Prevalence of oral disease among adults with primary HIV infection

OBJECTIVE

To explore the type and prevalence of oral mucosal lesions among adults with primary HIV infection (PHI) compared with HIV-negative adults at high risk for HIV disease, and in relation to HIV viral load.

METHODS

We conducted standardized oral examinations to identify specific oral mucosal lesions among adults with PHI, both pre-seroconversion and post- seroconversion-recently infected, compared with HIV-negative adults. We compared the group with oral lesions to those without oral lesions with respect to HIV-RNA load and CD4 + T-cell count.

RESULTS

Among 115 adults (predominantly men), pseudomembranous candidiasis was the most common oral lesion among those with PHI, and was found in 4% of the 23 participants in pre-seroconversion and in 9% of 69 participants with post-seroconversion recent infection, compared with none found among 23 HIV negatives. Among those with PHI, the median viral load was higher and the median CD4 + T-cell count lower among the 15 participants with an oral lesion of any type than among the 77 participants without oral lesions (P = 0.02 and 0.04, respectively).

CONCLUSION

This finding suggests that individuals with PHI who have oral lesions may be more likely to transmit HIV because of their higher viral load.

Performance of screening mammography among women with and without a first-degree relative with breast cancer

BACKGROUND

Although it is recommended that women with a family history of breast cancer begin screening mammography at a younger age than average-risk women, few studies have evaluated the performance of mammography in this group.

OBJECTIVE

To compare the performance of screening mammography in women with a first-degree family history of breast cancer and women of similar age without such history.

DESIGN

Cross-sectional.

SETTING

Mammography registries in California (n = 1), New Hampshire (n = 1), New Mexico (n = 1), Vermont (n = 1), Washington State n = 2), and Colorado (n = 1).

PARTICIPANTS

389 533 women 30 to 69 years of age who were referred for screening mammography from April 1985 to November 1997.

MEASUREMENTS

Risk factors for breast cancer; results of first screening examination captured for a woman by a registry; and any invasive cancer or ductal carcinoma in situ identified by linkage to a pathology database, the Surveillance, Epidemiology, and End Results program, or a state tumor registry.

RESULTS

The number of cancer cases per 1000 examinations increased with age and was higher in women with a family history of breast cancer than in those without (3.2 vs. 1.6 for ages 30 to 39 years, 4.7 vs. 2.7 for ages 40 to 49 years, 6.6 vs. 4.6 for ages 50 to 59 years, and 9.3 vs. 6.9 for ages 60 to 69 years). The sensitivity of mammography increased significantly with age (P = 0.001 [chi-square test for trend]) in women with a family history and in those without (63.2% [95% CI, 41. 5% to 84.8%] vs. 69.5% [CI, 57.7% to 81.2%] for ages 30 to 39 years, 70.2% [CI, 61.0% to 79.5%] vs. 77.5% [CI, 73.3% to 81.8%] for ages 40 to 49 years, 81.3% [CI, 73.3% to 89.3%] vs. 80.2% [CI, 76.5% to 83.9%] for ages 50 to 59 years, and 83.8% [CI, 76.8% to 90.9%] vs. 87.7% [CI, 84.8% to 90.7%] for ages 60 to 69 years). Sensitivity was similar for each decade of age regardless of family history. The positive predictive value of mammography was higher in women with a family history than in those without (3.7% vs. 2.9%; P = 0.001).

CONCLUSIONS

Cancer detection rates in women who had a first-degree relative with a history of breast cancer were similar to those in women a decade older without such a history. The sensitivity of screening mammography was influenced primarily by age.

[Circumscribed peritonitis of genital origin or gonococcal perihepatitis Fitz-Hugh Curtis syndrome (author's transl)]

Circumscribed peritonitis with perihepatitis resulting from previous female gonococcal infection is now commmonly known as Fitz-Hugh Curtis (FHC) syndrome. Contamination of the peritoneum through the Fallopian tubes and the fact that the gonococcal inflammation (frequency, though not always confirmed) remains superficial with little production of pus explain why the perihepatic lesions are fibrinous, adhesion-forming and tend to subside spontanesouly. The pathophysiological mechanisms, however, are complicated by recent reports of FHC syndrome in males. Beside Neisseria gonorrhoeae, other organisms growing in the genital tract are probably involved. When necessary, coelio-laparoscopy is the method of choice to confirm the diagnosis. The four cases reported here illustrate the various symptomatic and evolutive aspects of the syndrome.