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Background: Patients diagnosed with gonorrhea or chlamydia are at high risk for HIV and syphilis, and should be offered screening for both. Goal: This study measures HIV and syphilis screening rates among Medicaid patients diagnosed with another sexually transmitted disease (STD). Study Design: Using 1998 Medicaid claims data from 4 states, we identified individuals diagnosed with gonorrhea, urogenital chlamydia, or pelvic inflammatory disease, and then measured the proportion receiving screening tests for HIV and syphilis. Results: Only 25% of STD-diagnosed Medicaid patients received screening tests for syphilis and only 15% for HIV. We found significant state-to-state variability in screening rates. Conclusion: Medicaid patients diagnosed with a nonbloodborne STD represent a high-risk group that is not adequately screened for syphilis and HIV despite repeated contact with medical professionals. Interventions should focus on eliminating missed opportunities for screening these high-risk individuals.

Background: Risk factors for HIV infection have been scarcely studied in developing countries. Goal: The goal was to examine the seroprevalence and the risk factors for HIV infection among individuals submitting to voluntary and anonymous testing at counseling and testing centers in Porto Alegre, Brazil. Study Design: In this cross-sectional study HIV infection was diagnosed by enzyme-linked immunosorbent assays (ELISAs) and indirect immunofluorescence. Risk factors for HIV infection were investigated and fitted to logistic regression models according to a hierarchical framework. Results: The overall prevalence of HIV infection was 11.9%. It was greater among homosexual men, individuals with an HIV-positive partner, and intravenous cocaine users. The factors independently associated with risk for HIV infection were: history of detention, homosexual or bisexual orientation, positive VDRL, sex with male prostitutes, HIV-positive sex partner, sex with injectable drug user (IDU), use of cocaine, and sharing needles or syringes. Conclusion: A high prevalence of HIV infection among individuals attending anonymous testing centers was related to sexual behavior and IDU. Other risk factors might be just proxies of true risk behaviors.

HIV transmission, testing and health care staff exposure are discussed.

Introduction With increasing optimism about the benefits of antenatal HIV testing in terms of measures that can greatly reduce the chance of the baby being infected,[1 3] there is a [...]

Background: The advent of effective prophylactic treatments for asymptomatic persons infected with human immunodeficiency virus has led to interest in widespread screening programs. However, the costs of screening programs and therapy are high, and the prevalence of infection above which screening becomes an appropriate use of scarce health care dollars remains undetermined. Methods: To examine the cost-effectiveness of screening in populations with differing prevalences of infection, we developed a Markov model to compare costs and life expectancy for two strategies: (1) screening and prophylactic treatment for infected persons who have or who develop low CD4+ (T4) cell counts, and (2) no screening. Based on studies in the literature, we estimated the prevalence of HIV infection, the rate of T4-cell loss, the rates of developing the acquired immunodeficiency syndrome and Pneumocystis pneumonia stratified by T4 cell counts, the life expectancy with the acquired immunodeficiency syndrome, the efficacy of prophylactic therapies, and costs. Results: In populations with a prevalence of infection more than 5%, which includes known risk groups, screening costs less than $11 000 per life-year gained. In populations with a prevalence as low as 0.15%, screening costs only $29 000 per life-year gained. Even when the efficacy of zidovudine is assumed to be limited to 3 years, screening still costs less than $40 000 per life-year gained in populations with a prevalence of 0.5% or greater. However, in populations with a very low prevalence of infection (two to 10/100 000), such as members of the general population without reported risk factors, screening costs rise to between $290 000 and $1 277 400 per life-year gained. Conclusions: When considering only direct medical benefits, screening for asymptomatic human immunodeficiency virus infection in the general population, without regard to reported risk factors or seroprevalence data, would be expensive. In populations with a prevalence of infection of 0.5% or greater, however, the cost-effectiveness of screening falls within the range of currently accepted medical practices. These results suggest that screening be offered routinely to all persons in defined populations, such as persons receiving care at hospitals or clinics, or residing in geographic areas, where the seroprevalence is 0.5% or more, and underscore the need to conduct seroprevalence studies to identify such populations. (Arch Intern Med. 1993;153:1107-1116)

Infection with the human immunodeficiency virus (HIV) causes the immune system of the individual to produce antibodies against the virus. When antibodies can be detected in the blood of infected individuals, the individuals are considered seropositive. Otherwise, they are seronegative. Sometimes individuals are seronegative but still show clinical symptoms of HIV infection. Individuals who were seronegative but were at high risk for developing HIV infection because of their behavior, such as having high numbers of sexual partners, having sexually transmitted disease, or having sexual contact with a HIV-infected individual, were tested using more sensitive methods for detecting the presence of HIV. One test requires isolating lymphocytes and macrophages, cells of the immune system which are normally infected by HIV, from the individual and growing them outside of the body, in culture. The cells are stimulated to divide by means of chemicals or other cells, and tested to see if virus is produced. A second test detects very small levels of the virus in cells, using the polymerase chain reaction, which amplifies the genetic sequence of the virus to levels that can be detected. None of the 31 individuals tested were shown to be infected with HIV by either of the tests. This study showed that even more sensitive techniques could not detect virus in individuals who were seronegative. This finding is important because it confirms the reliability of using the presence of antibodies as the criteria for infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

