Impact of hepatitis C virus infection on the risk of death of alcohol-dependent patients.

Hepatitis C virus (HCV) infection is frequent among patients with alcohol use disorders. We aimed to analyse the impact of HCV infection on survival of patients seeking treatment for alcohol use. This was a longitudinal study in a cohort of patients who abused alcohol recruited in two detoxification units. Socio-demographic and alcohol use characteristics, liver function tests for the assessment of alcohol-related liver disease and HCV and HIV infection serologies were obtained at admission. Patients were followed until December 2008; causes of death were ascertained through clinical records and death registry. Cox models were used to analyse predictors of death. A total of 675 patients (79.7% men) were admitted; age at admission was 43.5 years (IQR: 37.9-50.2 years), duration of alcohol abuse was 18 years (IQR: 11-24 years), and median alcohol consumption was 200 g/day (IQR: 120-275 g/day). Distribution of patients according to viral infections was as follows: 75.7% without HCV or HIV infection, 14.7% HCV infection alone and 8.1% HCV/HIV coinfection. Median follow-up was 3.1 years (IQR: 1.5-5.1 years) accounting for 2,345 person-years. At the end of study, 78 patients (11.4%) had died. In the multivariate analysis, age at admission (HR = 1.71, 95%CI: 1.05-2.80), alcohol-related liver disease (HR = 3.55, 95%CI: 1.93-6.53) and HCV/HIV co-infection (HR = 3.86 95%CI: 2.10-7.11) were predictors of death. Younger patients (≤43 years) with HCV infection were more likely to die than those without viral infections (HR = 3.1, 95%CI: 1.3-7.3; P = 0.007). Among patients with alcohol-related liver disease, mortality rate was high, irrespective of viral infections. These data show that HCV infection confers a worse prognosis in patients with alcohol use disorders.

Progression of liver fibrosis in HIV/hepatitis C virus-coinfected individuals on antiretroviral therapy with early stages of liver fibrosis at baseline.

OBJECTIVES: The aim of the study was to assess the progression of liver fibrosis in HIV/hepatitis C virus (HCV)-coinfected patients with no or mild-to-moderate fibrosis (stages F0-F2). METHODS: Liver fibrosis was reassessed by transient elastometry (TE) between January 2009 and November 2011 in HIV/HCV-coinfected patients with stage F0-F2 fibrosis in a liver biopsy performed between January 1997 and December 2007. Patients with liver stiffness at the end of follow-up < 7.1 kPa were defined as nonprogressors, and those with values ≥ 9.5 kPa or who died from liver disease were defined as progressors. Cirrhosis was defined as a cut-off of 14.6 kPa. The follow-up period was the time between liver biopsy and TE. Cox regression models adjusted for age, gender and liver fibrosis stage at baseline were applied. RESULTS: The median follow-up time was 7.8 years [interquartile range (IQR) 5.5-10 years]. The study population comprised 162 patients [115 (71%) nonprogressors and 47 (29%) progressors; 19 patients (11.7%) had cirrhosis]. The median time from the diagnosis of HCV infection to the end of follow-up was 20 years (IQR 16.3-23.1 years). Three progressors died from liver disease (1.8%). The variables associated with a lower risk of progression were age ≤ 38 years (hazard ratio (HR) 0.32; 95% confidence interval (CI) 0.16-0.62; P = 0.001], having received interferon (HR 2.18; 95% CI 1.14-4.15; P = 0.017), being hepatitis B virus surface antigen (HBsAg) negative (HR 0.20; 95% CI 0.04-0.92; P = 0.039), and baseline F0-F1 (HR 0.43; 95% CI 0.28-0.86; P = 0.017). CONCLUSIONS: A high proportion of patients with stage F0-F2 fibrosis progress to advanced liver fibrosis. Advanced liver fibrosis must be included in the list of diseases associated with aging. Our results support the recommendation to offer HCV antiviral therapy to HIV/HCV-coinfected patients at early stages of liver fibrosis.

The impact of a school-based water supply and treatment, hygiene, and sanitation programme on pupil diarrhoea: a cluster-randomized trial.

