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Biomedical subjects

B Gazzard

Publications and source records attributed to B Gazzard.

At least 127 records · Page 7Linked to original sources
PubMed1993

AIDS surveillance: a direct assessment of under-reporting.

OBJECTIVE: To assess directly the extent of under-reporting of AIDS cases to the National AIDS surveillance system. DESIGN: All AIDS cases diagnosed from 1 January 1982 to 1 August 1989 in Riverside Health Authority were identified from a local register of HIV infection and cross-checked against records of AIDS cases reported to the national AIDS surveillance system. SETTING: Riverside Health Authority, London, UK. MAIN OUTCOME MEASURES: An estimate of under-reporting was made by identifying both the number of AIDS cases that had not been reported and the number of AIDS cases reported after August 1989 (allowing for reporting delay). Changes in the timeliness, 1982-1989, of AIDS reporting by Riverside physicians were measured by comparing reporting delay (time between diagnosis and report) and the proportion of AIDS cases reported more than a year after diagnosis (non-reports). RESULTS: A total of 807 AIDS cases were identified. Under-reporting of AIDS cases was found to be 10%; less than 3% (20 cases) of the AIDS identified had not been reported by September 1991. The timeliness of AIDS reporting from Riverside improved significantly from 1987, when the median reporting delay fell from 7 to 4 months, and the proportion of non-reports fell from 36 to 17% (Mann-Whitney U test P < 0.001, chi 2 test P < 0.001, respectively). CONCLUSIONS: Our estimate of 10% AIDS under-reporting is half that used to adjust the previous forecasts of the AIDS epidemic in the UK, confirms current thinking that under-reporting lies between 5 and 15%, and supports the view that AIDS reporting is more complete than the reporting of most other infectious diseases.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Natural history of AIDS related sclerosing cholangitis: a study of 20 cases.

A case control study of AIDS related sclerosing cholangitis indicates that it has no overall influence on prognosis, but is responsible for a striking reversal of the usual inverse correlation of age and survival in HIV infection. Pain, the principal symptom, was controlled in surviving patients with analgesics alone. Twenty consecutive patients with AIDS related sclerosing cholangitis, defined from at least two characteristic lesions at endoscopic retrograde cholangiopancreatography, were followed for a minimum of 10 months or until death. Median age was 33.5 years (range 27-50). All had abdominal pain; 11 had diarrhoea. Alkaline phosphatase was > 2X normal in 13, but the bilirubin was raised in only three. The median CD4 was 0.024 x 10(9)/l (0.005-0.341). Thirteen had cryptosporidiosis, six had active cytomegalovirus, five had no gastrointestinal pathogen. Three patients are alive without AIDS related sclerosing cholangitis symptoms at 10, 11, and 21 months. Seventeen have died at median 7 (1-23) months. Cytomegalovirus therapy had no apparent influence. The initial CD4 was < 0.11 in all those dying within six months, but correlation of CD4 with prognosis was otherwise poor. Controls, matched for age, CD4, and opportunistic infections had virtually identical overall outcome (median survival 7.5 months) and the expected worse prognosis with increasing age. Increasing age, however, appeared protective in AIDS related sclerosing cholangitis (r = +0.6; p < 0.05): this is not explained by disproportionate degrees of immunosuppression, nor by opportunistic infections.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Rate of CD4 cell decline and prediction of survival in zidovudine-treated patients.

OBJECTIVE: To investigate the relationship between survival and the rate of CD4 cell decline before and in the first year following initiation of zidovudine (ZDV) therapy. DESIGN: Retrospective observational study. SETTING: Hospital-based HIV clinics within the Riverside District Health Authority in London. PATIENTS: Patients (total, 1415) with AIDS (n = 476), symptomatic (n = 687) or asymptomatic (n = 194) HIV-1 infection, or of unknown clinical status (n = 58), who first received ZDV between June 1986 and October 1991. INTERVENTION: The majority of patients received ZDV at an initial dose of 200 mg every 6 h or 250 mg twice daily. The median duration of follow-up after receipt of ZDV was 17 months (range, 2-54 months). MAIN MEASUREMENTS: CD4 cell counts prior to and following initiation of ZDV; rate of decline of log-transformed CD4 cell count before ZDV therapy and during the first year of therapy; survival. RESULTS: As of 31 December 1991, 432 patients had died. Patients with the highest rate of log CD4 decline before initiation of ZDV (< or = -0.06 log cells per month) as well as in the first year of ZDV therapy (< or = -0.08 log cells per month) had a much poorer 3-year survival from initiation of ZDV (23 and 40.5%, respectively) compared with patients with no decline or an increase in their CD4 count before (39.0%) or after (72.3%) ZDV therapy. In a series of multivariate analyses, a high rate of log CD4 decline in the first year of ZDV therapy (< or = -0.08 log cells per month) was predictive of poor survival, after adjustment for age and clinical status at initiation of ZDV and most recent CD4 count. In contrast, rate of CD4 decline before ZDV, presence of an initial CD4 rise and the magnitude of change in the rate of CD4 decline following ZDV were no longer significantly associated with outcome. CONCLUSIONS: In this retrospective study, the rate of CD4 decline in the first year of ZDV therapy, but not the occurrence of an initial CD4 rise was predictive of survival, suggesting that the early CD4 response may be a poor measure of the impact of ZDV. Patients with a high rate of CD4 decline despite ZDV therapy represent a subgroup of patients with a poor prognosis who might benefit from alternative or combination antiretroviral therapies.

