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Biomedical subjects

J Elford

Publications and source records attributed to J Elford.

At least 73 records · Page 4Linked to original sources
PubMed1993

HIV prevalence among IDUs in Australia: a methodological review.

A review was carried out of Australian studies which have measured the prevalence of HIV infection among injecting drug users (IDUs). The review considered published studies which had reported on serologically-determined HIV prevalence. There were five studies reported from specialized sexually-transmissible disease of HIV clinics, five studies reported from health services aimed at IDUs, three studies reported from other health services and one multi-centre behavioural study. The main findings from the studies were that HIV prevalence in IDUs has been low in Australia, apart from in male IDUs who also had homosexual contact. HIV prevalence ranged from 20 to 24% in male IDUs reporting homosexual contact and from 0 to 5% in other IDUs.The studies, while reflecting a range of research methodologies, are subject to a number of limitations. Most of the studies did not provide detailed analyses of HIV prevalence by age and sex or behavioural factors, and several studies used sampling frames which were not clearly defined. There is little available information on temporal trends in seroprevalence and geographical comparisons are rendered difficult by differences in the study methodology. Adoption of standardized, continuing seroprevalence surveys on IDUs would provide a better means of monitoring the occurrence of HIV infection in this group, which has been a key determinant of the course of the HIV epidemic in a number of Western countries.

Journal Article↗
PubMed1993

CD8 lymphocyte counts and serum immunoglobulin A levels early in HIV infection as predictors of CD4 lymphocyte depletion during 8 years of follow-up.

OBJECTIVE: To assess the ability of the CD8 lymphocyte count and immunoglobulin (Ig) A level, measured at the early stage of HIV infection when the CD4 lymphocyte count remains relatively high, to predict the future rate of CD4 lymphocyte loss and hence the risk of AIDS. DESIGN: Cohort of recently infected haemophiliacs with relatively high CD4 lymphocyte counts followed for up to 8.5 years from baseline measurement of CD8 lymphocyte counts and IgA levels. SETTING: A regional haemophilia centre based in a major teaching hospital. PATIENTS: Eighty-four of 111 patients with haemophilia who seroconverted to HIV between 1979 and 1985 in whom CD8 lymphocyte counts and IgA levels were measured soon after seroconversion (mean, 2.7 years; maximum, 5 years) while CD4 lymphocyte counts remained relatively high (median, 600 x 10(6)/l; minimum, 300 x 10(6)/l). OUTCOME MEASURES: Development of severe immunodeficiency defined by a CD4 lymphocyte count falling below 50 x 10(6)/l, and AIDS. RESULTS: Individuals with high CD8 counts (P < 0.008) and high IgA levels (P < 0.003) at baseline experienced a more rapid rate of CD4 lymphocyte loss than those with low baseline levels. A score was derived to combine the predictive ability of CD8 count and IgA level. Estimated proportions with CD4 counts below 50 x 10(6)/l after 8 years of follow-up were 100, 30 and 14% for those with high, intermediate and low baseline scores, respectively. The CD8/IgA score showed similar ability to predict the future occurrence of AIDS (P < 0.0001; log-rank test). CONCLUSION: Immune activation seen in HIV infection, as reflected by raised CD8 counts and IgA levels, appears to be linked to the process of CD4 lymphocyte depletion. Measurement of these markers in the years following infection, when CD4 lymphocyte counts remain high, provides a first indication of a patient's long-term prognosis.

Acquired Immunodeficiency Syndrome↗
PubMed1993

The progression of HIV disease in a haemophilic cohort followed for 12 years.

