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PubMed2000

Long-term follow-up of patients with AIDS treated with parenteral cidofovir for cytomegalovirus retinitis: the HPMPC Peripheral Cytomegalovirus Retinitis Trial. The Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group.

OBJECTIVE: To evaluate patients with cytomegalovirus (CMV) retinitis treated with intravenous cidofovir for long-term outcomes. DESIGN: Patients with CMV retinitis enrolled in a randomized, controlled clinical trial of intravenous cidofovir as treatment for retinitis were followed for long-term outcomes, including 21 patients initially enrolled in the deferral group who received cidofovir therapy after progression of retinitis. SETTING: Thirteen tertiary care clinics specializing in AIDS care and ophthalmology. PARTICIPANTS: Fifty-eight patients with AIDS and small peripheral CMV retinitis lesions. INTERVENTIONS: Cidofovir 5 mg/kg once weekly for 2 weeks followed by low-dose maintenance cidofovir therapy (3 mg/kg) in 35 patients or high-dose maintenance (5 mg/kg) in 23 patients. MAIN OUTCOME MEASURES: Time to progression of retinitis, drug toxicities. RESULTS: Median time to progression of retinitis was 2.5 months. Median time to discontinuation of cidofovir because of intolerance was 6.6 months, and did not differ significantly between the two maintenance doses. Median time to discontinuation of cidofovir for intolerance other than probenecid reaction was 16.3 months for patients treated with low-dose maintenance and 5.0 months for patients treated with high-dose maintenance (P = 0.021). Proteinuria of 2+ or more occurred at a rate of 1.22/person-year. In patients with sufficient follow-up to determine resolution of proteinuria, 89.9% of episodes resolved, and the median time to resolution was 20 days. Rates of probenecid intolerance and of cidofovir-associated uveitis were 0.35/person-year, and 0.20/person-year, respectively. CONCLUSION: Although effective for the treatment of CMV retinitis, cidofovir has potential toxicity. Toxicity typically resolves with discontinuation of therapy, but careful attention to both concomitant therapy and monitoring for toxicity is required.

AIDS-Related Opportunistic Infections↗
PubMed1989

[AIDS and Aids: anthropological observations apropos the AIDS phenomenon in Lobaye, Central African Republic].

Human infestation by retrolentivirus which are incriminated in human disease called AIDS turns to be a "serious endemic". Once adequate medicine and vaccine discovered, it could perhaps be jugulated or eradicated in ethno-ecosystems combining a high socioeconomic level and a heavy attendance of efficient biomedicine. These criteria fit in neither with Quarter, nor with Third World, nor with worlds which do not think or live Health, Illness, Death, Misfortune in the same terms than those inspired by biomedical philosophies. Native logic apprehends AIDS as any form of sequence of misfortune, without taking care of its physiopathologic and epidemiologic specificity.

Acquired Immunodeficiency Syndrome↗
PubMed1996

[AIDS and AIDS: anthropological analysis of opinions relative to the death of AIDS patients in a district of Bangui (June 1994)].

Anthropological analysis and presentation of a corpus of information gathered during an ethnological survey on aids led in June 1994 in the district Jean XXIII, Bangui. The personality of the investigator-informator ( = Ego = the second author), and thus his subjectivity, are parameters deliberately considered for the presentation and analysis of the obtained data. The inquiry consists in making a list and gathering explanations of deceases ascribed to aids in this district, among a population made up by a representative part of the investigator's "social body": i.e. his nuclear family, members of his extended paternal, maternal and in-law families, past and present regular extra-matrimonial sexual partners, networks of former and present neighbours, friends and colleagues; that is to say a whole formal and informal community with changing outlines, which acts a fundamental role when misfortune, bad luck and disease appear.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Decision aids for people facing health treatment or screening decisions.

