Resolution of oral hairy leukoplakia during therapy with 9-(1,3-dihydroxy-2-propoxymethyl)guanine (DHPG).
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
B F Polk
Publications and source records attributed to B F Polk.
Infection with the human immunodeficiency virus: clinical manifestations and their relationship to immune deficiency. A report from the Multicenter AIDS Cohort Study.
In 1984 a large prospective study of gay and bisexual men was begun to elucidate the natural history of the human immunodeficiency virus (HIV) infection. At two successive semiannual examinations, clinical or hematologic abnormalities were found up to 13 times more often among HIV-seropositive men (n = 1611) than HIV-seronegative men (n = 2646). More than 30% of the seropositive participants had persistent generalized lymphadenopathy, independent of T-helper lymphocyte (CD4) counts and most other signs and symptoms. Other clinical manifestations such as thrush, anemia, thrombocytopenia, neutropenia, fever, and fatigue occurred with only slightly reduced CD4 counts (400 to 700/mm3) and appeared to increase exponentially with progressively lower counts. A simple systematically derived clinical index using these manifestations identified more than 70% of the seropositive men with significant T-helper cell depletion. This kind of clinical index may be useful for assessing groups of HIV-infected persons, especially those whose T-lymphocyte numbers and function cannot be readily measured.
Acquired Immunodeficiency Syndrome↗
Clinical manifestations of acute infection with human immunodeficiency virus in a cohort of gay men.
During a prospective study of the natural history of human immunodeficiency virus (HIV) infection in a cohort of gay/bisexual men, information on self-reported symptoms lasting for 3 or more days during the previous 6 months was collected without knowledge of the subject's HIV serological status. Twenty-two people were retrospectively found to have seroconverted to HIV during the interval. Each seroconverter was matched to two seronegative and two seropositive controls. Matched case-control analyses using the seronegative controls determined that the following symptoms lasting for 3 or more days were associated with new HIV infection: fever greater than 37.7 degrees C, swollen lymph nodes, night sweats and headaches. Matched case-control analyses using the seropositive controls determined that the following symptoms lasting for 3 or more days were associated with new HIV infection: fatigue, fever greater than 37.7 degrees C, swollen lymph nodes, night sweats and headaches. It was notable that the majority of seroconversions were not associated with any symptoms lasting for 3 or more days. Due to their non-specificity, symptoms associated with seroconversion are not likely to have a high positive predictive value. In high risk populations, however, appearance of these symptoms may facilitate identification of early infection that may be important for studies of natural history or for optimal timing for initiating antiviral therapy.
Fatigue↗
Effect of HIV antibody disclosure on subsequent sexual activity in homosexual men.
During a prospective study of the natural history of AIDS, 1001 homosexual or bisexual men were offered the opportunity to learn their HIV antibody status. Six hundred and seventy (67%) of the population who elected to do so were similar to the 331 (33%) people who declined in a number of baseline characteristics. All were counselled to practice safe sex. To determine whether disclosure of HIV serologic status affects subsequent sexual behavior, we examined changes at four time-points in three sexual activities during the previous 6 months: the number of male partners with whom the participant had (1) sexual intercourse, (2) unprotected anal receptive intercourse, and (3) unprotected anal insertive intercourse. All activities decreased strikingly over the 18-month study period. Following disclosure, the mean number of partners dropped to 47% of the baseline number in people remaining unaware of their antibody status, to 45% in people told that they were seropositive, and to 55% in people told that they were seronegative. The mean number of partners for younger seropositives declined less than that for older seropositives. The mean number of partners with whom unprotected anal receptive intercourse was practiced declined to 57% of baseline in unaware people, 42% in aware seropositives, and 62% in aware seronegatives. The mean number of partners with whom unprotected anal insertive intercourse was practiced declined to 52% of baseline in unaware people, 42% in aware seropositives and 59% in aware seronegatives. Disclosure of a negative test result led to a significantly smaller decline in these sexual activities.(ABSTRACT TRUNCATED AT 250 WORDS)
Acquired Immunodeficiency Syndrome↗
Update on HIV infection. Epidemiologic and clinical aspects.
