Health care workers with AIDS. National surveillance update.

OBJECTIVES--To characterize health care workers with the acquired immunodeficiency syndrome (AIDS) in the United States and to evaluate the role of occupational transmission of the human immunodeficiency virus (HIV). DATA SOURCE--National AIDS surveillance data. METHODS--Health care workers with AIDS are reported to the Centers for Disease Control by state and local health departments. Health care workers who do not report a nonoccupational risk for HIV infection are termed undetermined risk cases and are investigated by health departments using a standard protocol. RESULTS--Through June 30, 1990, there were 5425 cases of AIDS in health care workers reported in the United States. Three of these workers developed AIDS following well-documented occupational exposure to HIV-infected blood. Of the 539 health care workers initially reported without a nonoccupational risk, follow-up investigations were completed for 303. Nonoccupational risk factors were established for 237 (78.2%) of the 303 investigated health care workers; 66 workers (21.8%) remained in the undetermined category. Follow-up information was incomplete for 236 health care workers who also remained in the undetermined category, resulting in 5120 health care workers (94.4%) with AIDS with nonoccupational risks for HIV infection. Overall, health care workers were more likely than non-health care workers with AIDS to have an undetermined risk for HIV infection (5.6% vs 2.8%; P less than .001). While many of the 66 investigated health care workers had jobs involving contact with patients and/or potential contact with blood, none reported percutaneous, mucous membrane, or cutaneous exposures to blood or body fluids known to be infected with HIV. CONCLUSION--Surveillance data suggest that most health care workers with AIDS acquired their HIV infection through a nonoccupational route.     

Human retroviral infections in The Gambia: prevalence and clinical features

The prevalence of infection with human immunodeficiency virus type 1 (HIV 1) is lower in west Africa than in other parts of Africa. Human immunodeficiency virus type 2 (HIV 2) has been isolated from west African patients and may be transmitted by heterosexual contact. The prevalence of antibodies to HIV 1 and HIV 2 was studied by enzyme linked immunosorbent assay (ELISA) among various groups of subjects in The Gambia, west Africa--namely, prostitutes, blood donors, patients with suspected infection with HIV, patients attending clinics for sexually transmitted diseases, and patients with tuberculosis. Four cases of the acquired immune deficiency syndrome (AIDS) due to infection with HIV 1 were detected, of which three had been acquired abroad. No other subject was found to be positive for antibodies to HIV 1. The prevalence of antibodies to HIV 2 among the patients attending clinics for sexually transmitted diseases was found to have increased from 0/117 in 1984 to 10/185 (5%) in the last six months of 1986. One out of 278 blood donors was positive for antibodies to HIV 2 as were 10 out of 80 patients with suspected AIDS. HIV 2 seems to be transmitted sexually, and, although it has been present for only a short time, it seems to be endemic in The Gambia and is pathogenic.     

陕西省TB与HIV/AIDS双向筛查及TB/HIV患者抗结核治疗转归队列分析

目的 了解陕西省TB/HIV (结核分枝杆菌 /艾滋病病毒)双重感染防治工作。提高TB/HIV发现、治疗和管理力度,控制结核病和艾滋病的进一步传播,保护公众健康。方法 收集整理和分析2010—2017年陕西省各地上报的《TB/HIV 双重感染防治管理工作年度报表》。结果 2010—2017年,累计接受HIV抗体检测的结核病患者43 304例,检测率25.10%,HIV检测阳性数16例,阳性检出率0.04%;同期,HIV /AIDS患者中,新检出的HIV/AIDS中接受X线胸片或查痰9 666人,结核病检查率76.81%;诊断TB/HIV双重感染患者224人,结核病患者检出率2.32%;既往的HIV/AIDS中接受X线胸片或查痰24 277人次,结核病检查率80.43%;诊断TB/HIV双重感染患者105人,结核病患者检出率0.43%;结核中筛HIV/AIDS,新检出HIV/AIDS中筛结核,既往HIV/AIDS中筛结核,三组检出率两两进行对比,差别均有统计学意义（P<0.001）;共进行抗结核治疗263例,抗结核治疗率76.23%;进行抗病毒治疗256例,抗病毒治疗率74.20%;抗结核治疗的TB/HIV患者中治愈35例（17.59%）,完成疗程率141例（70.85%）,结核死亡1例（0.50%）,非结核死亡15例（7.54%）,丢失2例（1.00%）,其他5例（2.51%）。结论 双向筛查是切实有效的早期发现TB/HIV的方法,有利于提高TB/HIV的早期发现,并能提高TB/HIV双重感染患者结核病的治疗成功率、降低结核病死亡率,有效的控制TB/HIV双重感染疫情。     

