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1.
J Infect Dis ; 180(5): 1514-20, 1999 Nov.
Article in English | MEDLINE | ID: mdl-10515810

ABSTRACT

Human immunodeficiency virus (HIV) type 1 RNA load, CD4 T cell level, and Centers for Disease Control and Prevention (CDC) clinical class history were measured as potential correlates of a CDC class C diagnosis or death in 165 HIV-1-infected children followed from birth. These covariates were assessed at fixed "landmark" ages from 6 to 24 months and were also assessed as time-varying values. Virus load was associated with progression in all analyses, even after adjusting for immunologic and clinical status. This confirms its importance for monitoring pediatric disease progression. CD4 T cell level was associated with disease progression in time-varying but not in adjusted landmark analysis, suggesting that CD4 cells reflects immediate risk more than long-term risk. The distinction between clinical class B and lower classes is prognostic during the first 18 months of life; class C versus classes N/A/B becomes more important as the patient ages. Virologic, immunologic, and clinical status all provide information regarding disease progression risk.


Subject(s)
CD4 Lymphocyte Count , HIV Infections/physiopathology , HIV-1/physiology , Viral Load , Biomarkers , Centers for Disease Control and Prevention, U.S. , Child, Preschool , Disease Progression , HIV Infections/classification , HIV Infections/immunology , HIV Infections/virology , HIV-1/genetics , Humans , Infant , RNA, Viral/blood , United States
2.
J Infect Dis ; 178(2): 560-3, 1998 Aug.
Article in English | MEDLINE | ID: mdl-9697744

ABSTRACT

The Women and Infants Transmission Study (WITS) has established virologic definitions of human immunodeficiency virus (HIV)-infected and uninfected children that have been widely used but never formally compared with serologic definitions of infection. Data from the offspring of HIV-infected women in the WITS with frequent HIV cultures during the first year of life and with HIV serology at 18 and/or 24 months of age were analyzed. Seventy-seven infants were HIV-infected and 430 uninfected by both virologic and serologic criteria. Thirteen were virologically infected (> or = 2 positive cultures) but either seronegative or serologically indeterminate. All but 1 of these had clinical HIV disease at the time of analysis. In this pediatric cohort, children defined as infected by virologic criteria often (13/90) had negative or indeterminate serology despite symptoms of HIV disease. Results suggest that serology at 18-24 months has high specificity but poor sensitivity. It should not be considered the reference standard in identifying HIV infection in perinatally exposed children.


Subject(s)
HIV Infections/diagnosis , Infectious Disease Transmission, Vertical , Pregnancy Complications, Infectious/diagnosis , Blotting, Western , Cells, Cultured , Child, Preschool , Coculture Techniques , Cohort Studies , Enzyme-Linked Immunosorbent Assay , Female , HIV Infections/blood , HIV Infections/transmission , HIV Infections/virology , HIV Seropositivity , Humans , Infant , Infant, Newborn , Leukocytes, Mononuclear , Pregnancy , Pregnancy Complications, Infectious/virology , Time Factors
3.
J Infect Dis ; 177(6): 1480-8, 1998 Jun.
Article in English | MEDLINE | ID: mdl-9607823

ABSTRACT

Antepartum plasma hepatitis C virus (HCV) RNA was quantified in 155 mothers coinfected with HCV and human immunodeficiency virus type 1 (HIV-1), and HCV RNA was serially assessed in their infants. Of 155 singleton infants born to HCV antibody-positive mothers, 13 (8.4%) were HCV infected. The risk of HCV infection was 3.2-fold greater in HIV-1-infected infants compared with HIV-1-uninfected infants (17.1% of 41 vs. 5.4% of 112, P = .04). The median concentration of plasma HCV RNA was higher among the 13 mothers with HCV-infected infants (2.0 x 10(6) copies/mL) than among the 142 mothers with HCV-negative infants (3.5 x 10(5) copies/mL; P < .001), and there were no instances of HCV transmission from 40 mothers with HCV RNA concentrations of < 10(5) copies/mL. Women dually infected with HIV-1 and HCV but with little or no detectable HCV RNA should be reassured that the risk of perinatal transmission of HCV is exceedingly low.


