Lack of transmission of HTLV-III/LAV infection to household contacts of patients with AIDS or AIDS-related complex with oral candidiasis

Human immunodeficiency virus type 1 and cytomegalovirus in saliva

The aim of this study was to evaluate whether HIV-1 or cytomegalovirus (CMV) may contribute to oral lesions frequently found in patients with the acquired immunodeficiency syndrome (AIDS). Saliva samples from 63 HIV-1 positive patients and 21 healthy controls were tested for the presence of HIV-1 and CMV using the polymerase chain reaction (PCR) and virus isolation. CMV IgG titres in serum were also compared in the different groups. HIV-1 RNA, but not DNA, was detected in saliva from 15% (9 out of 59) of the HIV-infected patients. There was no correlation between the presence of HIV-1 RNA and oral symptoms in the patients. CMV DNA was detected significantly more frequently in samples from HIV-1 seropositive than from seronegative patients. CMV was detected in saliva from AIDS patients more often than in saliva from patients with mild or no symptoms. CMV IgG titres were also significantly higher in symptomatic than in asymptomatic patients. There was a significant correlation between the presence of CMV DNA and necrotizing gingivitis, and oral Kaposi's sarcoma in the patients, and also between these lesions and the stage of disease. This does not prove that CMV causes these oral lesions, but a direct or indirect role for CMV cannot be excluded.

HIV infection at home and in the workplace

Major questions have been raised concerning an individual's risk for contracting HIV infection when they come into contact with a patient who has AIDS in the home and/or workplace. Specific concerns are addressed and guidelines are reviewed.

Educating Athletes on HIV Disease and AIDS

In brief Team physicians are in a unique brief position to counsel athletes about HIV disease and AIDS-they may be the only medical resource that this predominantly healthy group regularly encounters. A team physician who establishes rapport with athletes and has a basic knowledge of the current information on HIV disease and AIDS has a unique opportunity to frankly discuss the issues surrounding HIV transmission, both on and off the field.

AIDS and the family: implications for counselling

The presence of HIV spectrum illness stimulates a powerful emotional reaction from a patient's family and friends. Grief and shock over the infection, and its implications are frequent observations. Sadness, anxiety, helplessness and anger are also common. Health care staff should address these responses in order to strengthen coping skills and maximize interpersonal comfort. Stigmatization and isolation are major stressors. Bereavement is complicated by fear, shame, dependency and hopelessness. Therefore, a task in counselling is to maintain the integrity and supportiveness of the patient's social unit by encouraging open communications between those involved and by educating about AIDS. Information should be provided on HIV transmission, self-protection, and illness progression as well as the safety of causal contacts and the practices of 'safer sex'. The significant others should retain outside interests and be encouraged to seek help for patients from supportive social agencies. Instillation of hope lends benefit to patient, family and friends. Kind, non-judgmental counselling and good quality medical care should be made available, especially since HIV-related disorders are increasingly becoming a chronic disease. Advocacy for the significant others translates into better adjustment and it enhances the patient's medical prognosis.

Oral diseases in HIV-1 infection

HIV-associated oral lesions have been reported since the beginning of the AIDS epidemic, be they fungal, viral, bacterial, neoplastic, or non-specific in origin. The most common lesions are oral candidiasis (OC; noted in several forms) and oral hairy leukoplakia (OHL). OC appears to be directly related to levels of immunosuppression while OHL, a newly described lesion, is associated with the Epstein-Barr virus. Although prevalence data for all types of oral lesions are scarce, this review identifies and describes those reported most often. Lesions associated with HIV may appear on most oral mucosal surfaces and may differ from those seen on other body areas. The role of saliva in reducing the potential for transmission of the HIV virus appears to be significant. Physicians and dentists should cooperate in the management of the HIV patient who has oral disease.

Refusal to care for patients with human immunodeficiency virus/acquired immunodeficiency syndrome: issues and responses

Nurses historically have accepted the risk of contagion while caring for patients with infectious diseases. The duty to care for patients is directly related to the care the patient requires, the nurse's knowledge, and the extraordinary risk to the nurse. The current infection with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) highlights other factors, such as fear, ignorance, and homophobia, that influence a nurse's decision to refuse to provide care. Professional associations, nurse administrators, and educators must assist nurses to gain the knowledge and skill necessary to provide care as well as explore feelings about different life-styles.

