Biomedical subjects
H M Ginzburg
Publications and source records attributed to H M Ginzburg.
AIDSphobia litigation.
A significant proportion of adolescent girls engaging in risky behaviors will use confidential HIV counseling and testing services that are linked to primary care. Health-care providers play an important role in helping teens address their risk for and concerns about HIV infection by engaging adolescents in repeated discussions about HIV testing.
Effects of drug misuse treatment on symptoms of depression and suicide.
In this longitudinal study of 9,904 clients who were treated at methadone, outpatient drug-free (OPDF), and residential treatment facilities, at intake more than half of all clients reported symptoms of depression or suicide. Females and multiple nonnarcotics users were at highest risk for suicide attempts. Despite a dramatic drop in the level of symptomatology by 4 weeks in treatment, many clients remained suicidal throughout the study period. Suicidal tendencies at both intake and 4 weeks were strongly related to suicidal tendencies at 12 months post-treatment; even more strongly related was the return to weekly or more frequent use of narcotics or nonnarcotics for residential and OPDF clients.
HIV infection in pregnancy: epidemiology and clinical management.
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Patterns of HIV-1 and HTLV-I/II in intravenous drug abusers from the middle atlantic and central regions of the USA.
Seroprevalence of human immunodeficiency virus type 1 (HIV-1) and human T lymphotropic virus types I and II (HTLV-I/II) was determined among 1160 intravenous (iv) drug abusers from five drug treatment or medical centers (Manhattan, Brooklyn, New Jersey, Detroit, and New Orleans). HIV-1 infection ranged from 5% in New Orleans to 48% in New York City. Hispanics and blacks had a significantly higher rate of HIV-1 infection than whites (P less than .01), but within each group rates were similar between males and females and by age stratum. HTLV-I/II seroprevalence increased with age from 3% in the 20-29 year age group to 37% in the group greater than 50 years. New Orleans and Manhattan (24%) had the highest rate, and blacks (19%) had a higher rate than either Hispanics (6.3%) or whites (7.3%). No association between HIV-1 and HTLV-I/II infection was observed except in Manhattan. When compared with iv drug abusers infected only with HIV-1, dually infected subjects had more clinical symptoms related to immune deficiency but a lower prevalence of HIV antigenemia. These data document the frequent occurrence of retroviral infections in iv drug abusers. The contrast between the two classes of virus suggests that HIV-1 is more efficiently transmitted, while the age-dependent rise in HTLV-I/II seroprevalence suggests cumulative exposure of a less-transmissible agent.
Needle exchange programs: a medical or a policy dilemma?
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Seroconversion, sexual activity, and condom use among 2915 HIV seronegative men followed for up to 2 years.
A cohort of 2915 HIV-1-seronegative men from the four centers of the Multicenter AIDS Cohort Study (MACS) was followed at 6 month intervals for 24 months to identify men who developed antibodies to HIV-1. Two hundred thirty-two men (8%) seroconverted. The highest attack rate was among men who reported practicing both receptive and insertive anal-genital intercourse. The attack rate among men who reported practicing receptive but not insertive intercourse was 3.6 times higher than among men practicing insertive intercourse although those practicing insertive only reported 38% more different partners. Only two men seroconverted who reported not practicing analgenital intercourse in the 12 month prior to the first antibody-positive visit. Because men were followed every 6 months, one of these men could have been infected within 6 months of the actual development of HIV-1 antibodies. The seroconversion rate was significantly lower among men who reported using condoms with all their partners. The results of this study (a) reaffirm that receptive anal-genital intercourse is the major route of infection among homosexual men of HIV-1, (b) suggest that there is a low risk of HIV-1 infection to the insertive partner in anal-genital intercourse, (c) suggest that infection may rarely occur through sexual activities other than anal-genital intercourse, (d) provide evidence that condoms as currently used by men in the MACS provide significant but not complete protection against HIV-1 infection, and (e) suggest that the number of men in the homosexual community engaging in high-risk behavior is declining.
Seroprevalence of human T-cell lymphotropic virus type 1 among homosexual men in the United States.
