The HIV/AIDS epidemic in Jamaica.

OBJECTIVE: To describe the HIV/AIDS epidemic in Jamaica. METHODS: Data from the national surveillance system for HIV infection and AIDS based in the Epidemiology Unit, Ministry of Health, were reviewed. These include case reports; HIV screening of blood donors, migrant farmworkers and US visa applicants; sentinel surveillance among antenatal clinic (ANC) attenders and sexually transmitted disease (STD) clinic attenders; and various serosurveys. RESULTS: A total of 669 AIDS cases were reported in Jamaica from December 1993 representing a cumulative AIDS case rate of 28 per 100,000 population. Since 1987 the annual AIDS case rate doubled every 2 years with 69% of individuals having died with AIDS. Heterosexual transmission predominates with the cumulative adult AIDS male-to-female case ratio declining from 2.8:1 in 1988 to 1.9:1 in 1993. A total of 55 children with AIDS account for 8.2% of all cases. The HIV infection rate per 1000 in 1993 was 3.8 among blood donors, 1.4 among ANC attenders and significantly higher among STD clinic attenders (men 6%, women 2.7%), homosexuals (9.6%), female prostitutes (12%) and individuals with repeat STD infections (10%). Consistent condom use increased from 27% in 1989 to 47% in 1993. CONCLUSIONS: HIV infection was introduced into Jamaica from abroad through several different routes including the Jamaican homosexual community, migrant farmworkers, female prostitutes, and informal commercial importers. HIV transmission is well established locally and is spreading more rapidly in Western Jamaica and along the North Coast, which may reflect increased sexual activity associated with tourism. Although awareness of AIDS and HIV is high and condom use has increased considerably, there are no grounds for complacency concerning the HIV/AIDS epidemic in Jamaica.

Long term effects of continuous subcutaneous infusion of the somatostatin analog octreotide in the treatment of acromegaly.

The marked pituitary tumor shrinkage achieved by continuous sc infusion (CSI) of the long-acting somatostatin analog octreotide in one acromegalic patient led us to treat 16 other acromegalic patients for up to 24 months by CSI. This therapy, given in doses ranging from 100-600 micrograms/day, resulted in normalization of the mean daily serum GH (mGH) and insulin-like growth factor I levels in 9 of the 17 patients (53%). In 7 patients, mean daily serum GH decreased but not to normal; 3 of these patients had hyperprolactinemia which was not influenced by octreotide. One patient was completely unresponsive. In contrast to the biochemical results, 80% of the patients had marked clinical improvement. Side-effects consisted of slightly impaired carbohydrate tolerance in 2 patients and cholelithiasis in 2 patients. Pituitary tumor size decreased in only 3 patients; in 1 of them visual field defects disappeared rapidly. These results suggest that octreotide treatment may prove beneficial before surgery in patients with macroadenomas, although its efficacy varies widely. Potential responsivity can usually be determined by a short course (24 h) of CSI of octreotide.

Thyroid function tests in ageing and their relation to associated nonthyroidal disease.

Thyroid function tests of 179 euthyroid geriatric inpatients (83 +/- 6 yr) unaffected by acute diseases or malnutrition were investigated and compared with those of 76 ambulatory healthy younger subjects (42 +/- 13 yr). Elderly population was divided in three groups, respectively: group G I (n = 37, 65-78 yr), group G II (n = 64, 79-85 yr) and group G III (n = 78, over 85 yr). Severity-of-illness index of the patients was evaluated at entry in the study protocol. While total thyroxine (TT4), free triiodothyronine (FT3) and TSH levels remained unchanged, circulating total triiodothyronine (TT3) was significantly lower (113 +/- 32 vs 150 +/- 31 ng/dl, p less than 0.05) and free thyroxine (FT4) was significantly higher (12.4 +/- 2.7 vs 10.3 +/- 2.3 pg/ml, p less than 0.05) in aged people. Furthermore, TT3 decreased significantly from 130 +/- 36 in G I to 110 +/- 33 in G II and to 108 +/- 25 in G III (p less than 0.01), and FT4 increased progressively although not significantly in the same groups. A close correlation was found between TT3 and severity index in male observations only (r = -0.43, p less than 0.01), as well as between FT4 and severity index in both sexes (r = 0.51, p less than 0.001 for men, r = 0.21, p less than 0.01 for women). These data suggest that thyroid function tests have to be cautiously interpreted in a geriatric population, particularly in relation to the severity of the clinical state, and reference values should be determined for TT3 and FT4 in the ageing process.

Shrinking of a growth hormone-producing pituitary tumor by continuous subcutaneous infusion of the somatostatin analog SMS 201-995.