The impact of improved water, sanitation, and hygiene (WASH) access on mitigating illness is well documented, although impact of school-based WASH on school-aged children has not been rigorously explored. We conducted a cluster-randomized trial in Nyanza Province, Kenya to assess the impact of a school-based WASH intervention on diarrhoeal disease in primary-school pupils. Two study populations were used: schools with a nearby dry season water source and those without. Pupils attending 'water-available' schools that received hygiene promotion and water treatment (HP&WT) and sanitation improvements showed no difference in period prevalence or duration of illness compared to pupils attending control schools. Those pupils in schools that received only the HP&WT showed similar results. Pupils in 'water-scarce' schools that received a water-supply improvement, HP&WT and sanitation showed a reduction in diarrhoea incidence and days of illness. Our study revealed mixed results on the impact of improvements to school WASH improvements on pupil diarrhoea.

Hyaluronic acid, transforming growth factor-beta1 and hepatic fibrosis in patients with chronic hepatitis C virus and human immunodeficiency virus co-infection.

Chronic hepatitis C virus (HCV) infection follows an accelerated course in patients co-infected with human immunodeficiency virus (HIV); establishing the extent of liver fibrosis is crucial for disease staging and determining treatment strategy in these patients. The utility of noninvasive markers of fibrosis as alternatives to liver biopsy has not been well-studied in these patients. We evaluated the predictive value of serum transforming growth factor-beta1 (TGF-beta1) and hyaluronic acid (HA) levels for determining the extent of liver fibrosis. Liver biopsies and blood samples were collected from 69 consecutive patients (74% male; median age, 41 years) between May 2005 and November 2006. Serum TGF-beta1 and HA were analysed using commercial kits. Aspartate aminotransferase, alanine aminotransferase and gamma-glutamyl transpeptidase levels were elevated in 81%, 70% and 60% of patients, respectively. Fifty-three patients (90%) were on highly active antiretroviral therapy and the median CD4-positive cell count was 422 cells/microL. The extent of fibrosis according to Scheuer's scoring was 32% F0 (no fibrosis), 16.5% F1, 16.5% F2, 26% F3 and 7% F4 (cirrhosis). Mean serum TGF-beta1 was 36.1 +/- 14.4 ng/mL; mean serum HA was 75.2 +/- 85.0 microg/L. Serum HA was positively associated and significantly correlated with the stage of fibrosis (r = 0.56; P < 0.05). The area under the curve for discriminating mild (F0-F2) from significant (F3-F4) fibrosis in receiver operating analysis using HA was 0.83 (sensitivity, 87%; specificity, 70%). These data suggest that HA is clinically useful for predicting liver fibrosis and cirrhosis in patients co-infected with HCV/HIV. However, serum TGF-beta1 was not predictive of histological damage in co-infected individuals treated with HAART.

Key interindividual determinants in MDMA pharmacodynamics.

INTRODUCTION: MDMA, 3,4-methylenedioxymethamphetamine, is a synthetic phenethylamine derivative with structural and pharmacological similarities to both amphetamines and mescaline. MDMA produces characteristic amphetamine-like actions (euphoria, well-being), increases empathy, and induces pro-social effects that seem to motivate its recreational consumption and provide a basis for its potential therapeutic use. Areas covered: The aim of this review is to present the main interindividual determinants in MDMA pharmacodynamics. The principal sources of pharmacodynamic variability are reviewed, with special emphasis on sex-gender, race-ethnicity, genetic differences, interactions, and MDMA acute toxicity, as well as possible therapeutic use. Expert opinion: Acute MDMA effects are more pronounced in women than they are in men. Very limited data on the relationship between race-ethnicity and MDMA effects are available. MDMA metabolism includes some polymorphic enzymes that can slightly modify plasma concentrations and effects. Although a considerable number of studies exist about the acute effects of MDMA, the small number of subjects in each trial limits evaluation of the different interindividual factors and does not permit a clear conclusion about their influence. These issues should be considered when studying possible MDMA therapeutic use.

Prevalence and distribution of HHV-8 in different subpopulations, with and without HIV infection, in Spain.

