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Biomedical subjects

J W Ward

Publications and source records attributed to J W Ward.

At least 37 records · Page 2Linked to original sources
PubMed1999

Trends in perinatal transmission of HIV/AIDS in the United States.

CONTEXT: Since 1994, the US Public Health Service (PHS) has recommended routine, voluntary prenatal human immunodeficiency virus (HIV) testing and zidovudine therapy to reduce perinatal HIV transmission. OBJECTIVE: To describe trends in incidence of perinatal AIDS and factors contributing to these trends, particularly the effect of PHS perinatal HIV recommendations. DESIGN, SETTING, AND PARTICIPANTS: Analysis of nationwide AIDS surveillance data and data from HIV-reporting states through June 1998. MAIN OUTCOME MEASURES: Trends in AIDS by year of diagnosis, incidence rates of AIDS and Pneumocystis carinii pneumonia (PCP) among infants younger than 1 year from US natality data for birth cohorts 1988 to 1996; expected number of infants with AIDS from national serosurvey data; and zidovudine use data from selected HIV-reporting states. RESULTS: Perinatal AIDS cases peaked in 1992 and then declined 67% from 1992 through 1997, including an 80% decline in infants and a 66% decline in children aged 1 to 5 years. Rates of AIDS among infants (per 100000 births) declined 69%, from 8.9 in 1992 to 2.8 in 1996 compared with a 17% decline in births to HIV-infected women from 1992 (n = 6990) to 1995 (n = 5797). Among infants, PCP rates per 100000 declined 67% (from 4.5 in 1992 to 1.5 in 1996), similar to the decline in other AIDS conditions. The percentage of perinatally exposed children born from 1993 through 1997 whose mothers were tested for HIV before giving birth increased from 70% to 94%; the percentage who received zidovudine increased from 7% to 91%. CONCLUSIONS: According to these data, substantial declines in AIDS incidence were temporally associated with an increase in zidovudine use to reduce perinatal HIV transmission, demonstrating substantial success in implementing PHS guidelines. Reductions in the numbers of births and effects of therapy in delaying AIDS do not explain the decline.

AIDS-Related Opportunistic Infections↗
PubMed1999

Effect of antiretroviral therapy on recent trends in selected cancers among HIV-infected persons. Adult/Adolescent Spectrum of HIV Disease Project Group.

We examined incidence trends in seven HIV-associated cancers (Kaposi's sarcoma [KS], invasive cervical cancer, immunoblastic lymphoma, primary brain lymphoma [PBL], Burkitt's lymphoma, other non-Hodgkin's lymphomas, and Hodgkin's lymphoma) and the effects of antiretroviral therapy on these trends. Data were abstracted from medical records in 89 hospitals and clinics in nine U.S. cities from January 1994 through June 1997. The stratified Cochran-Mantel-Haenszel statistic was used to test for trend. There were 19,684 HIV-infected persons representing 26,638 years of follow-up. Decreases in incidence per 1000 person-years were observed for KS (January through June 1994, 49.9; January through June 1997, 25.7; p = .001) and PBL (January through June 1994, 8.0; January through June 1997, 2.3; p = .01), especially during time on antiretroviral therapy, but changes in the incidence of other cancers were not significant. During the study, prescription of combination antiretroviral therapy increased from 16% to 57%. The incidences of KS and PBL are decreasing. Although for KS the decline occurred in both treated and untreated groups (difference in rate of decline not significant, p = .08), it was sharper in the treated group; additionally, KS declined faster in the era after highly active antiretroviral agents were introduced. Thus, these decreases may be due in part to the effect of antiretroviral therapy slowing the progression of HIV disease.

AIDS-Related Opportunistic Infections↗
PubMed1999

A portable virtual environment knee arthroscopy training system with objective scoring.

We have developed a Virtual Environment Knee Arthroscopy Training System (VE-KATS). Formative analysis indicated several features which surgical trainees indicated were necessary for a system to be useful. We have addressed this need by incorporating both rigid and deformable objects, simultaneous use of camera and surgical instrument, improved optical modeling, portability and low cost. A major advance has been the incorporation of automated objective scoring of performance. VE-KATS has now progressed to a viable training system which will be of practical benefit to trainee orthopaedic surgeons.