BACKGROUND: Decision aids are interventions designed to help people make specific and deliberative choices among options (including status quo) by providing (at a minimum) information on the options and outcomes relevant to a person's health status. A systematic review is needed to summarize what is known about their efficacy. OBJECTIVES: 1. To create an inventory of existing decision aids. 2. To conduct a systematic review of randomized controlled trials of decision aids aimed at improving people's decision making and outcomes. SEARCH STRATEGY: The following electronic databases were searched: MEDLINE, EMBASE, PsycINFO, CINAHL, Aidsline, Cancerlit, the Cochrane Controlled Trials Register. In addition, individuals known to be active in the field of decision support were contacted. SELECTION CRITERIA: We screened titles and abstracts for all interventions providing structured, detailed, and specific information on treatment or screening options and outcomes to aid decision making. Information about the decision aids was compiled in an inventory and those evaluated in a randomized controlled trial were reviewed in detail. DATA COLLECTION AND ANALYSIS: Using Cochrane review methods, two reviewers independently screened and extracted data on several evaluation criteria. Results of randomized trials were pooled using weighted mean differences and relative risks with all data analysed using a random effects model. MAIN RESULTS: Eighty-seven decision aids were identified. Twenty-three of them had been evaluated in 24 randomized controlled trials. Among the trials comparing decision aids to usual care interventions, decision aids performed better in terms of: a) greater knowledge of options in seven of seven studies (weighted mean difference (WMD = 19 out of 100, 95% confidence interval (CI): 13,25); b) more realistic expectations in two of three studies (RR=1.48 95%CI 1.02, 2.14); c) lower decisional conflict related to feeling informed in three of three studies (WMD = -9.0 of 100 95%CI: -15, -3); d) reducing the proportion of people who were passive in decision making in three of four studies (RR = 0.63, 95% CI: 0.5, 0.8). When simpler decision aids were compared to more detailed ones, the relative improvement was significant in: a) improved knowledge in two of seven studies (WMD = 4 out of 100, 95% CI: 2, 5); b) realistic expectations in two of two studies (relative risk (RR ranged from 1.5 95%CI: 1.3,1.8); and c) decisional conflict in one of two studies (WMD= -4 95% CI -8,-0.2). There was a consistent trend for decision aids to do no better than comparison interventions in affecting: satisfaction with the decision in five of six studies, satisfaction with the decision making process in four of five studies, and anxiety in four of five studies. Decision aids had a variable effect on which screening or treatment options were selected. Exposure to decision aids relative to controls resulted in a consistent non-significant trend toward reduced preference for major surgery over conservative options by 21 to 42 per cent in five of five studies; however, they had no impact on circumcision in two of two studies. For colon and prostate cancer screening choices, the results were inconsistent. Two studies have shown no impact on persistence with chosen option and few studies have shown significant benefits on general health outcomes (two of three studies), or disease-specific health outcomes (one of four studies). REVIEWER'S CONCLUSIONS: The number of decision aids is expanding, but there is considerable overlap in some areas leaving gaps in others. Trials of decision aids indicate that they are superior to usual care interventions in improving knowledge and realistic expectations of the benefits and harms of options; reducing passivity in decision making; and lowering decisional conflict stemming from feeling uninformed. When simpler versions of decision aids are compared to more detailed aids, the differences in knowledge are marginal but there are other benefits in terms of creating realistic expectations and in reducing decisional conflict. To date, decision aids have had little effect on anxiety or satisfaction with the decision making process or satisfaction with the decision. Their effects on choices vary with the decision. The effects on persistence with chosen therapies and health outcomes require further evaluation. The essential elements in decision aids for different groups and different types of decisions need to be established. Consensus needs to be reached regarding standards for developing and evaluating decision aids.

Decision Support Techniques↗
PubMed2000

Clarithromycin or rifabutin alone or in combination for primary prophylaxis of Mycobacterium avium complex disease in patients with AIDS: A randomized, double-blind, placebo-controlled trial. The AIDS Clinical Trials Group 196/Terry Beirn Community Programs for Clinical Research on AIDS 009 Protocol Team.

