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Fredericksen RJ, Whitney BM, Trejo E, Nance RM, Fitzsimmons E, Altice FL, Carrico AW, Cleland CM, Del Rio C, Duerr A, El-Sadr WM, Kahana S, Kuo I, Mayer K, Mehta S, Ouellet LJ, Quan VM, Rich J, Seal DW, Springer S, Taxman F, Wechsberg W, Crane HM, Delaney JAC. Individual and poly-substance use and condomless sex among HIV-uninfected adults reporting heterosexual sex in a multi-site cohort. BMC Public Health 2021; 21:2002. [PMID: 34736425 PMCID: PMC8567631 DOI: 10.1186/s12889-021-12026-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/15/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We analyzed the association between substance use (SU) and condomless sex (CS) among HIV-negative adults reporting heterosexual sex in the Seek, Test, Treat, and Retain (STTR) consortium. We describe the impact of SU as well as person/partner and context-related factors on CS, identifying combinations of factors that indicate the highest likelihood of CS. METHODS We analyzed data from four US-based STTR studies to examine the effect of SU on CS using two SU exposures: 1) recent SU (within 3 months) and 2) SU before/during sex. Behavioral data were collected via 1:1 or self-administered computerized interviews. Adjusted individual-study, multivariable relative risk regression was used to examine the relationship between CS and SU. We also examined interactions with type of sex and partner HIV status. Pooled effect estimates were calculated using traditional fixed-effects meta-analysis. We analyzed data for recent SU (n = 6781; 82% men, median age = 33 years) and SU before/during sex (n = 2915; 69% men, median age = 40 years). RESULTS For both exposure classifications, any SU other than cannabis increased the likelihood of CS relative to non-SU (8-16%, p-values< 0.001). In the recent SU group, however, polysubstance use did not increase the likelihood of CS compared to single-substance use. Cannabis use did not increase the likelihood of CS, regardless of frequency of use. Type of sex was associated with CS; those reporting vaginal and anal sex had a higher likelihood of CS compared to vaginal sex only for both exposure classifications (18-21%, p < 0.001). Recent SU increased likelihood of CS among those reporting vaginal sex only (9-10%, p < 0.001); results were similar for those reporting vaginal and anal sex (5-8%, p < 0.01). SU before/during sex increased the likelihood of CS among those reporting vaginal sex only (20%; p < 0.001) and among those reporting vaginal and anal sex (7%; p = 0.002). Single- and poly-SU before/during sex increased the likelihood of CS for those with exclusively HIV-negative partners (7-8%, p ≤ 0.02), and for those reporting HIV-negative and HIV-status unknown partners (9-13%, p ≤ 0.03). CONCLUSION Except for cannabis, any SU increased the likelihood of CS. CS was associated with having perceived HIV-negative partners and with having had both anal/vaginal sex.
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Affiliation(s)
- R. J. Fredericksen
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - B. M. Whitney
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - E. Trejo
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - R. M. Nance
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - E. Fitzsimmons
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - F. L. Altice
- Yale University AIDS Program, 135 College Street, Suite 323, New Haven, CT 06510-2283 USA
| | - A. W. Carrico
- Division of Prevention Science and Community Health, University of Miami, 1120 NW 14th St, Miami, FL 33136 USA
| | - C. M. Cleland
- Center for Drug Use and HIV Research, NYU School of Global Public Health, 665 Broadway, 11th Floor, New York, NY 10012 USA
| | - C. Del Rio
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE Room 7011, Atlanta, GA 30322 USA
| | - A. Duerr
- Fred Hutchinson Cancer Research Center, HIV Vaccine Trials Network, Box 358080 (LE 500), Seattle, WA 98109 USA
| | - W. M. El-Sadr
- Mailman School of Public Health, Columbia University, 722 West 168th Street, 13th floor, New York, NY 10032 USA
| | - S. Kahana
- National Institute on Drug Abuse, 6001 Executive Blvd, Rockville, Maryland 20852 USA
| | - I. Kuo
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW #2, Washington, DC 20052 USA
| | - K. Mayer
- The Fenway Institute, 1340 Boylston Street, Boston, MA 02215 USA
| | - S. Mehta
- Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - L. J. Ouellet
- School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St, Chicago, IL USA
| | - V. M. Quan
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - J. Rich
- Center for Prisoner Health and Human Rights, Immunology Center, The Miriam Hospital, Warren Alpert Medical School, Brown University, 1125 North Main St, Providence, RI 02904 USA
| | - D. W. Seal
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St, Suite 2200, New Orleans, LA 70112 USA
| | - S. Springer
- Department of Internal Medicine, School of Medicine, Yale University, 135 College Street, New Haven, CT 06510 USA
| | - F. Taxman
- Center for Advancing Correctional Excellence, Institute of Biohealth Innovation, George Mason University, 4461 Rockfish Creek Lane, Fairfax, VA 22030 USA
| | - W. Wechsberg
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27599 USA
| | - H. M. Crane
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - J. A. C. Delaney
- College of Pharmacy, University of Manitoba, Apotex Centre, 750 McDermot Avenue, Winnipeg, Manitoba R3E 0T5 Canada
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Ritsch A, Duerr A, Kahler P, Hunjadi M, Stojakovic T, Zewinger S, Speer T, Silbernagl G, Scharnagl H, Kleber M, März W. Independent effects of kidney function and cholersterol efflux on cardiovascular mortality. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
This study evaluated Amsel's criteria, the FemExam® card and pH plus amine methods for the diagnosis of bacterial vaginosis (BV) in a resource-poor setting. Two hundred Azerbaijani women participated in a study about reproductive health that included a gynaecological examination and an interviewer-administered survey. Using the WHO syndromic diagnosis algorithm, nearly all women (99%) had abnormal vaginal discharge. The prevalence of BV by Gram stain was 35%; using pH plus amine, the FemExam® card and Amsel's criteria, prevalence ranged from 29% to 49%. No behavioural or demographic characteristics were associated with BV as diagnosed by Gram stain. The sensitivity ranged from 0.59 to 0.74 and specificity from 0.65 to 0.92 using the three methods. The pH plus amine test is better than syndromic management protocols, and although it is not the most sensitive or specific of the three methods it will be easiest to implement in resource-poor settings.
