[Referral of drug addicts "in crisis" seen in the emergency room]. / Orientation des patients toxicomanes en crise vus aux urgences.

This survey was conducted to estimate the number of drug addicts seen in emergency care units in the Paris hospitals for a drug-related crisis and to analyze subsequent dispatching decisions made over a 14-day period. Twelve polyvalent emergency units participated in the study. These units cared for 116 drug abusers in a crisis situation during the 14-day study period. After initial assessment, the emergency care physician proposed a transfer center in 74% of the cases. Proposed referral centers included: an ECIMUD (Coordination and medical care team for drug addicts) for 27% of the patients, a psychiatric outpatient clinic for 33%, a CSST (Specialized center for drug abusers) for 2% and hospitalization for 11%. After a second assessment by a psychiatrist or an ECIMUD physician, 53% of the patients with a second assessment were referred to an ECIMUD, 32% to a psychiatric outpatient clinic, and 6% to a CSST; 26% were hospitalized. This survey points out the eminent role of psychiatric outpatient clinics and ECIMUD teams in providing emergency care for drug abusers.

[The health of prisoners]. / La santé des détenus.

In twenty years, the prison population, from the mother country and the overseas departments, has more than doubled, in spite of reprieve and amnesty decisions. This increase is more a consequence of longer penalties than of a rise in the number of imprisoned people The law no. 94-43, dated january 18th 1994, concerning the prisoners' medical care and welfare is an unprecedented health revolution. It comes in addition to provisions from 1986 and 1987 for the programme "13,000" prisons and those endowed with a regional medical and psychological service (SMPR). The prisoners' health must urgently be dealt with and particularly as regards infectious diseases, vaccination check-up, campaign against drug addiction health and nutrition education and dental care. As soon as incarceration has begun, the exist must be prepared and taken into consideration by the different interveners inside and outside the prison, in order to make sure of an efficient medical follow-up. As the number of intervening medical and social personnel, is increasing in prisons, a coordination inside the their walls as well as on the regional and national levels, would prove useful.

In vitro determination of antiviral activity of MS8209, a new amphotericin B derivative, against primary isolates of HIV1.

MS8209, an amphotericin B derivative, was previously reported to be an inhibitor of HIV1 replication in vitro. In the present study, we determined the 50 and 90% in vitro inhibitory concentrations of MS8209 for 9 HIV1 isolates including both zidovudine-sensitive and zidovudine-resistant isolates and the reference strain Lai, using the peripheral blood mononuclear cell (PBMC) assay. We also evaluated the sensitivity of HIV1 replication to MS8209 during primary isolation from PBMCs. An inhibitory effect of MS8209 in PBMC infection was observed either when the drug was only present during the adsorption step or when the drug was initially absent but maintained throughout the culture period; the combination of these two approaches provided the highest inhibition rate. These results indicate that MS8209 can inhibit the replication of HIV1 isolates in PBMCs and suggest that it mainly acts by blocking the virus entry into cells.

Virological markers in the cerebrospinal fluid from HIV-1-infected individuals.

We analysed 127 specimens of cerebrospinal fluid (CSF) from 118 HIV-1-infected individuals at different stages of infection. Intrathecal antibody synthesis was evident in 23 samples tested and was more frequently directed against HIV than against rubella virus, herpes simplex virus, varicella zoster virus or cytomegalovirus. HIV was isolated from only 14% of the 127 CSF specimens, but from 82% of CSF-paired blood samples. HIV antigen was detected in 12% of CSF specimens and 44% of paired plasma samples. Twenty specimens analysed using the polymerase chain reaction (PCR) detected proviral DNA in 75% of CSF specimens. The low rate of virus recovery from CSF was caused by neither the freezing of specimens prior to culture nor therapy. In contrast, virus isolation from CSF was significantly associated with CSF cell count. Virus isolation and antigen detection in CSF were not correlated with either the Centers for Disease Control disease stage or the peripheral CD4+ lymphocyte count, whereas viraemia was significantly associated with a low CD4+ lymphocyte count. Moreover, virus isolation and antigen detection in CSF were not associated with symptoms of subacute HIV encephalitis, suggesting that these markers are not of potential value in the diagnosis of HIV-specific neurologic complications. The value of PCR in this field merits further investigation.

