Suchergebnisse

Suicidal acts seem to be more frequent in AIDS patients than in the general population: nevertheless, the interpretation of these findings remains uncertain, because an increased risk of suicide has been found in some groups at risk of HIV infection (homosexuals, i.v. drug users) irrespective of the presence of HIV infection. The lack of adequate registration of causes of death in mortality statistics, the difficulty of identifying AIDS cases, and the lack of appropriate reference popula tions in the majority of register-based studies and post-mortem investigations are the main methodological problems in this research area.

BackgroundWe evaluated the frequency of hepatitis coinfection in Romanian adolescents who were diagnosed with human immunodeficiency virus (HIV) infection prior to 1995.MethodsOne hundred sixty‐one adolescents (13–18 years of age) with symptomatic HIV infection, but without signs of hepatic dysfunction, and 356 age‐matched, HIV‐uninfected controls underwent laboratory testing for markers of parenterally acquired hepatitis virus infection.ResultsSeventy‐eight percent of HIV‐infected adolescents had markers of past or present hepatitis B virus (HBV) infection, as compared with 32% of controls (P = .0001). The prevalence of HBV replicative markers was more than 5‐fold higher in HIV‐infected adolescents as compared with controls: 43.4% vs 7.9% (P = .0001), respectively, for hepatitis B surface antigen (HBsAg); and 11.2% vs 2.2% (P = .0001), respectively, for hepatitis B e antigen (HBeAg). The prevalence of HBsAg chronic carriers and the presence of HBV replicative markers was significantly higher in patients with immunologically defined AIDS (CD4+ cell counts < 200 cells/mcL): 59.6% vs 34.6% (P = .02) for HBsAg and 22.8% vs 5.7%, (P = .002) for HBV DNA. After 1 year of follow‐up, the proportion of those who cleared the HBeAg was considerably lower in severely immunosuppressed coinfected patients: 4.7% vs 37.1% (P = .003). Four additional HIV‐infected adolescents became HBsAg‐positive over the term of follow‐up (incidence rate, 24.9/1000 person‐years), despite a record of immunization against hepatitis B.ConclusionA substantial percentage of HIV‐infected and HIV‐uninfected Romanian adolescents have evidence of past or present HBV infection. In HIV‐infected adolescents, the degree of immunosuppression is correlated with persistence of HBV replicative markers, even in the absence of clinical or biochemical signs of liver disease.

Most women diagnosed with Acquired Immunodeficiency Syndrome (AIDS) in the United States are either intravenous drug users (IVDUs) or sex partners of male IVDUs. Research that looks at "IVDUs with AIDS" as one category, and "women with AIDS" as another, may fail to provide adequate information about this specific subgroup. The authors summarize the results of several studies of the prevalence of HIV infection among IVDUs, and discuss the difficulty of estimating the number of women IVDUs, or partners of male IVDUs, infected with HIV. They consider differences between female and male IVDUs, and between women IVDUs and non-IVDUs, including economic status, pregnancy, and child-rearing responsibilities. They conclude with a series of policy recommendations concerning AIDS prevention and service programs targeting this specific population.

BackgroundAntiretroviral drugs used to treat HIV may cause hepatotoxicity. The high prevalence of persons with chronic hepatitis B or C coinfected, raised aminotransferases have many causes and neither specific markers is a indicator of liver injury, difficulties in interpreting the hepatotoxicity.ObjectiveWe evaluated hepatotoxicity in HIV/HCV‐ and/or HBV‐coinfected patients, risk factors and severity.MethodsProspective study of HIV‐1 patients with start HAART in Hospital Provincial del Centenario from Rosario, Argentina. Patients were classified into two groups, HCV and/or HBV coinfected vs. no coinfected. The major endpoint was hepatotoxicity defined as Benichou's Score within the first 6 months. This score is among the few validated, but little used in clinical practice. Secondary endpoints were risk factors and severity of hepatotoxicity.Results140 patients were included, 39% coinfected and 61% no coinfected. Females were similar in both groups; 21% and 27% respectively. The hepatotoxicity within the first 6 month was 44.3%, 75% in coinfected patients and 25% in no‐coinfected. RR 3.97 (95% confidence interval 2.34–6.75, p<0.0001). The hepatotoxicity was associated with the use of illicit drugs and alcohol, symptoms, high level aminotransferases previous to HAART and NNRTI+PI. 3% of hepatotoxicity was severe.Conclusions44% of HIV patients experienced hepatotoxicity, 75% in coinfected vs 25% in no coinfected. The relative risk of hepatoxocity was almost 4 times higher among in chronic hepatitis‐coinfected patients, compared with those with HIV non‐coinfected. In multivariate analysis, the risk factors were illicit drugs, alcohol, symptoms, high level aminotransferases and NRTI+PI. Only 3% of hepatotoxicity was severe. The Benichou's Score is better than level of aminotransferase for evaluated hepatotoxicity, so it would be recommended for use in clinical practice.