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Biomedical subjects

D Vlahov

Publications and source records attributed to D Vlahov.

At least 289 records · Page 16Linked to original sources
PubMed1991

Trends of HIV-1 risk reduction among initiates into intravenous drug use 1982-1987.

To assess how injection practices may have changed during the course of the AIDS epidemic, active intravenous drug users (IVDUs) recruited from the community were asked to report year of first injection as well as specific details about the first 3 months after initial injection: frequencies of injection, using sterile needles, sharing needles and other equipment. For the analysis, the users were sorted into successive cohorts of initiation (by year of first injection), and tests for trends were completed using Mantel-Haenszel statistics. Among the 421 IVDUs who reported first injection between 1982 and 1987, the use of new sterile needles to self-administer drugs increased (p less than .05) along with its corollary behavior (i.e., using equipment one is sure that no one else had used before). Conversely, there was a decrease in the proportion of those who always used equipment previously used by another IVDU (p less than .05) and a decrease in the number of needle-sharing partners (p less than .01). Over the 6 years, heroin as first drug decreased and cocaine increased (p less than .01). Although these data are from a cross-sectional interview study, they suggest a shift toward lower risk practices among new IVDUs between 1982 and 1987. The shift from heroin to cocaine is compatible with other evidence on the cocaine epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Diagnosis and differentiation of HTLV-I and HTLV-II infection by enzyme immunoassays using synthetic peptides.

Synthetic peptides from the major envelope protein of HTLV-I (ENV-I, amino acid 177-213) and HTLV-II (ENV-II, amino acid 173-209) and a conserved region of the transmembrane protein (TM, amino acid 378-402) were used as antigens in microtiter plate enzyme immunoassays (EIA) to detect and discriminate antibodies to HTLV-I and II. The ENV-I and ENV-II peptide EIAs were able to correctly discriminate HTLV-I and II infections in 17 of 18 subjects whose infections were determined by a gene amplification method. Sera from 100 of 107 subjects with serologically confirmed infection with HTLV-I/II and 0 of 218 seronegative controls reacted with one or more of the peptides (sensitivity, 93.5%; specificity, 100%). Ninety-six of the 100 peptide positive sera reacted exclusively with either the ENV-I or the ENV-II peptide, thereby differentiating the two viral infections. The pattern of reactivity to the ENV peptides was distinct in different populations. Patients attending an Emergency Department, who had a history of drug abuse, and male inmate entering a correctional facility only had antibody reactivity to the ENV-II peptide. Subjects from Haiti and patients with HTLV-associated neurological disease only had antibody reactivity to the ENV-I peptide. Peptide-based enzyme immunoassays that distinguish antibodies to HTLV-I and HTLV-II will facilitate studies of the epidemiology of HTLV.

Amino Acid Sequence↗
PubMed1990

Blood and plasma donations among a cohort of intravenous drug users.

We evaluated the blood and plasma donation histories of a cohort of 2921 intravenous drug users in Baltimore, Md, and correlated these histories with their human immunodeficiency virus (HIV) serologic status, numbers of CD4 lymphocytes in the peripheral blood, and stigmata of intravenous drug use (scarred veins). Of the 793 intravenous drug users (27.1%) who had donated blood or plasma, 652 (82.2%) donated after they had started using intravenous drugs. Most subjects donated at commercial plasma centers, where they were paid $10 to $15 per donation. Although the HIV-1 seroprevalence of the entire cohort was 24.1%, the HIV-1 seroprevalence among those reporting plasma or blood donations declined progressively with time, from 17.1% in those who last donated in 1985 to 3.6% in those who last donated in 1988-1989. Many of the 437 intravenous drug users who had donated plasma or blood since 1985, when screening for HIV-1 was initiated, had not been notified and counseled about their HIV test results. Current programs to exclude individuals with a history of intravenous drug use from the plasma donor pool should be reevaluated and improved.

Baltimore↗
PubMed1990

Association between intravenous drug use and early misbehavior.

