An open-label efficacy pilot study with pimecrolimus cream 1% in adults with facial seborrhoeic dermatitis infected with HIV

BACKGROUND: Seborrhoeic dermatitis (SD) is a common dermatosis in human immunodeficiency virus (HIV)-positive patients, many of whom do not respond satisfactorily to conventional topical treatments such as corticosteroids and antifungals. OBJECTIVE: A pilot study to investigate the efficacy and tolerability of pimecrolimus cream 1% in HIV-positive patients with facial SD. METHODS: In a single-centre study, 21 HIV-infected patients with mild to severe SD were treated twice daily with pimecrolimus cream 1% for 14 days. Thereafter, treatment was discontinued and patients followed up for 5 weeks. Skin involvement at baseline and on days 7, 14, 21, 35 and 49 was assessed using a four-point clinical score and digital photography. MAIN OUTCOME MEASURES: Efficacy and safety of pimecrolimus cream 1% treatment and incidence of relapse in the follow-up phase. Results Marked improvement was seen in clinical parameters at day 7, with >or= 90% patients clear of symptoms at day 14. Relapse was observed at day 35 but signs were milder than at baseline. All patients responded to therapy, despite their immunological status. Pimecrolimus did not alter CD4(+) and CD8(+) T-cell counts or viral load during the treatment period. CONCLUSION: Pimecrolimus cream represents a new, effective therapeutic option for facial SD in HIV patients.     

海南省黎族中学生艾滋病知识干预效果分析

目的：通过干预提高黎族中学生的艾滋病知识水平，降低黎族人群感染艾滋病的危险。方法：采用集中授课、播发VCD等方式进行干预，利用自行设计的调查表对干预对象进行相关知识调查。结果：干预后中学生对艾滋病相关知识的认识均有不同程序的提高，最高提高22．90个百分点，最低提高6．50个百分点，平均提高15．46个百分点；艾兹病知识主要来源于电视广播和医生，分别占58．00％和22．00％。结论：在黎族中学生中开展艾滋病健康教育是完全可行且是十分必要的，应该引起重视。     

2004-2008年国家级暗娼综合监测点监测结果分析

目的 分析我国暗娼人群艾滋病相关行为变化及艾滋病病毒(HIV)感染流行趋势,为艾滋病综合防治和科学干预提供信息和依据.方法 对2004-2008年连续开展监测的15个国家级暗娼综合监测点,在监测期内以重复横断面调查的方法对社区娱乐场所及街头的暗娼人群进行问卷调查并采血,每个监测点每轮调查的样本量约为400例.结果 2004-2008年连续监测的15个国家级暗娼综合监测点,5年间监测对象HIV抗体阳性检出率(中位数)均为0.0%;梅毒抗体阳性检出率(中位数)分别为:0.5%、1.8%、1.6%、1.8%和1.0%.最近1次商业性行为安全套使用率(中位数)分别为:81.8%、80.5%、84.6%、87.0%和88.9%;最近1个月商业性行为坚持使用安全套的比例(中位数)分别为:65.8%、59.6%、60.3%、59.8%和73.7%.艾滋病知识知晓率(中位数)分别为:74.3%、84.1%、65.2%、66.0%和74.3%;接受过HIV检测并知晓检测结果者的比例(中位数)分别为:12.4%、20.4%、25.8%、25.3%和31.7%;最近1年接受过干预服务者的比例(中位数)分别为:46.4%、76.1%、72.1%、95.0%和90.8%.结论 暗娼人群商业性行为坚持使用安全套的比例和艾滋病知识知晓率有待于进一步提高.接受过HIV检测并知晓检测结果和最近1年接受过干预服务者的比例呈上升趋势.HIV感染率总体水平低,但高危行为状况不容乐观,需不断开展干预和综合防治工作.     

