[Should pregnant women be tested for antibodies against hepatitis C virus?].
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Female↗
Biomedical subjects
A Eskild
Publications and source records attributed to A Eskild.
Herpes simplex virus type-2 antibodies in pregnant women: the impact of the stage of pregnancy.
In this study the impact of pregnancy duration on the measured level of HSV-2 antibodies was assessed. The study population comprised 35,940 pregnant women in Norway, in 1992-4, followed during pregnancy. A random sample of 960 women was selected. A mean of 2.6 serum samples from each woman were analysed for HSV-2 specific IgG antibodies at different times in pregnancy. Crude and adjusted odds ratios were estimated in logistic regression models taking all observations per women into account. Twenty-seven percent of the pregnant women had antibodies against HSV-2 in the first trimester. The adjusted odds ratio of being HSV-2 antibody positive decreased during the pregnancy and was 0.5 (0.2-0.9, 95% confidence interval) in the 40th as compared to the 10th week of pregnancy. About 50% of initially HSV-2 positive women did not have detecable antibodies by the end of the pregnancy. This may be explained by haemodilution during pregnancy. Our findings have diagnostic implications and should encourage further studies.
Adolescent↗
Changes in condom use after HIV diagnosis.
We investigated changes in condom use after HIV diagnosis. The study population comprised 78 asymptomatic HIV-infected subjects recruited from a clinic in Oslo, Norway, during 1988-92. In total, 240 follow-up visits were carried out. The response variable was repeated measurements of whether or not condoms were always used during anal/vaginal intercourse at follow-up. The explanatory variables were: time from HIV diagnosis to follow-up, exposure group (heterosexually infected, homosexual men, or infected through injecting drug use), time of HIV diagnosis (before 1987 or later), and history of condom use before HIV diagnosis. Random effects logistic regression analysis was used to study incremental changes in condom use, accommodating an unbalanced repeated measurement design. The use of condoms increased monotonously over time after HIV diagnosis in all exposure groups. Condom use was least likely among injecting drug users, subjects diagnosed before 1987 and subjects without a history of frequent condom use before HIV diagnosis.
Adult↗
Back-calculation based on HIV and AIDS registers in Denmark, Norway and Sweden 1977-95 among homosexual men: estimation of absolute rates, incidence rates and prevalence of HIV.
BACKGROUND: The Scandinavian countries, Denmark, Norway and Sweden, have established both HIV and AIDS registers to monitor the HIV epidemic. Information in such registers can be used to estimate the number of new HIV infections over time, incidence rates and prevalence. Information from the HIV registers made it possible to study what kind of effects such information had in the estimation process, compared with using information about new AIDS cases only. METHODS: A Markov model back-calculation approach was used. One model incorporated data on cases of both HIV and AIDS. Another model incorporated data on cases of AIDS only. Death or emigration prior to the onset of AIDS and effects of treatment were included in both models. RESULTS: Estimates of absolute rates of HIV for men who have sex with men (MSM) showed a distinct development in each country. Significant differences in incidence rates and prevalence of HIV among MSM were found between Scandinavian countries when information on diagnosed HIV was incorporated. Precision was improved when using both HIV and AIDS diagnosed cases compared with using AIDS cases only. The epidemic in Denmark was more extensive than in the two other countries for the whole study period. DISCUSSION: The results were fairly robust against reasonable variation in the model parameters. The more extensive epidemic in Denmark may have been caused by the homosexual culture denying that HIV was a disease more relevant to them than to others, until the HIV test was publicly available in 1985.
Adult↗
[Antibodies against Herpes simplex virus type 2 among pregnant women in Norway].
The prevalence of antibodies against herpes simplex virus type 2 (anti-HSV-2) among pregnant women in Norway is not known. To study the prevalence of anti-HSV-2, a random sample of 961 women was drawn from a study population of 35,940 pregnant women in Norway during 1992-94. 27% (256/961) had anti-HSV-2. The prevalence increased with age. 17% of the 20-24-year-olds and 34% of the 35 year-old or older had anti-HSV-2. The presence of antibodies also varied geographically, from 18% in the south to 39% in the north of Norway. Among women with repeated anti-HSV-2 tests during pregnancy, 2.6% of the seronegative women seroconverted (16/623). HSV-2 infection is common among pregnant women in Norway. The public health implications of this infection need to be clarified.
Adult↗
[Increase in fatal cases among narcotic addicts--do we know why?].
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Adolescent↗
The estimated impact of the CCR-5 delta32 gene deletion on HIV disease progression varies with study design. Oslo HIV Cohort Study Group.
