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Biomedical subjects

M Marmor

Publications and source records attributed to M Marmor.

At least 55 records · Page 3Linked to original sources
PubMed1994

Bleach use and HIV seroconversion among New York City injection drug users.

We employed a nested case-control study design to evaluate the efficacy of bleach-cleaning of needles and syringes among injecting drug users (IDUs) as a means of preventing human immunodeficiency virus (HIV) infection. Sixteen HIV-seroconverters who responded to bleach use questions and who reported injecting with shared or used equipment in the 6 months prior to their first positive visit were compared with 89 controls. Controls had remained HIV-seronegative at two or more visits, reported injecting with shared or used equipment, responded to bleach-cleaning questions, and were seen at recall visits +/- 6 months from the date of seroconversion of the index case. Risk factors associated with HIV seroconversion in univariate analyses were a history of sexual intercourse with an HIV-infected partner and the frequency of speedball (mixed heroin and cocaine) injections. After adjusting for confounders, we found no evidence that bleach use protected against HIV infection.

Adult↗
PubMed1993

Interferon-associated retinopathy.

Interferon alfa is used to treat various systemic disorders and recently has been suggested as a possible treatment for choroidal neovascularization. We report 10 cases of retinal ischemia associated with the use of interferon alfa for various illnesses. The retinal findings include cotton-wool spot formation, capillary nonperfusion, arteriolar occlusion, and hemorrhage. The retinal complications may sometimes be reversible when treatment is stopped. Our findings emphasize the need to have patients who are receiving interferon alfa therapy monitored for these retinal complications, which may rarely be associated with permanent loss of vision secondary to closure of retinal capillaries.

Adult↗
PubMed1993

HIV risk-related sexual behaviors among heterosexuals in New York City: associations with race, sex, and intravenous drug use.

OBJECTIVE: To investigate the relationship between heterosexual behaviors associated with HIV infection and ethnicity, sex, and intravenous drug use. METHODS: Subjects were recruited from Bellevue Hospital Center, New York City between 1986 and 1989, and interviewed about sexual behaviors and intravenous drug use. Analyses were based on 1561 black, white, or Hispanic individuals who reported having sexual contact with a member of the opposite sex. RESULTS: Twenty-seven per cent of the study population were black, 43% Hispanic, and 31% white. Blacks were more likely than whites or Hispanics to have initiated sexual intercourse at an early age, and to have had a sexually transmitted disease. Sex with a female drug user was more common among white men, and contact with a prostitute more frequent among Hispanic men. Among the women, Hispanics had fewer sexual risk factors overall than whites or blacks. Use of barrier contraceptives was uniformly low across all ethnic groups. Intravenous drug use was significantly associated with sexual risk-taking. Women were more likely than men to have an intravenous drug-using (IVDU) sexual partner. CONCLUSIONS: The large prevalence of high-risk sexual practices observed in this study emphasizes the continuing need to target AIDS prevention programs at those at highest risk of heterosexually transmitted HIV: racial minorities, IVDU, and their sexual partners.

Acquired Immunodeficiency Syndrome↗
PubMed1993

CD4 lymphocytopenia among injecting drug users in New York City.

Recent cases of "AIDS-like" CD4 lymphocytopenia in the absence of HIV infection have generated considerable scientific and public interest. We studied CD4 cell counts and percentages from 1984 to 1992 among 1,246 HIV-seronegative injecting drug users in New York City, a population at very high risk for exposure to bloodborne pathogens. Severe CD4 lymphocytopenia was rare, and there was no evidence of an increase over time. Of 229 subjects with longitudinal data, only four met the surveillance definition for "idiopathic CD4 lymphocytopenia" (ICL). CD4 cell counts of < 500 cells/microliters were, however, associated with subsequent HIV seroconversion (12.7/100 person-years at risk, relative risk (RR) = 4.53, 95% exact binomial confidence interval (CI) 1.7-10.7, p = 0.002).

Adult↗
PubMed1992

Crack cocaine use in a cohort of methadone maintenance patients.

We examined crack use in a cohort of methadone patients originally enrolled in 1984-86. Crack use questions were added to the study in 1987. Of the 494 methadone patients originally enrolled, 228 subjects remained in methadone and were re-interviewed in 1987-88, and 234 remained in methadone and were re-interviewed in 1988-89. Approximately one-quarter of the subjects were using crack at each of the 1987-88 and 1988-89 data collection points, and only 3% of the subjects were using crack at daily or greater frequencies at each of the 1987-88 and 1988-89 interviews. Concurrent crack use was associated with (a) the number of noninjected drugs being used; (b) the number of IV drug-using sexual partners; (c) drug injection; and (d) the use of nonheroin opiates. Persistent crack use, defined as use in both 1987-88 and 1988-89, was associated with previous noninjected drug use and previous suicide attempts. While the potential problem of crack use among methadone patients should not be minimized, it appears that, compared to illicit drug injectors not in treatment, being in methadone maintenance may offer a protective effect against crack use.

