Home care for persons with AIds: a case-control study to identify determinants of referral to a hospital-based scheme.

We conducted a multicenter, hospital-based case-control study to identify specific characteristics of AIDS patients which determine referral to hospital care at home. The cases were patients referred to a hospital-based home care scheme, in the metropolitan area of Rome, during 1997. Each case was matched with two controls. Social, demographic and clinical characteristics were collected at referral. Univariate and multivariate analysis were performed. In the study period, 119 cases and 238 controls were recruited. In logistic regression analysis, social characteristics were not found to affect referral to the hospital-at-home scheme. A severely impaired functional status--assessed by the Functional Independent Measure--identified by a score below 100 (Odds Ratio [OR]=15.2, 95% confidence interval [CI] 2.8-82.7), and the need for prolonged intravenous therapy (OR=12.4, 95% CI=3.3-46.3) were the only two independent predictors of home-care referral. We conclude that home care, even in a period when new potent combination antiretroviral therapies are widely available, is an important integrated service component for persons with AIDS with severe functional impairment or requiring intravenous therapy.

Immunological responses of patients with recurrent herpes genitalis.

Immunological responses of patients with recurrent herpes genitalis (RHG) were assayed in comparison to those of patients affected by recurrent herpes labialis (RHL) and to those of normal seropositive and seronegative controls. Total T cells were normal while a significant (p less than 0.001) reduction of cells with helper phenotype was found only in people with RHG, who were also lacking specific cell-mediated immunity (CMI) to herpes simplex virus (HSV) antigen. HSV-type 2 was demonstrated in their active lesions. Number of human NK-1 positive (HNK-1 +) cells was increased in RHG showing an inverse correlation with depressed natural killer (NK) activity. These abnormalities were found irrespective or not if tests were carried out during the active phase of the disease or during quiescence and were confirmed during the 2-year follow-up period to which patients were submitted. Similar abnormalities were found in RHL only during the active phase and reversed to normal during quiescence. Our data indicate the presence of specific cellular and NK unresponsiveness in subjects with severe and long-lasting herpes genitalis.

A preliminary report on the immunological responses after oral vaccine (Ty 21a).

Humoral and cell-mediated immune responses, specific for lipopolysaccharide (LPS), were evaluated before and after oral immunization with the Ty 21a strain of Salmonella typhi in a group of healthy volunteers. No rise in seric and foecal antibody titres, detected by the ELISA technique, was seen after vaccination. On the contrary, we were able to demonstrate the development of specific cell-mediated immunity, as assayed by the leukocyte migration inhibition test, 21 days after vaccination. This conversion was still present 40 days after the last dose of vaccine. We believe that the Ty 21a strain of S. typhi, recently proposed for immunization against typhoid fever and based on the use of live micro-organisms, is effective due to its ability to induce specific cell-mediated immunity.

A placebo-controlled trial of thymic hormone treatment of recurrent herpes simplex labialis infection in immunodeficient host: results after a 1-year follow-up.

Twenty-one immunodeficient patients with recurrent herpes simplex labialis (HSL) were randomly allocated to either the saline or the bovine thymus extract Thymostimulin (TS) group and treated for a period of 6 months. A total of 17 recurrences with a mean severity index of 266.2 +/- 192 in the TS-treated group versus a total of 62 recurrences in the placebo group (score 458.8 +/- 299.6) were observed after 12 months of follow-up. A significant increase of total WBC (P less than 0.05 versus control group), lymphocyte count, and T-cell number (P less than 0.001) were detected in the TS group after 6 months as well as after 12 months. In vitro lymphoproliferative responses to herpes simplex virus antigen and natural killer cell activity were also significantly higher (P less than 0.05) in the TS group, whereas no significant difference in antibody titers to herpes simplex could be detected between the two groups. TS may be potentially useful in preventing viral reactivation in immunocompromised hosts by potentiating cell-mediated immune responses. Further studies evaluating TS for prophylaxis of infection in patients at risk should be considered.

A placebo-controlled trial of thymic hormone treatment of recurrent herpes simplex labialis infection in immunodeficient hosts.

Twenty-one immunodeficient patients with recurrent herpes simplex labialis (HSL) were randomly allocated to either saline or the bovine thymus extract thymostimulin (TS) and treated for a period of 6 months. An impressive reduction in both number and severity of the recurrences of the infection was observed in TS-treated patients during the trial and for up to 3 months afterward. A significant increase in total WBC, lymphocyte count, and T cells was detected in the TS group after 6 months. In vitro lymphoproliferative responses to herpes simplex virus antigen and natural killer cell activity were also significantly higher in the TS group, whereas no significant difference in antibody titers to herpes simplex could be detected between the two groups. TS can therefore help prevent viral reactivation in immunocompromised hosts by potentiating cell-mediated immune responses and should be considered for use in prophylaxis of infection in patients at risk and also in apparently normal subjects with recurrent HSL.

Cellular detection of HBsAg by immunofluorescence in liver of HBsAg positive and negative subjects.

Demonstration of direct immunofluorescence of HBsAg in the cytoplasm and the nucleus of hepatocytes. The study is based on 77 patients: 32 clinically healthy carriers and 45 patients with acute or chronic hepatitis.

A case of posthepatitic HBs-positive chronic hepatitis with transient monoclonal gammopathy.

Report of a case of HBsAg-positive chronic aggressive hepatitis associated with a transient monoclonal gammopathy.