Anonymous testing of newborn infants for HIV antibodies as a basis for estimating prevalence of HIV in childbearing women: the 1991-1994 study in Spain

During 1991-1994, anonymous screening of newborn infants for maternal antibody to human immunodeficiency virus (HIV) was carried out in three regions of Spain: Valencia, Galicia and Sevilla. The newborn infants whose heel-stick blood eluates were satisfactory for HIV antibody tests were a consecutive series of 104 876, representing 99.3% of all newborn infants undergoing routine metabolic screening and estimated as comprising at least 98% of all births in the three regions. Enzyme immunoassay (EIA) positives were confirmed by immunoblot, yielding 246 confirmations: a rate of 2.3 per 1000. Seropositivity rates ranged from 1.4 per 1000 in Galicia to 2.1 in Sevilla and 3.1 in Valencia, and remained relatively stable in each region during the years of the study. Within socioeconomically defined subgroups of birth hospitals in Valencia and Galicia, all subgroups contained seropositives, even though there was a twofold to fivefold over-representation in the "inner city" public hospitals. To estimate the proportion of HIV-1-seropositive newborn infants who were positive for HIV-1 DNA, polymerase chain reaction (PCR) assays were performed on 165 dried blood spots that had been retained following positive immunoblot assays. Fifteen (9%) were PCR positive, and when this proportion is adjusted for the age-specific sensitivity of the method, it translates into an estimated HIV-1 transmission rate of 24% (range 18-36%). For 94,906 of the 104,876 newborn infants screened, the EIA used could detect antibodies that react with epitopes of HIV-1 and HIV-2. There were 30 newborn infants whose blood eluate was positive by this combined HIV-1/HIV-2 antibody screen and whose secondary screening with monovalent HIV-2 and HIV-1 EIA indicated that the HIV-2 reactivity was above the cut-off whereas the HIV-1 was not. Ranking these 30 results according to absolute HIV-2 reactivity and relative reactivity with respect to HIV-1 indicated that four infants were probable true HIV-2 seropositives and a total of 12 were possible HIV-2 seropositives, a prevalence of the order of 1:10000 to 1:20000 newborn infants. These anonymous population-based serological studies provide "leading-indicator" data to complement traditional AIDS surveillance for epidemiological and planning purposes.

Impaired early growth of infants perinatally infected with human immunodeficiency virus: correlation with viral load

OBJECTIVE

To evaluate the effect of viral load on the early growth of infants infected with human immunodeficiency virus (HIV).

METHODS

Plasma concentrations of p24-antigen and HIV ribonucleic acid were measured retrospectively and correlated with growth parameters for the first 18 months of life in a cohort of 47 term infants born to HIV-infected mothers prospectively enrolled in a study of perinatal HIV transmission. Comparisons of the mean weight and length of the 18 HIV-infected and 29 uninfected infants for each interval and across intervals were made. Viral load was correlated with standard deviation scores. Infants were stratified by high and low viral load during the first 6 months of life.

RESULTS

At birth, no difference in weight and length was observed between HIV-infected and uninfected infants. Between birth and 6 months of age, the infected infants grew less rapidly than the uninfected infants, a finding temporally associated with an exponential increase in HIV viremia. The linear growth of infected infants remained consistently less than that of the uninfected infants after 6 months of life, although the differences were no longer statistically significant and tended to decrease with age in parallel with declines in viral load. The median plasma concentration of HIV ribonucleic acid was significantly higher at 3, 6, 12, and 18 months in infected infants in whom growth failure developed. Infants who had a high viral load in the first 6 months of life were significantly more likely to have severe growth failure. Though the mean SD for weight of the infected infants was always less than that of the uninfected infants, the differences were small and not significant.

CONCLUSIONS

Our results confirm the observation that stunting is an early frequent finding in perinatal HIV infection. The deleterious effect of HIV on linear growth appears to be correlated with the level of postnatal HIV viremia, although the exact mechanism of this association remains to be elucidated.

Human immunodeficiency virus type 2 infection in children

Human immunodeficiency virus type 2 infection is rare in children. This virus can be acquired through transfusion and also by the maternofetal route, especially when the mother becomes infected during pregnancy. Diagnosis based on specific serologic tests is simple after the age of 18 months. In the perinatal period, however, viral isolation by culture or polymerase chain reaction DNA amplification or both appears to be less sensitive than in the case of human immunodeficiency virus type 1. Disease progression is far slower than with human immunodeficiency virus type 1, but severe immunodeficiency can occur.

