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Biomedical subjects

Carlos del Rio

Publications and source records attributed to Carlos del Rio.

At least 19 recordsLinked to original sources
PubMed2007

Correlates of HIV risk and preventive behaviors in Armenian female sex workers.

This study describes HIV risk and preventive behaviors and their correlates among Armenian female commercial sex workers (CSWs) as a prerequisite to developing gender and culturally appropriate interventions. Ninety-eight CSWs from three Armenian cities were interviewed using a structured questionnaire. Quantitative findings were further elaborated by focus group discussions (N = 25) and key informant interviews (N = 8). Inconsistent condom use with all types of sexual partners was reported, as were condom tear/slippage, alcohol and drug use, and sex with drug injecting clients. Prominent misconceptions regarding HIV transmission, prevention and disease manifestations were noted. Correlates of condom use intentions included history of substance use, attitudes regarding condom use, risk perception, and comfort negotiating condom use. Intentions to use condoms were strongly associated with recent frequency of condom use. Understanding the relationship between condom use and its determinants is critical in the design and implementation of effective prevention programs tailored for Armenian CSWs.

Adolescent↗
PubMed2006

The economic burden of HIV in the United States in the era of highly active antiretroviral therapy: evidence of continuing racial and ethnic differences.

BACKGROUND: Assessing the economic burden of HIV/AIDS can help to quantify the effect of the epidemic on a population and assist policy makers in allocating public health resources. OBJECTIVE: To estimate the economic burden of HIV/AIDS in the United States and provide race/ethnicity-specific estimates. METHODS: We conducted an incidence-based cost-of-illness analysis to estimate the lifetime cost of HIV/AIDS resulting from new infections diagnosed in 2002. Data from the HIV/AIDS Reporting System of the Centers for Disease Control and Prevention were used to determine stage of disease at diagnosis and proportion of cases by race/ethnicity. Lifetime direct medical costs and mortality-related productivity losses were estimated using data on cost, life expectancy, and antiretroviral therapy (ART) use from the literature. RESULTS: The cost of new HIV infections in the United States in 2002 is estimated at $36.4 billion, including $6.7 billion in direct medical costs and $29.7 billion in productivity losses. Direct medical costs per case were highest for whites ($180,900) and lowest for blacks ($160,400). Productivity losses per case were lowest for whites ($661,100) and highest for Hispanics ($838,000). In a sensitivity analysis, universal use of ART and more effective ART regimens decreased the overall cost of illness. CONCLUSION: Direct medical costs and productivity losses of HIV/AIDS resulting from infections diagnosed in 2002 are substantial. Productivity losses far surpass direct medical costs and are disproportionately borne by minority races/ethnicities. Our analysis underscores economic benefits of more effective ART regimens and universal access to ART.

Antiretroviral Therapy, Highly Active↗
PubMed2006

Risk factors for mortality among patients with extrapulmonary tuberculosis at an academic inner-city hospital in the US.

Despite an overall decrease in numbers of tuberculosis (TB) cases in the US, the proportion of extrapulmonary TB cases has increased. The study objective was to determine the most important predictors of all-cause mortality among patients with extrapulmonary TB. A retrospective chart review of adult extrapulmonary TB cases registered between 01/1995 and 12/2001 at Grady Memorial Hospital (a 1,000 bed, public inner-city hospital in Atlanta) was performed. Risk factors for death within 12 months after diagnosis of extrapulmonary TB were identified in multivariate analysis using log-binomial regression model. A total of 212 cases of extrapulmonary TB were identified; 100 (47%) were HIV-infected. The majority of patients were male (68%) and African-American (84%); mean age was 40 years. The most common sites of extrapulmonary TB were: lymph node (26%), pleural (21%), disseminated (20%), and central nervous system (CNS) or meningeal (16%). All-cause mortality rate in patients with extrapulmonary TB was 15% (21% among HIV-seropositive and 9% among HIV-uninfected patients, p = 0.02). In multivariate analysis, independent predictors of mortality included disseminated disease (PR = 4.66, 95% CI 1.93-11.24) and CNS/meningeal extrapulmonary TB (PR = 4.29, 95% CI 1.78-10.33), controlling for HIV infection. Extrapulmonary TB continues to be a persistent problem in the inner city and is associated with high mortality rates, especially among HIV-infected. Disseminated disease and the presence of CNS/meningeal TB are associated with poor prognosis.

Adult↗
PubMed2006

Prevalence of hepatitis C, HIV, and risk behaviors for blood-borne infections: a population-based survey of the adult population of T'bilisi, Republic of Georgia.