HIV-related infections of the oral cavity

Oral infections are among the first manifestations of infection by the human immunodeficiency virus (HIV). They include fungal, viral, and bacterial infections and range from being essentially trivial, through troublesome to life threatening. Although some infections are due to overproliferation of the normal oral flora, others are due to organisms that normally are not found in the mouth. The clinical features of many of these infections have now been characterized, and clinical trials have indicated the optimal management. However, for many infections, the underlying processes are still not clear, and improvements in treatment are necessary.

AIDS acquired by drug consumption and other noncontagious risk factors

The hypothesis that human immunodeficiency virus (HIV) is a new, sexually transmitted virus that causes AIDS has been entirely unproductive in terms of public health benefits. Moreover, it fails to predict the epidemiology of AIDS, the annual AIDS risk and the very heterogeneous AIDS diseases of infected persons. The correct hypothesis must explain why: (1) AIDS includes 25 previously known diseases and two clinically and epidemiologically very different epidemics, one in America and Europe, the other in Africa; (2) almost all American (90%) and European (86%) AIDS patients are males over the age of 20, while African AIDS affects both sexes equally; (3) the annual AIDS risks of infected babies, intravenous drug users, homosexuals who use aphrodisiacs, hemophiliacs and Africans vary over 100-fold; (4) many AIDS patients have diseases that do not depend on immunodeficiency, such as Kaposi's sarcoma, lymphoma, dementia and wasting; (5) the AIDS diseases of Americans (97%) and Europeans (87%) are predetermined by prior health risks, including long-term consumption of illicit recreational drugs, the antiviral drug AZT and congenital deficiencies like hemophilia, and those of Africans are Africa-specific. Both negative and positive evidence shows that AIDS is not infectious: (1) the virus hypothesis fails all conventional criteria of causation; (2) over 100-fold different AIDS risks in different risk groups show that HIV is not sufficient for AIDS; (3) AIDS is only 'acquired,' if at all, years after HIV is neutralized by antibodies; (4) AIDS is new but HIV is a long-established, perinatally transmitted retrovirus; (5) alternative explanations disprove all assumptions and anecdotal cases cited in support of the virus hypothesis; (6) all AIDS-defining diseases occur in matched risk groups, at the same rate, in the absence of HIV; (7) there is no common, active microbe in all AIDS patients; (8) AIDS manifests in unpredictable and unrelated diseases; and (9) it does not spread randomly between the sexes in America and Europe. Based on numerous data documenting that drugs are necessary for HIV-positives and sufficient for HIV-negatives to develop AIDS diseases, it is proposed that all American/European AIDS diseases, that exceed their normal background, result from recreational and anti-HIV drugs. African AIDS is proposed to result from protein malnutrition, poor sanitation and subsequent parasitic infections. This hypothesis resolves all paradoxes of the virus-AIDS hypothesis. It is epidemiologically and experimentally testable and provides a rational basis for AIDS control.

AIDS education and a volunteer training program for medical students

The process of AIDS education poses exceptional challenges for teachers and students. Medical students are in a unique position in the health care system. They are young enough to be ideal role models for high school and college students. They are mature enough to be responsible educators. We describe a special program designed and implemented by a medical student to train other medical students to become AIDS educators. This student-run program provides education for student volunteers who are able to educate other students and members of the community. The program is designed to educate a generation of physicians who will be well-equipped to combat the HIV epidemic and who can serve the community as AIDS educators while still in medical school.

HIV infection in healthcare workers. How great is the risk? What can be done before and after exposure?

Healthcare workers know that there is a risk of HIV infection through exposure to AIDS patients. In both hospital and office settings, physicians have the opportunity to set standards and promote education about the degree of risk, effective precautions, and postexposure testing, prophylaxis, and treatment. Drs Henry and Thurn share the latest findings and offer policy recommendations based on their own experience.

Epidemiology of pediatric HIV infection

Perinatal transmission of human immunodeficiency virus (HIV) continues to increase. In 1989 alone, it is estimated that 1750 infected children were born in the United States. Although transmission is spreading to areas outside the cities originally most affected, these cities continue to bear the greatest toll. Adolescents may be particularly vulnerable to HIV infection; education and counseling are critical for controlling the epidemic in this age group.