Adult↗
PubMed1992

Implications of the revised surveillance definition: AIDS among New York City drug users.

The Centers for Disease Control (CDC) has proposed revising the AIDS surveillance definition to include any HIV-seropositive person with a CD4 cell count of less than 200 cells per microliter. Based on a study of persons receiving treatment for HIV infection, this new definition would lead to an estimated 50% increase in the number of persons recognized as living with AIDS. Among 440 HIV-seropositive research subjects recruited from drug treatment programs and through street outreach in New York City, 59 met this definition, yet only 25% of those had been reported to the New York City AIDS registry. The new definition, if combined with HIV and T-cell testing at drug treatment and street outreach programs, could thus yield very large increases in the number of injecting drug users meeting the new surveillance definition of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1992

HLA-B35 is associated with accelerated progression to AIDS.

To investigate the influence of HLA specificities on the rate of progression and outcome of human immunodeficiency virus (HIV) infection, we performed (a) a case-control study in 1989-1990 of HIV-seropositive individuals stratified by both risk behavior and ethnic background, (b) a longitudinal cohort study of HIV-infected male homosexuals enrolled in 1981-1982, and (c) an analysis of individuals with a diffuse infiltrative CD8 lymphocytosis syndrome. In the case-control study, there was a significantly higher frequency of HLA-B35 among intravenous drug users, but not homosexuals, who developed illnesses meeting the case definition for AIDS compared with asymptomatic HIV-positive controls, regardless of ethnic status. In the longitudinal study, HLA-B35-positive homosexuals had a significantly increased rate of progression to AIDS and decreased survival over a 7-year period compared with those without this specificity. Finally, there was a significantly decreased frequency of HLA-B35 in individuals with the diffuse infiltrative lymphocytosis syndrome, a clinically and genetically distinctive disorder occurring in HIV infection in which a low rate of progression to opportunistic infections was found. The high rate of salivary and lacrimal gland lymphoma in this group suggests that there is dissociation between the presence of HLA-B35 and the development of particular AIDS-defining conditions. We conclude that HLA-B35 is a risk factor for more rapid progression to AIDS, particularly opportunistic infections and Kaposi's sarcoma, operating in groups with high rates of newly acquired HIV infections such as New York City male homosexuals in 1981-1982, and intravenous drug users in 1989-1990.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1991

A case-control study of risk factors for postoperative endophthalmitis.

The authors conducted a case-control study to identify risk factors for postoperative endophthalmitis. Fifty-four cases of patients who developed endophthalmitis after intraocular surgery at the New York Eye and Ear Infirmary during the period from January 1988 through October 1990 were identified. A control group of 228 patients was randomly selected from the 24,105 patients who underwent intraocular surgery during this same period. Logistic regression analysis identified significant independent risks associated with intraoperative communication with the vitreous cavity (risk ratio 13.7, P less than 0.001) and use of an intraocular lens with haptics made of polypropylene (risk ratio 4.5, P = 0.007). The study predicts that there would be approximately 700 fewer cases of postoperative endophthalmitis annually in the United States (approximately a 50% decrease in incidence) if intraocular lenses with haptics made of polymethyl-methacrylate, rather than polypropylene, were used exclusively.

Adolescent↗
PubMed1991

Late bleb-related endophthalmitis after trabeculectomy with adjunctive 5-fluorouracil.

The incidence of late-onset bleb-related endophthalmitis was evaluated retrospectively in 229 consecutive trabeculectomies performed with adjunctive 5-fluorouracil (5-FU) therapy. Mean follow-up was 23.7 +/- 16.3 months (range, 3 to 60 months). Thirteen eyes (5.7%) of 11 patients developed bleb-related endophthalmitis an average of 25.9 +/- 17.4 months (range, 5 to 58 months) after surgery. Infection occurred in 9 of 96 (9.4%) procedures performed from below and in 4 of 133 (3.0%) procedures performed superiorly (P = 0.05, Fisher's exact test). The relative risk of bleb-related endophthalmitis in trabeculectomy from below versus above is 4.0 after adjustment for age and sex (95% confidence interval = 1.1, 14.8). Trabeculectomy with adjunctive 5-FU performed from below carries an increased risk of late bleb-related infection. The incidence of late bleb-related endophthalmitis after 5-FU trabeculectomy appears to be higher than that for trabeculectomy without adjunctive 5-FU injections.

