AIDS associated eosinophilic folliculitis which responded to both high dose co-trimoxazole and low dose isotretinoin.
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
A M Downs
Publications and source records attributed to A M Downs.
Hospital care for persons with AIDS in the European Union.
This study estimates the current and future hospital resources for AIDS patients in the European Union (EU), using multinational scenario analysis (EU Concerted Action BMH1-CT-941723). In collaboration with another EU-project ('Managing the Costs of HIV Infection'), six national European studies on the utilization of hospital care for AIDS have been selected to provide the data for our analysis. The selection criteria involve recentness, quality, comparability, accessibility and representativeness. Baseline hospital resource utilization is estimated for hospital inpatient days and outpatient contracts, using a standardized approach controlling for two severity stages of AIDS (chronic stage and late stage). The epidemiological part of the study is based on standard models for backcalculating HIV incidence and projecting AIDS incidence, prevalence and mortality. In the next step, baseline resource utilization is linked to epidemiological information in a mixed prevalence and mortality-based approach. Several scenarios render different future epidemiological developments and hospital resource needs. For the year 1999, hospital bed needs of 10,000-12,700 in the EU are indicated, representing an increase of 20-60% compared to the estimated current (1995) level. The projected range for 1999 corresponds to a maximum of 0.65% of all hospital beds available in the EU. The growth in the number of outpatient hospital contacts is projected to possibly exceed that of inpatient days up to 1.82 million in 1999. Our methodology illustrates that estimation of current and future hospital care for AIDS has to be controlled for severity stages, to prevent biases. Further application of the multinational approach is demonstrated through a 'what-if' analysis of the potential impact of combination triple therapy for HIV/AIDS. Estimation of the economic impact of other diseases could as well benefit from the severity-stages approach.
Acquired Immunodeficiency Syndrome↗
Reconstruction and prediction of the HIV/AIDS epidemic among adults in the European Union and in the low prevalence countries of central and eastern Europe.
OBJECTIVES: To reconstruct the HIV epidemic and to provide forecasts of AIDS incidence among adults in the European Union (EU) and in a group of low prevalence (LP) countries of central and eastern Europe (including the Asian republics of the former Soviet Union). METHODS: An empirical Bayesian back-calculation method was applied to AIDS incidence data reported by 31 March 1994. The HIV-infection curve was modelled as a yearly step function and a seven-stage Markov model of disease progression, incorporating effects of pre-AIDS treatment, was used. Estimation was by penalized maximum likelihood with empirical Bayesian smoothing. Data were analysed by transmission group and, within the EU, by country. Predictions of AIDS cases to 1998 were made assuming constant annual HIV incidence from 1993 onwards. RESULTS: Estimated HIV prevalences per 100,000 population aged 15-59 years were, at 31 December 1993, 198 (n = 447,800) in the EU and 2.7 (n = 6840) in the 22 LP countries, with increases of 41% (EU) and 71% (LP) between 1989 and 1993. Among homo/bisexual men in the EU, prevalence appears to have stabilized since 1989 and AIDS incidence appears to be reaching a peak. Among all prevalent HIV infections in the EU, 42% were estimated to be among injecting drug users, 25% among homo-/bisexual men and 18% among persons infected heterosexually, compared with 29%, 35% and 19%, respectively, in the LP countries. Without allowing for the 1993 revision of the case definition, annual AIDS incidence is predicted to increase, between 1994 and 1998, by 24% in the EU and by 48% in the LP countries, with the largest percentage increases among heterosexually-infected persons. CONCLUSION: The overall HIV prevalence rate is estimated to have been about 70-fold lower in the LP countries than in the EU in the early 1990s, but to be increasing much more rapidly in the former. Moreover, recent reports of rapidly increasing HIV infection rates suggest that back-calculation may seriously underestimate the size of the epidemic in the LP countries. Implementation of effective preventive measures is urgent if large-scale epidemics are to be avoided in the presently LP countries of the European region.
Acquired Immunodeficiency Syndrome↗
The HIV epidemic associated with injecting drug use in Europe: geographic and time trends.
