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Biomedical subjects

P Kissinger

Publications and source records attributed to P Kissinger.

52 records · Page 3Linked to original sources
PubMed1996

Incidence of three sexually transmitted diseases during a safer sex promotion program for HIV-infected women.

Promotion of safer sex practices typically includes education, skills building, and condom distribution. To evaluate the impact of such promotions and describe risk factors for sexually transmitted disease (STD), a retrospective review of 741 sexually active HIV-infected women was conducted. The cohort was African-American (82%), at least 22 years of age (81%), acquired HIV through sex (36%), had a CD4 count above 200/ mm3 (76%), and had a history of substance (alcohol or drug) use (38%). Those with incident STD (14.7%) were more likely to be under 22 years of age, to have a history of substance use, and to have an STD at entry. Traditional methods of promoting safer sex practices should be enhanced by other options such as regular screening, partner treatment, and the use of microbicides and other female-controlled methods.

Adult↗
PubMed1996

Clinical manifestations of infection with human immunodeficiency virus among adolescents in Louisiana.

PURPOSE: There is limited information regarding the clinical manifestations of human immunodeficiency virus (HIV) infection among adolescents. To better define the clinical presentation and course of HIV disease in this population, a retrospective review of all HIV-infected persons age 13-21 years at entry into a public, inner-city HIV outpatient clinic in New Orleans, Louisiana, was undertaken. RESULTS: A total of 141 adolescents were included in this study. The cohort was predominantly female (65%) and African-American (83%), and acquired HIV infection through sexual contact (89%). As many as 75% of the females and 48% of the males were diagnosed with at least one sexually transmitted disease (STD), respectively, and young African-American females with a CD4 cell count > 500/mm3 were at highest risk. The proportions of female adolescents having a gravida > or = 1 and 2 were 82% and 20%, respectively. A total of 55% of females were diagnosed with squamous intraepithelial lesions (SIL) at least once. Similar to adults, the majority of opportunistic processes occurred in adolescents with a CD4 cell count < 200/mm3. Known HIV-related symptoms (oral hairy leukoplakia, thrush, and zoster) were significantly predictive (p < .0001) for HIV disease progression. CONCLUSIONS: Although HIV-related symptoms and infections do not appear to be unique in the adolescent population, it is clear that STDs and pregnancies are common among female adolescents. Our results emphasize the need for aggressive STD and contraceptive protection counseling, and surveillance screening for STDs and cervical dysplasia.

AIDS-Related Opportunistic Infections↗
PubMed1996

Complementary therapy use among HIV-infected patients.

This study investigates factors associated with the self-reported use of complementary therapies, types of therapies used, and sources of complementary therapy information among HIV-positive patients attending a public, HIV outpatient clinic in New Orleans. A convenience sample of 287 clients (220 men and 67 women) was given a self-administered anonymous questionnaire. Overall, complementary therapy use was 31%. Patients who used complementary therapy were more likely to be white (O.R., 2.5), female (O.R. 3.3), a high school graduate (O.R. 2.9), and to know another complementary therapy user (O.R. 7.8). Age, sexual orientation, CD4 cell count, injection drug use, living with another HIV-infected person, having pain, and HIV support group membership were not associated. Men were more likely than women, and whites were more likely than nonwhites, to use vitamins/minerals, imagery/meditation, and dietary regimens. Nonwhites were more likely than whites, and women more likely than men, to use spiritual healing. Of those using complementary therapy, men were more likely than women, and whites more likely than nonwhites, to get information about complementary therapy from HIV organizations, friends, and homosexual-oriented media. Doctors and nurses were the most frequently cited source of complementary therapy information for women. Frequency, type of therapies used, and source of information about complementary therapy among HIV-infected persons vary by race and gender. Clinicians should be educated about complementary therapies so that they can provide information to their patients and be aware of self-treatment behavior.

Adult↗
PubMed1996

Contraceptive and sexually transmitted diseases protection among adult and adolescent women infected with human immunodeficiency virus.

The goal of this study was to describe contraceptive and sexually transmitted disease (STD) prevention practices in human immunodeficiency virus (HIV) infected adult and adolescent women, and to determine if hormonal contraception has unique adverse effects in this population. A retrospective review of 241 HIV-infected women age 15-45 years was performed. The associations between contraceptive methods and selected characteristics were determined by chi-square methods and logistic regression modelling. African American race (RR 8.6, 95% CI 3.3, 22.5), injection drug use history (RR 5.0, 95% CI 2.2, 11.2), age < 25 years (RR 1.9, 95% CI 1.1, 3.5) and progestin only contraceptive use (RR 3.0, 95% CI 1.4, 6.6) were significantly associated with incident STDs. The only potential adverse effect of hormonal contraception noted in this retrospective study was the significant association between STDs and progestin-only contraception. Prospective studies to better delineate the true association between STDs and progestin-only agents after adjustment for behaviour patterns are warranted.

