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HIV Course

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15681. Synergistic binding of inhibitors to the protease from HIV type 1. (PubMed)

Synergistic binding of inhibitors to the protease from HIV type 1. Inhibition of the protease in HIV is a potentially useful approach for the treatment of AIDS. In the course of evaluating inhibitors of the HIV-1 protease, we observed a strong synergism between certain inhibitors that might be expected to bind to different sites in this enzyme. The binding affinity of carbobenzyloxyisoleucinylphenylalaninol, for example, is increased 125-fold in the presence

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1996 Biochemical Journal

15682. Primary HIV infection--a public health opportunity. (PubMed)

on the spread of HIV. A combination of biological, behavioral, and social factors may account for the influence of primary infection on the HIV epidemic. HIV prevention measures can be focused on each of these factors. Biologically, detecting individuals early in the course of infection and offering treatment can reduce viral load and possibly an individual's infectiousness. Behaviorally, counseling newly infected persons about the importance of adopting safer practices may instill prevention behaviors (...) Primary HIV infection--a public health opportunity. Primary human immunodeficiency virus (HIV) infection should be considered a key target for HIV prevention activities. Mathematical models suggest that the primary HIV infection interval makes a disproportionate contribution to the HIV epidemic, perhaps accounting for as many as half of the existing infections at any point in time. If this is true, primary infection presents a special window of opportunity within which to exert a maximum impact

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1997 American Journal of Public Health

15683. Left Ventricular Structure and Function in Children Infected With Human Immunodeficiency Virus: The Prospective P2C2 HIV Multicenter Study (PubMed)

Left Ventricular Structure and Function in Children Infected With Human Immunodeficiency Virus: The Prospective P2C2 HIV Multicenter Study The frequency of, course of, and factors associated with cardiovascular abnormalities in pediatric HIV are incompletely understood.A baseline echocardiogram (median age, 2.1 years) and 2 years of follow-up every 4 months were obtained as part of a prospective study on 196 vertically HIV-infected children. Age- or body surface area-adjusted z scores were (...) calculated by use of data from normal control subjects. Although 88% had symptomatic HIV infection, only 2 had CHF at enrollment, with a 2-year cumulative incidence of 4.7% (95% CI, 1.5% to 7.9%). All mean cardiac measurements were abnormal at baseline (decreased left ventricular fractional shortening [LV FS] and contractility and increased heart rate and LV dimension, mass, and wall stresses). Most of the abnormal baseline cardiac measurements correlated with depressed CD4 cell count z scores

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1998 Circulation

15684. HIV antibody assay that gave false negative results: multicentre collaborative study. (PubMed)

patients tested with the assay who were reported as being negative for HIV antibody. An additional 497 patients were confirmed as HIV positive with the assay.Serum samples of 20,973 of the patients were retested, and four patients were found to have had false negative results with the kit; three further patients were found to have had false negative results in the course of other laboratory testing. The seven patients with false negative results with the kit were of diverse risk group and HIV-1 subtype (...) HIV antibody assay that gave false negative results: multicentre collaborative study. To identify false negative results arising from the use of a commercial kit to detect antibody to HIV-1 and HIV-2 between July 1995 and March 1996.The 56 laboratories in the United Kingdom that were using the assay were asked to retrieve and retest specimens with an alternative assay for HIV-1 and HIV-2. Details of false negative results were obtained and these serum samples further investigated.24,181

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1997 BMJ : British Medical Journal

15685. Paraprofessional delivery of a theory based HIV prevention counseling intervention for women. (PubMed)

Paraprofessional delivery of a theory based HIV prevention counseling intervention for women. This report describes a mid-course process evaluation of an HIV risk-reduction counseling intervention delivered by specially trained peer paraprofessionals. One of the key questions addressed is whether paraprofessionals can successfully implement a theory-based counseling intervention. The project, known as Project CARES, is a 5-year demonstration research project to prevent HIV infection (...) and unplanned pregnancies in women at risk for HIV infection and transmission who were recruited from homeless shelters, drug treatment facilities, and hospital-based service settings for HIV-infected women. Project CARES uses an enhanced counseling intervention based on the Transtheoretical Model, also known as the Stages of Change model, to promote condom and other contraceptive use for women who wish to avoid pregnancy, condom use for disease prevention, and reproductive health service use. Peer

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1996 Public Health Reports

15686. Active syphilis in HIV infection: a multicentre retrospective survey. The German AIDS Study Group (GASG). (PubMed)