Adolescent↗
PubMed1991

Initial 5-fluorouracil trabeculectomy in uncomplicated glaucoma.

The effectiveness of trabeculectomy with adjunctive low-dose 5-fluorouracil (5-FU) as the initial surgical procedure in uncomplicated glaucoma was evaluated retrospectively in a consecutive series of 52 patients (mean follow-up, 18.6 +/- 11.7 mos) and 74 control subjects. The cumulative 2-year success (intraocular pressure [IOP] less than 21 mmHg) was 100% in the 5-FU group and 78.9% in the control group (P = 0.01, Wilcoxon test). The 5-FU group had a mean postoperative IOP of 12.5 +/- 4.6 mmHg versus 17.4 +/- 5.7 mmHg in the control group at 2-year follow-up (P = 0.015, t test). Antiglaucoma medications were required in 5.8% of patients in the 5-FU group and in 41.9% of controls within 2 years (P less than 0.0001, Fisher's exact test). These results suggest that low-dose 5-FU at the time of initial trabeculectomy leads to a higher success rate, lower IOP, and less need for antiglaucoma medications postoperatively.

Adolescent↗
PubMed1991

A case-control study of risk factors for intraoperative suprachoroidal expulsive hemorrhage.

The authors performed a case-control study of risk factors for suprachoroidal expulsive hemorrhage (SEH); the study involved 68 SEH cases at their institution from 1981 to 1986. The authors examined 113 variables in the study group and a procedure-matched control group of 217 patients randomly selected from the 35,459 patients who underwent intraocular surgery during this period, and subjected them to bivariate and conditional logistic regression analysis. The incidence of SEH was 0.19% overall, 0.16% for lens-related procedures, 0.15% for glaucoma surgery, 0.41% for retinal and vitreous procedures, and 0.56% for keratoplasty. Statistically significant risk factors for SEH in age-adjusted bivariate analyses included: glaucoma (P less than 0.0001), increased axial length (P less than 0.0001), elevated intraocular pressure (IOP) (P less than 0.0001), generalized atherosclerosis (P = 0.007), and elevated intraoperative pulse (P = 0.0001). Conditional logistic regression analysis with frequency matching on age identified significant independent risks associated with a history of glaucoma, elevated IOP, increased axial length, and intraoperative tachycardia. One of the models predicts a 752-fold increased theoretical relative risk of SEH for a patient with axial length greater than or equal to 25.8 mm, a history of glaucoma, preoperative IOP greater than 18 mmHg, and intraoperative pulse greater than or equal to 85 beats per minute. The visual outcome after SEH was best in cases of extracapsular cataract extraction (ECCE), compared with other procedures. Results suggest that attention to multiple preoperative and intraoperative ocular and systemic variables may allow identification and prophylaxis of patients at risk for SEH.

Aged↗
PubMed1991

CD4% is the best predictor of development of AIDS in a cohort of HIV-infected homosexual men.

To determine the relationships between individuals' baseline T-cell subsets, their rates of change with time, and AIDS-free survival time, data were collected at 6-monthly intervals from 379 HIV-seropositive homosexual Sydney men, of whom 31 developed AIDS during the 3-year observation period. Both CD4% and rate of change of CD4% in an individual had significant prognostic value in determining AIDS-free survival time. Compared with subjects whose CD4% remained stable, subjects whose CD4% dropped by 7% or more in a year had a relative hazard of 35.1 (95% confidence interval = 11.7-105.6, P less than 0.001) of developing AIDS. Increasing CD4% had a significant protective effect, reducing the risk of developing AIDS. CD4%, CD4 cell count and CD4: CD8 ratios showed steeper declines in subjects who were later diagnosed with AIDS than in those who remained AIDS-free. The rates of immunological change in AIDS-free seroconverters and seropositives were similar, despite indeterminate differences in durations of infections. In the multivariate Cox regression analysis, baseline CD4%, the rate of change of CD4%, and baseline lymphocyte count were associated with AIDS-free survival time. Baseline CD4% had greater prognostic value than baseline CD4 cell count. Baseline CD8%, baseline CD8 count, their rates of change and their mean square errors were not independently significant in this analysis. These findings are important for clinicians monitoring HIV infection in an individual and for entry criteria and monitoring procedures in clinical trials. They also have implications for resource-poor settings; prognosis based on CD4% can be made with a flow cytometer without a full blood count.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1991

National AIDS incidence trends and the extent of zidovudine therapy in selected demographic and transmission groups.

