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PubMed1994

AIDS treatment costs during the last months of life: evidence from the ACSUS.

OBJECTIVE: The volume and cost of services consumed by persons with AIDS (PWAs) during their last months of life are examined in this study. DATA SOURCES: This study utilizes data from the AIDS Costs and Service Utilization Survey (ACSUS). The ACSUS is the most comprehensive survey of medical services that are consumed by persons with HIV. STUDY DESIGN: This study is restricted to persons with AIDS who survived the fifth time period (an approximately three-month period in the early spring and summer of 1992). The types and costs of services consumed during the fifth time period by PWAs who did survive (609) and who did not survive (79) the sixth time period are compared. DATA COLLECTION: The ACSUS consists of six interviews over an 18-month period from Spring 1991 to Fall 1992. PRINCIPAL FINDINGS: Decedents were hospitalized more than four times as many days and experienced more than four times the number of home health visits as survivors. Both the average length of stay (19.3 days for decedents and 10.3 for survivors) and the frequency of hospitalization during the fifth time period (.70 for decedents and .28 for survivors) were higher for decedents than survivors. The levels of outpatient care (including emergency room care) and of prescription drug use were similar for decedents and survivors. CONCLUSIONS: This study shows that the cost of treating decedents is more than three times the cost of treating survivors.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Nuclear medicine and AIDS.

Over the last decade the acquired immunodeficiency syndrome (AIDS) has become one of the leading causes of morbidity and mortality both in Europe and the United States. The disease is due to infection by the human immunodeficiency virus (HIV), which results in progressive loss of cellular immunity; consequently, patients are susceptible to both typical infections with high-grade pathogens and also low-grade opportunistic organisms. In addition, different cancers such as Kaposi's sarcoma and non-Hodgkin's lymphoma occur with increased frequency. Nuclear medicine has a central role to play in the diagnosis of these malignant and infectious conditions. This article reviews the role of radionuclide studies in the diagnosis of HIV-related disease.

AIDS Dementia Complex↗
PubMed2004

Prognostic value of plasma HIV RNA among highly active antiretroviral therapy users.

BACKGROUND: The study objective was to compare the prognostic value of plasma HIV RNA and CD4 cell count at baseline and as time-updated variables in highly active antiretroviral therapy (HAART) users for two outcomes: development of AIDS and change in CD4 cell count. METHODS: The study population comprised 387 men enrolled in the Multicenter AIDS Cohort Study who were AIDS-free and initiated HAART between 1996 and 2001. Follow-up until AIDS diagnosis (n=36, 9%) or the last AIDS-free visit was included. To determine the predictive value of combining HIV RNA and CD4 cell count, regression tree methods using recursive partitioning at pre-specified cut points for both variables were used. RESULTS: Low CD4 cell count was a strong predictor of AIDS among HAART users. However, HIV RNA showed strong prognostic value for AIDS development among those with CD4 cell counts > 250 x 10(6) cells/l, in whom an HIV RNA level > 1000 copies/ml carried a 4.6-fold greater risk of developing AIDS. HIV RNA < 5000 copies/ml was also predictive of subsequent increase in CD4 cell count with significantly higher increases among those with initial CD4 counts > 300 x 10(6) cells/l. CONCLUSION: Although, in HAART users, CD4 cell count was the primordial prognostic marker, an HIV RNA > 1000 copies/ml attained after HAART initiation was a strong predictor of the rate of subsequent CD4 cell count increase and of developing AIDS in patients whose CD4 cell counts were > 250 x 10(6) cells/l.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Will killing the last HIV1 particle cure AIDS patients? II: Second Part. Decrease of viral load and of T-suppressor cells, and increase of the cytotoxic cells, without effect on CD4, after the use of 10 virostatics applied in 3 or 4 drug combinations of different sequences. The time for CD4 immunotherapy?