Active syphilis in HIV infection: a multicentre retrospective survey. The German AIDS Study Group (GASG). To study syphilis in HIV infection focusing on immunocompromised patients with an atypical or aggressive clinical course of syphilis, inappropriate serological reactions or an unreliable response to therapy.A multicentre retrospective chart review using a standardised questionnaire for all patients with active syphilis.Thirteen dermatological and medical centres throughout Germany, all (...) VDRL titres (11 patients with non primary syphilis), false negative TPHA (1) or 19S-IgM-FTA-ABS-tests (16), and strongly reactive VDRL (> or = 512, 8) or TPHA titres (> or = 10 240, 47). Treatment failures were reported in at least 6 of 151 cases (4%).Atypical clinical and serological courses of syphilis were observed in HIV infected patients. Ulcerating secondary syphilis with general symptoms ("malignant syphilis") was 60 times more frequent than in historic syphilis series. Neurosyphilis

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1996 Genitourinary Medicine

15687. Functional impairment trajectories among persons with HIV disease: a hierarchical linear models approach. (PubMed)

Functional impairment trajectories among persons with HIV disease: a hierarchical linear models approach. This study investigates the level, time course, and stability of functional impairment in a population of persons with symptomatic HIV disease, and illustrates the application of hierarchical linear modeling (HLM) to trajectories of functional status in unbalanced longitudinal data.We utilized longitudinal interview data on a demographically diverse cohort of 246 individuals participating (...) in New Jersey's Medicaid waiver program for persons with AIDS or symptomatic HIV disease, with a mean of nine repeated observations per individual. MEASURES AND STATISTICAL METHODS: Impairment in ability to perform 16 activities of daily living (ADL) and instrumental activities of daily living (IADL) was assessed at monthly intervals. To achieve unbiased, efficient estimation of the level and within-individual rate of change of functional status utilizing all observations for each individual

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1996 Health Services Research

15688. Host genes and HIV: the role of the chemokine receptor gene CCR5 and its allele. (PubMed)

family serve as cofactors for HIV entry into cells. We describe the role of allelic polymorphism in the gene coding for the CCR5 chemokine receptor with regard to susceptibility to and disease course of HIV infection. We also examine the effect of this discovery on medical and public health practices. (...) Host genes and HIV: the role of the chemokine receptor gene CCR5 and its allele. Since the late 1970s, 8.4 million people worldwide, including 1.7 million children, have died of AIDS, and an estimated 22 million people are infected with human immunodeficiency virus (HIV)(1). During 1995 and 1996, major clinical and laboratory discoveries regarding HIV pathogenesis provided new hope for the prevention and treatment of HIV infection. One major discovery was that members of the chemokine receptor

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1997 Emerging Infectious Diseases

15689. Partner notification for HIV infection in Denmark: attitudes and preliminary results. (PubMed)

of the interview related to 102 out of 195 (52%) reports were compared between the 48 interviewed general practitioners (GPs) and the 33 interviewed hospital doctors (HDs). The proportion of traced reporting doctors were higher among GPs than among HDs.Both GPs and HDs found it difficult to give a positive HIV test result and wanted trained counsellors to work with them in the PN process. Less experience and fewer post-graduate courses about HIV may explain the GPs' lack of confidence to follow-up asymptomatic (...) Partner notification for HIV infection in Denmark: attitudes and preliminary results. To examine attitudes, experience and preliminary results of partner notification (PN) for HIV infection in Denmark among the doctors who inform one of their patients about being HIV infected.The doctors who had reported to the national HIV surveillance unit about a new-identified HIV infected person, during a 9 months period, were searched for one year later. The traced doctors were interviewed. The results

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1996 Genitourinary Medicine

15690. Rate and severity of HIV-associated dementia (HAD): correlations with Gp41 and iNOS. (PubMed)

Rate and severity of HIV-associated dementia (HAD): correlations with Gp41 and iNOS. Fifteen to thirty percent of AIDS patients develop some type of neurologic disorder during the course of their illness and the vast majority of these neurologic disorders will be HIV-associated dementia (HAD). These patients can exhibit varying degrees of severity and rates of progression of HAD. Neuropathologic variables that are associated with the rate of progression of HAD are not known.Tissue was collected (...) -Wallis test for multiple groups.We have identified unique groups within this spectrum and designated them slow, moderate, and rapid progressors. Slow and moderate progressors' neurological progression occurs over a course of months to years, whereas the rapid progressors' disease shows rapid increases in severity over weeks to months. In the present study we demonstrate that the severity and rate of progression of HAD correlates significantly with levels of the HIV-1 coat protein, gp41, iNOS