This investigation uses an epidemiologic strategy to examine a suspected association between misbehavior in early life and subsequent involvement in intravenous drug use. The 222 cases of i.v. drug use in this study were a subset of all persons recruited for a continuing study of drug use, HIV-1 infection, and the natural history of AIDS. It was possible to match these 222 i.v. drug users to 588 subjects from the NIMH Epidemiologic Catchment Area survey sample, for a total of 810 subjects in 60 matched sets. The matching factors were gender and census tract of residence. Conditional logistic regression models were used to estimate the degree of association between early misbehavior and i.v. drug use. The results showed a strong association between i.v. drug use and early misbehavior. For every unit increase in misbehavior score, the odds of being an i.v. drug user increased by a factor of 1.74 (P less than 0.001). Compared to subjects with low misbehavior scores, those with high scores were 24.67 times more likely to be i.v. drug users (P less than 0.001). Results of this study add to evidence now supporting field trials of public health strategies to modify the link between misbehavior in early life and later illicit drug use.

Adolescent↗
PubMed1990

Variation in risk for falls by clinical department: implications for prevention.

To examine rates of falls and injuries by clinical department, a retrospective analysis was performed of 874 inpatient falls during a one-year period in a 1,000-bed acute-care hospital. Incident reports were reviewed, and for those patients injured, medical records were abstracted. Fall rates were calculated by age, sex and service using total patient days as the denominator. During 1983, 874 falls occurred during 282,713 adult patient days (31/10(4) days). Fall rates were significantly higher (odds ratio = 2.12; 95% confidence interval [CI]: 1.84, 2.45) in the neuroscience and psychiatry departments (53/10(4) days) compared with other adult services combined (25/10(4) days); this difference persisted after direct adjustment for age. Differences by clinical department persisted throughout four additional years of surveillance, although fall rates for the oncology service increased. Injuries following falls occurred among 200 (22.8%) patients. These data indicate that falls are not random events, and that falls and injury prevention programs can be more appropriately focused by consideration of clinical department.

Accidental Falls↗
PubMed1990

Association of drug injection patterns with antibody to human immunodeficiency virus type 1 among intravenous drug users in Baltimore, Maryland.

During 1988 and 1989, intravenous drug users recruited through extensive community outreach efforts in Baltimore, Maryland, were interviewed about drug injection and sex practices in the prior 11 years, with screening for antibody to human immunodeficiency virus type 1 (HIV-1). Neither interviewers nor subjects were aware of HIV-1 serostatus until 2 weeks after the interview. Among 2,616 intravenous drug users who last injected drug within the same calendar year as screening, HIV-1 seroprevalence was 30.1% for those with any use of shooting galleries, 23.3% for those who shared needles but did not use shooting galleries, and 16.3% for drug users who denied both needle-sharing and gallery use between 1977 and 1987. Among 608 drug users who reported persistent use of shooting galleries since 1977 or subsequent initiation into drug use, there was a tendency for HIV-1 seroprevalence to increase with more recent onset of an injection career. Combined with a milder but similar tendency among 739 drug users who reported persistent sharing of needles, and a seroprevalence of 15.1% among participants who had just started injecting drugs in the 18 months prior to baseline, these data provide indirect evidence that a high risk for HIV-1 infection might occur early during a drug injection career.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Seasonal and annual variation of antibody to HIV-1 among male inmates entering Maryland prisons: update.

Previous serosurveys of antibody to HIV-1 among incoming male inmates in Maryland between April and June of 1985, 1986 and 1987 have shown a prevalence of 7.0, 7.7 and 7.0%, respectively, with stability persisting after multivariate adjustment. To investigate seasonality and update annual trends, excess sera were obtained from incoming male inmates between August 1987 and August 1988. Correctional personnel also provided demographic variables of age, race, offense, category, and jurisdiction. Once rendered anonymous, specimens were assayed for antibody to HIV-1 using enzyme-linked immunosorbent assay and Western blot. For the 12-month study period, 415 (7.9%) of 5262 consecutive male entrants were seropositive. On univariate and multivariate analyses, no significant change in seroprevalence or risk by subgroup was noted by month or season. For data from April to June 1988, 113 (8.1%) of 1398 consecutive entrants demonstrated anti-HIV-1; seropositivity was associated with age greater than 25 years, Black race, and Baltimore jurisdiction. No significant change was found over time in seroprevalence or risk of HIV-1 infection by subgroup in multivariate analysis combining data for 1985-1988. These data provide additional evidence to suggest stability of HIV-1 seroprevalence in Maryland male prison entrants.

