Reactivity of smooth-muscle antibodies, surface ultrastructure, and mobility in cells of human hematopoietic cell lines.

Seventeen human hematopoietic cell lines were tested by indirect immunofluorescence (IF) for reactivity with human serum containing smooth-muscle antibodies (SMA). The correlation of the IF pattern to the cell surface ultrastructure was revealed by scanning electron microscopy (SEM). Lymphoma cells, viewed by SEM, had short villi over the entire cell surface, but, by IF, showed a type of membrane fluorescence. Cells of lymphoblastoid lines had thin, long surface villi, sometimes asymmetric but most often distributed over the whole cell surface. Myeloma and leukemia cells, which had few membrane villi but a surface covered by "blebs" as revealed by SEM, demonstrated, by IF, only a few stub-like projections extending from the surface. Time-lapse cinematography revealed that the intensity and pattern of SMA staining were also correlated to the degree of motility. Indirect IF with human SMA-positive serum might be used in the classification of cell lines derived from human hematopoietic tissue.

The influence of age on the latency period to AIDS in people infected by HIV through blood transfusion.

We collected information on the development of clinical signs and laboratory results from a cohort of 58 people infected with HIV through blood transfusion. The observation time ranged from 36 to 100 months. Belonging to the older age group at the time of transfusion was found to be an important factor for rapid progression to AIDS. Sex or physical health at the time of transfusion did not influence the latency period.

Most HIV-1 genetic subtypes have entered Sweden.

OBJECTIVE: The aim of this study was to document which genetic subtypes of HIV-1 have entered Sweden and to study transmission patterns of these virus variants. PATIENTS: All HIV-1 infected individuals at Danderyds Hospital, Stockholm, Sweden, who were suspected of carrying a virus of African origin were prospectively included in the study. The study subjects originated from 15 different African countries. METHODS: The V3 domain of the HIV-1 envelope was directly sequenced from uncultured peripheral blood mononuclear cells from 75 individuals included in the study. Phylogenetic analyses were used to determine genetic subtype and to study transmission patterns. RESULTS: The virus strains carried by the study subjects belonged to six established subtypes of HIV-1 (27A, 4B, 18C, 18D, 2G, 2H). Two individuals from Zaire carried a subtype, which had not been classified previously, provisionally named subtype 1. Eleven transmissions of non-subtype B strains in Sweden were documented. CONCLUSIONS: This study shows that most genetic HIV-1 subtypes have entered Sweden despite the relatively low prevalence of HIV infection in the country. Thus, the complete dominance of subtype-B infections which was seen during the early phase of the HIV-1 epidemic in Europe and the US has been broken in Sweden.

Subtype-specific problems with quantification of plasma HIV-1 RNA.

OBJECTIVE: To determine whether two commercial assays for quantification of plasma HIV-1 RNA levels detect different genetic subtypes of HIV-1 with equal efficiency. DESIGN: Blind testing of stored plasma samples from 95 individuals infected with different genetic subtypes of HIV-1 (27 subtype A, 24 B, 18 C, 18 D, two E, two G, two H, and two J). The HIV-1 subtype had previously been determined by direct sequencing of the V3 domain of the env gene. METHODS: One plasma sample from each individual was tested once by the Roche HIV monitor assay and once by the Organon nucleic acid sequence-based amplification (NASBA) HIV-1 RNA quantitative assay, according to the manufacturers' recommendations. Information about CD4+ lymphocyte counts and antiretroviral treatment was available. RESULTS: The results from the two assays were strongly correlated with each other for subtypes B, C and D, but not for subtype A because many samples had RNA levels close to or below the lower detection limit of the assays. Thus, 15 out of 27 (56%) subtype A samples were negative by the HIV monitor assay and 12 (44%) were negative by the NASBA assay. These frequently occurring negative results among subtype-A-infected individuals were not due to better immunological status, more aggressive antiretroviral treatment, or differences in sample storage conditions. CONCLUSIONS: The HIV monitor assay and, possibly to slightly lesser degree, the NASBA assay appear unable to accurately quantify HIV-1 RNA levels in plasma samples from many subtype-A-infected individuals. These problems are likely to be due to primer mismatches and they limit the possibility of using these assays for routine monitoring of HIV-1-infected individuals in many parts of the world.

