Lower prevalence and incidence of HIV-1 syncytium-inducing phenotype among injecting drug users compared with homosexual men

OBJECTIVE

To study the prevalence, incidence and predictive value for progression to AIDS of the HIV-1 syncytium-inducing (SI) phenotype in HIV-infected injecting drug users (IDU) compared with HIV-infected homosexual men.

DESIGN

Two prospective cohort studies on HIV-1 infection among IDU and homosexual men.

METHODS

HIV-infected IDU (n = 225) and homosexual men (n = 366) without AIDS were studied from March 1989 through December 1993. Data on laboratory markers, including the presence of SI variants, demographics, behavioural characteristics and clinical events were collected at every visit.

RESULTS

At baseline, SI variants were detected in 4% of IDU and 17% of homosexual men. During the study period 18 IDU and 68 homosexual men switched from non-SI to SI phenotype (4-year cumulative incidence, 14.6 and 28.4%, respectively) before AIDS diagnosis. Among participants with a documented date of HIV infection the cumulative incidence of SI was lower among IDU than homosexual men (4-year cumulative incidence, 6.2 and 20.7%, respectively). At AIDS diagnosis, 21% of all AIDS cases among IDU had the SI phenotype compared with 54% among homosexual men. In both risk groups an accelerated CD4 decline was found after the non-SI-to-SI switch. The SI phenotype appeared to be a predictor of AIDS (multivariate relative hazard, 5.33), independent of CD4 cell count and p24 antigen at baseline. In the multivariate time-dependent analysis, the relative hazard of SI phenotype decreased considerably, which is consistent with the hypothesis that the effect of SI phenotype on progression to AIDS is mediated by CD4 cell count.

CONCLUSION

The SI phenotype is associated with accelerated CD4 decline and progression to AIDS in both risk groups. The remarkable lower prevalence and incidence of the SI phenotype among IDU may implicate a difference in pathogenesis and natural history of HIV infection linked to transmission group.

[The epidemiology and cost of AIDS in France]

Throughout the world the AIDS epidemic continues and even seems to accelerate in regions previously thought to be untouched. The number of cases has increased by 60% in one year. With its 15,000 seropositive persons and 35,000 cases of declared AIDS, France is the most affected of all European countries. Sexual contamination remains predominant with a relative increase of heterosexual transmissions. However, particularly in the South, transmission is prevalent in intra-venous drug addicts. In all cases worldwide it is the socially deprived, marginal and fragile populations which are the most vulnerable. Various previsions are possible in France, depending on the prophylactic measures applied. In any event, the number of seropositive subjects should be levelling out at the end of this decade, and the prevalence of the disease should stabilized at between 15,000 to 20,000 patients. At present, the cost of AIDS exceeds 5.5 billion francs.

Repeatedly positive human immunodeficiency virus type 1 DNA polymerase chain reaction in human immunodeficiency virus-exposed seroreverting infants

Three human immunodeficiency virus type 1 (HIV-1)-exposed children who had repeatedly positive DNA polymerase chain reaction (PCR) tests for HIV in > or = 5 samples before seroreversion to HIV-negative status are reported. The children belong to a cohort of 210 infants who were born to HIV-infected mothers and were tested at intervals of 1 to 3 months by HIV viral culture, PCR, and p24 antigen; only the PCR was positive in > or = 5 samples in the children reported here. Their clinical features were indistinguishable from other seroreverters. All three children had a transient drop in CD4:CD8 ratio to < 1.0. The transiently positive DNA PCR in HIV-exposed infants may indicate either that HIV infection was eliminated by a strong host immune response or that infection was caused by an attenuated/defective strain of virus.

Efficacy of antenatal zidovudine in reducing perinatal transmission of human immunodeficiency virus type 1. The New York City Perinatal HIV Transmission Collaborative Study Group

New York City women (321) enrolled during 1986-1993 in an observational cohort study were analyzed retrospectively to determine the effectiveness of antenatal zidovudine in reducing perinatal transmission of human immunodeficiency virus type 1 (HIV-1) in women with various CD4+ lymphocyte counts (< 200, 200-499, > 499/microL). When CD4+ lymphocyte level was controlled for, women prescribed zidovudine during pregnancy were less likely to transmit HIV-1 to their infants (adjusted odds ratio, 0.36; 95% confidence interval, 0.14-0.92). There was no conclusive evidence that efficacy of zidovudine depended on CD4+ lymphocyte level, suggesting that women with severe CD4+ cell depression, who are at highest risk of transmitting HIV-1, may also benefit from zidovudine. Antenatal zidovudine treatment alone may substantially lower the risk of perinatal HIV-1 transmission. These data are consistent with the results of AIDS Clinical Trial Group protocol 076 and suggest that a substantial portion of zidovudine's protective effect may occur when used during the antenatal period.