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Acquired Immunodeficiency Syndrome↗
Cytomegalovirus but not human T lymphotropic virus type III/lymphadenopathy associated virus detected by in situ hybridisation in retinal lesions in patients with the acquired immune deficiency syndrome.
Paraffin sections of retinal tissue from five patients who died from the acquired immune deficiency syndrome (AIDS) and retinopathy were examined by in situ hybridisation experiments with deoxyribonucleic acid (DNA) labelled with sulphur-35 of lentivirus, human T lymphotropic virus type III/lymphadenopathy associated virus (HTLV-III/LAV), and cytomegalovirus. HTLV-III/LAV ribonucleic acid (RNA) was not detected in any of the tissue sections. Cytomegalovirus RNA was identified, however, in three of the five patients. Retinopathy induced by cytomegalovirus may thus be one of the many syndromes potentiated by the immunosuppression caused by HTLV-III/LAV.
Acquired Immunodeficiency Syndrome↗
Risk factors for nosocomial urinary tract infection.
In a prospective study carried out in June 1979-April 1981, 134 of 1,458 adult inpatients at New England Deaconess Hospital, Boston, Massachusetts, acquired 136 urinary tract infections during 1,474 indwelling bladder catheterizations. Multiple logistic regression analysis identified nine factors that were significantly associated with acquisition of infection: duration of catheterization, lack of systemic antibiotic during short catheter courses, lack of urinemeter drainage, female sex, diabetes mellitus, microbial colonization of the drainage bag, serum creatinine greater than 2 mg/dl at the time of catheterization, the reason for catheterization, and the use of catheters with sealed collection junctions when no antibiotic was administered. When potential risk factors were considered individually, without adjusting for the influence of other factors, infection was also significantly associated with 11 other factors, including several that have been previously reported as risk factors for catheter-associated urinary tract infections; however, these associations were no longer significant after adjustment for one or more of the nine factors noted above. These findings suggest approaches to surveillance, prevention, and research activities. They also strongly support the widely-held but poorly documented belief that persons with diabetes are more susceptible to urinary tract infection than are persons without diabetes.
Adult↗
Nonresponsiveness to hepatitis B vaccine in health care workers. Results of revaccination and genetic typings.
Twenty-eight health care workers who had a poor antibody response when initially vaccinated with hepatitis B vaccine were revaccinated with three additional 20-microgram doses. Eight of the twenty nonresponders, who had levels of antibody to hepatitis B surface antigen (anti-HBs) of less than 8 estimated radioimmunoassay (RIA) units, and all 8 of the hyporesponders, who had anti-HBs levels of 8 or 16 RIA units, attained anti-HBs levels of 36 RIA units or more after revaccination. Tests for HLA-A, B, C, and DR; for complement proteins C2, C4A, C4B, and BF; and for the erythrocyte enzyme glyoxalase I were done in 17 nonresponders and 3 hyporesponders. Nine (45%) had HLA-DR7 and 8 (40%) had HLA-DR3, compared with an expected rate of 23% in the general population. At least one of two extended haplotypes (B44, DR7, FC31 or B8, DR3, SCO1) were detected in 6 of the 9 who did not respond to revaccination, compared with 2 of 11 who responded to a second course of vaccine. Poor responders to vaccine may benefit from revaccination, and genetic factors may modulate the immune response to vaccination.
Adult↗
Rarity of cesarean delivery in cases of juvenile-onset respiratory papillomatosis.
Papillomas of the respiratory and genital tracts are caused by the same papillomavirus genotypes, and mothers of children with respiratory papillomatosis often have a history of genital warts. Only one of 109 cases reviewed gave a history of birth by cesarean section, whereas ten cesarean deliveries would have been the expected number for this group on the basis of national rates. The single case was delivered by elective cesarean section before the rupture of the membranes, and the child developed respiratory papillomatosis in the first year of life. These findings suggest that in juvenile-onset disease, the transmission of infection from mother to child occurs most often during passage through an infected birth canal, but that intrauterine infection of the fetus is also possible. Papillomavirus infection of the female genital tract is common, but respiratory papillomatosis is rare. On the basis of crude estimates of annual number of children born to infected mothers and of new cases of juvenile-onset disease, the risk of developing disease for a child born to an infected mother was calculated to be one in several hundred exposures.
