Prácticas sexuales de chicos y chicas españoles de 14-24 años de edad / Sexual behavior in a Spanish sample aged 14 to 24 years old

Objetivo: Describir los comportamientos y prácticas sexualesde adolescentes y jóvenes españoles en función del género.Método: La información fue recogida mediante un cuestionario,realizado en el domicilio de los participantes y con presenciadel entrevistador, aplicado a una muestra aleatoria integradapor 2.171 chicos y chicas de 14-24 años de edad,representativa de las comunidades de Galicia, Madrid y Andalucía.Resultados: Un total de 1.439 sujetos (66,3%) refirieron habertenido actividad sexual en los últimos 6 meses, sin apreciarsediferencias estadísticamente significativas entre chicos(66,4%) y chicas (66,2%), excepto en las siguientes variables:haber practicado el coito anal (los chicos refieren haberlo practicadoen mayor proporción); número de parejas sexuales (laschicas manifestaron tener menor número de parejas), y frecuenciade coitos vaginales (las chicas presentaron una frecuenciamás elevada en esta práctica). También se encontrarondiferencias en frecuencia de uso del condón en lasprácticas coito-anales y en las bucogenitales, en las que loschicos refirieron utilizarlo más frecuentemente.Conclusiones: Los datos de este estudio indican que los chicosy las chicas mantienen comportamientos sexuales diferenciados.En este sentido, las chicas suelen tener menor númerode parejas sexuales y utilizan el preservativo en mayormedida que los chicos en las prácticas coito-vaginales; sin embargo,hacen menor uso de éste en las prácticas bucogenitalesy coito-anales. En función de estos datos consideramosnecesario tener en cuenta la variable género a la hora de diseñare implementar intervenciones preventivas(AU)

Objectives: To describe the sexual behaviors and practicesof Spanish adolescents and young adults according to gender.Method: Information was gathered by means of a questionnaireadministered in participants’ homes in the presence ofan interviewer. A random sample was used, consisting of 2,171adolescents and young adults of both sexes, ranging in agefrom 14 to 24 years old. The participants were from three distinctregions of Spain: Galicia, Madrid, and Andalusia.Results: A total of 1,439 participants (66.3%) reported havingbeen sexually active in the previous 6 months, with nostatistically significant differences between male (66.4%) andfemale (66.2%) respondents. However, significant differenceswere found between males and females in the following variables:anal intercourse was reported by a higher proportionof males than females, the number of sexual partners reportedby females was lower than that reported by males and thefrequency of vaginal intercourse reported by females was higherthan that reported by males. Condom use in anal intercourseand oral sex was more frequently reported by malesthan by females.Conclusions: The results of this study indicate that sexualbehavior differs between genders, with females having a lowernumber of sexual partners and more frequently using a condomin vaginal intercourse but less frequently in oral sex andanal intercourse. In view of these data, we believe that gendershould be taken into account when designing and implementingpreventive interventions(AU)

Evolução da síndrome de imunodeficiência adquirida (AIDS - SIDA) na clínica odontológica. O papel do cirurgião-dentista / The evolution of the acquired immunodeficiency syndrome in dental clinc and the dental team role

Evolução da infecção pelo HIV na clínica odontológica, mostrando a sua transmissão e seus diferentes estágios. A epidemiologia no mundo e Brasil, em especial, na clínica odontológica, o papel do cirurgião-dentista, discutindo os seus procedimentos, diante dos pacientes e suas manifestações bucais como a sua própria biossegurança durante o trabalho

Antibody to the ligand for CD40 (gp39) inhibits murine AIDS-associated splenomegaly, hypergammaglobulinemia, and immunodeficiency in disease-susceptible C57BL/6 mice.

Infection of genetically susceptible C57BL/6 mice with the LP-BM5 isolate of murine retroviruses cause profound splenomegaly, hypergammaglobulinemia, lymphadenopathy, and an immunodeficiency syndrome which includes the development of terminal B-cell lymphomas. Because many of these and the other manifestations of LP-BM5 virus-induced disease are similar to those seen in AIDS, this syndrome has been named murine AIDS, or MAIDS. Previous reports have shown that the onset of MAIDS depends on the presence of both CD4+ T cells and B cells and have suggested that CD4+ T-cell-B-cell interactions are important to disease pathogenesis. Here, we assessed the possibility that interactions between CD40 and its ligand on activated CD4+ T cells, CD40 ligand/gp39, are involved in the development of MAIDS. To test this hypothesis, LP-BM5-infected B6 mice were treated in vivo with anti-gp39 monoclonal antibody. As a result, MAIDS-associated splenomegaly, hypergammaglobulinemia, germinal center formation, and the loss of in vitro responsiveness to the T- and B-cell mitogens concanavalin A and lipopolysaccharide were inhibited. Anti-gp39 monoclonal antibody-treated LP-BM5-infected mice were also able to mount essentially normal alloantigen-specific cytolytic T-lymphocyte responses. These results support the possibility that molecular interactions between CD40 and gp39 are critical to the development of MAIDS.

