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PubMed2001

Incidence of acquired immune deficiency syndrome (AIDS)-related disorders at laparotomy in patients with AIDS.

BACKGROUND: Patients with acquired immune deficiency syndrome (AIDS) present for surgical management of abdominal conditions that are complications of advanced human immunodeficiency virus (HIV) infection or that are caused by other disease not related to AIDS. This study compared the clinical details and postoperative outcomes of patients with AIDS-related diseases found at laparotomy with those of patients with non-AIDS-related disorders. METHODS: The medical records of 30 consecutive patients with AIDS who underwent laparotomy were examined retrospectively. RESULTS: Fourteen patients had AIDS-related pathologies found at laparotomy, 13 had disease processes that were not AIDS related and three had no abnormal findings at laparotomy. Patients with AIDS-related conditions at laparotomy had lower mean body-weight, serum albumin concentration and CD4 lymphocyte count, and required a longer hospital admission than those who had non-AIDS-related disease. The duration of HIV infection and the number of complications and deaths were similar in the two groups. Complications occurred in 21 patients and there were five deaths (30-day mortality rate 17 per cent). CONCLUSION: AIDS-related pathologies are commonly found at laparotomy in patients with HIV/AIDS. An AIDS-related diagnosis does not confer a greater risk of complication or postoperative death than other conditions.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Exposure to HIV/AIDS information, AIDS knowledge, perceived risk and attitudes toward people with AIDS among primary school-children in northern Tanzania.

An AIDS survey based on WHO's KABP survey instrument for adolescents was implemented with sixth and seventh grade students attending one of 18 randomly selected primary schools in the Arusha and Kilimanjaro regions of Northern Tanzania (n = 2,026). While students reported having been exposed to several sources of AIDS information, overall knowledge level was low, particularly with respect to risk associated with causal contact, and the fact that a person can be infected and show no signs of the disease. Students who reported frequent exposure to AIDS information or who frequently talked to others about AIDS, were more knowledgeable regarding AIDS than students who reported less frequent exposure to AIDS information or communication. Furthermore, students with high scores on AIDS knowledge were more likely to report AIDS as a very severe disease. Also, they perceived themselves as less susceptible to AIDS, and were more likely to have a positive attitude toward spending time with and taking care of people with AIDS than did less knowledgeable students. It is recommended that primary schools be utilized as an arena for AIDS education in Tanzania.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Interleukin 6 and AIDS-associated Kaposi's sarcoma: a nested case control study within the Multicenter AIDS Cohort Study.

Since the beginning of the AIDS epidemic, there has been considerable research on the etiology of Kaposi's sarcoma (KS) among HIV-infected individuals. A number of studies have confirmed that HIV or HIV-encoded products can interact with human cells to induce the production of cytokines, including interleukin 6 (IL-6). In vitro observations have indicated that AIDS-KS cells can produce significant levels of IL-6 and also respond to this cytokine. Preliminary data suggested that IL-6 may be elevated among HIV-infected individuals that subsequently develop AIDS-KS. The objective of this study was to determine if elevated levels of IL-6 are associated with an increased incidence of AIDS-KS compared to other AIDS-defining illnesses such as opportunistic infections (OIs). Serum IL-6 levels were determined by ELISA in frozen sera collected from participants in the Multicenter AIDS Cohort Study (MACS) at 6 months prior to AIDS diagnosis, in 73 cases (AIDS-KS), and 152 controls (OI). Elevated IL-6 levels were more prevalent among men with AIDS-OI than those with AIDS-KS: crude odds ratio (OR), 0.4 (95% CI, 0.2-0.9). Models of multivariate logistic regression were used to study potential confounders. Sexual behavior variables did not seem to confound the association between IL-6 and AIDS-KS. The higher prevalence of IL-6 among controls could be explained by the association of higher levels of IL-6 with lower levels of CD4 T cell number. IL-6 may be a marker of severe immune dysfunction among HIV-infected individuals.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Laboratory technologists' attitudes towards AIDS and AIDS patients.

