SE). Regardless of HIV serological status, all patients demonstrated a severely depressed mitogenic response when compared with control subjects. There were no remarkable differences in complete blood cell counts and differentials within each serological group. Significant differences, however, were noted when CD4/CD8 lymphocyte counts and ratios were measured. Identification of clinical presentations, such as painful gingivitis, that reflect an early stage of HIV infection could aid in the timing of therapy and prevention of the spread of HIV infection.

Clinical and Laboratory Correlates of Human Immunodeficiency Virus Infection in a Cohort of Intravenous Drug Users From New York, NY

The human immunodeficiency virus (HIV) epidemic has increasingly involved intravenous drug users. Few studies have attempted to define its clinical and laboratory characteristics in this population. We recruited 223 intravenous drug users from New York, NY, for a prospective study of the natural course of HIV infection. Medical history, physical examination, medical staging, and immunologic assessments were performed at 6-month intervals. We examined the baseline findings among this cohort. Of the total cohort, 65.9% were men and 34.1% were women, with 70.9% African American, 12.6% white, 11.7% white Latino, and 4.9% black Latino. At baseline, 44.4% were HIV negative and 55.6% were HIV positive. No significant association was noted between ethnicity, gender, and serologic status. Also no significant difference was noted for homelessness either across serologic status or gender. There was a trend toward an association between gender and use of drugs during the week before interview; the women showed higher drug use. A significant association was noted between HIV serologic status and reported history of pneumonia, oral candidiasis, cough, night sweats, fever, and lymphadenopathy on physical examination. In a regression model, white blood cell count, hematocrit, symptom/sign complex score, and CD4 cell number were significantly associated with HIV status. This study provided important historical, clinical, and immunologic characteristics that are useful in the identification and evaluation of the HIV-infected intravenous drug user.

High risk of active tuberculosis in HIV-infected drug users with cutaneous anergy

<h3>Objectives.</h3> —To determine the incidence of active tuberculosis in human immunodeficiency virus (HIV)—seropositive and HIV-seronegative drug injectors with cutaneous anergy and to examine the effectiveness of isoniazid chemoprophylaxis in preventing tuberculosis among drug injectors with positive tuberculin test results. <h3>Design and Setting.</h3> —Prospective observational study linked to an ongoing study of HIV infection within a New York City (NY) methadone program; subjects also underwent routine intradermal tuberculin testing and multiple-antigen delayed-type hypersensitivity skin testing. The 31-month study period ended December 31, 1990. <h3>Methods.</h3> —Anergic subjects and tuberculin reactors who were HIV seropositive were compared by HIV disease status and CD4⁺T-lymphocyte levels. Tuberculosis incidence was calculated for anergics (none treated with isoniazid) and for treated and untreated tuberculin reactors, by HIV serological status. <h3>Results.</h3> —Among those seropositive for HIV, anergic subjects had more advanced HIV disease and fewer CD4⁺cells (median 0.33 vs 0.56 ×10⁹/L,<i>P</i>&lt;.01) compared with tuberculin reactors, although neither clinical status nor CD4⁺cell counts consistently predicted anergy. Five (7.6%) of 68 anergic subjects who were HIV seropositive and none of 52 anergic subjects who were HIV seronegative (n=18) or of unknown (n=34) HIV serological status developed active tuberculosis during the study period (<i>P</i>&lt;.05). The tuberculosis incidence rate among anergic subjects who were HIV seropositive was 6.6 cases per 100 person-years (95% confidence interval [CI], 2.1 to 15.3). Of 25 HIV-seropositive tuberculin reactors who did not receive or complete 12 months of isoniazid prophylaxis, tuberculosis incidence was 9.7 cases per 100 person-years (95% CI, 2.6 to 24.7;<i>P</i>=0.56, compared with the rate among anergic HIV seropositives); there were no cases of tuberculosis in 53.4 person-years of follow-up for 27 HIV-seropositive tuberculin reactors who received 12 months of prophylaxis (rate difference between treated and untreated groups, 9.7 cases per 100 person-years, 95% CI, 1.3 to 18.0). <h3>Conclusion.</h3> —Drug injectors with cutaneous anergy who are seropositive for HIV are at high risk of active tuberculosis, similar to that among untreated HIV-seropositive tuberculin reactors. A decreased incidence of active tuberculosis was seen in HIV-seropositive tuberculin reactors receiving 12 months of isoniazid chemoprophylaxis, compared with untreated or partially treated subjects. These results support the routine use of delayed-type hypersensitivity testing to accompany tuberculin testing for drug injectors with known or suspected HIV infection, and consideration of isoniazid prophylaxis for anergic as well as tuberculin-reactive subjects who are HIV seropositive, in populations with a high prevalence of coexisting HIV and<i>Mycobacterium tuberculosis infection</i>. (<i>JAMA</i>. 1992;268:504-509)