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Affiliation(s)
- S F Posner
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Mail Stop K-34, Atlanta, GA 30341, USA.
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Muller H, Kassubek J, Gron G, Sprengelmeyer R, Hobbs N, Roos R, Duerr A, Tabrizi S, Sussmuth S, Orth M, Landwehrmeyer G. E20 Diffusion Tensor Imaging In Huntington's Disease: Impact Of The Control For Corrupted Data In Comparisons At The Group Level. Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fitzgerald DW, Janes H, Robertson M, Coombs R, Frank I, Gilbert P, Loufty M, Mehrotra D, Duerr A. An Ad5-vectored HIV-1 vaccine elicits cell-mediated immunity but does not affect disease progression in HIV-1-infected male subjects: results from a randomized placebo-controlled trial (the Step study). J Infect Dis 2011; 203:765-72. [PMID: 21343146 DOI: 10.1093/infdis/jiq114] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Step study was a randomized trial to determine whether an adenovirus type 5 (Ad5) vector vaccine, which elicits T cell immunity, can lead to control of human immunodeficiency virus (HIV) replication in participants who became HIV-infected after vaccination. METHODS We evaluated the effect of the vaccine on trends in HIV viral load, CD4+ T cell counts, time to initiation of antiretroviral therapy (ART), and AIDS-free survival in 87 male participants who became infected with HIV during the Step study and who had a median of 24 months of post-infection follow-up. RESULTS There was no overall effect of vaccine on mean log(10) viral load (estimated difference between groups, -0.11; P = .47). In a subset of subjects with protective HLA types (B27, B57, B58), mean HIV-1 RNA level over time was lower among vaccine recipients. There was no significant difference in CD4+ T cell counts, time to ART initiation, or in AIDS-free survival between HIV-1-infected subjects who received vaccine versus those who received placebo. CONCLUSIONS HIV RNA levels, CD4+ T cell counts, time to initiation of ART, and AIDS-free survival were similar in vaccine and placebo recipients. There may have been a favorable effect of vaccine on HIV-1 RNA levels in participants with HLA types associated with better control of HIV-1.
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Affiliation(s)
- D W Fitzgerald
- Center for Global Health, Weill Cornell Medical College, New York, New York 10021, USA.
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Röttgen R, Renz DM, Kobi S, Al-Abady H, Duerr A, Neuhaus P, Lüdemann L, Hamm B. Die MRT des HCC mit hepatozytenspezifischem Kontrastmittel und Korrelation mit dem zytometrisch bestimmten DNA-Index. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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7
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Rood JE, Migueles SA, Berkley AM, Compton AA, Joshi RP, Duerr A, McElrath J, Connors M. 0A07-01. HIV-specific CD8+ T-cells of vaccinees exhibit proliferative and cytotoxic capacities comparable to those of progressors. Retrovirology 2009. [PMCID: PMC2767572 DOI: 10.1186/1742-4690-6-s3-o49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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8
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Vucinic V, Linck D, Duerr A, Fauser AA, Basara N. Isolated intraperitoneal relapse of AML after allogeneic hematopoietic stem cell transplantation in a patient with extensive chronic GVHD and full donor chimerism in bone marrow. Leuk Lymphoma 2006; 47:1716-8. [PMID: 16966298 DOI: 10.1080/10428190600658662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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9
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Costello C, Nelson KE, Suriyanon V, Sennun S, Tovanabutra S, Heilig CM, Shiboski S, Jamieson DJ, Robison V, Rungruenthanakit K, Duerr A. HIV-1 subtype E progression among northern Thai couples: traditional and non-traditional predictors of survival. Int J Epidemiol 2005; 34:577-84. [PMID: 15737969 DOI: 10.1093/ije/dyi023] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the continuing effort to introduce antiretroviral therapy in resource-limited settings, there is a need to understand differences between natural history of HIV in different populations and to identify feasible clinical measures predictive of survival. METHODS We examined predictors of survival among 836 heterosexuals who were infected with HIV subtype CRF01_AE in Thailand. RESULTS From 1993 to 1999, 269 (49.4%) men and 65 (25.7%) women died. The median time from the estimated seroconversion to death was 7.8 years (95% confidence interval 7.0-9.1). Men and women with enrolment CD4 counts <200 cells/microl had about 2 and 11 times greater risk of death than those with CD4 counts of 200-500 and >500, respectively. Measurements available in resource-limited settings, including total lymphocyte count (TLC), anaemia, and low body mass index (BMI), also predicted survival. Men with two or more of these predictors had a median survival of 0.8 (0.5-1.8) years, compared with 2.7 (1.9-3.3) years for one predictor and 4.9 (4.1-5.2) years for no predictors. CONCLUSIONS The time from HIV infection to death appears shorter among this Thai population than among antiretroviral naive Western populations. CD4 count and viral load (VL) were strong, independent predictors of survival. When CD4 count and VL are unavailable, individuals at high risk for shortened HIV survival may be identified by a combination of low TLC, anaemia, and low BMI. This combination of accessible clinical measures of the disease stage may be useful for medical management in resource-limited settings.
