Detection of human immunodeficiency virus-1 DNA, RNA and antibody, and occult blood in inactivated saliva: availability of the filter paper disk method.

Eighty three samples of saliva were collected from 60 subjects who were asymptomatic carriers of AIDS related complex (ARC) and AIDS. They included hemophiliacs, homosexuals and heterosexuals. Occult blood, human immunodeficiency virus-1 (HIV-1) antibody and DNA were assayed after heat treatment at 56 degrees C by strip method, particle agglutination and polymerase chain reaction (PCR), respectively. HIV-1 RNA was assayed by reverse transcription (RT)-PCR after heat treatment at 56 degrees C or 90 degrees C, or after application to filter paper disks with drying and heat treatment at 90 degrees C. Positive results were found in 53% (occult blood), 73% (HIV-1 antibody), 23% (HIV-1 DNA, 56 degrees C), 34% (HIV-1 RNA, 56 degrees C), 33% (HIV-1 RNA, 90 degrees C) and 25% (HIV-1 RNA, 90 degrees C, filter paper disk), respectively. The results did not depend on the stage of the disease or the route of infection. Other studies have reported the use of the filter paper disk method to detect antibodies against HIV and HIV genomes in blood samples. The present study demonstrated that it could also be used for the detection of HIV genomes in saliva samples.

[Between isolation and new hope: the psychosocial status of HIV-infected women]. / Zwischen Isolation und neuer Hoffnung: Die psychosoziale Situation HIV-infizierter Frauen.

HIV-infected women were an increasingly larger group among the risk groups in Germany. In order to illuminate the psychological situation of HIV-infected women in Germany, 100 women with HIV disease were enrolled in a basic study. 72% of the patients were intravenous drug addicted, 28% were infected through other means. The study population comprised patients of all stages of infection. We found 52% in the first stages, 28% in ARC and 20% with AIDS. Evaluated data included medical, socio-demographic, and data regarding the patients' history of drug abuse. The SCL-90-R, a psychological symptom inventory, was applied. Questions about differences between the two groups of HIV-infected women (iv drug addicted vs non-drug addicted) were answered first. Second, we described three clusters of HIV infected women with regard to different levels of psychological distress. Important factors to distinguish between these clusters are the subjective impact of physical distress (e.g. suffering from HIV-associated symptoms) and loss of joy and interest in sex. In order to illuminate the psychosocial situation, we discuss the specific situation of three patients.

Quantitation of human immunodeficiency virus in vertically infected infants and children.

We used a quantitative human immunodeficiency virus, type 1 (HIV-1) culture method to determine whether there is a relationship between the amount of replicating virus in the blood of vertically infected children and the relatively short latency period before development of symptomatic disease in these children. HIV-1 titers were determined by end point dilution in the peripheral blood mononuclear cells and the plasma of 30 infected (CDC class P1 and P2), 36 indeterminate (CDC class PO), and 19 uninfected (CDC class P3) infants and children born to HIV-1 seropositive mothers. HIV-1 was recovered from 35 (90%) of 39 PBMC cultures and 23 (60%) of 38 plasma cultures of infected patients not receiving antiretroviral therapy. The mean HIV-1 titers tended to be higher in patients with more advanced disease (P2, D, E, or F: 1760 TCID/10(6) PBMC, 460 TCID/ml plasma) than in asymptomatic or mildly symptomatic patients (P1; P2, A or C: 90 TCID/10(6) PBMC; 60 TCID/ml plasma). A poor correlation between HIV-1 titers and serum p24 antigen levels was found. No correlation was observed between viral titers and relative or absolute numbers of CD4 lymphocytes. Plasma virus titers were lower in 9 patients receiving zidovudine (ZDV) therapy (mean 2 TCID/ml) than in untreated patients of similar clinical status. The viral titers measured in the blood of vertically infected infants and children were on the same order of magnitude as the viral titers measured in HIV-infected adults. We conclude that the relatively rapid progression to symptomatic disease of the majority of vertically infected patients is not due to a higher load of replicating virus in blood.

The important role of mass media in the diffusion of accurate information about AIDS.

