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Biomedical subjects

I Grant

Publications and source records attributed to I Grant.

At least 127 records · Page 7Linked to original sources
PubMed1996

Pathogenic and protective correlates of T cell proliferation in AIDS. HNRC Group. HIV Neurobehavioral Research Center.

To investigate the association of antigen specific CD4 T cell activation with HIV disease progression and AIDS-related central nervous system damage, T cell proliferation responses to HIV, CMV, and HSV were evaluated in infected individuals. CD4 T cell loss and neurocognitive impairment were assessed at 6-mo intervals. Individuals with known times of seroconversion who responded to more HIV peptides were at greater risk of progressing to < 200 CD4 T cells (P = 0.04) and dying (P = 0.03) than those with responses to fewer peptides. A positive correlation (0.52) was seen between the breadth of the HIV proliferation response and HIV plasma RNA levels. Higher proliferation responses to CMV and HSV were also associated with more rapid CD4 loss (P = 0.05). HLA phenotyped individuals (n = 150) with two HLA-DR alleles associated with response to more HIV peptides and CMV (DR-2,5,w6,10) were less likely to develop neurocognitive (P = 0.002) and neurologic impairment (P = 0.04), but were not protected from CD4 loss and death. Thus, the ability to generate a greater T cell proliferation response to HIV and opportunistic herpes viruses may lead to resistance to central nervous system damage, but also risk of more rapid HIV disease progression.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Quality of well-being in late-life psychosis.

Research in mental health has generally used evaluation and outcome measures different from those applied in other medical specialties. We evaluated the utility of a general health measure, the Quality of Well-Being (QWB) scale, in older patients with psychosis. The QWB and standardized rating scales for assessing psychopathology, cognitive impairment, physical comorbidity, and neuroleptic-induced tardive dyskinesia were administered to 85 patients with functional psychoses (mostly schizophrenia or schizoaffective disorder) and 39 normal comparison subjects over age 45. The patients were more impaired than normal comparison subjects on the QWB and other rating scales. The QWB score was affected more by severity of positive symptoms than by any non-psychopathology-related variables. The patients' QWB scores were similar to those of previously studied ambulatory patients with AIDS. Use of the QWB scale may allow direct comparisons of the impact of different psychiatric and physical disorders on the quality of life.

Age of Onset↗
PubMed1996

Single photon emission computed tomography with iodoamphetamine-123 and neuropsychological studies in long-term abstinent alcoholics.

Ten long-term abstinent alcoholics (mean abstinence = 7.7 years) were compared with 13 recently detoxified substance-dependent inpatients (mean abstinence = 25 days) and 8 nonalcoholic control subjects on global end regional measures of cortical cerebral blood flow (CBF), and on neuropsychological measures. CBF was assessed using 123iodoamphetamine (IMP) single photon emission computed tomography (SPECT) under conditions of behavioral challenge (Raven's Progressive Matrices). CBF and neuropsychological test performance were worse in the recently detoxified inpatients. Of greater interest, there was a dissociation in the long-term abstinent group, which, while neuropsychologically indistinguishable from controls, showed significantly decreased mean cortical IMP uptake. We conclude that there may be persistent physiologic abnormalities in long-term abstinent alcoholics who have achieved full behavioral recovery. Smoking on the day of SPECT scanning was also identified to be a significant confound to understanding CBF changes in alcoholism.

Adult↗
PubMed1996

Visual field loss in HIV-positive patients without infectious retinopathy.

PURPOSE: To determine the extent of vision loss in a cross-sectional study of HIV-positive individuals who had no infectious retinopathy. METHODS: Visual field loss was determined by computerized achromatic automated perimetry and short-wavelength automated perimetry in both eyes in 65 HIV-positive individuals without infectious retinopathy and in one randomly selected eye each in 57 age-matched normal controls. Results were analyzed using the global index of mean defect and the Glaucoma Hemifield Test, and significance was determined through analysis of variance, chi-square, and Tukey-Kramer tests. RESULTS: We found that HIV-positive patients, compared with age-matched HIV-negative controls, demonstrated significant (at least P < .01) localized defects as well as an increased mean defect. The HIV-positive patients also had a significantly greater number of defective points, especially on short-wavelength automated perimetry, even while ophthalmoscopic examination and fundus photographs suggested that the retinas were normal. CONCLUSIONS: There is a significant loss of visual function in HIV-positive individuals that is not the result of infectious retinopathies. The finding by short-wavelength perimetry of more severe defects suggests that the vision defects are not caused by attentional or other suprachiasmatic problems because the neurologic difficulty of both achromatic and short-wavelength perimetry is similar. The effects of this vision loss on the daily living and occupational tasks of this population require further study.

