HIV-1 genetic subtype A/B recombinant strain causing an explosive epidemic in injecting drug users in Kaliningrad.

OBJECTIVES: To investigate the molecular epidemiology and genetic structure of the virus strain(s) causing an outbreak of HIV-1 infection in the Kaliningrad province of the Russian Federation and to investigate the relationship of this outbreak to some other emerging HIV-1 epidemics in the countries of the former Soviet Union. DESIGN: A molecular epidemiological investigation was conducted in the city of Kaliningrad amongst individuals recently diagnosed as HIV-1-positive. Samples were also collected from neighbouring Lithuania and from the Ukraine. METHODS: Incident and population data was collected from official health statistics in Kaliningrad. A standardized questionnaire was administered to newly diagnosed individuals to assess risk factors for HIV-1 infection. For genotyping, two regions of the virus (env C2-V3 and gag NCp7) were directly sequenced. RESULTS: The number of newly diagnosed individuals testing seropositive for HIV-1 infection in Kaliningrad rose from less than one per month to more than 100 per month during the period of July-October 1996. A total of 1335 new infections were identified between 1 July 1996 and 30 June 1997. The main reported risk factor for HIV-1 infection (80%) was injecting drug use, in particular with a locally produced opiate. Sequence analysis of patient viruses in Kaliningrad (n = 50) showed that the epidemic was caused by a highly homogenous HIV-1 strain, recombinant between the genetic subtypes A and B. Comparison with subtype A strains prevalent amongst injecting drug users (IDU) in the Ukraine showed that one of these strains was the direct subtype A parent of the epidemic A/B recombinant strain in Kaliningrad. CONCLUSIONS: The HIV-1 epidemic in Kaliningrad probably started from a single source, with rapid spread of the virus through the IDU population. The origin of the epidemic strain is a recombination event occurring between the subtype A strain virus prevalent among IDU in some southern CIS countries, and a subtype B strain of unknown origin.

Optimum treatment of genital warts.

Genital warts (condylomata acuminata) must be treated and controlled carefully because of their frequent relapses and the risk of malignancy. Treatment is by destruction of the lesions. The most frequently used treatment for external warts is podophyllin 20% in ethanol which is applied to the affected area and then carefully washed off after 4 to 6 hours. The effectiveness of this method of treatment varies between 20 and 98%, with the warts generally disappearing in 3 to 4 days. If podophyllin is ineffective or is contraindicated (e.g. in pregnancy), other measures such as surgical removal, electrocautery, cryo-surgery or laser treatment can be used independently or in combination. Other treatments that have been used include topical application of 5-fluorouracil and intralesional or systemic use of interferons. Patients and their sexual partners should be followed for several months after treatment. A Papanicolaou smear should be obtained from women prior to treatment because of the association of human papilloma virus infection with cervical invasive neoplasia.

Evolution of the HIV epidemic in Kaliningrad, Russia.

BACKGROUND: Our earlier epidemiological and virological analysis made in 1997 suggested that in the Kaliningrad region of Russia a rapidly spreading human immunodeficiency virus (HIV)-epidemic among injecting drug users had recently started and that it was caused by an unusual A/B subtype recombinant strain of HIV. Furthermore, it was evident that the societal and health care structures necessary to combat the spread of the infection were not well developed. Since June 1996 more than 2400 HIV-infections have been detected in the region with a population of less than 1 million. Here we report the current situation concerning the epidemic and its risk factors. The information is based on information collected during several visits and from written reports. OBJECTIVES: Whereas almost all cases in the earliest phase of the epidemic have occurred among injecting drug users (IDU), sexual transmission may soon become more common and spread the epidemic into the non-IDU population. We describe here the recent evolution of the epidemic and the various risk factors that seem to contribute to the outbreak. We also describe the current resources that are used for prevention. STUDY DESIGN: Information complementing earlier studies were collected during visits to Kaliningrad from direct observations, interviews with local authorities and official bulletins and written reports by local and national experts. CONCLUSIONS: Local resource building with the aid of international help is urgently needed to alleviate the forthcoming crisis due to clinical consequences of AIDS. Both prevention and patient management require resources that are not available at present. Also, more virological studies should be undertaken to identify the present and future pattern of the epidemic.

Treatment of syphilis with azithromycin.

The efficacy of oral azithromycin (500 mg daily for 10 days or 500 mg on alternate days for 11 days) in 100 patients with seropositive syphilis was studied. Clinical manifestations regressed more rapidly in azithromycin-treated patients compared with patients who received erythromycin or penicillin, and there was also a more rapid reduction in serum antibody levels. In 90.3% of patients, the complete resolution of classic serological tests was observed within 4 months of completion of the azithromycin treatment. The immobilization (TPI) test and absorbed fluorescent treponema antibody tests became negative 12 months after treatment in 40% of patients. After 4 years of follow-up, no symptoms of neurosyphilis or syphilitic changes of visceral organs were observed.

T- and B-lymphocytes in pemphigus vulgaris. A clinico-immunological follow-up study of fifty patients with pemphigus vulgaris.

Peripheral blood T-lymphocytes, studied in 50 patients with pemphigus vulgaris by means of spontaneous (E) and active (EA) rosette-formation, were increased in active disease and gradually returned to normal after achieving clinical remission of pemphigus vulgaris. The portion of B-cells quantified by M-rosette formation was increased in active disease as well (19.9 +/- 3.0% vs. 10.8 +/- 1.6% in controls) (p less than 0.02) but returned to normal immediately after clinical remission was obtained. Levamisole in vitro suppressed E-, EA-, and M-rosette formation in all the patients examined with active disease. The subsets of T-cells in 10 non-treated patients with active pemphigus vulgaris and 5 patients with a long-term steroid maintained remission of the disease were studied using OKT series monoclonal antihuman antibodies. A statistically significant increase in the percentage of OKT3+ cells (p less than 0.05) and a considerable increase in OKT4+ cell count (p less than 0.002) were registered in patients with active pemphigus vulgaris, compared with controls. In five patients with 2-9 years' remission the percentage of OKT3+, OKT4+, OKT5+ and OKT8+ cells did not significantly differ from controls.

