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PubMed1992

Hepatitis C in obstetrics and gynecology.

Because of the risk of perinatal transmission and possible sexual transmission, it is important for obstetrician-gynecologists to keep abreast of the rapidly expanding literature on hepatitis C. Acute hepatitis C represents about 5% of all reported cases of hepatitis. Approximately 50% of acute infections progress to chronic liver disease. Risk factors for infection include intravenous (IV) drug use (21-42% of cases), previous blood transfusion (6-17%), and multiple sexual partners (6%); 40-50% of cases have no identified risk factors. The seroprevalence of anti-hepatitis C antibody is 70.8% in IV drug users, 11.6% in patients with human immunodeficiency virus, 8.8% in prostitutes, 1.2% in hospital personnel, and 0.5-1.4% in volunteer blood donors. The risk of transmission to the neonate depends on the trimester at exposure. No perinatal transmission has been shown after acute maternal infection in the second trimester. Based on the few reported cases, chronic maternal infection or acute infection in the third trimester may result in neonatal infection rates of 45-87.5%. Universal screening is probably not cost-effective because the prevalence is low and over 70% of screening tests can be falsely positive using the currently approved assay. Selective screening of high-risk patients is recommended.

Female↗
PubMed1992

HIV-1 infection in the correctional setting.

The correctional setting provides an opportunity to serve IV drug users who might otherwise be difficult to access. Interventions--including education, counseling, treatment for HIV-1 infection, and treatment for drug abuse--conducted in the correctional setting could have benefits for individual inmates and the surrounding community.

HIV Infections↗
PubMedDate not supplied

Prevalence of Hepatitis B and C in the normal population and high risk groups in north Kerala.

BACKGROUND: Our aim is to assess the prevalence of Hepatitis B and Hepatitis C infections among normal healthy persons and high risk groups in the northern part of Kerala state in South India as there is insufficient published literature related to this subject. METHODS: HBsAg and AntiHCV screening were done in normal persons and in high risk groups. Normal persons screened included voluntary blood donors, those attending mandatory medical check up for jobs in middle east Asia and pregnant women. High risk groups were health care workers, intravenous drug abusers, commercial sex workers and male homosexuals. RESULTS: HBsAg and anti HCV antibody test results in the various groups were as follows. Voluntary blood donors--HBsAg was positive in 0.71 % and anti HCV was positive in 0.33%; job seekers to middle east Asia had 0.89% and 0.12% prevalence of HBV and HCV respectively. Among the pregnant women, 0.21% were HBsAg positive. Among the high risk groups, none of the health care workers were HbsAg positive and 0.79% were antiHCV positive. Among the IV drug abusers 2.7% were HBsAg positive and 51.89% were positive for antiHCV. In commercial sex workers, 3.47 % were HBsAg positive and 2.6 % were antiHCV positive. In male homosexuals, 4.49% were HBsAg positive and 3.37% were antiHCV positive. CONCLUSIONS: The prevalence of Hepatitis B and C in the normal population of Calicut in the northern part of Kerela is 0.52% and 0.24%. Compared to other areas of India, the seroprevalence of Hepatitis B and C are low in the normal population of Calicut. Among the high-risk groups, IV drug users have a high prevalence of AntiHCV.

Adult↗
PubMed1991

Cost-effectiveness of drug abuse treatment for primary prevention of acquired immunodeficiency syndrome: epidemiologic considerations.

The prevention of AIDS has justified recent increases in drug abuse treatment expenditures. Three of the epidemiologic considerations involved in assessing the cost-effectiveness of drug treatment for primary prevention of AIDS among IV drug users were discussed. First, the considerable geographic variation in the prevalence of the virus that causes AIDS suggests that areas with relatively low infection levels may be more cost-effective targets when allocating limited drug abuse treatment resources. Expansions and modifications in the current national HIV-1 serologic surveillance system will be needed to make informed resource allocation decisions. Second, when comparing the cost-effectiveness of two alternative treatment modalities or programs, the number of new HIV-1 infections does not appear to be an appropriate outcome measure. Serologic testing should be supplemented with self-reported drug use behaviors, with or without drug testing. Finally, significant opportunity costs may be associated with employing drug abuse treatment as the principal approach to primary prevention of HIV-1 infection among IVDUs, when alternative and complementary approaches are also effective. Specifically, treatment expansion is unlikely to be cost-effective when the demand for publicly funded treatment slots exceeds the number available and in communities where only a small minority of IVDUs are enrolled in treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Population characteristics of tuberculosis in an HIV/AIDS registry from an East Harlem Hospital.

