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

Acquired immunodeficiency syndrome: a new population of children at risk

Cases of AIDS in children have been described since 1982. Diagnosis is more complex in children than in adults owing to the more varied clinical presentations and the difficulty in interpretation of laboratory tests. Our current understanding of HIV infection in children is reviewed, as well as the controversies regarding medical, psychosocial, and public health issues.

Risk factors for infection with human immmunodeficiency virus among European expatriates in Africa

The pattern of cases of AIDS in Belgium suggests that Europeans infected with human immunodeficiency virus (HIV) acquired the infection in Africa. The prevalence of infection was assessed in Belgian advisers and European expatriates and risk factors for infection defined in a case-control study of expatriate men. Fifteen (1.1%) of 1401 Belgian advisers working in Africa and 41 (0.9%) of 4564 European expatriates living in Africa, were positive for antibody to HIV in a voluntary screening programme in Belgium. Among subjects with antibody to HIV the ratio of men to women was 3:1. These subjects did not have a history of intravenous drug abuse or blood transfusion and only one was homosexual. In a case-control study of 33 expatriate men who had antibody to HIV and 119 controls the men with antibody reported significantly more female sexual partners, who were more commonly local; and significantly more sexual contact with prostitutes in Africa. They had a significantly higher prevalence of history of sexually transmitted disease and had received significantly more injections by unqualified staff in Africa during the previous five years. No specific sexual practices were associated with having antibody to HIV. After multivariate analysis sexual contact with local women (adjusted odds ratio 14.7; 95% confidence interval 2.81 to 76.9), sexual contact with prostitutes (adjusted odds ratio 10.8 (1.6 to 71.9), and injections by unqualified staff (adjusted odds ratio 13.5 (3.7 to 49.8) remained independent risk factors for infection. European expatriates in Africa were at increased risk from infection with HIV and were a means of introducing HIV into the heterosexual population in Europe. Transmission from women to men by vaginal intercourse seemed to be the most probable route of infection.

Memorandum on the infections hazards of the common communion cup with especial reference to AIDS

Bacteriological studies on the communion cup have shown that there is a low level of contamination with mouth organisms on the rim. The death rate of bacteria on the cup surface would not be significant, but the wine had a bactericidal effect on most but not all organisms tested. However droplets of saliva did not readily mix with the wine. In considering the spread of AIDS, extensive studies of people infected with human immunodeficiency virus (HIV) in hospital or at home have shown that the established routes of spread are the injection of blood or blood products, sexual intercourse or at birth. There are only very rare examples of spread by other means. The virus is rarely isolated from the saliva and a study of homosexuals indulging in oral sexual intercourse suggests that it is very poorly infectious when taken into the mouth or swallowed. It is concluded that the risk of transmission of HIV by the common communion cup can be neglected under ordinary circumstances. Suggestions are made for improving the hygiene of the communion service which may be useful under special circumstances: there is no evidence that disease is spread in this way under normal conditions.

Cutaneous manifestations of the acquired immunodeficiency syndrome in children

The acquired immunodeficiency syndrome (AIDS) in children is now known to be a clinical entity separate and distinct from AIDS in adults. In this article we present a review of the recent literature describing the history, definitions, epidemiology, differential diagnosis, and immunologic and clinical features of pediatric AIDS. Special emphasis is placed on the cutaneous manifestations of human immunodeficiency virus infection in children, which, to date, have not been the subject of a comprehensive review.

Prevention of AIDS and HIV infection: needs and priorities for epidemiologic research

By the end of 1987, almost 50,000 cases of acquired immunodeficiency syndrome (AIDS) will have been reported in the United States. Although the primary epidemiology of the disease has been described, much work remains to be done to complete our understanding of the dynamics of transmission and infection with the causative virus, human immunodeficiency virus (HIV). At the state and local level, the highest priorities for epidemiologic research are to understand better the precise populations at risk of prevalent and incident HIV infection, and to use this information to direct and monitor specific prevention programs that are likely to be effective for the populations at risk. These parallel efforts-sophisticated investigative epidemiologic research and applied epidemiologic and serosurveillance studies-must be expanded rapidly and continued for the forseeable future if we are to accomplish the goal of preventing further spread of HIV.

Epidemics in perspective

Irrational responses to patient with AIDS, particularly in regards to the transmissibility of HIV (human immunodeficiency virus) are examined from an historical and psychosocial perspective. Although these responses are similar to those reported from past epidemics such as plague and leprosy, they are in direct conflict with our current level of understanding regarding the transmission of this virus. Their genesis may relate to the human penchant to react to illness metaphorically. In order to allay effectively public concern about the transmissibility of AIDS, it is essential to recognize the metaphor associated with venereal disease in general and AIDS in particular.

