[Fatal outcome of Strongyloides stercoralis infection in a patient with no previously known immunosuppression]. / Fatalt forløbende Strongyloides stercoralis-infektion hos patient uden forudgående kendt immunsuppression.

A case of fatal infection with Strongyloides stercoralis in a previously healthy young African with no known immunosuppression is reported. The patient suffered severe gastrointestinal bleeding and despite intensive treatment died of multiorgan failure. Postmortem, signs of ulcerating T-cell lymphoma were found in a jejunal specimen, and the patient was found to be infected with HTLV-1. Gastrointestinal bleeding in relation to infection with Strongyloides stercoralis is discussed as well as possible relations between the severity of infection, lymphoma and HTLV-1.

[Use of antiretroviral chemoprophylaxis after occupational HIV exposure]. / Anvendelse af antiretroviral kemoprofylakse efter erhvervsbetinget eksposition for HIV.

The study describes the use of postexposure antiretroviral prophylaxis (PEP) after occupational exposure to HIV in Denmark in the period 1/1 1997-31/12 1998. Forty-seven accidentally exposed persons received PEP in this period, of whom 14 were nurses, 13 physicians and 11 were not employed in the health care system. In 23 cases side effects to PEP were described. In 18 cases the index person was i.v. drug abuser and in 11 cases homosexual/bisexual men. In 18 cases the HIV status of the index person was unknown at the time of exposure. Ten of these index persons were subsequently tested and all found HIV-negative. It is concluded, that the frequency of occupational exposure to HIV is unacceptably high. Further it is emphasised that in cases where the HIV status of the index person is unknown, PEP should only be instituted if the index person is at risk of being HIV infected and has signs of HIV infection.

HIV-2 infection in Bissau, West Africa, 1987-1989: incidence, prevalences, and routes of transmission.

In a community study, the HIV-1 and HIV-2 antibody status of the inhabitants of 100 randomly chosen houses in Bissau, West Africa, were followed from 1987 to 1989. There was no HIV-1 infection alone, while the HIV-2 seroprevalence in adults was 8.9% (58 of 652) in 1987 and 10.1% (61 of 603) in 1989. HIV-2 seroprevalence in 15- to 39-year-olds was 6.1% in 1987 and 11.3% in newcomers in 1989 [the Mantel-Haentzel weighted relative risk (RRMH) = 1.86; 95% confidence interval (CI): 1.07-3.24]. Three hundred thirty adults who were HIV-2 seronegative in 1987 were reexamined in 1989; seven had seroconverted. Follow-up time was 700 person years, giving an incidence of HIV-2 infection of 1 per 100 person years. With a history of sexually transmitted disease (STD), the RR of seroconverting was 9.95 (2.31-42.80). Blood transfusions received since 1987 did not result in seroconversions. No case of vertical transmission of HIV-2 was seen. There was an excess mortality in those who were HIV-2 seropositive; however, it was statistically significant only for children (RR = 22.27; 95% CI: 6.92-71.70; p < 0.0001), not for adults (RR = 2.16; 95% CI: 0.81-5.76; p = 0.23), when considering death from disease only.

Risk factors for hepatitis B virus infection in heterosexuals attending a venereal disease clinic in Copenhagen.

Markers of hepatitis B virus (HBV) infection were measured in 465 non-drug-abusing heterosexually transmitted disease (STD) patients. HBV markers were found in altogether 70 persons, of whom 7 were HBsAg carriers. Those chronically infected were all born in HBV intermediate/high endemic areas. Gonorrhoea was the only STD that was correlated to an increased risk of HBV markers. Number of sexual partners, sex and age was not correlated with HBV infection, irrespective of country of origin. The risk of having HBV markers in an STD clientele in Copenhagen was highly dependent on the country of birth, as the prevalences were 7% (21/307) in persons born in Denmark, 19% (9/47) in those born in other low endemic areas and 36% (40/111) in those born in intermediate/high endemic areas. Falling incidence of gonorrhoea and other STD may render it difficult to point out risk factors indicative of HBV immunization in heterosexual STD patients. In low-risk countries, screening for HBV markers should however be offered to all immigrants and refugees as a part of an HBV immunization program.

Seroreactivity to human T cell leukemia/lymphoma virus type 1 and related retroviruses in multiple sclerosis patients from Denmark and the Faroes.