The purpose of this study was to examine the attitudes of laboratory staff towards AIDS and AIDS patients and related factors. The population consisted of the working-age laboratory technologists living in Finland (n = 5,973). A sample of 249 laboratory technologists was selected from the register of the National Research and Development Centre for Welfare and Health using systematic random selection. The material was collected with a questionnaire. The younger laboratory technologists had more knowledge about AIDS than the older ones, and those who had more knowledge about AIDS had a more positive attitude than those with less knowledge. The attitudes were connected with the way the disease was contracted: the most positive attitudes were expressed towards the patients who had contracted AIDS through blood transfusion and the most negative towards the patients who had contracted AIDS from non-sterile needles. The factor analysis yielded six factors representing attitudes. The fear factor explained most (19%) of the laboratory technologists' attitudes towards AIDS and AIDS patients. The older laboratory technologists were more afraid of work-related infections than the younger ones. The laboratory technologists with adequate knowledge of AIDS were less afraid of contracting the virus than those with little knowledge. They wanted information mainly on the care of AIDS patients, on how to respond to them and on the ways AIDS is transmitted.

Acquired Immunodeficiency Syndrome↗
PubMed2000

[Effects of the introduction of highly active antiretroviral therapy (HAART) on the temporal trend of diagnosis of AIDS and AIDS-defining disorders]

Objectives: to assess the features of AIDS and AIDS-defining events during the highly active antiretroviral therapy (HAART) era, compared with those observed before the introduction of HAART. Methods: the epidemiological, clinical and laboratory characteristics of 72 consecutive patients with AIDS diagnosed from 1997 to 1999, were compared to those of 144 subjects randomly selected from 436 AIDS patients diagnosed from 1985 and 1995, in a case control study. Results: a sharp drop in AIDS notifications was observed after the introduction of HAART, in association with an increase in mean patient age, and heterosexual transmission of HIV infection. A tendency to reduced frequency of Cytomegalovirus disease, cryptococcosis, mycobacteriosis, cryptosporidiosis and HIV encephalopathy was also noticed, with a slight proportion increase in pneumocystosis, esophageal candidiasis, wasting syndrome, tuberculosis and lymphoma. Non-infectious complications showed a slighly increased frequency during the HAART era, while a mild parallel decrease in overall opportunistic infections was observed. A considerable trend to an increased mean CD4+ lymphocyte count at diagnosis was found during the HAART era for most AIDS-related illnesses (significant for Candida esophagitis, wasting syndrome and tuberculosis) (p<.04). Only seven of the 72 patients with AIDS recognized since 1997 received HAART prior to diagnosis, while the remaining 65 cases HIV infection was detected concurrently with an AIDS-defining event (40 cases), or HAART was refused or carried out with poor adherence (25 patients) Conclusions: although remarkable changes of AIDS features of AIDS occurred after the widespread use of HAART, early diagnosis and treatment of HIV infection, and careful monitoring of the spectrum of AIDS-related diseases are strongly warranted in order to update and plan future management strategies.

Journal Article↗
PubMed1985

Antigen-specific primary cytotoxic T lymphocyte (CTL) responses in acquired immune deficiency syndrome (AIDS) and AIDS-related complexes (ARC).