Pediatric HIV disease. The newest chronic illness of childhood

HIV disease has emerged as a major chronic illness of childhood. Children with HIV infection and children with other chronic health impairments have much in common, including the need for comprehensive, multidisciplinary, coordinated care that includes special attention to the psychosocial effects on the child and family. However, because the mother and often the father and siblings share this lethal viral infection, the impact of HIV disease upon the family surpasses that of virtually all other chronic conditions. This is compounded by the association of the disease with drug use, its preponderance among the most disenfranchised populations in the United States, and the persistent public fear and discrimination surrounding AIDS. We have made substantial progress already in the medical management of this infection, and while we await the development of more effective therapies, we already have the tools and knowledge in hand to help these families.

Salivary detection of HIV-1 antibodies using recombinant HIV-1 peptides

Salivary antibodies may play a role in the absence of HIV-1 transmission by saliva. We evaluated the presence of salivary IgG antibodies to HIV-1 using a recombinant ELISA. Whole saliva was collected from 21 HIV-1-seropositive individuals and assayed in an ELISA, ASQ (Beckman Instruments, Brea, CA), consisting of a panel of six HIV-1 recombinant peptides. Saliva samples from 20 individuals demonstrated IgG to one or more peptides and 18 to two or more peptides. Samples from 20 seropositive individuals were reactive with the gp41 peptide, whereas only 12 were reactive with the two gp120 peptides. Nineteen of twenty salivas also had detectable IgG antibodies to HIV-1 by Western blotting. The results indicate that viral-specific IgG antibodies are present in the saliva of a high percentage of HIV-infected individuals and that a recombinant peptide ELISA for saliva might be useful for the detection of HIV-1 infection.

In vitro inhibition of HIV-1 infectivity by human salivas

Inhibitory factors to human immunodeficiency virus type 1 (HIV-1) in saliva may be responsible for the infrequent isolation of virus from saliva and also may account for the marked infrequency of salivary and/or oral transmission of HIV-1. Incubation of HIV-1 with human saliva followed by addition of the mixture to susceptible cells leads to partial or complete suppression of viral replication in vitro. We investigated the inhibitory effects of whole saliva and specific glandular salivas on HIV-1 infectivity as measured by viral-induced cytopathic effects in susceptible cells. Whole saliva contained marked inhibitory activity to HIV-1, strain HTLV-IIIB, and to virus infected cells. Submandibular saliva contained inhibitory activity, but of lesser quantity. Parotid saliva demonstrated no HIV-inhibitory activity. Whole saliva also appeared to contain filterable components that were inhibitory to lymphocyte growth. Passage through a .45 micron pore-size filter eliminated the viral inhibitory activity of submandibular saliva and some of the activity in whole saliva. All salivas except parotid incubated with HIV-1 followed by filtration were inhibitory suggesting that complexing of virus with high molecular weight, submandibular mucins may play a role in viral inhibition.

Pediatric AIDS in the United States: epidemiological reality versus government policy

Pediatric AIDS cases constitute approximately 2 percent of total AIDS cases in the United States, but HIV infection and AIDS among children pose a growing concern. Government policies have failed to match the epidemiological reality of the disease. The powerful shapers of public opinion have dedicated their energies to a handful of cases, involving the school attendance of primarily middle-class children. Unfortunately, coverage of school placement issues has overshadowed both the demographically more serious issue of perinatally transmitted AIDS cases and the growing concern over adolescent AIDS. Seventy-five percent of perinatal AIDS sufferers are poor, urban minorities: the disease is clearly related to other indicators of poor child health--urban poverty and oppressive social conditions. School-based prevention efforts for adolescents have been rendered impotent because of moralistic obstacles to explicit education. Prevention of perinatal and adolescent HIV transmission must be both sensitive and relevant to communities in which the greatest threat to survival is poverty, not AIDS. Ultimately, issues surrounding pediatric AIDS only reinforce the long-term position of child health advocates: the best investment a society can make is a sincere commitment of resources to improve the health, education, and welfare of its children.

AIDS: practising safe endoscopy

The emergence of HIV has provoked a widespread reappraisal of infection control practices in endoscopy units. Infection control practices should be applied to all patients alike without recourse to selection or screening. Although there has only been one reported instance of viral transmission at endoscopy, HIV could in theory be transmitted by a contaminated endoscope. Experience suggests that this is more likely to occur from damaged endoscopes, if an unsuitable disinfectant is used or endoscopes are not precleaned. In-use studies have shown that HIV contaminates endoscopes used on patients with AIDS, but in amounts too small to cause infection in tissue cultures. Cleaning in neutral detergent is extremely effective in removing contaminating micro-organisms, including HIV, from endoscopes. Aldehydes are the disinfectants of choice, but any disinfectant may fail if organic material is not removed by cleaning. After thorough cleaning, short disinfection times (e.g. four minutes) ensure inactivation of all relevant micro-organisms except Cryptosporidium and mycobacteria, although in practice even these organisms are likely to be reduced to non-pathogenic levels. Accidental needlestick injuries are the greatest hazard in the endoscopy suite; needles should not be resheathed and biopsy forceps must be handled with great care. The wearing of gloves should become second nature.