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1999 Molecular Medicine

15691. Analysis of the adult thymus in reconstitution of T lymphocytes in HIV-1 infection (PubMed)

Analysis of the adult thymus in reconstitution of T lymphocytes in HIV-1 infection A key question in understanding the status of the immune system in HIV-1 infection is whether the adult thymus contributes to reconstitution of peripheral T lymphocytes. We analyzed the thymus in adult patients who died of HIV-1 infection. In addition, we studied the clinical course of HIV-1 infection in three patients thymectomized for myasthenia gravis and determined the effect of antiretroviral therapy on CD4 (...) asymptomatic at least seven years after seroconversion. Both latter patients had rises in peripheral blood CD4(+) T cells after antiretroviral therapy. Most patients who died of complications of HIV-1 infection did not have functional thymus tissue, and when present, thymopoiesis did not prevent prolonged lymphopenia. Thymectomy before HIV-1 infection did not preclude either peripheral CD4(+) T-cell rises or clinical responses after antiretroviral therapy.

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1999 Journal of Clinical Investigation

15692. HIV-1 penetrates coronary artery endothelial cells by transcytosis. (PubMed)

) assay, infectious assay, and immunofluorescence were employed to show abortive nature of HIV-1 infection of CAEC. Tight junction (TJ) and cell adhesion proteins were visualized by immunofluorescence. The time course of HIV-1 invasion was measured by HIV-1 RNA assay. Inulin permeability assay determined paracellular leakage. Transmission electron microscopy demonstrated virus-induced endothelial vacuolization.Despite a strong display on CAEC of CXCR4 and a lesser expression of CCR3 and CCR5, HIV-1 (...) HIV-1 penetrates coronary artery endothelial cells by transcytosis. The pathogenesis of HIV-1-related cardiomyopathy is poorly understood, but HIV-1 has been detected in cardiomyocytes. Whether HIV-1 penetrates into the myocardium by infection of coronary artery endothelial cells (CAEC) or using transcellular or paracellular routes across CAEC has not been resolved.A model of the CAEC barrier was constructed with primary CAEC (derived from human coronary vessels). Polymerase chain reaction (PCR

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2001 Molecular Medicine

15693. Chemokine-receptor activation by env determines the mechanism of death in HIV-infected and uninfected T lymphocytes (PubMed)

Chemokine-receptor activation by env determines the mechanism of death in HIV-infected and uninfected T lymphocytes There is considerable confusion concerning the mechanism of lymphocyte death during HIV infection. During the course of HIV infection, M-tropic viruses (R5) that use CCR5 chemokine coreceptors frequently evolve to T-tropic viruses (X4) that use CXCR4 receptors. In this study we show that activation of the CD4 or CCR5 receptor by R5 HIVenv causes a caspase 8-dependent death of both

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2001 Journal of Clinical Investigation

15694. HIV/AIDS programmes should focus on improved access (PubMed)

. In this regard, it is therefore recommended that national HIV/AIDS programs be balanced with the needs of both the community and the individual and in prevention and care. Health workers should be explicit in confronting traditional beliefs, such as those about gender roles and traditional medicine, in prevention campaigns. Moreover, there is also an urgent need to improve access to condoms; strengthen health programs such as directly observed treatment short-term (DOTS) courses for tuberculosis (...) HIV/AIDS programmes should focus on improved access 11202957 2000 11 20 2018 11 13 0959-8138 321 7266 2000 Oct 14 BMJ (Clinical research ed.) BMJ HIV/AIDS programmes should focus on improved access. 963 Manning A A eng Comment Letter England BMJ 8900488 0959-8138 0 Antiviral Agents AIM IM J BMJ. 2000 Jun 10;320(7249):1551-2 10845944 Africa South of the Sahara Antiviral Agents economics Developing Countries Drug Costs HIV Infections prevention & control Health Services Needs and Demand Humans

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2000 BMJ : British Medical Journal

15695. A novel approach to directly observed therapy for tuberculosis in an HIV-endemic area. (PubMed)

A novel approach to directly observed therapy for tuberculosis in an HIV-endemic area. This study evaluated a novel approach to the delivery of directly observed therapy (DOT) for tuberculosis in Haiti.A total of 194 patients (152 HIV seropositive, 42 HIV seronegative) received daily unsupervised triple-drug therapy for 4 to 8 weeks, followed by twice-weekly 2-drug therapy for the remainder of the 6-month period. DOT was deferred until initiation of the twice-weekly phase.A total of 169 of 194 (...) patients (87.1%) completed the 6-month course. The program of deferred DOT had an effectiveness of 85%. Overall cost was reduced by approximately 40%.Flexible approaches to DOT, integrating behavioral knowledge, cost considerations, and practicality may improve completion rates and program effectiveness.

