HIV testing in Denmark: a nominator-denominator study.

In order to describe prevalence and trends of HIV infection, demographic variables, risk factors, and reasons for seeking testing, and self-administered anonymous questionnaire was distributed to approximately 75% of all individuals tested for antibodies to HIV on a voluntary basis, in all parts of the Danish health-care system, in November 1987 and in April 1988. The number of questionnaires returned was 2143 (55%). Overall, HIV prevalence was 1.2% and was highest among homosexual and bisexual men: 6% in November and 9% in April, with no statistical difference. Sixteen per cent of the men reported homosexual behaviour, 7% reported intravenous drug use, and 60% more than one opposite-sex partner within the last 12 months. No substantial difference was observed between reported risk factors in November and April. Overall, 18% had been tested at least once before; this figure rose to approximately 50% among homosexual men and intravenous drug abusers, a substantial number of whom had engaged in risk behaviour since the latest test. Sixty percent of men and 75% of women were tested at general practitioners', and 22% and 13% at sexually transmitted disease clinics; only 6% of men and 3% of women had used alternative test sites. It is concluded that studies of anti-HIV-tested people can give detailed information about patterns of HIV testing and indications of trends in HIV infection rates, thereby supplementing other forms of HIV surveillance.

Immunodeficiency in HIV-2 infection: a community study from Guinea-Bissau.

In a community study in Guinea-Bissau, West Africa, 47 HIV-2-seropositive cases and 87 matched controls were evaluated immunologically using immuno-alkaline phosphatase linked to avidin-biotin complex for the assessment of CD4 and CD8 status. HIV-2-seropositive individuals had significantly lower total numbers of CD4 cells and CD4/CD8 ratios, 38% having a total number of CD4 cells less than or equal to 0.5 x 10(9)/l and 36% having a CD4/CD8 ratio less than or equal to 0.8. Total numbers of CD4 cells less than or equal to 0.5 x 10(9)/l or CD4/CD8 ratio less than or equal to 0.8 were found in 53% of the HIV-2 seropositives compared with 11% among controls [odds ratio (OR) = 7.3; 95% confidence interval (CI): 3.1-17.1]. Lymphadenopathy was significantly more frequent among HIV-2 seropositives than among controls (OR = 3.4; 95% Cl: 1.5-7.6). HIV-2 seropositives with lymphadenopathy had significantly fewer lymphocytes (P = 0.008) and lower total CD4 (P = 0.029) and total CD8 number (P = 0.011) than HIV-2 seropositives without lymphadenopathy. This study indicates that HIV-2 has a significant immunosuppressive effect.

Imipramine metabolites in blood of patients during therapy and after overdose.

Plasma or serum concentrations of imipramine and five of its nonconjugated metabolites (desipramine, 2-OH-imipramine, 2-OH-desipramine, imipramine-N-oxide, and didesipramine) were followed in three cases of imipramine overdose and during steady state in 24 patients on continuous imipramine treatment. In the overdose cases the imipramine and desipramine concentrations declined monoexponentially with t 1/2s of 12 to 21 and 31 to 37 hr. The 2-OH-imipramine and 2-OH-desipramine levels were lower and declined in parallel with their corresponding parent compounds. In the patients on continuous imipramine treatment, the steady-state levels of 2-OH-imipramine and 2-OH-desipramine were very low or immeasurable (less than 15 nmol/l) in five patients. In most patients (n = 18) the hydroxymetabolite levels were much higher with 2-OH-imipramine/imipramine ratios of 0.09 to 0.45 and 2-OH-desipramine/desipramine ratios of 0.36 to 0.86. In one patient there were particularly high ratios (2-OH-imipramine/imipramine, 0.85; 2-OH-desipramine/desipramine, 1.30). The patients with very low hydroxymetabolite levels had considerably higher desipramine levels than the others, indicating that the low metabolite levels were due to poor hydroxylation. In one of these poor hydroxylators a desipramine t 1/2 of about 120 hr was estimated after imipramine discontinuation. With increased imipramine dose the 2-OH-imipramine levels tended to rise little or not at all. Imipramine-N-oxide could only be detected in the overdose cases during the first 6 to 12 hr and didesipramine was generally present only when the desipramine levels were above 200 nmol/l.