OBJECTIVES: To study the impact of the genotype CCR-5 wild-type +/A32 on the progression rate to AIDS and death, and to discuss sources of bias according to study design. METHODS: A prospective study of 310 HIV-positive subjects with follow-up time from study entry (prevalent cohort), and a prospective study of 105 HIV-positive subjects with well-defined time of HIV seroconversion, with follow-up time from the retrospectively assessed date of HIV seroconversion (retrospective incident cohort). RESULTS: Slower progression to AIDS among subjects with CCR-5 +/delta32 than those with CCR-5 +/+ genotype was estimated in the prevalent cohort (P=0.07, log-rank test). Slower progression to death from any cause was also estimated for subjects with CCR-5 +/delta32 (P < 0.05, log-rank test). No differences in survival after AIDS diagnosis were seen (P=0.89, log-rank test). No differences in the progression rate to AIDS (P=0.82, log-rank test) or death (P=0.78, log-rank test) were estimated in the retrospective incident cohort. CONCLUSIONS: The varying estimates of the impact of CCR-5 genotype on progression to AIDS in this and other studies, may be real and reflect differences in the dependence of HIV on the CCR-5 receptor, or may be due to systematic errors caused by study design. Several methodological difficulties occur when the factor studied, such as CCR-5 genotype, is associated both with the risk of being HIV-infected and the progression of disease.
Acquired Immunodeficiency Syndrome↗
[Risk assessment in preventive medicine].
The aim of this article is to present and discuss the value of risk analysis in preventive medicine. Risk analysis consists of three major areas; risk assessment, risk management and risk communication. Risk analysis is illustrated here by two examples: exposure to radon and the risk of lung cancer, and infection with toxoplasma gondii in pregnancy and adverse pregnancy outcome. The analyses highlight the complementary elements of scientific judgement and political valuation. The barriers against implementation of preventive measures are many. Adequate risk assessment and consequence analysis based on empirical studies, together with risk communication are important for implementing the correct measures. We suggest that risk analysis should be used more often in medicine as a tool for systematic evaluation of the need and usefulness of preventive measures.
Female↗
Prevalence of Toxoplasma gondii specific immunoglobulin G antibodies among pregnant women in Norway.
During one year from June 1992 serum IgG antibodies to Toxoplasma gondii among 35,940 pregnant women were measured in a cross-sectional study conducted in Norway. The overall prevalence was 10.9%. The lowest prevalences were detected in the north (6.7%) and in the inland counties (8.2%). A significantly higher prevalence was detected in the southern counties (13.4%) where a mild, coastal climate prevails. Women with foreign names had a higher prevalence (22.6%) than women with Norwegian names (10.0%). The high prevalence among women living in the capital city (Oslo) as compared to other cities and rural areas (13.2% vs. 10.1% and 10.2% respectively), was explained by the higher proportion of foreign women in Oslo. Prevalence significantly increased with age in women over 34 years old. This increase was only detected among women with Norwegian names. An increase in prevalence according to number of children was detected. Women without children had a prevalence of 8.8% while women with three children or more had a prevalence of 14.9%. Multivariate analyses showed that being seropositive was independently associated with county of residence, age, nationality and number of children.
Adolescent↗
Incidence of Toxoplasma gondii infection in 35,940 pregnant women in Norway and pregnancy outcome for infected women.
From 1992 to 1994 a screening program for detection of specific Toxoplasma gondii antibodies involving 35,940 pregnant women was conducted in Norway. For women with serological evidence of primary T. gondii infection, amniocentesis and antiparasitic treatment were offered. The amniotic fluid was examined for T. gondii by PCR and mouse inoculation to detect fetal infection. Infants of infected mothers had clinical and serological follow-up for at least 1 year to detect congenital infection. Of the women 10.9% were infected before the onset of pregnancy. Forty-seven women (0.17% among previously noninfected women) showed evidence of primary infection during pregnancy. The highest incidence was detected (i) among foreign women (0.60%), (ii) in the capital city of Oslo (0.46%), and (iii) in the first trimester (0.29%). Congenital infection was detected in 11 infants, giving a transmission rate of 23% overall, 13% in the first trimester, 29% in the second, and 50% in the third. During the 1-year follow-up period only one infant, born to an untreated mother, was found to be clinically affected (unilateral chorioretinitis and loss of vision). At the beginning of pregnancy 0.6% of the previously uninfected women were falsely identified as positive by the Platelia Toxo-IgM test, the percentage increasing to 1.3% at the end of pregnancy. Of the women infected prior to pregnancy 6.8% had persisting specific immunoglobulin M (IgM). A positive specific-IgM result had a low predictive value for identifying primary T. gondii infection.