The efficacy and safety of clarithromycin and rifabutin alone and in combination for prevention of Mycobacterium avium complex (MAC) disease were compared in 1178 patients with AIDS who had < or =100 CD4 T cells/microL in a randomized, double-blind, placebo-controlled trial. MAC disease occurred in 9%, 15%, and 7% of those randomized to clarithromycin or rifabutin alone or in combination, respectively; time-adjusted event rates per 100 patient-years (95% confidence interval [CI]) were 6.3 (4.2-8.3), 10.5 (7.8-13.2), and 4. 7 (2.9-6.5). Risk of MAC disease was reduced by 44% with clarithromycin (risk ratio [RR], 0.56; 95% CI, 0.37-0.84; P=.005) and by 57% with combination therapy (RR, 0.43; 95% CI, 0.27-0.69; P=. 0003), versus rifabutin. Combination therapy was not more effective than clarithromycin (RR, 0.79; 95% CI, 0.48-1.31; P=.36). Of those in whom clarithromycin or combination therapy failed, 29% and 27% of MAC isolates, respectively, were resistant to clarithromycin. There were no survival differences. Clarithromycin and combination therapy were more effective than rifabutin for prevention of MAC disease, but combination therapy was associated with more adverse effects (31%; P<.001).

AIDS-Related Opportunistic Infections↗
PubMed1997

Cytomegalovirus (CMV) culture results, drug resistance, and clinical outcome in patients with AIDS and CMV retinitis treated with foscarnet or ganciclovir. Studies of Ocular Complications of AIDS (SOCA) in collaboration with the AIDS Clinical Trial Group.

The objectives of the study were to examine the clinical significance of cytomegalovirus (CMV) culture results and drug susceptibilities in CMV isolates from patients with AIDS-related CMV retinitis. Blood and urine for CMV culture were obtained from 207 patients with newly diagnosed CMV retinitis who were enrolled in a randomized trial comparing foscarnet and ganciclovir. Culture-positive rates at baseline were 45% and 71% for blood and urine, respectively. Rates decreased 3- to 10-fold after initiation of either treatment. Mortality was related to both positive baseline blood and urine cultures; adjusted relative risks were 1.97 and 2.03, respectively. Positive blood cultures at baseline were associated with more rapid retinitis progression. Drug-resistant CMV was found, over comparable follow-up periods on assigned treatment, in 4 of 8 ganciclovir-assigned patients with persistent viremia and 0 of 5 foscarnet-assigned patients with persistent viremia. Results of virologic assays of blood appear to be associated with clinical outcome of CMV retinitis.

AIDS-Related Opportunistic Infections↗
PubMed2004

Traditional beliefs about the cause of AIDS and AIDS-related stigma in South Africa.

AIDS-related stigmas are pervasive in some segments of South African society and stigmas can impede efforts to promote voluntary counselling and testing and other HIV-AIDS prevention efforts. The current study examined associations among the belief that AIDS is caused by spirits and supernatural forces, AIDS-related knowledge and AIDS-related stigmas. A street intercept survey with 487 men and women living in a Black township in Cape Town, South Africa showed that 11% (n=54) believed that AIDS is caused by spirits and supernatural forces, 21% (n=105) were unsure if AIDS is caused by spirits and the supernatural, and 68% (n=355) did not believe that AIDS is caused by spirits and supernatural forces. Multiple logistic regression analyses controlling for participant age, gender, years of education and survey venue showed that people who believed HIV-AIDS is caused by spirits and the supernatural demonstrated significantly more misinformation about AIDS and were significantly more likely to endorse repulsion and social sanction stigmatizing beliefs against people living with HIV-AIDS. However, nearly all associations between beliefs that AIDS is caused by spirits and AIDS stigmas were non-significant when logistic regressions were repeated with AIDS-related knowledge included as a control variable. This finding suggests that relationships between traditional beliefs about the cause of HIV-AIDS and AIDS stigmas are mediated by AIDS-related knowledge. AIDS education efforts are urgently needed to reach people who hold traditional beliefs about AIDS to remedy AIDS stigmas.

Adult↗
PubMed1998

Investigation of the profile of hearing aid performance in experienced hearing aid users.