HIV and child-bearing: clinical outcome and aspects of mother-to-infant transmission.

Forty-four HIV-1-seropositive women and their children were followed-up and examined in connection with the course of pregnancy, mother-to-infant transmission of HIV and clinical outcome. Twelve out of 48 children were known to be infected and two children were lost to follow-up. Of the remaining 34 children, 22 are not infected, and 12 are clinically and immunologically normal at less than 18 months. There was no difference in intrauterine growth between infected and uninfected children. Forty-six per cent of the 39 mothers seen after delivery progressed to a more advanced stage of HIV infection during a mean follow-up time of 33 months after delivery. Although comparable in age, clinical and immunological status at delivery, and follow-up time, mothers of infected children had longer durations of HIV infection and were symptomatic and/or had low CD4 cell counts to a significantly greater extent at follow-up than mothers of uninfected children.

Similar rate of disease progression among individuals infected with HIV-1 genetic subtypes A-D.

OBJECTIVE: HIV-1 is characterized by a high degree of genetic variation and can be divided into at least 10 distinct genetic subtypes. The purpose of this study was to investigate whether the rate of disease progression shows subtype-specific differences. DESIGN: The investigation was divided into two parts; one study in which 49 ethnic Africans were compared with 49 ethnic Swedes irrespective of the subtype of the infecting virus, and a second study in which 126 individuals infected with different genetic subtypes (28 with subtype A, 59 with subtype B, 21 with subtype C and 18 with subtype D) were compared. METHODS: CD4 cell counts, the rate of CD4 cell decline, plasma HIV-1 RNA levels, clinical status and antiviral treatment were prospectively and retrospectively recorded. The HIV-1 subtype had previously been determined by direct sequencing of the V3 domain of the env gene. RESULTS: There were no significant differences in the rate of CD4 cell decline or clinical disease progression between Africans and Swedes over an observation period of 2 years. Similarly, there were no differences in the rate of CD4 cell decline, clinical progression or plasma HIV-1 RNA levels between individuals infected with subtypes A, B, C or D over a mean observation period of 44 months. CONCLUSION: Neither the genetic subtype of the virus nor the ethnicity of the host appear to be major determinants of disease progression.

Evaluation of HIV testing in Sweden, 1985-1991.

OBJECTIVE: Evaluation of the extent and outcome of HIV testing in Sweden. DESIGN: Data from screening programmes, laboratory and clinical reports were compared and a national survey on HIV testing was performed. RESULTS: The proportion found to be positive in screening of blood donors, pregnant women and sexually transmitted disease patients were approximately 1/100,000, 1/10,000 and 1-2/1000, respectively. One-quarter of the men and one-third of the women in Sweden aged 16-74 years reported that they had been tested for HIV at least once. CONCLUSION: There is a high cost involved in detecting HIV-infected individuals through general testing. This cost can be justified if we believe that awareness of an infection substantially reduces the risk of further transmission.

Epidemiology of hepatitis B in Somalia: inference from a cross-sectional survey of serological markers.

Hepatitis B markers were determined by radioimmunoassay in 383 adults from different areas of Somalia and in 135 pregnant females and 428 children from Mogadishu. The highest incidence of HBsAg among adults was among nomadic males (20/85; 23%). The frequencies were lower in males from the agricultural and coastal area, i.e. 16/93 (17%) and 14/98 (14%) respectively. The lowest frequency of HBsAg was among women from the coastal area (6/72; 8%). Among the pregnant women 14 were positive for HBsAg, none of whom had HBeAg. Low levels of positivity for HBsAg were found both among children under 4 years and among those between 4 and 13 years of age - 3/94 (3%) and 5/128 (4%) respectively. In the age group 15-19 years, 50% showed seroconversion from HBeAg to anti-HBe. 7 out of 41 HBsAg carriers of ages over 20 had HBeAg. Early seroconversion from HBeAg to anti-HBe and a low level of HBsAg positivity in children indicate that vertical transmission is not important in Somalia. The low frequency of HBsAg in Mogadishu children may have one of the following explanations: (i) the infection occurs during adolescence, (ii) Mogadishu is a low-prevalence area and the examined adults were not born in Mogadishu, or (iii) a change in hepatitis B epidemiology has taken place in the area during the last 2 decades and the relatively higher prevalence of HBsAg in adults might reflect higher rates of infection in their childhood.