Adolescent↗
PubMed1992

Impact of HIV infection on mortality in young men in a London health authority.

OBJECTIVE: To determine the number of deaths attributable to HIV infection among men aged 15-64 in a geographically defined population in the United Kingdom. DESIGN: Retrospective review of death certificates and linkage with local and national HIV and AIDS surveillance data. SETTING: Riverside District Health Authority, London. MAIN OUTCOME MEASURES: Numbers of deaths attributed to HIV infection in male residents of Riverside aged 15-64 and 15-44 over a six month period. Proportion of attributed deaths were (i) identified from death certificates by the Office of Population Censuses and Surveys as being due to HIV infection and (ii) reported as cases of AIDS or HIV related deaths to the Public Health Laboratory Service Communicable Disease Surveillance Centre. RESULTS: 34 of 213 (16%) deaths in men aged 15-64 and 27 of 69 (39%) deaths in men aged 15-44 were attributed to HIV infection. Six of 33 (18%) attributed deaths were identified by the Office of Population Censuses and Surveys and 32/34 (94%) were reported to the Communicable Disease Surveillance Centre. CONCLUSIONS: HIV infection was the leading cause of death in male residents of Riverside aged 15-44 and the third commonest cause of death in those aged 15-64. Most individuals dying of known HIV infection were reported to the Communicable Disease Surveillance Centre but identification of the true cause of death from the process of death certification was poor. Measures to improve the certification of HIV and AIDS or the use of AIDS surveillance information correctly to code the cause of death needs to be considered to ensure that the true impact of HIV infection is reflected in routine mortality statistics.

Adolescent↗
PubMed1992

T-cell receptor variable gene products and early HIV-1 infection.

To assess the hypothesis that the human immunodeficiency virus (HIV) might mimic major histocompatibility complex (MHC) allodeterminants and interact with T-cell receptors (TCRs) of alloreactive T-cells, we have done a preliminary analysis of the range of alpha beta TCR gene products in 16 HIV-1-seropositive individuals with normal CD4 counts and in 16 healthy HIV-1-negative controls. Using a panel of monoclonal antibodies with a two-colour direct immunofluorescence method, we found a significant increase in the expression of the V beta 5.3 subfamily in the HIV-positive patient group compared with controls (p less than 0.01). Selected increase in expression of V beta sequences has been described in various autoimmune conditions and our findings raise the possibility that the immunopathological damage from HIV infection may be due to the induction of autoreactivity. If HIV does mimic MHC II, the normal immune response to the virus could represent an autoimmune process similar to graft-versus-host disease.

Gene Expression↗
PubMed1992

Case report: pneumatosis intestinalis occurring in association with cryptosporidiosis and HIV infection.

We report a case of pneumatosis intestinalis (PI) occurring in association with cryptosporidiosis in a patient documented as being HIV-seropositive. Chest and abdominal radiographs taken 2 months previously were normal and the patient did not have any evidence of gastrointestinal infection at that time. The case was complicated by cyst rupture resulting in a pneumoretroperitoneum and pneumomediastinum. The association of pneumatosis and cryptosporidiosis has not been previously reported.

Adult↗
PubMed1992

Testing for HIV in the antenatal clinic: the views of midwives.

Self administered questionnaires were given to 34 midwives, who regularly counsel parturient women about the HIV antibody test, to investigate their attitudes to the test being offered in the antenatal clinic. Most of the midwives felt that testing should not be compulsory and that the test should be offered to all pregnant women who ask for it, not only those in recognized risk groups. Most also felt that women should be told the results of the test and that it should not be the midwives aim to increase the number of women having the test. Most felt that all midwives should counsel about the test but would like health advisers, GPs and obstetricians to be involved also. They also felt that they did not have sufficient knowledge in some areas to counsel particularly with regard to the practical and psychological implications of being HIV positive. This has implications in terms of the provision of adequate pre-test counselling for all pregnant women as an improvement in counselling services requires an allocation of finances, e.g. for training of midwives, which may be seen as unnecessary in areas of low seroprevalence. Further discussion and debate of these issues is required.

AIDS Serodiagnosis↗
PubMed1992

Comparison of nebuliser efficiency for aerosolizing pentamidine.

