Anticardiolipin antibodies in HIV-negative and HIV-positive haemophiliacs

Anticardiolipin antibodies (ACA) were determined in 72 heavily transfused haemophiliacs, 43 HIV-positive and 29 HIV-negative. The presence of ACA was detected in 10 patients, all of them infected by HIV: 8 in CDC II, 1 in CDC III and 1 in CDC IV. The comparison with alterations of other laboratory markers in HIV-infected patients did not show any statistically significant difference between ACA-negative and -positive patients. In summary, ACA were found only in HIV-infected haemophiliacs. In this subgroup of patients the presence of ACA was not associated with progression to AIDS.     

Refractory Trichomoniasis in HIV-positive and HIV-negative Subjects

Trichomonas vaginalis, a common pathogen, remains widely unknown to the public. Its clinical consequences include upper genital tract infection, increased risk of preterm delivery, and increased risk of HIV transmission. Diagnostic tests, especially in men, have historically had low sensitivity, but the recent development of rapid, reliable point-of-care testing is a step toward improved detection. Reliable treatments for trichomoniasis are limited to the nitroimidazoles, and options for cases with either hypersensitivity or resistance remain limited. In select resistant cases, alternatives, most notably paromomycin, may play a role. A complex interaction exists between T. vaginalis and HIV, whereby women with trichomoniasis are at increased risk for HIV and vice versa. It is hoped that diagnosis and treatment of trichomoniasis in women at high risk for HIV may help to lower the incidence of both infections.     

Long-term follow-up of HIV-positive and HIV-negative individuals in rural Malawi

OBJECTIVE: To measure the effect of HIV on survival in rural Africa. DESIGN: A retrospective cohort study with more than 10 years follow-up. METHODS: Individuals with known HIV status in the 1980s were identified from previous population surveys in Karonga District, northern Malawi. Follow-up studies were conducted in 1998-2000 to trace 197 HIV-positive and 396 age-sex-matched HIV-negative individuals and their spouses. RESULTS: Information was obtained on all but 11 index individuals. Half (302) were found and the others were reported to have died (161) or to be alive outside the district (119). Ten year survival was 36% in the HIV-positive cohort and 90% in the initially HIV-negative cohort. The death rate was 93.3 per 1000 person-years in the HIV-positive individuals, and 11.3 in the initially HIV-negative individuals. Survival time since the initial test in HIV-positive individuals decreased with age, but relative survival, compared with HIV-negative individuals, was similar across age groups. The effect of HIV on survival was similar in men and women. Spouses of HIV-positive individuals had four times the mortality rate, and among survivors, four times the HIV prevalence, of spouses of initially HIV-negative individuals. CONCLUSION: HIV-infected individuals had very high mortality rates, but one-third were still alive at 10 years. This is consistent with median survival from seroconversion being similar to that found in developed countries before antiretroviral therapy. Mortality rates in HIV-positive individuals increased with age, but relative mortality changed little with age.     

HIV infection in families of HIV-positive and 'at-risk' HIV-negative women

Research of HIV infection within the family has focused upon sexual partners and vertical transmission. The scope of the problem of multiple infections and clustering of HIV among family members has, thus far, been less extensively explored. The objectives of this study are to investigate HIV infection in family members of HIV-seropositive and HIV-seronegative high-risk women and to consider the impact of multiple HIV infections within the family. Baseline data were evaluated from a prospective observational cohort of 871 HIV-seropositive and 439 seronegative at-risk women who are participants in a longitudinal study of HIV in women at four sites in the USA (Montefiore, Bronx, NY; Johns Hopkins University, Baltimore, MD; Brown University, Providence, RI; Wayne State University, Detroit, MI). Women were asked if anyone close to them had HIV/AIDS or had died from HIV/AIDS. Responses which included HIV-positive family members were analyzed. In the seropositive cohort, 35% (307/871) of the women had a family member with HIV infection. Of these 307 women, 38% reported having a sibling, 24% a husband and 27% had more than one family member with HIV/AIDS. Forty-nine per cent of Latina women, 34% of black women, and 21% of white women reported having a family member with HIV/AIDS. Using logistic regression analysis, we found that Latina and black women were significantly more likely than white women to have a sibling, extended family member or more than one family member with HIV/AIDS. Compared to seropositive women, seronegative high-risk women enrolled in this study appear equally likely to have an HIV-infected family member. In this study of HIV-positive women and high-risk seronegative women, a third reported having multiple family members with HIV infection, most often in a sibling. The high prevalence of HIV within families, particularly in the families of Latina and black women, mandates attention in planning both prevention and care.     