OBJECTIVE: To estimate the seroprevalence of HHV-8 in several Spanish subpopulations with different risk levels of acquiring HIV-1 infection and from different geographical regions. DESIGN: Cross-sectional seroprevalence study. METHODS: A total of 1699 serum samples from blood donors (613), children under the age of 12 years (100), injecting drug users (IDU) (382), heterosexuals attending a sexually transmitted disease (STD) clinic (273) and homosexual men attending a STD clinic or a HIV-based hospital unit (331) were analysed for anti-HHV-8 antibodies. The presence of antibodies against HHV-8 was tested with an indirect immunofluorescence assay (IFA). A subsample of HHV-8-positive samples was also tested for antibody titre against HHV-8. RESULTS: The overall seroprevalence of antibodies against HHV-8 for the blood donor population was 6.5% (7.0% in Andalusia, 8.0% in Catalonia and 4.5% in the Basque Country). None of the children tested positive for HHV-8. The HHV-8 prevalence was 86.7% in HIV-positive homosexual men and 28.0% in HIV-negative homosexual men (P < 0.001). Of heterosexual men attending STD clinics, 17.2% tested positive for HHV-8; 11.5% of IDU tested positive for HHV-8. HHV-8 antibody titres by groups parallel the distribution of HHV-8 prevalence. No association between HHV-8 antibody titres and CD4 cell count or HIV viral load was identified. CONCLUSIONS: The HHV-8 prevalence among blood donors in Spain is higher than in Northern Europe and the USA, but is similar to that in Northern Italy. The distribution of HHV-8 is compatible with a sexually transmitted agent. The distribution of HHV-8 correlates with that of Kaposi's sarcoma but factors other than HHV-8 seem to explain the Kaposi sarcoma distribution.

Efficacy of sulfadoxine-pyrimethamine for prevention of placental malaria in an area of Kenya with a high prevalence of malaria and human immunodeficiency virus infection.

A fever case management (CM) approach using sulfadoxine-pyrimethamine (SP) was compared with two presumptive intertmittent SP treatment regimens in the second and third trimesters in pregnant primigravidae and secundigravidae in an area of intense Plasmodium falciparum malaria transmission in western Kenya. The investigation evaluated efficacy of the antimalarial regimens for prevention of placental malaria and examined the effect of human immunodeficiency virus (HIV) infection on antimalarial drug efficacy and adverse drug reactions. Twenty-seven percent (93 of 343) of pregnant women in the CM group had placental malaria compared with 12% (38 of 330; P < 0.001) of women who received two doses of SP and compared with 9% (28 of 316; P < 0.001) of women who received monthly SP. Fourteen percent (49 of 341) of women in the CM group delivered low birth weight (LBW) infants compared with 8% (27 of 325; P=0.118) of women who received two doses of SP and compared with 8% (26 of 331; P=0.078) of women who received monthly SP. Seven percent (7 of 99) of the HIV-negative women on the two-dose SP regimen had placental malaria compared with 25% (10 of 39; P=0.007) of HIV-positive women on the same regimen; the rate of placental malaria in HIV-positive women was reduced to 7% (2 of 28; P=-0.051) for women on the monthly SP regimen. Less than 2% of women reported adverse drug reactions, with no statistically significant differences between HIV-positive and HIV-negative women. Intermittent treatment with SP is safe and efficacious for the prevention of placental malaria in pregnant primigravidae and secundigravidae in sub-Saharan Africa. While a two-dose SP regimen may be effective in areas with low HIV seroprevalence, administration of SP monthly during the second and third trimesters of pregnancy should be considered in areas of high HIV seroprevalence to prevent the effects of maternal malaria on the newborn.

Emergence or re-emergence of visceral leishmaniasis in areas of Somalia, north-eastern Kenya, and south-eastern Ethiopia in 2000-01.