After mid-1987 fewer than the expected number of cases of AIDS were reported in the United States in some demographic and transmission groups but not in others. Gay men (regardless of intravenous drug use), adults with hemophilia, and transfusion recipients exhibited fewer cases than expected based on previously reliable models. These favorable trends could not be explained by assuming earlier cessation of human immunodeficiency virus (HIV) infection. Favorable AIDS incidence trends were not found in heterosexual intravenous drug users or in persons infected through heterosexual contact. White gay men from New York City, Los Angeles, and San Francisco experienced markedly favorable trends, whereas little changes was observed for nonwhite gay men from nonurban areas. AIDS incidence trends were quantitatively consistent with the fraction of AIDS-free persons with severe immunodeficiency who received zidovudine in three cohorts. Gay men in San Francisco used zidovudine more frequently than did adults with hemophilia, while little was used by intravenous drug users in New York City. Data describing the initial national distribution of zidovudine (March 31-September 18, 1987) indicated relatively high use by patients with severe immunodeficiency in those groups, such as urban white gay men, that subsequently experienced fewer cases of AIDS than expected. Available data suggest that zidovudine, perhaps in combination with other therapies, has been one factor contributing to favorable AIDS incidence trends in some groups. Broader application of therapy might further retard the incidence of AIDS, especially in intravenous drug users, persons infected through heterosexual contact, minorities, women, and persons diagnosed outside major metropolitan areas.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Sex, drugs, and HIV infection in a New York City hospital outpatient population.

Persons attending outpatient clinics at Bellevue Hospital Center in Manhattan, New York City were invited to be tested for antibodies to human immunodeficiency virus (HIV). In pretest counseling, males were asked if they had injected nonprescription drugs or engaged in sex with other men since January 1, 1977; if so, they were asked not to participate and were referred elsewhere for testing. Face-to-face interviews and HIV testing were completed for 1,119 subjects with no prior indication of HIV seropositivity. Willingness to participate in the study was significantly greater among women than men and among younger than older persons. After exclusion of two subjects with indeterminate HIV serology, seroprevalence was 6.3% (70/1,117) overall, 7.1% (26/368) among men, and 5.9% (44/749) among women. HIV seropositivity among female i.v. drug users was 37% (27/74). Among heterosexuals without other HIV risk factors, estimated seroprevalences were 2.7% (25/924) overall, 3.3% (10/305) among males, and 2.4% (15/619) among females. Among heterosexual men, the data suggested associations of HIV seropositivity with sex with prostitutes and sex with numerous partners. Multiple logistic regression analysis indicated that significant predictors of HIV infection among women were a history of sexual contact with a male intravenous drug user, recent last use of intravenous drugs, and long duration of residence in New York City. Sexual intercourse with persons from AIDS risk groups was reported by 11% of men and 18% of women. The modal method of birth control reported by both men and women was "no method".

Adult↗
PubMed1989

Incidence and risk factors for human immunodeficiency virus seroconversion in a cohort of Sydney homosexual men.

By means of prospective cohort data from the Sydney AIDS Project, we report on 55 homosexual or bisexual men who have become infected with human immunodeficiency virus (HIV), as measured by the development of serum HIV antibodies (seroconversion). We have compared the sexual practices, recreational drug abuse, history of sexually-transmissible diseases, and antecedent immunological findings of the men who seroconverted with those of 588 subjects who persistently remained seronegative in the same time-period. The cumulative incidence rate of HIV infection over the three years of observation was 8.5%. The cumulative incidence rate ranged from less than 1% for the six months before August 1, 1984, to a peak of 5% in the six months before August 1, 1985. Of those subjects for whom we had data for the period of seroconversion, all but two of the subjects who seroconverted admitted to a recognized high-risk sexual practice in the six months before the first visit at which they were found to be seropositive. Univariate analysis found that men who seroconverted were significantly more likely to have had a greater number of recent sexual partners (relative risk per partner, 1.02; P less than 0.001), to have engaged in receptive anal intercourse (incidence rate ratio, 3.1; 95% confidence interval [CI], 1.3-7.6; P = 0.01) and to have used nitrite inhalant (incidence rate ratio, 2.6; 95% CI, 1.2-5.9; P = 0.02) and amphetamine (incidence rate ratio, 4.8; 95% CI, 2.2-10.5; P less than 0.001) drugs. The men who seroconverted were significantly (incidence rate ratio, 2.7; 95% CI, 1.2-6.1; P = 0.014) more likely to have antecedent T-suppressor-cell counts of greater than 800 cells/microL. Factors that retained significance in multivariate analysis were the number of recent sexual partners, recent amphetamine abuse and a T-suppressor-cell count of greater than 800 cells/microL.

Adolescent↗