Manejo obstétrico de la paciente con infección por el virus de la inmunodeficiencia humana / Obstetrical management of the patient with infection by human inmunodeficiency virus

Con el aumento de los casos de SIDA en mujeres la posibilidad que el ginecoobstetra atienda a pacientes de este tipo es mayor, por lo que se requiere que estos especialistas adquieran una mejor preparación en relación a la infección por el Virus de la Inmunodeficiencia Humana (VIH). La transmisión perinatal, en nuestro país, constituye la principal vía de contagio en niños; estudios prospectivos recientes informan tasas de transmisión perinatal de 25 a 35 por ciento. El paso transplacentario del VIH es el factor más importante que condiciona la infección del feto. El estadio más avanzado de la infección y un recuento menor de linfocitos CD4 en la madre, se han asociado a una posibilidad mayor de infección al producto. Cada vez se soporta más el uso de zidovudina durante el embarazo. Todo trabajador de la salud que atiende pacientes VIH positivas debe acatar estrictamente las medidas de protección englobadas en el concepto de precauciones universales

Concorde: MRC/ANRS randomised double-blind controlled trial of immediate and deferred zidovudine in symptom-free HIV infection. Concorde Coordinating Committee.

Concorde is a double-blind randomised comparison of two policies of zidovudine treatment in symptom-free individuals infected with human immunodeficiency virus (HIV): (a) immediate zidovudine from the time of randomisation (Imm); and (b) deferred zidovudine (Def) until the onset of AIDS-related complex (ARC) or AIDS (CDC group IV disease) or the development of persistently low CD4 cell counts if the clinician judged that treatment was indicated. Between October, 1988, and October, 1991, 1749 HIV-infected individuals from centres in the UK, Ireland, and France were randomly allocated to zidovudine 250 mg four times daily (877 Imm) or matching placebo (872 Def). Follow-up was to death or Dec 31, 1992 (total 5419 person-years; median 3.3 years) and only 7% of the 1749 had not had a full clinical assessment after July 1, 1992. Of those allocated to the Def group, 418 started zidovudine at some time during the trial, 174 (42%) of them at or after they were judged by the clinician to have developed ARC or AIDS (nearly all confirmed subsequently) and most of the remainder on the basis of low CD4 cell counts. Those in the Imm group spent 81% of the time before ARC or AIDS on zidovudine compared with only 16% for those in the Def group. Despite the large difference in the amount of zidovudine between the two groups and the fact that the number of clinical endpoints (AIDS and death) in Concorde (347) outnumbers the total of those in all other published trials in symptom-free and early symptomatic infection, there was no statistically significant difference in clinical outcome between the two therapeutic policies. The 3-year estimated survival probabilities were 92% (95% CI 90-94%) in Imm and 94% (92-95%) in Def (log-rank p = 0.13), with no significant differences overall or in subgroup analyses by CD4 cell count at baseline. Similarly, there was no significant difference in progression of HIV disease: 3-year progression rates to AIDS or death were 18% in both groups, and to ARC, AIDS, or death were 29% (Imm) and 32% (Def) (p = 0.18), although there was an indication of an early but transient clinical benefit in favour of Imm in progression to ARC, AIDS, or death. However, there was a clear difference in changes in CD4 cell count over time in the two groups.(ABSTRACT TRUNCATED AT 400 WORDS)

Zidovudine twice daily in asymptomatic subjects with HIV infection and a high risk of progression to AIDS: a randomized, double-blind placebo-controlled study. The European-Australian Collaborative Group (Study 017)