Taxonomy and biology of liver flukes

Opisthorchis viverrini is a human liver fluke endemic in Thailand, Lao PDR and Cambodia. Three subspecies of Bithynia siamensis and 18 species of cyprinoid fish are susceptible first and second intermediate hosts, respectively. The differentiation between the adult worm of O. viverrini and that of the closely related species, Opisthorchis felineus and Clonorchis sinensis, is mainly based on the shape and position of the testes and the arrangement of the vitellaria. Eggs of these flukes are morphologically similar and problematic in identification. However, the differentiation between opisthorchid and lecithodendrid eggs is possible. Morphology and biology of each stage are comparatively reviewed. Biological aspects of snail and fish hosts are also included.     

Comparison of colorectal cancer screening and diagnoses in HIV-positive and HIV-negative veterans

Non-AIDS defining malignancies, including colorectal cancer (CRC), are emerging as significant problems in HIV-infected people. Some data suggest that HIV-positive patients have higher incidence of CRC at younger ages than those who are HIV-negative. This investigation examined CRC rates and screening types and trends between 943 HIV-infected cases and their age, race, and gender matched HIV-negative controls (n = 943) from 1 January 2005 to 31 December 2008 at the Atlanta VA Medical Center. The most common screening type among these patients was fecal occult blood testing (FOBT), but colonoscopies were more common in the controls (16.4% for cases, 27.5% for controls; p < 0.0001). Almost half of all patients included in this analysis did not have any screening for CRC during the four years of follow-up even though average age was 55 years. Fifty-one percent of cases had at least one screening test during follow-up compared to 48% of the controls; 7.6% of the cases had a screening each of the four years compared to only 2.4% of the controls (p < 0.0001). Ten HIV-positive patients were diagnosed with CRC during the study period compared to no CRC diagnoses among controls (p = 0.0015), though there was no difference in the diagnosis of colon polyps (4.6% vs. 5.1%, p = 0.5911). These data also suggest a discrepancy in CRC incidence between race and age groups: 80% of HIV-positive cases diagnosed with CRC during the study were black and two were less than 50 years of age. Future studies will need to address whether different recommendations are needed for screening based on HIV status, younger age, or race.     

Clinical Predictors for Death in HIV-positive and HIV-negative Tuberculosis Patients in Guinea-Bissau

Abstract Object: To assess easily monitored predictors for tuberculosis mortality. Design: Risk factors for tuberculosis mortality were assessed during the 8-month treatment in 440 men and 269 women diagnosed with confirmed or presumed intrathoracic tuberculosis included prospectively in Guinea-Bissau from May 1996 to April 2001. A civil war occurred in the study area from June 1998 to May 1999. Results: 12% were HIV-1 positive, 16% HIV-2 positive and 7% were HIV dually infected. Case fatality rates for HIV positive were higher during (35% [22/63]) and after the war (29% [27/92]) compared to before the war (17% [15/88]). The war did not have an effect on the case fatality rate in HIV negative (10% [13/135] before the war). HIV-1-infected patients had higher mortality than HIV-2 infected, mortality rate ratio (MRR) = 2.28 (95% confidence interval 1.17–4.46). Men had higher mortality than women but only among the HIV negative (MRR = 2.09 [0.95–4.59]). Hence, the negative impact of HIV infection on mortality was stronger in women (MRR = 6.51 [2.98–14.2]) than in men (MRR = 2.64 [1.67–4.17]) (test of homogeneity, p = 0.051). Anergy to tuberculin was associated with death in HIV positive (MRR = 2.77 [1.38–5.54]) but not in HIV negative (MRR = 1.14 [0.52–2.53]). Signs of immune deficiency, such as oral candida infection or leukoplakia (MRR = 4.25 [1.92–9.44]) and diarrhea (MRR = 2.15 [1.29–3.58] was associated with mortality in HIV positive. Tendencies were similar among HIV negative. HIV-positive relapse cases were at increased risk of dying (MRR = 2.42 [1.10–5.34]). Malnutrition, measured through mid-upper arm circumference (MUAC), increased the risk of death. Conclusion: Easily monitored predictors for mortality in tuberculosis patients include clinical signs of immune deficiency and low MUAC.     

