Child care providers and AIDS: a study of knowledge versus acceptance.

A survey of child care providers' knowledge of human immunodeficiency virus (HIV) transmission and attitudes toward recommended child care policies regarding AIDS was conducted in a Southeastern state. Significant knowledge differences regarding HIV transmission were found between certain comparison groups, although all groups agreed more than disagreed with current information about HIV transmission. In contrast, the child care providers were uniformly more cautious than accepting of recommended child care policies regarding AIDS. Suggestions for follow-up research and educational strategies to promote providers' acceptance of children with AIDS are discussed.     

CD8(+) T cells in preventing HIV infection and disease

The complex interplay between the host immune response and HIV has been the subject of intense research over the last 25 years. HIV and simian immunodeficiency virus (SIV) CD8 T cells have been of particular interest since they were demonstrated to be temporally associated with reduction in virus load shortly following transmission. Here, we briefly review the phenotypic and functional properties of HIV-specific and SIV-specific CD8 T-cell subsets during HIV infection and consider the influence of viral variation with specific responses that are associated with disease progression or control. The development of an effective HIV/AIDS vaccine combined with existing successful prevention and treatment strategies is essential for preventing new infections. In the context of previous clinical HIV/AIDS vaccine trials, we consider the challenges faced by therapeutic and vaccine strategies designed to elicit effective HIV-specific CD8 T cells.     

HIV/HCV重叠感染者疾病进展及病毒间相互作用机制的研究进展

自1981年美国首次从男同性恋患者中报道艾滋病(AIDS)以来,相同症状的患者不断被发现,该疾病也以其惊人的速度在世界范围内传播开来。由于丙型肝炎病毒(HCV)与艾滋病病毒(HIV)有相同的传播途径,使HCV在HIV感染者中得到广泛的传播。据报道,全球HCV感染者中大约6%～10%合并HIV感染,HIV感染者中大约有30%合并HCV感染。因此HIV/HCV重叠感染成为AIDS最关注的领域之一。现对HIV/HCV重叠感染者疾病进展及病毒间在人体内相互作用机制的最新研究进展综述如下。     

Animal models for acquired immunodeficiency syndrome

Substantial advances have already been made in the understanding of acquired immunodeficiency syndrome (AIDS). The major issues for AIDS research during the next few years must be practical ones: the development of a safe, effective vaccine for individuals not yet infected with the causative virus and the development of drug therapies for those already infected. Suitable animal models will be needed for studies designed to achieve these goals. Areas of investigation in animal models can be divided into four categories on the basis of increasing direct relevance to AIDS in humans: retroviruses that have no obvious, close relation to human immunodeficiency virus (HIV) but can induce chronic diseases with manifestations that include immunologic abnormalities; ungulate lentiviruses; HIV-related viruses of Old World primates; and HIV infection of chimpanzees. It is hoped that important research developments in experimental models can be quickly extrapolated to human AIDS.     

Linking HIV-seropositive youth with health care: evaluation of an intervention

The purpose of this study was to evaluate the use of a statewide human immunodeficiency virus (HIV) surveillance system to link infected adolescents with care. Eligible participants were HIV-seropositive youths who were reported to the Department of Health from 1985 to 1998 in a state with mandatory, name-linked reporting of HIV and acquired immunodeficiency syndrome (AIDS) cases. Standard public health disease surveillance and intervention strategies were used to link participants with HIV/AIDS case management services. Enrollment in case management services was assessed before and after the intervention was implemented in 1993. The proportion of participants receiving case management services increased from 33% to 51% (p = 0.058) after the intervention was implemented. Although enrollment in case management did not vary significantly with participants' demographic and transmission characteristics, people of color were less likely than Caucasians to be located and interviewed. In conclusion, the system of name linked reporting of HIV/AIDS cases was used successfully to increase case management by 55% above baseline levels.     