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2001 American Journal of Public Health

15696. Ensuring a Public Health Impact of Programs to Reduce HIV Transmission From Mothers to Infants: The Place of Voluntary Counseling and Testing (PubMed)

Ensuring a Public Health Impact of Programs to Reduce HIV Transmission From Mothers to Infants: The Place of Voluntary Counseling and Testing Since 1999, many African governments have launched programs to offer short-course antiretroviral drug regimens to reduce mother-to child transmission of HIV. HIV testing in prenatal care is the gateway to these antiretroviral regimens. Pilot projects in Africa show an uptake of antiretroviral drugs in 8% to 50% of pregnant women presumed to be HIV (...) infected; often, a minority of eligible women in care received these regimens. Use of lay counselors and rapid onsite HIV testing may alleviate health service barriers. Community education to promote voluntary counseling and testing, which involves men, is the long-term solution. In the short term, possibilities to enhance delivery of an effective intervention include group pretest counseling, universal offer of testing with women having the right to "opt out," universal treatment (mass treatment

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2002 American Journal of Public Health

15697. Neuropsychiatric aspects of HIV infection among older adults (PubMed)

the deleterious effects of HIV infection, little is actually known, however, regarding the incidence, prevalence, course, and clinical features of HIV-associated psychiatric and cognitive dysfunction among older adults. This article provides an overview of the epidemiology and clinical manifestations of HIV-associated cognitive and psychiatric disorder across the age spectrum, with particular focus on what is known regarding the interaction of advancing age and HIV infection. Future directions for research (...) are suggested, including basic epidemiologic study of incidence and prevalence rates of neurodisease among older HIV-infected adults as well as investigations designed to determine whether the nature, severity, course, or treatment of such disorders differs among older versus younger patients.

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2001 Journal of Clinical Epidemiology

15698. HIV-1 infection in a cohort of haemophilic patients. (PubMed)

HIV-1 infection in a cohort of haemophilic patients. The course of HIV infection in 53 haemophilic patients aged 5-20 years was evaluated by clinical examination and laboratory tests. During the evaluation time (median 30 months) two patients died of AIDS and 32 patients (60%) deteriorated when assessed by the Brodt-Helm classification. Nineteen patients (37%) had decreased absolute helper cell counts (less than 500 CD4 positive cells/microliters), and 45 patients (87%) had reduced helper cell (...) to lymphocyte ratios (less than 0.35). HIV-1 was isolated from peripheral lymphocytes in 29 of 46 patients. As the disease progressed the number of positive viral cultures increased. Considerable progression of the HIV infection was seen in haemophilic children and adolescents during the median evaluation period of 30 months. The transition from symptomless HIV infection to immunodeficiency was easily recognised. A lowered ratio of helper cells to lymphocytes seems to be a useful marker of the beginning

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1990 Archives of Disease in Childhood

15699. Sentinel surveillance of HIV infection among new inmates and implications for policies of corrections facilities. (PubMed)

) and needle-sharing (19.4 percent). Results from this study indicate that in spite of wide-spread HIV-associated risk behaviors, the extent of HIV-seropositivity among incoming inmates in Michigan is relatively low. Such data suggest that there is still time to impact the course of the AIDS epidemic among high-risk groups in States where the prevalence of HIV infection is relatively low. The data also indicate that the potential for HIV spread in correctional facilities is noteworthy and that HIV (...) Sentinel surveillance of HIV infection among new inmates and implications for policies of corrections facilities. Seroprevalence surveys of incoming inmates provide useful sentinel information on human immunodeficiency virus (HIV) infection rates among groups that practice HIV-associated high-risk behaviors. In addition, such data are beneficial to corrections officials in the formulation of institutional policies to prevent HIV infection. Inmates entering the Michigan corrections system from

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1990 Public Health Reports

15700. HIV seroprevalence surveys in sexually transmitted disease clinics. (PubMed)

evaluated in voluntary, nonblinded surveys to define groups for appropriate interventions and to detect changes in response to education and prevention programs. Although inferences drawn from the surveys are limited by the scope of the clinics and clients surveyed, HIV trends in STD clinic client populations should provide a sensitive monitor of the course of the acquired immunodeficiency syndrome (AIDS) epidemic among persons engaging in high-risk sexual behaviors. (...) HIV seroprevalence surveys in sexually transmitted disease clinics. The Centers for Disease Control, in cooperation with State and local health departments, is conducting human immunodeficiency virus, type 1 (HIV), seroprevalence surveys, using standard protocols, in sexually transmitted disease (STD) clinics in selected metropolitan areas throughout the United States. The surveys are blinded (serologic test results not identified with a person) as well as nonblinded (clients voluntarily

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1990 Public Health Reports

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