Relationship satisfaction of HIV-positive Ugandan individuals with HIV-negative partners

Challenges of relational coping are well documented in the literature on couples and chronic illnesses, but there is significantly less research on the psychological aspects of couple relationships and HIV, particularly in international contexts. Coping with the uncertainty of illness progression, family planning, disclosure to friends and family, social isolation and stigma, fear of transmission, sexual intimacy, changes to social and physical functioning, and receiving and providing care pose special challenges for couples with discordant HIV statuses. This study examined the correlates of relationship satisfaction in Ugandan HIV-positive individuals seeking treatment at a community clinic. Relationship satisfaction of HIV-positive individuals was uniquely predicted by their couple identity and depression, underscoring the importance of mental and relational health in HIV/AIDS.     

Physical activity in a cohort of HIV-positive and HIV-negative injection drug users

Physical activity is beneficial for persons with HIV infection but little is known about the relationships between physical activity, HIV treatment and injection drug use (IDU). This study compared physical activity levels between HIV-negative and HIV-positive injection drug users (IDUs) and between HIV-positive participants not on any treatment and participants on highly active antiretroviral therapy (HAART). Anthropometric measurements were obtained and an interviewer-administered modified Paffenbarger physical activity questionnaire was administered to 324 participants in a sub-study of the AIDS Linked to Intravenous Experiences (ALIVE) cohort, an ongoing study of HIV-negative and HIV-positive IDUs. Generalized linear models were used to obtain univariate means and to adjust for confounding (age, gender, employment and recent IDU). Vigorous activity was lower among HAART participants than HIV-positive participants not on treatment (p=0.0025) and somewhat lower than HIV-negative participants (p=0.11). Injection drug use and viral load were not associated with vigorous activity. Energy expenditure in vigorous activity was also lower among HAART participants than both HIV-negative and HIV-positive participants not on treatment. Thus, HIV-positive participants on HAART spend less time on vigorous activity independent of recent IDU. More research is needed into the reasons and mechanism for the lack of vigorous activities, including behavioral, psychological and physiological reasons.     

Aggressive Behaviors in the Adolescent Children of HIV-positive and HIV-negative Drug-abusing Fathers

This study examined aggressive behaviors in the adolescent children of HIV-positive and HIV-negative drug-abusing fathers. Data were collected via individual structured interviews of low-income, predominantly African American and Hispanic, father-child dyads (N = 415). Structural Equation Modeling was used to assess the interrelationship of several latent constructs with respect to adolescent aggression. Results showed a mediational model linking paternal attributes (including HIV status) and ecological factors with the father-child relationship, which impacted peer influences and the adolescent's vulnerable personality, which was the most proximal construct to aggressive behaviors. Ecological factors were also mediated by peer influences and directly linked with adolescent aggression.     

Aggressive behaviors in the adolescent children of HIV-positive and HIV-negative drug-abusing fathers

This study examined aggressive behaviors in the adolescent children of HIV-positive and HIV-negative drug-abusing fathers. Data were collected via individual structured interviews of low-income, predominantly African American and Hispanic, father-child dyads (N = 415). Structural Equation Modeling was used to assess the interrelationship of several latent constructs with respect to adolescent aggression. Results showed a mediational model linking paternal attributes (including HIV status) and ecological factors with the father-child relationship, which impacted peer influences and the adolescent's vulnerable personality, which was the most proximal construct to aggressive behaviors. Ecological factors were also mediated by peer influences and directly linked with adolescent aggression.     

Frequent injecting impairs lymphocyte reactivity in HIV-positive and HIV-negative drug users.

To investigate whether drug use affected immunological parameters, we conducted a cross-sectional study of 321 drug users. Absolute numbers of CD4+ lymphocytes and the T-cell reactivity were lower in HIV-positive than in HIV-negative people. The functional capacity of the T-cell system as measured after stimulation with a monoclonal antibody directed against CD3 was found to be strongly associated with the frequency of injecting, while no relationship was found between the frequency of injecting and the total number of lymphocytes or T-cell subsets. HIV-negative and HIV-positive drug users who had injected a mean of three times a day in the preceding 4-6 months had a T-cell reactivity which was 40-50% lower compared with seronegative and with seropositive drug users who had not injected in the preceding months. We conclude that lymphocyte reactivity is depressed by frequent injecting in HIV-negative and HIV-positive drug users.     