Inhaled pentamidine has become an important method of treatment and prophylaxis for Pneumocystis carinii pneumonia and we have compared nebuliser efficiency in terms of drug output and droplet sizes in four brands of jet nebuliser (Acorn-22, Inspiron, Cirrus, Respirgard II) and one brand of ultrasonic nebuliser (Fisoneb), at 2 pentamidine concentrations and 3 flow rates, using a laser particle sizer. Droplet size (which varied from 1.2 to 4.7 microns mass median diameter) was dependent in all cases, except with the Respirgard II system, on the flow rate of the gas driving the equipment and the concentration of pentamidine used. Drug output varied significantly between nebuliser brands and for a 300 mg dose of pentamidine was: 61% for the Acorn-22, 62% for the Inspiron, 49% for the Fisoneb and 43% for the Respirgard II. Both droplet size and drug output are important in determining nebuliser efficiency.

Aerosols↗
PubMed1992

Adenovirus infection of the large bowel in HIV positive patients.

AIMS: To describe the microscopic appearance of adenovirus infection in the large bowel of human immunodeficiency virus (HIV) positive patients with diarrhoea. METHODS: Large bowel biopsy specimens from 10 HIV positive patients, eight of whom were also infected with other gastrointestinal pathogens, with diarrhoea were examined, together with six small bowel biopsy specimens from the same group of patients. Eight of the patients had AIDS. The biopsy specimens were examined by light microscopy performed on haematoxylin and eosin stained and immunoperoxidase preparations, the latter using a commercially available antibody (Serotec MCA 489). Confirmation was obtained with electron microscopy. RESULTS: The morphological appearance of cells infected with adenovirus showed characteristic nuclear and cellular changes, although the inflammatory reaction was non-specific. Immunoperoxidase staining for adenovirus was sensitive and specific, and the presence of viral inclusions consistent with adenovirus was confirmed by electron microscopy. CONCLUSIONS: The light microscopic features of adenovirus infection are distinctive and immunocytochemistry with a commercially available antibody is a sensitive and specific means of confirming the diagnosis. Further studies of the role of adenovirus in causing diarrhoea in these patients are indicated.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Eating disorders in men with HIV infection.

Four men with HIV infection who were referred to liaison psychiatry for assessment of eating disorders are described. In all four cases the eating disorder had implications for the clinical management of their HIV infection. Investigations of weight loss, dietary intervention, and compliance may all be affected by the presence of an eating disorder. The development of HIV disease may exacerbate the symptoms of an eating disorder.

AIDS Serodiagnosis↗
PubMed1991

Pharmacokinetics of R 82913 in patients with AIDS or AIDS-related complex.

R 82913, a tetrahydroimidazobenzodiazepinthione (TIBO) derivative with potent activity against human immunodeficiency virus 1 (HIV-1) in vitro, was given to 22 patients with AIDS or AIDS-related complex in a dose-escalating pilot study. Doses of 10 to 300 mg administered daily by intravenous infusion were well tolerated for up to 50 weeks, with no haematological or biochemical evidence of toxicity. Mean OKT4 cell count rose slightly during the second month of treatment when higher steady-state plasma concentrations of the drug were achieved. Median p24 antigen concentration fell by 41% during the first month of therapy. When the rise in p24 antigen before therapy was compared to the fall during treatment, end-point analysis showed a significant difference (p less than 0.03). The combination of potent antiretroviral activity in vitro and the observed effect on HIV p24 antigen and absence of toxicity in vivo indicate that R 82913 and related TIBO derivatives merit further study in the treatment of retroviral infections.

AIDS-Related Complex↗
PubMed1991

Emergency laparotomy in patients with AIDS.

The presentation, operative management and final diagnosis were reviewed in 28 patients with AIDS (27 men and one woman) who underwent emergency laparotomy. On clinical and radiological examination, six patients showed features of toxic megacolon, five patients had small bowel obstruction, six patients had localized peritonitis and three had perforated viscus with generalized peritonitis. The most common disease processes were acute colitis in seven patients (associated with cytomegalovirus (CMV) infection in six), intra-abdominal lymphoma in five patients, acute appendicitis in five patients (associated with CMV infection in two), and atypical mycobacterial (MAI) infection in four patients. Two perioperative deaths occurred; one in a patient with acute pancreatitis and a second with generalized peritonitis. Later deaths were due to progression of AIDS, and patient survival at 1 month, 3 months and 6 months was 89 per cent, 64 per cent and 48 per cent, respectively. Lower operative mortality than in previously reported series may be due to earlier intervention in CMV toxic megacolon. Surgery, however, conferred less benefit in patients with acute abdominal pain from MAI infection or lymphoma. With careful patient selection, emergency laparotomy may achieve worthwhile palliation in patients with AIDS.

Acquired Immunodeficiency Syndrome↗