Arthroscopy↗
PubMed1998

Geographic differences in noninjection and injection substance use among HIV-seropositive men who have sex with men: western United States versus other regions. Supplement to HIV/AIDS Surveillance Study Group.

To study the prevalence of and factors associated with the use of alcohol and nonprescription drugs by HIV-seropositive men who have sex with men (MSM) and to describe variations in alcohol and nonprescription drug use by geographic region, we analyzed data from a multistate, population- and facility-based interview study conducted in 12 U.S. states and metropolitan areas. Among 9735 MSM with HIV infection or AIDS who completed a 45-minute interview, nearly one third reported possible alcohol abuse. Large proportions of MSM also reported the use of marijuana (51%), noninjected cocaine (31%), and crack cocaine (16%) in the 5 years before the interview. Smaller proportions of MSM reported ever having injected cocaine (13%), stimulants (8%), and heroin (8%). Results of logistic regression indicated that in the 5 years before interview, white MSM were significantly (p < .01) more likely than referent (mostly Hispanic) MSM to report use of hallucinogens, marijuana, nitrites, noninjected amphetamines, and diazepam; black MSM were significantly more likely than referent MSM to report use of noninjected crack cocaine. Use of injected stimulants was significantly associated with white race versus referent MSM, and residing in the West versus East. The prevalence of alcohol and drug use among HIV-seropositive MSM is high, and prevalences and types of substance use differ by region and racial/ethnic group. To prevent HIV transmission in this population, health departments and community-based organizations must understand the unique local patterns of substance use to develop effective substance abuse prevention and treatment programs.

Adult↗
PubMed1998

Epidemiology of anemia in human immunodeficiency virus (HIV)-infected persons: results from the multistate adult and adolescent spectrum of HIV disease surveillance project.

To study the incidence of, the factors associated with, and the effect on survival of anemia in human immunodeficiency virus (HIV)-infected persons, we analyzed data from the longitudinal medical record reviews of 32,867 HIV-infected persons who received medical care from January 1990 through August 1996 in clinics, hospitals, and private medical practices in nine United States cities. We calculated the 1-year incidence of anemia (a hemoglobin level of <10 g/dL or a physician diagnosis of anemia); the adjusted odds ratios showing excess risk of anemia associated with demographic factors, prescribed therapies, and concurrent diseases; the risk of death for patients who developed anemia compared with risk for patients who did not develop anemia; and, of patients who did develop anemia, the risk of death for those who did not recover from anemia compared with the risk for those who did recover. The 1-year incidence of anemia was 36.9% for persons with one or more acquired immunodeficiency syndrome (AIDS)-defining opportunistic illnesses (clinical AIDS), 12.1% for patients with a CD4 count of less than 200 cells/micron or CD4 percentage of <14 but not clinical AIDS (immunologic AIDS), and 3.2% for persons without clinical or immunologic AIDS. Of anemia diagnoses, 22% were identified by physicians as drug related. Incidence of anemia was associated with clinical AIDS, immunologic AIDS, neutropenia, thrombocytopenia, bacterial septicemia, black race, female sex, prescription of zidovudine, fluconazole, and ganciclovir, and lack of prescription of trimethoprim-sulfamethoxazole. The increased risk of death associated with anemia differed by first CD4 count: for patients with a CD4 count of >/=200 cells/microL at the beginning of the survival analysis, the risk of death was 148% (99% confidence interval [CI], 114 to 188) greater for those who developed anemia; for patients whose first CD4 count was <200 cells/microL, the risk of death was 56% (99% CI, 43 to 71) greater for those in whom anemia developed. For persons in whom anemia developed, the risk of death was 170% (99% CI, 132 to 203) greater for persons who did not recover from anemia compared with those who did recover. Anemia is a frequent complication of HIV infection, and its incidence is associated with progression of HIV disease, prescription of certain chemotherapeutics, black race, and female sex. Anemia, particularly anemia that does not resolve, is associated with shorter survival of HIV-infected patients.

AIDS-Related Opportunistic Infections↗
PubMed1998

Trends in AIDS-related opportunistic infections among men who have sex with men and among injecting drug users, 1991-1996.