Visceral leishmaniasis (VL) was known to be endemic in Somalia along the basins of the (Middle) Shebelle and (Lower) Juba rivers, and in Kenya in parts of the Rift Valley, on the border with Uganda and the Eastern Provinces. From May 2000 to August 2001, we diagnosed 904 patients with VL. The patients came from an area which spanned the Wajir and Mandera districts of north-eastern Kenya, southern Somalia, and south-eastern Ethiopia. Small numbers of patients were also seen in northern Somalia. These areas were either previously non-endemic for VL, or had only sporadic cases prior to the epidemic. We describe the features of the outbreak and review the history of VL in the region. Unusual rainfall patterns, malnutrition, and migration of a Leishmania-infected population seeking food and security may have contributed to this outbreak.

Creating spatially defined databases for equitable health service planning in low-income countries: the example of Kenya.

Equity is an important criterion in evaluating health system performance. Developing a framework for equitable and effective resource allocation for health depends upon knowledge of service providers and their location in relation to the population they should serve. The last available map of health service providers in Kenya was developed in 1959. We have built a health service provider database from a variety of traditional government and opportunistic non-government sources and positioned spatially these facilities using global positioning systems, hand-drawn maps, topographical maps and other sources. Of 6674 identified service providers, 3355 (50%) were private sector, employer-provided or specialist facilities and only 39% were registered in the Kenyan Ministry of Health database during 2001. Of 3319 public service facilities supported by the Ministry of Health, missions, not-for-profit organizations and local authorities, 84% were registered on a Ministry of Health database and we were able to acquire co-ordinates for 92% of these. The ratio of public health services to population changed from 1:26,000 in 1959 to 1:9300 in 1999-2002. There were 82% of the population within 5 km of a public health facility and resident in 20% of the country. Our efforts to recreate a comprehensive, spatially defined list of health service providers has identified a number of weaknesses in existing national health management information systems, which with an increased commitment and minimal costs can be redressed. This will enable geographic information systems to exploit more fully facility-based morbidity data, population distribution and health access models to target resources and monitor the ability of health sector reforms to achieve equity in service provision.

The management of lens damage in perforating corneal lacerations.

Lens damage is present in 30% of perforating injuries of the anterior segment of the eye. There is no consensus on whether the cataractous lens should be removed at the initial repair of the corneal laceration or later, when the eye has recovered from injury. Twenty-seven consecutive cases with a perforating corneal injury and lens damage were alternatively treated either with simultaneous corneal suturing and cataract removal or with corneal suturing and delayed cataract removal several weeks later. The difference in the frequency of complications between the 2 groups was significant. The 1-step procedure was technically easier to perform, the period of postoperative irritation was shorter, complications due to the presence of an injured lens were prevented, and visual rehabilitation occurred earlier.

Anterior segment surgery early after corneal wound repair.

Penetrating wounds of the cornea require immediate repair, generally within 24 hours. Tight closure of the wound and a reformed anterior chamber are the primary goals of surgery. However, there is no guarantee that further surgery will not be required for maintaining the healthy function of the anterior segment. At the second operation the effect of the procedure on the previously repaired wound is of prime importance, since in many cases the operation needs to be done before corneal healing is completed. In our series the lens, which was either partially or completely cataractous at the initial operation, became intumescent at different times afterwards, and an immediate removal was necessary. No change in the preoperative wound sealing or transparency of the cornea could be detected after lens surgery performed between 24 hours and 21 days from the initial corneal repair.

Syphilis in injecting drug users: clues for high-risk sexual behaviour in female IDUs.

The objective was to measure the gender-specific differences for syphilis and for the sexual transmission of human immunodeficiency virus (HIV) in a cross-sectional analysis of injecting drug users (IDUs) admitted to detoxification between February 1987 and January 1990. HIV was determined by enzyme-linked immunosorbent assay (ELISA) and confirmed with Western blot. For syphilis reactive samples to a rapid plasma reagent (RPR) were confirmed with treponemal tests (FTA-ABS or MHA-TP). Of the 386 heterosexual IDUs, 68% were HIV-positive and 4.7% had serologic syphilis (RPR and FTA-ABS or MHA-TP positive). Syphilis was higher in women (12%) than in men (3%), and women reported a significantly (P < 0.001) higher number of sex partners. Men had an IDU as a sex partner more often than women did (P = 0.001). Serologic syphilis in women was associated with having had more than one sexual partner in the previous year (P = 0.028) but this association was not present in men. HIV infection was not associated with syphilis in male IDUs. However, HIV was present in all women with syphilis that reported more than one partner.