Incidence of tuberculosis among reported AIDS cases in Quebec from 1979 to 1996

BACKGROUND: The impact of HIV infection on tuberculosis (TB) rates in Quebec has not been fully established. Because concurrent HIV infection is the single most important factor in TB reactivation, the authors used Quebec AIDS surveillance data to quantify the extent of TB among reported AIDS cases and to identify the characteristics of AIDS patients with TB. METHODS: The study population comprised people aged 15 years and over with AIDS diagnosed between Jan. 1, 1979, and Dec. 31, 1996, and reported by Mar. 13, 1997. Patients with TB (all forms) and those without TB were compared. Multivariate logistic regression analysis was used to examine the independent effect of each variable on the AIDS-TB cases. The authors also compared the number of AIDS-TB cases with the number of TB cases to estimate the effect of HIV infection on TB incidence. RESULTS: Of the 4684 people with AIDS reported in Quebec, 242 (5.2%) had active TB at some point during the course of their illness. During 1992-1995, 9.6% of the people with TB in Montreal, and 5.8% in the province of Quebec, also had HIV infection. Those with AIDS and TB were predominantly male (75.2%), manual workers (40.1%) and residents of Montreal (86.4%) and were born in an HIV-endemic country (63.8%). The multivariate analysis indicated that AIDS patients who were born in HIV-endemic countries in the Caribbean, sub-Saharan Africa or other developing regions were 21.8 times (95% confidence interval [CI] 19.5-28.5), 17.9 times (95% CI 12.7-27.1) and 4.9 times (95% CI 3.5-7.0) more likely to have TB than those born in Canada; manual workers and unemployed people with AIDS were 1.6 times (95% CI 1.3-2.0) and 2.0 times (95% CI 1.5-2.6) more likely to have TB than professional workers; and people who acquired HIV infection through heterosexual contact were 2.1 times (95% CI 1.6-3.1) more likely to have TB than men who acquired it through sexual contact with other men. INTERPRETATION: AIDS seems to contribute significantly to the number of TB cases. The results of this study reinforce the importance of offering HIV testing to people in high-risk groups, such as those born in a country where HIV and TB is endemic.     

The acquired immunodeficiency syndrome: a tuberculosis threat?

In the United States there has been an increase in mycobacterial infections that is attributable to the acquired immunodeficiency syndrome (AIDS). Since 1983, when the first case of AIDS was reported in Australia, there have been 523 patients (to June 30, 1987) notified with group-IV AIDS and, of these, 361 (69%) cases have been in New South Wales. Of these 361 notifications, 59 (16%) patients have had concurrent mycobacterial infection. Seven of these patients had Mycobacterium tuberculosis infection and five of these infections occurred in 1986. This means that, in 1986, patients with group-IV AIDS had a rate of infection with Myco. tuberculosis of 3000 per 100,000 population, compared with 5.2 cases per 100,000 population for New South Wales. We sought to determine whether or not there was any unexplained increase in notifications which might be attributable to AIDS. This paper reports cases that were notified to the AIDS and tuberculosis registers, finds that atypical mycobacterial infections are underreported by at least 19.5%, and examines trends in notifications for mycobacterial disease since the onset of the AIDS epidemic. It also raises the importance of appropriate measures to protect health workers from tuberculosis.     

Critical care of patients with AIDS.

OBJECTIVE--We sought to review the clinical and ethical issues surrounding critical care for patients with the acquired immunodeficiency syndrome (AIDS). DATA SOURCES--We reviewed published studies and abstracts dealing with the outcome of critical care for patients with AIDS, decision making about life-sustaining treatments in patients with AIDS, and infection control in the intensive care unit. We also consulted with a number of experts in the field. STUDY SELECTION--We selected outcome studies in which patients with documented AIDS or infection with the human immunodeficiency virus (HIV) were analyzed. We rejected data concerning patients with suspected or presumed AIDS and data concerning presumed cases of Pneumocystis carinii pneumonia (PCP). DATA SYNTHESIS--Most AIDS patients who require critical care do so because of respiratory failure caused by PCP. Although studies early in the epidemic reported survival rates to hospital discharge of 0% to 14%, recent studies demonstrate improved survival rates of 36% to 55%. Treatment for patients with PCP and respiratory failure should include either intravenous trimethoprim-sulfa-methoxazole or pentamidine isethionate, as well as adjuvant corticosteroids. Patients with AIDS may require critical care for many other indications, including seizures, sepsis, and hypotension, or reasons unrelated to their immunodeficiency. In general, such patients have a better prognosis than those with respiratory failure. CONCLUSION--The provision of critical care for PCP and respiratory failure specifically or AIDS generally cannot be considered futile. Therefore, decisions about the use of critical care should be guided by the particular clinical situation and the patient's preferences. More research is needed to elucidate the reasons for the improving survival for patients with PCP and respiratory failure and the predictors of such survival.     