We reported in the first part of this editorial and in an article AIDS therapy with five HIV1 virostatics applied in two then three, or initially three, or initially four agent combinations, given in 3 week sequences differing from each other due to drug rotation, the contrast between: a) the decrease of viral load, possible below the detectable level, b) the absence of effect on the helper CD4+, the CD8+ C57- cytotoxics and the CD8+ C57+ suppressor cells. We proposed a thesis according to which the HIV1-AIDS complex might have another pathogenic component other than HIV1, ie, a microchimerism graft-versus host reaction (GvH) or an autologous GvH-like reaction. Shifting from five to 10 virostatics owing to the availability of lamivudine or 3TC, stavudine or d4T and three HIV1 protease inhibitors, saquinavir, ritonavir and indinavir, applied according to the same modality, we have enhanced the reduction of viral load, and significantly decreased the CD8+ C57+ suppressor cell counts, and increased those of the CD8+ C57- cytotoxic cells. This result which indirectly shows the role of HIV1 in the increase of suppressor CD8+ cells, hence in the late loss of immune memory and of opportunistic infections, reinforces the thesis of a role, in AIDS pathogenesis, of a latent GvH reaction activated by HIV1 primo-infection, and its evolution from the hyperplastic phase to the hypoplastic one, which, inducing severe immune suppression, is responsible for HIV1 active infection relapse after the so-called latent phase. Hence the proposition we make, of an indication of CD4 modulation with non specific immunotherapy by bestatin, of which we showed the effect in another population of HIV1-AIDS complex patients. Its effect can be potentiated by tuftsin. When the suppressor cell number goes up over that of the cytotoxic one after the HIV1 active infection relapse, interferon gamma could be added, which, by amplifying the CD28 pathway on CD8+ cytotoxics, while suppressor cells lack CD28, which might reestablish a ratio of suppressor over cytotoxic cells nearer to normal. It remains that the role of the five secondarily included agents in the decrease of suppressor cells will only be attributed with certainty and entirely to their virostatic effect, if it is shown that none of them exerts a selective anti-suppressor cell action.

Acquired Immunodeficiency Syndrome↗
PubMed1991

[Thoracic lymphoma in AIDS].

Over the last 4 years, we observed 122 patients with AIDS and 20 with AIDS-related lymphomas (ARL) in the chest. Eighteen of the latter were non-Hodgkin's forms, mostly high-grade and high-stage B-cell (Burkitt or Burkitt-like) types (16 cases.) This prevalence reflects the overall increase in neoplasms secondary to immunodepression, which is parallel to improved prevention and control of opportunistic infections. Of 20 ARLs, 5 (25%) presented thoracic lesions; in 4 of them the onset of the disease was localized in the chest. The incidence of such manifestations is higher than that reported in the literature. Moreover, radiological features are quite atypical relative to the "classical" signs of lymphoma in the general population, with predominant (60%) nodules or quickly-growing peripheral masses which may subsequently invade chest walls. Isolated nodal enlargement is also a possible finding, as well as pleural effusion. This pattern, though not pathognomonic, is highly suggestive--in HIV-positive patients--of ARL. In all the patients with pulmonary lymphoma CT demonstrated bilateral lesions--more than conventional X-rays--with morphologic and densitometric features which helped make the correct diagnosis. Moreover, CT was helpful in choosing the appropriate site for biopsy.

Adult↗
PubMed2004

[New developments in hearing aid technology].

The last decade has seen numerous and significant improvements in hearing aid technology. Digital hearing aids are becoming increasingly common and have already replaced a considerable portion of the hearing aids using the older analogue technology. Efficient noise reduction methods, most notably multi-microphone systems for hearing aids, can increase speech intelligibility in adverse listening situations and noisy environments. Accessories, such as e.g. wireless classroom communication systems (FM systems) and remote controls are becoming smaller and less visible. As a consequence of the increased complexity of modern hearing aids, however, hearing aid fitting has become considerably more complex.

Acoustics↗
PubMed1997

[Clinico-diagnostic and odonto-stomatologic therapeutic problems in patients with HIV infection and AIDS].

