Antisocial personality disorder, HIV risk behavior and retention in methadone maintenance therapy

In a sample of 55 consecutive methadone maintenance admissions to our clinic, 42% were diagnosed with antisocial personality disorder (ASPD) using the National Institute of Mental Health Diagnostic Interview Schedule NIMH DIS. Individuals with ASPD exhibited greater risk for HIV infection as defined by more sexual contacts, needle use and equipment sharing. Data at 1 year follow-up were obtained on this group of patients. The objective was to compare the ASPD and non-ASPD groups with regards to demographics, drug abuse history, outcome and retention in treatment. There were no significant differences between the groups on any demographic or treatment outcome variables. Survival analysis indicated that there were no group differences in treatment retention. In conclusion, although there were no differences in treatment outcome between ASPD and non-ASPD groups it is possible that ASPD patients who drop out of treatment will be at higher risk for contracting and spreading HIV within the IV drug using population. These data also suggest that in this population the diagnosis of ASPD using primarily behavioral traits as measured in the NIMH-DIS-III, has little utility in predicting treatment outcome.     

Assessing the needs and quality of life of patients with HIV infection: development of theHIVOverview ofProblems-EvaluationSystem (HOPES)

Objective: To develop and evaluate the psychometric properties (reliability, validity etc.) of a comprehensive Quality of Life (QOL) tool, for patients infected with the human immunodeficiency virus (HIV), that was adapted from a previously validated cancer tool. Design: Cross-sectional, patient completed written surveys and interviews. Setting: The Medical Centers serving HIV infected patients in the Los Angeles community including UCLA, community physicians, Veterans Affairs Medical Centers, and a County hospital: and additional data contributed from Johns Hopkins University Medical Center CMV Retinitis Clinic. Patients: Patients (n=318) with HIV infection including asymptomatic (37%), ARC (20%), AIDS (25%) and AIDS with Cancer (18%) receiving health services at one of the above sites. Measurements: The patients self-administered the newly developed instrument, the HOPES (HIVOverview ofProblems-EvaluationSystem), other QOL related tools including the Medical Outcomes Study instrument adapted for HIV (MOS-HIV) the Profile of Mood States (POMS), the Perceived Adjustment to Chronic Illness Scale (PACIS), and the Physical Activity Scale (PAS). Brief interview to assess the Karnofsky Performance Status Score (KPS). Measured sociodemographic characteristics included age, sex, race, HIV risk factor, education etc. Assessed medical history, current medications, HIV clinical classification. Main results: The sociodemographic and medical characteristics of the sample resemble those of the general population with HIV infection in this geographic area: 96% male, 28% nonwhite, 84% homosexual contact as risk factor, 75% receiving antiretroviral therapy. The adaptation of the cancer QOL instrument to HIV appears to have face and content validity according to patients and health professionals who care for HIV infected patients. Analyses of the psychometric properties found that the HOPES has a similar structure to its parent instrument following factor analyses which results in five summary scales representing the Physical, Psychosocial, Medical Interaction, Sexual and Significant Other/Partners domains in addition to a Global Score. Internal consistency of 35 subscales is high with a mean alpha coefficient of 0.82. Correlations of the HOPES summary scales with other QOL instruments are in the predicted directions. Comparing patients within the HIV clinical diagnostic categories on the HOPES Global, Physical, and Psychosocial Summary Scales indicates that Asymptomatic Patients have better QOL than symptomatic patients. This finding is also found in the other QOL instruments which provides evidence of construct validity. Conclusions: The HOPES is an excellent tool for identifying the problems and needs of patients with HIV infection and for assessing their quality of life. It is reliable, valid and acceptable to patients. The tool may be especially useful in developing a normative data base.This paper is dedicated to the memory of Jimmy Stophel who died of AIDS and whose sense of humour improved the quality of many people's lives.This research was supported in part by the UCLA AIDS Clinical Research Center and CARES Consultants. To obtain information about the HOPES, please contact C. A. Coscarelli Schag, CARES Consultants, 2210 Wilshire Blvd., Suite 359, Santa Monica, CA 90403, USA.     

