[Less refusal to participate in HIV screening among pregnant women in the Amsterdam region since the introduction of standard HIV screening using the opting-out method]. / Minder weigering van deelname aan HIV-screening door zwangeren in Amsterdam sedert de invoering van de standaard-HIV-screening--tenzij weigering ('opting-out'-methode).

In 2003 the Municipal Health Service in Amsterdam started to screen pregnant women for HIV according to the opting-out method. In this method the HIV test is routinely included in the prenatal screening along with hepatitis B virus (HBV) and syphilis. If the woman does not want to be tested for HIV then she must actively opt out of this test. This screening method was chosen because in the universal screening method used in 2002, women had to give their explicit consent to test for HIV and this led to a high refusal rate (13.6%), especially among women from AIDS-endemic countries. After the introduction of the opting-out method, the refusal rate fell from 3% in the first quarter of 2003 to 1.4% in the last quarter of 2003. None of the women refused to be tested for HBV or syphilis. In 2003, the HIV prevalence among pregnant women was 0.3% (35/13.621). The experiences with this screening method in Amsterdam were used to implement the national opting-out method for HIV screening in pregnant women, which was introduced on 1 January 2004.

[HIV-screening among pregnant women in the region of Amsterdam in 2002]. / HIV-screening onder zwangere vrouwen in de regio Amsterdam in 2002.

In 2001, the Municipal Health Service started offering HIV tests to all pregnant women in and around Amsterdam. All midwives and all hospitals but one participated in this HIV screening. In 2002, of the 10,752 pregnant women offered HIV testing 13.6% refused. HIV antibodies were detected in 24 women (0.26%). The HIV prevalence was doubled compared to the prevalence in 1990-1991, but the number of newly HIV-infected pregnant women remained stable (0.1%). The high number of refusals, as a result of which many HIV-infected women might be missed, is alarming. For this reason, in January 2003, the Municipal Health Service started HIV testing by the opting-out approach. Under the opting-out approach, women are notified that an HIV test will be included in the standard test battery, together with tests for hepatitis B and syphilis, unless she explicitly refuses. It is expected that the opting-out approach for HIV screening of pregnant women will be implemented nationwide in 2003.

[Opportunistic screening for genital infections with Chlamydia trachomatis among the sexually active population of Amsterdam. Il Over 90% participation and almost 5% prevalence]. / Opportunistische screening op genitale infecties met Chlamydia trachomatis onder de seksueel actieve bevolking in Amsterdam. I. Meer dan 90% deelname en bijna 5% prevalentie.

OBJECTIVE: To determine in an opportunistic screening programme for Chlamydia trachomatis (CT) the participation and the CT prevalence among the heterosexual population. METHODS: Heterosexually active men and women, 15-40 years old, who consulted a general practitioner in Amsterdam, the Netherlands, in the period May 1996-April 1997, without symptoms of a sexually transmitted disease, were asked after informed consent had been given to provide a first-voided urine sample and a few sociodemographic data. The urine was investigated for CT by means of a ligase chain reaction. In case of a CT infection, the general practitioner was asked for information on treatment and partner notification. RESULTS: A total of 3689 persons were eligible for the study of whom 214 (5.8%) refused participation. Men refused more often than women (9.0% and 4.3% respectively). No relation was found with ethnic background or health care insurance (national health cost insurance/private medical insurance). Refusers were somewhat younger than participants (not statistically significant). CT was diagnosed in 4.9% (95% confidence interval (95% CI): 4.1-5.9) of the women and in 4.7% (95% CI: 3.6-6.1) of the men. In women a decreasing trend was seen in the prevalence of CT with an increase in age: from 13.4% in the group 15-19 years old to 2.3% in the group 35-40 years old. Independent of age a higher prevalence was found in Surinam Creole women. In 83% of the CT patients the general practitioner spoke with the patient about partner notification; usually there was one partner. CONCLUSION: There was a high participation rate (94%) in this opportunistic screening programme in which urine was tested for presence of CT. The CT prevalence in this asymptomatic population was almost 5%, but it was significantly higher in young women and women from Surinam. It is proposed to start such a screening programme in all general practices in Amsterdam.