Abortion, Spontaneous↗
[Are infections the cause of infant death?. Interview by Ingrid M. Høie].
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Cause of Death↗
The impact of exposure group on the progression rate to acquired immunodeficiency syndrome. A comparison between intravenous drug users, homosexual men and heterosexually infected subjects.
The objective was to study the impact of exposure group on the progression rate to the acquired immunodeficiency syndrome (AIDS). 289 subjects in Oslo, Norway, infected with the human immunodeficiency syndrome (HIV) and without major clinical signs of HIV infection (102 intravenous drug users, 151 homosexual men and 36 heterosexually infected subjects) were recruited to the Oslo HIV Cohort Study from 1989 and followed until 1 January 1995. 15 (14.7%) of the intravenous drug users, 56 (37.1%) of the homosexual men and 5 (12.5%) of the heterosexually infected subjects developed AIDS during a mean time of 47 months (p < 0.001, log rank test). When controlling for possible confounding variables (age, number of CD4+ lymphocytes, antiviral therapy at study entry, gender and year of HIV diagnosis), the relative risk of AIDS progression was 2.2 [1.1-4.5, 95% confidence interval (CI)] for homosexual men and 0.5 (0.2-1.3, 95% CI) for heterosexually infected subjects as compared to intravenous drug users. In a subgroup with known time of seroconversion (n = 60), 47% (18/38) of the homosexual men, 20% (3/15) of the intravenous users and none (0/7) of the heterosexually infected subjects developed AIDS (p = 0.04, log rank test). The results suggest that homosexual men have more rapid progression to AIDS than intravenous drug users and heterosexually infected subjects.
Acquired Immunodeficiency Syndrome↗
Prevalence and trends in homosexual behaviour in Norway.
The three main objectives of this study were to estimate the proportion of the Norwegian population with experience of homosexual behaviour, to study the degree of change in sexual practices among homosexual men during a 5-year period and to study the degree of change in sexual practices reported by HIV positive homosexual men from before to after awareness of HIV-positivity. The data comes from two questionnaire surveys (in 1987 and 1992) of sexual behaviour in the general population of Norway and a questionnaire study of sexual behaviour before and after awareness of HIV-positivity among HIV-positive homosexual men taking part in a cohort study starting in 1988 (the Oslo HIV cohort study). Estimation of the proportion of subjects with homosexual experience was made as well as a trend analysis of the number of male sexual partners per year, number of intercourses per month, condom use and anal sex. Among men aged 18 to 60 from the general population, 3.8% reported homosexual practice during lifetime and 1.2% during the past 3 years. Among women, the same percentages were 3.1 and 1.0. In the surveys, the number of male partners per year decreased significantly for men with current homosexual experience from a yearly median of 1.0 in 1987 to 0.3 in 1992 (p = 0.02). Among HIV-positives, the number of male partners decreased from a yearly median of 4.3 before to 1.6 after awareness of HIV-seropositivity (p < 0.01). Among HIV-positives, a significant increase in the use of condoms, a decrease in the number of intercourses and a decrease in the frequency of anal sex was found. The results show that some changes in sexual practice may have occurred among homosexual men in general in the period from 1987 to 1992, and that more significant changes may have occurred for HIV-positive men. The present data do not support other findings of a relapse to more unsafe sex, but suggest that there is still a need to keep modifying behaviour in order to stop the spread of HIV among men who have sex with other men.
Adult↗
Risk factors for Toxoplasma gondii infection in pregnancy. Results of a prospective case-control study in Norway.
From 1992 to 1994, a prospective case-control study designed to identify preventable risk factors for Toxoplasma gondii infection in pregnancy was conducted in Norway. Case-patients were identified through a serologic screening program encompassing 37,000 pregnant women and through sporadic antenatal testing for Toxoplasma infection. A total of 63 pregnant women with serologic evidence of recent primary T. gondii infection and 128 seronegative control women matched by age, stage of pregnancy, expected date of delivery, and geographic area were enrolled. The following factors were found to be independently associated with an increased risk of maternal infection in conditional logistic regression analysis (in order of decreasing attributable fractions): 1) eating raw or undercooked minced meat products (odds ratio (OR) = 4.1, p = 0.007); 2) eating unwashed raw vegetables or fruits (OR = 2.4, p = 0.03); 3) eating raw or undercooked mutton (OR = 11.4, p = 0.005); 4) eating raw or undercooked pork (OR = 3.4, p = 0.03); 5) cleaning the cat litter box (OR = 5.5, p = 0.02); and 6) washing the kitchen knives infrequently after preparation of raw meat, prior to handling another food item (OR = 7.3, p = 0.04). In univariate analysis, travelling to countries outside of Scandinavia was identified as a significant risk factor, but this variable was not independently associated with infection after data were controlled for factors more directly related to the modes of infection.