The human immunodeficiency virus type-2 (HIV-2) is found primarily in West Africa. However, isolated cases of HIV-2 infections have been found throughout the world. It has been reported that HIV-2 has been brought into Brazil. The presence of antibodies to both the human immunodeficiency virus type-1 (HIV-1) and HIV-2 was examined using 1,821 blood samples collected in 1987 and 1988 from individuals living in Brazil who were at high risk for infection. The samples were examined using various tests to confirm the results. Twenty percent (367 out of 1,821) of the blood samples contained antibodies to HIV-1, indicating infection. Two percent (33 samples) contained antibodies to HIV-2, by one type of testing. However, when the other tests were performed, the samples were shown in fact to contain antibodies against HIV-1 and not HIV-2. The two types of viruses are very similar and antibodies made against one virus can cross-react with the other virus. This study shows the necessity of confirmation of tests for infectivity with HIV-2. It was concluded that there remains no evidence that HIV-2 infections are occurring in Brazil. (Consumer Summary produced by Reliance Medical Information, Inc.)

PURPOSE: The purpose of this voluntary multi-center study was to estimate the prevalence and incidence of human immunodeficiency virus (HIV) infection and the risk of nosocomial transmission of HIV in hemodialysis patients in the United States. PATIENTS AND METHODS: In June 1986, we began collecting epidemiologic data, risk factor information, and serum for HIV antibody testing from long-term hemodialysis patients on entry into the study and 1 year later. RESULTS: Initial data and specimens were collected from 1,324 patients in 28 dialysis centers in 12 states. On entry, 26 were positive or equivocal by enzyme immunoassay; 13 of these were positive by Western blot assay (overall seroprevalence 0.98%). Seroprevalence was higher for patients tested in eight centers located in areas from which a high cumulative incidence of acquired immunodeficiency syndrome has been reported (500 or more cases per 1 million persons) than for patients in other areas (10 of 387 [2.6%] versus three of 937 [0.3%]; p = 0.00048). According to their dialysis records, all 13 of the Western blot-positive patients had received transfusions. Seropositive patients were not more likely to have received a transfusion than seronegative patients (13 of 13 versus 1,038 of 1,311; p = 0.08). The confidential risk factor questionnaire was completed by 1,206 (91%) patients including nine of 13 (69%) of the seropositive patients. A question on sharing needles for injection of drugs was answered by 1,158 patients; seropositive patients were more likely to report they had shared needles than seronegative patients (five of nine versus 17 of 1,149; p = 0.0000002). After 1 year of follow-up, data were collected from 667 patients, including 254 negative patients who underwent dialysis at centers with seropositive patients. None of the previously seronegative patients seroconverted, yielding an incidence rate of 0% (upper limit of 95% confidence interval = 0.45%). No case of possible nosocomial transmission was identified. CONCLUSION: These results suggest that use of long-standing infection control precautions is effective in minimizing the risk of transmission of HIV in hemodialysis settings., Hemodialysis is a method of artificially removing the wastes from the blood of patients with impaired kidney function. The patient is connected to a machine consisting of tubes that filter the blood, removing unwanted waste material. Blood-borne diseases, including hepatitis B, can be transmitted during hemodialysis. The transmission of human immunodeficiency virus (HIV) during hemodialysis has not been reported, but the epidemiology of the two viruses is similar. The proportion of centers performing dialysis for HIV-infected patients has increased from 11 to 25 percent since 1985. Therefore, the prevalence and incidence of human immunodeficiency virus (HIV) infection in hemodialysis patients were investigated, and the risk of HIV transmission during hemodialysis was also determined. The study, which involved 1,324 patients at 28 dialysis centers in 12 states was conducted by the Centers for Disease Control. Thirteen patients were seropositive for HIV infection, or had evidence of HIV disease based on blood testing. Seroprevalence, or prevalence of positive blood tests for HIV, was higher at dialysis centers in areas with a high incidence of AIDS. All 13 seropositive patients had received transfusions, but the likelihood having received a transfusion was similar for seronegative patients. Sharing of needles was reported more often by seropositive than seronegative patients. At one-year follow-up, none of the seronegative dialysis patients tested positive for HIV infection. No cases of transmission of HIV infection during dialysis occurred. These findings show that the use of infection control guidelines is effective in reducing the risk of transmitting HIV during hemodialysis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Kaposi's sarcoma (KS, a skin disorder associated with multiple skin tumors) takes several forms; the most recently recognized form is that associated with AIDS (epidemic KS, or EKS). EKS is typically found in male homosexual patients with HIV (human immunodeficiency virus) infection, where it takes a very aggressive form. In these cases, other organs may be affected, and the patient often deteriorates. The case history of a bisexual man without HIV infection who developed EKS is presented. The patient's initial symptoms were red-brown and purple nodules on the trunk and extremities. Biopsy specimens of a nodule on the back revealed basal cell carcinoma and KS. Additional examinations showed that the digestive tract was affected. Tests for HIV infection were negative. Treatment with a drug used against certain tumors was begun, but new lesions continued to form. The patient began a trial of interferon therapy, which is ongoing. His overall condition remains good. This is the sixth reported case of EKS in a homosexual or bisexual man who does not appear to be HIV-infected. It is possible that a transmissible agent, widespread among homosexuals, causes KS. Such cases as the one described should not be considered AIDS cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