The recent increase of tuberculosis nationally and in New York City has been attributed in part to the progression of the acquired immunodeficiency syndrome (AIDS)/human immunodeficiency syndrome (HIV) epidemic. The East Harlem/South Bronx/Bushwick sections of New York City have an especially high incidence of tuberculosis. An HIV/AIDS registry (1986-1990) consisting of 1,312 patients from a community hospital serving East Harlem was examined for population characteristics associated with documented tuberculosis in the registrants. Tuberculosis affected males more commonly than females and was observed in comparable frequency in patients with AIDS-related complex (ARC) (12.9%) and AIDS (15.0%). The proportion of cases in blacks (18.3%) was significantly greater than that in Hispanics (10.4%, chi 2 = 15.196, p = 0.0003) or whites (8.7%, chi 2 = 5.62, p = 0.0171). Among intravenous (IV) drug users, the proportion of tuberculosis cases was also significantly higher in blacks than in Hispanics. These data could be consistent with a difference in exposure to tuberculosis and/or the purported racial susceptibility of blacks to tuberculosis infection. A review of new tuberculosis cases in East Harlem also suggests that blacks are at a greater risk for developing tuberculosis than Hispanics.

AIDS-Related Complex↗
PubMed1991

Development of AIDS education and prevention materials for women by health department staff and community focus groups.

The New York City Department of Health (NYCDOH) has developed a comprehensive, empowering, and educational booklet for women in response to (1) the rapid increase in AIDS among women; (2) the lack of woman-specific, current, language-appropriate literature; and (3) the need to address the multitude of direct and indirect effects of the HIV/AIDS epidemic on women. Drafts of the booklet were developed during a 12-week series of consensus-driven meetings attended by a core group of women from various professional and personal backgrounds. Following NYCDOH approval, community focus groups reviewed the booklet to ensure that it met the needs of targeted women, community HIV/AIDS educators and other health and social service providers. This paper describes the issues encountered when designing materials for women of diverse cultures and roles (e.g., pregnant women, IV drug users, lesbians), as well as the dynamics of the development process and its benefits and difficulties. Criteria and guidelines for this development process are outlined.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Transmission of multidrug-resistant tuberculosis from an HIV-positive client in a residential substance-abuse treatment facility--Michigan.

In November 1989, a man with a history of intravenous (IV)-drug use first presented to the tuberculosis (TB) clinic of the Muskegon County (Michigan) Health Department (MCHD). The patient indicated that he had been treated for pulmonary TB in another city, and he produced for clinic staff his labeled medications, which included isoniazid (INH), rifampin (RIF), and ethambutol (EMB). The patient also stated that he was an IV-drug user (IVDU) and previously had tested positive for human immunodeficiency virus (HIV) infection. Sputum specimens for acid-fast bacilli (AFB) were obtained, and the patient was maintained on his anti-TB medications. His HIV-antibody status was confirmed.

Antitubercular Agents↗
PubMed1991

AIDS-related knowledge and behaviors among teenagers--Italy, 1990.

As of December 31, 1990, the number of acquired immunodeficiency syndrome (AIDS) cases in Italy exceeded 8000. Although 67% of AIDS cases in Italy occurred among intravenous (IV)-drug users, the role of transmission through heterosexual contact with human immunodeficiency virus (HIV)-infected persons has increased, accounting for 7% of cases in 1990, compared with 2% in 1985. As part of an AIDS epidemiology course in Frascati for regional AIDS epidemiologists (approximately 20 km [13 miles] south of Rome) in November 1990, course participants surveyed AIDS-related knowledge and behaviors among students attending the five high schools in the local school district. This report summarizes findings of the survey, which aimed to characterize AIDS-related knowledge and behaviors of this population.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Drug use and sexual behavior of indigent African American men.

A total of 108 African American men in a free lunch program with histories of drug abuse were surveyed to determine the relationships among drug use, sexual activity, AIDS prevention practices, and perceived risk of AIDS. Of the 108, 69.5 percent were homeless and only 12 percent were currently receiving drug abuse treatment. More than half of the participants had injected drugs, and 38 percent had shared needles. Among the 80 percent who were sexually active, 40 percent reported using condoms every time they had sex. Respondents in monogamous relationships tended to use condoms less frequently. Those who shared needles were more likely to have sex with IV drug users and had more sexual partners. Respondents who used crack used condoms less frequently. Those with multiple partners were more likely to engage in anal intercourse. Three-quarters perceived themselves at risk of AIDS.