北京市孕妇人群AIDS认知程度与健康教育干预的研究

目的：了解北京市孕妇对艾滋病(AIDS)的预防知识、态度，以便为在该人群中采取切实可行的AIDS干预措施提供依据。方法：将孕妇分为干预组和对照组，两组均进行干预前问卷调查，然后对干预组采取讲课、发放AIDS预防宣传资料和小组咨询等干预措施，时间为6个月；对对照组不采取任何措施。6个月后，对两组分别进行问卷调查，与干预前调查内容相同。结果：干预组孕妇于干预前调查时，对AIDS有关知识的正确认识率与对照组差异无显著的统计学意义。但采取措施6个月后，干预组正确认识率由干预前的65．5％上升至80．5％，两者差异有非常显著的统计学意义(X^2＝31.678，P＜0．01)，但对照组干预前后差异无显著的统计学意义(X^2＝3．284，P＝0．063)。结论：孕妇在干预前，对AIDS已有一定程度的了解，但对其传播途径认识模糊。因此，有必要对该人群开展AIDS预防的健康教育。     

Combination HIV prevention options for young women in Africa

Although the number of new HIV infections has declined by over 30% in the past decade, the number of people who acquire HIV each year remains unacceptably high. In 2014 the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that there were about 2 million new HIV infections. The virus continues to spread, particularly in key populations, such as men who have sex with men (MSM), transgender individuals, sex workers and people who inject drugs. In Africa, young women have the highest HIV incidence rates. Scaling up known efficacious HIV prevention strategies for these groups at high risk is therefore a high priority. HIV prevention has generally been targeted at HIV-negative individuals or in some instances, entire communities. Prevention efforts are, however, shifting from a narrow focus on HIV-uninfected persons to a continuum of prevention that includes both HIV-negative and HIV-positive individuals. Given that a single HIV prevention intervention is unlikely to be able to alter the epidemic trajectory as HIV epidemics in communities are complex and comprise a mosaic of different risk factors and different routes of transmission, there is need to provide combination prevention. Hence, a mix of behavioural, biomedical and structural HIV prevention options is likely to be needed to alter the course of the HIV epidemic. The combination of HIV prevention interventions needed will vary depending on cultural context, the population targeted and the stage of the epidemic. This paper reviews the available HIV prevention strategies for young women and discusses new HIV prevention approaches in development.     

Adult tuberculosis overview: African versus Western perspectives

Tuberculosis is currently an enormous global health problem. In industrialized countries in Western Europe and North America, tuberculosis case rates are low and an increasing proportion of cases now occur in foreign-born individuals and in marginalized populations, including the homeless, prisoners, drug users, and persons with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS). In contrast, the burden of tuberculosis in sub-Saharan Africa continues to grow, largely fueled by the HIV pandemic and poor public health infrastructure. Use of the World Health Organization's (WHO) directly observed therapy, short course (DOTS) strategy has been successful in improving outcomes and preventing the emergence of acquired drug resistance in several African countries; however, case rates are increasing throughout most of the region. It is clear that control of tuberculosis in Africa is closely linked to control of HIV and AIDS. Substantial external donor support and innovative approaches to enhance interactions between HIV/AIDS prevention and treatment efforts and tuberculosis control programs will be needed to improve the current tuberculosis situation in Africa. The purpose of this review is to provide a synopsis of recent developments in these areas and to serve as a reference source for interested readers.     

HGP-30, a synthetic analogue of human immunodeficiency virus (HIV) p17, is a target for cytotoxic lymphocytes in HIV-infected individuals.

Evaluation of the immune response of individuals exposed to human immunodeficiency virus (HIV) is an important component of any plan designed to lead toward the development of an AIDS vaccine. Since the levels of antibodies to HIV p17 and the synthetic p17 peptide HGP-30 correlate with stages of progression to AIDS, studies were initiated to determine whether cytotoxic lymphocytes directed toward target cells pulsed with HGP-30 and radioactive chromium were present in seropositive individuals. The significance of such cells in controlling HIV viral infection has recently been enhanced by reports that HIV p17 is on the surface of infected cells and that an inactivated virus vaccine depleted of viral envelope appears to be effective in controlling expression. The selection of HGP-30 as the p17 peptide to be evaluated in early studies is based on the presence of both T-cell and B-cell epitopes as predicted by computer modeling and mouse studies and the demonstration of in vitro neutralization activity by antibodies to the epitope. By using B-lymphoblastoid cells pulsed with HGP-30 and radioactive chromium as autologous targets and mixed leukocyte culture-expanded peripheral blood lymphocytes as effectors, CD8+ cytotoxic T lymphocytes against HGP-30-coated targets were identified in seropositive individuals. In this report we demonstrate that a synthetic p17 epitope can be a target for major histocompatibility complex-restricted cytotoxic T lymphocytes in HIV-infected individuals.     

