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Biomedical subjects

S M Forster

Publications and source records attributed to S M Forster.

26 records · Page 2Linked to original sources
PubMed1987

Diagnosis of lung disease in acquired immune deficiency syndrome: biopsy or cytology and implications for management.

One hundred and twenty consecutive bronchoscopic examinations were carried out on 80 patients with acquired immune deficiency syndrome (AIDS) between January 1982 and December 1986. Ninety one paired biopsy and cytology specimens from 72 of these patients were analysed. There was no significant difference between biopsy and cytology in diagnosing Pneumocystis carinii pneumonia (0.95 greater than p greater than 0.1). In 10 cases P carinii pneumonia was diagnosed by biopsy but not cytology and in seven cases by cytology but not biopsy. Nineteen patients had multiple infections or Kaposi's sarcoma. Biopsy was more useful than cytology in the diagnosis of other infections (n = 20) and Kaposi's sarcoma (n = 2) with positive cytological correlation in only three of the infections. Biopsy and cytology together have a diagnostic yield of 78.3%. We conclude that all patients presenting with respiratory disease who have, or are in a high risk group for, AIDS should be examined by bronchoscopy at an early stage with both cytology and biopsy.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Decline of anti-p24 antibody precedes antigenaemia as correlate of prognosis in HIV-1 infection.

A cohort of 84 homosexual men presenting with persistent generalized lymphadenopathy (PGL) was studied between March 1982 and March 1987. A progression rate to AIDS of 5% per year was seen in those who were infected with HIV. Certain clinical features and routine laboratory investigations were significantly associated with an increased risk of disease progression, but had only limited predictive value. Two hundred and fifty-two serial sera from 57 patients were analysed for the p24 antigen (Abbott), the principal core protein of HIV and antibody against p24 by direct enzyme-linked immunosorbent assay (ELISA). Patients who remained well retained a high titre of anti-p24 antibody compared with those who progressed to AIDS-related complex (ARC) or AIDS. HIV antigen was detectable in 40% of AIDS patients 2 years before diagnosis, but antigenaemia was preceded by loss of anti-p24 antibody by up to 18 months and preceded AIDS by up to 40 months. ARC patients tended to be negative when tested for both alpha-p24 antibody and antigen, suggesting a transitional state. Analysis of the humoral response against gag proteins appears to correlate closely with clinical status and may be an earlier and more consistent way of predicting disease progression than p24 antigenaemia, or clinical and routine laboratory investigations.

AIDS-Related Complex↗
PubMedDate not supplied

Eight year prospective study of HIV infection in a cohort of homosexual men--clinical progression, immunological and virological markers.

Three hundred and fourteen homosexual/bisexual men at risk for human immunodeficiency virus (HIV) infection (170 seroprevalent HIV-positive, 144 seronegative) were prospectively studied over 8 years to assess rates of HIV infection and disease progression, in conjunction with cellular and HIV serological markers. In HIV-positive subjects, CD4+ lymphocyte counts rose strikingly during the period surrounding seroconversion, then fell progressively over the intervening period to a mean level of 300 cells/mm3 when AIDS developed. Changes in CD8+ lymphocyte counts were less consistent. The trend for HIV serological markers over the study period was of progressive decline in the proportion of subjects with anti-p24 antibody, associated with an increase in the proportion of subjects with detectable HIV antigenaemia. However, only 45% of subjects tested had lost anti-p24 antibody by the time of AIDS diagnosis, and HIV antigen was detectable up to 4 years before this. Different HIV serological patterns were also observed in subjects presenting either with Kaposi's sarcoma or opportunist infections. Our data support the continued use of cellular and virological markers in the evaluation of HIV disease; however, the variability observed in this study highlights their limited ability in predicting specific clinical events. Care should therefore be taken to encompass both clinical and laboratory information in the medical assessment of the HIV-infected individual.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Trends in sexual behaviour in a cohort of homosexual men: a 7 year prospective study.

A cohort of homosexual men at risk for human immunodeficiency virus (HIV) infection were studied prospectively over a 7-year period (1982/88) to assess trends in sexual behaviour and amyl nitrite intake. During the period, there were dramatic declines in the proportion of HIV seropositive and seronegative subjects reporting multiple casual partners for anal intercourse, unprotected anal intercourse and recreational use of amyl nitrite. Reported rates of orogenital intercourse remained the same during the period, whilst the total number of seroconversions fell from 17 for the period 1982-84 to 8 for 1985-88. High-risk sexual and related social behaviour among homosexual men, as assessed by patterns of anal intercourse behaviour and nitrite intake, changed over the 7-year period, with the greatest changes apparent before the widespread availability of HIV antibody testing and public education campaigns. This highlights the effectiveness of peer-group and community-based programmes in modifying the sexual behaviour of their members.

Adolescent↗