This paper explores the vital role of mass media in diminishing the lack of consensus among those at risk for AIDS and those who treat them. It examines the perceptions of these groups with regard to the seriousness of the AIDS threat, what people at risk are really doing to protect themselves and others, and the accuracy and objectivity of media reports about AIDS. Results indicate that there is a disarming lack of consensus among those people who can do the most to influence the spread of AIDS. Results also indicate that those people at greatest risk for AIDS and for spreading the disease distrust the accuracy and objectivity of the media. The authors argue that consensus is required for a concerted fight on AIDS and that the mass media offer an effective avenue for encouraging it. They also explore methods for regaining media respect among high risk groups with regard to AIDS reporting.

[AIDS and pedodontics: the real risk and its prevention]. / AIDS e pedodonzia: rischio reale e sua prevenzione.

The daily increase in carriers of the AIDS virus (150,000 is the latest estimate for Italy) means that the dentist must pay the utmost attention in selecting cases at risk and in defending himself from the possibility of contagion. Albeit to a lesser extent, the pedodontist is also involved in this problem. Here situations in which the risk of contagion is greatest because of the patient's social position or associated pathologies and the difficulty of the operation required are reported and some indications are offered to guide the pedodontist's professional behaviour.

Update on the virology of AIDS

This article looks at the history, development, progress and research of the Human Immunodeficiency Virus (HIV) which causes AIDS. The author reports of the ongoing research into a vaccine for HIV, he examines the viral life cycle and indicates the points at which the virus can be attacked, and classifies antiviral strategies

Epidemiology of human immunodeficiency virus in families in Lusaka, Zambia.

Persons living in the same household as index patients with AIDS or ARC in Lusaka, Zambia were clinically and serologically evaluated for HIV-1 infection. In the 150 households of male index cases, 92 (61.3%) of their spouses were infected, compared with 57 (73.1%) of the spouses of the 78 female index cases. The more advanced the clinical stage of illness in the index cases, the greater the probability of HIV infection in the spouse (RR = 4.44), and the more likely the spouse was symptomatic. Four of the 11 spouses who seroconverted to HIV had also had sexual intercourse at a time when their HIV-infected partner had genital ulcers (RR = 7.45). Of 144 children under 5 years of age, 36 (25.0%) were infected, all had infected mothers and were the last to be borne in all but one household. Three of 120 children 5 to 10 years of age were also infected, presumably through perinatal transmission. Forty-six of 52 discordantly infected couples followed for 1 year continued to have unprotected vaginal intercourse, and 11 (21.2%) of these seroconverted to HIV. There were no HIV infections that could be attributed to transmission by other means than heterosexual intercourse between spouses or by perinatal infection in children borne of infected mothers. The study suggests that there is an increasing risk of HIV heterosexual transmission as infection progresses in the infected partner, and that more effective counseling is needed to prevent it.

PIP: An investigation of members of households of patients with acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC) in Lusaka, Zambia, revealed a high rate of human immunodeficiency virus (HIV) infection in marital partners, regardless of the sex of the index case. The study, conducted in August 1985-June 1987, involved individuals in 244 households of index patients diagnosed with AIDS or ARC. 92 (61.3%) of the 150 male index cases and 57 (73.1%) of the 71 female index cases had an HIV-infected marital partner, and the severity of HIV disease (AIDS or ARC) in the index partner was linearly associated with the severity of HIV disease in the spouse. 10 (25.6%) of 39 uninfected wives of HIV-positive men compared with only 1 (7.7%) of 13 uninfected husbands seroconverted during the 1st year of follow- up. 4 of the 11 spouses who seroconverted during this period reported sexual intercourse at a time when their HIV-infected partner had genital ulcers. Of the 264 children under 10 years of age from 154 households with an HIV-positive adult who were also evaluated as part of this study, 39 (14.8%) were infected--26 had ARC and 13 had asymptomatic infection. Only 3 of the infected children were older than 5 years of age; the mean was 24.9 months. In all cases, transmission in children was attributable to HIV infection in the mother. These findings suggest a need for more aggressive counseling to reduce the sexual transmission of HIV infection to uninfected partners. 46 of 52 discordantly infected couples followed for 1 year continued to have unprotected vaginal intercourse--a factor that certainly contributed to the high concordance of HIV infection among the couples in this study.