OBJECTIVE: A shortened version of the 66-item Profile of Hearing Aid Performance (PHAP), consisting of the 24 items from the Abbreviated Profile of Hearing Aid Benefit, was evaluated as an alternative to the full PHAP questionnaire as a measure of hearing aid performance. Objectives were to: 1) statistically determine factors underlying Abbreviated PHAP (APHAP) scores; 2) recommend modifications to the questionnaire, if indicated by the factor analysis; 3) compare scores for the PHAP and APHAP; and 4) determine the suitability of the abbreviated questionnaire for New Zealand hearing aid users. The relationship between hearing aid performance and subjective variables and other measures of hearing aid success also was investigated. DESIGN: PHAP data, hearing aid satisfaction ratings, and reported daily hearing aid use were obtained from experienced adult hearing aid users. Factor analysis was carried out for the 24 APHAP items, and two items were excluded because of low factor loadings. After this modification, APHAP and PHAP scores were compared. Pearson's correlation values were determined for PHAP and APHAP data and degree of hearing loss, hearing aid satisfaction, and hours of hearing aid use. RESULTS: APHAP hearing aid performance was better described as three factors rather than four subscales. PHAP and APHAP results were consistent with previous studies and showed that hearing aid performance was best for easy listening situations and poorest for noisy and/or reverberant conditions. Similar trends were seen for PHAP and APHAP data. APHAP scores were correlated with hours of hearing aid use and overall hearing aid satisfaction. CONCLUSIONS: A shortened, 22-item APHAP is a preferred alternative to the full PHAP, producing data representing several dimensions of hearing aid performance. Modified APHAP scores can be used together with overall satisfaction and estimates of daily hearing aid use to measure success with hearing aids.

Adult↗
PubMedDate not supplied

The ratio of AIDS to non-AIDS Medicaid medical costs from 1992 to 2000.

Our research objective was to calculate and forecast the monthly increase in medical and prescription costs for Medicaid patients with acquired immunodeficiency syndrome (AIDS) and compare these values with costs for non-AIDS patients. A retrospective analysis of AIDS patients and a control group of Georgia Medicaid beneficiaries was conducted between January 1, 1988, and December 31, 1991. AIDS patients were defined using the Keyes algorithm of combinations of International Classification of Diseases, 9th Revision, Clinical Modification codes. The AIDS patient group was matched demographically to a group of non-AIDS patients. Data were adjusted to account for eligibility status, and the ratio of AIDS costs to non-AIDS costs was modeled with an econometric time series procedure. A total of 1966 AIDS patients were identified from 900,000 Medicaid recipients in the study period; 58.0% were male and 59.8% were black. Age was bimodal at < or = 1 year and 33 years. The best fit for the medical cost ratios produced a significant regression coefficient of .37. The initial ratio of AIDS to non-AIDS forecast was 4.25 in January 1992. The January 2000 forecast of this ratio increased to 42.56. This increase equates to an additional $8510.19 per AIDS patient-month for January 2000 in 1991 dollars. The outpatient prescription ratio for AIDS versus non-AIDS patients was not predictable. However, the greatest observed discrepancies were attributed to the expense for antihemophilia products. Overall, the most important finding was the accelerating medical costs for treating AIDS patients compared with costs for treating non-AIDS patients. These results may, in part, reflect additional costs for treating intravenous drug users and pediatric AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Hearing aid use in nursing homes. Part 2: Barriers to effective utilization of hearing AIDS.

OBJECTIVE: This study examined barriers to hearing aid use among persons who were reported to have a hearing aid and among those reported to have hearing difficulties but no hearing aids. SETTING: Interviews were conducted at a large, mid-Atlantic nonprofit nursing home. PARTICIPANTS: Both nursing home residents (279) and nursing staff members (51) were interviewed. DESIGN AND MEASUREMENTS: In a cross-sectional survey of nursing home residents, brief structured interviews were performed by trained research assistants with both residents and caregivers to obtain information regarding residents' hearing ability, hearing aid use and daily maintenance, and potential barriers to such use. RESULTS: Among residents reported to have hearing problems but who did not use a hearing aid, the major problem was neglect of the issue; participants did not know why residents did not have a hearing aid, residents had not had hearing evaluations, and staff members were not aware of hearing problems in residents. Among residents who did use a hearing aid, the majority (69%) of those for whom information was available had problems with the devices. The most common problems reported were that the device was hard or inconvenient to use, it did not fit well or hurt, and the device was not functioning well. The vast majority (86%) needed help taking care of the hearing aids. Close to half of the staff members had not received any training in the use or maintenance of the devices. Lack of delegation of responsibility for the management of hearing was identified for 29%, and relatives were used for maintenance of hearing aids in 14% of residents with hearing aids. CONCLUSIONS: Barriers to hearing aid use are therefore complex and multifactorial, involving lack of system commitment to utilization of hearing aids, lack of knowledge by staff members, inappropriate delegation and care procedures, hearing aid design and fit issues, and difficulties for residents in handling the hearing aids. Addressing these issues requires change on multiple levels, including change at the institutional level, concerning policy and training; change at the unit level, regarding care procedures and follow up; change at the individual level, providing better checks of fit and function of the hearing aids; and finally, change at the societal level, addressing design and cost issues for hearing aids in this population.

