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PubMed1987

Acquired immune deficiency syndrome (AIDS) and neoplasia.

The acquired immune deficiency syndrome (AIDS) is a novel epidemic form of immunodeficiency that has been widely recognized within the last six years. AIDS is characterized by Kaposi's sarcoma, B cell lymphoma, and/or life-threatening opportunistic infections superimposed on an immune deficiency state which consists of lymphopenia with a selective depletion of the CD4 T cells. In addition, lymphocytes from AIDS patients show decreased responses to antigen or mitogen stimulation in vitro. Although the secondary infections and malignancies seen in these patients may be successfully treated, the underlying immune defect persists, leaving the patient susceptible to further complications.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Neural networks morbidity and mortality modeling during loss of HIV T-cell homeostasis.

Despite the proven clinical benefits of HAART, mortality may still occur; particularly in those with less than 50 CD4+ cells/mL and, in some cases, with a viral burden below detectable plasma levels of HIV-1 RNA. Multiple factors may predict mortality including initial response to therapy, viral factors and host immune parameters. Due to the complexity of this problem, we developed Artificial Intelligence based tools/Neural Network (NN) to optimally evaluate outcomes of therapy and predict morbidity and mortality. To further validate the accuracy of these tools, we challenged their performance with that of Cox regression modeling (RM). Our study population involved 116 HIV+ individuals who consistently maintained CD4+ count < 50 cells/mL for over 6 months. All patients were treated with antiretrovirals. To assess clinical outcomes, we developed a feedforward back-propagation Neural Network. We then compared the performance of this network to a Cox regression model. The Neural Network outscored the Cox regression model in the ROC curve areas: 0.888 vs 0.760 (HIV+ first Seropositivity to AIDS), 0.901 vs 0.758 (HIV+ first Seropositivity to Last Assessment incl. death) and 0.832 vs 0.799 (AIDS to Last Assessment incl. death), for the NN & Cox, respectively. In patients with a history of AIDS defining events and with severe T-Cell depletion, mortality occurs despite therapy. Although Neural Networks and Cox modeling were successful in predicting mortality, the Neural Network was superior in assessing risk in this population.

Biomarkers↗
PubMed2000

[AIDS and HIV infection in 1998].

Last years number of notified and registered AIDS cases was quite stable. Some increasing of HIV infections number was observed. Quality of collected epidemiological data will depend--among other things--on: easy access to HIV testing, completeness of data and diagnosis of AIDS indicator diseases by definitive methods.

Acquired Immunodeficiency Syndrome↗
PubMed1988

[The peripheral nervous system and HIV infection. 13 cases].

Disorders of the peripheral nervous system occur at all stages of HIV infection. From 13 patients referred for a peripheral neuropathy, 9 were known to be HIV seropositive and 4 were found to be seropositive. All were Caucasian males aged 27 to 58. Ten were homosexual, 2 were drug-addicts. Patients fell into several groups: the first group was made of 5 patients, 4 asymptomatic and 1 AIDS-related-complex (ARC), with an inflammatory demyelinating polyneuropathy, acute in 1 case and subacute in 4; the CSF showed pleiocytosis in all cases. Motor conduction nerve velocities were markedly reduced and motor distal latencies prolonged. Three patients recovered spontaneously, 1 responded to corticosteroids, 1 to plasmapheresis. In the second group, 4 patients, 1 asymptomatic and 3 ARC, had a distal symmetrical polyneuropathy; CSF was normal in 2 cases. Electrophysiological studies and nerve biopsies indicated a mixed axonal-demyelinating polyneuropathy. Three patients recovered spontaneously, 1 is unchanged. Among both groups, an infiltration of mononuclear cells was found on nerve biopsies in 4 cases. The third group was made of 3 patients with AIDS who presented with a painful sensory polyneuropathy involving the distal lower limbs. Electrophysiological and pathological study of the nerve indicated axonal degeneration. No cell infiltration was found. The last patient with AIDS had a progressive meningoradiculopathy. These 4 patients died within 6 months after the onset of the neuropathy. These findings are close to those previously reported, and confirm the wide spectrum of disorders of the peripheral nervous system associated to HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

United Nations system efforts to support the response to AIDS in China.