A total of 40 multiple sclerosis (MS) patients from Denmark and 10 from the Faroes were examined for antibodies with affinity to human T cell leukemia/lymphoma virus type 1 (HTLV-I) and human immunodeficiency virus type 1 and 2 (HIV-1 and HIV-2). Using ELISA, MS patients and a group of healthy controls did not differ significantly in their reactivities to HTLV-I. However, elevated reactivities were recorded with 5 MS sera, whereas only 2 of the sera from the controls produced highly values. Ten patients with other neurological diseases all seemed to exhibit low reactivity in HTLV-I ELISA. The reactivities of 2 MS sera decreased considerably by absorption with an HTLV-I lysate. In immunofluorescence assay, two other MS sera reacted with HTLV-I transformed cell lines as well as with non-infected cells. Examined by Western blotting (WB), a single MS serum produced a distinct HTLV-I p19 band. With ELISA for detection of HIV-1 and HIV-2 antibodies, 2 MS sera exhibited borderline reactions. Further examination of these two sera by WB revealed weak reactivities against p24 and p53 of HIV-1. One the whole, the present observations do not suggest that a putative MS retrovirus would be closely related with HTLV-I, HIV-1 or HIV-2.

HIV-2 infection in Denmark.

A collection of 3019 selected serum samples (ss), comprising 329 ss from intravenous drug abusers, 558 ss from homosexual men, 682 samples from persons attending a STD clinic, 100 ss from individuals of African origin, 300 ss from sexual contacts to Africans, 650 ss from Danish blood donors who resided in Africa greater than 2 years prior to donating the ss, and 400 ss with equivocal antibody reactions in an HIV-1 Western blot was tested for antibodies against HIV-2 by in-house HIV-2 ELISA and Western blot. Four ss were positive for antibodies against HIV-2. Three of the ss originated from West African men, the fourth belonged to the spouse of one of these men. Three of the samples presented with an uncharacteristic reaction in a HIV-1 Western blot. The study indicates that HIV-2 infection is not yet widespread in Denmark and that it remains closely related to West Africa.

PIP: Clinicians drew blood samples from 3019 people living in Denmark to determine whether HIV-2 had reached that country. The groups tested included drug users from Copenhagen, healthy HIV-1 positive and negative homosexual men from Copenhagen, patients at a clinic for sexually transmitted diseases (STDs), healthy Africans, Danes who had sexual intercourse with an African, Danish blood donors who went to Africa more than 2 years before they gave a blood sample, and people who had inconclusive HIV-1 Western Blot (WB) patterns. Laboratory personnel used an in-house HIV-1 ELISA and an in-house HIV-2 ELISA to test all samples and an in-house HIV-2 test. 4 (.13%) samples tested positive for HIV-2. 3 of the serum samples were from men from the Ivory Coast, Guinea Bissau and Senegal. The 4th sample belonged to the wife of one of these men. She was positive only for HIV-2 while the 3 men also tested positive for HIV-1. The serum of 2 of the 3 people who tested ELISA HIV-1 reactive had inconclusive HIV-1 WB patterns who tested ELISA HIV-1 reactive had inconclusive HIV-1 WB patterns which made the researchers suspect HIV-2 infection. The woman's serum reacted to the core and env proteins in both the HIV-1 Wb and HIV-2 WB, the HIV-1 ELISA was negative. RIPA and immunofluorescence tests confirmed HIV-2 infection. Her case demonstrates the need to do both HIV-1 and HIV-2 ELISA tests. None of the 650 blood donors who had been in Africa within the last 10 years tested positive for HIV-2. These findings indicated that HIV-2 was not prevalent in Denmark and was limited to West Africa. Health workers whose patients have ties with West Africa and have an inconclusive HIV-1 WB pattern should request testing for HIV-2. The researchers suggested that serological surveillance for HIV-2 should be done at regular intervals.

Lack of evidence of vertical transmission of human immunodeficiency virus type 2 in a sample of the general population in Bissau.

Twenty-nine human immunodeficiency virus type 2 (HIV-2) seropositive women identified in a cross-sectional study in Bissau in 1987 participated in a follow-up study in 1988, where each was matched for age and marital status with two HIV-2 seronegative women. Detailed information about all pregnancies was obtained. The HIV-2 seropositive women and their controls had similar mean numbers of pregnancies, live children, children who died, and abortions. The HIV-2 seropositive women did not have a greater risk of having had an abortion or a child who died than did the HIV-2 seronegative women. No difference in survival was seen between children born to HIV-2 seropositive and HIV-2 seronegative women. The H/S-ratios and CD4 numbers were lower in the seropositive group, but none had values lower than 0.4 and 0.4 x 10(9)/L, respectively. Seven prospectively observed children born to HIV-2 seropositive mothers showed no sign of infection. The lack of evidence of transmission of HIV-2 from mother to child is suggested to be due to the absence of marked immunodeficiency in this random sample of the general population.

