Metas de desarrollo de la Cumbre del Milenio: Progreso en Bolivia / Development goals of the millenium summit: Progres in Bolivia

Este iforme resume y actualiza la información que entregó el libro "Remontando la pobreza" y rescata otras iniciativas de colaboración que se vienen desarrollando entre el Sistema de la Naciones Unidas, el Gobierno de Bolivia y otros asociados del desarrollo. Es un medio para establecer, medir y alcanzar las metas de reducción de la pobreza y, junto a los informes nacinales de otros países

[The possibilities of using immunological indices as criteria for determining the stage of HIV infection and the disease prognosis]. / Vozmozhnosti ispol'zovaniia immunologicheskikh pokazatelei v kachestve kriteriev opredeleniia stadii VICh-infektsii i prognoza zabolevaniia.

The authors studied the immune status of 14 HIV-infected patients, 6 of whom had lymphadenopathy, 4 were diagnosed as having AIDS-related complex and 4, a full-blown AIDS. Analysis of laboratory findings showed that of predictive value are serum levels of immunoglobulin B, a CD4 cell count less than 200, reduced populations of CD20 and CD16 lymphocytes, and a depressed response to pokeweed mitogen. Based on the clinical manifestations and laboratory results, three stages characterizing the immune system in HIV infection have been identified.

Unusual skin pigmentation in a patient with human immunodeficiency virus (HIV) infection.

Diffuse addisonian hyperpigmentation in a male patient with acquired immunodeficiency syndrome related complex (ARC) is described. The etiology of pigmentation in this patient remains obscure but is most probably related to the H.I.V. infection. Other causes of addisonian hyperpigmentation are considered less likely.

[T4 lymphocytes (helper cells) and T8 lymphocytes (cytotoxic and suppressor cells) in patients with asymptomatic and symptomatic HIV infection]. / Limfocyty T4 (pomocnicze) oraz T8 (cytotoksyczne i supresorowe) u pacjentów z bezobjawowym i objawowym zakazeniem HIV.

250 determinations of lymphocyte T subsets in 130 HIV infected patients (79 asymptomatic carriers or with lymphadenopathy, 31 ARC- and 20 AIDS-patients) were analyzed as to the percentage, number, and ratio of T4 (helper) and T8 (cytotoxic/suppressor) lymphocytes in sequential clinical stages of HIV infection. Asymptomatic HIV carriers or patients with lymphadenopathy were found to have statistically significant higher counts of erythrocytes, platelets, total lymphocytes, percentage and number of T4 lymphocytes and T4/T8 lymphocyte ratio than the ARC-patients. Persons with ARC in comparison with AIDS-patients were found to have significantly higher values of erythrocytes, platelets, leucocytes, total lymphocytes, T4 lymphocytes, percentage and count of T8 lymphocytes and T4/T8 lymphocyte ratio. In AIDS patients a statistically significant correlation was seen between number of T4 lymphocyte and number of erythrocytes, platelets, total number of lymphocytes and value of T4/T8 lymphocyte ratio.

Human immunodeficiency virus (HIV) infection codes and new codes for Kaposi's sarcoma.

These addenda for Volumes 1 and 2 of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), are reported by the World Health Organization Collaborating Center for Classification of Diseases for North America at the National Center for Health Statistics. These addenda replace the addendum containing codes for human immunodeficiency virus (HIV) infection (042.0-044.9) that were effective January 1, 1988. These addenda will be effective October 1, 1991, and are the second revision of these codes for the classification of HIV infection. These addenda incorporate minor changes in content of the classification reflecting new scientific knowledge. The structure of the classification, the codes within the classification, and the manner in which the codes may be used remain unchanged. These changes are effective only for morbidity purposes; the cause-of-death codes are unchanged.

Serological markers as prognostic criteria for the course of HIV infection.

576 serum samples from 139 HIV infected patients were analyzed for the presence of HIV antigens, as well as anti-core, anti-env and neutralizing antibodies. The results were correlated with the clinical and immunological stages of the patients. While almost all sera were positive for anti-env antibodies, only two thirds of the same sera had antibodies to core proteins. The average antibody titres, particularly of anti-core antibodies, decreased with the onset of clinical symptoms. The presence of p24 antigen could be demonstrated in only 16% of the sera. A positive reaction for core antigen seemed to be correlated with the absence of anti-core antibodies. Env specific neutralizing antibodies were found to be present in all of the sera analyzed in the LC5-test with a maximum neutralizing capacity observed in sera from WR 4 patients. A useful serological marker must fulfil two criteria, namely positive reactivity in the majority of sera examined and a broad range of antibody titres. None of the above described parameters meet these demands. Here we describe the search for new antibody markers, for example antibodies directed against HIV regulatory proteins.