Epidemiology of HIV infection and AIDS in the United States

By the end of 1987, nearly 50,000 cases of acquired immunodeficiency syndrome (AIDS) had been reported since 1981, 20,745 in the past year alone. Black and Hispanic adults and children have reported rates 3 to 12 times as high as whites. This can be largely attributed to higher reported rates in black and Hispanic intravenous (IV) drug abusers, their sex partners, and infants. In 1986, reported AIDS deaths increased adult male and female mortality in the United States by an estimated 0.7 and 0.07%, respectively, with much greater increases in selected age groups or areas of the country. The greatest variation in infection with the human immunodeficiency virus (HIV) (0 to 70%) has been found in surveys of IV drug abusers, while surveys of homosexual men reveal infection rates of 20 to 50%. Infection with HIV ranged from 0 to 2.6% in limited sexually transmitted disease clinic surveys of heterosexual men and women without a history of IV drug abuse or known sexual contact with persons at increased risk. The modes of HIV transmission are now well understood, but a large amount of biologic variability in efficiency of transmission remains to be explained. The period between initial infection with HIV and the development of AIDS is variable, but the risk for disease progression increases with duration of infection.

The hazard of infection from the shared communion cup

Interest and concern that the shared communion cup may act as a vehicle for indirectly transmitting infectious disease was reawakened when the human immunodeficiency virus (HIV) was detected in the saliva of infected persons. Bacteriological experiments have shown that the occasional transmission of micro-organisms is unaffected by the alcoholic content of the wine, the constituent material of the cup or the practice of partially rotating it, but is appreciably reduced when a cloth is used to wipe the lip of the cup between communicants. Nevertheless, transmission does not necessarily imply inoculation or infection. Consideration of the epidemiology of micro-organisms that may be transmitted via saliva, particularly the herpes group of viruses, suggests that indirect transmission of infection is rare and in most instances a much greater opportunity exists for direct transmission by other means. There is substantial evidence that neither infection with hepatitis B virus nor HIV can be transmitted directly via saliva so that indirect transmission via inanimate objects is even less likely. No episode of disease attributable to the shared communion cup has ever been reported. Currently available data do not provide any support for suggesting that the practice of sharing a common communion cup should be abandoned because it might spread infection.

Strengths and weaknesses in methods for identifying the causative agent(s) of acquired immunodeficiency syndrome (AIDS)

Human immunodeficiency virus (HIV) is a cytoplasmic retrovirus which is transmitted via body fluids, especially through blood products and sexual contact, and is the causative agent of the acquired immunodeficiency syndrome (AIDS). Only about 5 to 10% of the patients infected with HIV contract AIDS; the great majority of infected people either develop a less aggressive condition (AIDS-related complex) or appear healthy. All persons infected with HIV may transmit the virus. In order to protect the national blood supply and to help in diagnosis, tests have been developed to identify infected persons. These include viral isolation techniques, enzyme-linked immunosorbent assay (ELISA), immunofluorescent assay (IFA), radioimmune precipitation (RIP) assay, Western blot, and, most recently, antigen identification and gene probes. Although the sensitivity and specificity among these methods varies, all are susceptible to false-positive and/or false-negative results. In order to understand the reasons for fragility in methodologies, it is necessary to appreciate several basic concepts related to the biochemistry, biology, pathophysiology, and genetic characteristics of HIV and related viruses. The purpose of this review is to present the strengths and weaknesses of each method, with emphasis on peculiar viral characteristics that lead to methodological defects or efficacies.

No evidence for vertical transmission in children born to HIV seropositive male haemophiliacs

In order to evaluate the risk of HIV transmission during conception or pregnancy from seropositive male haemophiliacs to their children, we have investigated the families of 8 HIV antibody positive haemophilia A patients. HIV antibodies could be demonstrated in 1/9 mothers after delivery of her second child, whereas all the other mothers tested were seronegative. Of the 14 children studied at least 7 must have been conceived when the father was already seropositive. HIV antibodies were tested for in 6 of these 7 children; all were negative. All 14 children are healthy and free from clinical signs of HIV infection. We conclude that the overall risk of perinatal HIV transmission in haemophilic families should be low and this knowledge may be invaluable in family counselling.

Risk of human immunodeficiency virus (HIV-1) infection among laboratory workers

In a prospective cohort study of 265 laboratory and affiliated workers, one individual with no recognized risk factors for human immunodeficiency virus type 1 (HIV-1) infection was HIV-1 seropositive at the time of entry into the study. Molecular analyses of two HIV-1 isolates derived in two independent laboratories from a blood sample from this worker showed that the isolates were indistinguishable from a genotypic form of HIV-1 present in the H9/HTLV-IIIB cell line. Exposure to this strain of virus most probably occurred during work with concentrated virus or culture fluids from virus-producing cell lines under standard Biosafety Level 3 containment. Although no specific incident leading to this infection has been identified, undetected skin contact with virus culture supernatant might have occurred. This worker was the only one found to be positive among the subgroup of 99 workers who shared a work environment involving exposure to concentrated virus. The incidence rate of 0.48 per 100 person-years exposure indicates that prolonged laboratory exposure to concentrated virus is associated with some risk of HIV-1 infection, which is comparable to the risk for health care workers experiencing a needle stick exposure. While none of the ten workers with parenteral exposure to HIV-1 in this cohort became infected, a worker in another laboratory did seroconvert following an injury with a potentially contaminated needle. Strict Biosafety Level 3 containment and practices should be followed when working with concentrated HIV-1 preparations, and further refinement of the procedures may be necessary.