[Surveillance of AIDS and HIV infections in Amsterdam, 1997]. / Surveillance van aids en HIV-infectie in Amsterdam, 1997.

Data were collected in Amsterdam in 1997 from the aids surveillance, from the HIV surveillance among pregnant women and visitors of a clinic for sexually transmitted diseases (STD), and from two 'alternative' HIV test sites, using various survey systems. The findings were compared with those of previous years. Aids was diagnosed in 1997 in 123 patients, in 194 in 1996. Of the 354 patients in whom aids was diagnosed in 1993-1997 in a hospital recording additional information, 113 patients (32%) only learned that they had an HIV infection when aids was diagnosed in them. In 1997, out of 225 pregnant women with an increased risk of HIV infection, 10 were HIV seropositive (4.4%); in 1996, this proportion was 3/285 (1.1%). Among those attending STD clinics, HIV infection was observed approximately as frequently as in earlier years: about 1% of heterosexual men and women.

Cockroach allergen in house dust.

The cockroach allergen (Bla g 1) content was determined in the floor dust of 46 homes with recent cockroach extermination in Amsterdam, The Netherlands. IgE antibodies to Blattella germanica, house-dust mite, cat dander, dog dander, and a mixture of molds were determined in venous blood samples of 46 children (4-12 years) and one of their biologic parents (24-54 years). Specific IgE to cockroach was also determined in a sample of the general population studied in a previous case-control study, one group (n = 20) with three groups (n =76) without history of cockroach infestation of the home. Cockroach allergen was detected in floor dust from 44% of the homes, with levels up to 3899 ng Bla g 1/g. Seven of the 46 adults and only one of the 46 children studied had positive RAST to cockroach. Geometric mean cockroach allergen concentrations in living room and master bedroom of sensitized adults were similar to those of nonsensitized adults. In the groups of children without a history of cockroach infestation of the home, positive RAST against cockroach was observed in 16% of the children with respiratory symptoms, in 4% of the children without respiratory symptoms, and in 48% of the children with two or more positive RAST to other allergens. Of the 18 children with positive RAST against cockroach, only one had a history of cockroach infestation of the home and 16 (89%) had also positive RAST against house-dust mite.

[Results of screening for HIV antibodies in pregnant women in Amsterdam reference stations, 1988-1995]. / Resultaten van de screening op HIV-antistoffen bij zwangere vrouwen in de Amsterdamse peilstations, 1988-1995.

In order to determine the prevalence of HIV in the general heterosexual population of Amsterdam, 16,709 pregnant women attending two hospitals and one maternity clinic in the period 1988-1995 were asked to undergo a HIV test, of whom 15,276 gave informed consent (91.4%). Pregnant women with a risk of HIV infection were possibly overrepresented in those who refused. The overall HIV prevalence in 1988-1995 was 0.28% and showed no significant differences over the years. In women with a known risk factor for infection the prevalence was 240:10,000, in those without 5:10,000. Whereas intravenous drug use was the most probable cause of infection before 1993, since then it was observed in only 2/20 of the HIV positive pregnant women. Heterosexual transmission appears to be increasing.

Euthanasia and physician-assisted suicide in homosexual men with AIDS.

