The development of AIDS or AIDS-related conditions in a cohort of HIV antibody-positive homosexual men during a 3-year follow-up period.

One hundred and thirty-three homosexual men seropositive for the antibody against human immunodeficiency virus (HIV) were enrolled in a prospective study in 1984-85. The 3-year cumulative incidences of the acquired immunodeficiency syndrome (AIDS) and AIDS-related conditions, by life-table analyses, were 18% and 34%. The cumulative incidence of immune deficiency defined as CD4 lymphocytes less than 0.5 x 10(9) l-1 was 70% at 3 years. Absence of antibodies to p24 antigen, HIV antigenaemia, CD4 lymphocytes less than 0.3 x 10 l-1 and elevated serum level of IgA were significantly associated with the development of AIDS. There was no association between disease progression and persistent generalized lymphadenopathy. When adjusted to the probable year of infection, these results are in accordance with previous cohort studies. It is concluded that most, or all, subjects seropositive for HIV will develop progressive loss of CD4 lymphocytes followed by clinical signs of immune deficiency, and that differences among previous cohorts with respect to disease progression are probably due to differences in the duration of infection.

Immunological studies in homosexual men with and without antibodies to human T-cell lymphotropic virus type III.

T-cell subsets were studied in 559 homosexual or bisexual men attending outpatient clinics for AIDS-screening in Copenhagen during the period July 1984 to April 1985. Of the 559 individuals studied, HTLV III antibodies were found in 161 (29%). Persistent generalised lymphadenopathy (PGL) defined as the presence of lymph nodes greater than 1 cm in diameter at two or more extrainguinal sites for at least three months were found in 91 patients, 72 (79%) of whom had HTLV III antibodies. The seropositive group had lower counts of T-helper/inducer cells (p less than 0.001), higher counts of T-suppressor/cytotoxic cells (p less than 0.001), lower T-helper/T-suppressor ratios (p less than 0.001) and higher levels of IgG (p less than 0.001), compared to the seronegative group. Compared to seropositive men without PGL, seropositive men with PGL had higher levels of IgA and IgG (p less than 0.05) and lower T-helper/T-suppressor ratios (p less than 0.05), the latter primarily caused by an elevated number of T-suppressor/cytotoxic cells. It is concluded that HTLV III infection is accompanied by a number of immunological abnormalities, including depletion of T-helper/inducer cells and B-lymphocyte activation. A subgroup of patients is characterised by having PGL and increased serum concentrations of IgA and IgG. The clinical and prognostic importance of PGL and B-cell activation is unknown. To study this more closely, prospective studies are needed.

The LAV/HTLV-III screening in Copenhagen. Epidemiological results from four clinics over the period 1 July 1984 to 1 April 1985.

Over the nine month period from 1st July 1984 to 1st April 1985, 737 persons attended the four AIDS-screening clinics in Copenhagen. The attendance was unconditional, and the examination free of charge. All were examined clinically and serologically for LAV/HTLV-III infection. Ninety-seven percent were males; 490 (68%) and 198 (28%) described themselves as homosexual or bisexual respectively. This study presents epidemiological data on that group. As in other studies, we found a relationship between anti-LAV/HTLV-III and male homosexual promiscuity, i.e. trends towards higher antibody prevalences, the higher the number of different sexual partners annually and the number of previous sexually transmissible diseases. The occurrence of 18 percent seropositivity in a group with no previous sexually transmissible disease indicate a dissemination of the infection to a subpopulation of Danish homosexuals with a nonpromiscuous lifestyle. Night sweats and lymph node enlargement as subjective complaints along with lymphadenopathy and anal pathology on objective examination were significantly (p less than 0.025) related to positive LAV/HTLV-III serology. Fifty-one percent (337 persons) had neither subjective symptoms nor objective signs, and 50 of these (28% of this asymptomatic group) were seropositive. At this stage of the AIDS epidemic, it is important for surveillance purposes that anti-LAV/HTLV-III testing is made available to all members of risk groups. The establishment of the screening clinics with unconditional attendance and ensured anonymity seems to be an important step in this effort.

Sublingual buprenorphine for premedication and postoperative pain relief in orthopaedic surgery.

The effect of sublingual buprenorphine (Temgesic) as a premedicant and for postoperative pain relief compared with morphine/pethidine was studied in 50 patients scheduled for elective surgery of the knee joint. Twenty-five patients received buprenorphine 0.4 mg sublingually 1 h before surgery and the same dose on demand postoperatively. Twenty-five patients were given morphine intramuscularly (7.5 mg or 10 mg to females and males respectively) 1 h preoperatively. This group received pethidine (75 mg) intramuscularly on demand postoperatively. All the patients were anaesthetized with halothane N2O/O2 after induction with thiopentone. No significant differences were found with regard to sedation, dizziness, nausea and vomiting during the study period. Emergence shivering, confusion and restlessness just after termination of the operation were equal in the two groups. In the recovery room, however, there was a higher frequency of shivering (P less than 0.05) in the morphine group. During the first 24 h postoperatively the buprenorphine group was given an average of 3.8 doses compared with 2.3 in the pethidine group (P greater than 0.05). It is concluded, that buprenorphine sublingually is as good as morphine intramuscularly for premedication and therefore should be recommended to patients who wish to avoid injections. For postoperative pain relief the initial dose of buprenorphine should be given intravenously. Only minor and unimportant side effects were seen.