Delivering syringe exchange services through “satellite exchangers”: the Sacramento Area Needle Exchange, USA

An important operational aspect of Syringe Exchange Programmes (SEPs) is the venue of service delivery. This report describes the programmatic features of the Sacramento Area Needle Exchange (SANE), an illegal SEP operating in California, USA. SANE utilises “satellite exchangers” to distribute the bulk of its syringes and HIV risk reduction supplies. Advantages of relying primarily on Designated Exchangers (DE) for delivery of SEP services are that it: (1) allows for coverage of a large geographical area; (2) keeps operational cost low; (3) provides syringes to clients who may not want to or cannot use fixed site programmes; (4) limits the possibility of detection of programme personnel and clients by law enforcement. Limitations are that: (1) it is not as conducive as fixed sites to providing a wide range of ancillary services; (2) it may not be optimal for drug users who do not want to be reliant on other people for access to syringes; (3) those who receive services from a satellite exchanger may not derive as much counselling and referral services as direct exchangers. The lack of legal status, political support and adequate funding threatens the programme’s existence.     

Diagnostic value of stereotactic biopsy of cerebral lesions in patients with AIDS

Summary A neurological complication occurs in 40–60% of HIV infected patients during the course of the disease. In 10–20% the neurological complication is the first manifestation of the HIV infection. A reliable neuropathological diagnosis is a prerequisite for a specifically selected treatment. While modern computer-assisted imaging techniques, such as computed tomography or magnetic resonance imaging, do possess a high sensitivity, they do not as a rule permit an unambiguous diagnosis.Between October 1989 and July 1994 we biopsied 38 HIV infected patients stereotactically. The indication for the biopsy was determined by having radiologically detectable lesions with no regression tendency in patients under antitoxoplasmosis therapy. In 89% an unambiguous diagnosis wa made based on the biopsy; 11 % of the biopsies were not diagnostic. For the most part, toxoplasmosis (31%) and progressive multifocal leucoencephalopathy (29%) were involved. 18% of the patients suffered from a non-Hodgkin lymphoma. The foci were primarily frontal (47%), parietal (21%) or localised in the basal ganglia area (11%). The result of the biopsy led to a change in treatment for 52% of the patients. Morbidity and mortality of the operation were 0%.The results or our research series are similar to other groups. It was shown that stereotactic brain biopsy is a safe and effective method for establishing a sound basis for treating the frequently life-threatening cerebral complications of AIDS.     

Periodontal diseases in HIV-infected patients

Abstract Periodontal diseases may be the first clinical sign of human immunodeficiency virus (HIV)-infection. Since the immunosuppression and subsequent susceptibility may alter the responses of the oral tissues as well as the microflora, both periodontal treatment and result of therapy may be modified. The periodontal diseases in HIV-seropositive patients include common as well as less conventional forms of gingivitis and periodontitis, and bacteria, mycotic and viral infections are seen. Neoplasias may also involve the periodontium; most common are Kaposi's sarcoma and non-Hodgkin's lymphoma. Recent studies of unselected groups of patients indicate that periodontal health in at least some groups of HIV-seropositive patients is better than previously reported.     

Autopsy findings in the tongues of 20 patients with AIDS

An extensive examination of the tongue was performed at autopsy in 20 consecutive patients who had died with AIDS. Abnormalities in the tongue were detected in 18 (90%) of the cases; the commonest lesions were ulceration (11), candidosis (8) and small foci of hyperkeratosis (10). The most extensive lesions were caused by Aspergillus infection (1), non-Hodgkin's lymphoma juxtaposed with Kaposi's sarcoma (1), herpetic infection (1) and candidosis (5). The disease causing death was identified in the tongue in two cases. There was a surprisingly low prevalence of oral hairy leukoplakia. which may be related to anti-viral or retroviral therapy.     