Alloantigen specific primary cytotoxic T lymphocyte (CTL) responses were examined in vitro in 10 patients with AIDS and nine with AIDS-related complex (ARC). The lymphocytes from patients with AIDS and ARC expressed significantly less (P less than 0.01) CTL activity (mean +/- s.d.; 4.7 +/- 9% and 10 +/- 11% respectively) when compared with CTL activity in normal healthy heterosexual controls (28 +/- 9.5%). When data were analysed for individual patients, lymphocytes from nine of 10 patients with AIDS and six of nine with ARC had deficient or no CTL activity. In vitro addition of purified human interleukin-2 (IL-2) during the generation of CTL resulted in significant enhancement (P less than 0.05) of CTL activity in ARC group (mean +/- s.d.; 27 +/- 18) but not in AIDS group (mean +/- s.d.; 8 +/- 8%). The presence of IL-2 augmented the induction of CTL activity in three of nine patients in AIDS group and in five of six in ARC group. In vitro addition of lectin-free supernatant (SN) obtained from cultures stimulated with PHA as well as with lymphoid cell restored the CTL functions in three of six AIDS patients and in one patient with ARC who did not respond to exogenous IL-2. The CTL activity developed in the presence of SN was higher than that manifested in the presence of IL-2 in both AIDS (SN versus IL-2; mean +/- s.d., 18 +/- 15.6% versus 8 +/- 8%) and in the ARC group (SN versus IL-2; mean +/- s.d., 35 +/- 13.9% versus 27 +/- 18.3%). Lymphocytes from three AIDS patients, however, failed to develop any CTL activity in the presence of either IL-2 or SN. These results demonstrate that: (i) the lymphocytes from majority of patients with AIDS and with ARC have deficient ability to develop into alloantigen specific primary CTL effectors, and (ii) the defective CTL functions are restored by the addition of purified IL-2 or SN in all patients with ARC and only in a subset of patients with AIDS, suggesting heterogeneity of pre-CTL to respond to IL-2 and some differentiation factor in order to differentiate in CTL effectors.

Acquired Immunodeficiency Syndrome↗
PubMed1986

The Vancouver Lymphadenopathy-AIDS Study: 5. Antecedent behavioural, clinical and laboratory findings in patients with AIDS and HIV-seropositive controls.

In a group of homosexual men in Vancouver studied prospectively since November 1982, 26 cases of acquired immune deficiency syndrome (AIDS) have arisen. To identify behavioural, clinical and laboratory findings that might predict the development of AIDS in people with antibody to human immunodeficiency virus (HIV), we compared data for 25 patients with AIDS with corresponding data for 80 controls serologically positive for HIV selected from the cohort. The clinical and laboratory data for the patients with AIDS preceded the diagnosis of the syndrome by a mean of 17.5 months. The controls had been both seropositive and AIDS-free for a mean of 16.7 months after acquisition of their data. We detected significant differences between the patients with AIDS and the controls in IgG and IgA levels, absolute number of helper T cells and ratio of helper to suppressor T cells but not in lifetime number of male sexual partners, frequency of receptive anal intercourse or receptive fisting, illicit drug use or history of infectious disease. We also detected an increased risk of AIDS among those who had an elevated number of sexual contacts in AIDS-endemic areas in the 5 years before enrollment. A history of increased early sexual contact in AIDS-endemic areas is likely to be associated with early infection and with an increased risk of AIDS among men with HIV infection of unknown duration. Thus, although our analysis had limited statistical power, we conclude that most lifestyle variables appear to act as exposure factors in HIV infection but not as cofactors in the development of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Weight loss prior to clinical AIDS as a predictor of survival. Multicenter AIDS Cohort Study Investigators.

In this analysis the aim was to determine the independent effect of moderate to severe weight loss prior to an AIDS diagnosis on survival after AIDS. The study was conducted as part of the Multicenter AIDS Cohort Study (MACS), a longitudinal study of HIV-1-seropositive gay or bisexual men. Measured weight and self-reported weight loss data were collected semiannually from 1984 through 1993. The study population included 962 HIV-1-seropositive men who developed clinical AIDS during the follow-up period. Median survival after AIDS was significantly lower for men with measured weight loss of > or = 4.5 kg 3-9 months and 3-15 months prior to AIDS, or who had lost > 10% of their baseline body weight compared with men with less weight loss or weight gain. Men with self-reported unintentional weight loss of > or = 4.5 kg 3-9 months prior to AIDS had significantly poorer survival (median = 1.05 years vs. 1.48 years; p = 0.0001) compared with men not reporting weight loss. After adjusting for potential confounding factors, men in the high measured weight loss group 3-9 months prior to AIDS still had significantly poorer survival [relative hazard (RH) = 1.36; p = 0.02]. Similar trends were seen for the two longer intervals prior to AIDS (RH = 1.38, p = 0.01; and RH = 1.50, p = 0.02, respectively). Men who self-reported weight loss > or = 4.5 kg 3-9 months prior to AIDS also had significantly poorer survival after AIDS (RH = 1.43; p = 0.002) in multivariate analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1993

An in-service education program as a means to improve nurses' knowledge and attitude about AIDS and to increase their willingness to care for AIDS patients.