Acquired Immunodeficiency Syndrome↗
PubMed1990

The risk of transmission of HIV-1 through non-percutaneous, non-sexual modes--a review.

To date, three well-documented modes of transmission of HIV-1 (sexual, percutaneous and perinatal) have been described. Although the theoretical possibility exists for HIV-1 transmission through other routes, including non-percutaneous, non-sexual modes often referred to as 'casual' contact (and several anecdotal reports suggest this possibility), there is no credible epidemiological evidence to support this. Fourteen combined surveys, with over 750 individuals with potential exposure through non-percutaneous, non-sexual modes of contact, have failed to find a single case of HIV-1 infection (upper bound of 95% confidence interval = 0.40%), indicating that the risk of transmission by non-percutaneous, non-sexual modes is remote. Given the emotionally charged concerns about transmission of an infection which may end fatally in a high proportion of affected individuals, critical review of the low probability of transmission through non-percutaneous, non-sexual modes is important so that preventive efforts can be focused appropriately.

Epidemiologic Methods↗
PubMed1990

Antibody to human T-lymphotropic virus type I/II (HTLV-I/II) among male inmates entering Maryland prisons.

Serum specimens that had been obtained for routine operational procedures from consecutive entering male inmates during Spring 1987 and the same calendar period in 1988 were tested to identify prevalence and risk groups for antibody to HTLV-I/II. Specimens were assayed for antibody to HTLV-I/II using ELISA, RIPA, and Western blot techniques. Demographics were compared by serostatus using chi 2 and Fisher's exact tests. Of the 1,932 inmates entering prison, 49.3% were 25 years of age or older, 70.1% were black, 62.4% were committed from the Baltimore metropolitan area, 34.1% were intravenous drug users, and 7.0% demonstrated antibody to HIV-1. Among 1,932 inmates, 18 (0.9%) were HTLV-I/II seropositive. All seropositives were black; age greater than 25 years old was significantly (p less than 0.01) associated with seropositivity. Reactivity to HTLV-I/II did not vary significantly by year of entry, HIV-1 serostatus, jurisdiction, offense category, or sentence. Prevalence of HTLV-I/II among incoming male inmates was elevated compared to available local population comparisons. Additional blinded epidemiological serosurveys of antibody to HTLV-I/II are indicated for prison populations in order to monitor the extent and scope of infection in this population.

Adult↗
PubMed1990

HIV infection risk to health-care workers.

The risk of occupationally acquired human immunodeficiency virus (HIV) infection in exposed health-care workers has been estimated to be 0.5% after accidental needlestick with an HIV-contaminated needle. Needlestick injuries resulting in parenteral exposure to HIV-infected material are the most common reported cause of occupational HIV infection in health-care workers. With 60% of these exposures unpreventable even with strict adherence to current infection control procedures, it is necessary to develop technical changes in work protection in order to further reduce the risk.

Anxiety↗
PubMed1990

HIV infection risk to nonhealth-care workers.

As has been summarized above, the risk of casual contact transmission of HIV virus is remote. A review of these data should provide reassurance to both workers and management. No evidence exists for direct contact spread through shaking hands and nonsexual touching. There is also no evidence for indirect spread through contact with shared inanimate objects such as typewriters, telephones, computers, water fountains, rest rooms, dining facilities, exercise equipment, bathing facilities, spas, saunas, and swimming pools. In addition, there is no evidence to suggest the airborne spread of HIV, thus there should be no potential risk of transmission through air-conditioning units, air-handling systems, or by sharing the same office space with an infected individual. The fear of AIDS may lead to irrational beliefs and biased perceptions of risk. This, unfortunately, can sometimes lead to discriminatory and inhumane treatment of persons with AIDS. The best way to manage this potential problem in the workplace is through effective educational interventions.