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Affiliation(s)
- C Costello
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, USA
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10
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Zakrzewski JL, Lentini G, Such U, Duerr A, Tran V, Guenzelmann S, Braunschweig T, Riede UN, Koldehoff M. Toxic epidermal necrolysis: differential diagnosis of an epidermolytic dermopathy in a hematopoietic stem cell transplant recipient. Bone Marrow Transplant 2002; 30:331-3. [PMID: 12209357 DOI: 10.1038/sj.bmt.1703624] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2001] [Accepted: 04/12/2002] [Indexed: 11/09/2022]
Abstract
Toxic epidermal necrolysis (TEN) is an epidermolytic skin disorder associated with drug administration. It is associated with an erythematous rash with full thickness epidermal loss and characteristic histology. A 35-year-old woman underwent allogeneic hematopoietic stem cell transplantation (HSCT) for severe aplastic anemia (SAA). She developed an acute epidermolytic rash and TEN was diagnosed on the basis of skin biopsy. In the HSCT setting, TEN should be thought of as an important differential diagnosis of epidermolytic dermopathies. The most distinctive diagnostic test in the differential diagnosis of these disorders is skin biopsy
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Affiliation(s)
- J L Zakrzewski
- Bone Marrow Transplantation Center Idar-Oberstein, Germany
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12
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Jamieson DJ, Duerr A, Klein RS, Paramsothy P, Brown W, Cu-Uvin S, Rompalo A, Sobel J. Longitudinal analysis of bacterial vaginosis: findings from the HIV epidemiology research study. Obstet Gynecol 2001; 98:656-63. [PMID: 11576584 DOI: 10.1016/s0029-7844(01)01525-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the natural history of bacterial vaginosis in women with or at risk for human immunodeficiency virus (HIV). METHODS A cohort of 854 HIV-infected women and 434 HIV-uninfected women from four US sites was followed prospectively with gynecologic exams every 6 months over a 5-year period. The prevalence, incidence, persistence, and severity of bacterial vaginosis, which was defined using a Gram-staining scoring system, were calculated using generalized estimating equation methods. RESULTS In adjusted analyses, HIV-infected women had a higher prevalence of bacterial vaginosis than HIV-uninfected women (adjusted odds ratio [OR] 1.29; 95% confidence interval [CI] 1.08, 1.55). Although HIV-infected women were not more likely to have incident infections, they were more likely to have persistence of their infections (adjusted OR 1.49; 95% CI 1.18, 1.89). Similarly, immunocompromised women (CD4+ cell count less than 200 cells/microL) were more likely than HIV-infected women with higher CD4+ cell counts (more than 500 cells/microL) to have prevalent (adjusted OR 1.29; 95% CI 1.03, 1.60) and persistent (adjusted OR 1.38; 95% CI 1.01, 1.91) bacterial vaginosis infections, but not more likely to have incident infections. Immunocompromised women had more severe bacterial vaginosis by both clinical criteria (adjusted OR 1.40; 95% CI 1.08, 1.82) and by Gram-staining criteria (adjusted OR 1.50; 95% CI 1.12, 2.00). CONCLUSIONS Bacterial vaginosis is more prevalent and persistent among HIV-infected women, particularly among those who are immunocompromised. Immunocompromised women are more likely than HIV-infected women with higher CD4+ cell counts to have severe bacterial vaginosis.
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Affiliation(s)
- D J Jamieson
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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13
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Ahdieh L, Klein RS, Burk R, Cu-Uvin S, Schuman P, Duerr A, Safaeian M, Astemborski J, Daniel R, Shah K. Prevalence, incidence, and type-specific persistence of human papillomavirus in human immunodeficiency virus (HIV)-positive and HIV-negative women. J Infect Dis 2001; 184:682-90. [PMID: 11517428 DOI: 10.1086/323081] [Citation(s) in RCA: 244] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2000] [Revised: 05/31/2001] [Indexed: 12/15/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection and related immunosuppression are associated with excess risk for cervical neoplasia and human papillomavirus (HPV) persistence. Type-specific HPV infection was assessed at 6-month intervals for HIV-positive and HIV-negative women (median follow-up, 2.5 and 2.9 years, respectively). The type-specific incidence of HPV infection was determined, and risk factors for HPV persistence were investigated by statistical methods that accounted for repeated measurements. HIV-positive women were 1.8, 2.1, and 2.7 times more likely to have high-, intermediate-, and low-risk HPV infections, respectively, compared with HIV-negative women. In multivariate analysis, high viral signal, but not viral risk category, was independently associated with persistence among HIV-positive subjects (odds ratio [OR], 2.5; 95% confidence interval [CI], 2.1-2.9). Furthermore, persistence was 1.9 (95% CI, 1.5-2.3) times greater if the subject had a CD4 cell count <200 cells/microL (vs. >500 cells/microL). Thus, HIV infection and immunosuppression play an important role in modulating the natural history of HPV infection.
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Affiliation(s)
- L Ahdieh
- Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland 21205, USA.
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Duerr A, Kieke B, Warren D, Shah K, Burk R, Peipert JF, Schuman P, Klein RS. Human papillomavirus-associated cervical cytologic abnormalities among women with or at risk of infection with human immunodeficiency virus. Am J Obstet Gynecol 2001; 184:584-90. [PMID: 11262457 DOI: 10.1067/mob.2001.111791] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Correlates of abnormal human immunodeficiency virus cervical cytologic findings were examined among women infected with human immunodeficiency virus and uninfected women. STUDY DESIGN We performed a cross-sectional analysis of baseline data on demographically similar women with infection or risk factors for it. RESULTS Among 1050 women without hysterectomy, squamous intraepithelial lesions were more common among women infected with human immunodeficiency virus than among uninfected women (18.8% vs 5.3%; P <.001). In multivariate analysis the association of squamous intraepithelial lesions with human papillomavirus infection was strong; adjusted prevalence ratios were 27 for high-risk, 25 for intermediate-risk, and 10 for low-risk types (95% confidence intervals, 12-58, 12-54, and 4-25, respectively). Much lower adjusted prevalence ratios were seen for the only other factor significantly associated with squamous intraepithelial lesions, namely, infection with human immunodeficiency virus in conjunction with a reduced CD4(+) cell count. Adjusted prevalence ratios were 1.9 for CD4(+) cell counts <200 and 1.6 for CD4(+) cell counts between 200 and 500 (95% confidence intervals, 1.2-3.0 and 1.0-2.5, respectively). Adjusted attributable fractions calculated for this study population indicated that if both human immunodeficiency virus and human papillomavirus were removed, 47.6% of the observed lesions with atypical squamous cells of uncertain significance and 93.4% of the observed squamous intraepithelial lesions would be prevented. CONCLUSION Squamous intraepithelial lesions are more common among human immunodeficiency virus-infected women and are associated most commonly with high- and intermediate-risk human papillomavirus types and secondarily with human immunodeficiency virus-associated immune compromise.