This study evaluates changes in nurses' knowledge and attitudes about AIDS and changes in their willingness to care for AIDS patients following a 2 hour educational program. The nursing staff of Kaohsiung Medical College Hospital was divided into two groups: an experimental group (n = 280) and a control group (n = 119). Scores were obtained from a pre-test and from a post-test. The questionnaire that was given to both groups. The results were analyzed by 2-way ANOVA with repeated measures. The experimental group's overall pre-test score on their knowledge of AIDS was 25.9 +/- 4.5 (66.4% of the maximal score of 39) and the post-test score showed an improvement to 28.7 +/- 4.2 (73.6% of the maximal score). The difference between the pre-test and post-test scores of the experimental group was statistically significant (P < 0.01). The difference in the post-test scores between the experimental group and the control group (26.0 +/- 4.0) was also statistically significant (P < 0.01). Pertaining to attitudes towards AIDS, the experimental group had a pre-test score of 47.2 +/- 5.2 and a post-test score of 47.3 +/- 5.5, and there was neither a significant difference between the pre-test score and the post-test score of the experimental group nor in the post-test scores between the experimental group and the control group (47.6 +/- 4.3). The post-test score of willingness to care for AIDS patients was slightly higher than the pre-test score in both groups, but the difference was not significant. Nurses who originally were willing to care for AIDS patients had a more positive attitude toward AIDS than did nurses who had originally refused to care for AIDS patients in the pre-test and post-test (p < 0.01). In conclusion, the in-service education apparently enhanced the knowledge of AIDS, however, no statistical difference was established for changes in nurses' attitudes or in their willingness to care for AIDS patients. In order to provide better nursing care, we believe, AIDS knowledge needs to be further promoted.

Acquired Immunodeficiency Syndrome↗
PubMed1996

[Guidelines for the facilitation of wholeness in patients with AIDS: the experience of patients with AIDS: I].

AIDS will be remembered as the illness that was discovered in the 1980s of which the effects of this epidemic were only realised in the 1990s. Statistics show that the number of patients with AIDS increase annually because of the number of patients now diagnosed as HIV infected. Statistics indicate that AIDS has a much wider impact on the community than only homosexuals and drug-dependent people. Much attention is paid currently to the prevention of AIDS, but the problem is vested in the third phase of the HIV infection, namely AIDS. Nurses will be more and more exposed to the patient with AIDS and she can make a valuable contribution to facilitating the quest to wholeness of the patient with AIDS. This research was aimed at exploring and describing the experiences of the patient with AIDS and to lay down guidelines for the nurse and the psychiatric nurse specialist as consultant to facilitate the quest for wholeness of the patient with AIDS. A exploratory, descriptive contextual study was done with the aim of achieving insight into the experiences of the patient with AIDS, by way of a specific convenience test sample, five patients who complied with the set criteria were included in the research. The application possibilities of this research are generally set out as regards practice, research and teaching, and also as specific guidelines for the nurse treating the patient with AIDS. By following the guidelines set out in this research, the nurse can facilitate the patient's quest for wholeness.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Efficacy of zidovudine treatment in homosexual men with AIDS-related complex: factors influencing development of AIDS, survival and drug intolerance. Australian Zidovudine Study Group.