Adult↗
PubMed1990

Epidemiology of falls among patients in a rehabilitation hospital.

Falls in institutional settings have been associated with considerable morbidity. Although risk factors for falls have been described for acute care and geriatric settings, data from the rehabilitation setting are sparse. To provide a descriptive epidemiology, incident reports of falls were reviewed at a 151-bed rehabilitation facility. Of 567 patients admitted between January 1 and December 31, 1984, 71 (12.5%) experienced at least one fall; most (75%) of the falls occurred in patients using wheelchairs. Risk for falls was associated with increasing age (p less than 0.05), a diagnosis of stroke, or lower extremity amputation (p less than 0.05). Of the 71 fallers, 31% experienced repeat falls which tended to occur more frequently with older age, disorientation, and nonambulatory status at first fall. Nearly 13% sustained injuries, which tended to occur more frequently among disoriented and wheelchair or bedfast patients. These data suggest that groups of patients who are at high risk for falls within the rehabilitation setting can be identified for the purposes of prevention, and targeted for preventive measures.

Accidental Falls↗
PubMed1989

Cocaine injection and ethnicity in parenteral drug users during the early years of the human immunodeficiency virus (HIV) epidemic in New York City.

Parenteral drug users have a high prevalence of infection with human immunodeficiency virus (HIV), the etiologic agent of acquired immune deficiency syndrome (AIDS). New York City has had a prolonged and extensive epidemic of HIV infection and AIDS. In this study, we analyze, in relation to antibody to HIV (anti-HIV), available data from sera from parenteral drug users collected in New York City during 1978 through 1983 in the course of studies of liver disease. Among parenteral users of both heroin and cocaine, 30 (52%) of 58 had anti-HIV, compared with six (13%) of 48 injectors of heroin only (P less than 0.0001). Only two (11%) of 18 white patients were HIV-infected, compared with 34 (39%) of 88 black or Hispanic patients (P = 0.03). No other factors studied were linked to anti-HIV. In a multiple logistic regression, anti-HIV was significantly more common in parenteral users of both cocaine and heroin (P less than 0.0001), black patients (P = 0.02), and Hispanic patients (P = 0.049). We conclude that parenteral users of both cocaine and heroin as well as black and Hispanic patients were disproportionately HIV-infected during the early years of the HIV epidemic. Use of cocaine and heroin as well as ethnicity were independently linked to anti-HIV. Measures to prevent or treat drug use, HIV infection, and other medical problems while addressing the specific needs of cocaine users and black and Hispanic patients are urgently needed.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Immunological effects of HIV-1 infection on the humoral response to malaria in an African population.

We conducted a cross-sectional study to determine the serological response to malaria in an HIV-1 infected population and in a control population in a region of high malaria transmission. The study group consisted of 66 hospitalized patients with clinical acquired immunodeficiency syndrome (AIDS) and 70 trauma patients without clinical AIDS (controls). Mean optical densities of antibody produced against RESA-4, RESA-8, RESA-11, (PNAN)5 and (NAAG)5 synthetic peptides of Plasmodium falciparum were compared between HIV-1 seropositive and HIV-1 seronegative patients using non-parametric statistics. HIV-1 seropositive patients with clinical AIDS had significantly less antibody to the synthetic P. falciparum ring stage peptide, RESA-8 (P = 0.001), than a comparable group of seronegative patients. Antibody levels were also low for the other ring stage peptides, RESA-4 (P = 0.024) and RESA-11 (P = 0.024). Although not statistically significant, antibody levels among the HIV-1 seropositive trauma patients were higher than among the HIV-1 seronegative trauma patients. During HIV-1 infection, a polyclonal B cell activation may occur as noted in the HIV-1 seropositive trauma patients, but with increased immunosuppression in advanced clinical AIDS, B cell stimulation appears to be diminished. This results in decreased production of malaria antibody.

Acquired Immunodeficiency Syndrome↗