Injection drug use and associated hepatitis C virus (HCV) and HIV infections are on the rise in Russia and the republics of the former Soviet Union. While small targeted studies have found widespread drug use and disease among at-risk populations, there have been few attempts to comprehensively evaluate the extent of these epidemics in general post-Soviet societies. We conducted a two-stage cluster randomized survey of the entire adult population of T'bilisi, Republic of Georgia and assessed the burden of HCV, HIV, and risk behaviors for blood-borne infections in 2,000 study participants. Of the 2,000 surveyed individuals, 162 (8.1%) had injected illicit drugs during their lifetimes. Of the individuals who had injected illicit drugs, 138 (85.2%) reported sharing needles with injection partners. HCV was found in 134 (6.7%) of the total surveyed population, but in 114 (70.4%) of those who had injected illicit drugs. We found HIV in only three (0.2%) individuals, all of whom had injected illicit drugs. Injection drug use and high-risk injection practices are very common in Georgia and may be harbingers of a large burden of HCV-associated liver diseases and a potentially serious HIV epidemic in the years to come.

Adult↗
PubMed2006

Rapid HIV testing: a review of the literature and implications for the clinician.

HIV counseling and testing services are critical for individuals to access HIV prevention and treatment. Unfortunately, the standard HIV testing algorithm is complex and includes the use of a sensitive enzyme immunoassay (EIA), followed by a Western blot if the EIA is positive. This process can take 1 week or longer. Therefore, innovative approaches that incorporate simpler diagnostic algorithms are needed to reach the large number of individuals who are not aware that they are HIV-infected. Currently available rapid HIV tests have demonstrated sensitivities and specificities comparable to those of standard HIV testing without the requirements of sophisticated laboratory resources or highly trained personnel. These rapid HIV tests are increasingly being used in various clinical scenarios to decrease the number of missed opportunities for detection of HIV-infection. Their use is particularly applicable in specific clinical and nonclinical settings; public health settings; labor and delivery wards; in the management of occupational exposures; and in resource-constrained settings. The overarching goals of achieving wide implementation of rapid HIV tests are to increase the number of individuals who are aware of their serostatus, to improve entry of persons with HIV into prevention and care services, and to prevent further HIV transmission.

AIDS Serodiagnosis↗
PubMed2006

Risk behaviors and HIV, hepatitis B, and hepatitis C seroprevalence among injection drug users in Georgia.

INTRODUCTION: HIV is an emerging epidemic in Eastern Europe. Most HIV infections in this region have occurred among injection drug users (IDUs) and their sexual partners. The objective of this study was to determine the seroprevalence and risk behaviors for HIV, HBV, and HCV infection among IDUs in Georgia. METHODS: Between 2000 and 2001, we studied 583 IDUs aged 18 to 46 years from 3 cities in Georgia. Tbilist, Poti, and Batumi, Structured questionnaires were administered to measure risk behaviors, including IDU, sexual, and other risks. Blood was drawn for HIV hepatitis B (HBV), and hepatitis C (HCV) serologies. RESULTS: 401 (68.8%) participants were seropositive for HCV; 322 (55.2%) for HBV (HBsAg or anti-HBc): and 10 (1.7%) for HIV, Heroin (58.7%) was the most frequently used drug, followed by homemade drugs (31.6%) and opium, (9.8%). In multivariate analysis, risk factors, for HCV and HBV infection included unsafe cleaning practices for injection parapheralia. The number of drug-using partners was associated with HCV infection. Sexual risk factors (i.e., the number of sex partners, paying for sex, and a history of sexually transmitted infections [STIs] were associated with HIV but not with HCV infection. Those injecting homemade drugs and optium most frequently reported risky drug-using behavior. DISCUSSION: Our data suggest a high prevalence of HBV and HCV infection among IDUs in Georgia associated with significant drug- and needle-sharing behaviors. HIV seroprevalence appears to be relatively low and is associated with risky sexual behaviors, rather than drug-using behaviors. Further research is needed among Georgian IDUs to develop effective prevention strategies and limit the transmission of HIV in this population.

Adolescent↗
PubMed2006

Emphysematous cholecystitis due to Salmonella derby.

We present the case of a woman with diabetes mellitus who developed symptoms and signs consistent with gastroenteritis. After admission for hydration, the patient rapidly became critically ill and an abdominal catastrophe was suspected as the cause of her deterioration. Computed tomography of her abdomen was done and revealed gas in the lumen of the gallbladder consistent with emphysematous cholecystitis. She underwent emergent cholecystectomy, which revealed that the gallbladder had already ruptured. Blood cultures grew Salmonella derby. After a prolonged hospitalisation she eventually recovered and was discharged home. Emphysematous cholecystitis, thought to be a variant of acute cholecystitis, is a medical and surgical emergency. Diagnosis relies heavily on imaging findings by ultrasound or computed tomography since the clinical presentation is often non-specific. Cholecystectomy remains the treatment of choice in addition to broad spectrum antibiotics and other supportive measures.

