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J W Ward

Publications and source records attributed to J W Ward.

At least 19 recordsLinked to original sources
PubMed1996

Toxoplasmic encephalitis in HIV-infected persons: risk factors and trends. The Adult/Adolescent Spectrum of Disease Group.

OBJECTIVE: To evaluate the incidence of and risk factors for toxoplasmic encephalitis among HIV-infected persons. DESIGN: Medical facility-based prospective medical record reviews of consecutive patients. METHODS: We analysed data collected from January 1990 through August 1995 in more than 90 inpatient and outpatient medical facilities in nine US cities. Incidence was calculated as cases per 100 person-years and risk ratios (RR) for annual incidence were calculated using proportional hazards regression while controlling for city, sex, race, age, county of birth, HIV exposure mode, and prior prescription of trimethoprim-sulfamethoxazole (TMP-SMX). RESULTS: The incidence of TE was 4.0 cases per 100 person-years among persons with a CD4+ T-lymphocyte count of < 100 x 10(6)/l. In multivariate analysis, among the nine cities the annual incidence of toxoplasmosis was significantly lower only in Denver [RR, 0.3; 95% confidence interval (CI), 0.1-0.7; referent city, Seattle]. Persons prescribed TMP-SMX were half as likely to develop toxoplasmic encephalitis as those who were not (RR, 0.5; 95% CI, 0.4-0.7). Of the 4173 persons with AIDS (1987 Centers for Disease Control and Prevention definition) who died during the study period, 267 (6.4%) had toxoplasmic encephalitis in the course of HIV disease. CONCLUSIONS: Toxoplasmic encephalitis in HIV-infected persons varies by geographic area in the United States. TMP-SMX reduces the risk for toxoplasmic encephalitis.

AIDS-Related Opportunistic Infections↗
PubMed1996

Tuberculosis among AIDS patients in the United States, 1993.

To evaluate the demographic characteristics, risk factors, and reported mortality of adults and adolescents with AIDS and tuberculosis (TB), we analyzed surveillance reports of persons with AIDS from state, territorial, and local health departments. Of 72,306 persons with AIDS diagnosed in 1993, 3,589 (5%) were reported with TB; of these, 2,782 (78%) with pulmonary TB, 552 (15%) with extrapulmonary TB, and 255 (7%) with both pulmonary and extrapulmonary TB were reported. In multivariate analysis, black [odds ratio (OR) 3.3, 95% confidence interval (CI) 2.9-3.7] and Hispanic (OR 2.5, 95% CI 2.2-2.9) persons had a higher risk of TB than white persons; injecting drug users (IDUs: OR 2.3, 95% CI 2.0-2.5) and persons exposed to HIV by heterosexual contact (OR 1.4, 95% CI 1.2-1.7) had a higher risk than men who have sex with men, and persons who were foreign born (OR 2.1, 95% CI 1.8-2.4) had a higher risk than those born in the United States. The highest proportions of AIDS patients with TB were in New York (11%), Illinois (7%), Florida (6%), Georgia (6%), and Texas (5%). The 1-year mortality rate among AIDS patients with pulmonary TB only (26%) and among those with extrapulmonary TB only (28%) was lower than among those with other AID-defining illnesses (38%) (p<0.001 and p<0.001, respectively). The high rate of TB among persons with AIDS, particularly in specific areas of the country and HIV exposure groups, emphasizes the need for continued support of strong TB control measures among persons infected with HIV.

AIDS-Related Opportunistic Infections↗
PubMed1995

Trends in infectious diseases and cancers among persons dying of HIV infection in the United States from 1987 to 1992.