Adolescent↗
PubMed1995

Comparison of multiple drug therapy regimens for HIV-related disseminated Mycobacterium avium complex disease.

In June 1993, the United States Public Health Service (USPHS) made recommendations for treatment of disseminated Mycobacterium avium complex (MAC) in patients infected with the human immunodeficiency syndrome (HIV). It was suggested that every treatment regimen include either azithromycin or clarithromycin plus one or more of the following drugs: ethambutol, clofazimine, rifabutin, rifampin, ciprofloxacin, or amikacin. This study compares the effect of multiple drug therapy regimens on the survival of patients of the HIV outpatient department of the Medical Center of New Orleans, Louisiana. A retrospective chart review of 122 confirmed cases of MAC was conducted. Three treatment groups were considered: no/monotreatment (n = 40), multitreatment without clarithromycin (n = 32), and multitreatment with clarithromycin (n = 50). Azithromycin, amikacin, and rifabutin were not used in this clinic during the study period. Both multitreatment without clarithromycin (p < 0.03) and multitreatment with clarithromycin (p < 0.005) were significantly protective for survival after adjusting for CD4 cell count at time of diagnosis, nonadherence to treatment, number of concomitant opportunistic infections at diagnosis, and weight loss > 10%. Neither of the groups that received multidrug therapy were significantly less likely to have MAC-related symptoms than the no/mono group at 3 and 6 months postdiagnosis. These findings support the USPHS recommendation for multiple drug treatment either with or without clarithromycin. Prospective controlled clinical trials will clarify the optimal regimen for disseminated MAC disease.

AIDS-Related Opportunistic Infections↗
PubMed1995

Evaluation of a program to remove barriers to public health care for women with HIV infection.

To facilitate access to care for HIV-infected women, a maternal-child program was started at an HIV outpatient clinic in New Orleans. The program consisted of free child care and transportation, separate waiting and examination rooms, female care providers, merged visits for mother and child, and on-site colposcopy services. This study evaluates the efficacy of the program on improving attendance at the clinic by follow-up of 143 women and 557 men (serving as controls). Multivariate models were adjusted for history of intravenous drug abuse, race, age, CD4 cell count, staging of disease, and time in the clinic. Half of the clients achieved high attendance rates. Women were as likely as men to achieve high attendance rates before the interventions, but more likely to do so at both 6 months and 1 year postintervention (after adjustment for the other variables). These results suggest that responding to special gender-related needs can improve women's attendance for clinic visits.

Adult↗
PubMed1995

Compliance with public sector HIV medical care.

Despite the availability of free or low-cost public sector human immunodeficiency virus (HIV) health-care services, important inequities in utilization exist. This study examined two measures of compliance with HIV medical care: attendance of scheduled outpatient visits and use of the emergency room. Clients of two public HIV outpatient clinics were followed from time of health-care initiation to either death or the end of the study. The association of race, sex, age, and injection drug use (IDU) with these measures were examined in multivariate logistic regression. Models were adjusted for disease staging at time of entry and for length of follow-up time in clinic. Of 1824 clients followed, 15% failed to attend scheduled visits and 18.1% had at least one emergency room visit. Clients who missed visits were more likely to be African American, to have a history of IDU, and to have a CD4 cell count < 500/mm3 or an acquired immunodeficiency syndrome (AIDS)-defining opportunistic infection at entry. They were also more likely to have > or = 12 months of follow-up time in the HIV clinic, but were less likely to have entered into health care from an early intervention clinic. Clients who had at least one emergency room visit were more likely to be African American, female, IDU, and under 22 years of age; these clients were also more likely to have entered with CD4 < 200/mm3 or with an opportunistic infection, and to have > or = 12 months of follow-up in the clinic.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Sexual behavior, smoking, and HIV-1 infection in Haitian Women.