Activities of Daily Living↗
PubMed1985

Immunopathology of AIDS (acquired immune deficiency syndrome) observations in 75 patients with pre-AIDS and AIDS.

Sequential changes in the morphology of immunocompetent and other organs, in the accompanying immunocytological and immunovirological measurements are described in 75 patients with lymphadenopathy syndrome and with AIDS. The data presented demonstrate a stepwise development of the disease from a hyperimmunization syndrome to T-cell immune deficiency. Excessive antigenic stimulation by a large number of infectious organisms or by transfusion of blood and blood products account for antigenic overloading and hyperimmunization. Among such infectious organisms are certain viruses which per se interfere with cells of the immune system as for instance Epstein-Barr virus, cytomegalovirus, and HTLV3. Developing immunological incompetence will favor the persistence of these and other infectious organisms enhancing the damage of the immune reactivity and finally allow lethal infections or malignant tumors to occur.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Tuberculosis and AIDS. Statement on AIDS and tuberculosis. Geneva, March 1989. Global Programme on AIDS and Tuberculosis Programme, World Health Organization, in collaboration with the International Union Against Tuberculosis and Lung Disease.

In a number of developing countries, particularly in Sub-Saharan Africa, infection with both M. tuberculosis and human immunodeficiency virus (HIV) is highly prevalent. HIV infection results in an impairment of the immune system and entails a substantial risk of TB in those individuals who are or become infected with the tubercle bacillus. Because persons with both infections have an increased risk of developing clinical TB and further transmitting M. tuberculosis infection, some of these countries are facing, or will have to face, a rapid upsurge of the TB problem. The interaction between HIV and M. tuberculosis infection poses a serious health problem which will result in a major increase in disease, death and health care service needs in many countries. Immediate action at the global, national and local levels is needed to address this problem. In their national plans of action, national AIDS and TB control programmes should include coordinated activities to reduce the impact of the problem and international organizations and donor countries should be encouraged to support them technically and financially. Control of this TB epidemic linked with HIV infection will depend largely on the availability of prompt diagnosis and adequate treatment for TB, and possibly of effective chemoprophylaxis, not just for HIV-infected persons but for other groups as well. To deal with this problem, a number of issues need to be studied urgently. In addition, a number of immediate steps can be taken by control programmes.

Acquired Immunodeficiency Syndrome↗
PubMed1996

The soluble form of the IL-6 receptor (sIL-6R alpha) is a potent growth factor for AIDS-associated Kaposi's sarcoma (KS) cells; the soluble form of gp130 is antagonistic for sIL-6R alpha-induced AIDS-KS cell growth.

Kaposi's sarcoma (KS) is most frequently associated with HIV-infected individuals (AIDS-KS). While AIDS-KS-derived spindle cells (AIDS-KS cells) contribute to the development of KS lesions, growth regulation of these cells in vivo is poorly understood. AIDS-KS cells express considerable amounts of the signal transducing subunit (gp130) of the IL-6 receptor, but only a scanty amount of its binding subunit (IL-6R alpha). This phenotype can account for the lack of IL-6 responsiveness of AIDS-KS cells. We now report that the soluble form of IL-6R alpha (sIL-6R alpha), lacking transmembrane and cytoplasmic regions, functions as a potent growth factor for AIDS-KS cells by making these cells responsive to IL-6. After exposure to sIL-6R alpha together with IL-6 in culture, AIDS-KS cells assumed a spindle-shaped morphology and showed a remarkable augmentation of growth, while IL-6 alone did not induce AIDS-KS cell growth. Even without the addition of IL-6, sIL-6R alpha induced significant growth levels of AIDS-KS cells. Since AIDS-KS cells express high levels of IL-6, it is likely that, in the presence of sIL-6R alpha, these cells acquire an IL-6 autocrine growth loop. Anti-gp130 antibodies blocked the action of sIL-6R alpha on AIDS-KS cells; hence, we refer to sIL-6R alpha as a gp130-related AIDS-KS cell growth factor. In contrast, the soluble form of gp130 (sgp130) had inhibitory effects on AIDS-KS cell growth, thereby suggesting that a complex regulatory system is involved in the modulation of the gp130-mediated AIDS-KS cell growth. In recent years, soluble forms of IL-6R alpha and gp130 have been detected in the sera of healthy individuals and increased levels of sIL-6R alpha as well as IL-6 have been noted in the sera of HIV-infected patients. It seems reasonable to assume that perturbed production of sIL-6R alpha and sgp130 may play a crucial role in the development and regression of AIDS-KS lesions by directly acting on growth of KS cells through the gp130-mediated pathway.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Risk of cancer in children with AIDS. AIDS-Cancer Match Registry Study Group.