Clinical progress and the future of HIV exceptionalism.

In the 18 years since the first cases of the acquired immunodeficiency syndrome (AIDS) were reported by the Centers for Disease Control and Prevention (CDC), the epidemic has undergone profound transformations, and so, too, has the sociomedical context within which public health policy is fashioned and implemented. The early years of neglect and panic were also characterized by relative therapeutic impotence and deep uncertainty about the epidemiological course the new threat would take. In the United States and in other economically advanced nations, the threat of contracting the human immunodeficiency virus (HIV) has abated. The incidence of infection has declined, and the prevalence of infection has stabilized and, in some instances, begun to fall. The pattern of HIV spread, where it has continued, has been dramatically circumscribed to marginalized populations. The panic of the mid-1980s has passed, and in many nations, AIDS has lost its salience as a public issue. A sense of therapeutic impotence no longer prevails, and a new mood of triumphalism has taken hold. How have these crucial changes affected AIDS policies in America?     

Blind spots in the epidemiology of HIV in black Americans

In the USA, annual rates of new human immunodeficiency virus (HIV)/AIDS diagnoses are seven and 21 times higher in black men and women, respectively, than in whites. Epidemiological inquiry on this disparity has chiefly focused on contextual factors; such emphasis has eclipsed study of direct HIV vectors. The US Centers for Disease Control and Prevention recently announced its intention to curb HIV propagation in black communities, recommending culturally appropriate HIV/AIDS strategies. Contemplated societal interventions should be informed by data evaluating more direct (and under-assessed) HIV transmission vectors, specifically anal intercourse and unsuspected blood exposures. This recommendation involves tracing sexual and non-sexual contacts of recently infected persons and uninfected controls, coupled with DNA sequencing of HIV isolates. Public health authorities do not know the extent to which unmeasured yet plausible HIV transmission vectors can account for ethnic disparities. Appropriate prevention strategies depend critically on direct, rather than ecologic, evidence.     

“四免一关怀”政策实施10年中国艾滋病防治主要进展

目的分析"四免一关怀"政策实施以来,中国艾滋病防治在检测、抗病毒治疗、预防母婴传播以及高危人群预防干预等方面重点工作的主要进展。方法利用国家艾滋病综合防治信息系统收集的信息进行分析,展示2004-2013年开展艾滋病检测的机构数、检测人次数及发现的感染者人数、抗病毒治疗人数及机构数,孕产妇检测人数及阳性孕产妇抗病毒治疗药物应用率,美沙酮治疗人数及机构数等主要防治工作指标的进展。结果 2004-2013年间,具备艾滋病病毒(HIV)初筛和确认检测能力的实验室分别增加6.1和7.9倍,年检测人数增加近5倍,2013年达1.11亿人次,当年新确诊病例90 119人。抗病毒治疗当年新增治疗人数增加7.4倍,截止2013年底,全国累计治疗282 529人,在治227 489人。目前使用8种抗病毒治疗药品,5个品种为国内仿制。累计为5000万名孕产妇提供了HIV抗体检测,2013年阳性孕产妇抗病毒药物应用率达到80.9%。美沙酮维持治疗门诊数从8个扩大到763个,至2013年底累计治疗41.27万人,在治20.17万人。10年间,中央财政艾滋病防治专项经费增加3.8倍。结论落实"四免一关怀"政策的10年里,中国艾滋病防治工作在检测发现感染者、抗病毒治疗、预防母婴传播,以及高危人群干预等方面的工作取得了显著进展。     

HIV,Homelessness, and Public Health: Critical Issues and a Call for Increased Action

