Transfusion-acquired human immunodeficiency virus infection in twelve neonates: epidemiologic, clinical and immunologic features.

Twelve neonates in 3 cohorts received blood transfusions from two donors who were infected with human immunodeficiency virus (HIV). All 12 infants developed laboratory and/or clinical evidence of HIV infection, usually in the first year of life. Ten of 12 infants had serum antibody to HIV when tested between 9 and 42 months of age. The two seronegative infants were severely hypogammaglobulinemic when they were tested. Nine infants developed a variety of illnesses attributable to HIV infection, but only 2 fulfilled criteria for the diagnosis of acquired immunodeficiency syndrome. In follow-up ranging from 2 1/2 to 4 years 5 patients (42%) have died. Four patients had HIV-associated illnesses but recovered and now have few if any symptoms attributable to HIV infection. Three children have never had signs or symptoms attributable to HIV. Immunologic abnormalities were present in all patients; the most consistent finding was a decrease in the proportion of T helper cells. Three patients had severe panhypogammaglobulinemia. The hypogammaglobulinemic infants had significantly lower numbers and percentages of T helper cells compared to the remaining patients (P less than 0.01). We conclude that exposure to HIV via transfusion in the neonatal period results in an extremely high rate of infection with substantial mortality and morbidity, but clinical recovery occurs in some patients. Also hypogammaglobulinemia may be more common in infants with HIV infection than previously appreciated.

Delusions of parasitosis: a review.

Patients who are erroneously convinced that they harbor dermatologic parasites present a diagnostic and therapeutic challenge to the practitioner. Delusions of parasitosis can exist as an isolated psychosis or as part of a much more complicated medical and/or psychiatric illness. To diagnose these patients, physicians must be familiar with the patterns of presentation usually seen in patients with delusions of parasitosis and must be confident that other psychiatric and/or medical conditions that could be causing the symptoms--including true parasitosis--have been ruled out. Clinical signs, such as the presence of cutaneous lesions on exposed and accessible parts of the body (wounds self-inflicted in efforts to extricate parasites with needles, knives, or fingernails), and behavioral signs, such as the collection of bottles and jars purported to contain samples of the parasites, are characteristic. These patients can be rigid, antagonistic, distant, and demanding; they may write long letters to physicians describing their parasites in detail, enclosing drawings or samples. Psychotherapy, with or without confrontational denial, has a reported efficacy of approximately 10%; placebo therapy is usually not recommended. The recent application of a new neuroleptic agent, pimozide, to the treatment of this disorder is controversial and a new neuroleptic agent, pimozide, to the treatment of this disorder is controversial and needs further study. Guidelines for an appropriate approach to patients with delusions of parasitosis include the necessity of identifying medical or psychiatric disease, if present, and of listening carefully to the patient's history.(ABSTRACT TRUNCATED AT 250 WORDS)

Human immunodeficiency virus: seroprevalence in parturients in rural South Carolina.

To establish the prevalence of human immunodeficiency virus (HIV) in the population of childbearing women in a rural South Carolina community, a blinded seroprevalence survey was conducted using all cord blood samples collected during a one-year period at a signal hospital. There were 1,811 live births (57% white, 43% black) during that period. Of the 1,365 samples collected and tested, six (0.44%) were HIV-positive by enzyme-linked immunosorbent assay, and three (0.22%) were confirmed by Western blot analysis. Based on these percentages, we estimate that there are approximately 80 HIV-infected women of childbearing age among the 180,000 residents of our health district. Although the seroprevalence of HIV in our parturients is low, it is somewhat higher than that reported from other rural areas. We therefore recommend counseling and voluntary blood testing for HIV antibodies, with informed consent, for all pregnant women living within our health district.

Thrombocytopenia as the presenting manifestation of human T-lymphotropic virus type III infection in infants.

Three infants between 8 and 9 months of age developed thrombocytopenia resulting from immune-mediated platelet destruction, as evidenced by the presence of serum antibody to platelets and elevated platelet-associated immunoglobulin G in two patients, and abundant bone marrow megakaryocytes in all patients. The patients had a satisfactory response to corticosteroid therapy, and platelet counts have remained normal during observation after therapy. All patients had serum antibody to human T-lymphotropic virus type III, and HTLV-III was isolated from the peripheral blood lymphocytes in two patients. The HTLV-III infections were presumably acquired via blood transfusions in the neonatal period; none of the patients' mothers belonged to a risk group for HTLV-III infection, and all were HTLV-III seronegative. Although thrombocytopenia was the major clinical manifestation, the patients had a number of immunologic abnormalities characteristic of HTLV-III infection; these included hyperimmunoglobulinemia, a decreased proportion of peripheral blood T cells, and a marked reduction in the proportion of peripheral blood T helper-inducer lymphocytes. We conclude that the patients had immune-mediated thrombocytopenia caused by HTLV-III infection.