Gender differences in perceived health-related quality of life among patients with HIV infection.

This article explores how a group of human immunodeficiency virus (HIV)-infected patients perceived their health-related quality of life (HRQOL) in relation to their coping capacity expressed as sense of coherence. The emphasis was on gender differences. The sample consisted of 55 women (29%) and 134 men (71%), receiving outpatient medical care in a hospital. Self-report instruments, the health index, the HIV symptom scale, the well-being scale, the sense of coherence (SOC) scale and the Interview Schedule for Social Interaction were used. Disease status (HIV CDC classification, absolute CD4+ lymphocyte count and HIV/RNA) was also measured, and demographic data were collected. The total sample scored significantly worse self-rated health and weaker SOC than healthy controls. The HIV-infected women were significantly younger than the men (p < 0.0001). The majority of the women (60%) were infected by heterosexual transmission and of the men (58%) by homosexual/bisexual contacts. In the univariate analysis the women scored significantly less positive well-being (p < 0.05), weaker SOC (p < 0.05), and less social support (p < 0.01) than the men despite less advanced disease. Multiple regression analyses revealed that SOC was the strongest predictor of subjective HRQOL in both genders. The results suggest that health professionals who individualize their care of HIV-infected patients should try to be sensitive to the different ways in which men and women express their HRQOL.

Screening for HIV-1 antibodies in pregnancy: results from the Swedish national programme.

OBJECTIVE: To determine the effectiveness of a national screening programme for HIV infection in pregnant women. DESIGN: Observational study. SUBJECTS: All pregnant women presenting to antenatal or abortion clinics. SETTING: Sweden, September 1987 to December 1991. MAIN OUTCOME MEASURES: Number and characteristics of infected women. RESULTS: By the end of the study period 510,000 tests had been performed and 54 women with HIV infection identified (1.06/10,000). Of the 33 women identified in Stockholm, 14 women (4.4/10,000) had attended abortion clinics and 19 antenatal clinics (1.8/10,000; p < 0.05). Three women had been intravenous drug users, one was infected through a blood transfusion, and 50 were probably infected sexually. Of the 20 women who attended antenatal clinics early enough to allow an abortion, 12 continued with their pregnancies. CONCLUSIONS: Testing of all women, not just those perceived to be at risk, probably contributed to the high uptake of HIV testing. With high uptake such screening provides valuable data on spread of HIV in the heterosexual population and presents opportunity for preventing transmission of HIV to children and partners.

[Reasons for HIV testing. Casual sexual contacts are the most common reasons for voluntary HIV testing]. / Orsaker till HIV-test. Sexuell kontakt vanligaste skälet till frivillig testning.

In Sweden, voluntary testing for HIV (human immunodeficiency virus)-antibodies has been given an important place in combating AIDS (acquired immunodeficiency syndrome). To elicit the reasons why people seek voluntary testing on their own initiative outside general screening programmes, during a three-year period (1989-91) applicants at a major urban testing locale were asked to fill in an anonymous questionnaire, which was completed by 68.6 per cent (831/1,212) of those eligible. Of the 831 respondees (both men and women), 88.9 per cent cited recent casual sexual contact as the reason why they might be at risk. Although in most cases no particular risk factors were reported to be associated with the sexual contact, in 17 cases (2.3 per cent) the partner was known to be an HIV-carrier. Of 664 people completing the item on the questionnaire 208 (31.3 per cent) reported the sexual contact to have occurred abroad. When the reason for undergoing the test was not possible recent exposure, the commonest reasons given were persistent anxiety or the establishment of a new sexual relationship. Only one of the 1,212 tests performed was HIV-positive.