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Predictors of decline in CD4 lymphocytes in a cohort of homosexual men infected with human immunodeficiency virus.
Longitudinal data on four visits scheduled at 6 month intervals were available on a cohort of 1,827 homosexual men who were human immunodeficiency virus (HIV) seropositive at entry. To identify predictors of the rate of decline of CD4 T-lymphocytes, we used an autoregressive model that relates CD4 counts to predictor variables, while adjusting for previous CD4 counts. Significant predictors of steeper decline of CD4 counts were high CD8 count, low hemoglobin, low platelets, high serum IgA, high cytomegalovirus (CMV) antibody, and low HIV antibody. Using the fitted model, a subject with an initial deficit of 314 CD4 cells (median value of study sample) with respect to seronegative subjects and with average values in all other predictors is estimated to lose approximately 53 cells in a 6 month period (95% C.I. = 45-61 cells). Contrasting this estimate to the one obtained with similar methods in intravenous drug users, it is suggested that a faster rate of decline is present among i.v. drug users. This analysis provides evidence that several covariates in addition to previous number of CD4 counts have significant predictive power for estimating the decline in CD4 counts in HIV seropositive subjects.
Selected public health observations derived from Multicenter AIDS Cohort Study.
Selected findings from the Multicenter AIDS Cohort Study (MACS) of homosexual/bisexual men are reviewed. High risk sexual behaviors, the use of drugs/alcohol, condom use, and behavior change are addressed in a public health context. The potential significance of education/behavior modification programs as strategies for public health intervention emerges from these findings. Until there is a realistic timetable for vaccine availability and more effective chemotherapy, the MACS provides the opportunity to continue to study the effects of behavior change on the AIDS epidemic.
Clinical-pathological correlates of human immunodeficiency virus (HIV) infection: a conference summary.
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AIDS, HTLV-III diseases, minorities and intravenous drug abuse.
Minorities and women who are engaging in activities which place them at high risk for infection with HTLV-III are developing HTLV-III related illnesses including AIDS. In Northeastern urban areas the relatively large number of minorities who use intravenous drugs are responsible for producing large numbers of patients with AIDS (PWAs). Eighty percent of heterosexual male and female PWAs are Black or Hispanic. The development and implementation of effective prevention and education programs for these individuals rests upon an understanding of the less traditional approaches which may be necessary to reach these groups. The general public must be made aware of the hazards of HTLV-III related diseases and that the risk of infection is restricted to very well defined high risk groups. Minorities must be made to understand that they are at increased risk for HTLV-III related diseases only because of the high incidence of drug abuse in their community.
Prevalence of antibodies to HTLV-I, -II, and -III in intravenous drug abusers from an AIDS endemic region.
Antibody prevalences for human T-cell lymphotropic virus (HTLV) types I, II, and III were determined for 56 intravenous drug abusers from Queens, NY. While control serum samples lacked antibodies to all HTLV subgroups, seropositivity among drug users was 41% for HTLV-III, 18% for HTLV-II, and 9% for HTLV-I. Infection by HTLV-I and -II occurred independently of HTLV-III infection. Blacks had greater HTLV-III antibody prevalence than whites (54% vs 16%) and were more likely than whites to be seropositive for HTLV-I or -II (46% vs 11%). They exhibited a greater incidence than whites of double infection with HTLV-I or -II and HTLV-III (27% vs 0%), and 73% were seropositive for at least one of the viruses, compared with only 26% of the whites. The increased HTLV-I and -II infection seen in intravenous drug users suggests that once introduced into a population, these viruses may be transmitted by the same routes as HTLV-III. Transmission may have been restricted mainly to blacks in this study because of local drug use practices.
Three-year incidence of AIDS in five cohorts of HTLV-III-infected risk group members.