[Histologic classification of HIV-1 induced lymphadenopathy. Current results on the pathogenesis of germinal center changes]. / Histologische Klassifikation des HIV-1-verursachten Lymphadenopathie. Beiträge zur Pathogenese der Keimzentrumsveränderungen.

At the IV International Conference on AIDS in Stockholm, a Symposium on the pathology of HIV-related diseases was organized. During this Symposium the "European Study Group on HIV-Pathology" presented a histological classification of lymph node alterations seen in HIV-associated lymphadenopathy. The goal of the Study group was to offer a common terminology for histologic changes previously described with different terms by different authors. In the present review the most important histological criteria used in the proposed classification are summarized. Since the classification is based on the conspicuous changes of the follicles, a brief review of the possible pathogenic mechanisms leading to disintegration of the germinal centers will also be given.

Quality of life as a function of HIV classification.

The purpose of this research was to identify variables related to life quality for persons with Human Immunodeficiency Virus Infection and to ascertain if life quality differs according to the classifications of a positive serologic test for HIV antibodies (HIV+), AIDS-related complex (ARC), and Acquired Immunodeficiency Syndrome (AIDS). A convenience sampling technique was used to obtain subjects from AIDS support groups and affiliated agencies in a major southwest urban area. Ninety-five HIV-infected subjects completed a demographic data sheet, the Sickness Impact Profile (SIP), and the Symptom Distress Scale (SDS). The majority of subjects (59%) listed AIDS as their category of diagnosis, 25% were HIV+ only and 16% identified ARC as their disease classification. Subjects had SIP and SDS scores which indicated HIV-infection significantly affected their quality of life. Multivariate results indicated that quality of life indicators varied as a function of HIV classification. HIV-infection had the greatest disruption in psychosocial aspects of life. The impact of HIV-infection (both physical and psychosocial) was greatest in subjects with ARC and least among subjects who were HIV+ only.

[The clinical classification of the acquired immunodeficiency syndrome]. / O klinicheskoi klassifikatsii sindroma priobretennogo immunodefitsita.

Standard HIV infection classifications are reviewed. They are considered impracticable for complexity, insufficient specificity, difficult application. The original clinical experience with a group of AIDS inpatients allowed the authors to propose a new scheme of detecting adults infected with HIV.

Neuropsychometric performance of asymptomatic HIV-infected subjects.

The objective of this study was to determine whether there are measurable differences in neuropsychometric performances between HIV-positive asymptomatic subjects and high-risk HIV-negative individuals. We carried out concurrent neuropsychological testing of HIV-positive subjects screened for drug treatment protocols at a clinical research center and HIV-negative subjects seeking confidential testing. Fifty HIV-negative and 33 HIV-positive subjects who did not admit to use of central nervous system (CNS)-active drugs, more than one drink of alcohol per day, or drug use comprised the final group for analysis. A neuropsychological test battery designed to evaluate verbal memory, motor function, orientation and attention was administered to all subjects. In addition, affective state was assessed with the Beck depression inventory. Multivariate analysis of variance indicated no difference in the performance of the two groups. Only one subtest, the Wechsler Adult Intelligence Scale digit span (forward) reached a level of significant difference (P less than 0.05) by univariate analysis. We conclude that neuropsychometric performance of asymptomatic HIV-positive subjects cannot be distinguished from that of high-risk HIV-negative subjects by a battery of traditional neuropsychological tests.

[AIDS-related complex: a superfluous concept?]. / Der AIDS-related complex: Ein überflüssiger Begriff?

The clinical value of different classification systems of HIV-infection has been examined in a cohort of 99 HIV-infected individuals. AIDS-related complex (ARC), Walter-Reed (WR) stage 5 and Centers for Disease Control (CDC) group IV without AIDS cases were equally capable of identifying patients with bad prognosis: Out of 12 patients progressing to AIDS, 9 WR 5, 7 CDC IV and 7 ARC. Prognostic parameters (Erythrocyte sedimentation rate, Haemoglobin, Leucocytes, CD4-lymphocytes and Beta 2-Microglobulin) did not differ in the three groups. However, there were great differences in the frequency of patients infected by homosexual contacts and of intravenous drug-abusers. Drug-abusers were more often seen in the ARC-group, whereas there was a slight dominance of homosexuals in the WR 5-group (and a marked preponderance in the AIDS-group). Using 3 different ARC-definitions we found an ARC-frequency of 10%, 24% and 41% in our cohort. Thus the great variability of the ARC-concept could be demonstrated. In conclusion we believe that for the purpose of clinical documentation and studies the ARC-concept is unnecessary. Further studies have to evaluate other classification systems (Walter-Reed, CDC) or to establish new ones.

