Blood-borne sexually transmitted infections among substance abuse patients in Jamaica

OBJECTIVE: The objective of this study was to determine the prevalence of blood-borne sexually transmitted infections (STI) including the human immunodeficiency virus (HIV), human T-cell lymphotropic virus type-1 (HTLV-1), hepetitis B virus (HBV) and syphillis in residents of a detoxification/rehabilitation unit in Jamaica. METHODS: The records of 301 patients presenting, over a 5-year period, for treatment of substance abuse were reviewed for demographic and laboratory data. The laboratory results were compared with those of 131 blood donors who were used as representative of the general population. The substances used were alcohol, cannabis and cocaine. None of the subjects was an intravenous (IV) drug user. Female substance abusers were at higher risk than males for STI. The prevalence of STI in substance abusers did not differ significantly from that in blood donors (12 percent v 10 percent). The prevalence of syphilis in substance abusers was significantly higher than in blood donors (6 percent v 3 percent; p < 0.05). The prevalence of syphilis was dramatically increased in female substance abusers and female blood donors (30 percent; p < 0.001 and 13 percent; p < 0.05, respectively) compared with males. An increased frequency of HTLV-1 was observed in female compared to male substance abusers. Unemployment was identified as a risk factor for sexually transmitted disease in substance abusers. CONCLUSION: These results support the policy of screening patients in detoxification units for STI and indicate a need for gender specific approaches in the control of substance abuse and STI in Jamaica.(Au)

The significance of immune disorder in tropical spastic paraparesis

The reports of the occurrence of HTLV-1 infection and/or HTLV-1 associated myelopathy (HAM)/tropical spastic paraparesis (TSP) in patients with certain organ-specific and nonorgan-specific autoimmune diseases prompted us to assess the relationship between TSP and humoral autoimmunity. Blood samples from 76 TSP patients, 60 asymptomatic HTLV-1 carriers and 100 HTLV-1 seronegative blood donors were examined for the presence of organ-specific and nonorgan-specific autoantibodies, reactive serological tests for syphilis, immunoglobulin and complement concentrations as well as immunecomplexes. High prevalences of autoantibodies (39/76, 51 percent), reactive serological tests for syphilis (23/76; 30 percent), hypergammaglobulinaemia (69/76, 90 percent) and the complement fixing immune complexes (44/76, 58 percent) were found in the TSP patients. These indicators of immunological disorder were found in statistically significantly lower prevalences in asymptomatic HTLV-1 carriers (12/60, 20 percent; p < 0.001; 6/60, 10 percent; p < 0.05; 32/60, 53 percent; p < 0.001 and 8/60, 13 percent; p < 0.001, respectively) and HTLV-1 seronegative blood donors (8/100, 8 percent; p < 0.001; 3/100, 3 percent; p < 0.001; 15/100, 15 percent p < 0.001 and 5/100, 5 percent; p < 0.001, respectively). The profiles of autoimmune phenomena observed in the patient and control groups revealed that they were associated with TSP rather than mere HTLV-1 infection and consequently pathogenic significance. The array of immunological features present in TSP was suggestive of autoimmune disease resulting from immune dysfunction. Studies which explore the possible existence of HTLV-1 induced autoantibodies with specificity for antigens of the spinal cord in TSP might be useful in elucidating its pathogenesis.(Au)

The HIV/AIDS epidemic in Jamaica

OBJECTIVE:To describe the HIV/AIDS epidemic in Jamaica. METHODS: Data from the national surveillance system for HIV infection and AIDS based in the Epidemiology Unit, Ministry of Health, were reviewed. These include case reports; HIV screening of blood donors, migrant farmworkers and US visa applicants; sentinel surveillance among antenatal clinic (ANC) attenders and sexually transmitted disease (STD) clinic attenders; and various serosurveys. RESULTS: A total of 669 AIDS cases were reported in Jamaica from December 1993 representing a cumulative AIDS case rate of 28 per 100 000 population. Since 1987 the annual AIDS case rate doubled every 2 years with 69 percent of individuals having died with AIDS. Heterosexual transmission predominates with the cumulative adults AIDS male-to-female case ratio declining from 2:8:1 in 1988 to 1:9:1 in 1993. A total of 55 children with AIDS account for 8.2 percent of all cases. The HIV infection rate per 1000 in 1993 was 3.8 among blood donors, 1.4 among ANC attenders and significantly higher among STD clinic attenders (men 6 percent, women 2.7 percent) homosexuals (9.6 percent), female prostitutes (12 percent) and individuals with repeat STD infectious (10 percent). Consistent condom use increased from 27 percent in 1989 to 47 percent in 1993. CONCLUSIONS: HIV infection was introduced into Jamaica from abroad through several different routes including the Jamaican homosexual community, migrant farmworkers, female prostitutes, and informal commercial importers. HIV transmission is well established locally and is spreading more rapidly in Western Jamaica and along the North Coast, which may reflect increase sexual activity associated with tourism. Although awareness of AIDS and HIV is high and condom use has increased considerably, there are no grounds for complacency concerning the HIV/AIDS epidemic in Jamaica.(AU)

Mononuclear cells in sickle cell disease: subpopulations and in vitro response to mitogens

The subpopulations of mononuclear cells and the lymphocyte proliferative capacity following mitogen stimulation were studied in 22 patients with homozygous sickle cell (SS) disease and 25 controls with a normal haemoglobin (AA) genotype. The total number of lymphocytes in peripheral blood samples was higher in SS patients compared to controls. Expressed as a percentage of total lymphocytes, the number of B lymphocytes (detected by membrane immunoglobulin Fluorescence) was normal and of T lymphocytes (identified by sheep erythocyte rosetting) was slightly reduced in SS disease. Expressed in absolute numbers, both B and T lymphoctes were increased. Lymphocyte proliferation measured by tritium labelled thymidine incorporation following stimulation with phytohaemaeglutin A and concanavalin A was normal. Following pokeweed mitogen stimulation, thymidine incorporation was significantly increased in SS disease although normal when expressed as a stimualtion index. These results do not suggest a major defect in cell mediated immunity in sickle cell disease. The number of circulating monocytes was increased in SS disease and correlated inversely with the number of reticulocyytes (r= -0.58, p < 0.005) (AU)

Climate and painful crisis of sickle-cell disease in Jamaica

In a 10-year retrospective study a close correlation was found between low temperatures and hospital admissions for severe painful crises of sickle-cell disease.(Summary)