A single measurement of CD38CD8 cells in HIV+, long-term surviving injecting drug users distinguishes those who will progress to AIDS from those who will remain stable

This study compares the predictive power of a single measurement of CD8+CD38+, CD8+CD45RO+ or CD8+CD38+CD45RO+ subpopulations in predicting progression to AIDS in a cohort of HIV+ long-term surviving injecting drug users. The results showed that both the total CD8+ percentage, and the CD8+CD38+ and CD8+CD38+CD45RO+ subpopulations of cells all individually predicted progression to AIDS. In combination with CD4, only the CD8+CD38+ subpopulation enhanced the predictive power of the CD4 percentage alone. The CD8+ percentage correlated negatively with the CD4 percentage and the CD8+CD45RO+ subpopulation did not predict disease progression. The proportion of CD8+CD38+ cells identified which patients with a moderate CD4 level were more likely to progress to AIDS, and conversely, which patients with a low CD4 count were likely to remain clinically stable. The results were consistent irrespective of whether time was measured from the date of seroconversion, or from the date of the test. This study is the first to measure these markers in HIV-infected injecting drug users, and in long-term survivors. The results demonstrate the considerable added value of the CD8+CD38+ cell percentage over the CD4 count alone, in predicting HIV clinical progression.

Hysterectomy: a medical-legal perspective, 1975 to 1985

Since 1975 the crisis in professional liability has been the most important problem affecting the future of obstetrics and gynecology. Increasing numbers of physicians have stopped delivering babies and most obstetricians have decreased their high-risk obstetrics. Most of the attention in the specialty has been directed toward the liability problem in obstetrics as opposed to gynecology. The liability problem in gynecology is not insignificant, however, and has increased in importance in the last several years. This is particularly true in the areas of failure to diagnose and complications of surgery. This study reports on the closed cases involving hysterectomy from Norcal Mutual Insurance Company, a physician-owned mutual company founded in Northern California in 1975. A number of factors are analyzed in comparing those cases involving payment of money because of a settlement or loss at trial with those cases in which no money was paid.

Vertical transmission of HIV: a prospective study

Forty nine infants of HIV seropositive women were followed up for a median of 24 months, together with 24 controls. The infection status of 11 index children under 18 months of age was indeterminate; 34 were presumed uninfected while four showed clinical and laboratory evidence of HIV disease. Based on current definitions of HIV infection and excluding children under 18 months old as well as those who had not been studied from birth, two out of 28 children were infected. The estimated rate of maternofetal transmission was therefore 7.1%. In children with proved infection, sequential laboratory data showed that hypergammaglobulinaemia was noted as early as 6 months and often predated clinical signs. This observation, in the presence of non-specific clinical findings, was helpful in alerting the paediatrician to a diagnosis of HIV infection.

Intravenous immunoglobulin in HIV infection: evidence for the efficacy of treatment

Eight children with symptoms of HIV infection were treated for 12-26 months (median 14 months) with infusions of intravenous immunoglobulin (200 mg/kg) every three weeks. Significant improvement was noted in all children in terms of weight gain, number of infectious episodes, and days spent in hospital. This resulted in a 49% saving in cost on treatment compared with costs accrued previously during inpatient admissions. Immunoglobulin concentrations, which were raised at the start of treatment were not altered, and T4 counts continued to decline slowly. HIV core antigen was detected in four children before treatment, but all became core antigen negative after treatment was commenced, this effect being sustained in three. Intravenous immunoglobulin therefore has major clinical benefit, and by reducing viral activity may delay disease progression.