Cesarean Section↗
Female-to-male transmission of AIDS.
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Acquired Immunodeficiency Syndrome↗
Isolated antibody to hepatitis B surface antigen and response to hepatitis B vaccination.
To determine the need for immunization of health workers with antibody to hepatitis B surface antigen (anti-HBs) as their only serologic marker of previous hepatitis B exposure, we studied the level, persistence, and immunologic specificity of isolated anti-HBs in 46 persons identified during screening for hepatitis B vaccine. We rescreened these persons 1 year later, administered a single dose of hepatitis B vaccine, and determined the anti-HBs level at 1, 2, and 8 weeks after vaccination. Isolated anti-HBs levels were low and antibody did not persist; 22 subjects tested had lost detectable anti-HBs within 19 months even though immunologic specificity was shown in vitro in 34. Anamnestic responses suggesting previous exposure and immunity were seen in only 10 subjects; 5 of these subjects had moderate-level, persistent anti-HBs. Although some persons with naturally acquired, isolated anti-HBs may be protected from hepatitis B, the immunologic specificity and protective value of anti-HBs, especially when levels are low, remain questionable.
Antibody Specificity↗
A comparative trial of cefazolin and moxalactam as prophylaxis for preventing infection after abdominal hysterectomy.
In a randomized, double-blind clinical trial, 208 women who underwent abdominal hysterectomy received either cefazolin (N = 108) or moxalactam (N = 100) as perioperative antimicrobial prophylaxis. There were no differences between the two groups in rates of serious infection, minor wound infection, standard febrile morbidity, duration of hospitalization, proportion receiving other postoperative antibiotics, or rates of rehospitalization. Women who received moxalactam had significantly more urinary tract infections, 87% of which were caused by the enterococcus. It is concluded that perioperative prophylaxis with third-generation cephalosporins is not justified at this time.
Adult↗
Relation of serum vitamins A and E and carotenoids to the risk of cancer.
Epidemiologic studies suggest that low carotene intake and low levels of serum retinol may be associated with an increased risk of cancer. Likewise, in some animal studies vitamin E has been associated with a reduced rate of induced cancers. Therefore, we measured retinol, retinol-binding protein, vitamin E (alpha-tocopherol), and total carotenoids in serum collected in 1973 from 111 participants in the Hypertension Detection and Follow-up Program who were free of cancer at the time but were diagnosed as having cancer during the subsequent five years. These measurements were compared with those in 210 controls who were matched for age, sex, race, and time of blood collection, and who remained free of cancer. Mean values for retinol were similar for cases and controls (67.3 and 68.7 micrograms per deciliter, respectively [95 per cent confidence limits for case-control difference, -6.7 to 3.5]). Values were also similar for retinol-binding protein (6.01 and 5.94 mg per deciliter [-0.42 to 0.56]), and carotenoids (114.5 and 111.6 micrograms per deciliter [-9.1 to 15.9]). The mean base-line retinol level in the 18 subjects with subsequent lung cancer was higher than that in their matched controls (79.0 vs. 71.4 micrograms per deciliter, -4.9 to 19.7). Serum vitamin E levels were somewhat lower in subjects who later had cancer than in controls (1.16 and 1.26 mg per deciliter, -0.22 to 0.02), in part because of the confounding effect of serum cholesterol levels (when adjusted for lipid levels, the case-control difference was -0.05 mg per deciliter; -0.17 to 0.07). These data do not support hypotheses relating intake or serum levels of antioxidant vitamins to a reduced cancer risk.
Adult↗
Microvascular aspects of acquired immune deficiency syndrome retinopathy.
Twelve of 13 patients with the acquired immune deficiency syndrome exhibited ophthalmoscopically detectable retinal findings, including cotton-wool spots, hemorrhages, Roth spots, and microvascular changes. When we used fluorescein angiography, we detected focal nonperfusion and microvascular changes in all 13 of our patients. Most patients had no visual complaints unless they had cytomegalovirus involvement of the optic papilla or the central retina. One patient lost central visual acuity from loss of perfusion in a portion of his perifoveal capillary net. Histopathologic studies demonstrated the loss of retinal capillary cells and focal occlusions of small vessels. Retinal vessel walls were also thickened with PAS-positive material.
