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Biomedical subjects

H W Jaffe

Publications and source records attributed to H W Jaffe.

At least 37 records · Page 2Linked to original sources
PubMed1993

HIV-1 seroconversion in patients with and without genital ulcer disease. A prospective study.

OBJECTIVE: To determine the relative risk for human immunodeficiency virus (HIV-1) seroconversion in patients with and without genital ulcers caused by chancroid, syphilis, and herpes. DESIGN: A prospective cohort study. SETTING: An inner-city, sexually transmitted disease clinic. PATIENTS: Patients seronegative for HIV-1 with and without genital ulcers who were followed for a minimum of 3 months. INTERVENTIONS: Questionnaire to obtain data on demographics, sexual behavior, and illicit drug use; testing for HIV-1 at entry and at a minimum of 3 months after entry; medical examination for the presence or absence of genital ulcer disease. RESULTS: Overall, 758 heterosexual men with no history of injection drug use completed the study; HIV-1 seroconversion occurred in 10 of 344 (2.9%; 95% CI, 1.4% to 5.3%) men with a genital ulcer and in 4 of 414 (1%; CI, 0.2% to 2.5%) without a genital ulcer (relative risk, 3.0; P = 0.05). In a multiple logistic regression analysis, those men with chancroid and a new sexually transmitted disease during follow-up each had about three times the risk for HIV-1 seroconversion (P < or = 0.04). CONCLUSIONS: In this group of heterosexual men, chancroid and repeated acquisition of sexually transmitted diseases appeared to facilitate the sexual transmission of HIV-1.

Adult↗
PubMed1991

Health care workers with AIDS. National surveillance update.

OBJECTIVES: To characterize health care workers with the acquired immunodeficiency syndrome (AIDS) in the United States and to evaluate the role of occupational transmission of the human immunodeficiency virus (HIV). DATA SOURCE: National AIDS surveillance data. METHODS: Health care workers with AIDS are reported to the Centers for Disease Control by state and local health departments. Health care workers who do not report a nonoccupational risk for HIV infection are termed undetermined risk cases and are investigated by health departments using a standard protocol. RESULTS: Through June 30, 1990, there were 5425 cases of AIDS in health care workers reported in the United States. Three of these workers developed AIDS following well-documented occupational exposure to HIV-infected blood. Of the 539 health care workers initially reported without a nonoccupational risk, follow-up investigations were completed for 303. Nonoccupational risk factors were established for 237 (78.2%) of the 303 investigated health care workers; 66 workers (21.8%) remained in the undetermined category. Follow-up information was incomplete for 236 health care workers who also remained in the undetermined category, resulting in 5120 health care workers (94.4%) with AIDS with nonoccupational risks for HIV infection. Overall, health care workers were more likely than non-health care workers with AIDS to have an undetermined risk for HIV infection (5.6% vs 2.8%; P less than .001). While many of the 66 investigated health care workers had jobs involving contact with patients and/or potential contact with blood, none reported percutaneous, mucous membrane, or cutaneous exposures to blood or body fluids known to be infected with HIV. CONCLUSION: Surveillance data suggest that most health care workers with AIDS acquired their HIV infection through a nonoccupational route.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Heterosexual transmission of HIV-1 associated with the use of smokable freebase cocaine (crack).

A study of risk factors for HIV-1 infection was conducted at a sexually transmitted disease clinic in an area of New York City where the cumulative incidence of AIDS in adults through mid-1990 was 9.1 per 1000 of the population and where the use of illicit drugs, including smokable freebase cocaine (crack), is common. The overall seroprevalence among volunteers was 12% (369 out of 3084), with 80% of those who were seropositive reporting risk behavior associated with HIV-1 infection, including male-to-male sexual contact, intravenous drug use and heterosexual contact with an intravenous drug user. The seroprevalence in individuals denying these risks was 3.6% (50 out of 1389) and 4.2% (22 out of 522) in men and women, respectively. Among these individuals, the behaviors significantly associated with infection were use of crack and prostitution in women, and history of syphilis and crack use in men. These results suggest that in areas where the level of HIV-1 infection in heterosexual intravenous drug users is high and the use of crack is common, increased sexual activity (including the exchange of drugs or money for sex) may result in increased heterosexual transmission of HIV-1.

Crack Cocaine↗
PubMed1991

The aetiology of Kaposi's sarcoma.