Increased suppressor T cells in probable transmitters of human immunodeficiency virus infection.

To evaluate behavioral and immunologic factors related to transmission of human immunodeficiency virus (HIV) by homosexual intercourse, we studied a population of 329 homosexual/bisexual men (155 partner-pairs) seen in a community health center and medical outpatient clinic. Logistic regression analysis showed that behavioral risk factors for infection in the 130 HIV-infected men included: receptive anal intercourse (OR 4.6, 95% CI-1.8, 12.1); receptive fisting (OR 2.5, CI-1.1, 7.0); nitrite use (OR 2.3, CI-1.2, 4.6); history of gonorrhea or syphilis (OR 2.3, CI-1.4, 3.9); and history of sexual contact with men from areas with many AIDS cases (OR 1.9, CI-1.0, 3.5). Comparing seven men who were probable transmitters of HIV and 11 men who had not transmitted HIV to their uninfected partners despite unprotected insertive anal intercourse, we found no differences in HIV isolation from peripheral blood mononuclear cells, circulating HIV antigen detection, or presence of neutralizing antibody to HIV. Helper T-cell numbers were not significantly different between the two groups, but transmitters had more suppressor T-cells than did nontransmitters.

[Natural history and classification of HIV-virus infections]. / Histoire naturelle et classification de l'infection par le virus H.I.V.

Clinical concepts about the acquired immunodeficiency syndrome, are evolving constantly. Laboratory tests are used to prove the infection virologically and serologically, to quantify the importance of immunodeficiency and to give a tentative prognosis. We discuss three classification systems (CDC, Haverkos, Walter Reed). They are more or less precise and suitable. They may indicate the status of the disease, from seroconversion up to opportunistic infections and secondary cancers. Then we compare those different systems of classification, their advantages and disadvantages. These classification systems may change with evolving concepts about the syndrome.

The value of lymph node histology in human immunodeficiency virus related persistent generalized lymphadenopathy.

Histological changes in lymph nodes were evaluated in a prospective study of 124 homosexual men who presented with generalized lymphadenopathy. The histological changes were classified according to a classification system with three stages. HIV antibodies were present in 88% of the patients. The finding of one of the three histopathological stages was highly indicative--although not absolutely pathognomonic--for HIV infection. The subsequent course of HIV infection after biopsy was significantly correlated to the histopathological changes, but it was not possible to evaluate if the biopsy added new information to that already available. Among the group of HIV infected, immediate clinical consequences of lymph node biopsy were not observed (95% confidence limits 0-3.3%). In a retrospective investigation of 123 consecutive AIDS patients, it was found that lymph node histopathology had been able to identify secondary infections and neoplasms among 10%. It is concluded that lymph node biopsy is indicated in the HIV infected patients with unexplained generalized symptoms or with atypical enlargement of the lymph nodes. The prognostic significance of lymph node histology compared to other prognostic parameters of HIV infection, remains to be determined.

Lymphadenopathy in HIV infection: histological classification and staging.

The histological alterations seen in HIV-related lymphadenopathy have been described with different terms by different authors. In order to facilitate comparisons of results from various laboratories, a group of pathologists of the European Lymphoma Study Group (later the European Association for Haematopathology) have proposed a histological classification for the evaluation of HIV related lymphadenopathy. Most observers agree that the morphological and immunohistochemical alterations in the follicles (germinal centres) are the most conspicuous and earliest changes seen. The follicular alterations were therefore used as the basis for the proposed classification. In addition, some features occasionally seen were also included, i.e. angioimmunoblastic hyperplasia, multicentric Castleman-like lesions, and vascular lesions, especially pretumorous and tumorous stages of Kaposi's sarcoma. The proposed classification was used by the members of the group of a collection of lymph nodes compiled from the various centres. The classification was shown to be reproducible and to have clinical relevance in staging of the patients. The prognostic relevance as to the survival of the patients has to be further substantiated by follow-up studies. The proposed classification offers a common terminology for the alterations previously described by different terms by various authors.

[HIV (human immunodeficiency virus) and HIV-associated diseases]. / HIV (Human Immundeficiency Virus) und HIV-assoziierte Erkrankungen.

The discovery of the Human Immunodeficiency Virus (HIV), the characterization of its molecular biology and the development of serologic methods for detecting antibodies have led to a better understanding of HIV-associated clinical syndromes. Recently, the Centre of Disease Control has proposed a classification of HIV-related conditions. This classification forms the basis for this review. It is completed by remarks on antiviral and immunomodulating drugs and its effects on HIV. Difficulties in development of vaccines are discussed.