In the last two years, we have seen a remarkable intensification in the response to AIDS in China. A number of organizations have joined and contributed to the efforts of the Chinese government in responding the AIDS epidemic in China. This article specifically describes the role of the United Nations (UN) in supporting and strengthening those responses. Achievements of the United Nations highlighted in the article include: strengthened leadership and political commitment to respond to AIDS; improved HIV/AIDS surveillance and information; expanded prevention efforts; improved treatment, care and support to people living with HIV and increased resources for AIDS programs. Additional roles of the United Nations system in the near future include strengthening national leadership by supporting the 'three ones', i.e., one national plan on AIDS; one national coordinating authority for AIDS; and one monitoring and evaluation system for AIDS. In addition, the UN system is expected to strengthen alignment and harmonization of activities of all international organizations and improved accountability and oversight. Remaining challenges identified include increasing awareness of AIDS and reducing stigma and discrimination; reducing vulnerability and risk behaviour among specific groups; providing improved treatment, care and support for people living with HIV; promoting stronger engagement by civil society, and; addressing the gender dimensions of AIDS.

China↗
PubMed1992

Delayed hypersensitivity skin tests in prognosis of human immunodeficiency virus infection.

Delayed hypersensitivity skin tests (DHST) with recall antigens were investigated as prognostic markers in five different approaches. In the first study, 42 acquired immunodeficiency syndrome (AIDS) patients (IVb, IVcl, IVd, and IVe; MMWR 35:334-339, 1986) 26 AIDS-related complex (ARC) patients (IVa and IVc2), and 98 asymptomatic patients (II and III) were evaluated with candidin, tricophytin, PPD and streptokinase-streptodornase. In the second study, 10 patients (II and III) were evaluated sequentially with the same antigens. In the third, 45 patients with at least two positive skin tests ("reactors") were followed for one year and evaluated every 6 months with the same antigens. In the fourth, 16 "reactors" were followed and evaluated every 3 months with the same antigens. We measured the interval from the time at which patients first presented with only one or no positive DHST until the development of ARC or AIDS. In the last study, the correlation between absolute number of CD4+ lymphocytes and the number of DHST was studied in 151 patients. We found that the decrease in reactiveness to DHST correlated directly with the progression to AIDS, demonstrating the usefulness of this simple procedure as a valid prognostic marker.

AIDS-Related Complex↗
PubMed2003

[Why viral (SARS, Ebola and AIDS) epidemics now?].

In the last three decades we have seen several viral (and bacterial; i.e. TB) epidemics which took place at an era where we would have expected the eradication of many infectious diseases. There are many hypotheses to explain this paradox; 1) Is it the hygiene theory, namely extensive use of wide spread and too potent antibiotics which eliminate protective infecting agent? And hence the beneficial effect of probiotics? Is it the widespread use of vaccine? Is it a mistake or a terror acts of leakage of viral mutant from research or other laboratories? Be it as it may, the globalization and the employment of long distance flights make the spread easy to extreme points in the globe (Shanghai-Toronto). The new epidemiology? Immunology fields will have to deal with these novel aspects to combat and to prevent more events.

AIDS Vaccines↗
PubMed2003

Stem-cell transplantation for autoimmune diseases.

The use of intensive immunosuppressive treatment coupled with BM stem-cell transplantation (SCT) to treat human autoimmune diseases (AID) follows anecdotal observations of responses of AID to allogeneic SCT and an extensive background of experience with SCT in animals with AID. In the last decade, numerous clinical trials have been initiated to explore a potential benefit of (mainly autologous) SCT in advanced and debilitating cases of rheumatoid arthritis, scleroderma, systemic lupus erythematosis and multiple sclerosis. In this review the etiology of AID and the experimental basis of SCT is presented, together with recent clinical results of SCT for AID. While much has been learned about the risks and benefits of SCT in AID, the underlying mechanisms regulating remission and relapse of AID after treatment remain largely unknown.