OBJECTIVES: To investigate (1) the efficacy and safety of zidovudine treatment in homo-/bisexual men with AIDS-related complex (ARC) and (2) factors associated with development of intolerance to zidovudine. DESIGN: A multicentre open-label study. SETTING: Australian public hospital system. SUBJECTS: A total of 235 homo-/bisexual men with ARC were enrolled. INTERVENTIONS: All subjects received 1200 mg zidovudine daily. MAIN OUTCOME MEASURES: Survival, incidence and time to development of AIDS and to development of haematological and clinical side-effects. RESULTS: Median time to development of AIDS was 61 weeks, significantly longer (P < 0.03) than the median of 22 weeks in a small control group of 12 untreated ARC subjects. Median survival from development of AIDS was 48 weeks, marginally longer than the 44 weeks in untreated historical AIDS controls. Anaemia requiring transfusion occurred in 113 subjects (48%). Significant differences in time to development of AIDS were found in favour of subjects not requiring transfusions (P < 0.001) with no weight loss (P = 0.004), and who received the full zidovudine dose (1200 mg) during the first 52 weeks of treatment (P = 0.021). Significantly longer median survival times from commencement of zidovudine were found in subjects with a baseline Karnofsky score > or = 90, baseline Hb > or = 13 g/dl, baseline CD4+ cell count > or = 50 x 10(6)/l, no weight loss during first year of treatment, and no or not more than one blood transfusion during treatment. The ability to tolerate full-dose zidovudine was best predicted by a baseline Hb > or = 13 g/dl. Zidovudine-intolerant subjects (defined as the development of either anaemia requiring transfusions, WCC 1000 x 10(6)/l or zidovudine-related myopathy) had a significantly shorter time to development of AIDS than zidovudine-tolerant subjects (P = 0.002). CONCLUSIONS: Zidovudine may benefit people with ARC by significantly postponing the development of AIDS. This benefit appears to be greater in those who do not develop clinical intolerance whilst receiving zidovudine. However, administration of zidovudine to subjects with ARC does not appear to contribute to improved survival after the development of AIDS. People with ARC who develop AIDS while receiving zidovudine, or who develop intolerance to zidovudine, should be considered immediately eligible for other antiretroviral therapies.

AIDS-Related Complex↗
PubMed1996

AIDS-associated non-Hodgkin's lymphomas as primary and secondary AIDS diagnoses in hemophiliacs. Hemophilia Malignancy Study Group.

We studied the characteristics and temporal trends of AIDS- associated non-Hodgkin's lymphoma (AIDS-NHL) in individuals with hemophilia. Prospective data were collected on 33 HIV-positive hemophiliacs with AIDS-NHL enrolled in the Hemophilia Malignancy Study (HMS), of whom 21 had primary and 12 had secondary or subsequent AIDS-defining illnesses, and analyzed for frequency and temporal trends. As compared with primary AIDS- NHL, secondary AIDS-NHL occurred at an older mean age, 37 versus 29 years (p = 0.12); at a lower mean CD4 count, 46 versus 154 (p = 0.07); after a longer period of immunosuppression (CD4 < 200/microl), 41 versus 16 months (p = 0.03); and with shorter median survival, 2 versus 7 months (p = 0.09). The presence of EBV in tumor tissue was associated with shorter survival, 1 versus 7 months (p = 0.17). Between 1981 and 1988 and 1989 and 1994, the proportion of primary AIDS diagnoses that were AIDS-NHL changed minimally, 4.6 versus 6.1%, whereas there were significant decreases in Pneumocystis carinii pneumonia (PCP, p = 0.02) and wasting (p = 0.07), and an increase in Candida (p = 0.004). These findings confirm that an increasing proportion of AIDS-NHL in hemophiliacs are occurring as secondary or later AIDS diagnoses, and they are associated with prolonged duration of immunosuppression.

AIDS-Related Opportunistic Infections↗
PubMed2000

Efficacy of 3 commonly used hearing aid circuits: A crossover trial. NIDCD/VA Hearing Aid Clinical Trial Group.