Subject(s)
HIV Infections/complications , HIV-1 , Hepatitis C/transmission , Infectious Disease Transmission, Vertical , Pregnancy Complications, Infectious , Adult , Cohort Studies , Female , Follow-Up Studies , Hepacivirus/classification , Hepacivirus/genetics , Hepacivirus/immunology , Hepatitis C/complications , Hepatitis C/immunology , Hepatitis C/virology , Humans , Infant , Infant, Newborn , Pregnancy , Pregnancy Complications, Infectious/immunology , Pregnancy Complications, Infectious/virology , Prospective Studies , RNA, Viral/analysis , Sequence Analysis, RNA
4.
J Infect Dis ; 176(2): 414-20, 1997 Aug.
Article in English | MEDLINE | ID: mdl-9237706

ABSTRACT

To determine if hepatitis C virus (HCV) infection affects vertical transmission of human immunodeficiency virus (HIV), 487 HIV-infected pregnant women in the prospective, multicenter, Women and Infants Transmission Study had HCV antibody (anti-HCV by second-generation ELISA) and HCV RNA (by quantitative polymerase chain reaction) measured in peripartum maternal plasma; 161 (33%) were anti-HCV-positive. HIV vertical transmission occurred from 42 HCV-infected mothers (26.1%) versus 53 HCV-uninfected mothers (16.3%; odds radio [OR], 1.82; P = .01). In a logistic regression model that included maternal drug use, a potential confounder, HCV infection was marginally associated with perinatal HIV transmission (OR, 1.64; P = .05), whereas drug use was not. Women who transmitted HIV had higher levels of HCV RNA (median, 721,254 copies/mL) than those who did not (337,561 copies/mL; P = .01). Maternal HCV infection is associated with increased HIV vertical transmission. Further studies are needed to ascertain if HCV directly affects perinatal HIV transmission or is a marker for another factor, such as maternal drug use.


Subject(s)
HIV Infections/transmission , HIV-1 , Hepatitis C/complications , Infectious Disease Transmission, Vertical , Pregnancy Complications, Infectious/virology , Adult , Anti-HIV Agents/therapeutic use , Female , HIV Antibodies/blood , HIV Infections/complications , HIV Infections/drug therapy , HIV-1/immunology , Hepacivirus/genetics , Hepacivirus/isolation & purification , Humans , Infant, Newborn , Multivariate Analysis , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Prospective Studies , RNA, Viral/blood , Risk Factors , Zidovudine/therapeutic use
5.
Am J Public Health ; 86(8): 1112-5, 1996 Aug.
Article in English | MEDLINE | ID: mdl-8712270

ABSTRACT

OBJECTIVES: The purpose of this study was to assess the relationship between syphilis and human immunodeficiency virus (HIV) infection in injection drug users. METHODS: A 6-year prospective study of 790 injection drug users receiving methadone maintenance treatment in the Bronx, NY, was conducted. RESULTS: Sixteen percent (4/25) of HIV-seroconverting patients, 4.8% (16/335) of prevalent HIV-seropositive patients, and 3.5% (15/430) of persistently HIV-seronegative patients was diagnosed with syphilis. Incidence rates for early syphilis (cases per 1000 person-years) were 15.9 for HIV-seroconverting patients, 8.9 for prevalent HIV-seropositive patients, and 2.9 for persistently HIV-seronegative patients. Early syphilis incidence was higher among women than men (8.4 vs 3.2 cases per 1000 person-years). Independent risks for early syphilis included multiple sex partners, HIV seroconversion, paid sex, and young age. All HIV seroconverters with syphilis were female. CONCLUSIONS: Diagnosis of syphilis in drug-using women reflects high-risk sexual activity and is associated with acquiring HIV infection. Interventions to reduce the risk of sexually acquired infections are urgently needed among female drug users.