OBJECTIVES: To evaluate the magnitude and trends of the HIV epidemic associated with injecting drug use in Europe. METHODS: AIDS cases associated with injecting drug users (IDU) diagnosed through 1995 were analysed, including IDU, homo-/bisexual IDU, heterosexual partners of IDU and children whose mothers were IDU. HIV seroprevalence studies among IDU were reviewed. RESULTS: Of the 171,932 cumulative AIDS cases, 73,119 (43%) were IDU-associated (IDU, 89.0%; homo-/bisexual IDU, 3.5%: heterosexual partners of IDU, 6.2%; children with IDU mothers, 1.4%). Over 90% of IDU-associated cases were concentrated in south-western European countries with considerably higher rates in Spain (124 cases per million in 1995) than elsewhere (Italy, 68 per million; Portugal, 42 per million; France, 38 per million). During 1990-1995, incidence increased at an average annual rate of 11% overall and > 23% in central and eastern Europe; overall, incidence increased in older persons (12%) while decreasing in those aged 13-24 years (by 6%). HIV prevalence in IDU showed considerable geographic variation across and within countries. In several countries of western Europe, prevalence decreased. In the former Soviet Union, large HIV outbreaks have recently been detected among IDU through systematic HIV testing (e.g., in Ukraine, 6750 HIV infections were diagnosed in IDU tested during 1995-1996). CONCLUSIONS: IDU have played a major role in the spread of HIV in Europe. In several western European countries, the incidence of HIV acquired through drug use has declined following high rates in mid-1980s. Studies to assess current transmission are needed and prevention efforts must be maintained. In eastern Europe, emerging epidemics reinforce the urgency for prevention.
Acquired Immunodeficiency Syndrome↗
Subungual squamous cell carcinoma in Darier's disease.
We report the first case of subungual squamous cell carcinoma in a patient with Darier's disease (keratosis follicularis). The presence of human papillomavirus DNA was confirmed, consistent with its probable role in carcinogenesis at this site. The role of an altered immune state is discussed as an additional factor. Squamous cell carcinomas may be overlooked when they occur among the other cutaneous manifestations and complications of Darier's disease. A solitary, ulcerating nail bed lesion warrants biopsy to exclude squamous cell carcinoma.
Adult↗
Probability of heterosexual transmission of HIV: relationship to the number of unprotected sexual contacts. European Study Group in Heterosexual Transmission of HIV.
The objective of this study was to investigate the relationship between the number of unprotected heterosexual contacts with an HIV-infected person and the probability of HIV transmission. Data from a European study involving 563 heterosexual partners of HIV-infected subjects were analyzed. The number of unprotected contacts could be estimated for 525 couples (377 with male index case, 148 with female index case) from the reported frequency of unprotected contacts and an estimate of the length of the period during which transmission could have occurred. Nonparametric (isotonic regression) and parametric (Bernoulli model) analyses were performed on data at study entry and on follow-up data (121 couples). The nonparametric analysis resulted in several exposure groups, with the proportion of infected partners increasing with the number of contacts. For example, the percentage of female partners infected ranged from 10%, among those with < 10 unprotected contacts with an infected male, to 23% after 2,000 unprotected contacts. The parametric estimates of (assumed constant) per-contact infectivity were higher for male-to-female than for female-to-male transmission, but not significantly so. However, in comparison with nonparametric estimates, the model assuming constant infectivity appears to seriously underestimate the risk after very few contacts and to seriously overestimate the risk associated with a large number of contacts. Our results suggest that the association between the number of unprotected sexual contacts and the probability of infection is weak and highly inconsistent with constant per-contact infectivity. Probable explanations for these findings include large variability in infectivity between couples and within individuals over time. Estimates based on partner study data under the hypothesis of constant infectivity can, therefore, be highly misleading at a public health level, particularly when extrapolated to multiple casual contacts.
Disease Transmission, Infectious↗
Physical therapy in lung transplantation.
Lung transplantation requires the skillful attention of a health care team to provide optimal results. The physical therapist is an integral part of this team, providing expertise in exercise testing and prescription in all phases, from initial evaluation through postoperative rehabilitation and beyond. In addition, the physical therapist promotes effective ventilation, offers techniques for enhanced coughing and mucociliary clearance, and provides treatment of the musculoskeletal system. Lung transplantation is reserved for patients in whom all other treatments have been exhausted. It is important for the physical therapist to stay abreast of the evolving field of lung transplantation, including medications and complications. The physical therapist has a critical role in helping lung transplant recipients achieve optimal function, increased survival, and improved quality of life.
Activities of Daily Living↗
Male duct ectasia associated with HIV infection.
The incidence of male duct ectasia (periductal mastitis) is extremely rare, only eight cases having been reported. The underlying cause (as in females) is uncertain. Two cases in HIV positive males of recurrent unilateral nipple lesions are reported with histology consistent with duct ectasia. At presentation neither patient had an AIDS defining illness. An impaired immunity secondary to HIV infection may result in an increased susceptibility to repeated nipple infections, and the clinical as well as histological features of duct ectasia. The consideration of HIV infection in future cases of male duct ectasia may be warranted.
Adult↗
Incubation period of vertically acquired AIDS in Europe before widespread use of prophylactic therapies.