HIV infection in children

Human immunodeficiency virus (HIV) infection in children has emerged as a major, rapidly growing public health problem. The majority of children become infected by perinatal transmission of the virus from an infected mother. The disease is frequently associated with progressive neurologic dysfunction and with opportunistic infections. The cutaneous manifestations of pediatric HIV infection include a wide variety of fungal, bacterial, and viral infections of the skin. These diseases tend to be less responsive to conventional therapies than in the healthy child. In addition, severe seborrheic dermatitis, vasculitis, and drug eruptions are sometimes signs of HIV infection.

Risk of transmission of HIV to home care and health care workers

There are only three known routes of transmission of the human immunodeficiency virus (HIV): (1) exposure to blood via transfusion, sharing of contaminated needles by drug abusers, occupational needle stick or blood spill, unsterile needle injections; (2) sexual transmission; (3) perinatal exposure. There is no evidence for transmission by close interpersonal nonsexual contact or insect vectors. Health care workers are at risk for HIV transmission through accidental parenteral inoculation or extensive exposure to blood on nonintact skin or mucous membranes. Fortunately, population studies indicate that this risk is low and may be further reduced by adherence to simple infection control guidelines. The accumulated information on low rates of occupational transmission of HIV makes unwarranted the treatment of patients with acquired immunodeficiency syndrome (AIDS) or HIV infection as if they were highly contagious in the health care setting.

Prevention of transmission of infection during mouth-to-mouth resuscitation

The risk of infection transmitted during mouth-to-mouth or mouth-to-nose resuscitation procedures is difficult to define but is possibly quite low. However, the perceived risk is sufficient to cause serious concern for many individuals, including trained hospital personnel as well as the general public, and may preclude prompt and effective action. A novel airway device was evaluated for the retention of infective droplets and fluid permeability under simulated resuscitation conditions using a cardiopulmonary resuscitation training manikin. Retention of a 0.5-5.0 micron aerosol of Staphylococcus aureus cells was greater than 80% at flow rates of 6 l/min while under simulated resuscitation conditions the trapping of bacteria, originating predominantly from saliva, was over 90%. These data suggest that this device may afford significant protection against transmission of infection during exhaled air resuscitation manoeuvres.

Detection of HIV antibody and antigen (p24) in residual blood on needles and glass

There is a significant rate of percutaneous injury with needles during the care of patients with acquired immunodeficiency syndrome (AIDS). Following puncture injury, it is recommended that the source of the contaminating blood be checked, and if human immunodeficiency virus-type 1- (HIV-1)-seropositive, zidovudine prophylaxis be considered. As the source of contaminating blood may be unknown, we studied the detectability of HIV-1 antibody and circulating antigen (p24) in the residual blood from needles and pieces of glass at various intervals following exposure to blood. The residual volume of blood remaining in needles varied from 183 +/- 50 microliters for a 20 G needle to 7.8 +/- 1 microliter for a 27 G needle, and the residual blood on small pieces of glass varied from 23 microliters for a piece weighing 558 mg to 2 microliters for a piece weighing 21 mg. Analysis of washed samples of residual blood from all 20 G through 26 G needles and from broken pieces of glass larger than 0.41 g that had been exposed to HIV-1-seropositive blood and left at room temperature for one hour, one day and one week resulted in positive tests for HIV-1 antibody by enzyme-linked immunosorbent assay (ELISA), immunofluorescence and Western blot assays. The circulating antigen was detected in residual blood of 20 G through 26 G needles, but not from contaminated pieces of glass. This technique could be applied to situations where a healthcare worker pricked him- or herself with a needle or with a piece of glass that had been contaminated with blood of unknown seroreactivity.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsychosocial approach to the human immunodeficiency virus epidemic. A clinician's primer