SMS 201-995, a long-acting somatostatin analog, was given as the initial treatment to an acromegalic patient. SMS 201-995 (200 micrograms, sc, three times daily) reduced, but did not normalize, serum GH levels. Complete and prolonged control of GH secretion was obtained with a 600-micrograms daily continuous sc infusion (CSI), and the patient was treated in this way for 6 months. Rapid improvement of clinical signs and symptoms of acromegaly occurred, as did major tumor shrinkage. The other pituitary functions did not change. After 6 months, the daily SMS 201-995 dose was progressively reduced; GH secretion remained suppressed. After 12 months of treatment, GH secretion was controlled with a CSI of 100 micrograms SMS 201-995 daily, but not with two daily sc 100-micrograms injections. Further significant reduction in tumor size occurred. We conclude that CSI of SMS 201-995 resulted in constant GH normalization and marked clinical and morphological improvement. This form of treatment should be considered as an alternative to ablative treatment of acromegaly.

Leydig cell tumor with gynecomastia: further studies--the recovery after unilateral orchidectomy.

The recovery of exocrine and endocrine testicular function was studied in six patients orchidectomized for an estrogen-producing Leydig cell tumor. Gynecomastia disappeared in four patients. The contralateral testis, whose volume was reduced, returned to normal size after 30 days. Sperm density returned to normal in only one of the four patients in whom the preoperative sperm count was reduced. One day after unilateral orchidectomy, plasma estradiol decreased to normal and testosterone (T) fell about 50%. On the 10th postoperative day, plasma T [5.60 +/- 1.20 ng/ml (SD)] was normal. On day 120, T was higher than on day 10 (6.83 +/- 1.20 ng/ml). There was no significant increase of T after a single injection of hCG (5000 IU) on day 10, and the T response was similar to that of normal men on day 120. Plasma FSH and LH were increased on the 10th postoperative day; they then decreased between 60 and 120 days after the operation but were still above the normal values on day 120. The FSH/LH ratio, which was 0.43 +/- 0.17 preoperatively returned to normal (1.60 +/- 0.25) 10 days postoperatively. In conclusion, after hemicastration for an estrogen-secreting tumor, testicular hormonal secretion returns to normal within 120 days but spermatogenesis may still be impaired at this time.

Detection of human papillomavirus type 5 DNA in skin cancers of an immunosuppressed renal allograft recipient.

A renal allograft recipient with an epidermodysplasia-verruciformis-like syndrome was found to have human papillomavirus type 5 (HPV-5) in his benign warty lesions and HPV-5 DNA in two of his skin cancers. This finding points to a role for HPV-5 in skin oncogenesis in renal allograft recipients.

[Hyperkeratosis of the keratotic plug type in patients with chronic renal failure and metabolic diseases]. / Hyperkératose à type de bouchons kératosiques au cours de l'insuffisance rénale chronique et des maladies métaboliques.

We have noticed in eight male patients transepithelial keratotic plugs which appeared preferentially on zones of supporting points. These plugs evoked in a more or less accurate way, Kyrle's disease or other related syndromes, particularly reactive perforating collagenosis and perforating folliculitis. Seven cases were associated with chronic and severe renal failure complicating a serious diabetes in four cases, one of them with a viral hepatitis. One case has been observed during an important denutrition with digestive disorders.

An unusual wart-like skin lesion found in a renal allograft recipient.

Immunosuppressed renal allograft recipients have an increased tendency to acquire warts. While studying such patients, we found a virus-induced, wart-like lesion that had an unusual histologic picture. Light microscopic studies showed bizarre keratinocytes with cytoplasmic, juxtanuclear, giant, crescentic bodies and round, nuclear inclusions, By electron microscopy, the giant cytoplasmic bodies were found to be composed of tonofilaments, and the nuclear inclusions were found to be composed of papillomavirus-like particles in a filamentous matrix. Typical papillomavirus particles were observed in a wart extract by the negative-staining method. Although virus was abundant in infected cells, no structural viral antigens of the human papillomavirus (HPV) types 1, 2, 3, or 5 could be detected by immunofluorescence microscopy, indicating infection by HPV 4 or some other, as yet undescribed, HPV type.

A potentially oncogenic human papillomavirus (HPV-5) found in two renal allograft recipients.

We have observed 2 immunosuppressed renal allograft recipients with skin lesions induced by human papillomavirus type 5 (HPV-5). One recipient had multiple pityriasis versicolor-like (PV-like) skin lesions on his arms and trunk, and multiple Bowenoid in-situ skin cancers. The other had 2 warty lesions on the back of her fingers. Structural antigens of human papillomavirus type 5 (HPV-5) were identified in benign lesions from both patients by immunofluorescence. The histologic and ultrastructural features observed in lesions from both patients were similar to those previously seen in HPV-5-induced lesions occurring in patients with the rare disease epidermodysplasia verruciformis (EV). The severe form of EV is characterized by HPV-5-induced PV-like lesions, multiple skin cancers, and usually depressed cell-mediated immunity. The picture seen in one of our renal allograft recipients recalls this severe form of EV. HPV-5, until now, has been found only in EV patients. The role of this potentially oncogenic virus in skin cancers which are known to occur with increased frequency in immunosuppressed renal allograft recipients must be determined.