European surveillance data on vertically acquired (VA) AIDS cases were used to investigate the incubation period of AIDS in the absence of widespread prophylactic treatment and to assess the uncertainty associated with parametric estimates based on retrospective data. Nonparametric and parametric analyses, taking into account the effects of data truncation, were based on a total of 792 children diagnosed with AIDS between July, 1982, and June, 1990, inclusive. Among HIV-infected children who develop AIDS within 8 years, the nonparametric estimate of the median age at diagnosis was 34 months. If 20% of children are assumed to develop AIDS by the age of 1 year (a plausible estimate on the basis of published cohort data), the estimated median among all maternally HIV-infected children is 4.4 years, with 26% of children expected to remain AIDS free by 8 years of age. Results from the parametric (double Weibull) model support the hypothesis of a bimodal distribution, with a subgroup of children progressing rapidly to AIDS at a median age of approximately 5 months. However, neither the relative size of this group nor the median age at which AIDS develops in the remaining children can yet be estimated with any reasonable precision.
Acquired Immunodeficiency Syndrome↗
Recent trends in Pneumocystis carinii pneumonia as AIDS-defining disease in nine European countries. Coordinators for AIDS Surveillance.
We analyzed the proportion of AIDS cases with Pneumocystis carinii pneumonia (PCP) at diagnosis among the 43,198 adult AIDS cases diagnosed since January 1988 and reported by June 1992 in Austria, Belgium, France, Germany, Italy, Portugal, Switzerland, United Kingdom, and the city of Amsterdam. In multivariate analysis, the risk of having PCP at AIDS diagnosis decreased slightly with increasing age and was strongly associated with country of diagnosis, transmission category, and year of diagnosis, but not with gender. Since 1989, the proportion of AIDS cases with PCP decreased significantly among homosexual and bisexual men in five of the nine countries examined and among injecting drug users in four of seven countries. In three countries with sufficient data for analysis, no significant decrease was seen among heterosexual patients with a partner originating from a country where heterosexual transmission is common (i.e., Africa/Caribbean). Among other heterosexual patients, a significant decreasing trend was demonstrated in only one of six countries analyzed. For all countries combined, the decrease was significant among hemophiliacs and of borderline significance among transfusion recipients. Results suggest that medical management before AIDS diagnosis is not homogeneous among all human immunodeficiency virus (HIV)-infected persons in Europe. Efforts should be made to provide better information on the potential benefit of early HIV testing and to facilitate the use of preventive treatments.
AIDS-Related Opportunistic Infections↗
Impact of 1993 revision of adult/adolescent AIDS surveillance case-definition for Europe. National Coordinators for AIDS Surveillance in 38 European countries.
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Acquired Immunodeficiency Syndrome↗
Rates of regression and progression of dysplastic lesions in the nasal mucosa in nickel workers: a Markov model approach.
Nasal epithelial dysplasia is considered a precancerous state. From 1976 through 1989, regular screening for such lesions has been performed among workers at the Falconbridge nickel refinery in Kristiansand. The longitudinal data thus obtained have been evaluated to ascertain to what extent, if any, pre-existing dysplasia can regress when exposure to nickel is reduced. A total of 418 pairs of observations were available from 243 workers. Interpretation of the data is complicated by the fact that dysplasia may remain undetected in small biopsies and the probability of detection of existing dysplasia was, therefore, incorporated into the two-state Markov model. Transition probability rates were estimated by maximum likelihood. The results suggest that regression of dysplasia has taken place and that regression rates increased with time. This finding probably reflects a decreased exposure resulting from a combination of a reduction in airborne nickel, improved personal hygiene and allocation of workers with dysplasia to work in areas with lower nickel exposure. Our results indicate that the chance of developing carcinomas related to nickel exposure is reduced. There are, however, indications that dysplasias continue to develop at a low rate.
Humans↗
Economic impact of the AIDS epidemic in the European Community: towards multinational scenarios on hospital care and costs.
OBJECTIVE: To underpin multinational public-health HIV/AIDS strategy planning in the European Community (EC) by integrating national studies on HIV/AIDS in scenario analysis. METHOD: Three types of data are used: routine surveillance data, information on disease progression and observational studies on the economic impact. The HIV/AIDS epidemic is simulated using two models (MIDAS and PC-Based AIDS Scenarios). Selected simulations, consistent with surveillance data, are connected to economic impact (hospital-bed needs and annual hospital costs for AIDS patients). Parameter values expressing per person-year economic impacts are derived from a structured review of publications on economic aspects of AIDS. RESULTS: Evaluation of published studies on hospital resource use and costs in EC countries shows that there are significant differences between both countries and studies, even after conversion to similar measures (for example, using purchasing power parities). These differences are partly due to factors such as the composition of the patient population. Differences in methodology may also have influenced the results. Economic impact is analysed for combinations of three factors; survival time after AIDS diagnosis, hospital inpatient days needed per person-year and corresponding hospital costs per person-year. All scenarios indicate 1995 hospital-bed needs above the 1990 level of 5400 beds. Hospital cost projections for 1995 vary (up to US$1050 million). CONCLUSIONS: (1) For economic impact assessment, there are important gaps in epidemiological and economic data, and in the methods for linking these. (2) Standardization of studies on the resource use and costs of HIV/AIDS is necessary to provide a sound basis for multinational scenarios. (3) Preliminary multinational scenarios show that by 1995 hospital-bed needs for AIDS might reach 0.45% of all hospital beds available in the EC, and that hospital cost projections for AIDS in that year will range from 0.15% to 0.30% of EC health-care expenditure.