[HIV infected women in Copenhagen. Risk factors and sex behavior]. / HIV-smittede kvinder i København. Risikofaktorer og seksualadfaerd.

A total of 115 women were found to be HIV-antibody positive during the period January 1985 to September 1988 in the three large hospitals in Copenhagen. Thirty-five women (31%) had been infected heterosexually, 63 (55%) were intravenous drug addicts, 12 (10%) had been infected by transfusion and in five (4%) the mode of transmission was unknown. In 1988, 73% of the women who were found to be HIV-positive were infected heterosexually while only 14% were infected in this manner in 1985. Out of the heterosexually HIV-infected women, 25 (71%) had probably been infected by a man from a risk group while nine further women were infected by a known HIV-positive man with-out connection to any risk group. Eleven women (31%) stated that they practised "safe sex" prior to the HIV test while 22 (74%) did so after the positive HIV-test, which represents a considerable improvement. Out of the drug addicted women, six (10%) stated that they had always practiced "safe sex" prior to the test while 13 (28%) did so after the HIV-test. Approximately 1/3 of these women periodically shared syringes and needles with others. It is concluded that heterosexual contact among HIV-infected women in Copenhagen is a route of transmission of significance. Women infected heterosexually appear to alter their sexual behavior when they are made aware of the positive HIV-test.

[HIV infection, syphilis and genital diseases in Maun, Botswana]. / HIV-infektion, syphilis og genitale laesioner i Maun, Botswana.

The prevalence of HIV-infection was studied in a district hospital in Botswana, in southern Africa. Sera from 466 patients were analysed. The sexually transmitted diseases (STD) group consisted of 175 women and 178 men, who consulted the STD-clinic for complaints which could be attributed to STD or infertility and the antenatal clinic (ANC) group consisted of 113 pregnant women, who attended routine ANC. Sera were analysed with HIV-ELISA, and 3% were positive. All sera were negative in Western blot and were considered false-positive in HIV-ELISA. In the STD group, 42% of the women and 39% of the men, were seropositive for syphilis, while 41% were positive in the ANC group. The figures for clinically demonstrated genital lesions were 33%, 60% and 13%, respectively. It is concluded that HIV-infection is a new disease in Botswana, and that the prevalence is still low in the rural population examined in the present survey.

Immunofluorescence assay for detection of antibodies to human immunodeficiency virus type 2.

A total of 215 serum samples were tested for antibodies against human immunodeficiency virus type 2 (HIV-2) with an immunofluorescence assay (IFA). Some samples originated from Denmark and some originated from Guinea-Bissau. The IFA results were compared with enzyme-linked immunosorbent assay (ELISA) and Western (immuno-) blot (WB) results. Twenty-nine serum samples were found to be true positive for HIV-2 antibodies as judged from WB and radioimmunoprecipitation results; all of these were also found to be positive in the HIV-2 IFA. Of 80 serum samples originating from HIV-1-infected persons, 60% showed reactivity in the HIV-2 ELISA, and 51% cross-reacted with at least one band in the HIV-2 WB. None of the sera cross-reacted in the HIV-2 IFA. A total of five serum samples (three African and two Danish) gave unspecific results in the HIV-2 IFA. It is concluded that the HIV-2 IFA is more specific and at least as sensitive as a first-generation ELISA and that IFA is superior to WB in discriminating between HIV-1 and HIV-2 infections.

Intestinal calcium absorption in man during lithium therapy.

Intestinal absorption of calcium was determined in 11 patients prior to and after 4 weeks of lithium therapy. In 6 patients the absorption decreased and in 5 patients the absorption increased. The urinary calcium excretion decreased in all patients during lithium therapy, representing a relative reduction of 55%. Serum calcium remained unchanged. These findings indicate a retention of calcium, which probably accumulates in the intracellular space.

Pitted erythrocytes in splenectomized subjects with congenital spherocytosis and in subjects splenectomized for other reasons.

Pitted erythrocytes counts are used in the quantitative assessment of functional hyposplenism and in the prediction of recurrence of splenic function in splenectomized subjects. Pitted erythrocyte counts were investigated in 16 patients splenectomized for hereditary spherocytosis, in 21 patients splenectomized for other reasons and in 23 healthy controls. In both groups of splenectomized patients the pitted erythrocyte counts were equally increased compared with the healthy controls.