High Risk of Active Tuberculosis in HIV-Infected Drug Users With Cutaneous Anergy

To determine the incidence of active tuberculosis in human immunodeficiency virus (HIV)-seropositive and HIV-seronegative drug injectors with cutaneous anergy and to examine the effectiveness of isoniazid chemoprophylaxis in preventing tuberculosis among drug injectors with positive tuberculin test results. Prospective observational study linked to an ongoing study of HIV infection within a New York City (NY) methadone program; subjects also underwent routine intradermal tuberculin testing and multiple-antigen delayed-type hypersensitivity skin testing. The 31-month study period ended December 31, 1990. Anergic subjects and tuberculin reactors who were HIV seropositive were compared by HIV disease status and CD4+ T-lymphocyte levels. Tuberculosis incidence was calculated for anergics (none treated with isoniazid) and for treated and untreated tuberculin reactors, by HIV serological status. Among those seropositive for HIV, anergic subjects had more advanced HIV disease and fewer CD4+ cells (median 0.33 vs 0.56 x 10(9)/L, P less than .01) compared with tuberculin reactors, although neither clinical status nor CD4+ cell counts consistently predicted anergy. Five (7.6%) of 68 anergic subjects who were HIV seropositive and none of 52 anergic subjects who were HIV seronegative (n = 18) or of unknown (n = 34) HIV serological status developed active tuberculosis during the study period (P less than .05). The tuberculosis incidence rate among anergic subjects who were HIV seropositive was 6.6 cases per 100 person-years (95% confidence interval [Cl], 2.1 to 15.3). Of 25 HIV-seropositive tuberculin reactors who did not receive or complete 12 months of isoniazid prophylaxis, tuberculosis incidence was 9.7 cases per 100 person-years (95% Cl, 2.6 to 24.7; P = 0.56, compared with the rate among anergic HIV seropositives); there were no cases of tuberculosis in 53.4 person-years of follow-up for 27 HIV-seropositive tuberculin reactors who received 12 months of prophylaxis (rate difference between treated and untreated groups, 9.7 cases per 100 person-years, 95% Cl, 1.3 to 18.0). Drug injectors with cutaneous anergy who are seropositive for HIV are at high risk of active tuberculosis, similar to that among untreated HIV-seropositive tuberculin reactors. A decreased incidence of active tuberculosis was seen in HIV-seropositive tuberculin reactors receiving 12 months of isoniazid chemoprophylaxis, compared with untreated or partially treated subjects. These results support the routine use of delayed-type hypersensitivity testing to accompany tuberculin testing for drug injectors with known or suspected HIV infection, and consideration of isoniazid prophylaxis for anergic as well as tuberculin-reactive subjects who are HIV seropositive, in populations with a high prevalence of coexisting HIV and Mycobacterium tuberculosis infection.

Cognitive and Motor Development in Infants at Risk for Human Immunodeficiency Virus

To evaluate the natural course of cognitive and motor development among infants infected with human immunodeficiency virus from birth, the Bayley Scales of Infant Development were administered to 96 infants between 5.5 and 24 months of age. Infants were divided into three groups on the basis of subsequent assessment of human immunodeficiency virus serologic status: seronegative (N = 45), seropositive (N = 12), and seroreverter (N = 39). Groups did not differ in race, infant age at initial testing, maternal age, maternal education level, maternal history of intravenous drug abuse, or percentage of children in foster care placement. Significant group differences were found on the Mental Development Index and Psychomotor Development Index, with the seropositive infants scoring significantly lower than the seronegative or seroreverter infants.