Subject(s)
HIV Infections/etiology , Methadone/therapeutic use , Narcotics/therapeutic use , Sexual Behavior , Substance Abuse, Intravenous/complications , Syphilis/etiology , Adolescent , Adult , Female , Humans , Incidence , Male , New York City , Prospective Studies , Risk Factors , Sex Distribution , Substance Abuse, Intravenous/drug therapy , Urban Health
6.
Am J Public Health ; 85(1): 83-8, 1995 Jan.
Article in English | MEDLINE | ID: mdl-7832267

ABSTRACT

OBJECTIVES: The purpose of this study was to examine factors associated with heroin use during methadone maintenance treatment. METHODS: Logistic regression statistical models were used to examine data obtained in a cross-sectional sample of 652 methadone patients. RESULTS: Heroin use during the 3 months prior to interview was shown to be greatest among (1) patients maintained on methadone dosages of less than 70 mg/day (adjusted odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.3, 3.4) and (2) patients who used cocaine during treatment (adjusted OR = 5.9, 95% CI = 3.8, 9.1). These results were independent of treatment duration, treatment compliance, alcohol use, and socioeconomic factors. Cocaine users were more likely than nonusers of cocaine to use heroin at all methadone dosage levels. CONCLUSIONS: This study confirms and extends past research showing high-dose methadone maintenance to be important to heroin abstinence. Further investigation of the independent association between heroin use and cocaine use is needed.


Subject(s)
Cocaine , Heroin Dependence/rehabilitation , Methadone/therapeutic use , Adult , Cross-Sectional Studies , Female , Heroin Dependence/complications , Heroin Dependence/diagnosis , Humans , Male , Substance Abuse Detection , Substance-Related Disorders/diagnosis
7.
AIDS ; 8(1): 107-15, 1994 Jan.
Article in English | MEDLINE | ID: mdl-7912083

ABSTRACT

OBJECTIVE: To characterize the progression to HIV-1 disease among injecting drug users (IDU) according to laboratory markers. DESIGN: Prospective study of cohort of HIV-1-seroprevalent IDU, with case-comparison component. METHODS: Different laboratory markers were examined as predictors of progression to HIV-1-associated diseases including AIDS in a cohort of 318 HIV-1-infected IDU. The cohort was enrolled from a methadone treatment program in the Bronx, New York, USA. The independent utility of non-CD4 cell markers was evaluated after adjustment for the association of low CD4 lymphocyte count with AIDS risk. Clinical events in the natural history of HIV-1 were related to changes in levels of two variables related to duration of infection, CD4 lymphocyte count and serum beta 2-microglobulin (beta 2M) concentration. RESULTS: On univariate analysis, AIDS incidence measured from baseline increased with declining CD4 lymphocyte number and percentage, increasing serum beta 2M level, low platelet count, low leukocyte count and p24 antigenemia. Among HIV-1-related outcomes prior to any AIDS diagnosis, the relative risk of pyogenic bacterial infections conferred by these markers was similar to the relative risk of AIDS. For all HIV-1 outcomes, the elevated risk encountered at CD4 lymphocyte number < or = 200 x 10(6)/l was entirely due to the high risk at < or = 150 x 10(6)/l. On multivariate analysis, control for CD4 lymphocyte count eliminated the association of any other marker with increased AIDS hazard. HIV-1-related outcomes tended to occur in this order: multiple constitutional symptoms, oral candidiasis, pyogenic bacterial infections and AIDS. CONCLUSIONS: In HIV-1-infected IDU, several laboratory markers may predict AIDS when analyzed individually. These are not, however, independently related to increased AIDS risk after adjustment for low CD4 lymphocyte count. A CD4 count < or = 150 x 10(6)/l is more strongly related to immediate risk of adverse outcome than a count of 200 x 10(6)/l. A progressive series of clinical events is associated with markers of duration of HIV-1 infection, prior to and including AIDS diagnosis.


Subject(s)
Acquired Immunodeficiency Syndrome/epidemiology , HIV Infections/epidemiology , HIV-1 , Substance Abuse, Intravenous/complications , Acquired Immunodeficiency Syndrome/physiopathology , Adult , Biomarkers , CD4-Positive T-Lymphocytes , Cohort Studies , Female , HIV Infections/physiopathology , Humans , Leukocyte Count , Male , Prospective Studies , Risk Factors , Time Factors
8.
Pediatr Infect Dis J ; 12(3): 222-7, 1993 Mar.
Article in English | MEDLINE | ID: mdl-8451099