AIDS Serodiagnosis↗
PubMed1991

[HIV infection and tuberculosis--result of a survey].

At the fall of 1989 a questionnaire was sent to 19 institutions particularly involved with AIDS. 17 (89 percent) responded at all, 11 (and one more additionally) delivered qualified data. Overall 8,518 persons with proved HIV infection of different stages were treated from 1987 to 1989 in institutions distributed over the whole Federal Republic and Westberlin. 94 of the HIV infected suffered from tuberculosis. The risk of tuberculosis was approximately equally high for males and females. It was elevated by the factor 7 to 11 in the early stages of the HIV infection (CDC-classification). The factor was 157 in stage IVB-E (AIDS). The risk was higher for male homo- or bisexuals compared with iv drug users. The rate of tuberculosis did not significantly increase from 1987 to 1989. There were much more cases with multiple sites or of extrapulmonary localisations, especially of peripheral lymph nodes in males and an unusual high percentage of bacteriological confirmation of cases with respiratory tuberculosis with an uncommonly low rate of positive sputum smears. Up to now epidemiology of tuberculosis in the Federal Republic will not be in general markedly influenced inspite of the high risk of HIV infected.

Cross-Sectional Studies↗
PubMed1990

Surveillance for AIDS and HIV infection among black and Hispanic children and women of childbearing age, 1981-1989.

Surveillance systems indicate that the most documented human immunodeficiency virus (HIV) infections and acquired immunodeficiency syndrome (AIDS) cases among children and women of childbearing age in the United States occur among black and Hispanic populations. Intravenous-drug use (IVDU) is the presumptive origin of HIV infection for most of these cases, through direct IVDU, sexual contact with an intravenous (IV)-drug user, or birth to women with either mode of exposure. These data confirm the need for HIV-prevention programs directed to the racial, ethnic, age, and reproductive concerns of black and Hispanic women of childbearing age and their children. Services should be available for those who are HIV infected, as well as for those who are not infected with HIV, to prevent the further spread of HIV. Services for prevention and treatment of drug abuse are an integral part of HIV prevention and treatment for these groups.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

A study of the deficiencies in the condom-use skills of gay men.

The use of condoms has been advocated as an important method of reducing the risk of AIDS for such people as gay men, prostitutes, IV drug users, adolescents, hemophiliacs, and others who may become infected with the human immunodeficiency virus (HIV) that causes AIDS. Although AIDS risk-reduction programs have provided information on condoms, none has assessed baseline or followup skills in their use. Because most condom failures have been attributed to errors in use, promoters of condom use should determine whether they are used correctly among those persons targeted for education. A total of 219 gay men entering an AIDS risk-reduction program were asked to demonstrate the use of condoms on a model. All errors made during the demonstration were corrected, and participants were trained during the exercise in the proper use of condoms. More than 80 percent required correction in such things as opening the package, determining the outside of the condom, unrolling the condom to the base of the penis, and expressing air from the space at the tip of the penis. Although proper use of condoms may seem obvious, this small study demonstrates that it must be taught. Since instructions found in condom packaging frequently are not easily understood by potential users, explicit instructions for condom use are needed.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Chemical dependency and black America: the government responds.

Alcohol and other drug abuse is public enemy number one in America's inner-city communities. Youngsters are joining gangs that specialize in dealing drugs, the number of addicts dying from overdoses continues to increase, IV-drug users are spreading AIDS, and homicide and other types of violence are at an all time high. Blacks are disproportionately affected by these social ills. The federal government is waging a war on drugs, and many agencies are involved. Each department has minority initiatives that address chemical dependency among Blacks. In particular, one federal agency is directing considerable resources to prevention, intervention, and treatment programs for high-risk youth and high-risk families. Overall, the federal government is placing increased emphasis on user responsibility and the involvement of young people in anti-drug programs. The newly passed Omnibus Drug Bill provides increased resources for the war on drugs and broadens the scope of many programs.

Adolescent↗
PubMed1989

A bridge to treatment: the needle exchange pilot program in New York City.

The needle exchange pilot program in New York City is one element in a spectrum of drug prevention and treatment modalities under way to slow the spread of the human immunodeficiency virus. The program's aim is to help us learn about the addict behaviors that spread the AIDS virus, including whether needle exchange can help reduce the frequency or eliminate those behaviors. Thus far, its primary value for clients lies in drug counseling and referral to treatment. Where an active IV drug user has taken the first step in changing the direction of his or her life by seeking treatment, needle exchange has been a significant means of helping keep that change in focus. Because of its value in helping change, and save, the lives of intravenous drug users and their sex partners and children, it should be expanded, and should be considered for adaption by other communities according to their needs as one relatively small element in a comprehensive AIDS prevention program.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Heterosexual transmission of AIDS].