Sexual behavior and attitudes of University students in Northern Ireland

Two surveys of a Northern Ireland student sample were conducted in 1987 and 1988. A total of 419 female and 201 male subjects completed self-administered anonymous questionnaires concerning their behavior, knowledge, and attitudes towards sex, AIDS, homosexuality, contraception, and relationships. Results indicated a relatively low level of sexual experience, and for those with experience, relatively few partners. The possible influences of gender and religiosity on sexual behavior and attitudes, in the context of Northern Ireland, are discussed. Subjects reported considerable variation in the amount of sex education, but the majority received little or none. This student sample held relatively conservative attitudes towards love, sex, and marriage and this was particularly true for females and for regular churchgoers. In addition, attitudes towards homosexuality were negative (particularly among regular churchgoers). Attitudes towards contraception were more positive than expected among Catholic subjects, and few indicated that they would refuse to use contraceptives on principle. Responses to items about AIDS were highly uniform, suggesting that much of the information made available to the public has been absorbed. However, the lack of uniformity of response to more general items about sex, relationships, and contraception may indicate that fundamental changes in sexual behavior are unlikely to be brought about by influencing a rather narrowly defined set of attitudes about AIDS.     

AIDS: Awareness and blood handling practices of health care workers in Lagos,Nigeria

A questionnaire survey of 260 health care workers from 13 randomly selected health care facilities was undertaken. Their knowledge, attitude, belief and blood handling practices regarding HIV/AIDS were enquired about. Virtually all (99.0%) respondents had heard about AIDS but only 57.0% had seen an AIDS patient before. Although 83.0% knew that AIDS is caused by a virus, a high proportion still confuses mode of transmission with causative agent. Deficient knowledge was exhibited when asked about groups of people who were at a higher risk of contracting HIV and AIDS: Only 54.6% and 51.5% identified homosexuals and IV drug users as being at a higher risk. Almost all (97.0%) of our respondents claimed to have been more careful in their blood handling practices since the emergence of AIDS, 68.5% wore gloves for all procedures involving handling of blood and 28.5% sometimes although as many as 30.4%, 40.4% and 18.1% do not wear gloves for cleaning up blood stained materials, nursing procedures and taking obstetric delivery respectively. It was evident from their responses that not all the health workers knew the correct method for disposing of used bloodstained instruments and left-over blood samples and neither were they all adhering to the safety guidelines recommended for handling these materials. Education of all health care workers in Nigeria on the Universal Precautions Guidelines issued by the Centers for Disease Control (CDC) in 1987 regarding blood, body fluids and contaminated instruments' handling precautions is urgently recommended.     

Stereotactic brain biopsy in AIDS

Summary In the hope of finding a treatable condition, the need for rapid diagnosis in HIV-seropositive patients with brain lesions is apparent. In order to evaluate the efficacy of stereotactic brain biopsy in AIDS patients, we retrospectively studied 25 HIV-infected patients undergoing stereotactic biopsy. Brain lesions were identified with gadolinium-enhanced MRI and/or contrastCT. Brain biopsy was performed using the system of Riechert. From 8 up to 15 small tissue samples from one or two targets were obtained in every patient. The biopsy material was examined cytologically, histologically (including electron microscopy), immunohistochemically and, in part, by animal test and polymerase chain reaction (PCR). A definite diagnosis was achieved in 92%. Diagnosis included primary central nervous system lymphoma (PCNSL) (10), toxoplasmosis (10), progressive multifocal leukoencephalopathy (2) and one case of co-existing toxoplasmosis and cytomegalovirus infection. Two biopsies were non-diagnostic. All PCNSLs showed polymorphic B-cell populations of high malignancy; accurate classification according to the Kiel classification was not possible. In 3 lymphomas Epstein-Barr nuclear antigen (EBNA) 2-mRNA could be detected by PCR and confirmed immunohistochemically by EBNA 2 expression. In 6 cases autopsy confirmed the biopsy diagnosis. Conventional histology was not sufficiently decisive for toxoplasmosis and progressive multifocal leukoencephalopathy, so that immunohistochemistry and animal tests became very important for a final diagnosis. With the help of different morphological and molecular biological techniques stereotactic brain biopsy appears to be an effective method in the diagnosis of HIV-associated brain lesions. In view of the marked radio- and chemosensitivity of PCNSLs it is mandatory to establish an early and accurate histological diagnosis for adequate treatment.