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Affiliation(s)
- A Duerr
- Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA
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Sobel JD, Ohmit SE, Schuman P, Klein RS, Mayer K, Duerr A, Vazquez JA, Rampalo A. The evolution of Candida species and fluconazole susceptibility among oral and vaginal isolates recovered from human immunodeficiency virus (HIV)-seropositive and at-risk HIV-seronegative women. J Infect Dis 2001; 183:286-93. [PMID: 11204125 DOI: 10.1086/317936] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Antifungal agents can effectively treat mucosal candidiasis; however, their use can lead to colonization with less susceptible species and to resistance among normally susceptible strains. Oral and vaginal Candida isolates obtained at 3 points over 2 years from human immunodeficiency virus (HIV)-seropositive and at-risk HIV-seronegative women were identified by species and were evaluated for in vitro fluconazole susceptibility. Prevalence of non-C. albicans strains increased over time, and these strains were more likely among women reporting current antifungal use. Among C. albicans isolates, resistance was rare, with no evidence for progressive reduction in susceptibility over time. Among non-C. albicans isolates, reduced susceptibility occurred frequently and increased with time. HIV-seropositive women were more likely to have non-C. albicans isolates with reduced susceptibility as were women reporting current antifungal use. This evolution and section of mucosa-colonizing Candida species with reduced susceptibility could play a critical early role in the development of antifungal resistance among C. albicans isolates responsible for refractory candidiasis.
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Affiliation(s)
- J D Sobel
- Wayne State University School of Medicine, Detroit, Michigan, USA.
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16
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Jamieson DJ, Hillis SD, Duerr A, Marchbanks PA, Costello C, Peterson HB. Complications of interval laparoscopic tubal sterilization: findings from the United States Collaborative Review of Sterilization. Obstet Gynecol 2000; 96:997-1002. [PMID: 11084192 DOI: 10.1016/s0029-7844(00)01082-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To estimate the risk of intraoperative or postoperative complications for interval laparoscopic tubal sterilizations. METHODS We used a prospective, multicenter cohort study of 9475 women who had interval laparoscopic tubal sterilization to calculate the rates of intraoperative or postoperative complications. The relative safety of various methods was assessed by calculating overall complication rates for each major method of tubal occlusion. Method-related complication rates also were calculated and included only complications attributable to a method of occlusion. We used logistic regression to identify independent predictors of one or more complications. RESULTS When we used a more restrictive definition of unintended major surgery, the overall rate of complications went from 1.6 to 0.9 per 100 procedures. There was one life-threatening event and there were no deaths. Complications rates for each of the four major methods of tubal occlusion ranged from 1.17 to 1.95, with no significant differences between them. When complication rates were calculated, the spring clip method had the lowest method-related complication rate (0.47 per 100 procedures), although it was not significantly different from the others. In adjusted analysis, diabetes mellitus (adjusted odds ratio [OR] 4.5; 95% confidence interval [CI] 2.3, 8.8), general anesthesia (OR 3.2; CI 1.6, 6.6), previous abdominal or pelvic surgery (OR 2.0; CI 1.4, 2.9), and obesity (OR 1.7; CI 1.2, 2.6) were independent predictors of one or more complications. CONCLUSION Interval laparoscopic sterilization generally is a safe procedure; serious morbidity is rare.
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Affiliation(s)
- D J Jamieson
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Abstract
CONTEXT Little is known about pregnancy outcomes among the approximately 11 million refugees worldwide, 25% of whom are women of reproductive age. OBJECTIVE To estimate incidence of and determine risk factors for poor pregnancy outcomes and to calculate the contribution of mortality from neonatal and maternal deaths to overall mortality in a refugee camp. DESIGN Cross-sectional review of records and survey, conducted in February and March 1998. SETTING Mtendeli refugee camp, Tanzania. PARTICIPANTS For the overall assessment, 664 Burundi women who had a pregnancy outcome during a recent 5-month period (September 1, 1997-January 31, 1998) and their 679 infants; 538 women (81%) completed the survey. MAIN OUTCOME MEASURES Incidence of fetal death (fetus born > or =500 g or > or =22 weeks' gestation with no signs of life), low birth weight (<2500 g), neonatal death (death <28 days of life), and maternal death (deaths during or within 42 days of pregnancy from any cause related to or aggravated by the pregnancy or its management). RESULTS The fetal death rate was 45.6 per 1000 births, the neonatal mortality rate was 29.3 per 1000 live births, and 22.4% of all live births were low birth weight. Compared with women without poor pregnancy outcome, those with poor pregnancy outcome were more likely to report prior high socioeconomic status (adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.4), having a first or second pregnancy (OR, 2.2; 95% CI, 1.4-3.4), and having 3 or more episodes of malaria during pregnancy (OR, 2.0; 95% CI, 1.4-3.1). Neonatal and maternal deaths accounted for 16% of all deaths during the period studied. CONCLUSIONS Poor pregnancy outcomes were common in this refugee setting, and neonatal and maternal deaths, 2 important components of reproductive health-related deaths, contributed substantially to overall mortality.
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Affiliation(s)
- D J Jamieson
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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18
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Abstract
The aim of this study was to identify factors ascertainable at initial presentation that predict a complicated clinical course in HIV-negative women hospitalized with pelvic inflammatory disease (PID). We used data from a cross-sectional study of women admitted for clinically diagnosed PID to a public hospital in New York City. A complicated clinical course was defined as undergoing surgery, being readmitted for PID, or having a prolonged hospital stay (> or = 14 days) but no surgery. Logistic regression was used to identify independent predictors of complications. In adjusted analyses, older age (> or = 35 years) was a risk factor for prolonged hospital stay (adjusted odds ratio [OR] = 3.9; 95% confidence interval [CI] = 1.3-11.6) and surgery (OR = 10.4; CI = 2.5-44.1); self-reported drug use was a risk factor for readmission for PID (OR = 7.7; CI = 1.4-41.1) and surgery (OR = 6.2; CI = 1.8-20.5). Older age and self-reported drug use appear to be independent risk factors for a complicated clinical course among women hospitalized with PID.