Acquired Immunodeficiency Syndrome↗
Disability days associated with detection and treatment in a hypertension control program.
Labeling individuals as hypertensive has been associated with increased absenteeism from work. Distributions of disability days were compared for the years before and after screening for hypertension among 10,049 participants in a clinical trial of intensive antihypertensive therapy. Stepped care participants attended special clinics and referred care participants returned to their usual sources of medical care. For those unaware of their hypertension at screening, disability days increased between baseline and one year among referred care (n = 1805), while there was no change among stepped care (n = 1842) participants. Neither referred care (n = 1868) nor stepped care (n = 1906) participants who were aware but untreated at baseline reported a change in disability days over the following year. For those aware and treated at baseline, there was no change in disability days in referred care (n = 1275), but a decrease was reported in stepped care (n = 1353). Further descriptive analyses suggest that neither labeling alone nor treatment alone was associated with increased absenteeism. However, detection and treatment were associated with increased absenteeism among newly diagnosed referred care hypertensives, while management of previously treated hypertensives in stepped care clinics was associated with reduced absenteeism. Because these latter comparisons are made between groups stratified on a postrandomization variable, selection bias is possible and interpretations must be made with caution.
Absenteeism↗
A multivariate analysis of risk factors for hepatitis B virus infection among hospital employees screened for vaccination.
Previous studies of risk factors for hepatitis B virus infection among hospital employees have been based on surveys in single institutions or have been analyzed with univariate techniques. From November 1980 through August 1981, the authors performed a multi-institutional seroepidemiologic survey of hospital employees screened for entrance into a hepatitis B vaccine trial who represented groups at high risk for hepatitis B infection. Using a logistic regression model for the analysis of risk factors, the investigators determined the relative odds and 95% confidence intervals for risk of hepatitis B infection to be as follows: race (nonwhite/white: 3.4; 2.4-4.8) (p less than 0.001); history of acute viral hepatitis of an unspecified type (3.6; 2.2-5.9) (p less than 0.001); and employment at hospitals 1 through 5 as compared with hospital 6 (1.8; 1.1-2.9) (p = 0.015). In addition, certain job categories and the duration of employment within some of these categories were associated with increasing risk for hepatitis B infection over time. Laboratory workers (1.4; 1.2-1.7), surgical staff (1.2; 1.1-1.4), and medical staff (1.3; 1.1-1.5) had significant (p less than 0.05) increased risk of prior infection with longer duration of employment. Such time-job interaction was not demonstrable for nursing staff, anesthesiology staff, dental personnel, pathology staff, or ancillary personnel. The logistic regression model also shows that the highest gradient of risk for laboratory workers, surgeons, and medical staff occurs during the first five years of employment. An effective preventive strategy, such as the use of hepatitis B vaccine, should be targeted for these groups at the time of initial employment.
Adult↗
Hepatitis B vaccine in health care personnel: safety, immunogenicity, and indicators of efficacy.
In a double-blind trial, we randomly assigned 1330 high-risk health care personnel to receive three 20-micrograms doses of hepatitis B vaccine or placebo. Among vaccine recipients 58% responded within 1 month and 97% within 9 months; there was no difference in immune response to the vaccine between men and women. Efficacy was evaluated after a mean follow-up of only 13.2 months, just before the vaccine was released commercially. Five hepatitis B infections were identified in placebo recipients and one in a vaccine recipient. Although the number of infections was too small to allow confident conclusions about protective efficacy of the vaccine, we saw a 67% reduction in the need for hepatitis B immune globulin after accidental hepatitis B inoculation in the vaccine group (relative risk, 5.08; 95% confidence intervals, 1.3 to 19.9). Minor side effects occurred with equal frequency after vaccine (28.7%) and placebo (27.2%) injections; no participant had a severe adverse reaction. Vaccination with the 20-micrograms hepatitis B vaccine was highly immunogenic and safe in health care workers.
Adult↗