OBJECTIVE: To evaluate the efficacy of zidovudine given twice daily in subjects with asymptomatic HIV-1 infection and a high risk of progression to AIDS. DESIGN: Randomized, double-blind placebo-controlled trial. SETTING: Multicentre study in five European countries and Australia. PATIENTS: Asymptomatic subjects (n = 329) with CD4 cell counts between 200 and 400 x 10(6)/l, or if > 400 x 10(6)/l, subjects with HIV p24 antigenaemia (> 10 pg/ml). INTERVENTION: Patients were randomly assigned to receive zidovudine 500 mg or placebo twice daily for 104 weeks, following a 250 mg four times daily dose regimen for the first 4 weeks. MAIN OUTCOME MEASURES: The primary end-point was the development of AIDS or severe AIDS-related complex (ARC). Before unblinding the study other end-points were defined: the development of Centers for Disease Control and Prevention (CDC) group IV disease (AIDS, severe ARC and other CDC stage IV disease) and the development of symptomatic HIV disease (AIDS, severe ARC, other CDC stage IV disease and minor HIV disease). Changes in CD4+ cell counts, p24 antigenaemia and toxicity were also reviewed. RESULTS: Median treatment duration was 57 weeks for the placebo and 60 weeks for the zidovudine group, respectively. Progression to AIDS or severe ARC occurred in 17 placebo and 12 zidovudine recipients (log-rank P = 0.26). However, in the first of the 2 study years the rate of progression to AIDS or severe ARC was significantly higher in the placebo than in the zidovudine group. Zidovudine delayed progression to symptomatic HIV disease (P = 0.01); a trend in a delay in progression to CDC stage IV disease was observed (P = 0.08). Zidovudine recipients maintained CD4+ cell counts at or above baseline levels for longer than placebo recipients (P = 0.04). HIV p24-antigen levels decreased in the zidovudine group and returned to pretreatment levels by week 36. Substantial toxicity was not observed. CONCLUSIONS: Zidovudine twice daily is effective in delaying progression to symptomatic HIV disease in high-risk, asymptomatic HIV-infected subjects. Modified definitions of clinical end-points may be useful for evaluating Phase III trials in comparable patient groups in the light of changes in the definition of AIDS and the increasing use of primary prophylaxis against opportunistic infections.

Measures of effect based on the sufficient causes model. 2. Risks and rates of disease associated with a single preventive agent.

We considered a simple formulation of the sufficient causes model, in which a preventive agent exerts its effect by preventing a sufficient cause of the disease from occurring, while leaving another sufficient cause unaffected. In a group unexposed to the preventive agent, a case of the disease is caused by whichever of the two sufficient causes occurs alone or first in the subject. Among exposed subjects, the preventive agent prevents only the cases of disease in which the sufficient cause it blocks would have occurred alone, not the cases in which the other sufficient cause also occurs during the study period. The proportion of subjects who would avoid the disease if exposed to the preventive agent is the risk difference. The risk difference varies over time, even when the rates of occurrence of the sufficient causes are constant. It increases to a maximum and then declines, as the subjects who have avoided the disease because of the agent later contract the same disease because of exposure to the other sufficient cause. This maximum and the time at which it occurs are readily computed from the incidence rates of disease among exposed and unexposed subjects.

Comparison of four commercial enzyme-linked immunosorbent and one agglutination assays for the detection of HIV antibodies in sera from Zimbabwe.

Sera from 871 AIDS and AIDS related complex patients were used to evaluate four ELISA and one agglutination assays. Commercial tests compared were Abbot, Wellcoyzyme, Biotest, Du Pont and Serodia. Wellcozyme and Serodia had the highest sensitivity (96.8 pc and 98.8 pc respectively) but the lowest specificity (53.3 pc and 46.5 pc respectively). Du Pont was the least sensitive test (89.1pc). Biotest and Abbot were comparable--Biotest had a higher sensitivity (93.2pc as compared with 90.6pc) but Abbot had a higher specificity (94.1 pc as compared with 89.1 pc). Thus, Abbott and Biotest both had a satisfactory high sensitivity and specificity and could thereby be recommended for use in screening of HIV-1 antibodies in south east Africa.

Placebo-controlled trial to evaluate zidovudine in treatment of human immunodeficiency virus infection in asymptomatic patients with hemophilia. NHF-ACTG 036 Study Group.