Synthesis of 14C‐labeled piperidines and application to synthesis of [14C]SCH 351125, a CCR5 receptor antagonist

1‐Benzyl‐4‐hydroxy[2‐¹⁴C]piperidine, a useful intermediate in labeled compound synthesis, was prepared from [¹⁴C]formaldehyde in high yield. The distribution pattern of ¹⁴C in the product is consistent with a mechanism involving reversible iminium ion formation and rapid equilibration of the iminium ion through a cationic aza‐Cope rearrangement. These steps precede the rate‐determining intramolecular cyclization step. SCH 351125 is a potent, selective CCR5 receptor antagonist with potential as a treatment for HIV infection. [¹⁴C]SCH 351125, required for metabolism studies, was prepared from 1‐benzyl‐4‐hydroxy[2‐¹⁴C]piperidine in six steps. [¹⁴C]SCH 351125 is a mixture of four atropisomers. Preparation of [¹⁴C]SCH 351125 besylate salt of the desired atropisomer pair is also described. Copyright © 2007 John Wiley & Sons, Ltd.     

1993年云南省瑞丽等地吸毒者艾滋病病毒感染定群研究

１９９３年３月对已建立一年的吸毒者定群研究现场──云南省德宏州瑞丽市、陇川县及潞西县再次进行调查。本次调查７５５例吸毒者及１０２例配偶。从１９９２年进入定群研究ＨＩＶ阴性的８９例静脉吸毒者中，１９９３年又采到血样有５４例，其中９例血清转阳。瑞丽市、陇川县及潞西县１９９２年和１９９３年静注者血清阳转率（／百观察人年）分别为４３．２％及４０．０％，１２．２％及１２．２％，０％及０％。１９９３年新进入定群研究的１１６例静注者中，采集到血样的有１０４例，发现ＨＩＶ阳性３８例。上述三市县１９９２年及１９９３年入定群研究的静注者的ＨＩＶ感染率分别为８１．８％及８５．７％，４４．６％及４０．０％，５．１％及０％。可以看出血清阳转率的高低与ＨＩＶ感染率高低相吻合。ＨＩＶ阳性者的配偶１９９０、１９９２及１９９３年的ＨＩＶ感染率分别为３．１％、９．８％和７．４％，有上升趋势。潞西县ＨＩＶ阳性者少，静脉注射出现时间晚，但近年来静脉吸毒者比例上升快，值得注意。     

广东省1995～2001年HIV抗体阳性献血员合并HBV、HCV、梅毒感染状况调查

目的 了解广东省1995～2001年献血员HIV流行的特征及与其他传染病合并感染情况，为制定HIV经血源传播防治策略提供依据。方法 收集1995～2001年广东省HIV抗体阳性献血员资料进行分析，并进行HBV、HCV和梅毒血清学检测。结果 1995～2001年，广东省累计HIV抗体阳性献血员167例，占全省报告HIV感染总数的5．44％(167／3072)，且献血员中HIV抗体阳性人数逐年增长。167例病例中以男性为多(88．02％)；年龄主要集中在20～29岁组(55．09％)；病例送检地区以广州、深圳和东莞为主；其原籍主要是广东省和河南省。128例肌，抗体阳性献血员中抗-HCV、梅毒抗体及HBsAg阳性率分别为79．69％、7．81％及3．13％，HIV／HCV／梅毒、HIV／HBV／HCV、HIV／HBV／梅毒三重感染率分别为7．81％、3．13％及0，未发现四重感染。结论 广东省肌，抗体阳性献血员合并HCV和梅毒感染率高。应加强献血员的筛查及流动人口的管理，以控制HIV,HBV和HCV经献血员向一般人群传播。     