Adolescent↗
[The AIDS epidemic in Norway--where did it go?].
The 1986 prognosis for the AIDS-epidemic in Norway has not been fulfilled. The epidemic has been far less extensive than anticipated. In 1986, little knowledge existed about the parameters that influence the spread of the human immunodeficiency virus (HIV): the prevalence of HIV, the HIV transmission rate, the duration of the infectious period and the extent of risk behaviour. The prognosis was therefore not reliable. The causes of the variability in HIV transmission and in the duration of the infectious period are still poorly understood and thus cannot be easily influenced. A reduction of risk behaviour among homosexual men has been observed. In the general population there has been a slight increase in use of condoms. The behavioural changes may express HIV-preventive measures. However, the large discrepancy between the early HIV/AIDS prognosis and the observed epidemic in Norway cannot be explained by behavioural change alone.
Acquired Immunodeficiency Syndrome↗
Steady sexual relationship with an HIV-positive partner and the progression rate to AIDS.
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Acquired Immunodeficiency Syndrome↗
Screening for toxoplasmosis in pregnancy: what is the evidence of reducing a health problem?
OBJECTIVES: Toxoplasma gondii is a parasite which may give rise to congenital infection. Screening pregnant women for antibodies against toxoplasmosis is being debated in many countries. The preventive impact of toxoplasmosis screening of pregnant women depends on the magnitude of disease caused by congenital toxoplasmosis (incidence x transmission rate to fetus x diseased proportion of infected children), on the one hand, and the preventable proportion of disease (sensitivity of the screening test x efficacy of the treatment x compliance), on the other. In this study the preventive impact of screening pregnant women for toxoplasmosis antibodies is assessed by letting the value for these variables change within reasonable limits. METHODS: To obtain information on these variables, relevant publications were reviewed in the Medline database from 1983 to February 1996 and the Cochrane Pregnancy and Childbirth Database. References in review articles on congenital toxoplasmosis were also studied. RESULTS: The literature review showed that no population based prospective studies of the natural history of toxoplasmosis infection during pregnancy, nor any randomised controlled trials of the efficacy of antiparasitic treatment, had been carried out. In the empirical studies which have been performed the values of most variables show considerable differences. According to these values, the estimates in this study of the impact of toxoplasmosis screening in pregnancy may range from 0 to 40 children in whom disease is preventable per 100,000 pregnant women susceptible to toxoplasmosis infection. CONCLUSION: Sufficient scientific evidence is not yet available to propose screening for toxoplasmosis in pregnant women, and efforts should be made to provide such knowledge. Also, the magnitude of the negative impact of screening, such as induced abortion of healthy fetuses, anxiety in women with false positive screening tests, and side effects of treatment, has not been sufficiently examined.
Antiprotozoal Agents↗
Co-infection with HIV-1/HTLV-II and the risk of progression to AIDS and death. The Oslo HIV Cohort Study Group.
Human T-cell lymphotropic virus (HTLV) types I and II were the first discovered human retroviruses. While HTLV-I has been clearly associated with disease, the health implications of HTLV-II infection are still unsettled. A prospective epidemiological study of 409 HIV-infected subjects of different transmission categories was performed to study the presence of HTLV-II antibodies, and whether HTLV-II antibodies are associated with the progression to AIDS and to death of any cause. Of 409 subjects, 30 (7.3%) were HTLV-II positive at study entry; 2 subjects seroconverted during follow-up. In the HTLV-II-positive group 2 were heterosexually HIV infected, 28 (of whom 2 were seroconverters) were IDUs and 2 were homosexual men. When controlling for transmission category, gender, age and CD4+ lymphocyte count at study entry, the relative risk of AIDS progression for the HTLV-II-positive group was 2.1 (0.8-5.1, 95% confidence interval (CI)) as compared to the HTLV-II-negative group. The adjusted relative risk of dying was 2.1 (1.0-4.3, 95% CI). When studying IDUs separately, the adjusted relative risk of AIDS progression was 2.3 (0.8-6.9, 95% CI) and the relative risk of dying was 2.0 (0.9-4.6, 95% CI). The results of this study suggest that HTLV-II is a cofactor in HIV disease progression. The number of HTLV-II-infected subjects, was, however, small, and insufficient control of confounding factors must be taken into consideration.
Acquired Immunodeficiency Syndrome↗