[Mother-to-child transmission of HIV infections. Antiviral agents and Cesarean section reduce the risk of transmission]. / HIV-smitta från mor till barn. Läkemedel och kejsarsnitt minskar risk för smitta.

There has been a substantial decrease in maternal-infant transmission of HIV in many European and North American countries during the past five years, from 15-25 per cent to approximately 5%. Reasons include the prophylactic administration of zidovudine to mother and child, more effective treatment strategies leading to decreased viral load during pregnancy, and increased use of elective Caesarean section. In developing countries however, the vertical transmission rate of HIV is still high at 25-40 per cent. Simpler and less expensive prophylactic regimens, such as nevirapine to mother and child at delivery and after birth, respectively, have raised hope. Drug resistance and the risk of adverse effects of antiretroviral drugs on the child are threats to the prevention of mother-to-infant transmission of HIV.

[Children of HIV-infected women. An exposed group]. / HIV-infekterade kvinnors barn. En utsatt grupp.

PIP: In order to describe the social situation of children of HIV-infected mothers, an investigation was carried out between November 1991 and February 1992. A questionnaire inquiring about children (under 18) of HIV-infected mothers was sent out to all HIV treatment wards in Stockholm and institutes engaging in family and social care. The mothers (21-45 years old, average age 32 years) were divided into 4 groups: 1) known or probable infection through sexual contact in Europe (mainly in Sweden), 2) known or probable infection through sexual contact in the rest of the world (mainly in Africa), 3) infection via blood products, and 4) infection via intravenous drug abuse. Data were received about 92 living mothers and their 144 children under 18 years of age. Almost two-thirds of the mothers' infection were known to be or probably sexually transmitted, and of these more than two-thirds were from countries outside Europe, mainly from Africa. Only 32% of mothers were infected by IV drug use, and the remaining 6% via blood products. 24% of all children had mothers with an advanced stage of the disease (AIDS or severely reduced immune response). All children 11-18 years old were HIV negative, while 10 children of 105 who were under 11 years of age were infected with HIV, and 15 had a still undetermined HIV status. In all, 63% (91/144) of children had a known living father, 40% of whom (36/91) were infected with HIV. 40% of all children (58/144) had regular contact with their fathers, while only 1 child of 20 children who were under guardian care had regular contact. 74% of the children faced the risk of being left without parents.^ieng

[The year of the world aids day: children in a world of AIDS]. / Arets världsaidsdag: barn i en värld med aids.

PIP: "Children living in a world with AIDS" was the theme of a UNAIDS campaign launched because 1 million children are infected with HIV and 9 million children have become orphans due to AIDS (90% in sub-Saharan Africa). During 1996 alone, 400,000 children were infected: 90% were infected during pregnancy, delivery, or while breast feeding; the remaining 10% were infected sexually or via blood or blood products. In Africa, only one-third of HIV-infected children survive their 3rd birthday, and 8% of all children in Zimbabwe have lost their mothers to AIDS. A similar situation is rapidly evolving in Asia and South America. In Spain and Italy, more than 600 children have AIDS; most of them were infected through drug-abusing mothers. In France the figure is comparable, but here a large segment is represented by children of mothers from African countries. The total number of children with AIDS in the European Community is 2800: 86% were infected through their mothers. Romania has 4000 children with AIDS, who were predominantly infected via nonsterile syringes and blood transfusion. The European Commission has a specific AIDS prevention program, which addresses the measurement of disease spread, counteracting the disease, information and education, support for persons with HIV/AIDS, and countering discrimination. The risk of mother-to-child HIV transmission can be reduced from 25% to 8% by zidovudine (AZT) treatment during pregnancy and delivery.^ieng