[The HIV/AIDS Epidemic in Cambodia]

In December 1995 and March 1996, we visited institutes which were conducting epidemiological studied of HIV/AIDS in Cambodia, and obtained data for further collaborative study between Japan and Cambodia. Data included information on AIDS patients and HIV infected persons, and behavioral epidemiology of CSWs (Commercial Sex Workers). The cumulative reported number of AIDS patients and HIV infected persons in Cambodia was 86 and 2,536 cases respectively in 1995. The cause of infection was mostly heterosexual contact with very few cases from injecting drug use (IDU) and other causes. The seroprevalence rate of HIV antibody among donated blood rapidly increased from 0.08% in 1991 to 4.47% in 1995, and those among CSWs and pregnant women were 37.9% and 2.6%, respectively, in 1995. The average rate of condom use among CSWs was 66%, but the rate of usual usage was only 14%. These results indicate that the HIV/AIDS epidemic had spread rapidly through CSWs, that it had been spread among peoples in communities, and that usage of condoms among CSWs was insufficient in Cambodia. Without strong countermeasures against HIV/AIDS in this country, HIV/AIDS epidemic may spread significantly to not only peoples in this country but also those in neighbouring countries in the future.

[Study of HIV localization in sperm]

The aim of the study was to investigate the presence and the localization of HIV in human ejaculate and its different components. Sixty-three ejaculates from 19 HIV-positive patients have been studied. By using cellular as well as molecular biology methods, we never detected HIV in living and mobile spermatozoa although we sometime found the virus in seminal liquid and in nuclear fractions. Up to date, frozen sperms free of HIV particles from 11 HIV-positive male partners were used to inseminate safely and with success the 11 HIV-negative female partners (no female partner as well as babies contamination). In conclusion, our procedure of HIV-free spermatozoa screening allowed discordant couples to have HIV-negative descendants. In contrast to the natural coïtus in ovulated period or to insemination with washed spermatozoa that are really "Russian roulette", our procedure ensure a total security of no contamination for the pregnant mother.

A four-year cohort study of HIV seropositive Ethiopian infants and children: clinical course and disease patterns

Sixty-two HIV positive infants who were admitted to the Missionaries of Charity Orphanage in Addis Ababa were followed From July 25, 1991 to July 30, 1995 for a total period of 4 years. Regular clinical examination and treatment by a paediatrician was being offered to these infants in addition to monitoring of their HIV serostatus every three months until the age of 18 months and every year after that. Among those aged above 18 months, 14 children were HIV sero-positive and alive and 4 children were HIV sero-positive but died. Thirty-three children had sero-reverted to negative. The mother-to-child transmission was crudely estimated at 29% to 47%. Among the clinical signs, generalized lymphadenopathy, hepatomegaly, splenomegaly, wasting, stunting and delayed motor development were found more commonly in the definitely HIV positive children. Upper respiratory tract infections, acute diarrhoea, pneumonia, pyogenic skin infections, sepsis and candidal infections were the commonest causes of illness. Comparison of the HIV positive with the HIV negative cases indicates that the risk is higher for the indefinitely HIV positive group for episodes of acute diarrhoea, pneumonia, sepsis and candidal infections.

HIV-related risk factors of blood donors in northern Thailand before and after knowing HIV test results

BACKGROUND

The epidemic of Human Immunodeficiency Virus (HIV) infection led blood banks to initiate donation deferral criteria based on self-reported risk factors. However little information is available on the differences in reporting risk factors before and after HIV status is known.

METHODS

Between April and July 1994, blood donors in a provincial hospital in northern. Thailand were interviewed at the time of donation, about their demographic characteristics and risk factors. All donors had agreed to learn their test results and were called back for post-test counselling and reinterview.

RESULTS

HIV-positive blood donors were more likely to change from 'denying' to 'acknowledging' risk factors while HIV-negatives were more likely to change from 'acknowledging' to 'denying'. The differences between risk factors obtained before and after test results were known resulted in stronger, weaker or even opposite risk measures.

CONCLUSION

The study results raise questions about the impact of the differences in reporting HIV-related risk factors by the donors on how effective donation deferral criteria can be developed.

Human immunodeficiency virus (HIV) infection and quality of life: the potential impact of Axis I psychiatric disorders in a sample of 95 HIV seropositive men

OBJECTIVE

The purpose of this study is to assess whether Axis I psychiatric disorders exert effects on function and well-being independent of human immunodeficiency virus (HIV)-related disease progression.

METHODS

A convenience sample of 95 HIV seropositive individuals completed the Medical Outcomes Study Short Form Health Survey (SF-20). The Standardized Clinical Interview for DSM-III-R (SCID-NP-HIV) was used to screen subjects for Axis I psychiatric disorders in the previous 6 months. HIV-related disease severity was defined for each subject using the 1993 revised Centers for Disease Control (CDC) Classification System.

RESULTS

Thirty-seven (39%) subjects had asymptomatic HIV disease and 58 (61%) had symptomatic disease. Thirty-three (35%) subjects had Axis I disorders in the previous 6 months. After controlling for HIV-related disease severity, psychiatric disorders were independently associated with substantive decrements in the mental health and health perceptions dimension scores (beta-coefficients were approximately -18.0 for both dimensions; p < or = 0.01). Axis I disorders were also associated with decrements in the social functioning dimension at a p value that approached significance (p = 0.04).