Incidence trends for the 13 most frequent AIDS-defining opportunistic infections (OIs) among men who have sex with men (MSM, n = 15,588) and injecting drug users (IDUs, n = 4475) were examined using data abstracted from medical records in >90 hospitals and clinics in nine US cities during 1991-1996. Among MSM, the most frequent OIs were Mycobacterium avium complex (MAC) disease, Pneumocystis carinii pneumonia (PCP), and cytomegalovirus (CMV) retinitis; decreasing (P < or = .05) trends occurred for 11 OIs (MAC disease, PCP, CMV retinitis, Kaposi's sarcoma, esophageal candidiasis, CMV disease, extrapulmonary cryptococcosis, toxoplasmic encephalitis, tuberculosis, chronic herpes simplex, and disseminated histoplasmosis). Among IDUs, the most frequent OIs were PCP, MAC disease, and esophageal candidiasis; decreasing trends occurred for 5 OIs (PCP, esophageal candidiasis, tuberculosis, chronic herpes simplex, and chronic cryptosporidiosis) and an increase occurred in recurrent pneumonia. The differences in trends for MSM and IDUs may be due to differences in medical care and adherence to preventive medications.

AIDS-Related Opportunistic Infections↗
PubMed1998

Sexual abuse of children: intersection with the HIV epidemic.

OBJECTIVE: Sexual transmission of human immunodeficiency virus (HIV) is the predominant risk exposure among adolescents and adults reported with HIV infection and acquired immunodeficiency syndrome (AIDS). Although perinatal transmission accounts for the majority of HIV infection in children, there have been reports of HIV transmission through sexual abuse of children. We characterized children <13 years of age who may have acquired HIV infection through sexual abuse. METHODS: All reports by state and local health departments to the national HIV/AIDS surveillance system of children with HIV infection not AIDS (n = 1507) and AIDS (n = 7629) through December 1996 were reviewed for history of sexual abuse. Information was ascertained from data recorded on the case report form as well as investigations of children with no risk for HIV infection reported or identified on initial investigation. For children with a possible history of sexual abuse, additional data were collected, including how sexual abuse was diagnosed; characteristics of the perpetrator(s) (ie, HIV status and HIV risks); and other possible risk factors for the child's HIV infection. RESULTS: Of 9136 children reported with HIV or AIDS, 26 were sexually abused with confirmed (n = 17) or suspected (n = 9) exposure to HIV infection; mean age of these children at diagnosis of HIV infection was 8.8 years (range, 3 to 12 years). There were 14 females and 3 males who had confirmed sexual exposure to an adult male perpetrator at risk for or infected with HIV; of these, 14 had no other risk for HIV infection, and 3 had multiple risks for HIV infection (ie, through sexual abuse, perinatal exposure, and physical abuse through drug injection). The other 9 children (8 females, 1 male) had no other risk factors for HIV infection and were suspected to have been infected through sexual abuse, but the identity, HIV risk, or HIV status of all the perpetrator(s) was not known. All cases of sexual abuse had been reported to local children's protective agencies. Sexual abuse was established on the basis of physician diagnosis or physical examination (n = 20), child disclosure (n = 15), previous or concurrent noncongenital sexually transmitted disease (n = 9), and for confirmed cases, criminal prosecution of the HIV-infected or at-risk perpetrator (n = 8). For the 17 children with confirmed sexual exposure to HIV infection, 19 male perpetrators were identified who were either known to be HIV infected (n = 18) or had risk factors for HIV infection (n = 17), most of whom were a parent or relative. CONCLUSIONS: These 26 cases highlight the tragic intersection of child sexual abuse and the HIV epidemic. Although the number of reported cases of sexual transmission of HIV infection among children is small, it is a minimum estimate based on population-based surveillance and is an important and likely underrecognized public health problem. Health care providers should consider sexual abuse as a possible means of HIV transmission, particularly among children whose mothers are HIV-antibody negative and also among older HIV-infected children. The intersection of child abuse with the HIV epidemic highlights the critical need for clinicians and public health professionals to be aware of the risk for HIV transmission among children who have been sexually abused, and of guidelines for HIV testing among sexually abused children, and to evaluate and report such cases.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Recent trends in the HIV epidemic in adolescent and young adult gay and bisexual men.