The incidence of the acquired immune deficiency syndrome (AIDS) among persons infected with human T-lymphotropic virus type III (HTLV-III) was evaluated prospectively among 725 persons who were at high risk of AIDS and had enrolled before October 1982 in cohort studies of homosexual men, parenteral drug users, and hemophiliacs. A total of 276 (38.1 percent) of the subjects were either HTLV-III seropositive at enrollment or developed HTLV-III antibodies subsequently. AIDS had developed in 28 (10.1 percent) of the seropositive subjects before August 1985. By actuarial survival calculations, the 3-year incidence of AIDS among all HTLV-III seropositive subjects was 34.2 percent in the cohort of homosexual men in Manhattan, New York, and 14.9 percent (range 8.0 to 17.2 percent) in the four other cohorts. Out of 117 subjects followed for a mean of 31 months after documented seroconversion, five (all hemophiliacs) developed AIDS 28 to 62 months after the estimated date of seroconversion, supporting the hypothesis that there is a long latency between acquisition of viral infection and the development of clinical AIDS. This long latency could account for the significantly higher AIDS incidence in the New York cohort compared with other cohorts if the virus entered the New York homosexual population before it entered the populations from which the other cohorts were drawn. However, risk of AIDS development in different populations may also depend on the presence of as yet unidentified cofactors.
Intravenous drug abusers and HIV infections: a consequence of their actions.
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Patterns of alcohol and drug abuse in drug treatment clients from different ethnic backgrounds.
In this paper we have sought to identify differences in alcohol consumption patterns and problems among young adult males from white, black, and Hispanic ethnic groups entering drug treatment programs. In overall consumption patterns we found results similar to those obtained in general population studies. However, about one-third of the clients in all ethnic groups could be classified as heavier drinkers (drinking at least once a week and 4 or more drinks per drinking occasion) in the period immediately prior to treatment. About one-fourth of the clients in each ethnic group consumed a daily average of 2.5 ounces of absolute alcohol. Compared with the other ethnic groups, blacks were the most likely to be abstainers and reported regular alcohol use and drunkenness at later ages. Regardless of the pattern of development, similar proportions of the clients in all ethnic groups reported heavier drinking levels by age 21-30. Consistent with the current hypotheses in the literature, whites reported much higher levels of alcohol-related problems and prior treatment. Despite having similar levels of drinking, black and Hispanic ethnic groups did not appear to recognize alcohol as a problem or to report alcohol-related problems to the extent that whites did. Examination of drug-use patterns showed great variation in the nature and extent of drug use among the three ethnic groups. Whites were distributed among the seven patterns of use. Heroin use with cocaine, marijuana, and alcohol was the predominant pattern for blacks and Hispanics. Although the patterns of drug use differed greatly, these patterns were not differentially related to alcohol consumption or alcohol-related problems within ethnic groups. On the contrary, the drug-use patterns appeared to be a stronger predictor than ethnicity of use and problems. Multiple-nonnarcotic-users reported the highest levels of alcohol consumption and the greatest numbers of alcohol-related problems. This group typically reported the highest number of alcohol-related problems. Expression of a current need for treatment and a history of prior alcohol treatment were highest for black multiple-nonnarcotic-users. Our examination of the influences of family and friends was based on a limited number of questions available in the data. Heavier drinking was reported by clients who lived with friends, had family or friends who drank regularly, or had extensive involvement in the drug-use network, including drug sales. No ethnic differences were found.(ABSTRACT TRUNCATED AT 400 WORDS)
Effect of naltrexone on apnea of prematurity and on plasma beta-endorphin-like immunoreactivity.
Plasma levels of beta-endorphin-like immunoreactivity (beta-ELI) were measured in premature infants with apnea (n = 11) and compared to those in nonapneic controls (n = 9). Naltrexone (1-3 mg/kg) was given to the infants with apnea, 6 of whom were also receiving methylxanthines. Chest wall movements, nasal airflow, transcutaneous PO2 and electrocardiogram were recorded for 4-6 h prior to and for 4-6 h after administration of naltrexone. Samples for beta-ELI were taken prior to and 1 h post naltrexone. beta-ELI levels were significantly higher (p less than 0.007) in infants with apnea of prematurity than in control infants. No significant difference was found in beta-ELI levels before and after naltrexone. Naltrexone did not decrease the incidence of apnea.
Validation of a three-item measure of depressive and suicidal symptoms.
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