[Socioeconomic aspects of human immunodeficiency virus (HIV) infection in developing countries]. / Aspects socio-économiques de l'infection à virus de l'immunodéficience humaine (VIH) dans les pays en voie de développement.

The assessment of the socio-economical aspects of the human immunodeficiency virus (HIV) infection is difficult because of the relative scarcity of information. This study addresses mainly the socio-economic aspects of the AIDS pandemic in the inter-tropical zone of Africa, which, at the moment, constitutes the epicenter of the disease. In the absence of a possible radical treatment, the HIV infection prevalence should range between 25 and 30 million individuals by the year 2000 in the world, and the number of cases of AIDS, between 5 and 6 million, among which 4 to 5 million in the developing world alone. At the current rate, the overmortality rate related to AIDS in Africa is estimated at 0.1%, which should result in a drop by 30% of the Gross National Products advance (GNP). Each case of AIDS in Africa leads to a loss of productivity of 8.8 years. Already, losses caused by AIDS screening and its medical treatment in five countries of Central Africa should exceed the total amount of the foreign assistance received by each country. The estimated economic weight of the AIDS attendance is 15 to 20 times more heavy for a developing country than for an industralized one. Overcoming economically the cost of AIDS is an objective impossible to reach for deprived countries.

PIP: Tropical Africa is the epicenter of the AIDS epidemic, with an estimated 500,000 AIDS cases and 5 million seropositive individuals as of October 1990. The World Health Organization estimates that 3 times as many persons will be infected by HIV in 1991-2000 as in 1981-90. In the absence of an effective treatment, the worldwide prevalence of HIV infection is expected to reach 20 million adults and the number of reported cases 5-6 million by the year 2000. 400,000 children are estimated to have contracted AIDS since the beginning of the epidemic, in addition to some 8800,000 adults. It is projected that from now to the year 2000, at least 10 million children will be infected by Hiv, 90% of them in sub-Saharan Africa. The direct costs of treating AIDS are enormous and far outstrip available resources in Africa. The annual budget of the principal hospital in Kinshasa is lower than a cost of treating 10 AIDS patients in the US. The funds destined for AIDS prevention programs in Africa and other developing areas are not likely to increase significantly. On the other hand, some indicators such as total condom sales in some African countries suggest that public awareness of protective measures may be growing. The World Health Organization estimates that of 3 million persons affected by both AIDS and tuberculosis, 2.4 million are in Africa. A chemotherapy has been developed that shortens tuberculosis treatment from 12 to 6 months, but its cost, about US $30-50 per person or $200 if hospitalization is required, will further burden health budgets. It will be difficult for Africa to meet the direct costs alone of AIDS, given that annual per capita health expenditures are much lower than the cost of a diagnostic test for HIV infection. The age group most affected by AIDS is 25-45 years. The World Bank estimates that excess mortality related to AIDS in Africa amounts to .1%, which may result in a 30% decline in the progress of the GNP. Each case of AIDS results in a loss of productivity of 8.8 years. HIV prevalence is higher in urban areas and among the upper classes and elites. Airline pilots, physicians and nurses, and members of the armed forces have particularly high rates in some countries. Despite the lack of reliable statistics, the epidemic is known to be spreading into rural areas. The zones of greatest prevalence is in countries bordering Lakes Victoria and Tanganyika, with prevalence nearing 20% of the population. Estimated prevalence is 4-10% among adults in Congo, the Central African Republic, and Zaire. AIDS has reversed the infant mortality declines in many developing countries. It is estimated that expenditures for AIDS diagnosis and medical care in 5 Central African countries exceed their total amount of foreign assistance. Millions of small children will be orphaned, requiring a massive effort to provide support.