ABSTRACT

More than one-half of the children born to women with human immunodeficiency virus (HIV) infection are not infected with HIV. Most of these children, although born antibody-positive, lose maternal antibody and remain asymptomatic. However, it has been unclear how many antibody-negative children of HIV-infected women may truly be infected despite the loss of passively acquired maternal antibody. One hundred nine children who lost maternal antibody after birth to HIV-infected women recruited in four United States maternal HIV transmission studies were examined for HIV infection. Polymerase chain reaction (PCR) was used to determine whether children had HIV proviral DNA in peripheral blood mononuclear cells. A total of 268 samples from 109 children were tested. Clinical status and other laboratory findings were also evaluated. The median age at last follow-up was 25 months (range, 12 to 48 months). One hundred seven (98%) children were negative by PCR on all samples tested. None (95% confidence interval, 0.0 to 1.9%) of 109 children had a repeatedly positive PCR. Two children had single positive PCR results that could not be confirmed on subsequent testing. No other laboratory or clinical findings supported HIV infection in either of these children. The loss of HIV antibody in an asymptomatic child born to an HIV-infected woman strongly suggests that the child is not infected with HIV. Single positive PCR results, particularly in the absence of other clinical or laboratory evidence of HIV infection, should not be used alone to diagnose HIV infection.


Subject(s)
HIV Infections/diagnosis , HIV Infections/transmission , HIV Seropositivity/immunology , Prenatal Exposure Delayed Effects , AIDS Serodiagnosis , Child, Preschool , Female , Follow-Up Studies , HIV Seropositivity/diagnosis , Humans , Infant , Infant, Newborn , Polymerase Chain Reaction , Pregnancy , Prospective Studies
9.
Ann Intern Med ; 118(5): 350-5, 1993 Mar 01.
Article in English | MEDLINE | ID: mdl-8094280

ABSTRACT

OBJECTIVE: To describe the effects of human immunodeficiency virus (HIV) infection on the serologic manifestations and response to treatment of syphilis in intravenous drug users. DESIGN: Cohort study of intravenous drug users. SETTING: Medical clinic in a hospital-based methadone maintenance treatment program in New York City. PATIENTS: Fifty patients with syphilis, of whom 31 were HIV seropositive and 19 HIV seronegative. MEASUREMENTS: Serologic tests for syphilis and clinical manifestations. RESULTS: Stage of syphilis at presentation was not associated with HIV serologic status. No unusual or fulminant manifestations of early syphilis or neurosyphilis were noted among HIV-seropositive cases. Maximum nontreponemal titers were higher among HIV-seropositive (median, 1:128) than among HIV-seronegative (median, 1:32) patients with syphilis (P = 0.05); this difference was present only among patients with first-episode syphilis. All 26 evaluable, HIV-seropositive patients treated for syphilis responded appropriately, including 13 patients given standard or less-than-standard doses of penicillin. Seven of 43 patients (16%) showed reversion to negative treponemal antibody assay results after treatment for syphilis; this finding was not associated with HIV infection, CD4 count, or stage of syphilis. Low nontreponemal titer was weakly associated with treponemal test reversion. CONCLUSIONS: Infection with HIV did not alter the stage at presentation, clinical course, serologic manifestations, or response to treatment of syphilis in this cohort of intravenous drug users.


Subject(s)
HIV Seropositivity/immunology , Substance Abuse, Intravenous/immunology , Syphilis/immunology , Adult , Antibodies, Bacterial/blood , CD4-Positive T-Lymphocytes , Cohort Studies , Female , HIV Seropositivity/complications , Humans , Leukocyte Count , Male , Substance Abuse, Intravenous/complications , Syphilis/complications , Syphilis/drug therapy , Treatment Outcome , Treponema pallidum/immunology
10.
N Engl J Med ; 327(24): 1697-703, 1992 Dec 10.
Article in English | MEDLINE | ID: mdl-1359411