Heterosexual bidirectional transmission of HIV is now clearly proved. In Western countries, and in particular in Belgium, the existence of clusters of heterosexual transmission demonstrates that, as in Central Africa, the epidemic could spread among heterosexuals. Sexual contacts with partners who belong to different high risk groups for HIV may introduce the virus in the general population. This is mainly true with bisexual men, IV drug users or people originating from endemic areas. Prostitutes are also at high risk to be infected and to transmit HIV. Prevention campaigns toward heterosexuals should begin at a pre-epidemic stage and focus on counselling of infected individuals, voluntary testing of contacts of these subjects and selected screening programmes.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Delta viral hepatitis. Histopathology and course.

Delta viral hepatitis is important to recognize on hepatic tissue as its presence may explain severe or fulminant acute viral hepatitis, "relapse" of acute viral hepatitis, fulminant acute viral hepatitis in a chronic hepatitis B carrier, exacerbation of previously silent chronic active hepatitis, and the change in course of persistent viral hepatitis to progressive chronic active hepatitis. Histologic clues to support delta infection are primarily the severity of hepatocellular necrosis and inflammatory response. Specific immunologic procedures are required for diagnosis and include serum testing (antigen, antibody for IgG and IgM types) and antigen detection in tissue by immunofluorescence or immunoperoxidase staining. This agent is currently important as a cause of hepatitis in IV drug users, male homosexual patients, and recipients of blood products. Further studies are needed with careful accurate classification of hepatitis B patients in order to recognize the pattern of spread, severity, and outcome of delta hepatitis in other populations.

Carcinoma, Hepatocellular↗
PubMedDate not supplied

Continuing outbreak of hepatitis A linked with intravenous drug abuse in Multnomah County.

A communitywide outbreak of hepatitis A occurred in Portland, OR, from 1983 through 1986. At the peak of the outbreak, the age- and sex-specific annual incidence rate approached 400 cases per 100,000 population among men ages 25 to 34, the highest risk group. The community incidence rate was nearly 10 times the relevant national incidence rate. A review of the records concerning cases of hepatitis A reported in the last 6 months of 1985 revealed that about half the number of young adults whose cases were investigated during that time reported a history of intravenous (IV) drug use--a proportion about 50 times greater than expected among persons in that age range. A simultaneous epidemic of overdose deaths from heroin and a concomitant increase in hepatitis B incidence rates led to the suspicion that this was a drug-abuse-associated epidemic of hepatitis among new IV drug users. Control of this outbreak was difficult because the population most at risk was distrustful of public health officials. Increased surveillance in food service establishments and schools might have prevented outbreaks from a common source in the general population; however, an increase of sporadic cases in the nondrug-using population clearly occurred.

Adolescent↗
PubMed1985

[Immunologic laboratory tests in acquired immunodeficiency syndrome (AIDS) and suspected AIDS].

Since AIDS-specific laboratory tests are not yet commercially available, laboratory diagnoses of AIDS or of the AIDS-related complex (ARC) are based on "surrogate markers". While single tests are of limited diagnostic value, test combinations are of greater help. However, these tests should be applied restrictively and stepwise. The following parameters were analyzed in respect of their diagnostic and differential-diagnostic value: absolute number of lymphocytes, delayed type hypersensitivity skin tests to seven recall antigens, beta-2-microglobulin, serum-neopterin, C-reactive protein, complement factor B, circulating immune complexes, immunoglobulins, hepatitis B markers, and the ratio of T helper to T suppressor cells. 14 AIDS patients, 11 ARC patients, 23 healthy homosexuals, 6 iv drug users, 6 hemophiliacs and 35 patients with various other disorders were investigated. To analyse the value of a given test or of test combinations in the diagnosis of AIDS and ARC, a discrimination index was introduced and defined as the difference between the percentage of pathological values in one patient group compared to the percentage of pathological values in the other group. A discrimination index of 100 means that a given test is pathologic in all members of one group and negative in all members of the other group. A discrimination index of 60 may mean 80% of pathological values in one group versus 20% in the other. To distinguish AIDS patients from ARC patients the test combination yielding the highest mean discrimination index included serum neopterin, complement factor B and C-reactive protein.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