CONTEXT: Population-based data on cancers associated with acquired immunodeficiency syndrome (AIDS) in children are lacking. OBJECTIVE: To determine risk of pediatric AIDS-associated cancers. DESIGN, SETTING, AND PARTICIPANTS: Using records from 11 locations in the United States for varying periods between 1978 and 1996, we linked data for children aged 14 years and younger at AIDS diagnosis to local cancer registry data. MAIN OUTCOME MEASURES: Cancer frequency and, in the 2-year post-AIDS onset period, cancer incidence and relative risk (RR; measured as standardized incidence ratio), by cancer type. RESULTS: Among 4954 children with AIDS, 124 (2.5%) were identified as having cancer before, at, or after AIDS onset, including 100 cases of non-Hodgkin lymphoma (NHL), 8 of Kaposi sarcoma (KS), 4 of leiomyosarcoma, and 2 of Hodgkin disease; there were 10 other or unspecified cancers. Expected numbers for all cancers identified in the study sample, based on population rates (using area-specific registry data), were less than 1. In the first 2 years after AIDS diagnosis (5485 person-years), NHL incidence was 510 per 100,000 person-years (RR, 651; 95% confidence interval [CI], 432-941). Median time for developing NHL after AIDS diagnosis was 14 months (range, 3-107 months). The most common type of NHL was Burkitt lymphoma. However, the risk of primary brain lymphoma (91 per 100,000 person-years) was especially high (RR, 7143; 95% CI, 2321-16,692), and 4 cases were diagnosed more than 2 years (range, 37-98 months) after AIDS onset. Leiomyosarcomas also tended to occur several years after AIDS onset, with 3 of the 4 cases occurring 33 to 76 months after AIDS diagnosis, whereas KS was reported only at or within 2 years of AIDS diagnosis. Hodgkin disease risk was also significantly increased (RR, 62; 95% CI, 2-342). CONCLUSIONS: The spectrum of AIDS-associated pediatric cancers resembled that seen in adults, with the addition of leiomyosarcoma. Both primary brain lymphomas and leiomyosarcomas tended to occur in children surviving several years after AIDS onset. Because the expected numbers of these cancers in this population were less than 1 and because of the small numbers of some types of observed cancers, the RR estimates are imprecise and caution is warranted in their interpretation. JAMA. 2000;284:205-209

Acquired Immunodeficiency Syndrome↗
PubMed1996

Epidemiology of AIDS dementia complex in Europe. AIDS in Europe Study Group.

The aim of the study was to describe the epidemiology of AIDS dementia complex (ADC) in Europe and to assess the possible role of zidovudine therapy in preventing or delaying its occurrence. We used an inception cohort, with data collected retrospectively from patients' clinical records from 52 clinical centers in 17 countries across Europe. The subjects were 6,548 adult people with AIDS consecutively diagnosed from 1979 to 1989. The main outcome measures were codiagnosis of ADC at the time of AIDS diagnosis and ADC-free time after AIDS diagnosis. ADC was reported in 295 patients (4.5%) at the time of AIDS diagnosis and during follow-up in a further 402 of the 5,160 patients (7.8%) who were diagnosed with AIDS based on diseases other than ADC. Whether at the time of AIDS diagnosis or later, the occurrence of ADC was significantly associated with age, transmission category, and CD4+ cell counts. The risk was greater in older patients (14 and 19% greater, at AIDS diagnosis and after, respectively, for a 5-year difference in age), in i.v. drug users than in homosexual and bisexual men (89 and 60% greater, at AIDS diagnosis and after, respectively), and for people with lower CD4+ cell counts (14 and 30% greater for a reduction of 1 on the natural log scale). Risk was almost double for women than for men. A significant reduction, of approximately 40%, was found in the risk of developing ADC after AIDS diagnosis for patients receiving zidovudine therapy, but this effect was present only during the first 18 months of treatment, irrespective of whether treatment began before or after AIDS diagnosis. In conclusion, an increase in the risk of developing ADC either at the time of AIDS diagnosis or thereafter is associated with increasing age, i.v. drug use, and decreased CD4+ cell count. Women tend to have a higher risk of ADC at the time of AIDS diagnosis. Zidovudine therapy appears to have a definite, but time-limited, effect of protecting patients against ADC development after AIDS diagnosis.