Autoimmune Diseases↗
PubMed1990

Additional evidence for lack of transmission of HIV infection by close interpersonal (casual) contact.

To further study the possibility of transmission of HIV infection by close personal but non-sexual, non-parenteral contact we have continued to enroll and evaluate household contacts of adult patients with AIDS. Two hundred and six household contacts of 90 patients with AIDS were evaluated with detailed interviews, physical examinations, and detection of HIV antibodies and p24 antigen from 1984 to 1987; 118 of these contacts were re-evaluated 6-12 months after cessation of household contact or death of the patient. The median duration of household contact from 18 months prior to symptoms in the AIDS patients to last contact was 23 months (range 3-101 months). The median time elapsed from first contact during this period to the last evaluation was 38 months (range 13-66 months). No household contact had signs or symptoms suggesting HIV infection. All 206 were negative for serum antibodies to HIV and HIV p24 antigen, despite extensive sharing of household facilities and items and personal interactions with AIDS patients. This study continues to show that household members without other risks remain at minimal to no risk for HIV transmission (95% confidence interval, 0-1.44) despite prolonged and substantial close non-sexual contact with AIDS patients, and after re-evaluation at a median of 10.9 months after initial evaluation.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Planning, implementation, and evaluation of AIDS education programs for dentists.

Because many dentists were trained before HIV disease was recognized and its implications for dentistry understood, there is a need for effective continuing education programs about the disease for health professionals. Unfortunately, much of the continuing professional education about AIDS in the last few years has been poorly evaluated and the value of continuing education itself has increasingly been called into question. In order to clarify how continuing educational efforts can be designed and evaluated, we report on our continuing educational projects and research which culminated in research on a nationwide educational intervention about AIDS for dentists. We outline and evaluate the steps taken in designing both the intervention and the research. The strengths and weaknesses of the design are discussed and suggestions made about how the design could be improved.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Existence and failure of T-cell homeostasis prior to AIDS onset in HIV-infected injection drug users.

Prior studies, based on populations of homosexual men, have shown that during HIV infection, levels of total circulating T-cells (CD3+ lymphocytes) remain constant for long periods of time after seroconversion. This suggested homeostatic phenomenon was observed to break down about 18 months prior to AIDS diagnosis with a quick loss of T-cells. The objective of this study was to determine whether (a) total T-cells are maintained at a constant level for long periods of time among HIV-infected injection drug users (IDUs) and (b) total T-cells decline before AIDS onset in this risk group and, if so, by how long. The design and setting was prospective follow-up, with semiannual clinic visits, of 646 HIV-infected IDUs who participate in the ALIVE study (Baltimore, MD). Among AIDS cases, T-cell levels remained quite stable at about 1500 cells/microl up to approximately 24 months prior to AIDS. However, a steep decline in CD3+ cell levels began approximately 24 months prior to AIDS diagnosis and was -17.5% per 6 months in the last 18 months before AIDS. Among seropositive IDUs without AIDS, a gradual decline of less than -4% per 6 months was observed. These trends remained virtually unchanged after accounting for current injection drug use, smoking, and HIV-related medications. IDUs, like homosexual men, exhibited T-cell homeostasis following HIV infection, as well as failure of this homeostasis about 2 years before AIDS. Although the mechanisms for the maintenance and later failure of the homeostasis of T-lymphocytes are not well understood, the observation has a potentially important prognostic value as well as biological interest.

Acquired Immunodeficiency Syndrome↗
PubMed1977

Student health team project at the Wayside Chapel.

The student health teams were organized by the Australian Medical Students Association (AMSA) as the means of student involvement in community health projects. In July, 1976, at the Wayside Chapel several student health teams each consisting of a medical student, a nursing student, and a student social worker, began a friendly, non-judgemental "first aid" service for street people with health problems. The project lasted 12 weeks and aid was given to 76 people. An evaluation of the project appears below.