Acute Disease↗
PubMed2005

Vaccination strategies to prevent tuberculosis in the new millennium: from BCG to new vaccine candidates.

Current global control efforts targeting tuberculosis (TB) include the treatment of latent TB infection, case detection and treatment with directly observed therapy short-course (DOTS), and BCG (bacille Calmette-Guérin) vaccination. However, BCG has been found to decrease only childhood TB morbidity and mortality but has a very limited effect in the transmission dynamics of the infection. These limitations of BCG are the driving force for the development of new TB vaccines. New TB vaccine candidates have entered clinical evaluation and many more are in the pipeline to undergo clinical testing. New vaccine candidates may offer better protection than that afforded by currently available BCG vaccines. Furthermore, combined vaccination schedules against TB seem to be a promising strategy in the new millennium.

BCG Vaccine↗
PubMed2005

Genetic differences in Pneumocystis isolates recovered from immunocompetent infants and from adults with AIDS: Epidemiological Implications.

Polymerase chain reaction analysis, direct DNA sequencing, and histological staining were used to determine whether Pneumocystis jirovecii was present in lung tissue specimens obtained, at autopsy, from 58 infants without identifiable immunodeficiency. The results of genotyping of these specimens were compared with the results of genotyping of specimens obtained from 384 human immunodeficiency virus (HIV)-infected adults with Pneumocystis pneumonia. P. jirovecii DNA was detected at the mitochondrial large subunit rRNA and dihydropteroate synthase loci in 100% and 53%, respectively, of the specimens obtained from infants. All specimens obtained from adults tested positive for P. jirovecii at both loci. Genotype distributions at both loci were significantly different in the 2 populations (P < .0001). The observation of different strains circulating in immunocompetent infants and HIV-infected adults suggests independent transmission cycles that warrant further study.

AIDS-Related Opportunistic Infections↗
PubMed2005

Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care.

OBJECTIVE: The Antiretroviral Treatment Access Study (ARTAS) assessed a case management intervention to improve linkage to care for persons recently receiving an HIV diagnosis. METHODS: Participants were recently diagnosed HIV-infected persons in Atlanta, Baltimore, Los Angeles and Miami. They were randomized to either standard of care (SOC) passive referral or case management (CM) for linkage to nearby HIV clinics. The SOC arm received information about HIV and local care resources; the CM intervention arm included up to five contacts with a case manager over a 90-day period. The outcome measure was self-reported attendance at an HIV care clinic at least twice over a 12-month period. RESULTS: A higher proportion of the 136 case-managed participants than the 137 SOC participants visited an HIV clinician at least once within 6 months [78 versus 60%; adjusted relative risk (RR(adj)), 1.36; P = 0.0005) and at least twice within 12 months (64 versus 49%; RR(adj), 1.41; P = 0.006). Individuals older than 40 years, Hispanic participants, individuals enrolled within 6 months of an HIV-seropositive test result and participants without recent crack cocaine use were all significantly more likely to have made two visits to an HIV care provider. We estimate the cost of such case management to be 600-1200 US dollars per client. CONCLUSION: A brief intervention by a case manager was associated with a significantly higher rate of successful linkage to HIV care. Brief case management is an affordable and effective resource that can be offered to HIV-infected clients soon after their HIV diagnosis.

Adolescent↗
PubMed2005

It is time to implement routine, not risk-based, HIV testing.

Approximately one-quarter of a million persons in the United States who are infected with human immunodeficiency virus (HIV) do not know it. To decrease the number of such persons, primary care providers should make HIV testing a routine component of health care. HIV testing should also be offered routinely in other settings, such as emergency departments, jails, and substance abuse treatment centers. Currently, the Centers for Disease Control and Prevention and the Infectious Diseases Society of America recommend routine HIV testing only in settings where the prevalence of HIV infection is > or =1%; in settings where the prevalence of HIV infection is <1%, testing should be based on risk assessment. Because of the impracticality of strategies for testing that are based on estimates of prevalence, and because of the inaccuracy of risk assessment, we propose that HIV testing be routinely offered to any person who is sexually active. As an adjunct to the implementation of routine testing programs, counseling practices need to be streamlined, and rapid HIV testing needs to be implemented in the appropriate settings.

Diagnostic Tests, Routine↗
PubMed2005

Potential for medical transmission of HIV in Ethiopia.

The potential medical transmission of HIV through unsafe medical injections was evaluated in 16 rural health institutions in Ethiopia. Most institutions reported re-using disposable needle/syringes, and 12% of observed injections were given with used, disposable syringes prepared for re-use. Analysis of used needle flushes showed no HIV RNA; however, the sensitivity of our method was limited. Despite the re-use of disposable needles, medical injection practices are not likely to contribute significantly to HIV transmission in this region.

Adolescent↗