Natural History Of HIV Infection Research Articles

2. HIV IN PAEDIATRICS-THE EUROPEAN COLLABORATIVE STUDY (ECS)

The objectives of the ECS are to determine:- 1. the prevalance of HIV infection in infanats born to positive mothers; 2. the risk factors influencing transmission to infants; 3. the natural history of HIV infection in infants; 4. precursors of AIDS/ARC onset in infected infants. Seven centres are participating; Padua, Edinburgh, Berlin, Madrid, Valencia and Amsterdam. Seropositive women are identified in the antenatal period and the paediatrician is notified. Children are investigated in the newborn period and at 3-monthly intervals. By 31/3/88 204 children, mean birth wt. 2800g mean gest. age 38wks, had been enrolled into the study. 85% of mothers were IV drug abusers; 25% of babies had drug withdrwal symptoms. 122 children have been followed for at least 6 months and 89 for over 1 year. The median age at last visit was 12 months. 10 children had developed AIDS or ARC (all by 9 months) 5 had died of opportunistic infections; 3 premature infants died in the neonatal period. 18 infants had nonspecific signs or symptoms. The majority 173/204 were clinically normal when last seen. No cases of AIDS dysmorphic syndrome were described. 9/65 (14%) children over 15 months remain antibody positive. 4 other children died of AIDS/ARC who would have been over 15 months had they survived. Several children have lost antibody despite being virus and/or antigen positive. At present the numbers are too small for meaningful estimates of risk factors in relation to infection to be calculated. There have been no side effects with any immunisations.

Primary Human Immunodeficiency Virus Infection: Clinical and Serologic Aspects

The identification of characteristic clinical, serologic, and immunologic responses to primary HIV infection has contributed greatly to our understanding of the natural history of HIV infection. Subjects usually present with a mononucleosis-like illness and during the period of primary infection there is a characteristic four-phase T cell response. Early serologic findings of infection include IgM antibody and free HIV p24 antigen. Tests for mononucleosis yield negative results, but atypical lymphocytosis may be present. We believe there are three primary goals for future research into primary HIV infection: to further define the features of this phase of infection, to develop early intervention strategies effective against HIV, and to further develop and foster education strategies that will prevent primary HIV infection.

The clinical spectrum of the HIV infection. A working hypothesis

Many clinicians have realised that AIDS is only the most dreadful aspect of HIV infection. Together with the “asymptomatic carrier” condition, other syndromes have been described, including LAS, ARC and Lesser-AIDS. We have developed a working hypothesis to explain the natural history of HIV infection, basing our assumptions on the international literature and our own experience. We have found many analogies and some slight differences between the clinical courses of HIV infection and other chronic infections, especially syphilis. It is possible that, on clinical grounds, the natural histories of both diseases are so similar as to allow us to describe one of them within the scheme of the other. Only careful and prolonged clinical observation will solve the problem of the natural history of HIV infection and solve the problems which are still present in its comprehension.

ABC of AIDS. Development of the epidemic.

The 1st recognized cases of the acquired immunodeficiency syndrome (AIDS) occurred in the summer of 1981 in America. HIV has been isolated from semen cervical secretions lymphocytes cell free plasma cerebrospinal fluid tears saliva urine and breast milk. Particularly infectious are semen blood and possibly cervical secretions. The commonest mode of transmission of the virus is by sexual intercourse. Other methods of transmission are through the receipt of infected blood or blood products and donated organs and semen and through the sharing or reuse of contaminated needles by injecting drug abusers or for therapeutic procedures and from mother to child. There is no well documented evidence that the virus is spread by saliva. It is not spread by casual or social contact. By March 1987 31526 adult cases of AIDS had been reported in the US plus an additional 456 pediatric cases. There is a wide geographical variation. New York for example has a rate of 991/million. The US as a whole has a rate of 140/million. In the US and the UK the 1st wave of the epidemic occurred in homosexual men the next and current wave is among intravenous drug abusers and after this it might affect the heterosexual population. Transmission into the heterosexual population will occur through bisexual men intravenous drug abusers and prostitutes. In Africa strong evidence shows that HIV is spread mainly by heterosexual intercourse. The advent of an effective antibody test in 1984 has allowed for a clearer understanding of the changing prevalence and natural history of HIV infection. Surveys show that the proportion of individuals infected must be high before cases of AIDS start to become apparent. AIDS is the most major public health problem in the world this century.

THE EPIDEMIOLOGY OF HIV INFECTION IN PREGNANT WOMEN AND THEIR CHILDREN

The effect of HIV on pregnancy, the rate of perinatal transmission, and a description of perinatally acquired HIV infection are important aspects of the natural history of HIV. Pregnant women with a history of drug abuse were examined and followed with their children. 56 pregnant women on methadone were approached for study recruitment, with 42 women consenting to participate. 35 women have completed their pregnancies with 33 liveborn infants, 1 spontaneous and 1 induced abortion. Of the 35 women, 14 were seropositive (SP) and 21 were seronegative (SN). The SP and SN women were similar in age, ethnicity, smoking during pregnancy, gravidity, parity, education, income, and types of drugs used. Of the women who had at least 1 post-partum visit, 81% of SP and 36% of SN women have been reported to have at least 1 of the following: unexplained fevers, weight loss, sweats and/or diarrhea and/or significant adenopathy. The gestational age of children born to SP vs SN women was 37.6 vs 38.6 weeks while the birth weight of babies born to SP vs SN woman was 2612 vs 2877 g. Perinatal complications in the infants were more common in those born to SP vs SN women (2.3 vs 1.5 complications /infant), more of the SP vs SN women had pregnancy complications (78 vs 41%), and the mean Apgar scores were lower in children bom to SP vs SN women(6.8/7.9 vs 8.0/8.9). Of the 14 children born to SP mothers (X followup=4.7 mos) 1 has died of AIDS and 2 have symptoms suggestive of HIV disease. Expansion and continued followup of this cohort will better define the natural history of HIV infection in pregnant women and their children.

PREVALENCE OF ANTIBODIES TO HUMAN IMMUNODEFICIENCY VIRUS, GONORRHOEA RATES, AND CHANGED SEXUAL BEHAVIOUR IN HOMOSEXUAL MEN IN LONDON

The prevalence of antibody against human immunodeficiency virus (anti-HIV), which rose among British homosexual/bisexual men attending a London sexually-transmitted-disease clinic from 3.7% (4/107) in March, 1982, to 21% (26/124) in July, 1984, was 18·1% (17/94) in April/May 1985, 24·5% (61/249) in January, 1986, and 25·3% (25/99) in November/ December, 1986. This slower rise in anti-HIV prevalence coincided with a fall in the annual gonorrhoea rate from 15·3% in 1982 to 5·1% in the first half of 1986 in the same male homosexual clinic population. Over the same period a reduction in the number of sexual partners and a change to safer sexual practices has been documented among homosexual and bisexual men taking part in a prospective study of the natural history of HIV infection. These data support the value of continuing preventive efforts to control viral spread in the absence of an effective vaccine or therapy.