A cohort of haemophilic patients who seroconverted to HIV-1 between October 1979 and July 1985 has been followed to 1 January 1992. The median age at initial seropositivity was 24 years with a range of 2-77 years. By January 1992, 38/111 (34%) had developed AIDS and 39/111 (35%) had died (four of liver failure including one hepatoma). Using Kaplan-Meier plots, the calculated progression to AIDS at 12 years is 45% (95% CI 31, 58): for age > 25 years 63% (95% CI 45, 82), age < 25 years 32% (95% CI 15, 48) P = 0.0001; CMV positive 68% (95% CI 48, 87) CMV -ve 20% (95% CI 8, 32) P = 0.0009. The 12-year progression rate to CD4 + 0.2 or AIDS is 66% (95% CI 55, 76). 21/34 (63%) of patients who are p24 antigen positive have developed AIDS compared to 17/77 (22%) who are p24 antigen negative (= 0.0001). 19/34 (56%) and 20/77 (23%) of those p24 positive and negative respectively have died (P = 0.007). Before antiviral and prophylactic treatment for asymptomatic patients there were nine AIDS cases in 3.84 years experience with CD4+ < 0.05 (1/0.43 years) and since treatment, 10 AIDS cases in 18.22 years (1/1.8 years). Age, CMV status and p24 remain strongly predictive of disease progression. Treatment appears to reduce the incidence of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Factors associated with Kaposi's sarcoma in a cohort of homosexual and bisexual men.

The relationship between the occurrence of Kaposi's sarcoma (KS) and a range of factors was studied in a cohort of homosexual and bisexual men. Overall, 134 men had AIDS, including 46 for whom KS was the first AIDS-defining illness. The proportion of men diagnosed with AIDS whose first AIDS-defining illness was KS declined from 54 to 24% between 1984-85 and 1989-90 (p = 0.03 for linear trend). Kaposi's sarcoma was not associated with a history of any specific communicable disease, nor with the reported use of selected nontherapeutic drugs, at the 0.05 level of significance. No single sexual practice was significantly associated with KS, and only the relative risks for insertive oroanal contact (1.5, 95% confidence limits 0.73-2.4) and receptive fisting (1.3, 0.61-2.6) exceeded unity. Kaposi's sarcoma occurred significantly less frequently in men who reported orogenital intercourse than in those who did not (relative risk 0.47, 0.23-0.98 for receptive orogenital intercourse). History of sexual contact in the United States was associated with KS, but this association was not statistically significant. While this study provides some support for the hypothesis that Kaposi's sarcoma in people with AIDS may be caused by a sexually transmissible infectious agent, no specific sexual practice could be implicated. In particular, there was little evidence that the postulated KS agent was transmitted by fecal-oral contact.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Kaposi's sarcoma as a sexually transmissible infection: an analysis of Australian AIDS surveillance data. The National HIV Surveillance Committee.

OBJECTIVE: To further examine the hypothesis that Kaposi's sarcoma (KS) among people with AIDS is caused by a sexually transmissible infectious agent. DESIGN: Analysis of Australian AIDS surveillance data for the period 1982-1991 by sex, age, exposure category, country of birth, year and place of diagnosis. MAIN OUTCOME MEASURES: Percentage of people with AIDS who had KS. RESULTS: In Australia, by November 1991, 17.2% (527 out of 3067) of individuals with AIDS aged > or = 13 years had presented with KS as their AIDS-defining illness: men, 17.6% (524 out of 2977); women, 3.4% (three out of 87) (P < 0.001). KS was predominantly reported in people aged 20-49 years and there were no cases in children < 13 years of age. In general, KS was more common in those who had acquired HIV by sexual contact rather than parenterally. Among people aged > or = 13 years, the proportion with KS ranged from 0.0% (none out of 41) in men with haemophilia to 1 Iford 9.0% (483 out of 2542) in men reporting homosexual contact. Between 1984-1985 and 1990-1991, the percentage of men with AIDS reporting homosexual contact who presented with KS declined from 30% (37 out of 124) to 15% (145 out of 995) (chi 2 for a linear trend, P < 0.001). For men with AIDS reporting homosexual contact, the percentage with KS in New South Wales and Victoria (20.3%) was higher than in the other States and Territories (12.5%) (P < 0.001). New South Wales and Victoria have also reported the highest incidence of AIDS in Australia. CONCLUSION: The epidemiological characteristics of KS among people with AIDS in Australia are broadly consistent with those reported from the United States and Europe. This provides further evidence that KS may be caused by a sexually transmissible infectious agent. The nature of the infectious agent and its mode of transmission have yet to be determined.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Immunodeficiency and the risk of death in HIV infection.