Attitude of Health Personnel↗
PubMed2000

CPI-1189 prevents apoptosis and reduces glial fibrillary acidic protein immunostaining in a TNF-alpha infusion model for AIDS dementia complex.

AIDS dementia complex (ADC) is characterized by increased apoptosis, gliosis, and oxidative stress in the CNS, as well as a compromised blood-brain barrier. TNF-alpha has been shown to be elevated in AIDS dementia complex brains and may contribute to AIDS dementia complex. To model elevated TNF-alpha in AIDS dementia complex, TNF-alpha was infused ICV bilaterally into rats for 3 days. TNF-alpha treatment increased apoptosis around the infusion site and selectively in the septum and corpus callosum. Co-administration of the synthetic antioxidant CPI-1189 prevented TNF-alpha induced apoptosis. Both TNF-alpha and CPI-1189 treatment suppressed glial fibrillary acidic protein (GFAP) staining at the infusion site. TNF-alpha did not significantly affect the integrity of the blood-brain barrier, but CPI-1189 treatment increased blood-brain barrier integrity at the infusion site. No effect of TNF-alpha or CPI-1189 treatment was found on measures of oxidative stress. These results support TNF-alpha as a key agent for increasing apoptosis in AIDS dementia complex. Additionally, CPI-1189 treatment may protect against TNF-alpha induced apoptosis and astrogliosis in AIDS dementia complex. Lastly, the toxic effect of TNF-alpha and the protective effect of CPI-1189 may not be mediated primarily through manipulation of classic reactive oxygen species.

AIDS Dementia Complex↗
PubMed1990

Audiological rehabilitation with cochlear implants and tactile aids.

Although a tremendous amount of information has been obtained about the benefits derived from implants and tactile aids during the last few years, many areas of research need to be addressed. Objective measures are needed to assess nerve survival in potential implant candidates, factors need to be identified that predict levels of implant performance, and extensive research needs to be conducted to identify methods to optimize fitting strategies with implants. To date, relatively few studies have examined the performance of clinical populations, especially profoundly hearing-impaired children, with sophisticated multichannel tactile aids. Further, it is not known what type of tactile transform provides the greatest improvements in performance. It appears as if learning effects extend over many years in pediatric users of implants and tactile aids, and it is crucial that longitudinal data be collected. Further, there is a need to document gains in speech perception and speech production skills when both hearing aids and tactile aids are used by profoundly hearing-impaired children who demonstrate residual hearing. As technology improves and new sensory aids become available, the need for continued research expands. Even in these early stages of investigation, both cochlear implants and tactile aids have proven effective in the rehabilitation of children and adults who are profoundly deaf.

Adult↗
PubMed1992

Self-efficacy, hedonistic expectancies, and condom-use intentions among inner-city black adolescent women: a social cognitive approach to AIDS risk behavior.

The effects on condom-use intentions of an acquired immune deficiency syndrome (AIDS) prevention intervention based on social cognitive theory were investigated among 19 sexually active black adolescent women recruited from an inner-city family planning clinic. The women received the social cognitive intervention designed to increase perceived self-efficacy and favorable outcome expectancies about the hedonistic consequences of using condoms or one of two control interventions: An information-alone intervention designed to increase AIDS knowledge or a general health-promotion intervention designed to provide information about important health problems other than AIDS. All interventions lasted 105 min and involved films and small-group exercises. Participants' evaluations did not differ among conditions. As hypothesized, analysis of covariance indicated that participants in the social cognitive condition reported greater intentions to use condoms than did those in the two control conditions. In addition, participants in the social cognitive condition scored higher in perceived self-efficacy and favorable hedonistic expectancies--the two hypothesized mediators of the intervention effect. Although participants who received the information-alone intervention subsequently had greater AIDS knowledge than did those in the health promotion condition, they did not express greater intentions to use condoms. These results highlight the value of a social cognitive approach to AIDS risk behavior: outcome expectancies regarding the effects of precautionary practices on sexual enjoyment and perceived self-efficacy to implement such practices play an important role in decisions about condom use.

Acquired Immunodeficiency Syndrome↗