Looking down the barrel of a cannon: the potential economic costs of HIV/AIDS in Papua New Guinea

The HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) epidemiological model for southern Africa appears to fit data available for the Papua New Guinea (PNG) experience to date. Using certain aspects of the southern African experience, we can create some scenarios for the potential economic costs of HIV/AIDS in PNG. The first part of this paper surveys relevant literature that reports the economic impact of HIV/AIDS in southern Africa, primarily in terms of the microeconomic (health system) and macroeconomic (economy-wide) costs. The second part of the paper presents alternative scenarios for PNG at the micro- and macro- levels, both of which are grounded on the southern African experience.     

Comparisons of hospital care for patients with AIDS and other HIV-related conditions.

OBJECTIVE--To compare utilization and financing of inpatient care for persons with the acquired immunodeficiency syndrome (AIDS) (as defined by the Centers for Disease Control) and those with "other HIV [human immunodeficiency virus]-related illness." DESIGN--A mailed survey of the members of five national organizations representing public, teaching, children's, community, and Catholic hospitals. The survey requested information on demographics, service utilization, costs, and financing of care for AIDS and other HIV patients. Statistical analysis using paired t tests was conducted to evaluate differences between group means for AIDS and other HIV patients. Differences among categorical variables were evaluated by calculation of proportions and compared using chi 2 tests. PARTICIPANTS--Five hundred eighteen of 1158 hospitals surveyed responded to the AIDS and other HIV portions of the survey. RESULTS--Three hundred twenty-five hospitals reported treating at least one other HIV patient. These 325 hospitals treated 30% of all AIDS patients (16,213) estimated to have been alive during 1988, and provided care to over 11,000 other HIV patients. Service utilization by other HIV patients was found to comprise a substantial portion of the total HIV burden and related costs, representing 35% of all HIV-related admissions, 29% of all inpatient costs, and 35% of all inpatient losses. Demographic and mode of exposure analysis indicated that other HIV patients were more likely than AIDS patients to be intravenous drug users, female, nonwhite, and to have no source of public or private coverage for their health care. CONCLUSIONS--Our results demonstrate that accounting for only the utilization of services by persons with AIDS as defined by the Centers for Disease Control will understate significantly the total burden of the HIV epidemic on hospitals. The results suggest that the expanded definition proposed by the Centers for Disease Control would incorporate a large hospitalized HIV population.     

A surgeon with AIDS. Lack of evidence of transmission to patients

In January 1989 [corrected], the media reported the identity of a surgeon who was recently diagnosed with the acquired immunodeficiency syndrome (AIDS). Concern about surgeon-to-patient transmission of human immunodeficiency virus (HIV) persisted despite reassurances from health authorities. Therefore, HIV antibody testing was offered to the surgeon's patients. We identified 2160 patients operated on since 1982; none had been reported to Tennessee's AIDS registry. A total of 264 had already died; none were reported to have died of AIDS or other HIV-related diseases. Of the 1896 patients remaining, we contacted 1652; 616 (37%) were tested. Only one (an intravenous drug user) was HIV antibody positive, and his medical history suggested that he may already have had AIDS at the time of his surgery. These results support the concept that the risks to patients operated on by HIV-infected surgeons are most likely quite low and support recommendations for the individualized assessment of HIV-infected health care workers.     

全球结核病的流行与控制

结核病是一个全球性的疾病,在被忽略近20年后又死灰复燃,成为当今世界一个主要的公共卫生问题.1993年,世界卫生组织因结核病的流行规模及控制全球结核病的迫切需要,宣布全球进入结核病紧急状态.中国是世界上人口最多的国家,位居全球结核病感染最严重的22个国家之首位.在20世纪80年代中晚期,美国也终止了其长期以来结核病的下降趋势,1992年美国结核病的发病率达到一个高峰.撒哈拉以南非洲地区是世界结核病例分布最多的三个区域之一,世界结核病发病率最高的15个国家有13个在这个地区内,并且HIV是这一区域结核病发病率最主要的单一预计因子.世界最严重的HIV相关结核病发病也是在这个区域.全球持续的严重结核感染状态,是由于贫困人口的增加和来自于结核高发病率国家的人口流动和HIV的影响,最主要的是没有维持必需的公共卫生组织及设施,以及错误的认为结核病已成为一个过去的问题.依靠现有的诊断和治疗方法,WHO推荐的DOT方案有效而经济,适用于全球在不同条件下的结核控制.     