Techniques for reversing the failure of empathy towards AIDS patients

Educating the general population and health care workers about the acquired immunodeficiency syndrome (AIDS) is of paramount importance. There is a need to address the many fears and anxieties concerning this dreaded illness. Experience has shown that simple information-giving alone does little to allay the panic in the general population and in hospital personnel. The paper offers a psychodynamic explanation of the origins of the irrational fear and anxieties around AIDS patients and why information alone does not help the anxieties hospital workers experience. We have suggested a training program using group process and videotape techniques which can address the underlying fears and concerns about AIDS patients. These sessions can help hospital staff to deliver more empathic care to this patient group.

HIV infection in children: sizing up the paediatric problem

Cases of paediatric AIDS have increased each year in the USA, as the disease has spread to the heterosexual community. In the USA the geographic distribution of perinatal AIDS cases mirrors the distribution of cases in women. To date, 503 HIV antibody positive women have been reported in the UK. It is likely that the increasing number of seropositive women will be reflected in an increase in the number of reports of perinatal HIV infection and AIDS. Although screening of blood donors and blood products has stopped further increase in infections from this route, as transfusion-infected children become symptomatic the burden on paediatric services will increase.

Pediatric human immunodeficiency virus infection and its cutaneous manifestations

Acquired immunodeficiency syndrome was first observed in children in 1982. Human immunodeficiency virus (HIV) is now known to be the etiologic agent of this disease complex. Children acquire the viral infection in utero or perinatally, or by receiving contaminated blood products. The cutaneous manifestations include persistent oral thrush, herpes simplex, herpes zoster, molluscum contagiosum, and a variety of fungal and bacterial skin infections. Vasculitis, unusual drug eruptions, and cutaneous manifestations of nutritional deficiencies are also seen.

Transmission of human immunodeficiency virus from parents to only one dizygotic twin

The acquired immunodeficiency syndrome-related complex was identified in a mother and one of her nonidentical twins. Generalized lymphadenopathy was first noted in the infant at age 17 months, and that of the mother was incidentally discovered 6 months later. The father, who had had homosexual contacts before the conception of the twins, appeared to be in good health. No one in the family had constitutional symptoms or showed signs of opportunistic infection. Both parents and the patient had hypergammaglobulinemia, low T-helper-to-suppressor-cell ratio, and positive serum antibody to human immunodeficiency virus. Attempts to isolate the virus from all family members were unsuccessful. The twin brother was in good health with a normal immunologic profile and negative antibody to human immunodeficiency virus.

Acquired immunodeficiency syndrome (AIDS)

The Acquired Immunodeficiency Syndrome (AIDS), caused by the human immunodeficiency virus (HIV), also called the human T-lymphotropic virus type III/lymphadenopathy-associated virus [HTLV-III/LAV], has affected over 23,000 people; more than half of those with the disease have died. The actual case fatality rate approaches 100%. AIDS affects all groups and classes of people, although some are at special risk. Distribution of the disease is worldwide. The illness' effects on the body are widespread; of special interest are the ophthalmologic manifestations. The eye may be infected by various viruses (cytomegalovirus, varicella-zoster virus, herpes simplex virus or HIV itself), toxoplasma gondii, candida sp, cryptococcus neoformans, M. tuberculosis, or M. avium-intracellulare. Kaposi's sarcoma may affect the eye as well. Retinal vascular abnormalities (e.g., cotton-wool spots, vasculitis) are not uncommon in AIDS. The syndrome may present with neuro-ophthalmologic manifestations. No effective treatment for the illness is currently available, although several hold promise and there is hope for an AIDS vaccine. Prevention of infection through reduction of risks appears to be the only defense against AIDS at this time.

Dermatologic findings and manifestations of acquired immunodeficiency syndrome (AIDS)

We present a review of the spectrum of human T-lymphotropic virus type III (HTLV-III) infection with particular emphasis on cutaneous manifestations in 217 patients. Correlations are made with immunodeficiency as measured by absolute T-helper cell number. A classification is presented of these dermatologic findings.

Updating of methods for prevention of HIV transmission during ophthalmological procedures

The presence of HIV (human immunodeficiency virus) particles in the tear fluid, on the conjunctival surface or in the contact lenses of patients with chronic HIV infection has made it necessary to establish better for guide-lines for decontamination of instruments during ophthalmological procedures. The methods are now at the stage of evolution. The present paper describes the disinfection procedures used in the Helsinki University Eye Hospital and updates the present decontamination protocols.