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PURPOSE: To determine whether past infection by Chlamydia pneumoniae strain TWAR is associated with asymptomatic atherosclerosis. Previous studies have linked this organism with symptomatic coronary heart disease. SUBJECTS AND METHODS: Between 1986 and 1989, 15,800 men and women aged 45 to 64 years were examined as part of the Atherosclerosis Risk in Communities Study, a prospective cohort study of atherosclerosis being conducted in 4 United States communities. The examination included B-mode ultrasonography of the carotid arteries and an assessment of cardiovascular disease risk factors. Carotid wall thickening (blood-intima to media1-adventitial interface) in the absence of clinical cardiovascular disease was considered evidence of asymptom-tic atherosclerosis. In 1991, IgG antibody titers to TWAR were assayed by microimmunofiuorescence in stored sera from 326 case-control pairs matched by age group, race, sex, examination period, and field center. A titer of 1:8 or higher was considered a positive TWAR antibody response. RESULTS: Seventy-three percent of atherosclerosis cases had serologic evidence of past TWAR infection versus 63% of controls (matched odds ratio 1.76; 95% confidence interval, 1.21 to 2.57). After adjustment for age, hypertension, diabetes, cigarette smoking, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and education, the odds ratio for atherosclerosis was essentially unchanged at 2.00 (95% confidence interval, 1.19 to 3.35). The association was stronger for individuals aged 45 to 54 years than for those aged 55 to 64 years. CONCLUSION: There was a significant crosssectional association between past TWAR infection and asymptomatic atherosclerosis. This organism may be a contributor to the pathogenesis of atherosclerosis.

Intraoral lesions, abnormalities on the tongue or tissues in the mouth and throat, caused by infections have been associated with AIDS and HIV infection from the early stages of the epidemic. Increasingly, HIV disease is being defined by CD4+ and CD8+ T lymphocyte counts. This study examined if there is a relation between T lymphocyte counts and intraoral lesions. HIV-infected individuals, enrolled in a drug study, underwent oral examinations between January and December 1989. Up to four examinations were performed during the study period. T lymphocyte counts were averaged for a given time frame covering a period just prior to the first examination, and for later examinations, for a period between the prior and present examination. A total of 106 patients participated in the study and were examined at least once. Of the 106 participants, 88 percent participated in the second examination, 72 percent in the third, and 56 percent in the fourth. Oral lesions were seen in 38 patients (36 percent) at some point during the study. CD4+ and CD8+ counts did not differ significantly for patients who did not have lesions and those who did. At the first examination, oral lesions were seen in 25 percent of the patients. For subsequent examinations, the rates were 19, 15, and 20 percent. The most commonly seen lesions were ulcerative lesions and hairy leukoplakia. CD4+ counts were stable until after examination 4. CD8+ counts increased slightly by examination 4. When data on T lymphocyte counts performed before and after the examinations were compared with examination results, a relation was found between an elevated CD8+ count before the examination and the presence of an oral lesion at the examination. This relationship remained unchanged when smoking and alcohol use were considered. These results indicate that information on changes in CD8+ counts may be useful for preventing or managing HIV-related oral lesions. (Consumer Summary produced by Reliance Medical Information, Inc.)

OBJECTIVE: To assess racial differences in the use of antibiotics, including penicillins, erythromycins, tetracyclines, sulfas, and cephalosporins.DESIGN: Population-based surveys, conducted from 1985 to 1987.SETTING: The seven-county metropolitan area of Minneapolis-St. Paul, MN.PARTICIPANTS: 3127 whites (response rate 68 percent) and 1047 blacks (response rate 65 percent), aged 35–74 years.RESULTS: White women (26 percent of 1625) were more likely to report having taken an antibiotic in the past year than were white men (18 percent of 1502), black women (18 percent of 590), or black men (15 percent of 457). Reported antibiotic usage decreased with increasing age. Black men were more likely than white men to report the use of tetracyclines or sulfas; otherwise, white men reported higher usage prevalences. White women reported higher usage prevalences of all drug classes than black women.CONCLUSIONS: Significant independent predictors of antibiotic use were younger age, white race, and female gender. Potential explanations for these differences include differences in patient access, physician-prescribing behaviors, or both.