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Affiliation(s)
- D J Jamieson
- Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Jamieson DJ, Duerr A, Macasaet MA, Peterson HB, Hillis SD. Risk factors for a complicated clinical course among women hospitalized with pelvic inflammatory disease. Infect Dis Obstet Gynecol 2000. [PMID: 10805363 PMCID: PMC1784670 DOI: 10.1002/(sici)1098-0997(2000)8:2<88::aid-idog5>3.0.co;2-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The aim of this study was to identify factors ascertainable at initial presentation that predict a complicated clinical course in HIV-negative women hospitalized with pelvic inflammatory disease (PID). We used data from a cross-sectional study of women admitted for clinically diagnosed PID to a public hospital in New York City. A complicated clinical course was defined as undergoing surgery, being readmitted for PID, or having a prolonged hospital stay (> or = 14 days) but no surgery. Logistic regression was used to identify independent predictors of complications. In adjusted analyses, older age (> or = 35 years) was a risk factor for prolonged hospital stay (adjusted odds ratio [OR] = 3.9; 95% confidence interval [CI] = 1.3-11.6) and surgery (OR = 10.4; CI = 2.5-44.1); self-reported drug use was a risk factor for readmission for PID (OR = 7.7; CI = 1.4-41.1) and surgery (OR = 6.2; CI = 1.8-20.5). Older age and self-reported drug use appear to be independent risk factors for a complicated clinical course among women hospitalized with PID.
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Affiliation(s)
- D J Jamieson
- Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Nelson KE, Rungruengthanakit K, Margolick J, Suriyanon V, Niyomthai S, de Boer MA, Kawichai S, Robison V, Celentano DD, Nagachinta T, Duerr A. High rates of transmission of subtype E human immunodeficiency virus type 1 among heterosexual couples in Northern Thailand: role of sexually transmitted diseases and immune compromise. J Infect Dis 1999; 180:337-43. [PMID: 10395847 DOI: 10.1086/314882] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The heterosexual transmission of subtype E human immunodeficiency virus type 1 (HIV-1) infection was evaluated in 467 couples in Thailand in whom the man was HIV-1 positive and the woman had no risk factors for HIV other than sex with her infected partner. At baseline, 216 (46.3%) of the 467 women were positive for HIV-1; prevalence of HIV among women was 52.2% when their male partners had CD4+ lymphocyte counts of <200 cells/microL, 45.9% in women whose partners had counts of 200-499 micro/L, and 39.2% in women whose partners had counts of >/=500/microL. Women were twice as likely to be HIV positive if their partners had a history of a sexually transmitted disease (STD); however, their HIV prevalence was 29% among couples who had no STD history. It appears that female partners of men infected with subtype E HIV-1 are at high risk of infection even when the man's CD4+ cell count is relatively high. A high rate of STDs may contribute significantly to this risk [corrected].
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Affiliation(s)
- K E Nelson
- Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205, USA.
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Rugpao S, Nagachinta T, Wanapirak C, Srisomboon J, Suriyanon V, Sirirojn B, Chaiyarassamee O, Prasertwitayakij W, Celentano DD, Nelson KE, Vernon SD, Duerr A. Gynaecological conditions associated with HIV infection in women who are partners of HIV-positive Thai blood donors. Int J STD AIDS 1998; 9:677-82. [PMID: 9863581 DOI: 10.1258/0956462981921341] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Women who were partners of HIV-positive blood donors were enrolled in a study of heterosexual HIV transmission between March 1992 and December 1996 and were interviewed and examined. Gynaecological conditions, including cervical dysplasia, human papillomavirus (HPV) infection, gonorrhoea, chlamydial infection, trichomoniasis, bacterial vaginosis, vaginal candidiasis and syphilis were assessed in addition to HIV status and CD4 level. Of 481 women enrolled, 224 (46.6%) were HIV seropositive. HIV-infected women were more likely to have abnormal vaginal discharge on physical examination (OR=2.6, P <0.01), HPV infection with a high-risk type (OR=6.9, P <0.01), and cervical dysplasia (OR=5.3, P <0.01). The prevalence of other gynaecological conditions detected at the enrolment visit did not differ by HIV status. History of prior STD (OR=2.0, P <0.01) was more common among HIV-infected women. The median CD4 count was 400 cells/microl among HIV-infected women. The prevalence of abnormal vaginal discharge and bacterial vaginosis increased significantly with decreasing CD4 count. The prevalence of ectopy, vaginal candidiasis, and cervical dysplasia increased with decreasing CD4 count, but these trends were not significant. We conclude that HIV-infected Thai women appear to have increased prevalences of abnormal vaginal discharge, squamous intraepithelial lesions and self-reported history of STD.
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Schuman P, Sobel JD, Ohmit SE, Mayer KH, Carpenter CC, Rompalo A, Duerr A, Smith DK, Warren D, Klein RS. Mucosal candidal colonization and candidiasis in women with or at risk for human immunodeficiency virus infection. HIV Epidemiology Research Study (HERS) Group. Clin Infect Dis 1998; 27:1161-7. [PMID: 9827263 DOI: 10.1086/514979] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The epidemiology of mucosal candidal colonization and candidiasis was studied in a multicenter cohort of 871 human immunodeficiency virus (HIV)-seropositive and 439 demographically and behaviorally similar HIV-seronegative women. Cross-sectional analyses at baseline revealed that oropharyngeal colonization with Candida species was more prevalent among seropositive women and among women reporting recent cigarette smoking and injection drug use. Oropharyngeal candidiasis was also more prevalent among seropositive women. Both oropharyngeal colonization and candidiasis were significantly associated with a lower median CD4 lymphocyte count among seropositive women. Vaginal candidal colonization was more prevalent among seropositive women and among those reporting recent injection drug use and current insulin or oral antihyperglycemic therapy. Vaginal candidiasis was equally likely to be diagnosed in seropositive and seronegative women and was not significantly related to recent sexual contact. Neither vaginal colonization nor candidiasis was significantly related to a lower median CD4 lymphocyte count among seropositive women. Baseline evaluation indicated differences in the epidemiology of oropharyngeal and vaginal candidal colonization and candidiasis in HIV-seropositive women and suggested possible variation in pathogenesis of candidal infection at these two mucosal sites.