Homelessness and housing instability are significant public health issues that increase the risks of HIV acquisition and transmission and adversely affect the health of people living with HIV. This article highlights the contributions of selected papers in this special issue of AIDS and Behavior and considers them within the broader context of prior research on the associations between housing status and HIV risk, use of HIV medical care, adherence to HIV treatment, and the physical health of HIV-seropositive persons. Special recognition is given to the roles of interrelated health problems, such as substance abuse, poor mental health, and physical and sexual abuse, that often co-occur and exacerbate the challenges faced by those who are homeless or unstably housed. Taken as a whole, the findings indicate a critical need for public health programs to develop strategies that address the fundamental causes of HIV risk among homeless and unstably housed persons and, for those living with HIV, contribute to their risk of disease progression. Such strategies should include “mid-stream” and “upstream” approaches that address the underlying causes of these risks. The successful implementation of these strategies will require leadership and the formation of new partnerships on the part of public health agencies. Such efforts, however, may have significant effects on the individuals and communities most affected by HIV/AIDS.     

Patients' fear of contracting the acquired immunodeficiency syndrome from physicians

This study investigates patients' concern about the human immunodeficiency virus transmission from their physician during the course of routine medical care. We examined patients' fear of acquired immunodeficiency syndrome (AIDS), knowledge of human immunodeficiency virus transmission, level of comfort with medical procedures performed by a physician suspected of having AIDS, perceived risk of AIDS transmission in physician-patient interactions, and the desire to be informed of the human immunodeficiency virus status of physicians. Three hundred fifty patients attending a university-based outpatient center in a large midwestern city were surveyed. Findings show that, as fear of AIDS increases, so does reported level of discomfort with procedures conducted by a physician suspected of having AIDS. Fear of AIDS was inversely correlated with knowledge. Patient concerns regarding susceptibility to the human immunodeficiency virus infection in routine care call attention to the need for education about transmission of AIDS in the health care context.     

北京市石景山区某社区外来流动人员艾滋病知识现状调查及连续宣教效果评价

目的了解北京市石景山区某社区流动人员的来源、构成、文化水平、艾滋病（HIV/AIDS）相关知识、对AIDS病人的态度,以及在为期1年的连续宣教后其知识、态度的改变情况。方法对某社区内外来流动人员在为期1年时间内（每2个月1次,共6次）进行问卷调查与AIDS相关知识宣教,问卷包括流动人员人口学现状、HIV/AIDS相关知识知晓情况、对待HIV感染者的态度等方面。结果 6次宣教后,受访者对HIV/AIDS的性、血液和母婴3种传播途径的知晓率达到或超过90%,较宣教前提高20个百分点;对HIV感染者的态度改善,但对疾病普遍存在恐惧。结论针对北京市石景山区某社区流动人员的连续艾滋病宣教取得良好效果,应当进一步加强教育,改善流动人员对HIV感染者的态度。     

Transfusion-Transmitted AIDS with Blood Negative for Anti-HIV and HIV-Antigen

A four-year-old boy who was diagnosed with Glanzmann's thrombasthenia received supportive treatment and desmopressin for his bleeding episodes. He seldom received blood components, except for platelet concentrates, due to severe bleeding. He was exposed to 18 routine donors and 2 plateletpheresis donors who were negative for human immunodeficiency virus (HIV) antigen and anti-HIV upon screening. At the age of 3 years and 9 months (4.5 months after the transfusion of platelet concentrate), he developed full-blown AIDS and died from circulatory failure 3 months later. The source of HIV transmission was identified as 1 donor who developed anti-HIV 3 months after the last donation. The rather short incubation time of AIDS in this case was attributed to a large inoculum of HIV virus in the ‘window perioD' of infectivity of the newly infected donor. This case illustrates transfusion-transmitted HIV leading to AIDS, even though HIV antigen and anti-HIV screening tests were negative.     

A sensitive viral capture assay for detection of plasma viremia in HIV-infected individuals.