[Tumor necrosis factor-alpha in human immunodeficiency virus infection]. / El factor de necrosis tumoral alfa en la infección por el virus de la immunodeficiencia humana.

BACKGROUND: The aim of the present was to determine the levels of the tumor necrosis factor (TNF)-alpha in patients with HIV infection to study the relationship with the concentration of triglycerides (TG), CD4 lymphocyte count and clinical diagnosis. METHODS: Seventy-eight HIV-infected patients (58 males, 20 females); mean age 32 years presenting different clinical situations were studied. TNF, TG, CD4 lymphocyte count, and clinical diagnosis at the time of the study were analyzed. RESULTS: The mean TNF values in the sample was 25.5 x 10(-3) pg/l with a confidence interval of 95% (Cl 95%), 16.6 x 10(-3) pg/l to 34.4 x 10(-3) pg/l with a trend to being higher in the group with less than 200 x 10(6) CD4/l (Cl 95%: 18.6 x 10(-3) pg/l-44.3 x 10(-3) pg/l). Mean TG values in the sample were 2.02 milligrams (Cl 95%: 1.72 milligrams-2.31 milligrams) being significantly higher in the group with less than 200 x 10(6) CD4/l (X = 2.35 +/- 1.32 milligrams; p < 0.005). TNF concentrations were found to be significantly higher in the group with acute infection (Cl 95%: 27 x 10(-3) pg/l-69 x 10(-3) pg/l) with respect to the group without infection at the time of the study (Cl 95% 7 x 10(-3) pg/l-19 x 10(-3) pg/l). The correlation coefficient between TNF and TG was r = 0.34 (p = 0.01). CONCLUSIONS: Both the tumor necrosis factor and triglycerides are high in patients with HIV infection and CD4 lower than 200 x 10(6)/l. The correlation between tumor necrosis factor and triglyceride concentrations is positive and significant. The increase in the former is more important when there is concomitant infection and could be considered as a marker of opportunistic infection.

[HIV infection declines among intravenous drug addicts in Barcelona: 1987-1993]. / Desciende la infección por el virus de la inmunodeficiencia humana en drogadictos intravenosos de Barcelona: 1987-1993.

BACKGROUND: The evolution of the prevalence of HIV infection in intravenous drug addicts who initiate hospital detoxication was analyzed. METHODS: Six hundred fifty intravenous drug addicts (535 males, 115 females) were analyzed for HIV and surveyed in regard to demographic variables and the use of drugs over a period of 7 years (1987-1993): age, sex, year of initiation of intravenous drug addiction, length of the habit and year of admission. RESULTS: Most of the subjects were men (82%) with a mean age of 19.7 years at the time of initiation to the use of i.v. drugs and an age of 25.9 years on admission to the unit. The mean time of i.v. drug addiction at admission was 74 months. The characteristics of the patients according to the year of admission were homogeneous in regard to age, length of drug addiction and male/female ratio. More than 50% of the subjects had initiated the use of i.v. drugs during the first half of the last decade. The global prevalence of HIV infection was of 66.3% with no differences being observed between sexes. The frequency of infection was shown to have globally decreased from 1987 to 1993 (p = 0.06) although the rates of HIV infection in women did not significantly modify (p = 0.08) in contrast to that of men (p = 0.05). CONCLUSIONS: The epidemia of HIV infection in intravenous drug addicts may have entered into remission following a decade characterized by a spread in the use of heroin and great diffusion of the disease.

[Dyslipemia and HIV-1 infection in intravenous drug addicts]. / Dislipemia e infección por VIH-1 en adictos a drogas intravenosas.

