The psychosocial impact of HIV infection in women.

The aim of the investigation was to study the prevalence of current and past psychiatric morbidity and psychosocial problems in HIV seropositive (HIV +ve) asymptomatic women. A cross-sectional controlled study including 57 HIV +ve women belonging to CDC group II and III (43 intravenous drug users and 14 non-IVDUs heterosexuals) and 23 HIV -ve women (15 intravenous drug users and 8 non-IVDUs heterosexuals) is reported. Outcome measures included, past psychiatric history, current psychological status (Zung Anxiety and Depression scales, Symptom Check List 90-Revised), Social Supports and Locus of Control Scales, and information on changes in work, social and sexual life after HIV testing. Results showed that HIV +ve women differed very little from HIV -ve controls regarding outcome measures and indeed for some variables HIV infected women had lower levels of psychological morbidity. Multiple regression analyses showed that alcohol misuse and a predominantly external locus of control accounted for the 29% of the variance of psychiatric distress (F = 9.23, p < 0.0006). The implications of the findings are discussed.

Factors associated with psychological help-seeking in HIV disease.

The study was aimed at evaluating the psychosocial and psychopathological characteristics of individuals with Human Immunodeficiency Virus (HIV) infection seeking psychological help compared with a sample not seeking help. Two hundred and seventy-one HIV seropositive (HIV+ve) subjects belonging to three transmission categories (90 gay men, 154 intravenous drug users and 27 heterosexuals) who were assessed at their first clinic appointment and offered access to psychological help were studied. Subsequently, it was found that 45 (17%) took advantage of the offer of psychological help, and attended a specialist clinic, while 226 (83%) did not seek help. Stepwise logistic regression analysis was used to establish the characteristics of subjects who received psychological help. Results showed that five factors identified at the time of first clinic appointment were significantly associated with seeking psychological help subsequently: (1) having a current DSM-III-R Axis I psychiatric diagnosis; (2) being single; (3) belief of being affected by a serious physical illness (negative correlation); (4) higher level of education; and (5) no past or current history of substance misuse. The implications of the findings are discussed.

[Reticulated and necrotic purpura (necrotic angiodermatitis type) due to arterial calcifications in chronic renal insufficiency]. / Purpura réticulé et nécrotique (à type d'angiodermite nécrotique) dû à des calcifications artérielles au cours d'une insuffisance rénale chronique.

Hyperparathyroidism secondary to chronic renal failure is often accompanied by metastatic calcification with involvement of the skin. The cutaneous lesions appear to be of two types: in the first there was massive calcification of the skin and the subcutaneous tissue; in the second there was necrotic purpura due to intimal proliferation and medial calcification of the cutaneous arterioles. We report the case of a 75-year-old-woman with osteodystrophy who had painful necrotic ulcer and reticulated purpura of the legs (fig. 1 a, b). The new lesions progressed by lateral extension and central necrosis. Biopsy of the skin underlying the purpuric areas revealed intimal proliferation with narrowing of the lumen (fig. 2 a, 3). The most prominent feature was the considerable intimal and internal elastic membrane calcification in several small arteries (fig. 4 a, 5). Von Kossa's stain showed calcium to be present (fig. 2 b, 4 b). There was no calcification of the tunica media. Serum calcium phosphorus product was increased (table I). Tubular reabsorption of phosphate was abnormally low. The serum immunoreactive parathyroid hormone was normal. An iliac crest biopsy revealed the classical lesions of osteodystrophy. Her skin lesions showed spontaneous resolution without parathyroidectomy: the ulcers were healing within two months. A progressive reticulated necrotic purpura has previously been reported in chronic renal failure with secondary hyperparathyroidism. These black ischemic lesions bear a strong resemblance to those accompany atheromatous necrotic angiodermatitis. The metastatic calcification seen in uremia often involves the media; the present case is the first to be reported with intimal calcification.(ABSTRACT TRUNCATED AT 250 WORDS)