Adult↗
PubMed1996

An evaluation of community nursing services for HIV/AIDS patients in Lothian, Scotland.

This paper reports on a postal questionnaire survey of district nurses' work with HIV positive patients. Each nurse was asked to provide information about their contact with HIV positive patients and the level of training they had received in HIV/AIDS care. The nature of nursing activities carried out for these patients was established along with levels of confidence the nurses had in being able to provide a high standard of care. Where the nurses indicated less than full confidence they were asked to indicate what factors predisposed their response. Questionnaires were completed by 101 district nurses. On average, each nurse made 1.25 visits to HIV-infected patients in the two weeks preceding the study. The nursing activities most commonly carried out for these patients were providing advice/counselling, carer support, general nursing care and specialist treatments. The activities least commonly carried out were technical procedures, tests and assessments. Nurses were most confident in providing a high standard in relation to general nursing care and least confident that high standards were being achieved in providing specialist treatments. The most frequently encountered explanations offered by the district nurses for their lack of confidence in achieving a high standard were a lack of specialist training and a lack of experience with HIV-infected patients.

Attitude of Health Personnel↗
PubMed1996

Social and psychological characteristics of HIV-infected women and gay men. HIV Neurobehavioral Research Center (HNRC) Group.

In this paper, we examine social and psychological characteristics of 60 HIV+ women and gay men, matched on age and stage of HIV infection. A discriminant function analysis was performed using measures of life adversity, psychological distress, and psychosocial resources. The best combination of predictors for distinguishing between HIV+ women and gay men was comprised of satisfaction with emotional support, network size, use of avoidant coping, Hamilton depression, and loneliness scores [chi 2(7) = 14.8, p < .05]. Women reported more satisfaction with emotional support, although gay men had larger social networks. Gay men used more avoidant coping and had higher lonelines scores as compared to women, although women reported more depressive symptoms. Utilizing this set of psychosocial variables, we correctly classified 73% of the HIV+ women and 67% of the HIV+ men. These findings suggest the importance of considering subgroup differences in the design of counseling programs for HIV+ individuals.

Adaptation, Psychological↗
PubMed1996

Neurological Symptoms, Not Signs, Are Common in Early HIV Infection.

UNLABELLED: Objective. To examine the cross-sectional prevalence of neurological symptoms and signs in a large cohort of human immunodeficiency virus (HIV)-seropositive men, and determine the relationship of the symptoms to disease stage, immunologic markers, and independent variables from neuropsychological (NP) testing and psychiatric interview. METHODS: One hundred-nine controls and 386 HIV-infected volunteers enrolled in the HIV Neurobehavioral Research Center (HNRC) longitudinal study. The majority, without acquired immune deficiency syndrome (AIDS), were screened for alcohol/substance abuse; previous diagnosis of HIV-associated dementia; and HIV-unrelated developmental, neurological, medical, and neurobehavioral conditions which potentially impair cognition; and underwent a structured neurological interview and examination, standardized NP testing, and psychiatric interview as part of a more extensive battery. A large subset (N = 377) underwent lumbar puncture for cerebrospinal fluid (CFS) examination. We examined the relationship of sixteen select but independent variables, using stepwise multiple regressions, from demographic/staging, immunological, NP, and psychiatric domains to neurological symptoms in an effort to identify possible predictors of subclinical nervous systems involvement. Results. All categories of neurological symptoms were significantly more prevalent among medically asymptomatic (CDC stage A) subjects than controls, with a further rise in prevalence in those with more advanced stages of infection. The most marked rise was seen in cognitive and sensorimotor complaints. In contrast, significant findings on neurological examination were evident in only the sicker (stage C) subjects. Stage of illness, serum &beta;2-microglobulin, psychiatric indices of depressed mood or anxiety, and NP "motor" performance were the most significant independent variables associated with the presence of neurological symptoms. CSF pleocytosis was seen early (CDC stage A), and may reflect the presence of HIV in the central nervous system (CNS) at the least stages of infection. We also confirmed the value of CSF &beta;2m and neopterin as important markers of advancing disease stage. Whether they predict subclinical CNS involvement is to be determined by longitudinal observations. Conclusion. Neurological complains are common in medically asymptomatic HIV subjects whereas signs are not. The symptoms correlate with commonly determined independent measures of depression, anxiety, NP tests of fine motor speed and strength, as well as indices of disease worsening (CDC stage, serum &beta;2m).