BACKGROUND: It has been demonstrated that hypertriglyceridemia and hypocholesterolemia are frequent signs in homosexual patients with AIDS. Lipid abnormalities of the intravenous drug addict (IVDA) however, and its relation with infection by the human immunodeficiency virus (HIV) have not been sufficiently studied. METHODS: Four hundred thirty-five consecutive patients attended for infectious complications or for carrying out detoxication treatment were studied. Demographic (age, sex), anthropometric (weight, height), use of intravenous drugs (principal drug used, time of addiction) and analytic data (HIV-1 antibodies, total lymphocytes, CD4+ lymphocytes, serum albumin, total cholesterol, plasma triglycerides and transferrinemia) were collected. RESULTS: The age of the patients was found to be between 15-44 years of age. Ninety-five percent were heroin addicts with a time of addiction greater than 4 years. Those who were HIV-1 positive had been drug users for a longer period of time (p < 0.01), had less weight (p < 0.01), lower albuminemia (p < 0.05) and cholesterolemia (p < 0.01), as well as a lower number of CD4+ lymphocytes (p < 0.01). No differences were observed with regard to age, transferrinemia and plasma triglyceride concentration. The prevalence of hypertriglyceridemia (> 1.97 mmol/l; 175 mg/dl) was of 18% for the IVDA with HIV-1 infection and 23% for seronegative individuals (p = 0.3). Hypercholesterolemia was significantly more prevalent in HIV-1 positive individuals (20%) than in the seronegative subjects (9%) (p < 0.01). In the HIV-1 positive patients, most of whom where asymptomatic, a decrease in total cholesterol and an increase in plasma triglycerides was observed according to the decrease in the number of CD4+ lymphocytes. CONCLUSIONS: Infection by the human immunodeficiency virus is accompanied by an increase in plasma triglycerides and a decrease of total cholesterol in relation with the alteration of cellular immunity. However, heroin addicts present some differential characteristics similar to those of chronic alcoholics, poor diet, anorexia induced by opioids, autoimmunity phenomena and recurrent infections throughout drug addiction which may justify lipid abnormalities of multifactorial origin.

[Evidence of infection by type 2 (HIV 2) human immunodeficiency virus in heroin addicts in Barcelona]. / Evidencia de infección por el virus de la inmunodeficiencia humana tipo 2 (VIH 2) en heroinómanos de Barcelona.

The presence of antibodies against human immunodeficiency virus type 2 (HIV-2) was retrospectively investigated in serum samples from 433 parenteral drug abusers from Barcelona. A third generation ELISA was used for the initial screening of sera, and a specific western blot technique for the definitive confirmation of the results. The presence of anti-HIV-2 was demonstrated in 9 samples (prevalence 2.1%). All of them belonged to patients also infected with HIV-1. The 9 cases reported here are the first seropositive patients for HIV-2 described in native individuals from this country.

[Rates of human immunodeficiency virus (HIV) infection in intravenous drug addicts from the Barcelona area, according to sex and age of drug consumption onset]. / Tasas de infección por el virus de la inmunodeficiencia humana (VIH) en drogadictos intravenosos del área de Barcelona, según sexo y edad de inicio en el consumo.

BACKGROUND: The differences in the rates of HIV infection in intravenous drug addicts according to the age of onset of drug consumption, sex and length of intake were evaluated. METHODS: The study sample was made up of 650 intravenous drug addicts (535 males and 115 females) admitted to a Hospital Detoxication Unit over 7 years (1987-1993). Of all these patients HIV serology and a questionnaire related to sociodemographic variables and drug consumption (age, sex, year of onset of intravenous drug intake, length of addiction and year of admission) were obtained. RESULTS: The rate of HIV infection for any length of addiction was higher in females than in males with this difference being significant for a length of addiction of less than 24 months (p = 0.03). The greater the age of onset in the use of intravenous drugs the lower the rate of HIV infection (p < 0.0001). In addiction times of less than 24 months the subjects who began drug consumption at an earlier age than the mean (19 years) presented significantly higher HIV infection rates (p = 0.04). CONCLUSIONS: Among the intravenous drug consumers in the area of Barcelona, Spain subgroups may be found: those who enter the consumption of intravenous drugs early and women, demonstrating high rates of HIV seroprevalence from the onset of their addiction.

[Mortality in a cohort of intravenous drug users before the introduction of potent HIV therapy]. / Mortalidad en una cohorte de usuarios de drogas por vía intravenosa antes de la introducción de la terapia VIH potente.