CONTEXT: Numerous studies have demonstrated that hearing aids provide significant benefit for a wide range of sensorineural hearing loss, but no carefully controlled, multicenter clinical trials comparing hearing aid efficacy have been conducted. OBJECTIVE: To compare the benefits provided to patients with sensorineural hearing loss by 3 commonly used hearing aid circuits. DESIGN: Double-blind, 3-period, 3-treatment crossover trial conducted from May 1996 to February 1998. SETTING: Eight audiology laboratories at Department of Veterans Affairs medical centers across the United States. PATIENTS: A sample of 360 patients with bilateral sensorineural hearing loss (mean age, 67.2 years; 57% male; 78.6% white). INTERVENTION: Patients were randomly assigned to 1 of 6 sequences of linear peak clipper (PC), compression limiter (CL), and wide dynamic range compressor (WDRC) hearing aid circuits. All patients wore each of the 3 hearing aids, which were installed in identical casements, for 3 months. MAIN OUTCOME MEASURES: Results of tests of speech recognition, sound quality, and subjective hearing aid benefit, administered at baseline and after each 3-month intervention with and without a hearing aid. At the end of the experiment, patients ranked the 3 hearing aid circuits. RESULTS: Each circuit markedly improved speech recognition, with greater improvement observed for soft and conversationally loud speech (all 52-dB and 62-dB conditions, P</=.001). All 3 circuits significantly reduced the frequency of problems encountered in verbal communication. Some test results suggested that CL and WDRC circuits provided a significantly better listening experience than PC circuits in word recognition (P =.002), loudness (P =.003), overall liking (P =.001), aversiveness of environmental sounds (P =.02), and distortion (P =.02). In the rank-order ratings, patients preferred the CL hearing aid circuits more frequently (41.6%) than the WDRC (29.8%) and the PC (28.6%) (P =.001 for CL vs both WDRC and PC). CONCLUSIONS: Each circuit provided significant benefit in quiet and noisy listening situations. The CL and WDRC circuits appeared to provide superior benefits compared with the PC, although the differences between them were much less than the differences between the aided vs unaided conditions. JAMA. 2000;284:1806-1813.

Adult↗
PubMed1987

Prevalence of cutaneous disease in patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex.

Ninety adult patients with acquired immunodeficiency syndrome (AIDS) and 27 with AIDS-related complex were seen consecutively, when available, either as inpatients or in AIDS clinics and given complete cutaneous examinations. Skin disease was common both in patients with AIDS and in those with AIDS-related complex. The most common cutaneous findings were candidiasis in 55 patients (47.0%), dermatophytosis in 35 (30%), herpes simplex infections in 26 (22%), molluscum contagiosum in 11 (9%), seborrheic dermatitis in 37 (32%), and acquired ichthyosis or xerosis in 36 (30%). Several cutaneous conditions previously reported in association with AIDS were infrequently seen: Psoriasis was seen in only one patient, and deep fungal infections and basal and squamous cell carcinomas were seen in none. No significant differences were noted in the prevalence of skin disease between patients with AIDS and those with AIDS-related complex, although xerosis and ichthyosiform skin changes tended to be more common in those with AIDS. The yellow nail syndrome and "a papular eruption" associated with AIDS were seen. Skin diseases also tended to be widespread and severe in the patients studied.

AIDS-Related Complex↗
PubMed2001

Hearing-aid outcome measured following one month of hearing aid use by the elderly.

This study reports the results of a large number of hearing-aid outcome measures obtained from 173 elderly hearing-aid wearers following one month of hearing-aid use. All participants in this study were fit binaurally with identical full-concha in-the-ear (ITE) hearing aids having linear Class-D amplifiers with output-limiting compression. Outcome measures included several measures of speech recognition, as well as several self-report measures of hearing-aid performance, benefit, satisfaction, and use. Comparison of mean data from this sample of hearing-aid wearers to other larger sets of data, obtained previously for several of these measures of hearing-aid outcome evaluated in isolation, indicated that the participants in this study were representative of the participants in other larger-scale studies. Subsequent principal-components factor analysis of the data from this study indicated that there were seven distinct dimensions of hearing-aid outcome. Attempts to document the effectiveness and efficacy of hearing aids for elderly persons with impaired hearing will be most complete when assessing performance along all seven dimensions of hearing-aid outcome. Clinically efficient procedures for doing so are discussed.

Aged↗
PubMed1997

Impact of the 1994 expanded World Health Organization AIDS case definition on AIDS surveillance in university hospitals and tuberculosis centers in Côte d'Ivoire.