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Affiliation(s)
- P Schuman
- Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan 48201, USA
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Wetstein L, Duerr A, Wagner RB. Esophageal perforation. Ann Thorac Surg 1998; 65:875-6. [PMID: 9527243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- L Wetstein
- Department of Surgery, Monmouth Medical Center, Long Branch, New Jersey, USA
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Nagachinta T, Duerr A, Suriyanon V, Nantachit N, Rugpao S, Wanapirak C, Srisomboon J, Kamtorn N, Tovanabutra S, Mundee Y, Yutrabutr Y, Kaewvichit R, Rungruèngthanakit K, de Boer M, Tansuhaj A, Flowers L, Khamboonruang C, Celentano DD, Nelson KE. Risk factors for HIV-1 transmission from HIV-seropositive male blood donors to their regular female partners in northern Thailand. AIDS 1997; 11:1765-72. [PMID: 9386812 DOI: 10.1097/00002030-199714000-00014] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To describe risks for HIV transmission from male blood donors to their regular female sex partners in Chiang Mai, Thailand. DESIGN Cross-sectional study. METHODS From March 1992 through September 1995, 405 HIV-seropositive male blood donors (index cases) and their regular female partners were enrolled in the study. Women with risk factors for HIV infection other than sexual contact with the index male were excluded. Couples were interviewed and examined; specimens were collected for laboratory analysis. RESULTS Overall, 46% of the 405 women enrolled were HIV-positive. Ninety-eight per cent of male index cases had a history of sex with a female prostitute; 1.5% reported always using condoms with their regular partner. History of sexually transmitted disease (STD) and swollen inguinal lymph nodes in the female partner were associated with an increased risk of HIV infection in the female. History in the female of genital herpes [odds ratio (OR), 3.46; 95% confidence interval (CI), 1.50-8.78], gonorrhea or chlamydia infection (OR, 2.71; 95% CI, 1.39-5.53), and stable relationship of longer than 24 months (OR, 2.28; 95% CI, 1.02-5.09) were associated with an increased risk of HIV infection in the female. Consistent condom use in the past 2 years (OR, 0.10; 95% CI, 0.01-0.79) was associated with a decreased risk of HIV infection in the female. CONCLUSIONS Married women in northern Thailand who appear otherwise to be at low risk for HIV infection may be exposed to this virus by their husbands. High rates of sex with commercial sex workers among men and low use of condoms within stable relationships may be important factors promoting the transmission of HIV in married couples. Programs to increase the regular use of condoms among married couples could be an important public health intervention to prevent transmission of HIV and other types of STD in northern Thailand.
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Affiliation(s)
- T Nagachinta
- Contraceptive Research and Development Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA
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Duerr A, Sierra MF, Feldman J, Clarke LM, Ehrlich I, DeHovitz J. Immune compromise and prevalence of Candida vulvovaginitis in human immunodeficiency virus-infected women. Obstet Gynecol 1997; 90:252-6. [PMID: 9241304 DOI: 10.1016/s0029-7844(97)00253-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate the effect of human immunodeficiency virus (HIV) infection on vaginal yeast colonization and symptomatic vulvovaginitis and to explore the effects of immune compromise on these conditions in HIV-positive women. METHODS Between September 1991 and May 1993, 223 HIV-positive women without AIDS-defining conditions were enrolled for prospective follow-up and compared with 289 HIV-negative women enrolled in a concurrent study. Standardized gynecologic assessment was carried out. RESULTS Cultures from 81 of 223 (36%) HIV-positive women and 72 of 289 (25%) HIV-negative women were positive for any yeast. The most commonly isolated yeasts were Candida albicans and Torulopsis glabrata; the proportion of non-C albicans isolates (26%) did not differ by serostatus. The rates of C albicans colonization and vulvovaginitis among immunocompetent (CD4 count at least 500 cells/mm3) HIV-positive women did not differ from those among HIV-negative women. Among HIV-positive women, risks for colonization and for symptomatic vulvovaginitis were increased approximately threefold and fourfold respectively, in women with CD4 counts below 200 cells/mm3 compared with either immunocompetent HIV-positive women or HIV-negative women. CONCLUSION The yeast species isolated from HIV-positive and HIV-negative women were similar. Rates of vaginal colonization and vaginitis were similar among nonimmunocompromised HIV-positive women and HIV-negative women. Elevated rates of yeast colonization and vaginitis were not seen among this population of HIV-infected women before immune compromise. Both vaginal colonization and symptomatic vaginitis increased with immune compromise among HIV-positive women, especially at CD4 counts below 200 cells/mm3.
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Affiliation(s)
- A Duerr
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Clarke LM, Duerr A, Yeung KH, Brockman S, Barbosa C, Macasaet M. Recovery of cytomegalovirus and herpes simplex virus from upper and lower genital tract specimens obtained from women with pelvic inflammatory disease. J Infect Dis 1997; 176:286-8. [PMID: 9207384 DOI: 10.1086/517268] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Lower genital tract specimens and endometrial biopsies from 147 women with pelvic inflammatory disease (PID) and surgical specimens (fallopian tubes, ovaries, or both) from 22 women with PID and 37 women without PID were cultured for cytomegalovirus (CMV) and herpes simplex virus (HSV), as well as for organisms commonly associated with PID. CMV was isolated from 39 cervical or endometrial samples from 30 (20.4%) of 147 women with PID and from ovaries or fallopian tubes from 5 (22.7%) of 22 women with PID, but CMV was not recovered from surgical specimens obtained from 37 women undergoing surgery for tubal ligation, ectopic pregnancy, or other gynecologic conditions (P = .005). HSV was isolated from cervical samples obtained from 5 (3.4%) of 147 women with PID but not from any endometrial or surgical specimens. These data suggest that CMV, but not HSV, may contribute to the pathogenesis of PID in some patients.