BACKGROUND: In the Netherlands a nationwide study has shown that, in 38% of deaths, there have been medical decisions concerning the end of life (MDEL); 2.1% of all deaths were brought about by euthanasia or physician- assisted suicide (PAS). We investigated the incidence of MDEL in homosexual men with AIDS, suspecting that it might be higher, and studied the effect of euthanasia/PAS on survival time. METHODS: The patients were 131 male homosexual participants in a cohort study in Amsterdam, diagnosed between 1985 and 1992 as having AIDS; all had died before Jan 1, 1995. Clinical and laboratory data and information on mode of death were obtained from their physicians and by review of hospital records. Those who died by euthanasia/PAS or in whom there had been other MDEL were then compared with those who died naturally. FINDINGS: 29 men (22%) had died by euthanasia/PAS and in 17 (13%) another MDEL had been made; thus, more than one-third of these men had made medical decisions concerning the end of life. The greatest difference between the groups was in age at time of diagnosis-72% aged 40 or more in the euthanasia/PAS group compared with 38% in the natural death group. The likelihood (relative risk) of euthanasia/PAS increased with duration of survival after AIDS diagnosis. Comparison of the groups in terms of three laboratory markers (CD4+ and CD8+ cells and phytohaemagglutinin responses) in the two years before death, and estimates of these markers at the time of death, did not indicate any substantial shortening of life by euthanasia/PAS; in the judgment of the physicians, most of these patients would have died naturally within one month. INTERPRETATION: A possible reason for the high incidence of MDEL in this cohort was a good knowledge of the characteristics of AIDS acquired through long-term awareness of HIV infection. The higher rate of euthanasia in those with long survival from AIDS diagnosis could reflect either additional suffering or the greater opportunity to discuss this option with friends and physicians. Our findings indicate that euthanasia and other MDEL did little to shorten life; rather, they were an extreme form of palliation, applied in the terminal phase of a lethal disease.

[Prevalence of HIV antibodies in pregnant women in the Amsterdam HIV reference station research, 1988-1993]. / Prevalentie van HIV-antistoffen bij zwangere vrouwen in het Amsterdamse HIV-peilstationonderzoek, 1988-1993.

Pregnant women were asked to undergo a HIV test in two hospitals, one maternity clinic (n = 12.784; 1988-1993) and one abortion clinic (n = 2089; 1990-1993) in Amsterdam, in order to establish trends in HIV prevalence. Participation rates were 92.4% and 84.4%, respectively. Among pregnant women the overall HIV prevalence was 0.27% (0.04% for pregnant women without a known HIV risk and 2.6% for women with a known HIV risk) and in the abortion clinic the overall HIV prevalence was 0.91%. The HIV prevalence over the years remained fairly constant. In the most recent years a slight rise was noticed in the HIV prevalence in the group pregnant women with a known HIV risk caused by an increase in the number of women from AIDS endemic countries in this group.

The HIV prevalence among pregnant women in the Amsterdam region (1988-1991).

The objective of the study was to monitor the HIV prevalence in the years 1988-1991 among pregnant women in the Amsterdam region, visitors to an abortion clinic and 3 outpatient infertility clinics. All women attending these clinics were asked to participate in the study on a voluntary basis and were tested with informed consent. The women were questioned about risk-bearing behaviour of themselves and their sexual partner(s). In the period 1988-1991, of the 23,827 eligible pregnant women, 22,165 women participated (93.0%). Twenty-seven women were found to be positive for HIV antibodies (0.12%, 95% CI: 0.08%-0.17%), of whom twenty belonged to a known HIV risk group or had a partner who belonged to one of these groups and 7 women had no known HIV risk. Seventeen of the 27 women had a foreign nationality. The annual HIV prevalence among pregnant women was: 1988: 0.28%; 1989: 0.10%; 1990: 0.10%; 1991: 0.11%. In the years 1990 and 1991, of the 1,128 eligible women visiting the abortion clinic 953 (84.5%) were tested. Eleven women were HIV-seropositive (1.15%, 95% CI: 0.6%-2.0%), of whom 9 were from an AIDS endemic region, 1 woman had a partner from this region and 1 woman had no known HIV risk. Four African women had HIV-2 antibodies. At the 3 outpatient infertility clinics 1 woman was found to be HIV-positive (0.13%; 95% CI: 0.02-0.9). She had no other risk than a partner from an AIDS endemic area. In the Amsterdam region there was a steady and low HIV prevalence (0.1%) among pregnant women through the years 1988-1991. The prevalence in the abortion clinic was ten times higher. The program was able to detect possible high risk groups within the population. Migration and travelling can play an important role in the spread of HIV in the general heterosexual population.