ABSTRACT

BACKGROUND AND METHODS: To examine the clinical course of human immunodeficiency virus (HIV) infection in injection-drug users, we conducted a prospective study of a cohort of patients in a methadone-treatment program in New York City from July 1985 through December 1990. The patients underwent standardized evaluations at base line and semiannually thereafter and received on-site primary medical care. Rates of progression to the acquired immunodeficiency syndrome (AIDS) and major outcomes before the development of AIDS were examined by univariate analyses; the risk of AIDS was also assessed by product-limit survival analysis and proportional-hazards regression. RESULTS: Of 318 HIV-seropositive patients who did not yet have AIDS (171 men and 147 women), 90 were black, 179 were Hispanic, and 49 were white; the median age was 33 years. Over a median of 3.0 years of follow-up, 55 (17 percent) received a diagnosis of AIDS (incidence per 100 person-years, 5.8). Major outcomes before the development of AIDS included oral candidiasis (incidence per 100 person-years, 11.2), pyogenic bacterial infections including pneumonia and sepsis (8.0), pulmonary tuberculosis (1.2), multiple constitutional symptoms (13.6), and herpes zoster (1.3). There were 41 deaths from AIDS, and 13 seropositive patients without AIDS (4.1 percent) died of bacterial infections, as compared with only 1 of 411 seronegative patients studied (P < 0.001). The incidence of AIDS was 62 percent lower among those who took zidovudine than among those who did not (P = 0.02). In the multivariate analysis, progression to AIDS was best predicted by low numbers and percentages of CD4+ lymphocytes, nonuse of zidovudine, and the presence of oral candidiasis, bacterial infections, or tuberculosis. There was no consistent relation between progression to disease and the continued use of injection drugs. CONCLUSIONS: HIV-infected injection-drug users have progression to AIDS at rates comparable to those of other HIV-infected groups, but they have substantial pre-AIDS morbidity and mortality, particularly from bacterial infections, which also appear to predict disease progression.


Subject(s)
Acquired Immunodeficiency Syndrome/complications , HIV Infections/complications , Substance Abuse, Intravenous/complications , AIDS-Related Opportunistic Infections/complications , Adult , Bacterial Infections/complications , CD4-Positive T-Lymphocytes , Candidiasis, Oral/complications , Female , Follow-Up Studies , HIV Infections/drug therapy , HIV Infections/mortality , Humans , Leukocyte Count , Male , Multivariate Analysis , New York City/epidemiology , Proportional Hazards Models , Prospective Studies , Racial Groups , Zidovudine/therapeutic use
12.
Pediatrics ; 88(6): 1248-56, 1991 Dec.
Article in English | MEDLINE | ID: mdl-1956745

ABSTRACT

A prospective study was conducted in the Bronx, New York, of 70 infants of human immunodeficiency virus (HIV)-infected (n = 33) and uninfected (n = 37) mothers who had a history of intravenous drug use or of intravenous drug-using sex partners. Infants were observed from birth to a median age of 23 months (range 3 to 54 months). HIV infection was confirmed in seven infants (21%) of seropositive mothers; six developed HIV disease, with symptoms observed in the first year. Of these, three died (3, 9, and 36 months) of HIV-related causes; 3 of 4 survivors were greater than 25 months of age. HIV symptoms preceded or were concurrent with abnormalities in T-lymphocyte subsets; postneonatal polymerase chain reaction confirmed HIV infection in five infants with symptoms and one without symptoms. Among infants of seropositive mothers, seven without laboratory evidence of HIV (including polymerase chain reaction) had findings suggestive of HIV infection, including persistent generalized lymphadenopathy, hepatosplenomegaly, oral candidiasis, parotitis, and inverted T-lymphocyte ratios. These findings were not observed in infants of seronegative mothers. Although the presence of HIV proviral sequences was associated with HIV disease, the observation of indeterminate symptoms in at-risk infants indicates the importance of long-term clinical follow-up to exclude HIV infection. Disease manifestations in comparable infants of seronegative mothers are important for assessment of the impact of maternal drug use, development of specific clinical criteria for early diagnosis of HIV and eligibility for antiretroviral therapy.