The human immunodeficiency virus (HIV) epidemic has created a multidimensional crisis that is challenging the health care system. Individuals with or without risk behaviors have anxieties about acquired immunodeficiency syndrome (AIDS) and need support and counseling. Once symptoms of HIV infection develop, crisis intervention and support need to be integrated into ongoing medical care. A biopsychosocial approach enables persons with AIDS to develop strategies for coping, to improve adherence, and to prevent transmission and suicide. Persons with AIDS are confronted with severe illnesses, neuropsychiatric disorders, discrimination, and death. Each person deserves the best medical and psychologic care available and the services of other disciplines where indicated. Caregivers, anxious about contagion, are devastated by the complexity, severity, and multiplicity of the illnesses that comprise AIDS and the lack of adequate resources to combat the epidemic. AIDS is a paradigm of a medical illness that requires a biopsychosocial approach. Psychiatric sequelae complicate the HIV epidemic, affecting both the uninfected and infected. The psychiatric manifestations of the uninfected include anxiety, phobia, factitious disorder, delusions, and Munchausen's AIDS. Psychiatric disorders associated with HIV infection include organic mental disorders, substance abuse disorder, affective disorders, adjustment disorders, anxiety disorders, and personality disorders. The consultation-liaison (C-L) psychiatrist is in a unique position to clarify and treat the psychiatric complications and to provide leadership for multidisciplinary programs. The biopsychosocial approach enables persons with HIV infection, their loved ones, and caregivers to meet the challenges of the HIV epidemic with compassion, optimism, and dignity.

Human immunodeficiency virus and the emergency department: risks and risk protection for health care providers

The AIDS epidemic is having an increasing impact on the practice of emergency medicine. In inner-city emergency departments, significant numbers of patients have unrecognized human immunodeficiency virus (HIV) infection. Transmission of HIV in the health care setting has been predominantly from exposure to patients' infected blood, but most of the exposures (80%) are due to injuries from sharp instruments. There are only 18 documented cases of occupational HIV transmission worldwide. Four of these have occurred from nonparenteral exposures. Based on surveillance studies, the best estimate of seroconversion after exposure is about 0.5%. However, due to methodologic limitations, these figures may be underestimations. The effectiveness of azidothymidine for postexposure prophylaxis has not been shown. Currently, the best protection against HIV and other blood-borne pathogens remains use of universal precautions.

An investigation into support for restrictions on HIV carriers in the Chicago metropolitan area

An investigation into support for restrictions on people testing seropositive for HIV is reported on. Data were collected during telephone interviews with two-hundred adults aged eighteen to sixty-five in the Chicago metropolitan area. Using the analytic technique of LISREL, six models which attempt to explain support for restrictions were tested. It was found that the model best supported by the data indicates that two groups contribute to support for restrictions on HIV carriers--one due to intolerance of homosexuality and one to mistrust of public health officials regarding their control and management of the AIDS epidemic. The relevance of these findings for public health policy makers is discussed.

Immunology of HIV infection

The goal of finding an effective vaccine against the human immunodeficiency virus (HIV) is hampered by our uncertainty of the mechanism(s) responsible for the pathogenesis as well as the lack of knowledge of protective mechanisms. The effects of HIV on the immune system are myriad and thus the truly significant manifestations of the pathology are difficult to dissociate from those more peripheral. In this article we will initially characterize the natural history of HIV infection which shows a chronic and perhaps inexorable course. The second part will deal with the immune response mounted against this assault and the final section is a discussion of the possible unfavorable consequences of the immune response that humans muster against this agent.

HIV/AIDS and school boards: a policy approach

In general, there is a low incidence of HIV infection in members of school communities. Moreover, all available evidence supports the conclusion that HIV is not transmitted by the everyday contacts which occur in family, social, employment and educational settings. Despite this, the presence, in a school community, of persons infected with HIV or who have an HIV related disease have been perceived by some as presenting a threat to their children's, and even to their own health and well-being, which, in turn, has led to serious conflicts between various participants in that community. Experience, however, has shown that the fears of many persons and the risks of conflict and confrontation can be minimized, if not negated, if a school board has adopted policies and procedures in relation to HIV/AIDS. Such policies and procedures must be based on current medical knowledge and clearly identified ethical and legal principles, including identification of the rights, interests and needs of all persons and development of appropriate analyses, especially where these are required to resolve conflicts. In this text, educational authorities and their advisors are provided both with a comprehensive model HIV/AIDS policy, and a commentary which examines, amongst other matters, the fundamental ethical and legal considerations which have guided its formulation and the justifications for each of the principles contained therein.