Association between HIV1 infection and sexually transmitted disease among men in central Africa

In Africa, heterosexual contact is the major route of transmission of the human immunodeficiency virus (HIV). Previous studies have strongly suggested that other sexually transmitted diseases (STD) may facilitate HIV transmission. However, the association of HIV infection with other STD may simply be a marker of sexual promiscuity. Thus, we compared the association of different STD, HIV status, and sexual behaviour of 160 STD patients and 95 STD-free control individuals. Results showed that STD patients differed from controls in most of the sociological and behavioural parameters, as well as in HIV serological status. Within the STD group, people with genital ulcer disease (GUD) (n = 62) were more likely to be HIV-seropositive (21%) than people with urethritis (n = 98, 11.2%). Meanwhile, there was almost no difference in the sociological and behavioural parameters between the GUD and the urethritis group. Thus, our results reinforce the specific role of mucosal breakage (i.e. genital ulcers) in the transmission of HIV.

Age and human immunodeficiency virus infection in persons with hemophilia in California.

Thirteen hemophilia centers provide comprehensive care to approximately 90 percent of persons with hemophilia in California. For 1987, these centers reported patient human immunodeficiency virus (HIV) antibody status, age group, level of clotting factor deficiency, and hemophilia type on 1,438 persons with hemophilia A and B; HIV serologic status was known for 860 persons (59.8 percent) of whom 537 (62.4 percent) were HIV-antibody-positive. The HIV positivity rate increased with age after taking into account hemophilia type, clotting factor level and treatment center type. The three-year cumulative incidence of reported AIDS (acquired immunodeficiency syndrome) cases based on the number of HIV positive patients, was 11.6 percent. The cumulative incidence rate was 14.6 percent (54 of 370) for those patients over 20 years of age and 4.8 percent (8 of 167) for those under 21 years of age. Although a comparable distribution of the date of diagnoses of AIDS was seen by age group, there appeared to be a bimodal distribution in the rate of AIDS among the age groups, with the 6-12-year-olds and the 21 and older age groups showing higher incidence rates.

Can acquired immunodeficiency syndrome and Creutzfeldt-Jakob disease be transmitted via otologic homografts?

Materials commonly employed in the preparation of otologic homografts such as ethanol and formaldehyde are effective in vitro in inactivating human immunodeficiency virus (HIV). However, to our knowledge, the complete permeation of homograft materials with preservative has not been demonstrated. Ethanol and formaldehyde have not been shown to be effective in inactivating the Creutzfeldt-Jakob agent. The literature on sterilization procedures for these agents is reviewed. Standard procedures for preparation of otologic homografts are examined. It is recommended that donor HIV serologic status be determined when otologic homografts must be used. Further research is required to determine the efficacy of otologic homograft sterilization techniques against HIV and Creutzfeldt-Jakob disease.

Influence of human immunodeficiency virus antibody testing on sexual behaviour in a "high-risk" population from a "low-risk" city.

A survey was undertaken of homosexual and bisexual men in Brisbane to establish whether knowledge of their human immunodeficiency virus (HIV)-antibody status had influenced any sexual behaviour that was likely to spread HIV type 1 (HIV-1). Of the 318 respondents, 123 respondents knew their HIV serological status, and 13 of these were HIV seropositive. Of the 195 respondents who previously had not been tested, 10 individuals proved to be HIV seropositive. Eighty-two per cent of subjects stated that they had reduced their sexual activity because of their awareness of the acquired immunodeficiency syndrome (AIDS); this reduction was equally common among those who had or had not previously had their HIV serological status checked. Anal intercourse was practised most frequently by those subjects who were HIV seropositive and were not aware of it; nevertheless, unprotected anal intercourse was common among subjects who knew their HIV serological status, including those who knew that they were HIV seropositive. Eighty-nine of 208 subjects who were practising anal intercourse had never used a condom. Usage of a condom was marginally more common among those subjects who previously had been tested for the presence of HIV antibodies (P = 0.06), and this was particularly so for those subjects who knew that they were HIV seropositive (P less than 0.01). Condom usage was no more common among those subjects who knew that they were HIV seronegative, when compared with those subjects who did not know their status. These data show that knowledge of a negative HIV-antibody test-result has no substantial association with safer sexual behaviour and suggest that whereas targeted information programmes have had some impact on behaviour in high-risk groups in Brisbane, by the end of July 1986, these programmes had not yet resulted in safer sexual practices by the majority of homosexual and bisexual men.