OBJECTIVE: To determine trends in the relative frequency of infectious diseases and cancers among U.S. residents dying of human immunodeficiency virus (HIV) infection. DATA SOURCE: National multiple-cause mortality data for 1987 to 1992 compiled from death certificates. SUBJECTS: Deaths reported with HIV infection as the underlying cause and with nonunderlying causes that could be secondary to HIV infection. DATA ANALYSIS: Trends in the annual percentage of deaths associated with each infectious disease or cancer that accounted for at least 1.0% of all HIV-related deaths. RESULTS: From 1987 to 1992, the percentage of HIV-related deaths associated with the following diseases decreased: pneumocystosis, from 32.5% to 13.8%; cryptococcosis, from 7.7% to 5.0%; and candidiasis, from 2.3% to 1.7%. The percentage of deaths associated with the following diseases increased: nontuberculous mycobacteriosis, from 6.7% to 12.2%; cytomegalovirus disease, from 5.2% to 9.9%; bacterial septicemia, from 9.0% to 11.5%; non-Hodgkin lymphoma, from 3.9% to 5.7%; tuberculosis, from 2.9% to 4.1%; progressive multifocal leukoencephalopathy, from 0.8% to 1.9%; bacterial pneumonia, from 1.2% to 2.1%; and cryptosporidiosis or isosporiasis, from 0.7% to 1.2%. The percentages of deaths associated with toxoplasmosis, Kaposi sarcoma, and pneumonia caused by unspecified organisms had no significant linear trends (ranges from 4.9% to 5.5%, 10.4% to 12.1%, and 17.6% to 18.6%, respectively). CONCLUSIONS: The percentage of HIV-related deaths associated with pneumocystosis has decreased dramatically, probably because of chemoprophylaxis and improved treatment. Pneumonia caused by unspecified organisms has now become the leading secondary cause of death among persons dying of HIV infection. Decreases in the percentages of HIV-related deaths associated with cryptococcosis and candidiasis may reflect the use of new antifungal agents such as fluconazole.

AIDS-Related Opportunistic Infections↗
PubMed1995

How important is race/ethnicity as an indicator of risk for specific AIDS-defining conditions?

In order to examine differences in the prevalence of AIDS-defining conditions by race/ethnicity, we analyzed U.S. surveillance data for 203,470 adolescents and adults diagnosed with AIDS from 1988 through 1992. A number of AIDS-indicator conditions were more common among certain racial/ethnic groups. The prevalence of extrapulmonary tuberculosis was higher among blacks, Hispanics, Asians/Pacific Islanders, and American Indians/Alaskan Natives than among whites. The prevalence of isosporiasis and toxoplasmosis was higher among Hispanics than among blacks or whites. Furthermore, the likelihood of being diagnosed with extrapulmonary tuberculosis (TB), toxoplasmosis, or isosporiasis was generally higher among foreign-born than among U.S.-born persons of all racial/ethnic groups. The prevalence of all malignancies was higher among whites than among blacks or Hispanics. However, the magnitude of prevalence differences by race/ethnicity was reduced when we controlled for other demographic and exposure risk categories. Although race/ethnicity was significantly associated with the prevalence of a number of conditions, the relative frequency and patterns of AIDS-indicator conditions in different populations are probably most influenced by differences in (1) underlying prevalence or exposure to various etiologic agents causing these conditions, (2) diagnosis and reporting of conditions, and (3) access to care and therapy for HIV-related conditions.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Distribution of CD4+ T lymphocytes at diagnosis of acquired immunodeficiency syndrome-defining and other human immunodeficiency virus-related illnesses. The Adult and Adolescent Spectrum of HIV Disease Project Group.

BACKGROUND: Depletion of circulating CD4+ T lymphocytes among persons infected with the human immunodeficiency virus (HIV) is associated with increased risk for development of opportunistic, life-threatening diseases and death. METHODS: To describe the levels of CD4+ T lymphocytes at which acquired immunodeficiency syndrome (AIDS)-defining and other illnesses initially occur, we analyzed data from an ongoing survey of medical records of 18,062 HIV-infected patients who received medical care between January 1990 and August 1993 in more than 100 clinics, hospitals, and private practices in 10 US cities. We report the median and upper 80th percentile CD4+ T-lymphocyte counts at diagnosis. RESULTS: We found that AIDS-defining conditions first occurred in HIV-infected patients with CD4+ T-lymphocyte counts below 0.20 x 10(9)/L (200/microL) for 80% of diagnoses. Similarly, AIDS-defining diseases occurred at counts below 0.05 x 10(9)/L for 50% of diagnoses. Exceptions to both criteria were invasive cervical cancer and pulmonary tuberculosis. Non-AIDS-defining illnesses with which 80% of patients were diagnosed at CD4+ T-lymphocyte counts below 0.20 x 10(9)/L were bacterial sepsis and retinopathy (excluding cytomegalovirus). CONCLUSION: Our observations support the need for continued CD4+ cell count monitoring below a level of 0.20 x 10(9)/L as a guide to diagnosis and medical management of HIV-infected persons.

AIDS-Related Opportunistic Infections↗
PubMed1995

AIDS and cancer registry linkage: measurement and enhancement of registry completeness. The National AIDS/Cancer Match Study Group.

