Outline of the Human Retrovirus Registry: profile of a Puerto Rican HIV infected population

OBJECTIVE: To present the general socio-demographic profile, some risk related parameters and elements of the clinical spectrum of disease at presentation, of those HIV/AIDS patients enrolled in the Human Retrovirus Registry. METHODS: This is a prospective longitudinal cohort study, which has been identifying since May 1992, adults or adolescents 18 years or older with AIDS or HIV infection at the time they present to our health care facilities: University Hospital Ramon Ruiz Arnau and the Bayamon Immunology Clinic. The present analysis include patients enrolled between May 1992 and December 1996 (n = 1520). The measurement instrument is a modular questionnaire which actually includes 237 variables including socio-demographic data, risk variables, lifestyle and affective parameters, clinical and immunological variables and therapeutic data. RESULTS: The mean baseline age of the 1520 patients was 35.7 years of age. Most participants were male (77.7) and Hispanic (98.8). Forty-five percent (45.1) of the population were single and only 21.9 were married; nevertheless, fifty-one percent (51.7) indicated to have children. 70 reported to be unemployed. Injecting Drug Usage appears as the first exposure mode (54.3), followed by heterosexual contact cases (25.71) and by men having sex with men (12.9). The study of other risk practices revealed a large proportion of patients smoking tobacco (65.6) and using alcohol (49.5). Based on the 1993 CDC definition, forty-seven percent (47) of the subjects had a clinical or immunological criterion to be considered as an AIDS case at first presentation. Among all AIDS cases, 440 patients presented with clinical AIDS (61.7) and 274 persons were classified as AIDS due to low CD4 counts alone (38.3). The most common AIDS defining conditions were: Pneumocystis carinii pneumonia (n = 201, 28.1), Candidiasis Esophageal (n = 123, 17.2), Toxoplasmosis (n = 95, 13.3), Wasting syndrome (n = 68, 9.5), and Tuberculosis (n = 68, 10.3). CONCLUSIONS: The socio-demographic and risk profile of AIDS patients in the present study is representative of the Puerto Rican AIDS population with regards to gender, age distribution, and risk scenario groups. This study revealed that a wide spectrum of social and behavioral vulnerabilities are impacting this population. A large proportion of patients is arriving to the health care facilities at a late stage of disease. Further studies including data from follow-up interviews wil

Dengue fever with thrombocytopenia: studies towards defining vulnerability of bleeding

PURPOSE: To define the period of greater vulnerability of bleeding in patients with Dengue fever in reference to the onset of their constitutional symptoms and the laboratory abnormalities. PATIENTS AND METHODS: In a retrospective study we reviewed the records of all patients admitted to San Pablo Medical Center in 1991 with a diagnosis of Dengue Fever or Hemorrhagic Dengue. All patients with a platelet count of less than 125,000 were included for analysis. The exclusion criteria included the presence of systemic disorders which may influence the platelet count, and patients without documentation regarding the presence of constitutional symptoms suggestive of viral illness. RESULTS: A total of 101 patients were analyzed of which only 74 were included in the study. All patients had fever and chills; skin rash, asthenia and general malaise was seen in over 50 of patients. Over 70 of patients had recovery of their platelet count, and most had their maximal thrombocytopenia within the 5th day and 8th day from the onset of constitutional symptoms. Leukopenia was seen in over 70 of patients with its lowest level within the 5th and 8th day from the onset of the constitutional symptoms. Significantly prolonged partial thromboplastin time was seen in 11 of the patients. Proteinuria was seen in 22 of the patients, 38 of which had it within the first 4 days of the onset of constitutional symptoms and also noted on the 5th and 6th day. Alteration in liver enzymes were noted in 47 of patients, with a maximal severity distributed in all time frames. Hypoalbuminemia was present in 28 of the patients, of these 67 presented within the first 4 days from the onset of constitutional symptoms. The pulse rate was usually normal in spite of the patient's dehydration and fever. CONCLUSIONS: We identified three phases that define the sequence of events seen in the majority of patients with Dengue Fever and Thrombocytopenia. These are: 1. proteinuria and hypoalbuminemia; 2. maximal cytopenia; 3. bradycardia and liver enzyme elevation. We believe this information is useful in the management of patients with Dengue Fever and thrombocytopenia