AIDS-related illness and AIDS risk in male homo/bisexual substance abusers: case reports and clinical issues.

Little has been written about the treatment of substance use disorders among seropositive HIV patients or high-risk seronegative substance abusers. Demographic and clinical characteristics, along with treatment issues, were examined based on experience with 18 patients in a substance abuse program in a university medical center (3 AID, 3 ARC, 9 seropositive only, and 3 seronegative high risk). Scores on a substance abuse rating scale were extremely high. Most of them abused three or more different substances, had used drugs parenterally, had more than 50 sex partners, and/or had received previous substance abuse treatment. Affective disorder, suicide attempt, and antisocial personality were frequent in this group. About half of the patients complied with treatment and showed improvement in their substance disorder. Several common themes in the management of these patients are described.

Antibodies to HIV2 in genital secretions.

In order to study the local immune response to HIV2, three exclusively heterosexual, infected West African patients were selected: one male with full blown AIDS, one female with ARC and one healthy HIV2-carrier female. Sera and genital secretions were obtained and tested for anti-HIV2 IgG and IgA antibodies by Western blotting. In semen and in vaginal secretions, IgG antibodies directed against all viral antigens were detected. In comparison with the IgG response, local IgA antibody response was less intense and heterogenous. Two out of 3 patients had local antibodies of the IgA class directed against the envelope glycoprotein GP105. Such antibodies of both the IgG and IgA classes in genital secretions could play a protective role in heterosexual transmission of HIV2.

Infectiousness of HIV between male homosexual partners.

To estimate the risk of transmission of HIV per receptive anal sexual contact, 329 homosexually-active men, representing 155 sexual partnerships, were enrolled into a study. Information on HIV infection status and sexual behavior within and outside the primary relationship was collected. Of these 329 men, 24 had AIDS and 31 had ARC. Of the 155 couples, 35 consisted of partners that were both HIV +; 62 of partners that were both HIV-; and 58 were discordant. A binomial model was fit to data obtained in the first visit to estimate per contact risk of HIV transmission. Assuming a constant risk of transmission per sexual contact between infected and uninfected partners, the estimated risk is about 5 to 30 per 1000 receptive anal exposures to ejaculate. Although the average risk of HIV transmission per sexual contact appears to be low, there appears to be great variability in infectivity. To model this variability over time and across individuals, more complex models must be fit to longitudinal studies of sexual partners.

Main routes of transmission of human immunodeficiency virus (HIV) infection in a family setting in Palermo, Italy.

A cross-sectional seroepidemiologic study was carried out on household contacts and sexual partners of human immunodeficiency virus (HIV) antibody-positive intravenous drug abusers in Palermo, Italy, in 1985 to evaluate factors that influenced HIV transmission. A total of 43 index cases, 36 spouses or heterosexual partners, 28 children, and 55 adult household members were enrolled. None of the household members without sexual contact, who had shared items and facilities and had interacted with the index cases, contracted HIV infection. However, six of 36 sexual partners had antibodies to HIV. It was observed that the risk of HIV infection was significantly associated with the frequency of sexual intercourse with the seropositive partner. Four children were also found to be infected: two had acquired immunodeficiency syndrome-related complex, and the other two were clinically and immunologically normal. Furthermore, one other child had evidence of passive transfer of maternal antibodies. The infection was confined to the younger children (ranging in age from eight months to three years). The data support a high rate of vertical transmission from mother to infant, an intermediate rate of transmission to sexual partners, and no transmission attributable to household contact.

[A case of AIDS-related complex (ARC/LAS) in a health worker]. / Considerazioni su un caso di sindrome correlata alla AIDS (ARC/LAS) in una operatrice sanitaria.

A case of ARC/LAS syndrome in a student nurse accidentally pricked by an infected needle is reported. This case-report is published to encourage the recognition of hospital staff.