BACKGROUND AND METHODS: To measure AIDS registry completeness for Kaposi's sarcoma (KS) and cancer registry completeness for KS and non-Hodgkin's lymphoma (NHL), we linked AIDS and cancer registries at selected health departments. RESULTS: We found 10,350 people with KS: 1,935 reported only to the AIDS registry, 1,428 reported only to the cancer registry, and 6,987 reported to both. Ninety-three cases of non-HIV-associated KS were expected. For KS, AIDS registry completeness was 84% [6,987/(6,987 + 1,428 - 93)] and cancer registry completeness was 78% [6,987/(6,987 + 1,935)]. Cancer registry completeness for AIDS-related NHL was 76%. CONCLUSION: If this linking were conducted nationally, about 5,700 additional cases of AIDS and 10,000 additional cases of AIDS-related cancers would be recorded.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Coccidioidomycosis among persons with AIDS in the United States.

Adults and adolescents diagnosed with AIDS from 1987 through 1992 residing in counties endemic (selected counties in California, Arizona, Texas, New Mexico, Nevada, Utah) and not endemic for Coccidioides immitis were assessed to determine the frequency of and risk factors for disseminated coccidioidomycosis. Of 602 AIDS patients reported with disseminated coccidioidomycosis, 323 (1.1% of AIDS patients) resided in C. immitis-endemic counties and 279 (0.1% of AIDS patients) resided in C. immitis-nonendemic counties in 35 states. In multivariate analysis, patients with disseminated coccidioidomycosis in C. immitis-endemic counties were more likely to be injecting drug users (odds ratio, 2.6; 95% confidence interval, 1.8-3.7) and blood product recipients (odds ratio, 3.6; 95% confidence interval, 1.5-8.3) than to be homosexual or bisexual men. Of patients with disseminated coccidioidomycosis, 63% had died by 1 year after AIDS diagnosis. Disseminated coccidioidomycosis should be considered in AIDS patients in all areas of the United States.

AIDS-Related Opportunistic Infections↗
PubMed1995

HIV testing patterns: where, why, and when were persons with AIDS tested for HIV?

OBJECTIVE: To describe the location of, primary reason for, and time between the first positive HIV test and AIDS diagnosis in a sample of persons with newly diagnosed AIDS. DESIGN: Interviews supplementing information routinely collected through AIDS case reporting. SETTING: Eleven US states and cities. PATIENTS: Persons with AIDS (2441) diagnosed between January 1990 and December 1992. MAIN OUTCOME MEASURES: Location of first positive HIV test, primary reason for testing, and time interval between first positive HIV test and AIDS diagnosis. RESULTS: Overall, persons were tested late in their course of HIV infection: 36% were tested for HIV within 2 months and 51% within 1 year of their AIDS diagnosis. Sixty-five per cent were HIV-tested in acute health-care settings: 33% in hospitals, 28% in physicians' offices, and 4% in emergency departments. Testing during hospitalization was most common among injecting drug users (43%) and persons infected through heterosexual contact (50%). Persons primarily sought HIV testing because of illness (58%); other reasons included being in a known risk group (13%) and having had a known HIV-infected sex partner (8%). Testing because of being in a known risk group was least common among persons infected through heterosexual contact (1%). Among persons in these exposure categories, testing differed by race/ethnicity. CONCLUSION: Most persons with AIDS were tested relatively late in their course of HIV infection, in acute health-care settings, and because of illness. Not knowing one's serostatus precludes early medical intervention and may increase transmission.

AIDS Serodiagnosis↗
PubMed1995

Unrecognized human immunodeficiency virus type 1 infection in a cohort of transfused neonates: a retrospective investigation.

OBJECTIVE: To retrospectively identify unrecognized human immunodeficiency virus type 1 (HIV-1) infection among a cohort of children transfused as neonates before donated blood was routinely screened for HIV-1 antibody. METHODS: Records at a large, private, metropolitan hospital were reviewed to identify children who were transfused as neonates between January 1980 and March 1985 and discharged alive from the hospital. Multiple data sources were used to locate these children. Parents or guardians were contacted, and their children were offered HIV-1 antibody testing and physical examination. RESULTS: Of the 775 children identified as having received transfusions during the project period, 644 (83%) were located, and 443 (69%) were evaluated for HIV-1 infection. Among those evaluated, 33 (7%) had antibody to HIV-1, including 14 whose infections had not been previously diagnosed. At the time of enrollment, 13 children infected with HIV-1 were asymptomatic an average of 63 months after transfusion. CONCLUSION: HIV-1 antibody testing should be considered for all children, regardless of clinical status, who were transfused before routine blood donor screening was implemented in March 1985, particularly in areas with a high incidence of acquired immunodeficiency syndrome during those years.