To explore recent patterns in the HIV epidemic in young gay and bisexual men, we analyzed national AIDS surveillance data for men who have sex with men (MSM) 13 to 25 years of age. Estimates of annual AIDS incidence were calculated by adjusting the surveillance data for reporting delays, unreported HIV risks, and the 1993 change in the AIDS case definition. Between 1990 and 1995, estimated AIDS incidence in young MSM declined 29%, from 1400 to 1000 cases; however, trends in incidence varied greatly by race/ethnicity. Annual AIDS incidence decreased 50% in whites during this period (from 720 to 360), but fell just 2% in blacks (from 430 to 420) and rose 5% in Hispanics (from 220 to 230). Trends in incidence also differed by metropolitan statistical area (MSA) size. Between 1990 and 1995, AIDS incidence declined 37% in MSAs with populations of 2,500,000 people or more and 28% in MSAs with 1,000,000 to 2,499,999 people, but incidence decreased only 15% in MSAs with 500,000 to 999,999 people, and 13% in MSAs with 50,000 to 499,999. Incidence in nonmetropolitan (i.e., rural) areas was unchanged. Young black and Hispanic MSM now account for most young MSM with AIDS, and incidence in young MSM in small MSAs and rural areas has been relatively constant. Trends in AIDS incidence indicate that levels of HIV infection have remained persistently high in certain populations of young MSM, underscoring the immense need for HIV prevention programs targeted specifically toward these young men.

Adolescent↗
PubMed1997

Estimating the number of AIDS-defining opportunistic illness diagnoses from data collected under the 1993 AIDS surveillance definition.

Expansion of the surveillance definition for AIDS in the United States in 1993 caused a substantial distortion in the trend in AIDS incidence, mainly because CD4-positive (CD4+) T-lymphocyte criteria were added to the definition. To evaluate trends in the rate at which HIV-infected persons develop the opportunistic illnesses listed in the AIDS surveillance definition (AIDS-OIs), we developed a procedure for estimating the incidence of these diseases. This estimate is based primarily on the probability distributions of the time from a CD4+ count in given ranges to the diagnosis of the first AIDS-OI. Our estimates of AIDS-OI incidence change by <4% during most calendar quarters during 1991 through 1995 if we also include the estimated effects of unreported AIDS-OIs among persons with AIDS reported based on the CD4+ criteria. Our procedure eliminates the transient effect of adding the CD4+ criteria to the AIDS surveillance definition and permits us to evaluate trends in the incidence of AIDS-OIs.

AIDS-Related Opportunistic Infections↗
PubMed1997

Trends in heterosexually acquired AIDS in the United States, 1988 through 1995.

We used national AIDS surveillance data to characterize trends in the numbers and proportions of heterosexually acquired AIDS cases diagnosed from January 1988 through December 1995 among adults and adolescents. We adjusted for expansion of the 1993 AIDS surveillance case definition and for delays in reporting, and we redistributed cases initially reported without risk. The chi-square test for linear trend was used to analyze trends at the p < 0.01 level by half-year of diagnosis and by sex, age, race or ethnicity, geographic region of residence at diagnosis, and partner's HIV exposure risk. From 1988 through 1995, heterosexual contact accounted for 10% of all AIDS cases. Heterosexual contact increased the most rapidly of all HIV exposure modes, with increases found among men and women in all age groups; among blacks, whites, and Hispanics: and among persons living in all geographic regions of the country. Blacks and Hispanics accounted for 75% of all persons reported with AIDS attributed to heterosexual contact. Although heterosexual contact with an injection drug user (IDU) accounted for most cases until 1993, cases increased most rapidly among persons reporting heterosexual contact with an HIV-infected partner whose risk was not specified. Findings suggest continued growth of the heterosexual AIDS epidemic. Because of the disproportionate and increasing number of heterosexually acquired AIDS cases among blacks and Hispanics, black and Hispanic communities at risk for HIV infection should be considered a high priority for prevention and education programs specifically targeting heterosexually active adolescents and adults. Epidemiologic and behavioral research and prevention program evaluation are urgent public health priorities to better control and prevent the further spread of HIV among heterosexually active adults and adolescents.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Impact of the 1993 expanded AIDS surveillance case definition on reporting of persons without HIV risk information.