AIDS and the lung. 1--AIDS, aprons, and elbow grease: preventing the nosocomial spread of human immunodeficiency virus and associated organisms

Epidemiological evidence indicates that transmission of human immunodeficiency virus (HIV) other than by direct inoculation or sexual contact is extremely rare. HIV has, however, been found on fibreoptic bronchoscopes used on patients with AIDS and there is a clear theoretical risk of transmission by bronchoscopy. Applied experiments have underlined the importance of cleaning equipment thoroughly and have shown the limitations of disinfection. Infection control policies should be revised to meet the following four basic requirements: (1) all precautions should apply to all patients alike--that is, whether infectious or not; (2) equipment should be cleaned thoroughly in detergent immediately after use to remove body secretions and reduce contamination; (3) staff who may be exposed to body secretions should wear simple barrier clothing routinely; and (4) contaminated bronchoscopes should be disinfected for 20 minutes in 2% alkaline glutaraldehyde after cleaning.

Psychiatric response to HIV spectrum disease in children and adolescents

Five clinical situations involving children and adolescents exposed to human immunodeficiency virus illustrate the psychosocial spectrum of the disease. For at-risk gay youth, anxiety and stigma complicate developing sexual practices. Children with perinatal infection may survive for years with a chronic illness, management of which is complicated by parental illness or death. Hemophiliac families must deal with the intrusion of a lethal virus into a long illness course. "Street" adolescents and substance-abusing youth pose particular challenges to public health and education. The range of child psychiatric responses described includes individual and family therapy, neuropsychological assessment, psychopharmacological management, and consultation liaison work.

Lung function testing and AIDS

Lung function testing on patients with acquired immune deficiency syndrome (AIDS) has been restricted because of the risks of cross infection. We have adapted equipment which is currently used for routine lung function testing with inexpensive disposable components to remove the risk of contamination. Results from the modified equipment were compared with those obtained using conventional equipment on 56 subjects. We found an excellent correlation between compared values for all parameters.

HIV protocol for the pediatric otolaryngology office

With the increasing awareness and concern over the transmission of human immunodeficiency virus (HIV) to health care providers, the development of a reasonable approach to patient care is necessary with those suspected of or documented as being HIV-positive. Children are all too frequently the innocent victims of this deadly disease and will often require the services of the otolaryngologist for evaluation, diagnosis, and treatment. In order to provide appropriate care for these children and reduce the risk of possible contamination of health care professionals or other patients a protocol was established for the Pediatric Otolaryngology Division of Children's Hospital at Washington University. This protocol is discussed in detail with explanation of rationale and alternatives.

Acquired Immunodeficiency Syndrome in Infants, Children, and Adolescents

The acquired immunodeficiency syndrome (AIDS) was first described as a disease of homosexual men. The first cases of AIDS in children were reported in 1982 and involved a transfusion recipient and four infants born to women at increased risk for AIDS. Infants may acquire their infection perinatally or possibly postnatally through infected breast milk. Parenterally acquired infection, through transfusion of blood or blood products, occurs in infants, children, and adolescents. Adolescents are also at risk for infection through sexual transmission and through shared needles among intravenous drug users. By January 1987, 1.4% of the AIDS cases were in children less than 13 years old, and 0.4% were in adolescents 13 to 19 years old. Additionally, 4.4% of the total AIDS cases were reported in 20 to 24 year olds, which most likely reflects infection which occured during adolescence. In children less than 13 years old, infection occurred primarily thorugh perinatal transmission from mothers who were intravenous drug users or sexual partners of intravenous drug users. Adolescent cases of AIDS have followed adult patterns of transmission with most cases resulting from sexual transmission. As the prevalence of infection with the human immunodeficiency virus increases, increases in drug-use-associated transmission in women followed by perinatal transmission to infants and sexual transmission in adolescents seems likely to occur. To prevent further spread, health agencies must develop and target extensive AIDS prevention campaigns at adolescents, young adults, and sexually active women.

AIDS and Athletes

In brief: AIDS is the most significant public health problem of our generation and has implications for athletes and their health care professionals. A growing body of scientific data supports the position that most individuals infected with the human immunodeficiency virus (HIV) can and should remain physically active and may participate in most sports. Current public health guidelines regarding transmission of HIV also apply to the training room and to organized sports. In addition, physicians and athletic trainers who disseminate the facts about AIDS and HIV are invaluable assets in the worldwide effort to eradicate AIDS.