CONCLUSIONS

In HIV seropositive individuals, the presence of an Axis I psychiatric disorder in the previous 6 months is associated with diminished scores in multiple areas of functioning and well-being, independent of HIV-related disease progression. Axis I disorders, therefore, appear to impact quality of life. These findings, in part, suggest that the SF-20 (the mental health subscale, in particular) may have utility as a screening tool for the presence of a recent Axis I diagnosis.

[Serotypes of the human immunodeficiency virus type 1 in Madrid]

BACKGROUND

HIV-1 shows high genetic variability, mainly in the genomic region codifying the envelope proteins, which are the most immunogenic. This fact explains the high heterogeneity of antibodies against HIV-1 epitopes. Both genetic and serologic diversity has allowed to classify HIV-1 variants in several subtypes (genotypes and serotypes, respectively). The clinical and epidemiological significance of infection caused by each subtype remains to be clarified.

PATIENTS AND METHODS

Serum samples from 154 HIV-seropositive individuals living in Madrid were studied. Serotyping was performed using 4 peptides belonging to the V3 env region. Epidemiological and clinical variables examined in these patients were the route of infection, the year in which HIV infection occurred, the country of birth, and the rate of disease progression (rapid versus slow).

RESULTS

148 (96.2%) samples could be serotyped, and the B class was recognized in 131 (88.5%) of them. Serotype A/C was found in 9 (6.1%). Two samples (1.3%) reacted to peptide E; however, both were also reactive against the B peptide, suggesting co-infection with B and E subtypes. Six samples were EIA-reactive for HIV-1/2 but were typed as HIV-2 alone. Infection with serotypes A/C was more frequent amongst immigrants, mainly in Africans. There was not association between any subtype and the route of infection neither a different rate of disease progression.

CONCLUSION

HIV-1 serotype B is the most frequently found in HIV-seropositive individuals living in Madrid, without association with the route of infection or the clinical course of the disease. Serotypes A/C and E were found sporadically, mainly among immigrants.

HIV seroprevalence among people with severe mental illness in the United States: a critical review

The authors reviewed all studies in the peer-reviewed literature reporting HIV seroprevalence among people with severe mental illness in the United States, which varied from 4.0% to 22.9%. Findings across samples suggest that seroprevalence varies with geographic concentration of HIV and presence of comorbid psychoactive substance use disorders, but is consistently high. Unsafe sex, drug injection, and noninjected drug use were associated with infection, and in most studies women were as likely to be infected as men. Seroprevalence also varied with age and ethnicity, but not psychiatric diagnosis. The authors review questions and methodological issues important to future studies.

The prevalence of nipple disease among breast feeding mothers of HIV seropositive infants

OBJECTIVE

To determine the prevalence of nipple disease among breast feeding mothers of symptomatic HIV seropositive infants and factors associated with nipple disease.

DESIGN

Cross sectional survey.

SETTING

Harare Central Hospital general paediatric wards.

SUBJECTS

One hundred and four symptomatic, HIV seropositive breast feeding infants and their mothers.

MAIN OUTCOME MEASURES

Prevalence of nipple disease.

RESULTS

The majority of the hospital admissions (90%) were for pneumonia. The prevalence of nipple disease was high (30.8%). Nipple eczema was seen in 22.1%, cracked nipples in 10.6% and sore nipples in 10.6% of these breast feeding mothers. The odds of developing nipple disease in the mother if the infant had oral disease were 11.47 (95% CI 5.28 to 25.39). There was no significant association between nipple disease and mother's age, infant's age, nutrition status or mode of feeding. Malnutrition was a major problem.

CONCLUSION

Nipple disease was highly prevalent and oral disease was the major risk factor for the development of nipple disease in breast feeding HIV seropositive mothers.

Confidentiality versus disclosure of a patient's infectious status

Patients in health care settings have a legal and moral right to privacy, which includes confidentiality of all information related to the patient or gathered by the patient's health care team. Even so, the right to privacy is not total. Under certain circumstances, that right must yield to a state's fundamental right to enact laws to promote public health and to ensure public safety and welfare. Justifiably, dental health care team members are concerned with their health and with the possibility of being infected by a fatal disease such as acquired immunodeficiency syndrome (AIDS). The right to know patients' infectious status is growing with the mortality rate of the disease. However, as more health care workers learn of a patient's infectious status, that patient's privacy diminishes. Abiding by laws that enforce doctor-patient confidentiality while still fulfilling their obligations to their staffs and related third parties often proves difficult for dentists and physicians. Since the discovery of AIDS, believed to be caused by the human immunodeficiency virus (HIV), health care providers have been increasingly conscientious in maintaining these professional relationships.