Cohort Studies↗
PubMed1994

Demographic differences in cumulative incidence rates of transfusion-associated acquired immunodeficiency syndrome.

To describe the demographic patterns of blood transfusion in the United States, the authors analyzed the cumulative incidence rate of transfusion-associated acquired immunodeficiency syndrome (AIDS) (total cases reported from June 1981 through May 1993 per million population) by sex, race/ethnicity, age (at transfusion), and geographic area. Except for a high rate in infants, the rate increased with age, peaking at ages 55-64 years in men and at 65-74 years in women. Overall, the rate in males was 1.7 times that in females. By age, the rate in males was significantly higher than that in females only at ages 0-4 years and 45-84 years, when the rate in males was 2-3 times that in females. Overall, the rates in blacks and Hispanics were twice the rate in non-Hispanic whites. By age, the rates in blacks and Hispanics were significantly higher only at ages 0-4 years and 15-54 years, when they were 2-5 times those in whites, respectively. By state of residence, the incidence of transfusion-associated AIDS was correlated with the rate of all other AIDS cases (Spearman correlation coefficient, 0.83; p = 0.0001). Most of these demographic differences probably reflect differences in exposure to blood transfusion and in the incidence of conditions requiring transfusions.

Acquired Immunodeficiency Syndrome↗
PubMed1994

The expanding regional diversity of the acquired immunodeficiency syndrome epidemic in the United States.

BACKGROUND: The geographic spread of the human immunodeficiency virus (HIV) epidemic reflects multiple subepidemics in different regions and population groups. METHODS: To describe regional trends in the acquired immunodeficiency syndrome (AIDS) in the United States, we analyzed national surveillance data for persons with AIDS diagnosed from 1988 through 1991. RESULTS: Highest annual AIDS incidence rates were in the US territories (52.7 per 100,000) and the Northeast (27.7 per 100,000). The greatest percentage increases were in the US territories (68.8%), the South (60.1%), and the Midwest (52.4%). Men who have sex with men constituted the majority of AIDS cases nationally (54.6%), as well as in the Midwest (67.8%), the South (57.4%), and the West (75.3%). Among injecting drug users, the greatest rates of increase in AIDS cases were observed among blacks in the South. Although large increases in the number of persons with HIV transmitted through heterosexual contact were reported from almost all regions, the largest increase was in the South. CONCLUSION: High rates of increase in AIDS cases from the Midwest, South, and US territories probably reflect later entry of HIV into these regions compared with the earlier HIV epidemics in large metropolitan areas of the Northeast and West. In particular, because the South has the largest population of the regions, and sexually transmitted disease surveillance data suggest that substantial populations in the South are at risk, the marked increase in AIDS incidence in this region suggests that the major impact of the epidemic may yet be seen. The continuing spread of HIV and AIDS in different communities and regions demonstrates the need to expand preventive and therapeutic services.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Surveillance of AIDS-defining conditions in the United States. Adult/Adolescent Spectrum of HIV Disease Project Group.

OBJECTIVE: To examine the reporting of AIDS-defining illnesses using two national surveillance systems. METHODS: Comparison of AIDS indicator diseases reported to the national AIDS reporting system (ARS) for AIDS cases diagnosed from January 1990-December 1992 among individuals aged > 13 years in 10 metropolitan areas, with that observed in the Adult/Adolescent Spectrum of HIV Disease (ASD) project, a surveillance project that monitors the clinical diagnoses of HIV-infected individuals receiving medical care. RESULTS: In the 10 metropolitan areas, 39,265 individuals with AIDS were reported to ARS, and 5969 with AIDS had medical record reviews as part of ASD. At initial AIDS diagnosis, the number of indicator diseases reported to ARS was almost identical to the number observed in ASD (mean number of diagnoses, ARS 1.3; ASD 1.2). However, ASD recorded a greater number of diagnoses over time than ARS (mean number of indicator diagnoses > 12 months after initial diagnosis, ASD 2.3; ARS 1.4). Conditions that typically occur late in the course of AIDS such as Mycobacterium avium infection and cytomegalovirus disease, were more frequently recorded by ASD than by ARS. CONCLUSION: ARS provides complete, population-based information on the frequency of AIDS-defining conditions at initial diagnosis. However, specialized surveillance projects such as ASD are needed to accurately describe subsequent AIDS-defining conditions.

AIDS-Related Opportunistic Infections↗