OBJECTIVE: To describe the rate of development of immunodeficiency in human immunodeficiency virus (HIV) infection and to relate this to the risk of death. DESIGN: Inception cohort followed up for up to 12 years from HIV seroconversion until January 1, 1992. SETTING: A regional hemophilia center based in a major teaching hospital. PATIENTS: All 111 patients with hemophilia who seroconverted to HIV-1 between 1979 and 1985 were registered at the center. Patients have been closely followed up clinically and immunologically. OUTCOME MEASURES: Development of immunodeficiency, defined by a CD4 lymphocyte count falling beneath 0.20 and 0.05 x 10(9)/L, and death. RESULTS: Kaplan-Meier estimates suggest that almost half (46%; 95% confidence interval [CI], 26% to 66%) of patients alive 12 years after seroconversion will have a CD4 lymphocyte count that has remained above 0.05 x 10(9)/L. Thirty-five percent (95% CI, 22% to 48%) remain above 0.20 x 10(9)/L. Thirty-seven patients died of HIV-related causes, and there was a 52% probability (95% CI, 35% to 69%) of HIV-related mortality by 12 years from seroconversion. Mortality risk was closely associated with severe immunodeficiency. There was only a 15% chance (95% CI, 6% to 25%) of HIV-related death occurring before a CD4 count of below 0.05 x 10(9)/L had been reached. There was an average of one HIV-related death per 96.7 patient-years of observation before the CD4 count had fallen below 0.05 x 10(9)/L, as compared with one death per 2.5 patient-years of observation after the CD4 count had fallen below this level (P < .0001). CONCLUSIONS: In patients with HIV infection who are closely followed up, the risk of death is low before the CD4 lymphocyte count has fallen to 0.05 x 10(9)/L, a count many patients remain above up to 12 years after seroconversion.

CD4-Positive T-Lymphocytes↗
PubMed1992

Evaluation of an intensive HIV/AIDS counselling course in Zimbabwe.

The anticipated increase in the number of people with HIV infection and AIDS in Zimbabwe, together with those who have associated worries, will place extra demands upon clinical and counselling services in the coming decade. To meet these demands, a wide range of health care staff will have to acquire specialist counselling skills. For this reason, an intensive 2 day HIV/AIDS counselling training course was run at the Family Counselling Unit, Harare, in February 1989. The structure, content and evaluation of the course are presented here. Overall, the course was positively evaluated by the 38 trainees. However, a number of trainees were critical about some of the teaching methods and the degree of emphasis given to some of the objectives. Our experiences may help others in establishing HIV/AIDS counselling courses elsewhere.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Social care services for patients with HIV at a London teaching hospital; an evaluation.

OBJECTIVE: To investigate outpatients' use of, and satisfaction with social care services in an HIV unit. DESIGN: Survey of patients with HIV infection using self administered questionnaire. SETTING: Outpatient HIV clinics at the Royal Free Hospital, London, March-April 1991. MAIN OUTCOME MEASURES: Patients' social circumstances, use or intended use of social care services and satisfaction with social care services. RESULTS: The greatest demand was for counselling about coping with HIV (38% of respondents), available medical treatment (24%), counselling for the HIV test (33%), psychological support for emotional (24%) or relationship problems (16%), advice about housing (24%) and financial matters (20%). In general, the use of social care services by men and women was similar. Twice as many men, however, sought help with payment of domestic bills, compared with women. Women were more likely to seek advice about financial benefits, obtaining sterile injecting equipment and discuss sleep and relationship problems. Thirty eight percent of patients were unemployed. Overall, 84% thought the service was good or excellent. Although less than 40% of patients currently used any one service, 60% thought they would use these services in the future. CONCLUSION: The greatest demand for social care services was for coping with HIV, housing and financial matters, and HIV test counselling. More than half the patients stated that they would probably need social care services in future.