AIDS Dementia Complex↗
PubMed1995

Is gender dysphoria dysphoric? Elevated depression and anxiety in gender dysphoric and nondysphoric homosexual and bisexual men in an HIV sample. HNRC Group.

Few if any studies before the AIDS epidemic suggested that male homosexuals may on average have higher levels of depression than male heterosexuals. However, several samples of homosexual and bisexual men in HIV studies suggest that depression and anxiety are high in these populations, and that this psychiatric morbidity began before the AIDS epidemic. We tested the hypothesis that high childhood gender nonconformity (CGN) is associated with depression and anxiety, and so might account for differences in these variables among samples of homosexuals. A total of 254 homosexual or bisexual male subjects were assessed for depression, anxiety, and associated symptoms using various self-report and interview measures, as well as for CGN (using the Freund Feminine Gender Identity scale, FGI). For comparison purposes only, we also evaluated the subjects for the DSM-III diagnosis of Ego-Dystonic Homosexuality. Highly gender nonconforming men (high FGI scores) were more likely to have current symptoms of anxiety and depression by self-report, and to have had a lifetime history of depression by clinical interview. This association was more often due to FGI items dealing with childhood than adulthood. When the FGI was broken into subscales by a prior factor analysis, stepwise regression suggested that the subscale measuring core gender identity nonconformity (so-called "gender dysphoria") was more reliably associated with depression and anxiety than were the factors measuring nonconformity in the areas of masculine and feminine gender roles, or genitoerotic (sexual) roles. This subscale was also the only FGI measure correlating with Ego-Dystonic Homosexuality. AIDS (CDC stage and HIV serostatus) and age did not account for these findings. We conclude that the often-reported higher levels of depression, anxiety, and associated symptoms among homosexual and bisexual men in AIDS studies are more common in the subgroup of such men who are gender dysphoric. Theoretical and clinical implications of these data are discussed.

Adult↗
PubMed1995

Characterization of mechanisms causing hypoalbuminemia in rats with long-term bile duct ligation.

Albumin kinetics and albumin synthesis were studied in rats with chronic bile duct ligation and compared with pair-fed control rats. The plasma albumin concentration was significantly reduced in bile duct ligated rats as compared to control rats, averaging 35 +/- 1 vs 40 +/- 2 g/l after 2 weeks and 28 +/- 3 vs 38 +/- 5 g/l after 4 weeks of bile duct ligation. Two weeks after bile duct ligation, the transcapillary escape rate of albumin was increased by 60% in bile duct ligated rats, whereas the plasma volume was unchanged. Albumin synthesis expressed as a fraction of total liver protein synthesis, as assessed by the 'flooding' dose method using [3H]phenylalanine, was decreased by 46% in bile duct ligated rats. However, absolute albumin synthesis expressed per 100 g body weight was not different from control rats. Four weeks after bile duct ligation, the transcapillary escape rate of albumin was no longer different, whereas the plasma volume was increased by 38% in bile duct ligated rats. At this time point, albumin synthesis as a fraction of total liver protein synthesis was decreased by 60% in bile duct ligated rats, and absolute albumin synthesis expressed per 100 g body weight averaged 80 +/- 8 vs 53 +/- 12 mg/(day x 100 g) in control and bile duct ligated rats (p < 0.05). The hepatic steady-state levels of albumin mRNA determined by Northern blot analysis were decreased in bile duct ligated rats at both 2 and 4 weeks after surgery. The studies suggest that reduced plasma albumin concentrations in bile duct ligated rats are caused by increased capillary permeability and lack of compensatory increase in albumin synthesis 2 weeks, and by increased plasma volume and decreased albumin synthesis 4 weeks after surgery.