Subject(s)
Acquired Immunodeficiency Syndrome/transmission , HIV Seropositivity , Maternal-Fetal Exchange , Substance Abuse, Intravenous , Acquired Immunodeficiency Syndrome/physiopathology , Female , Follow-Up Studies , Humans , Infant, Newborn , Male , New York City , Pregnancy , Prospective Studies , Sex
13.
N Engl J Med ; 321(13): 874-9, 1989 Sep 28.
Article in English | MEDLINE | ID: mdl-2770823

ABSTRACT

To identify risk factors for human immunodeficiency virus (HIV) infection in intravenous drug users, we undertook a study of the seroprevalence of HIV antibody in 452 persons enrolled in a methadone-treatment program in the Bronx, New York. The seroprevalence of HIV was 39.4 percent overall, 49.1 percent in blacks, 41.8 percent in Hispanics, and 17.2 percent in non-Hispanic whites (P less than 0.001 for all comparisons). The presence of HIV antibody was associated with the number of injections per month (P less than 0.001), the percentage of injections with used needles (P less than 0.001), the average number of injections with cocaine per month (P less than 0.001), and the percentage of injections with needles that were shared with strangers or acquaintances (P less than 0.001), a practice that was more common among blacks and Hispanics than among whites. The number of heterosexual sex partners who used intravenous drugs was associated with HIV infection in women (P less than 0.004) and was the only risk factor found for users who had not injected drugs after 1982 (P less than 0.05). The presence of HIV antibody was independently associated with being black or Hispanic (adjusted odds ratio, 4.56; 95 percent confidence interval, 2.65 to 8.14), a more recent year of the last injection of drugs (adjusted odds ratio, 1.24; 95 percent confidence interval, 1.13 to 1.35), the percentage of injections of drugs that took place in "shooting galleries" (adjusted odds ratio, 1.49; 95 percent confidence interval, 1.19 to 1.88), having sex partners who used intravenous drugs (adjusted odds ratio 1.24; 95 percent confidence interval, 1.06 to 1.45), and low income (adjusted odds ratio, 1.55; 95 percent confidence interval, 1.10 to 2.17). We conclude that differences in both the social setting of drug use and behavior related to injection carry different risks for infection with HIV and may explain, in part, the higher seroprevalence of HIV among blacks and Hispanics. In addition, we found that heterosexual activity was an independent risk factor for drug users.


Subject(s)
Acquired Immunodeficiency Syndrome/transmission , Substance-Related Disorders , Adult , Black or African American , Ethnicity , Female , HIV Antibodies/analysis , HIV Seropositivity/epidemiology , Humans , Income , Injections, Intravenous , Male , Needles , New York City , Risk Factors , Sexual Behavior , Social Environment , White People
14.
JAMA ; 261(9): 1289-94, 1989 Mar 03.
Article in English | MEDLINE | ID: mdl-2915455

ABSTRACT

To determine the effects of human immunodeficiency virus (HIV) infection on pregnancy outcomes, we prospectively studied female intravenous drug users in a methadone program in New York City. Of 191 women with HIV status known prior to pregnancy, 17 (24%) of 70 seropositives and 26 (22%) of 121 seronegatives became pregnant during 28 months of follow-up. Including 54 additional women first tested for HIV antibody after becoming pregnant, 125 pregnancies were studied in 97 women (39 seropositive, 58 seronegative). None of the seropositive pregnant women had advanced HIV-related disease at entry, and only one developed symptomatic disease (oral candidiasis) during pregnancy. No differences were observed between groups in the frequency of spontaneous or elective abortion, ectopic pregnancy, preterm delivery, stillbirth, or low-birth-weight births. Among women giving birth to live infants, seropositives were more likely than seronegatives to be hospitalized for bacterial pneumonia during pregnancy and had an increased tendency for breech presentation, although these events were infrequent. There were otherwise no differences between groups in the occurrence of antenatal, intrapartum, or neonatal complications. Results suggest that asymptomatic HIV infection is not associated with a decreased pregnancy rate or an increased risk of adverse pregnancy outcomes in intravenous drug users, and that an acceleration in HIV-disease status during pregnancy is uncommon.


Subject(s)
HIV Seropositivity/complications , Pregnancy Complications , Pregnancy Outcome , Substance-Related Disorders/complications , Adult , Female , HIV Seropositivity/diagnosis , Hospitalization , Humans , Injections, Intravenous , Methadone/therapeutic use , New York City , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/rehabilitation , Prospective Studies , Substance-Related Disorders/rehabilitation
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