One hundred ninety-three asymptomatic patients with hereditary coagulation disorders and human immunodeficiency virus (HIV) infection were studied in a controlled trial of zidovudine (ZDV) versus a placebo (with an average of 9.7 months on study). Pretreatment characteristics were well balanced between the placebo and drug-treated groups, including CD4 distributions, types of clotting disorders, transaminase abnormalities, and use of various hemostatic agents. At the time of analysis, 161 patients either were still receiving treatment or had previously reached an endpoint of disease progression while receiving treatment. Twenty-five patients withdrew voluntarily. The toxic effects noted included granulocytopenia and anemia, especially in older patients, and subjective symptoms of asthenia, malaise, and nausea, consistent with the known consequences of treatment with 300 mg ZDV five times daily. There was a trend toward more diagnoses of acquired immunodeficiency syndrome (AIDS), advanced or early AIDS-related complex (ARC), single ARC symptoms, or death in placebo recipients as compared with those receiving ZDV (22 v 13). Because older patients with hemophilia have more rapid disease progression, the same efficacy analysis was performed in the 89 patients aged more than 30 years who were receiving treatment. In this subgroup, there was a similar trend (11 v 6). With regard to the most advanced problems of the infection among the older patients, there were five patients who were newly diagnosed with AIDS or died in the placebo group versus none in the ZDV group (P = .02) among the older patients. The pretreatment distribution of CD4 counts for the placebo and ZDV groups were similar, but patients aged more than 30 years had significantly (P less than .049) fewer CD4 cells than patients aged less than 30 years. A beneficial ZDV effect is also supported by a trend toward higher CD4 counts (a 48-cell increase in the ZDV group at 24 weeks as compared with a four-cell increase in the placebo group) and a significant (P = .03) difference in weight gain in the ZDV patients aged more than 30 years (8 pounds) as compared with the older placebo patients (aged more than 30 years) (2 pounds) at week 24. The findings in the asymptomatic hemophilic patients aged more than 30 years support a useful effect of ZDV, which is similar to observations in the larger study of its use in asymptomatic, nonhemophilic patients.

Results of a one year longitudinal study of HIV antibody test notification from the San Francisco General Hospital cohort.

We examined the psychological impact of HIV antibody testing in 107 homosexual men in San Francisco. Seventy-eight percent of the seropositives but only 43% of the seronegatives correctly anticipated their results. Twelve months after notification (but not earlier), notified seropositives reported significantly greater increases in total distress than nonnotified controls. However, notified seronegatives demonstrated significantly lower levels of hopelessness than nonnotified controls at every follow-up assessment. Thus, knowledge of HIV antibody status appears to dispel a sense of gloom in persons who incorrectly believe themselves to be infected with HIV, but does not appear to induce significant distress in those whose expectation of a positive result is confirmed. Both groups reported lower distress than men with ARC or AIDS, suggesting that distress was related more to symptomatology than knowing antibody status. These results suggest the benefits of HIV testing for the considerable proportion of seronegative subjects believing themselves to be seropositive and should be weighted against the more limited induction of distress in seropositives who receive confirmation of their test result expectation. The benefits of testing are also supported by increasing knowledge of the usefulness of early intervention in HIV disease.

The important role of mass media in the diffusion of accurate information about AIDS.

This paper explores the vital role of mass media in diminishing the lack of consensus among those at risk for AIDS and those who treat them. It examines the perceptions of these groups with regard to the seriousness of the AIDS threat, what people at risk are really doing to protect themselves and others, and the accuracy and objectivity of media reports about AIDS. Results indicate that there is a disarming lack of consensus among those people who can do the most to influence the spread of AIDS. Results also indicate that those people at greatest risk for AIDS and for spreading the disease distrust the accuracy and objectivity of the media. The authors argue that consensus is required for a concerted fight on AIDS and that the mass media offer an effective avenue for encouraging it. They also explore methods for regaining media respect among high risk groups with regard to AIDS reporting.

[AIDS and pedodontics: the real risk and its prevention]. / AIDS e pedodonzia: rischio reale e sua prevenzione.

The daily increase in carriers of the AIDS virus (150,000 is the latest estimate for Italy) means that the dentist must pay the utmost attention in selecting cases at risk and in defending himself from the possibility of contagion. Albeit to a lesser extent, the pedodontist is also involved in this problem. Here situations in which the risk of contagion is greatest because of the patient's social position or associated pathologies and the difficulty of the operation required are reported and some indications are offered to guide the pedodontist's professional behaviour.

Rationale for anti-AIDS chemotherapy directed at HIV-1 infected dendritic cells in seropositive individuals prior to the appearance of ARC and AIDS.