Detection of intestinal parasites from dogs in Tochigi-City in 1979 and 1991]

To clarify whether sanitary and hygienic conditions surrounding humans and pet animals have improved or not, we examined feces from dogs for intestinal parasites in Tochigi in 1979 and 1991. Intestinal parasites were detected from 109 of the 262 dogs (41.9%) in 1979 and 86 of the 260 dogs (32.8%) in 1991. Among the parasites. Ancylostoma caninum, Tirchuris vulpis and Toxocara canis were most commonly detected, and their detection rates were higher in 1979. On the contrary, Dipylidium caninum, Strongyloides stercoralis, Isospora spp., which are important causes of human diseases, were detected at higher rates in 1991. In the dogs of outdoor feeding, the detection rates of parasites were markedly decreased, but slightly increased in the dogs of indoor feeding in 1991. These results suggest that sanitary conditions surrounding pet animals have not been sufficiently improved, in spite of the fact that humans are in more contact with their pet animals.     

Procoagulant and fibrinolytic activities in bronchoalveolar fluid of HIV-positive and HIV-negative patients.

Imbalance between intra-alveolar procoagulant activity (PCA) and fibrinolytic activity may lead to fibrin deposition, as described in several pneumopathies, and may eventually contribute to fibrotic changes as observed in Pneumocystis carinii pneumonia (PCP). The aim of our study was to compare these activities in bronchoalveolar lavages of human immunodeficiency virus (HIV)-positive and HIV-negative patients. The material comprised: a) controls (n = 7); b) HIV-positive patients subdivided into PCP (n = 11), bacterial pneumonia (n = 8) and other pneumopathies (n = 22); and c) HIV-negative patients with bacterial pneumonia (n = 8). PCA was significantly increased (p less than 0.05) in all patient groups compared to controls. The urokinase-type plasminogen activator (u-PA) antigen levels were highest during bacterial pneumonia. Regardless of the HIV status, in bacterial pneumonia there was a marked elevation of plasminogen activator inhibitor antigens with little residual fibrinolytic activity. In contrast, the fibrinolytic activity was not decreased in PCP. D-dimer were elevated during PCP compared to controls; the highest levels were found in HIV-negative bacterial pneumonia. These data indicate that transient fibrotic changes seen in PCP may be favoured by increased PCA, but not by a depressed fibrinolytic activity. In bacterial pneumonia PCA is increased and fibrinolysis decreased independently of the HIV status.     

Trematode infections: liver and lung flukes

Food-borne trematodiases are an emerging public health problem in Southeast Asia and Latin America and of growing importance for travel clinics in Europe and North America. The disease is caused by chronic infections with liver, lung, and intestinal flukes. This article focuses on the most important liver and lung flukes that parasitize man, namely Clonorchis sinensis, Fasciola gigantica, Fasciola hepatica, Opisthorchis felineus, Opisthorchis viverrini, and Paragonimus spp. The article describes the epidemiology of major liver and lung fluke infections, including current distribution, burden, life cycle, clinical signs and symptoms, diagnostic approaches, and current tools for prevention, treatment, and control.     

Prevalence, incidence and risk factors of anaemia in HIV-positive and HIV-negative drug users

Aims. To determine the prevalence of anaemia among HIV-positive and-negative drug users, estimate the incidence of anaemia among HIV-positive drug users and study risk factors for prevalent anaemia with emphasis on HIV infection, gender and drug use behaviour. Design, setting and participants. Cross-sectional study among HIV-positive and HIV-negative drug users (n = 360) and a longitudinal study among HIV-positive drug users (n = 175, 860 visits) participating in a cohort study of drug users in Amsterdam. Measurements. Self-reported data on socio-demographics, drug use behaviour and zidovudine and protease inhibitor therapy on regular cohort visits. Laboratory determinations of haemoglobin concentration, CD4 ⁺ -cell counts and HIV-1 RNA. Findings. The prevalence of anaemia was 21.1% among participating drug users according to the WHO definition. The incidence of anaemia in HIV-positive individuals was 33.0/100 person-years. The main risk factor for anaemia was high frequency of injecting drugs. A Quetelet body mass index <20 and female gender were also positively and significantly related to anaemia in the cross-sectional study. In the longitudinal study among HIV-positive drug users progression of HIV infection indicated by low CD4 ⁺ -cell count and AIDS diagnosis were predictive of anaemia. Conclusion. The results indicate that drug users in the Amsterdam cohort study have a high prevalence of anaemia, which can be explained mainly by high frequency of injecting drugs and HIV infection progression. Reduction or cessation of injecting drug use should reduce anaemia.