The aetiology of KS remains unknown, but recent evidence suggests that the disease is caused by the presence of an infectious agent in an immunosuppressed host. Although there are a variety of clinical presentations, the putative infectious agent is likely to be the same in all cases. The pathophysiology of the lesions, the types of immunosuppression that facilitate disease expression, the response to therapy and the distribution of disease within immunosuppressed populations provide important clues to the nature of the unidentified infectious agent.

Humans↗
PubMed1990

Duesberg, HIV and AIDS.

Last century there was a sharp difference of opinion between those, such as Koch and Pasteur, who proposed that disease could be caused by invisible microbes, and others who held that epidemics are the result of evil vapours (mal'aria). Arguments that AIDS does not have an infectious basis are as quaint as those of the miasmalists.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Kaposi's sarcoma among persons with AIDS: a sexually transmitted infection?

In the United States Kaposi's sarcoma is at least 20,000 times more common in persons with acquired immunodeficiency syndrome (AIDS) than in the general population and 300 times more common than in other immunosuppressed groups. Among persons with the acquired immunodeficiency syndrome (AIDS) reported to Centers for Disease Control by March 31, 1989, 15% (13,616) had Kaposi's sarcoma. Kaposi's sarcoma was commoner among those who had acquired the human immunodeficiency virus (HIV) by sexual contact than parenterally, the percentage with Kaposi's sarcoma ranging from 1% in men with haemophilia to 21% in homosexual or bisexual men. Women were more likely to have Kaposi's sarcoma if their partners were bisexual men rather than intravenous drug users. Kaposi's sarcoma risk was not consistently related to age or race but varied across the United States, being greatest in the areas that were the initial foci of the AIDS epidemic. Thus Kaposi's sarcoma in persons with AIDS may be caused by an as yet unidentified infectious agent, transmitted mainly by sexual contact.

Acquired Immunodeficiency Syndrome↗
PubMed1990

AIDS: epidemiologic features.

At the end of October 1988, more than 75,000 adults and more than 1000 children had been reported with acquired immunodeficiency syndrome (AIDS); more than half of those diagnosed have died. Most adult cases fall into specific risk categories: homosexual and bisexual men, intravenous drug abusers, hemophiliacs and transfusion recipients, and heterosexual partners of infected persons. These categories are related to the known transmission routes of the human immunodeficiency virus (HIV). In children, the risk groups are different; most cases represent perinatal transmission of HIV. Black and Hispanic persons are disproportionately affected by AIDS in the United States and make up almost 40% of all reported cases. In 1986, AIDS was the eighth leading cause of premature death in this country, and if current trends continue, it will become the second by 1992. Although HIV infection rates in "risk group" members have been extensively studied, much less is known about infection rates in persons outside these groups. A variety of surveys are under way to monitor the spread of HIV. The epidemiologic puzzle of Kaposi's sarcoma is considered, as well as reasons for the decrease in it as a proportion of all AIDS cases.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Heterosexual transmission of hepatitis B virus in Belle Glade, Florida. Belle Glade Study Group.

A population-based serosurvey of human immunodeficiency virus in Belle Glade, FL, enabled evaluation of risk factors for hepatitis B virus (HBV) infection in this racially mixed community. Serum samples from 725 adults and 130 children were tested for markers of HBV infection, and histories of exposure to HBV were obtained by interview. The overall prevalence of past or present HBV infection was 26%; prevalence was 9% among whites, 5% among Hispanics, 30% among blacks, and 57% among Haitians. Prevalence of HBV infection was 3% in children aged 2-10 years and increased to 31% in adults greater than 17 years. Of adults seropositive for HBV, only 5% had homosexual partners or used parenteral drugs, but 47% had a positive serologic test for syphilis. Factors associated with HBV infection in adults were positive serologic test for syphilis (odd ratio [OR] = 3.1; 95% confidence limits [CL] = 2.0, 4.8), and having had two or more lifetime heterosexual partners (OR = 3.2; 95% CL = 1.6, 6.4). In this community, HBV infection was transmitted predominantly by heterosexual contact.

Adolescent↗
PubMed1990

Risk factors for human immunodeficiency virus type 1 (HIV-1) infection in patients at a sexually transmitted disease clinic in New York City.