Adaptation, Psychological↗
PubMed1992

The cumulative risk of AIDS as the CD4 lymphocyte count declines.

A method is proposed for assessing the cumulative risk of various AIDS-defining conditions as the CD4 lymphocyte count declines in HIV-infected individuals. The method is analogous to survival analysis but is based on the CD4 lymphocyte count rather than on time. Thus, the level to which the CD4 lymphocyte count has declined, rather than the length of time since seroconversion, is considered as an individual's survival interval. The survival interval may be censored (due to lack of follow-up) or treated as an interval to failure (if the individual develops AIDS). The Kaplan-Meier (product-limit) estimates, of the proportion of individuals developing AIDS before reaching a given low CD4 lymphocyte count, may be useful for determining when prophylactic treatment should begin.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Use of general practice by intravenous heroin users on a methadone programme.

Users of intravenous heroin represent a major challenge for general practice. A study was undertaken in a general practice in central London in 1990 to investigate the use of general practice made by intravenous heroin users who were on a methadone programme. Using information recorded in the patients' notes, 29 intravenous heroin users on a methadone programme were identified; 58 non-drug users (two controls per case) were matched for age, sex and general practitioner. A study of the number of routine consultations, missed appointments, emergency appointments and prescribed items showed that during the study period, those on a methadone programme made a larger number of routine consultations than the control subjects (median number of consultations 14 versus 0). When consultations at which only a prescription was issued were excluded this difference disappeared. Appointments were missed by 14 drug abusers (48%) but by none of the control group (P < 0.001). Emergency appointments were made by seven drug abusers (24%) compared with only two controls (3%) (P < 0.01). Even after prescriptions for methadone hydrochloride had been excluded from the analysis, patients on the methadone programme were prescribed significantly more items than patients in the control group (P < 0.001). This research has shown that intravenous heroin users on a methadone programme used general practice to a greater extent than non-drug users, according to the criteria used in the study. The implications that this may have in discouraging budget holding practices from running such schemes are discussed.

Adult↗
PubMed1991

Progression of HIV disease in a haemophilic cohort followed for 11 years and the effect of treatment.

OBJECTIVE: To describe the progression of HIV disease in a haemophilic cohort and to show the influence of treatment. DESIGN: 11 year longitudinal clinical and laboratory study. SETTING: A haemophilia centre. PATIENTS: 111 patients infected with HIV during October 1979 to July 1985. MAIN OUTCOME MEASURES: Symptoms of HIV infection, AIDs, and death. INTERVENTIONS: 26 asymptomatic patients started taking zidovudine or placebo (1000 mg/day) during November 1988 to February 1990; 10 patients with CD4+ counts of 0.2 x 10(9)/l started zidovudine 500 mg/day during January to November 1990. 35 patients used pentamidine for primary or secondary prophylaxis. RESULTS: At 11 years from seroconversion the estimated rate of progression to AIDS was 42% (95% confidence interval 27% to 57%); to symptoms 85% (75% to 95%); and to death 41% (25% to 57%). Progression to AIDS was significantly faster in patients aged 25 and over than in those aged less than 25 (relative risk 5.0 (2.4 to 10.4); p less than 0.00001) and in those with previous cytomegalovirus infection than in those not infected (relative risk 3.0 (1.4 to 6.8); p = 0.006). 16 of 27 (59%) patients with p24 antigenaemia developed AIDS compared with 17 of 84 (20%) patients without p24 antigen (p less than 0.001). The risk of progression to AIDS before 30 November 1988 in patients with CD4+ counts less than or equal to 0.2 x 10(9)/l was higher than after November 1988 (relative risk 1.9 (0.85 to 4.43); p = 0.1). For 1989 and 1990 the observed cumulative numbers of AIDS cases (among 81 patients with sufficient CD4+ counts) were 22 and 25 compared with 29 and 37 predicted from the rate of fall of CD4+ counts up to the end of 1988 (p = 0.03). CONCLUSION: Treatment seems to be reducing the progression of HIV disease in this haemophilic cohort.

Acquired Immunodeficiency Syndrome↗