[Study on reverse transcriptase inhibiting antibody in plasma of HIV-1 seropositive subjects]

Reverse transcriptase (RT) inhibiting antibody in a series of plasma of HIV-1-seropositive subjects was quantitatively measured by poly A-linked colorimetric microtiter plate assay. The plasma were obtained from 6 asymptomatic carrier (AC)s and from 3 patients who progressed to AIDS. They had been followed 29-51 months. RT inhibiting antibody levels in the plasma were measured by inhibition assay against HTLV-IIIB RT activity. In five of the 6 AC cases, RT inhibiting antibodies in the serial plasma maintained high levels, and 50% inhibiting titers of the serial plasma did not decrease throughout the observation periods (45-51 months). HIV isolation from peripheral blood mononuclear cell (PBMC) of these 5 ACs did not succeed, and HIV p24 antigens were not detected in the plasma. In one AC case (046) RT inhibiting antibody levels gradually decreased after 48 months. In this case, HIV p24 antigen was not detected in the serial plasma throughout the observation period (48 months), but HIV was isolated from PBMC after 27 months. On the other hand, RT inhibiting antibody levels in the serial plasma of all 3 patients who progressed to AIDS gradually decreased in observation periods (29-35 months). HIV strains were isolated from these 3 cases. These results suggest that reduction of RT inhibiting antibody levels correlate well with the success of HIV isolation and with progression of clinical manifestation.

[Studies on maternal transmission of HIV-1]

To investigate HIV-1 transmission from mother to child, samples taken from 3 HIV-1 sero-positive pregnant mothers, 3 children born by caesareans from their mothers and therapeutic abortion from 2 HIV-1 sero-positive mothers were tested for HIV-1 antibody by westernblot, p24 antigen by antigen captured ELISA, proviral DNA by Nested-PCR and isolation of HIV-1 virus from peripheral blood, cord blood, amniotic fluid and placenta. HIV-1 proviral DNA was detected in the peripheral blood of all mothers, but p24 antigen and virus isolation were not detected. None of the HIV-1 markers, except for antibody, was detected in the samples from their children and placenta. These facts strongly suggest that there was no HIV-1 transmission from mother to child.

Early neurodevelopmental growth in children with vertically transmitted human immunodeficiency virus infection

OBJECTIVE

To examine mental and motor development in children with vertically transmitted human immunodeficiency virus (HIV) infection in the first 30 months of life.

DESIGN

Prospective longitudinal study comparing two groups: children with HIV infection and HIV-exposed but uninfected children.

SETTING

Pediatric Immunodeficiency Clinic at Boston (Mass) City Hospital, Boston University Medical Center.

STUDY PARTICIPANTS

Twenty-four children with vertically transmitted HIV infection and 27 children who were born to HIV-infected mothers and became HIV negative served as controls. Socioeconomic status, gestational age, and prenatal drug exposure were comparable in the two groups.

MEASUREMENTS/RESULTS

Using the Bayley Scales of Infant Development, all children were assessed at least once between 4 and 16 months and again between 17 and 30 months of age. Individual mean mental and motor scores were calculated for the early and later age span. Motor development in the infected group was delayed in comparison to the seroreverter group in both age spans and remained stable in both groups over time. Mental development was comparable in the two groups at 4 to 17 months, but HIV infection was associated with delay in mental development at 17 to 30 months of age.

CONCLUSION

Early and persistent delay in motor development and deceleration in mental development in late infancy distinguishes many children who are HIV infected from exposed but uninfected children, but there is significant variability in early neurodevelopmental outcome among children with HIV infection.

Attitudes towards people with HIV: are they as stigmatizing as people with HIV perceive them to be?

Stigma is a feature of HIV disease and many people who are HIV-positive report that their lives are affected by fear of discrimination (felt stigma). Although opinions do not necessarily predict behaviour, this article examines whether the public's avowed attitudes to people with HIV are as punitive and stigmatizing as those infected think they are, and the extent to which public attitudes may contribute to felt stigma. A street survey was conducted in Glasgow and Edinburgh, Scotland, asking a stratified quota sample of 300 men and women of all ages to complete a short questionnaire about their attitudes toward people with HIV. The same questionnaire was also completed by 42 men and women with HIV. One in five respondents in the street survey, and all of those with HIV, were also asked to complete the questionnaire imagining that they were a typical member of the public, to find out whether both groups attributed more hostile attitudes to generalized others than they themselves professed. Overall, the general public had relatively liberal views about people with HIV although a majority felt that some restrictions should be placed upon their freedom. Controlling for age, sex, socioeconomic status and city, people with HIV had more liberal attitudes than the general public, but perceived public attitudes to be far less liberal than were reported in the street survey. Respondents in the street survey also perceived generalized others to be less liberal than themselves. These results provide evidence of felt stigma among people with HIV and the policy implications are discussed. The findings are also set within a theoretical framework concerning the nature of attitudes, their relationship to behaviours, and the pervasiveness of negative images associated with AIDS.