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Affiliation(s)
- L M Clarke
- Department of Pathology, State University of New York Health Science Center at Brooklyn, 11203, USA
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Abstract
OBJECTIVE To identify the effect of human immunodeficiency virus (HIV) infection on the clinical course of pelvic inflammatory disease (PID). METHODS Women hospitalized with PID at an urban hospital serving a population at high risk for HIV were studied cross-sectionally. Data abstracted from medical records of 349 women, admitted between July 1992 and April 1994 were linked anonymously to HIV serology. Main outcome measures were length of hospital stay, prolonged fever, tubo-ovarian abscess, surgery, and change in antibiotics. RESULTS Among the 349 women with PID, 27 were HIV-positive. These HIV-positive women had lower mean white blood cell counts at admission (7411 versus 11,266, P < .01), lower mean lymphocyte counts (1411 versus 1928, P < .01), greater febrile morbidity (54 versus 28.3%, P < .01), and longer hospital stays (10.5 versus 6.4 days, P < .01) than HIV-negative women. Women who were HIV-positive required more time for defervescence and needed to change their antibiotic regimen more frequently (41 versus 12.7%, P < .01); differences in tubo-ovarian abscesses (19 versus 14%, P = .52) or surgery (15 versus 6.2%, P = .10) were not significant. The differences in hospital course between HIV-positive and HIV-negative women were modest, and they were resolved largely by the fourth or fifth hospital day. All HIV-positive women were treated successfully with first- or second-line antibiotic regimens. CONCLUSION Despite more severe initial presentation and a prolonged hospital course, HIV-positive women with PID, but without other acute illnesses, were treated successfully with standard therapeutic regimens. These observations support current recommendations for hospitalization of HIV-positive women with PID and treatment according to current standards.
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Affiliation(s)
- C Barbosa
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, USA
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Clarke LM, Duerr A, Feldman J, Sierra MF, Daidone BJ, Landesman SH. Factors associated with cytomegalovirus infection among human immunodeficiency virus type 1-seronegative and -seropositive women from an urban minority community. J Infect Dis 1996; 173:77-82. [PMID: 8537686 DOI: 10.1093/infdis/173.1.77] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Cytomegalovirus (CMV) seroprevalence and genital tract shedding in human immunodeficiency virus (HIV)-seronegative and HIV-seropositive women from an urban minority community were investigated. CMV seropositivity was high in both groups: 181 (95.2%) of 190 HIV-negative and 158 (90.3%) of 175 HIV-positive subjects. Cervicovaginal shedding was detected in 8 (4.4%) CMV-positive HIV-negative subjects and 31 (19.6%) HIV-positive subjects (odds ratio [OR], 5.28; P < .001). Multiple logistic regression analysis revealed that CMV shedding was independently associated with younger age (OR = 0.90; P < .001) and concurrent Chlamydia trachomatis or Neisseria gonorrhoeae infection (OR = 3.60; P = .08). However, shedding was observed over a broad age range in HIV-positive subjects, with 54.8% of shedders being > or = 30 years old. Among HIV-positive subjects, CMV shedding was also associated with decreased CD4 cell counts (P = .04) and, compared with HIV-negative subjects, was significantly higher (P < .001) among subjects with CD4 cell counts < 500 x 10(6)/L (26.5% in subjects with counts < or = 200 and 22.1% in subjects with counts of 201-499 x 10(6)/L).
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Affiliation(s)
- L M Clarke
- Department of Pathology, State University of New York Health Science Center at Brooklyn 11203, USA
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Abstract
BACKGROUND Kaposi sarcoma has become a common manifestation in people with AIDS, especially men. A few reports of Kaposi sarcoma in women with AIDS have involved nongenital areas. However, of the few patients with genital Kaposi sarcoma reported in the United States, none was believed to be human immunodeficiency virus (HIV)-positive. Genital Kaposi sarcoma associated with HIV has been reported in other parts of the world. CASE A 29-year-old black woman presented with severe vulvar pain, vaginal discharge, and a vulvar mass. She had been diagnosed with AIDS 25 months earlier. Biopsy of the vulvar mass revealed Kaposi sarcoma; viral analysis of the tumor was positive for herpes simplex virus type 2. Sequencing of polymerase chain reaction product verified the presence of human papillomavirus 26. CONCLUSION We report an HIV-associated Kaposi sarcoma presenting as a vulvar mass. This report should alert health care providers to include Kaposi sarcoma in the differential diagnosis of vulvar lesions.
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Affiliation(s)
- M A Macasaet
- Department of Obstetrics and Gynecology, SUNY Health Science Center, Brooklyn, USA
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Cohen CR, Duerr A, Pruithithada N, Rugpao S, Hillier S, Garcia P, Nelson K. Bacterial vaginosis and HIV seroprevalence among female commercial sex workers in Chiang Mai, Thailand. AIDS 1995; 9:1093-7. [PMID: 8527084 DOI: 10.1097/00002030-199509000-00017] [Citation(s) in RCA: 175] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To investigate the relationship between HIV seropositivity and bacterial vaginosis (BV) in a population at high risk for sexual acquisition of HIV. DESIGN A cross-sectional study was conducted among 144 female commercial sex workers in Chiang Mai, Thailand. METHODS The participants were tested for cervical gonorrhea and Chlamydia infection, syphilis, Trichomonas vaginitis, Candida vaginitis, BV, and HIV infection. BV was diagnosed by clinical criteria (pH > 4.5, positive amine test, and presence of clue cells) and using Gram stains. RESULTS Thirty-three per cent of participants had BV, and 43% were HIV-positive. Using clinical criteria, the association of BV and HIV seropositivity was significant [odds ratio (OR), 2.7; 95% confidence interval (CI), 1.3-5.0]. Although the association between BV and HIV prevalence was not significant using Gram stains alone for diagnosis of BV, an association was found between abnormal vaginal flora and HIV (OR, 2.1; 95% CI, 1.0-4.8). In multiple logistic regression analysis, adjusting for age, number of sexual encounters per week, current condom use, and currently having a sexually transmitted disease (STD), both BV and a history of an STD were independently associated with HIV seropositivity (adjusted OR for BV, 4.0 and 95% CI, 1.7-9.4; adjusted OR for history of an STD, 6.9 and 95% CI, 2.1-22.9). CONCLUSIONS When diagnosed clinically, BV is independently associated with HIV seroprevalence. HIV infection may promote abnormal vaginal flora, or BV may increase susceptibility to sexual transmission of HIV. Alternatively, the association seen here may result from intervening variables; in this case BV may be a marker or a cofactor of HIV transmission.