OBJECTIVE: To determine whether a previously observed association between human immunodeficiency virus type 1 (HIV-1) infection and smoking in Haitian women could be explained by confounding high-risk behaviors. DESIGN AND SETTING: A nested case-control study at a primary care health clinic in Cité Soleil, Haiti. PARTICIPANTS: Women who reported having smoked (n = 89) and randomly selected nonsmokers (n = 329) who had participated in a survey 1 to 12 months earlier evaluating risk factors for HIV-1 infection. MAIN OUTCOME MEASURES: Lifetime sexual practices, smoking, health beliefs and practices, and other factors potentially confounding the relationship between smoking and HIV-1 infection. RESULTS: Compared with nonsmokers, smokers reported higher rates of high-risk behaviors, including more lifetime sex partners (P less than .001), being less likely to be married (P less than .01), and being more likely to have visited folk healers (P less than .01). No intravenous drug use was reported, and no significant differences were noted between smokers and nonsmokers in numbers of past surgical or dental procedures or injections. Adjustment for all factors associated with HIV-1 infection and smoking in regression analyses revealed an independent association between smoking and HIV-1 infection (odds ratio [OR], 3.4; 95% confidence interval [Cl], 1.6 to 7.5). Other factors associated with HIV-1 infection included having more than two life-time sex partners (OR, 3.4; 95% Cl, 1.7 to 6.8) and lower socioeconomic status as reflected by a dirt floor in the home (OR, 8.6; 95% Cl, 3.3 to 22.0). CONCLUSIONS: Smoking is a marker for high-risk sexual behavior and is associated with an increased risk of HIV-1 infection in this population. The persistent association between smoking and HIV-1 infection after adjustment for all known risk factors suggests the possibility of a biologic effect of smoking that warrants further evaluation in other populations.

Adult↗
PubMed1987

Detection and identification of three thioether conjugates of 2-hydroxyacetanilide by liquid chromatography/electrochemistry.

The three 2-mercaptoethanol (ME) thioether conjugates of 2-hydroxyacetanilide (2HAA) are detected and identified using liquid chromatography/electrochemistry (LC/EC). The conjugates are produced either by incubations of 2HAA with liver microsomes in the presence of NADPH and ME or by chemically oxidizing a solution of 2HAA and allowing it to react with ME. Identification of the three isomers is based on retention time and comparison of the electrochemical behavior of model compounds. Production of the three isomers by microsomal protein occurs only in the presence of NADPH and shows that 2HAA proceeds through a cytochrome P-450 mediated pathway to a reactive intermediate similar to acetaminophen, possibly N-acetyl-o-quinoneimine. The relative percentages of each isomer produced were calculated as the percentage of the total peak areas of the isomers. Compound A (2HAA-5-ME) is produced in 53.7% and 24.6%, compound B (2HAA-4-ME) is produced in 16.2% and 70.3% and compound C (2HAA-3-ME) is produced in 30.1% and 5.1% by microsomal incubations and chemical oxidation respectively.

Acetaminophen↗
PubMedDate not supplied

Understanding barriers to condom usage among HIV-infected African American women.

Drawing on focus group discussions with adolescent and adult HIV-infected women between the ages of 16 and 45, this study explores the barriers to condom use among women infected with HIV. Although most of the participants were comfortable discussing condoms and sexuality, there was little, if any, negotiation of condom use with their male partners. Most of the participants used condoms inconsistently or not at all. Reasons for nonuse included a lack of trust in the reliability of condoms to protect them, a lack of desire for pregnancy prevention, and the male partner's refusal to use condoms. Women in discordant relationships explained their uninfected partner's refusal to use condoms as denial of the risk of contracting HIV or as a way of expressing their love for the infected partner. Women also had great difficulty in disclosing their HIV status to both family and partners. Prevention efforts to increase condom use among HIV-infected women should target both men and women and focus on negotiation and communication skills.

Adolescent↗
PubMedDate not supplied

Transmission of HIV-1 infections from mothers to infants in Haiti. Impact on childhood mortality and malnutrition. The CDS/JHU AIDS Project Team.

Of 4588 pregnant women in a high-risk Haitian population, 443 (9.7%) were serologically positive for the human immunodeficiency virus type 1 (HIV-1). Infants born to women who were HIV-1 seropositive were more likely to be premature, of low birth weight, and malnourished at 3 and 6 months of age than were infants born to women who were HIV-1 seronegative. Increased mortality was observed in infants born to women who were HIV-1 seropositive by 3 months of age. At 12 months of age, 23.4% of the infants born to women who were HIV-1 seropositive had died compared with 10.8% of the infants born to women who were HIV-1 seronegative; at 24 months of age, the mortality rates were 31.3% and 14.2%, respectively. Maternal HIV-1 infections resulted in an 11.7% increase in the overall infant mortality rate in this population. The estimated mother-to-infant HIV-1 transmission rate in these breast-fed infants was 25%, similar to the rates reported for non-breast-fed populations in the United States and Europe.

Adult↗