OBJECTIVE: To assess the impact of the 1994 expanded World Health Organization (WHO) AIDS case definition on AIDS surveillance in Côte d'Ivoire. DESIGN: Prospective AIDS case surveillance. METHODS: From March 1994 through December 1996, passive AIDS case surveillance was conducted at the three university hospitals in Abidjan, and active AIDS case surveillance was conducted at the eight tuberculosis (TB) centers in Côte d'Ivoire. Standardized questionnaires were administered and blood samples for HIV serologic testing were collected from the patients evaluated. The numbers of persons who met the modified 1985 WHO clinical AIDS case definition (Bangui definition) and the 1994 expanded WHO AIDS case definition were determined, and the clinical characteristics of these patients were assessed. RESULTS: Of 8648 university hospital patients, 3658 (42.3%) met the clinical and/or the expanded case definition: 744 (20.3%) HIV-seropositive persons met only the expanded definition, 44 (1.2%) HIV-seropositive persons met only the clinical definition, 2334 (63.8%) HIV-seropositive persons met both definitions, and 536 (14.7%) HIV-seronegative persons met only the clinical definition. Of 18,661 TB center patients, 9664 (51.8%) met the clinical and/or the expanded definition: 5685 (58.8%) HIV-seropositive persons met only the expanded definition, none of the HIV-seropositive persons met only the clinical definition (by definition), 2625 (27.2%) HIV-seropositive persons met both definitions, and 1354 (14.0%) HIV-seronegative persons met only the clinical definition. CONCLUSIONS: Because of the inclusion of multiple severe HIV-related illnesses into the expanded definition, the number of reportable AIDS cases in HIV-seropositive patients increased 31.3% in the university hospitals, and 217% in the TB centers. The inclusion of HIV seropositivity as a criterion for the expanded definition also enhanced the specificity of AIDS case reporting, eliminating 536 cases in the university hospitals and 1354 cases in the TB centers in HIV-seronegative patients who had clinical signs of AIDS. The use of the 1994 expanded definition for surveillance purposes should be encouraged in areas of the developing world where HIV serologic testing is available.

AIDS-Related Opportunistic Infections↗
PubMed1988

New hearing aid users' perception of the "hearing aid effect".

The negative attitude elicited by the presence of a hearing aid has been termed the "hearing aid effect." The purpose of this study was to examine the negative reactions associated with hearing aids among new hearing aid users themselves and their perception of the hearing aid effect in their immediate environment. This was accomplished through a questionnaire completed just prior to hearing aid fitting and again 6 months after initial use of amplification. The responses to the questionnaires were compared between individuals who had chosen either in the ear or behind the ear type hearing aids, and between those using either monaural or binaural instruments. The effect of age on the data was also examined. The results indicated that the hearing aid effect was not expected or perceived very widely among these subjects, as only about 10% of them reported sensing negative attitudes to the use of hearing aids. Positive responses to the benefits of hearing aid use from other people often fell short of expectations.

Adult↗
PubMed1997

Estimating the number of AIDS-defining opportunistic illness diagnoses from data collected under the 1993 AIDS surveillance definition.

Expansion of the surveillance definition for AIDS in the United States in 1993 caused a substantial distortion in the trend in AIDS incidence, mainly because CD4-positive (CD4+) T-lymphocyte criteria were added to the definition. To evaluate trends in the rate at which HIV-infected persons develop the opportunistic illnesses listed in the AIDS surveillance definition (AIDS-OIs), we developed a procedure for estimating the incidence of these diseases. This estimate is based primarily on the probability distributions of the time from a CD4+ count in given ranges to the diagnosis of the first AIDS-OI. Our estimates of AIDS-OI incidence change by <4% during most calendar quarters during 1991 through 1995 if we also include the estimated effects of unreported AIDS-OIs among persons with AIDS reported based on the CD4+ criteria. Our procedure eliminates the transient effect of adding the CD4+ criteria to the AIDS surveillance definition and permits us to evaluate trends in the incidence of AIDS-OIs.

AIDS-Related Opportunistic Infections↗