我院住院结核病患者艾滋病病毒感染现况分析

目的了解我院住院结核病患者艾滋病毒(HIV)感染现状及流行病学特征。方法对住院结核病患者进行艾滋病毒(HIV)筛查,对疑似阳性标本送哈市疾控中心艾滋病实验室做确证试验。结果自2009-01～2011-08间,我院筛查18 550例患者标本,确证HIV阳性25例。HIV感染率1.35‰。低于世界卫生组织(WHO)估算我国新发结核患者艾滋病发病率的1.9%。人群分布为25～50岁的结核病患者HIV感染率最高3.61‰(χ2=37.7,P<0.001)。结论我院住院结核患者HIV感染处于低水平。     

Situation analysis of HIV/AIDS epidemic in sub-Saharan Africa

At the end of 1997 about twenty one million persons were living with HIV/AIDS in sub-Saharan Africa, representing almost two third of the world's total. Three broadly defined areas, which include countries with severe epidemics and others with epidemics at their intermediate stage, account for almost 90% of all current HIV infections in tropical Africa. According to World Health Organization (WHO), the current data show very high increases in HIV/AIDS incidence as well as serious underreporting of the disease in the last five years. Sub-Saharan Africa has been particularly hard hit by the disease because of a combination of poor social and health education and also because of other endemic sexually transmitted diseases which significantly increase the chance of HIV transmission.     

AIDS: the HIV epidemic. A time of transition

The surveillance of clinical cases of acquired immune deficiency syndrome (AIDS) in the United States began in June 1981 when the first case was reported. Since then, state and federal public health officials have continuously monitored progression of the epidemic by the number of persons reported with diagnosed clinical AIDS. The human immunodeficiency virus (HIV) that causes AIDS was identified in 1983 and an antibody test was licensed by the Food and Drug Administration in 1985. Recent studies have shown that the time from HIV infection to development of clinical AIDS is an average of seven or more years. Consequently, the reported cases of clinical AIDS reflect the severity of the epidemic an average of seven years ago or more, not now, and certainly not in the future. The AIDS epidemic is in reality an HIV epidemic. The number of persons with HIV infections is a better measure of the present status and future course of the disease. This paper discusses the development of HIV prevalence and incidence studies and illustrates the use of these data to predict the future number of persons with clinical AIDS and the economic impact of the epidemic.     

The reality of despair: AIDS in Malawi.

While completing a recent medical elective in the Central African country of Malawi, medical student Dale Needham learned firsthand that HIV/AIDS represents a true pandemic in Africa. By the end of 1993, Malawi had the continent's highest per capita number of cumulative reported AIDS cases. Although Canadian physicians have had their own struggles helping patients with HIV/AIDS, many more battles are being fought in countries like Malawi, where financial resources are limited. In Africa, HIV-positive people of all ages suffer incredibly from diseases such as protein energy malnutrition, tuberculosis and cryptococcal meningitis. Primary health care programs, education in the primary schools and community awareness and support are partial answers to the pandemic.     

Review: Head and neck squamous cell carcinoma in sub-Saharan Africa

Aim

Review the literature from 1990 to 2013 to determine known anatomic sites, risk factors, treatments, and outcomes of head and neck squamous cell carcinoma (HNSCC) in sub-Saharan Africa.

Methods

Using a systematic search strategy, literature pertaining to HNSCC in sub-Saharan Africa was reviewed and patient demographics, anatomic sites, histology, stage, treatment, and outcomes were abstracted. The contributions of human immunodeficiency virus (HIV), human papillomavirus (HPV) and behavioural risk factors to HNSCC in the region were assessed.