Animals↗
PubMed1995

The HNRC 500--neuropsychology of HIV infection at different disease stages. HIV Neurobehavioral Research Center.

The present study examined neuropsychological (NP) functioning and associated medical, neurological, brain magnetic resonance imaging (MRI), and psychiatric findings in 389 nondemented males infected with Human Immunodeficiency Virus-Type 1 (HIV-1), and in 111 uninfected controls. Using a comprehensive NP test battery, we found increased rates of impairment at each successive stage of HIV infection. HIV-related NP impairment was generally mild, especially in the medically asymptomatic stage of infection, and most often affected attention, speed of information processing, and learning efficiency; this pattern is consistent with earliest involvement of subcortical or frontostriatal brain systems. NP impairment could not be explained on the bases of mood disturbance, recreational drug or alcohol use, or constitutional symptoms; by contrast, impairment in HIV-infected subjects was related to central brain atrophy on MRI, as well as to evidence of cellular immune activation and neurological abnormalities linked to the central nervous system.

AIDS Dementia Complex↗
PubMed1995

Stress and depressive symptoms prospectively predict immune change among HIV-seropositive men. HIV Neurobehavioral Research Center Group.

LIFE stress, mood, and other psychosocial factors may help to explain variability in HIV (human immunodeficiency virus) disease progression. Attempts to support this notion empirically have produced mixed findings; several studies report a positive relationship between psychosocial factors and various indicators of disease progression or immune function (e.g., Evans et al. 1992; Goodkin et. al. 1992), whereas others have failed to detect any association (e.g., Perry et. al. 1992).

Adaptation, Psychological↗
PubMed1995

The relationship among stress, depression, locus of control, irrational beliefs, social support, and health in Alzheimer's disease caregivers.

This study evaluated the hypothesis that Alzheimer's disease caregivers and control subjects who experienced stressful life events, held the belief that external factors control one's destiny, endorsed irrational beliefs, and had decreased social support would experience more depression and poor health than less stressed individuals who were more internal, had less rigid cognitive beliefs, and had better support. A battery of psychosocial and health measures were administered at baseline and 6 months later. The results suggest that, overall, the experience of marked adversity, increased externality, and the endorsement of irrational beliefs were related to depression and poor health. While diminished social support was not associated with poor health in this study, satisfaction with social support and diminished adherence to irrational beliefs were related to improved ratings of subjective health over time. These findings indicate that psychosocial interventions designed to modify cognitive reactions to stress might improve the quality of life and the physical well being of a population at risk for poor health as a result of their age and life circumstances.

Adaptation, Psychological↗
PubMed1995

Psychiatric morbidity associated with acquired immune deficiency syndrome-related grief resolution.

This study examined acquired immune deficiency syndrome (AIDS)-related grief resolution and psychiatric morbidity in 286 human immunodeficiency virus (HIV)-positive and HIV-negative gay men examined between 1989 and 1993 in San Diego, CA. Psychiatric morbidity, mood ratings, and bereavement assessments were obtained using the Structured Clinical Interview for DSM-III-R, Hamilton Rating Scales for Depression and Anxiety, and Texas Revised Inventory of Grief. Sixty percent of the men (N = 171) reported a loss within the previous 12 months. Eighteen percent of the bereaved met criteria for unresolved grief. No differences were evident in lifetime psychiatric disorders, yet men with unresolved grief demonstrated an elevated prevalence of current major depression and panic disorder when compared with resolved grievers. Clinician sensitivity to the grief process and its relationship to psychiatric complications is an important component of comprehensive psychiatric and medical care of men at high risk for HIV during this era of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Stress, vulnerability and adult alcohol relapse.