During the last decade, scientific studies and new knowledges concerning HIV infection and AIDS, have constituted one of the main topics for discussion in the fields of biology and medicine. AIDS is a serious disease and it is unfortunately characterized by a very high death rate. In spite of all the efforts deployed by researchers and scientists, there is at present no effective therapy capable of restoring a proper immunological balance in the affected subjects. In the field of odontostomatology all diagnostic, clinical or therapeutic operation in HIV patients, is to be considered as particularly complex and characterized by some degree of real risk. It is therefore necessary to develop a whole set of health-care models which must provide a broad range of different interventions in order to assure a rational and technically profitable service. We point to the various diagnostic, clinical and therapeutic methods and approaches to be recommended in the case of HIV and AIDS patients, and we add some reference to health care activities at the "San Luigi Center" of the Scientific Istitute San Raffaele Hospital in Milan.

AIDS-Related Opportunistic Infections↗
PubMed1982

The effectiveness of binaural hearing aids.

In the last ten years the findings of most published research into binaural hearing aids are undoubtedly in favour of two hearing aids as opposed to one. This paper summarizes and discusses the findings of one of these researches and puts forward practical guidelines for the selection of binaural hearing aids. The research in question was carried out at the Institute of Sound and Vibration Research, University of Southampton, and it was supported by the Wates Foundation.

Audiometry, Pure-Tone↗
PubMed2005

Reproductive decisions by couples undergoing artificial insemination with donor sperm for severe male infertility: implications for medical counselling.

Since 1992, ICSI has been introduced as a successful treatment for male infertility, including azoospermia. The present study is aimed at evaluating the practice of insemination with donor sperm (AID) in infertile couples who may benefit from the new developments that ICSI has brought in the last decade. AID was performed in 440 heterosexual couples. Twelve couples were lost for follow-up (3%). In 128 (29.9%) and 229 (53.5%) of the couples the husband was either oligozoospermic (OAT) or azoospermic. In 60 couples (14.0%) the man had a transmissible genetic trait. In 11 couples (2.6%) there were other indications for performing AID. In the OAT group 36 couples never had ICSI treatment (28.1%) because they had already an AID child born before the introduction of ICSI (n = 16), the burden of ICSI treatment was too high (n = 9) or they considered that ICSI success rate was too low (n = 7). Ninety-two couples tried ICSI treatment before opting for AID (71.9%), mainly because ICSI failed (n = 43). In 229 couples the husband had azoospermia (53.5%). In 112 couples (49%) no sperm or too few testicular sperm were found at testicular biopsy (TESE) and 15 couples (6.5%) had more than three failed ICSI-TESE attempts. Eighty-one azoospermic men refused TESE (35.4%) because of an anticipated low success rate (n = 28) or the burden of this approach (n = 23). Although a majority of patients could opt for ICSI, our results show that AID is still an option for many couples for whom these techniques were either not feasible or not successful. A substantial proportion of patients (33%) did not even opt for these advanced fertility treatments.

Counseling↗
PubMed2000

AIDS cases rise in China.

New cases of Chinese people with the AIDS virus grew by more than 40% in 1999, with women increasingly at risk, the newspaper of China's Health Ministry reported on March 29, 2000. Health experts detected 4677 new cases of HIV, the virus that causes AIDS and last year a 41.5% rise over 1998, the Health News said. It reported that China has recorded 17,316 Chinese carriers of HIV, 647 of them with full-blown AIDS, since the first case was reported in 1985. The number of reported cases is small by international standards, especially given China's population of 1.25 billion. India, with about 1 billion people, has an estimated 3.7 million people infected with the HIV virus. Chinese and foreign AIDS experts believe the actual number of Chinese that are infected with HIV may be closer to 400,000. Chinese health officials increased testing of high-risk groups last year by conducting more than 4.4 million tests, the Health News said. Women account for 15.4% of all HIV cases--¿an obvious increase¿, the newspaper said, without providing comparisons. The Health News quoted a vice chairman of the Association for the Prevention of AIDS and Sexually Transmitted Diseases, Dai Zhicheng, as calling the increase among women ¿a special warning¿. For much of the last 15 years, HIV has largely been confined to needle-sharing heroin addicts and their sexual partners. But in recent years, the disease has begun to show up among truck drivers and prostitutes in areas with thriving sex trades, foreshadowing an outbreak in the general population.

Acquired Immunodeficiency Syndrome↗