Results

Of the 342 papers identified, 46 were utilized for review, including 8611 patients. In sub-Saharan Africa, the oropharyngeal/oral cavity was found to be the most common site, with 7750 cases (90% of all cases). Few papers distinguished oropharyngeal from oral cavity, making identification of possible HPV-associated oropharyngeal squamous cell carcinoma (SCC) difficult. SCC of the nasopharynx, nasal cavity, or paranasal sinuses was identified in 410 patients (4.8% of all cases). Laryngeal SCC was found in 385 patients (4.5% of all cases), and only 66 patients (0.8% of all cases) with hypopharyngeal SCC were identified. In 862 patients with data available, 43% used tobacco and 42% used alcohol, and reported use varied widely and was more common in laryngeal SCC than that of the oropharyngeal/oral cavity. Toombak and kola nut use was reported to be higher in patients with HNSCC. Several papers reported HIV-positive patients with HNSCC, but it was not possible to determine HNSCC prevalence in HIV-positive compared to negative patients. Reports of treatment and outcomes were rare.

Conclusions

The oropharyngeal/oral cavity was by far the most commonly reported site of HNSCC reported in sub-Saharan Africa. The roles of risk factors in HNSCC incidence in sub-Saharan Africa were difficult to delineate from the available studies, but a majority of patients did not use tobacco and alcohol.     

艾滋病与非结核分枝杆菌的双重感染研究进展

非结核分枝杆菌（non-tuberculous mycobacterium,NTM）感染是指除了结核分枝杆菌复合群和麻风分枝杆菌以外的分枝杆菌引起的感染。属于条件致病菌,常见于有基础疾病和存在免疫缺陷的患者,最好发于HIV感染者,被认为是引起艾滋病患者发生常见机会性感染的病原菌之一,尤其常见于CD4⁺T细胞小于50个/μL的艾滋病患者。近年来,由非结核分枝杆菌引起的感染在全球各地的报道呈现明显上升趋势,严重威胁着人类尤其是艾滋病患者的健康。由于NTM感染的相关临床症状、体征以及影像学表现等缺乏典型,容易被误诊为结核感染,且病死率高。故了解NTM的病原学分类、感染途径、HIV患者感染NTM后两者之间的相互作用机制,以及该病相关临床表现、实验室诊断方法和目前关于该病的治疗方法等显得至关重要,因此本综述就上述内容的研究进展做一概述。     

The acquired immune deficiency syndrome and epidemic of infection with human immunodeficiency virus: costs of care and prevention in an inner London district

The epidemic of the acquired immune deficiency syndrome (AIDS) and infection with human immunodeficiency virus (HIV) necessitates early planning of services and allocation of resources. The use of hospital resources by patients with AIDS and the planned additional costs of clinical and preventive services for the epidemic of infection with HIV were calculated for an inner London health district that has treated 18% of the cases in the United Kingdom. Patients with AIDS required on average 50 days of inpatient hospital care each at an estimated current average lifetime cost of pounds 6800. These costs, however, underestimated the additional capital and revenue costs of planned new preventive and treatment services, estimated as being pounds 388,000 revenue and pounds 472,000 capital for 1986-7. It is important to invest now in preventive services throughout the United Kingdom to reduce the future social and financial costs of AIDS.     

HIV/AIDS国家模型促进艾滋病健康教育探索

目的建立人类免疫缺陷病毒/艾滋病（HIV/AIDS）国家模型,探索基于案例的动态、计算机可视化的HIV/AIDS教育方法。方法根据撒哈拉以南非洲国家的典型数据建立参考模型。根据T21国家模型的基本设计理念,采用系统动力学方法建立HIV/AIDS国家模型,并结合T21国家模型进行人口、社会、经济的系统分析。结果 HIV/AIDS国家模型清晰地模拟了艾滋病50年的传播趋势及其对国家人口、经济和社会的影响。结论 HIV/AIDS国家模型能够直观地反映艾滋病对人口、社会、经济发展的危害,有助于艾滋病健康教育的推进。     

HIV/AIDS国家模型促进艾滋病健康教育探索

目的 建立人类免疫缺陷病毒/艾滋病(HIV/AIDS)国家模型,探索基于案例的动态、计算机可视化的HIV/AIDS教育方法.方法 根据撒哈拉以南非洲国家的典型数据建立参考模型.根据T21国家模型的基本设计理念,采用系统动力学方法建立HIV/AIDS国家模型,并结合T21国家模型进行人口、社会、经济的系统分析.结果 HIV/AIDS国家模型清晰地模拟了艾滋病50年的传播趋势及其对国家人口、经济和社会的影响.结论 HIV/AIDS国家模型能够直观地反映艾滋病对人口、社会、经济发展的危害,有助于艾滋病健康教育的推进.