Patients who attended a sexually transmitted disease clinic in New York City in 1987 were offered enrollment in a nonblinded study to estimate human immunodeficiency virus type 1 (HIV-1) seroprevalence in adults with multiple sexual partners and to determine risk factors associated with HIV-1 infection. In addition, a blinded serosurvey of a representative sample of patients was performed to obtain an unbiased estimate of seroprevalence in clinic attendees. The seroprevalence in the blinded serosurvey was 7.5% (26/348), while the seroprevalence of the 1,201 volunteers for the nonblinded study was 11.2%. For men in the nonblinded study, the risk behaviors most strongly associated with HIV-1 infection were intravenous drug use, sexual contact with another man, and sexual contact with a female intravenous drug user. For women, intravenous drug use and sexual contact with a man at risk for HIV-1 infection (an intravenous drug user or a bisexual) were most important. The seroprevalence among persons who denied all high-risk behavior was 1% (7/723). The results of this study, conducted in a city with one of the nation's highest reported cumulative incidences of acquired immunodeficiency syndrome, suggest that HIV-1 infection in clinic attendees was primarily limited to intravenous drug users, homosexual/bisexual men, and the sexual partners of these two groups.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Kaposi's sarcoma in a cohort of homosexual and bisexual men. Epidemiology and analysis for cofactors.

Acquired immunodeficiency syndrome (AIDS) surveillance data for both the United States and San Francisco indicate that Kaposi's sarcoma is more common in homosexual and bisexual men with AIDS than in other adults with AIDS, and that the proportion of newly diagnosed AIDS cases presenting with Kaposi's sarcoma has been significantly declining over time. The changing epidemiology of Kaposi's sarcoma was analyzed in a well-characterized cohort of homosexual and bisexual men; laboratory and interview data from a sample of these men were evaluated for determinants of and cofactors associated with Kaposi's sarcoma. Among 1,341 men with AIDS, the proportion presenting with Kaposi's sarcoma declined from 79% in 1981 to 25% in 1989. Compared with other men with AIDS, men with Kaposi's sarcoma had a shorter interval from human immunodeficiency virus (HIV) seroconversion to AIDS diagnosis (median, 77 vs. 86 months). Men with and without Kaposi's sarcoma did not significantly differ with respect to number of sexual partners, history of certain sexually transmitted or enteric diseases, use of certain recreational drugs (including nitrite inhalants), or participation in certain specific sexual practices. The decline in Kaposi's sarcoma may at least partly be due to a shorter latency period from infection to disease. Although cofactors for the development of Kaposi's sarcoma may exist, many previously hypothesized agents were not supported by this analysis.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Kaposi's sarcoma among homosexual and bisexual men enrolled in the San Francisco City Clinic Cohort Study.

The changing epidemiology of Kaposi's sarcoma (KS) and possible explanations for this change were analyzed using data from a well-characterized cohort of homosexual and bisexual men. Among 1,341 men with AIDS, the proportion presenting with KS declined from 79% in 1981 to 25% in 1989. For 250 men whose date of HIV seroconversion could be well characterized, persons presenting with KS had a shorter interval from HIV seroconversion to AIDS diagnosis than other AIDS patients without KS (mean = 77 vs. 86 months). Among 182 men who were interviewed prior to a diagnosis of AIDS, men with and without KS did not significantly differ with respect to number of sex partners, a history of certain sexually transmitted or enteric diseases, use of certain recreational drugs (including nitrite inhalants), or participation in certain specific sexual practices. The decline in KS may at least partly be due to a shorter latency period from infection to disease. Although cofactors for the development of KS may exist, many previously hypothesized agents were not supported by this analysis.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Biologic factors in the sexual transmission of human immunodeficiency virus.

The probability that any single episode of genital-genital or anogenital sexual intercourse will result in transmission of HIV may be determined by multiple biologic factors of the infectious person, the virus itself, and the exposed susceptible person. Some of these factors are known or suspected (figure 1), and they may explain observed differences in the sexual transmission of HIV in different parts of the world, notably in Africa, where genital ulcerative disease is probably influencing the epidemiology of HIV. Several studies have shown that infection in partners of HIV-infected persons is not determined solely by numbers of sexual encounters; on the contrary, HIV-infected partners have usually had fewer sexual encounters with infectious mates than have noninfected partners. Thus, sexually active persons should be cautioned that, to our knowledge, there are no nonsusceptible persons and that any single unprotected sexual encounter may lead to HIV transmission. Research into biologic factors that modulate HIV transmission continues to be hampered by difficulties in identifying HIV transmitters and nontransmitters, infective and noninfective variants of HIV (if the latter exist in vivo), and persons relatively more or less susceptible to HIV infection. However, as the number of partner studies and the number of those enrolled in them increase, a progressively clearer idea of the biologic determinants of sexual transmission of HIV should emerge.

Acquired Immunodeficiency Syndrome↗