A cross-sectional seroprevalence survey for HIV-1 and high risk sexual behaviour of seropositives in a prison in India

This study was conducted to know whether prisoners constitute a "high risk group" for HIV transmission in India today. A sero-epidemiological period prevalence survey was conducted in Central Prison, Bangalore, South India covering 1007 undertrials and 107 permanent convicts during January to December 1993. Twenty (1.98%) undertrials and none of the permanent convicts were seropositive for HIV infection. All of them were males and 1.6(80%) of them were in the age group of 20-30 years. Low literacy, poor income, sexual promiscuity and low condom usage were observed among the seropositives. Thus, prisoners constitute a high risk group and routine screening and counselling are recommended.

Female prostitutes in south London: use of heroin, cocaine and alcohol, and their relationship to health risk behaviours

The present study looks at the association between drug and alcohol use and sexual risk behaviours in a sample of 51 women who were currently working as prostitutes and also currently using opiates and/or stimulants. Most women reported regularly using condoms with clients but a substantial minority sometimes had unprotected sex with clients. There was no overall association between any of the drug use variables (including the use of crack cocaine) and the likelihood of unprotected sex. The use of drugs appears to have affected the sexual practices of different women in different ways: a substantial minority (just under a quarter of the sample) reported that for them, drug use did reduce the chances that they would use a condom. There was a link between willingness to have unprotected sex for more money and drinking larger amounts and drinking more often. The results also indicate that these women were exposed to a variety of health risks, including sharing injecting equipment and having unprotected sex with their regular partner who was often a current or former drug injector. A sub-sample (n = 34) completed a confidential questionnaire which showed that one-third had previously had at least one sexually transmitted disease and 15% of them had been infected during the previous year. These findings about rates of STD infection raise questions about the extent to which self-reported condom use by prostitutes can be used as an indicator of actual levels of infection risk.

Responding to a challenge: nursing care and AIDS

Those providing nursing services have been at the forefront in responding to the AIDS epidemic. This paper poses the question as to what extent AIDS work makes unique demands of nursing staff. It explores the implications of AIDS-related nursing work and considers these within the broader context of the role of nurses and their work environment. Although intense, many of the demands of AIDS-related work are also features of nursing in other contexts. There is thus potential to draw on already formulated training responses and to contribute significantly to ongoing debates about nursing and nurse education.

Harnessing the heightened public awareness of celebrity HIV disclosures: "Magic" and "Cookie" Johnson and HIV testing

This article investigates the impact NBA basketball star Earvin ("Magic") Johnson's HIV disclosure had on changes in demand for HIV counseling and testing services in New York State's 61 Anonymous HIV Counseling and Testing sites. Interrupted time-series analyses were conducted on weekly data from over 34,000 clients seeking anonymous HIV counseling and testing services from January 1991 to June 1992, to determine whether demand for these services changed as a result of the disclosure. Results indicated that immediately following the HIV disclosure, there was a substantial increase in service demand, which transcended all sex, race, age, and most HIV risk-related boundaries. Seven months later, demand had not returned to pre-disclosure levels. The strong impact on females, coupled with additional data analyses in obstetrical settings, suggests that previous research has been too narrow in focus, and that the effect of Johnson's HIV disclosure has been enhanced, in part, by the publicity surrounding his wife and baby. The importance of harnessing the heightened public awareness of celebrity HIV disclosures is discussed.

Human immunodeficiency virus (HIV-1) seropositivity among children in a rural population of south-west Uganda: probable routes of exposure

Serological studies on 7796 rural Ugandans showed 377 (4.8%) were HIV-1 antibody-positive, of whom 343 (8.2%) were adults, ten (0.4%) 5-12-year-olds and 24 (1.7%) under 5 years of age. Serological tests done on 18 mothers of the under-5s showed 17 to be HIV-1-positive. One mother was persistently negative. Her child had a history of multiple injections. Structured interviews with parents or guardians of the ten HIV-1-seropositive children aged 5-12 years to determine possible sources of exposure revealed that six were vertically infected and that blood transfusion, injections and sexual exposure each accounted for one case. It was not possible to identify a source of exposure in one instance. There was no evidence that casual household contact or scarifications played a role in the transmission of HIV-1 in children in this population. Our data show that in this rural population HIV-1 seropositivity in children is mainly associated with seropositivity in the mothers and that HIV-1 infection in children aged between 5 and 12 years is rare.

Factors associated with pregnancy and pregnancy resolution in HIV seropositive women

This study examines factors associated with pregnancy and pregnancy resolution among 238 HIV-infected women, 55 of whom experienced a recent pregnancy since learning of their HIV positive serostatus. Results suggest the importance of psychosocial and cultural factors, particularly those involving the primary sex partner, to reproductive decision-making in HIV-infected women. They also indicate a consistency of reproductive behavior before and after HIV infection, suggesting that the infection itself does not significantly alter existing childbearing trends. Biomedical considerations relating to the mother's health status and the risk of transmission to the child have a greater impact on decisions surrounding pregnancy resolution than they do on the probability of becoming pregnant.