Partner acceptance of health department notification of HIV exposure, South Carolina.

To determine the acceptability of health department notification of sex and needle-sharing partners of persons infected with human immunodeficiency virus (HIV), we administered an anonymous questionnaire to partners notified of their exposure to HIV during the previous 2 years. Of the 202 partners notified, 132 (65%) were locatable and completed the questionnaire. Only 12 (9%) thought they may have been exposed to HIV before health department notification. When the 132 partners were asked if they thought the health department did the right thing in telling them about their exposure, 87% responded "yes;" when asked if the health department should keep notifying persons exposed to HIV, 92% responded "yes." Responses were similar for homosexual-bisexual men, heterosexuals, and intravenous drug users; men and women; and whites and blacks. We conclude that health department notification is acceptable to persons exposed to HIV in this rural South Carolina district.

KIE: To determine the acceptability of South Carolina's policy of notifying the sex and needle-sharing partners of persons infected with HIV, the authors administered an anonymous questionnaire to 132 partners who had been notified by the state health department. Most respondents (87%) thought that the health department had done the right thing in telling them that they had been exposed to HIV. Ninety-two percent thought the health department should continue its notification policy. Only 9% of those surveyed suspected that they had been exposed to HIV before health department notification. Answers to the questionnaire were similar among respondents regardless of race, sex, sexual orientation, or drug use.

Contact tracing to identify human immunodeficiency virus infection in a rural community.

This report describes a contact investigation conducted in rural South Carolina to identify, counsel, and educate persons infected with or exposed to the human immunodeficiency virus (HIV). Starting with one HIV antibody-positive man and his 19 sex contacts, we identified 83 sex contacts of HIV antibody-positive men. Of these, 64 were residents of the county and 63 (98%) agreed to be tested for evidence of HIV infection. Eight (13%) were HIV antibody positive. Thirty-six initially HIV antibody-negative men were reevaluated at a six-month follow-up visit, and three had seroconverted during this time. Of 25 men who reported practicing anal receptive intercourse, 13 (52%) were HIV antibody positive vs none of 43 men who reported strictly anal insertive intercourse. Comparing reported numbers of sexual contacts for the six-month periods before and after our initial investigation, the mean numbers of named sex contacts decreased by 82% for antibody-positive men and 54% for antibody-negative men. None of the men reported using condoms before entering the study; at the six-month follow-up visit, four (80%) of five of the antibody-positive men and 25 (69%) of 36 of the antibody-negative men reported using condoms at least some of the time.

KIE: A report is provided of a contact investigation conducted in rural South Carolina to identify, counsel, and educate men infected with or exposed to the human immunodeficiency virus (HIV). Valuable information was gained about the demographic patterns of persons at risk for HIV in the community studied, and data from the investigation suggest that, at least in the short term, significant behavior change takes place as a result of highly-directed counseling of the high-risk persons identified. Contact tracing in this instance proved relatively cost-effective despite the large amount of professional time devoted to patient counseling. The authors believe that the obvious benefits of direct contact tracing far outweigh the remote risk that confidentiality may be breached.

Notification of the sex and needle-sharing partners of individuals with human immunodeficiency virus in rural South Carolina: 30-month experience.

The authors conducted a confidential and voluntary partner notification program to identify and educate the sex and needle-sharing partners of individuals with the human immunodeficiency virus (HIV) in a rural health district in South Carolina. During the first 30 months, of 485 named contacts, 290 (60%) were residents of the health district and were contacted and offered testing. Of the 290 contacted, 280 (97%)--53 women and 227 men; age range 14-74 years--accepted counseling and testing and 49 (18%) were HIV-antibody positive. Only 3 of the 49 (6%) had been previously tested. All HIV-infected individuals received appropriate physician, laboratory, and public health referrals. During the study, the mean number of sex partners per 6-month period decreased from 5.6 to 1.1 (80% reduction) for HIV-antibody positive persons and from 4.0 to 2.0 (50% reduction) for HIV-antibody negative persons. The authors conclude that in a rural setting, partner notification of HIV exposure can accurately target education and testing and can produce positive behavior change.