Kyrgyzstan: WHO initiated projects on STD control and prevention.

PIP: The constant increase in the incidence of syphilis in Kyrgyzstan, particularly in the country's capital, Bishkek, in the last five years has prompted action by WHO. WHO started a project in January 1998 based on free confidential out-patient treatment of syphilis with benzathine benzylpenicillin by short regimen. Since the initiation of the innovative treatment procedure, there has been an increase in attendance at STD clinics by patients for check-ups and treatment. Exceptions to the outpatient rule are made for pregnant women, children, and other difficult diagnostic cases. The project resulted in a decrease in the incidence of syphilis for 1998 as compared to 1997. Another problem facing Bishkek is the widespread incidence of STDs among sex workers, as seen all over the city. In response to this problem, a project for the creation of a support center that would cater to the medical and psychosocial needs of sex workers was recommended.^ieng

Heparin action in pemphigus vulgaris: clinical and immunologic studies.

Heparin administration to 34 patients with pemphigus vulgaris before the beginning of steroid treatment or in combination with it proved to be therapeutically useful. Its suppressive effect on T- and B-lymphocytes in vitro and in vivo was revealed in the examined patients by the test of rosette-formation.

[When is it possible to discontinue therapy in pemphigus vulgaris?]. / Wann ist es möglich, die Therapie beim Pemphigus vulgaris abzusetzen?

Discontinuation of therapy in pemphigus vulgaris is risky, even after long remission under therapy. In active pemphigus vulgaris, levamisole suppresses the formation of T-cell-rosettes. The change from suppression to stimulation under the influence of levamisole, parallel to the disappearance of pemphigus antibodies seems to indicate that the therapy may be discontinued with all due caution.

[The increase of nuclear DNA in the cells of the malpighian layer in pemphigus vulgaris]. / Die Zunahme der nukleären DNS in den Zellen des Stratum Malpighii bei Pemphigus vulgaris.

A scanning absorbance cytophotometry of nuclear DNA in the cells of Malpighian layer was made of biopsies obtained from the perilesional areas of 23 patients with different severity of pemphigus vulgaris. The quantity of DNA was expressed in relative units of ploidy with regard to peripheral blood lymphocyte diploid nuclei. The ratio of cells with diploid to tetraploid DNA-values in the Malpighian layer of 30 controls was 71.4 +/- 2.5% to 24.6 +/- 2.7% (p less than 0.05). A statistically significant greater number of cells with tetraploid DNA content and a corresponding lower number of those with the diploid value of DNA was revealed in all the examined patients with pemphigus vulgaris. These changes were most pronounced in the group of seven patients in whom the course of the disease was particularly severe. In these patients the mean ratio of the diploid to tetraploid DNA nuclei was 39.2 +/- 0.8% to 54.6 +/- 2.3% (p less than 0.01).

Mucous membrane manifestations of pemphigus vulgaris. A 25-year survey of 185 patients treated with corticosteroids or with combination of corticosteroids with methotrexate or heparin.

One hundred and eighty-five patients with pemphigus vulgaris were treated and followed up over a period of 25 years, from 1962 to 1987, at the Department of Dermatology of Moscow Medical Stomatological Institute. In all these patients the diagnosis was confirmed clinically, histologically and cytologically, and in 152 patients by means of direct and indirect immunofluorescence. The patients were treated with corticosteroids or with a combination of corticosteroids with methotrexate or heparin. The initial manifestations of the disease and their development at the period before the treatment and during therapy were studied. The optimum regimens of the maintenance treatment were investigated including those in 31 patients whom the treatment could be discontinued. The treatment-related complications and 28 cases with fatal outcome are analysed.

Percutaneous absorption of hydrocortisone during exacerbation and remission of atopic dermatitis in adults.

Percutaneous absorption of hydrocortisone was studied in 18 young adults during and after the acute phase of atopic dermatitis using the direct hydrocortisone absorption test. In the acute phase the post-application increase in serum cortisol concentration ranged between 18 and 711 nmol/l (median 125 nmol/l). In remission the increase in serum cortisol ranged between 0 and 114 nmol/l (median 16 nmol/l), which was significantly lower than the rise in the acute phase. In the acute phase of dermatitis, topical hydrocortisone treatment has both a local and a systemic effect, due to percutaneous absorption.

Local involvement of antigen-presenting cells and activated T cells in perilesional and clinically uninvolved skin in pemphigus vulgaris.

Biopsies obtained from both the perilesional areas and clinically uninvolved skin of patients with pemphigus vulgaris (PV) were studied for antigen-presenting cell and lymphocyte phenotype and/or activation phenotype using monoclonal antibodies in avidin-biotin-peroxidase complex staining. Perilesional PV skin contained CD4+ and CD8+ T lymphocytes as the predominant cell type, but cells with a potential antigen-presenting function displaying CD11b phenotype of monocyte/macrophages and, in particular, CD1 phenotype of Langerhans cells were also present. The number of mononuclear inflammatory cells was greater in perilesional than in clinically uninvolved PV skin, and so were the proportions of CD4+, CD8+, CD25+, Ia+ cells (p less than 0.01), and CD1+ Langerhans cells and transferrin receptor positive cells (p less than 0.05). These findings confirm and extend earlier observations on local involvement of immunocompetent cells in PV.