OBJECTIVE: Alcoholics experiencing highly threatening or chronic psychosocial stress following treatment are more likely to relapse than abstaining individuals not experiencing such stress. Expanding upon this stress-relapse hypothesis, we predicted that individual risk and protective characteristics would contribute to vulnerability to relapse in alcoholic men confronted with significant life adversity. The present investigation examined the relationship between psychosocial vulnerability and return to drinking. METHOD: A group of abstinent male alcoholics (N = 67) who experienced marked life adversity that posed a severe and/or chronic threat participated in this study. Men completed a psychosocial assessment first as an inpatient in treatment for alcohol dependence, and again at 3 months and 1 year following discharge. RESULTS: Among alcoholic men exposed to severe psychosocial stressors, those with higher composite psychosocial vulnerability scores were more likely to subsequently relapse than those with lower vulnerability scores. Additionally, men who improved in psychosocial functioning following treatment had better outcomes than men whose vulnerability increased. In particular, coping, self-efficacy and social support most consistently predicted relapse among this sample of severely stressed abstaining alcoholics. CONCLUSIONS: These findings supported the stress-vulnerability model of relapse. Results indicated that improvement in psychosocial domains (e.g., coping skills, social networks, perceived ability to tolerate relapse-risk situations) enhanced the ability of these men to remain abstinent despite severe stress. This study highlights the importance of cognitive and behavioral interventions for increasing improvement in these psychosocial domains.

Adaptation, Psychological↗
PubMed1994

Neurological dysfunction in asymptomatic HIV-1 infected men: evidence from evoked potentials. HNRC Group.

Neurological function in 159 subjects infected by the human immunodeficiency virus (HIV) who had no neurological symptoms or signs (129 asymptomatic, 30 with ARC/AIDS) was compared to that of 62 controls by means of pattern-reversal evoked potentials (PREPs), brain-stem auditory evoked potentials (BAEPs), median nerve somatosensory evoked potentials (MSEPs), tibial nerve somatosensory evoked potentials (TSEPs) and nerve conduction studies (NCSs). Central nervous system somatosensory conduction from lumbar cord to cortex was prolonged in both asymptomatic seropositive and ARC/AIDS groups, while peripheral somatosensory conduction, NCSs and PREP delays occurred only in the ARC/AIDS group. BAEPs did not show significant differences among groups. TSEPs were abnormal in 8% of asymptomatic carriers and 43% of patients with ARC/AIDS, MSEPs in 7% and 20%, PREPs in 4% and 0%, and BAEPs in 1% and 0% respectively. One or more evoked potentials were abnormal in 18 of 129 (14%) asymptomatic carriers and 13 of 30 (43%) subjects with ARC/AIDS as compared with 1 of 62 (2%) seronegative controls. We conclude that asymptomatic HIV carriers have subclinical neurological impairment of central somatosensory function and that the neurological impairment increases with disease progression to involve peripheral nerves and visual system.

Adolescent↗
PubMed1994

Neuroleptic treatment of HIV-associated psychosis. HNRC group.

The aim of this rater-blinded randomized study was to evaluate the efficacy and side effects of haloperidol and thioridazine in the treatment of new-onset psychosis in HIV-positive individuals. Participants were 13 men who had no history of psychosis prior to infection with HIV, and whose psychosis was not attributable to delirium or to non-HIV-related organic factors. Participants were evaluated at baseline after at least one month without neuroleptic treatment and then weekly for six weeks of the experimental treatment using several rating scales. The mean daily dose in chlorpromazine equivalents was 124 mg. Both neuroleptics produced modest but significant reduction in overall level of psychosis and in positive symptoms, but not in negative symptoms. All the haloperidol-treated patients developed extrapyramidal side effects and required treatment with anticholinergic medication, whereas three of the five thioridazine-treated patients had noticeable side effects. We make recommendations for the treatment of HIV-associated psychosis with neuroleptics.

AIDS Dementia Complex↗