农村居民艾滋病防治知识及高危行为调查研究

目的　通过对农村居民艾滋病 (AIDS)防治知识及高危行为的研究 ,为制定AIDS预防控制措施提供依据。方法　运用横断面调查研究方法 ,通过两阶段人群抽样对其AIDS防治知识及相关行为进行研究。结果　调查对象听说过AIDS的为 6 1.78% ;答对 0～ 3题为 5 6 .91% ,4～ 9题为 38.4 8% ,10～ 13题为 4 .5 5 % ;认为不可能感染艾滋病病毒的为 5 6 .94 % ,不清楚的为 38.38% ,有可能的为 4 .6 8%。 12人有卖血史 ,15人有性病史 ,在有性行为的 886人中 ,7.6 7%有过 1个以上多性伴。结论　农村居民AIDS知识匮乏 ,存在着相关危险行为。所以 ,我省预防AIDS的策略主要是开展健康教育积极推进健康促进 ,改善危险行为 ,提倡安全性行为和推广安全套的使用     

Chronic cryptococcal meningitis in an intravenous drug addict without evidence of infection by HIV-1,2 in southern Italy

Before the emergence of AIDS, extra-pulmonary cryptococcosis was very rare. By contrast, meningeal cryptococcosis is a very common opportunistic infection in AIDS patients. We report an intravenous drug addict with cryptococcal meningitis, who was not infected with HIV and had no apparent predisposing conditions. This case, as those elsewhere described, supports the potential existence of viral agents, other than HIV-1,2, capable of encouraging the occurrence of unusual infections as have emerged during the AIDS pandemic.     

IgE and atopy in perinatally HIV-infected children

Elevated serum immunoglobulin E (IgE) and increased prevalence of atopy is reported in patients infected with human immunodeficiency virus (HIV). The elevated serum IgE may be attributed to polyclonal stimulation of B cells or IgE production against allergens, viruses, fungi and bacteria. This study investigates the prevalence of atopy in perinatally HIV-infected children, and the relationships between serum IgE (and other serum immunoglobulins) with atopy, CD4+ cell count and HIV-disease stage. Serum immunoglobulin levels, epicutaneous skin test for common aeroallergens, clinical Centers for Disease Control and Prevention (CDC) classification, CD4+ cell counts and allergy history were extracted from the charts of perinatally HIV-infected children on highly active antiretroviral therapy. The prevalence of atopy (52%) and the pattern of aeroallergen sensitivity were comparable with the US pediatric population. Serum IgE levels did not correlate with clinical disease stage. However, in non-atopic patients, serum IgE levels increased with disease progression (p = 0.02). There was an inverse relationship between the prevalence of elevated serum IgE levels and atopy with progression of disease (p = 0.019). Serum IgE did not correlate with atopy, CD4+ cell count, or duration of HIV infection or levels of serum immunoglobulins. This is the first study to show no increased prevalence of atopy in perinatally HIV-infected children compared with the general population. In advanced stages of HIV, elevated serum IgE may be specific for antigens other than those known as allergens.     

Describing the health-related quality of life impact of HIV infection: Findings from a study using the HIV Overview of Problems—Evaluation System (HOPES)

This study aimed to describe the results of findings from data collected with an HIV-specific health-related quality of life tool, and to examine the relationship between clinical and biological factors and health-related quality of life (HRQL). Data were collected as a cross-sectional, patient-completed assessment of health-related quality of life. Laboratory data were abstracted from the medical chart. Patients (n=318) with HIV infection including asymptomatic (37%), ARC (20%), AIDS (25%), and AIDS with cancer (18%) were receiving health services at one of the medical centres serving HIV-infected patients in the Los Angeles community, including UCLA, community physicians, Veterans Affairs Medical Centers, and a county hospital. Additional data were contributed by the Johns Hopkins University Medical Center CMV Retinitis Clinic. Symptomatic patients and patients with the lowest CD4 counts reported poorer HRQL than asymptomatic patients and patients with higher CD4 counts. However, medical and demographic variables explained only 35% of the variability of HRQL ratings in this sample of HIV-infected patients. While clinical status and Karnofsky performance status may be used to estimate the impact of HIV infection on HRQL, they are not a substitute for independent assessment of HRQL by the patient.This research was funded in part by the UCLA AIDS Clinical Research Center and CARES Consultants. To obtain more information about the HOPES, please contact the second author at CARES Consultants, 2210 Wilshire Blvd, Suite 359, Santa Monica CA 90403