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Affiliation(s)
- C R Cohen
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
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Dowell SF, Toko A, Sita C, Piarroux R, Duerr A, Woodruff BA. Health and nutrition in centers for unaccompanied refugee children. Experience from the 1994 Rwandan refugee crisis. JAMA 1995; 273:1802-6. [PMID: 7769778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- S F Dowell
- Centers for Disease Control and Prevention, Respiratory and Enteric Viruses Branch, Atlanta, GA 30333, USA
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Reef SE, Levine WC, McNeil MM, Fisher-Hoch S, Holmberg SD, Duerr A, Smith D, Sobel JD, Pinner RW. Treatment options for vulvovaginal candidiasis, 1993. Clin Infect Dis 1995; 20 Suppl 1:S80-90. [PMID: 7795112 DOI: 10.1093/clinids/20.supplement_1.s80] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Vulvovaginal candidiasis (VVC), the second most common form of vaginitis, particularly affects women of childbearing age. Since the 1970s, several new agents have become available for the treatment of VVC. This review focuses on options for the treatment of this condition, critically evaluating the relevant published studies. For the treatment of acute episodes of VVC in nonpregnant women, several topical and oral antifungal agents are clinically and mycologically effective. Topical agents should be considered the first line of therapy; however, oral agents are sometimes associated with better compliance among patients. For acute episodes in pregnant women, a topical agent is the treatment of choice. Until data become available on the treatment of VVC in women infected with human immunodeficiency virus (HIV), the same approach as that used for women without HIV infection should be considered as previously written. For recurrent VVC, the optimal maintenance therapy has not yet been established; however, administration of low-dose oral ketoconazole (100 mg/d) has proven effective. Well-designed studies of the best therapy for VVC in women with HIV infection and for recurrent VVC are urgently needed.
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Affiliation(s)
- S E Reef
- Centers for Disease Control and Prevention, Emerging Bacterial and Mycotic Diseases Branch, Atlanta, Georgia 30333, USA
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Abstract
OBJECTIVE To determine the frequency of active tuberculosis during pregnancy in two hospitals located in an area where tuberculosis is epidemic and to describe its course and association with human immunodeficiency virus (HIV) infection. METHODS We reviewed and analyzed the medical records of 16 pregnant women diagnosed with tuberculosis between 1985-1992 at Kings County Hospital (n = 12) and Saint Vincent's Hospital (n = 4) in New York City. RESULTS Ten of the 16 pregnant women with proven active tuberculosis had pulmonary tuberculosis, two had tuberculous meningitis, and one each had mediastinal, renal, gastrointestinal, and pleural tuberculosis. Eleven were tested for HIV, and seven were seropositive. One HIV-infected patient with pulmonary tuberculosis died of respiratory failure. In the 6 years between 1985-1990, five cases of active tuberculosis during pregnancy were identified (12.4 per 100,000 deliveries). During the 2 years of 1991-1992, 11 cases were recorded (94.8 per 100,000 deliveries). CONCLUSION Cases of active tuberculosis are increasing among pregnant women in epidemic communities and are associated with HIV infection. Early tuberculin skin test screening with appropriate preventive therapy should reduce morbidity due to tuberculosis in HIV-infected women of reproductive age. Identification of pregnant women with tuberculosis requires a high index of suspicion.
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Affiliation(s)
- F Margono
- Division of Maternal Fetal Medicine, State University of New York Health and Science Center, Brooklyn
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36
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Warren DL, Duerr A. HIV infection in non-pregnant women: a review of current knowledge. Curr Opin Obstet Gynecol 1993; 5:527-33. [PMID: 8400053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
HIV infection has become an important health problem among American women. The natural history of HIV infection and AIDS appears to be similar for women and men, and preliminary studies demonstrate similar survival and clinical events for both sexes. The natural history and presentation of common gynecologic infections and conditions may be altered by HIV. Most is known about cervical dysplasia. The risk of cervical dysplasia appears to be increased in women with HIV infection, progression of cervical dysplasia may be more rapid, severity of disease increased, particularly for women with HIV-related immunocompromise. Recently, the Centers for Disease Control and Prevention added invasive cervical cancer as an AIDS-defining condition. Vulvovaginal candidiasis, sexually transmitted diseases, including syphilis, herpes, and cytomegalovirus, and pelvic inflammatory disease are also common in HIV-infected women. Preliminary data suggest that these conditions may be more severe and more difficult to treat in HIV-infected women than uninfected women. Women who are HIV-infected should have thorough evaluation and follow up of all gynecologic conditions, particularly as they become immunosuppressed.
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Affiliation(s)
- D L Warren
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
We have analyzed the molecular components of cytoplasmic microtubules in situ in several types of cultured cells. Our approach makes use of preparations of detergent-extracted cytoskeletons that contain the original cellular microtubules. Identification of microtubule components is based on two criteria: their presence in the cytoskeleton preparations is dependent upon the presence of intact microtubules, and they are released from such preparations by buffers that depolymerize microtubules. Proteins that meet these criteria are described. Some of them are restricted to cells of certain species or tissues of origin. Others appear to be of widespread distribution. Among the latter is a protein homologous to one of the tau polypeptides in brain microtubule protein.
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Abstract
We prepared the cytoskeletal framework by gently extracting cells with Triton X-100. Lipids and soluble proteins were removed, leaving a complex meshlike structure which contains the cell nucleus and is composed of the major cell filament networks as well as the microtrabeculae with attached polyribosomes. The surface sheet or lamina covering this structure contains most of the cell surface proteins by the following criteria. Intact cells are labeled externally with radioiodine and then extracted with detergent. The iodinated poteins remain almost entirely with skeletal framework. A new major integral protein, the coat protein of Sindbis virus, is inserted into the plasma membrane of infected cells. This new protein is heavily iodinated and remains almost completely associated with the framework after extraction. Lectin binding and poliovirus binding sites are also retained after detergent extraction. Our results indicate that plasma membrane proteins form a sheet or lamina upon removal of lipids. This lamina reproduces even complex surface convolutions and appears to be supported by and intimately connected to the underlying skeleton. In this case, the surface lamina, and hence the plasma membrane of the original intact cell, might be viewed as a component of the cytoskeletal framework.
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