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.

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.

Quantitative evaluation of iodine-123 hippuran gamma camera renography in normal children.

In a retrospective study of 39 normal children submitted to [123I]hippuran gamma camera renography, a quantitative evaluation of the recorded data showed that: (a) the rate constant for renal plasma clearance of [123I]hippuran was -0.166 +/- 0.043 min-1 corresponding to a hippuran plasma clearance of 518 +/- 142 ml/min per 1.73 m2; (b) the fractional renal clearance of [123I]hippuran was 0.51 +/- 0.03 and 0.49 +/- 0.03 for the left and the right kidney, respectively; and (c) the mean values for the mean transit times of [123I]hippuran through the whole kidney, the renal parenchyma, and the renal pelvis, respectively, were 4.2, 1.9, and 2.5 min. Five kidneys (in four patients) showed prolonged renal mean transit times of [123I]hippuran. Follow-up renographies were performed in three of the four children and gave normal results. Patients with renal mean transit times above the present 5% significance limit of 8.2 min should not necessarily be considered having an abnormal renal function.

Subtype-specific problems with qualitative Amplicor HIV-1 DNA PCR test.

BACKGROUND: commercial HIV-1 qualitative DNA PCR tests have the potential to detect virus in patients in whom antibody tests may be ineffective, such as patients with primary HIV infection and infants born to HIV seropositive mothers. However, the genetic diversity of HIV-1 raises concern about the ability of the PCR tests to detect all current subtypes. OBJECTIVES: to asses the sensitivity of the Amplicor HIV-1 test on 126 whole-blood samples representing seven different subtypes and to investigate the sensitivity when the standard assay was modified by including the primer pair SK145 and SKCC1B. RESULTS: of the 126 HIV-1 infected persons, 113 were tested positive and 13 were DNA PCR negative. On the basis of these results, the standard Amplicor HIV-1 test had a sensitivity of 90% in our cohort. In addition, 9% of the positive samples showed a low reactivity but above the cut-off of the assay. The standard assay yielded sensitivities of 100% for subtype B (n=16), D (n=9) and G (n=1), but only 83% for subtype A (n=41), 98% for subtype C (n=43), 79% for subtype E (n=14) and 0% for subtype F (n=2). All samples with low reactivity were non-B subtype. Eight of the DNA PCR negative samples, four subtype A, one C and three E were amplified with the modified Amplicor HIV-1 test with addition of SK145/SKCC1B primers. Using this modified protocol, six samples out of eight became positive. However, two samples (one A and one C) remained DNA PCR negative. CONCLUSION: this study confirms that the Amplicor HIV-1 test does not detect all subtypes with equivalent sensitivity and 10% of the samples, tested negative. Thus, it is preferable to add the SK145/SKCC1B primers to the standard test, where infection with non-B subtype is suspected.

Competition ELISA using a human monoclonal antibody for detection of antibodies against human immunodeficiency virus type 1.

A novel competition ELISA for detection of antibodies against HIV-1 was developed. The assay is based on competition at the single epitope level and utilises a human monoclonal antibody and an E. coli-produced fragment of the transmembrane glycoprotein gp41. The sensitivity of the assay was 100% in tests on 247 serum samples obtained from 219 individuals previously shown to be HIV-1 antibody positive by both conventional indirect ELISA and the immunoblotting test. The patients represented various clinical and immunological stages of HIV-1 infection. Likewise, the specificity of the assay was 100% in tests on 105 serum samples from normal individuals previously tested negative by indirect ELISA. Further, among 105 serum samples selected due to consistent false positive reactions in the indirect ELISA only 2 samples (1.9%) demonstrated false positive reactions in the competition ELISA, i.e. 98.1% specificity. Finally, only 2 of 57 (3.5%) serum samples from HIV-2 infected individuals showed positive reactions in the assay, while 54 (94.7%) had absorbance values similar to the negative controls. These results demonstrate that human monoclonal antibodies may form the basis for highly sensitive and specific assays for detection of antibodies to HIV-1.