To evaluate the impact of the 1993 expansion of the acquired immunodeficiency syndrome (AIDS) surveillance definition on reporting of persons with no HIV risk exposure information, we compared persons reported with and without risk in 1992 and 1993. The expanded case definition resulted in a large increase in both the number of persons reported with risk (121% increase) and without risk (167% increase). The changes in demographic characteristics for each group were similar from 1992 to 1993. Persons reported based on immunologic criteria were more likely and persons with pulmonary tuberculosis (PTB) less likely than those meeting the pre-1993 definition criteria to be reported with risk. Many persons with PTB were retrospectively identified from tuberculosis registries that do not systematically include HIV risk information. Ascertainment of risk information continues to be an essential part of AIDS surveillance with >90% of reports including risk exposure.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Effect of the human immunodeficiency virus epidemic on mortality from opportunistic infections in the United States in 1993.

To measure the effect of the human immunodeficiency virus (HIV) epidemic on mortality from opportunistic infections (OIs) in 1993, national multiple-cause death certificate data were examined using two approaches. First, for each OI, the percentage of deaths with HIV infection reported as the underlying cause was calculated. Second, the age-adjusted rate of death per million population was compared with the rate predicted from a model of rates in 1970-1980 or 1979-1981, as available. The percentage of deaths with HIV as the underlying cause and the ratio of observed to predicted death rates were as follows: toxoplasmosis, 91% and 86 (5.24/0.06); cryptosporidiosis/isosporiasis, 90% and infinite (1.61/0.00); progressive multifocal leukoencephalopathy, 87% and 19 (2.58/0.13); pneumocystosis, 82% and 18 (15.44/0.87); cytomegalovirus disease, 82% and 17 (12.60/0.74); nontuberculous mycobacteriosis, 79% and 18 (15.51/0.84); cryptococcosis, 76% and 4 (5.80/1.35); and histoplasmosis, 68% and 6 (1.36/0.23). Thus, the HIV epidemic has greatly increased mortality from several OIs.

AIDS-Related Opportunistic Infections↗
PubMed1997

Changes in AIDS incidence for men who have sex with men, United States 1990-1995.

OBJECTIVES: To describe changes in AIDS incidence for men who have sex with men (MSM) from 1990 to 1995, by demographic and geographic groups. METHODS: We examined national AIDS surveillance data reported up to 30 September 1996, for men who received AIDS diagnoses in the years 1990-1995 and whose only reported risk behavior was sex with men. We evaluated trends in AIDS rates by estimating the incidence of clinical AIDS (AIDS defined by opportunistic illnesses), and report clinical AIDS incidence rates for MSM (AIDS rates) and proportional change in rates from 1990 to 1995. RESULTS: Clinical AIDS rates (MSM per 100,000 men per year) increased by 12% from 25.5% in 1990 to 28.5% in 1995. Significant variations in AIDS rates and 5-year changes in AIDS rates were observed in various subgroups of MSM. Five-year increases in AIDS rates were highest for American-Indian/Alaskan native (53%), black (45%), and Hispanic (23%) MSM; the only decrease occurred for white MSM (-2%). Incidence for black MSM increased from twofold (in 1990) to threefold (in 1995) the rate for white MSM. Large increases in AIDS rates were observed for MSM in rural areas (34%) and areas with 50,000 to 249,999 residents (34%) and for MSM aged over 60 years (32%). CONCLUSIONS: The high national AIDS rate for MSM continued to rise, but more slowly than earlier in the epidemic. Racial/ethnic minority MSM had consistently large increases in AIDS rates; AIDS rates decreased only slightly for white MSM. The AIDS epidemic among MSM is not homogenous, and AIDS rates continue to increase for minority MSM, and MSM living in rural areas. HIV prevention remains a high priority for all MSM, especially black and Hispanic MSM.

Acquired Immunodeficiency Syndrome↗
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↗