Acquired Immunodeficiency Syndrome↗
How often is dysplasia diagnosed by biopsy or smear examination? Application of a maximum likelihood based method to the assessment of detection rates in the nasal mucosa of nickel workers.
In view of the known increased risk of nasal carcinoma and the high prevalence of dysplastic lesions of the nasal mucosa among nickel workers, regular screening for the existence of possibly precancerous dysplastic lesions is offered to workers in a Norwegian nickel refinery. Unfortunately, available sampling techniques do not allow the identification of all subjects in whom dysplastic changes are present. Independent histological and cytological (brush cytology) diagnoses, obtained for each of a group of 90 workers, have been used to estimate, by a maximum likelihood method, the probabilities that existing dysplastic lesions will be detected by each of these two screening methods. In the group studied, cytology performed rather less well than histology in unambiguously detecting dysplasia. However, when cytological specimens showing irregular (possibly dysplastic) epithelial cells were grouped with those showing clear dysplastic changes, detection probabilities were estimated at 0.52 by histology and 0.57 by cytology. Detection probabilities were estimated to be higher among subjects with a previously known history of dysplasia, particularly by histology (P < 0.01), probably due to larger dysplastic areas. In view of both its greater facility and speed of sampling, and its greater acceptability, brush cytology may be preferable to biopsy sampling for the screening of large numbers of workers at risk.
Biopsy↗
Three-dimensional DNA image cytometry by confocal scanning laser microscopy in thick tissue blocks.
A method for the quantification of nuclear DNA in thick tissue blocks by confocal scanning laser microscopy is presented. Tissues were stained en bloc for DNA by chromomycin A3. Three-dimensional images, 60 microns deep, were obtained by stacking up confocal fluorescent images obtained with an MRC-500 (Bio-Rad, Richmond, CA). The effects due to bleaching and attenuation by depth of fluorescence emission were corrected mathematically. The DNA contents were estimated by summing up the detected emission intensities (discretized into pixel gray levels) from each segmented nucleus. Applications to an adult rat liver and to a human in situ carcinoma of theesophagus are shown to demonstrate, respectively, the precision of the method and its potential usefulness in histopathology. Comparisons are made with DNA histograms obtained on the same materials by image cytometry on smears and by flow cytometry. Ploidy peaks obtained with the confocal method, although wider than with other methods, are well separated. Confocal image cytometry offers the invaluable advantage of preserving the tissue architecture and therefore allowing, for instance, the selection of histological regions and the evaluation of the degree of heterogeneity of a tumor.
Animals↗
Modelling and analysis of 3-D arrangements of particles by point processes with examples of application to biological data obtained by confocal scanning light microscopy.
Within the concept of point processes, a review is presented of quantities which can be used in studies of three-dimensional (3-D) aggregates of particles. Suitable characteristics and estimators are given for both unmarked and marked point processes. To demonstrate the feasibility of such quantitative approaches, an application in histology, dealing with 3-D arrangements of cell nuclei in rat liver, is described. Using a confocal scanning light microscope, 3-D images are recorded and image analysis used to obtain the coordinates of the centroid, together with the volume and DNA content, of each cell nucleus. Examples of results are given, using both unmarked and marked point processes. In the latter case, cell type, nuclear volume and ploidy group are suitable marks.
Animals↗
Transfusion-associated AIDS cases in Europe: estimation of the incubation period distribution and prediction of future cases.
European data on transfusion-associated (TA) AIDS cases reported by December 31, 1989 have been analyzed using both parametric and nonparametric methods. Parametric estimates of the median incubation period of TA AIDS in adults vary from 6.5 to 11 years according to the type of distribution assumed (Weibull or gamma) and the latest year of diagnosis included (1987 or 1988). The latter finding may reflect a lengthening of the incubation period due to increasing treatment of HIV-infected patients prior to the development of AIDS. It is predicted that, by the end of 1991, between 2,000 and 3,000 cases of AIDS will have been diagnosed in Europe among adults infected by transfusion between 1978 and 1985 (when systematic screening of donated blood was introduced in most western countries). It is not possible, however, to predict how many further cases may arise among those transfused more recently in countries in which screening was introduced at a later date.
Acquired Immunodeficiency Syndrome↗
Kaposi sarcoma as a sexually transmitted disease.
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Acquired Immunodeficiency Syndrome↗