Human immunodeficiency virus surveillance at a sexually transmitted disease clinic in Copenhagen.

During four study periods, each of 3-4 weeks' duration in 1987 and 1988, all patients attending the Copenhagen outpatient Venereal Disease Clinic were encouraged to have a test for human immunodeficiency virus (HIV) antibody. Anonymous testing or testing for research purposes only without any data was also offered. Patients known to be HIV antibody-positive were not re-tested. A total of 1753 patients (1118 men, 635 women) were counselled and testing recommended. Testing was refused by 255 patients, 57 of whom had been tested (all negative) within the previous 3 months. HIV serology was therefore unknown in 11.7% (198 of 1696 persons), including 120 of 922 heterosexual men (13%), 16 of 159 homo/bisexual men (10%) and 62 of 615 women (10%). There was no substantial difference between the four study periods in the numbers refusing the test. Sixteen of the 1498 patients tested were HIV antibody-positive, including one woman and 3 men with a history of intravenous drug abuse and 11 homo/bisexual men; one heterosexual man with HIV antibodies had no known risk behaviour. It is concluded that HIV testing with informed consent at a sexually transmitted disease clinic will not include all persons, and therefore will not exclude a self-selection bias. Surveillance studies using unlinked HIV testing are therefore necessary and it is recommended that they should be performed in Denmark. In this study, unlinked HIV testing of the serum specimens taken for syphilis serology would have decreased the percentage of 'non-attenders' from 12.4% to 0.8% during the final study period.

Risk behaviours for HIV infection and sexually transmitted diseases among female sex workers from Copenhagen.

In 1990-91, 237 female sex workers from Copenhagen were enrolled in a larger study performed in 9 European countries. None of 206 women accepting serological testing was HIV-infected despite the fact that 36 (17.5%) were injecting drug users (IDU). Whereas 95% of the women always used condoms with clients over the last 6 months, this proportion was 25% and 9% respectively for casual and regular non-paying partners (P < 0.0001 for both comparisons). Those reporting at least one STD over the last year had more non-paying sexual partners than the others (P < 0.01) and the frequency of STD was lower in women who always used condoms with non-paying partners (7% vs 31%, P = 0.01). Women working on the street were more often IDU than others (78% vs 7%, P < 0.001). Independently of drug use, street prostitutes also tended to have more clients (P = 0.007) and more STD (P = 0.05). The striking differences in condom use with clients as compared to non-paying partners and the association between STD and sexual behaviours with such partners but not with clients show that specific interventions should be designed to promote safer sex with non-paying partners.

Heterosexually acquired human immunodeficiency virus infection in women in Copenhagen: sexual behavior and other risk factors.

In order to describe the risk pattern including sexual behaviour among HIV-infected women in Copenhagen we studied the charts of all women tested seropositive between January 1985 and August 1988 in the three main hospitals handling HIV/AIDS. One hundred and fifteen women were positive for HIV antibodies: 35 (31%) were infected by heterosexual contact and 63 (55%) were intravenous drug users. Among the heterosexually transmitted cases 25 (71%) had intercourse with a man from a high risk group and nine women had intercourse with a known HIV antibody positive man without known risk factors. Use of condoms was claimed by 31% of the heterosexually-transmitted women before the HIV test, and by 74% (P = 0.002) after the test. In 1988 73% of the women tested HIV positive were infected by heterosexual contact, in 1985 only 14%. We conclude that among HIV infected women in Copenhagen heterosexual transmission is a problem. These women seem to change sexual behaviour when informed about HIV positivity.

[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.

[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.

[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.