[Survival of patients following the diagnosis of AIDS in the Amsterdam region, 1982-1991]. / De overlevingsduur van patiënten na de diagnose AIDS in de regio Amsterdam, 1982-1991.

OBJECTIVE: To evaluate the survival of 975 AIDS patients diagnosed in the Amsterdam region between 1982 and 1991, with follow-up until December 31st, 1992. METHODS: Analysis of data from the active AIDS surveillance system for the Amsterdam region at the Municipal Health Service. RESULTS: Amsterdam region residents had 1, 2 and 3-year survivals of 69.8%, 42.6% and 21.2%, respectively. The 5-year survival was 7.7%. The median survival probability for all patients showed great improvement, from 9 months in 1982-1985 to 26 months in 1990. For patients initially presenting with only Pneumocystis carinii pneumonia (PCP) the greatest improvement occurred between the period 1982-1985 and the year 1986. For patients without PCP the most important improvement occurred one year later. From 1988 onwards no important improvement in the 1-year survival is noticed. The 2-year survival, however, appears still to be increasing. In a Cox proportional hazards model the following variables were found to be independent predictors for survival: age at diagnosis, earliest clinical AIDS manifestations, year of diagnosis and HIV risk group. No differences were seen in the 1 and 2-year survival probabilities for men and women with AIDS. Heterosexual men and women tended to have a poorer survival than intravenous drug users and homosexual and bisexual men. CONCLUSION: A noticeable improvement in the survival probability with time occurred for AIDS patients living in the Amsterdam region through the years 1982-1991, although the overall survival after AIDS diagnosis is still poor. The 1-year survival appears to have reached a plateau, the 2-year survival is still increasing. Improved clinical experience, awareness of HIV related complaints in high risk groups, better diagnostic methods and the availability of proper medication (prophylactic and treatment) are the most likely explanations of the improvement in survival.

Impact of AIDS on premature mortality in Amsterdam, 1982-1992.

OBJECTIVE: To study the impact of AIDS on premature mortality in the city of Amsterdam (1982-1992). METHODS: We combined aggregated data from the Netherlands Central Bureau for Statistics with data from the municipal death and population registry and data from the Amsterdam AIDS surveillance system to calculate age standardized mortality rates for men aged 15-64 years and 25-54 years and working years of potential life lost before 65 years (WYPLL). RESULTS: AIDS was the leading cause of death for men aged 25-54 years in Amsterdam from 1990 onwards, and the third leading cause of death for men aged 15-64 years in 1991. In this larger age group AIDS will probably become the leading cause of death in the coming years. In 1991, AIDS was already the leading cause of WYPLL before 65 years for men in the 15-64 age group. Without AIDS, there would have been a decrease in premature WYPLL from 1982 onwards; however, because of AIDS the number of WYPLL is increasing again. CONCLUSION: AIDS has had a significant impact on the pattern of premature mortality in Amsterdam in the period 1982-1992. Its impact will probably increase over the next few years.

[HIV prevalence in pregnant women in and around Amsterdam in 1989]. / HIV-prevalentie bij zwangeren in en rond Amsterdam in 1989.

The HIV prevalence among pregnant women in 3 hospitals in Amsterdam was found to be 0.28% in 1988. As the population of these 3 hospitals is not representative of all pregnant women in Amsterdam, this study--which is done on a voluntary basis--in 1989 was slowly extended to all hospitals, clinics and practices of midwives. Of 5,176 pregnant women who were eligible in 1989, 4,812 (93.0%) participated in the study. Non-Dutch women were overrepresented among the refusers. Antibodies to HIV were found in 5/4, 812 women (0.10%, 95% confidence interval 0.01-0.19) and all 5 infected women reported an AIDS risk factor either for themselves or for their present or previous partner(s). Three of the infected women were only tested during the third trimester; the 2 others were tested in the first trimester of their pregnancy and underwent an abortion. The prevalence in 1989 was lower than that found in 1988 and this may have been influenced by an increased effort to counsel seropositive women--and especially intravenous drug users--on the risk of pregnancy.