An approach to anti-AIDS chemotherapy is presented from the point of view of treating seropositive individuals by eliminating the infected dendritic cells that are the in vivo target of HIV-1. Special attention is given to the treatment of Langerhans (dendritic) cells in the skin and epithelia that are infected in vivo by HIV and are involved in the development of the symptoms leading to AIDS and ARC. Since HIV is released through the cervical and vaginal epithelia in seropositive women, it is suggested that combined local treatment of vaginal epithelium with steroids that inactivate dendritic cells and azidothymidine (AZT) that inhibits HIV-1 replication might prevent virus dissemination. Abrogation of HIV-1 transmission will help to prevent its spread throughout the heterosexual population. Thus a new rationale for anti-AIDS treatment is presented, namely selective elimination of HIV-1 infected dendritic cells in the skin and epithelia of infected individuals before the appearance of ARC or AIDS. Subsequent restoration of dendritic cells in HIV-1-infected persons (and in AIDS patients) by means of orally administered retinoids in combination with an antiviral drug might be a useful approach to prevent or delay AIDS.

Zidovudine in asymptomatic human immunodeficiency virus infection. A controlled trial in persons with fewer than 500 CD4-positive cells per cubic millimeter. The AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases.

Zidovudine (AZT) is a potent inhibitor of the replication of the human immunodeficiency virus (HIV), and it has been shown to improve survival in advanced HIV disease. We conducted a randomized, double-blind trial in adults with asymptomatic HIV infection who had CD4+ cell counts of fewer than 500 per cubic millimeter on entry into the study. The subjects (92 percent male) were randomly assigned to one of three treatment groups: placebo (428 subjects); zidovudine, 500 mg per day (453); or zidovudine, 1500 mg per day (457). After a mean follow-up of 55 weeks (range, 19 to 107), 33 of the subjects assigned to placebo had the acquired immunodeficiency syndrome (AIDS), as compared with 11 of those assigned to receive 500 mg of zidovudine (P = 0.002; relative risk, 2.8; 95 percent confidence interval, 1.4 to 5.6) and 14 of those assigned to receive 1500 mg of zidovudine (P = 0.05; relative risk, 1.9; 95 percent confidence interval, 1.0 to 3.5). In the three treatment groups, the rates of progression (per 100 person-years) to either AIDS or advanced AIDS-related complex were 7.6, 3.6, and 4.3, respectively. As compared with those assigned to placebo, the subjects in the zidovudine groups had significant increases in the number of CD4+ cells and significant declines in p24 antigen levels. In the 1500-mg zidovudine group, severe hematologic toxicity (anemia or neutropenia) was more frequent than in the other groups (P less than 0.0001). In the 500-mg zidovudine group, nausea was the only toxicity that was significantly more frequent (in 3.3 percent) than in the placebo group (P = 0.001). We conclude that zidovudine is safe and effective in persons with asymptomatic HIV infection and fewer than 500 CD4+ cells per cubic millimeter. Additional study will be required to determine whether such treatment will ultimately improve survival for persons infected with HIV.

ELISPOT: a new approach to studying the dynamics of virus-immune system interaction for diagnosis and monitoring of HIV infection.

A new approach to detect and enumerate HIV-specific antibody-secreting cells (ASC) in the peripheral blood was developed using the enzyme-linked immunospot (ELISPOT) methodology. ASC to an HIV envelope recombinant protein were demonstrated in 75% of 16 adults and 72% of 21 children with untreated AIDS or ARC and in 63% of 34 asymptomatically infected adults but in none of the 51 HIV antibody-negative individuals. Only 1 of the 13 adults receiving AZT therapy yielded a positive reaction, and 27% of the 30 infants born to seropositive mothers were found to have HIV-ASC. The number of HIV-ASC in positive individuals varied from 8 to 202 per 10(6) circulating mononuclear cells. The reactivity was specifically inhibited by soluble HIV antigen and was abrogated by cycloheximide, indicating that the observed reaction was the result of de novo synthesis of HIV-specific antibodies. Nonspecific polyclonal B cell activation was unlikely to be responsible for the results observed as no reactivity was found to a common antigen, tetanus toxoid. Since circulating antigen-specific ASC reflect persistent or recent antigenic stimulation, our findings indicate that this new approach could provide a dynamic perspective of the natural course of virus-immune system interactions in individuals infected with HIV, as well as in those undergoing prophylactic or therapeutic interventions.

[AIDS-complex and our Leviathan. Can and should the state educate us about AIDS?]. / Der Aids-Komplex und unser Leviathan. Kann und soll uns der Staat über Aids aufklren?

Sigusch pleads for removing AIDS education from the jurisdiction of the state. He reasons that as caretaker of citizens' sexual lives the state cannot avoid consolidating their status as its subjects.