The polymerase chain reaction, which amplifies (increases) the quantity of DNA (the genetic material of the cell), is a very sensitive method for detecting the human immunodeficiency virus (HIV). The DNA is usually analyzed with probes that are radioactive. However, this study describes a method of detection which uses a nonradioactive probe based on the chemical alkaline phosphatase. Mononuclear white blood cells were examined for the presence of HIV using this method. Using blood cells from 59 individuals who were known to have antibodies against HIV in their blood, this method detected HIV in 57 (97 percent) of the individuals. The technique also detected HIV in 11 out of 12 samples that were negative by other diagnostic tests that are normally used to detect HIV. The method described using the DNA polymerase chain reaction is a sensitive method for detecting small quantities of HIV in the tissues of individuals. Various types of cells or tissues can be examined in this way, and large numbers of samples can be tested because the technique is rapid. (Consumer Summary produced by Reliance Medical Information, Inc.)

Heath care employees risk exposure to the human immunodeficiency virus (HIV) as a result occupational mishaps, and chances appear to be high that exposure will result in eventual development of AIDS. Since the discovery that the drug AZT (zidovudine) may be an effective means by which to slow the progression from HIV seroconversion (development of antibodies to the infecting virus) to the development of full-blown AIDS, its usefulness for health care workers has been examined as well. Results thus far have been mixed, but in animals it has been shown that therapy with AZT is effective in modifying the course of infections similar to those caused by HIV. To determine whether or not therapy with AZT might suppress HIV infection in humans, SCID-hu mice, which are immunodeficient mice that have been surgically implanted with human lymph nodes, were injected with HIV and then treated with AZT at different times after infection. It was found that mice treated with AZT within two hours of infection showed no signs of infection after two weeks. Those treated between two hours and 36 hours later showed correspondingly less infection, and those treated after 48 hours showed no suppression in the replication of the virus two weeks after infection. This provides evidence that the time of treatment with AZT with respect to infection with HIV is a critical factor in the ability of AZT to suppress HIV replication. (Consumer Summary produced by Reliance Medical Information, Inc.)

A rational clinical approach is employed to explain the strong interaction present between HIV and the Mycobacterium tuberculosis (MTB) infection. Patients with HIV infection are found to be extremely prone to MTB, as MTB leads to the fastening of the HIV disease.

A new, aggressive strain of HIV has surfaced in New York City. At a press conference held in the city, health officials announced that a highly resistant and rapidly progressive [...]

World Diagnostics, Inc. has won approval from the governments of South Africa and Argentina to supply tests for early detection of HIV/AIDS. The test detects sero-converters, which exist in the [...]

Provider recommendation and free, confidential testing strong motivators Are you talking with sexually active teens about HIV testing? You should be. A recommendation from a health care provider has been [...]

How can you encourage HIV testing among adolescents? First, take a quick look around your facility and see if it qualifies as a 'teen-friendly' place. A 1999 study prepared for [...]

4 Birth-Control Bunglers--Busted Some medications and products can mess with the efficacy of your method, says Lisa Masterson, a gynecologist at Cedars-Sinai Hospital in Beverly Hills, California. To maximize your […]

The benefits of testing pregnant women for HIV are increasingly assured, particularly with regard to reducing vertical transmission.[1] Yet uptake of antenatal HIV testing in Britain remains low.[2] Our previous [...]

CASE REPORT Synopsis: RT-PCR and bDNA assays for HIV-1 yielded different results in a young woman from Cameroon, suggesting she has a non-B clack virus. A PREVIOUSLY UNTREATED HIV-INFECTED PATIENT [...]