BACKGROUND: The HIV/AIDS epidemics has contributed to an excess of morbidity and mortality in injecting drug users. The main goal of this study is to estimate incidence and factors associated with mortality from different causes among intravenous drug users. SUBJECTS AND METHODS: Prospective study of patients admitted to a detoxification unit between 1987 and 1990. At baseline they underwent interviews (drug injecting patterns) and venipuncture for HIV and other parameters including T-cell subsets. Viral status was determined for those who returned at least once. Cumulative incidence, overall and cause-specific mortality rates were calculated according to gender, HIV at admission and length of injecting drugs. RESULTS: 420 patients (334 men, 86 women), 69.6% HIV+, were admitted to treatment; the mean age of participants was 26 years and the mean duration of injecting drugs was 73 months. Three hundred and eighty seven patients were followed-up (92% of the initial cohort) for 2,029 persons-years and 101 deaths occurred. The overall mortality rate was 50/1000 persons-year (52/1000 for men and 40/1000 for women). The relative risk (RR) for death among women compared with men was 1.3 (95% CI = 0.8-2.2). The mortality rates for HIV+ was 60/1000 persons-year and 29/1000 persons-year for the seronegatives (RR: 2.1; 95% CI = 1.2-3.4). The HIV+ patients with CD4/microliter < or = 500 showed a threefold increase in mortality rates compared to HIV+ patients without immunosuppression (CI = 1.7-5.3). The cause-specific mortality rates were 27/1000 persons-year for HIV/AIDS, 15/1000 persons-year for drug overdose, 3/1000 persons-year for violence/trauma and 1/1000 persons-year for non-AIDS conditions. CONCLUSIONS: In this hospital cohort, HIV/AIDS and overdose have had a marked effect on mortality among intravenous drug users. Detoxification units may provide clinical services and extensive use of antiretroviral treatment for HIV infected drug users as a strategy to reduce the risk of death from AIDS.

[Primary infection caused by human immunodeficiency virus: clinical and serologic aspects of 7 cases]. / Primoinfección por el virus de la inmunodeficiencia humana: aspectos clínicos y serológicos de 7 casos.

We report 7 individuals in whom HIV seroconversion developed, in 6 associated with symptoms and in one without any symptom at all. The most florid and sustained symptoms appeared in the oldest patients: a female and her heterosexual partner, who was a promiscuous male with recent seroconversion. A heroin abuser had oral muguet, and another had esophageal candidiasis. Rash was absent in all cases. Antigenemia was demonstrated in 6 of the 7 patients. In one case, a third generation ELISA was more sensitive than Western blot for the identification of seroconversion.

[The evidence of human immunodeficiency virus infection in the seronegative subjects of high-risk groups]. / Evidencia de infección por el virus de la inmunodeficiencia humana en sujetos de colectivos de alto riesgo que son seronegativos.

BACKGROUND: Polymerase chain reaction (PCR) is a new diagnostic procedure which has been used to recognise HIV-infected individuals who remain seronegatives. METHODS: Genomic DNA isolated from the peripheral blood mononuclear cells of 90 high-risk individuals were analyzed by PCR using gag primers SK 38/39. Subjects were classified in four groups: 42 drug abusers, 35 heterosexual partners of HIV-infected individuals, 9 homosexual men, and 4 health care workers accidentally exposed to HIV. Liquid hybridization using radiolabelled probes was done to confirm the results. All samples were also tested for HIV antigen and antibodies (Ab) using EIA and Western blot (WB). RESULTS: Two out of 11 (18%) drug abusers and 5 out of 34 (14%) couples were PCR positive in absence of HIV antibodies. This silent HIV infections were not recognized in homosexuals and health care workers. All 38 seropositive samples were PCR positive. None of the samples PCR+/Ab- was positive for HIV antigenemia or showed indeterminate results in the WB assay. CONCLUSIONS: Silent HIV infections were recognized in drug abusers (18%) and couples of HIV-infected individuals (14%). Mechanisms involved in the production of this "occult" HIV infections are reviewed.