AIDS Dementia Complex↗
PubMed1995

Cognitive performance after progression to AIDS: a longitudinal study from the Multicenter AIDS Cohort Study.

OBJECTIVE: To describe changes in cognitive functioning before and after development of an acquired immune deficiency syndrome (AIDS)-defining illness or CD4+ lymphocyte count < 200/mm3 in participants in the Multicenter AIDS Cohort Study. METHODS: The study population included participants who either were diagnosed with an AIDS-defining illness (n = 52) or had at least one measurement of CD4+ count < 200/mm3 (n = 57) and who had at least four neuropsychological (NP) evaluations, two or more before and two or more after the AIDS diagnosis. A group of subjects with clinical diagnosis of dementia (n = 29) was also included for comparison. The NP test battery included measures of attention, memory, constructional abilities, and psychomotor speed. Longitudinal data analysis, using the generalized estimating equation, was performed separately for each NP measure. Time was measured in months from the date of clinical AIDS or CD4+ < 200/mm3. RESULTS: Before AIDS< the dementia group showed significant decline (slope different from zero) only on measures of psychomotor speed. For all other measures, there was no evidence of decline in performance before AIDS for the other groups. After development of AIDS, the group with clinical AIDS showed significant decline on psychomotor speed but none on the other cognitive measures. The group with CD4+ < 200/mm3 did not show significant decline on any of the cognitive measures after AIDS. As expected, the dementia group showed significant decline on all measures. Sensory neuropathy was associated with a significant decline in performance on measures of psychomotor speed after AIDS. Antiretroviral therapy was not associated with any measurable changes in NP performance. CONCLUSION: These results are consistent with previous findings showing no significant decline in cognitive functions before AIDS, unless overt dementia is present, and no decline in immunosuppressed subjects who have had no AIDS-defining illness. By contrast, in subjects who have developed clinical AIDS, there is mild decline in fine motor skills but no significant change in other cognitive domains.

AIDS Dementia Complex↗
PubMed1987

Speech discrimination with an 8-channel compression hearing aid and conventional aids in background of speech-band noise.

The design for a multichannel compression hearing aid was developed from previous experimental and theoretical work in our laboratory concerning pitch perception in normal-hearing subjects. The new hearing aid, implemented with off-line digital signal processing, was tested on twenty subjects with sensorineural hearing loss using speech sounds in a background of speech-spectrum noise. Five signal-to-noise ratios (+15 to -5dB) were used at two noise levels (60 and 70 dB SPL). Hearing-loss subjects listened to these stimuli under three different conditions: a) processed by the new multichannel compression hearing aid; b) processed by a conventional hearing aid; and c) unprocessed. The performance of normal-hearing subjects with the unprocessed stimuli provided another condition against which the performance in the two hearing aid conditions could be evaluated. Both aided conditions provided improved performance over the unprocessed condition and the multichannel compression aid produced better performance than the conventional aid. In the case of 4 of the 20 subjects, with less severe gradually sloping hearing losses, the new multichannel compression aid produced near-normal performance even at low signal-to-noise ratios. Some aspects of the results also suggested that learning to use the aid was more important in the case of the multichannel compression aid than in the case of the conventional aid. These results indicate that a multichannel compression hearing aid can be very effective in some individuals with sensorineural hearing loss and is superior to a conventional hearing aid in most subjects.

Acoustics↗