[Transmission of acquired immunodeficiency syndrome among intravenous drug abusers in Belgrade]. / Sirenje sindroma stecene imunodeficijencije u Beogradu medju osobama koje koriste droge intravenskim putem.

The prevalence of HIV infection among intravenous drug addicts (IVDAs) was 11% in Belgrade in 1997 (500 IVDAs). There are only two ways of transmission of HIV infection among IVDAs: the use of contaminated needles and syringes and sexual intercourse with an infected partner. We established in the counselling office for IVDAs that only 47.8% of them were injected with their own devices, 43% shared somebody's equipment, and 9.2% used other routes for drug taking. Condoms or safe sex were exceptional. Only 10.17% used condoms regularly; 12.5% from time to time and 77.32% never. Among 391 interviewed IVDAs 7% were not sexually active during the last year, 40% had one constant partner, 32% had intercourses with 2 to five partners, and 21% were promiscuous (more than 5 partners over one year). Fifty five were seropositive against HIV. Ten of them were promiscuous and used no condom. There is some evidence that the majority of IVDAs after twelve years of post seroconversion (average age between 35 and 45), stopped their sexual activity. The prostitution of female IVDAs in order to finance their own and their partners supply of drugs is found in 3% of cases. This study can be helpful in implementing a selective and individual approach to some IVDAs with risk behaviour, who accept treatment, to prevent the spreading of infection.

[Clinical spectrum of HIV infection and classification systems]. / Klinicki spektar HIV infekcije i klasifikacioni sistemi.

Diseases spectrum caused by the human immunodeficiency virus (HIV) manifests with a wide range of clinical symptoms, due to the involvement of different organs and systems. Patients infected with HIV may present with a spectrum of clinical manifestations ranging from asymptomatic infection to severe immunodeficiency associated with different secondary infections, tumors, or other conditions. Since 1981 when the acquired immunodeficiency syndrome (AIDS) was recognized and the causative agent discovered thereafter, various systems have been proposed to classify manifestations of HIV infection and AIDS definition has bean revised several times. The evolution of classification systems for HIV infection and revision of case definitions for AIDS have closely followed current knowledge of biologic features of this infection, primarily related to its natural hystory and predictive value of immunologic parametres. Various classification systems for HIV infection, which have been widely used in clinical practice will be discussed in this review.

Neoplastic angioendotheliomatosis (NAE) of the CNS in a patient with AIDS subacute encephalitis, diffuse leukoencephalopathy and meningo-cerebral cryptococcosis.

A 12-year-old, hemophilic boy died with acquired immune deficiency syndrome (AIDS) after a clinical course characterized by progressive psycho-organic syndrome and opportunistic infections. Postmortem neuropathological examination revealed a cerebral form of neoplastic angioendotheliomatosis (NAE), leukoencephalopathy, giant cell encephalitis and meningo-cerebral cryptococcosis. The most unusual finding was the presence of proliferated neoplastic cells within lumina of some blood vessels throughout the central nervous system (CNS). These cells displayed cytologic features of malignancy and stained positively for common leukocyte antigen. Coronal sections showed diffuse cerebral and cerebellar leukoencephalopathy with most pronounced loss of myelin and axons in deep white matter, while the subcortical arcuate fibers and the corpus callosum were partially spared. In these areas numerous small foci of severe myelin loss were present. Microglial nodules and distinctive multinucleated giant cells (MGC) were numerous. Intracytoplasmic and intranuclear acidophilic inclusions were found in a few multinuclear and mononuclear cells. Close contact between mononuclear and multinuclear cells suggesting their fusion was also observed. As far as we know this is the first case of NAE encountered in AIDS, one of the rare primary cerebral forms and the youngest reported case of NAE up to now. This case could be considered as one proof more that NAE is a special form of malignant lymphoma.

[Pathogenesis of infection due to human immunodeficiency virus]. / Patogeneza infekcije virusom humane imunodeficijencije.

The constant increase in number vf patients with AIDS contributed to an increased interest for the mechanisms by which the human immunodeficiency virus provoked disorders of the immune system and disturbed functions of infected tissues and organs. The complex structure, tropism for some cell populations, specific life cycle and multiple interactions with host defence-system make the human immunodeficiency virus one of the most challenging pathogenic agents in medicine. The article deals with data from literature on some known facts as well as with assumptions which partially elucidate the pathogenesis of infection with human immunodeficiency virus.

[The effect of vaccination status on the clinical form and outcome of the disease in smallpox patients (author's transl)]. / Der Einfluss des Impfstatus auf die klinische Pockenform und den Krankheitsausgang

During the smallpox epidemic in Yugoslavia in 1972, which involved 175 persons altogether, with 35 (=20 per cent) fatal cases, a number of very important aspects emerged, especially at Kosowo (124 cases0: smallpox vaccination gives almost complete protection for 5 years and a relative immunity for about 10 years. Vaccinations carried out on the first 2 days after contact with smallpox patients provide a convincing protection, reduce mortality and result in the appearance of a particular form of smallpox. The highest mortality (52.1 per cent) was seen in persons who had never been vaccinated, with the appearance of the "flat type" (47.8 per cent). Hemorrhagic smallpox was seen in 8 out of 9 persons who were vaccinated too late after contact and had an immunological deficiency.