Human immunodeficiency virus was detected in the serum/plasma of individuals infected with human immunodeficiency virus (HIV) after capture of virions on microparticles coated with monoclonal antibodies to external and transmembrane proteins of HIV-1. We analyzed serial samples obtained from 6 individuals who seroconverted, 18 asymptomatic, and 12 AIDS patients. HIV-1 RNA was detected in all (29/29) seropositive samples and in 6 seronegative samples immediately preceding seroconversion. In contrast, HIV antigen was detected in 13/29 (45%) of seropositive samples. HIV-1 RNA was also detected in 3 antigen-negative samples from one individual 8-5 months prior to seroconversion and in one sample from another person 2 days before antigen positivity. The intensity of the polymerase chain reaction (PCR) signal paralleled the concentration of HIV antigen. Conversely, seropositive HIV antigen-negative samples gave a weaker PCR signal. HIV-1 RNA was detected in 10/18 (60%) samples from asymptomatic, HIV antigen-negative, individuals and in 11/12 (92%) specimens obtained from AIDS patients. The viral capture method may provide a sensitive, specific, and semiquantitative means of detecting circulating HIV at all stages of infection.     

Antibodies mediating cellular cytotoxicity and neutralization correlate with a better clinical stage in children born to human immunodeficiency virus-infected mothers

In children born to human immunodeficiency virus (HIV)-infected mothers, factors that determine disease outcome and progression are unclear. Also, early diagnosis is hampered by maternally transferred antibodies. Children aged 0-24 months were retrospectively divided into two groups based on HIV seroreactivity or nonreactivity at age 15 months and analyzed for the presence of antibodies that mediate cellular cytotoxicity (ADCC) and virus neutralization. No difference was seen in the presence of these functional antibodies between groups. The persistently seropositive group was further divided into non-AIDS and AIDS groups according to clinical status at serum collection. The ADCC antibody frequencies were much higher (70%) in the non-AIDS group than in the AIDS group (30%). Of the non-AIDS children, 63% had neutralizing antibodies; no children with AIDS had these antibodies. HIV-specific ADCC and neutralizing antibodies do not seem to protect against transmission of HIV from mother to child but are significantly correlated with a better clinical stage of childhood HIV infection.     

Changing trends in human immunodeficiency virus and acquired immunodeficiency syndrome in the population aged 50 and older

OBJECTIVES: To alert persons in the public and private healthcare professions to the increasing trends in higher proportions of persons aged 50 and older who are newly diagnosed with human immunodeficiency virus (HIV) and who are living with HIV and acquired immunodeficiency syndrome (AIDS). DESIGN: Data from the period 1992 through 2004 from the HIV/AIDS Reporting System (HARS) were analyzed. SETTING: New Jersey is the eleventh-most-populous state, with the highest density of persons per square mile. It also has the fifth-highest number of AIDS cases. PARTICIPANTS: All persons residing in New Jersey and reported to HARS with HIV infection or who are considered to have AIDS. MEASUREMENTS: Trends in persons aged 50 and older were compared with those in the population younger than 50 during 1992 through 2004 for the numbers of persons living with HIV/AIDS and the number of persons newly diagnosed with HIV infection. RESULTS: The proportion of all persons aged 50 and older living with HIV/AIDS in 2004 was significantly greater than the comparable proportion of persons in 1992. Proportionally, more persons were newly diagnosed with HIV who were aged 50 and older according to sex and for each of the three major race or ethnicity groups (white non-Hispanic, black non-Hispanic, and Hispanic) than were persons younger than 50. Each of these increases was statistically significant. CONCLUSION: HIV/AIDS social marketing campaigns should include images and issues related to older persons in educational and prevention efforts. New methods that reach older populations should be considered. Physicians and other healthcare providers should be made aware of their role in prevention and education about HIV. Testing of older populations with risk factors should be encouraged.     

AIDS and haemophilia. A study among Dutch haemophiliacs on the psychological impact of the AIDS threat, the prevalence of HIV antibodies and the adoption of measures to prevent HIV transmission

More than 75% of all Dutch haemophiliacs participated in a mail survey that included a section on acquired immunodeficiency syndrome (AIDS). Although no cases of haemophilia-related AIDS had been reported in the Netherlands at the time of our survey, the threat of AIDS had caused considerable anxiety among Dutch haemophiliacs. This had led almost a third of the patients to change their therapy schedules. These changes were mostly not beneficial and possibly counterproductive, since they were not likely to reduce the risk of human immunodeficiency virus (HIV) infection. Measures that were advised to prevent HIV transmission, such as the use of condoms, were seldom carried out, even by the 17% seropositive individuals. We conclude that an increase in the informational efforts towards the patients is called for to avoid ill-advised treatment changes and to enhance preventive behaviour.