Risk-based versus alternative algorithms for antibiotic prophylaxis among women seeking early suction abortion: a cost-effectiveness simulation.

BACKGROUND: Particularly in resource-poor settings, simple, inexpensive, and cost-effective algorithms are needed to direct antibiotic prophylaxis to prevent sequelae of infections with Chlamydia trachomatis, Neisseria gonorrhoeae, and bacterial vaginosis-associated organisms among women undergoing abortion. GOAL: To assess the prevalence of and risk factors for infections among women seeking abortion in Bali, Indonesia, and to use these data in designing a cost-effective risk-based prophylaxis algorithm. STUDY DESIGN: A cross-sectional analysis and data-based simulation of risk-based and alternative prophylaxis algorithms were performed. RESULTS: The risk-based algorithm would have provided prophylaxis to 70% (95% CI, 53-83%) of women with cervical infection, 64% (95% CI, 54-74%) of those with bacterial vaginosis, and 57% (95% CI, 42-72%) of those with trichomoniasis. For cervical infection, the algorithm was more cost effective than all others evaluated. The cost-effectiveness was acceptable for bacterial vaginosis. CONCLUSIONS: Risk-based algorithms may be cost effective in identifying women likely to benefit from preabortion prophylaxis. Prospective evaluation is needed to validate these findings.

Human papillomavirus, anal squamous intraepithelial lesions, and human immunodeficiency virus in a cohort of gay men.

Cross-sectional associations between human papillomavirus (HPV), anal squamous intraepithelial lesions (SIL), and human immunodeficiency virus (HIV) were studied in a cohort of gay men. HPV DNA was detected by generic and type-specific polymerase chain reaction (PCR) probes and hybrid capture assay (HC). HPV virus load was estimated by HC relative light unit (RLU) ratio. HPV prevalence, number of HPV types detected, and HC RLU ratios were each greater in HIV-positive than HIV-negative participants. Further, among HIV-positive men, HC RLU ratio was inversely associated with CD4 cell count. SIL was more frequent in HIV-positive participants, particularly those with a CD4 cell count <200/microL and was positively associated with HPV. Men with a high HC RLU ratio were nearly 3 times more likely to have SIL than were those both PCR- and HC-negative. These data support that HIV augments HPV-associated anal disease in this population.

Cytologic diagnosis of anal intraepithelial neoplasia using smears and cytyc thin-preps.

To investigate the optimal cytologic method for detecting anal intraepithelial neoplasia, the quality and diagnostic findings in 117 conventionally prepared smears and 191 CYTYC Thin-Preps were compared. Samples were obtained with a dacron swab from subjects participating in a longitudinal study of gay or bisexual men known as the Study to Help the AIDS Research Effort (SHARE). The smear takers were general clinicians who had no experience in obtaining cytologic specimens from the anus. Smears were entirely satisfactory in 48 (41.0%) subjects, limited for interpretation in 41 (35.0%), and unsatisfactory in 28 (23.9%). CYTYC preparations were satisfactory in 158 (82.7%) cases and unsatisfactory in 33 (17.3%). Insufficient cellularity was the most frequent reason for both unsatisfactory smears and CYTYC preparations, but air drying artifact was present in nearly every smear. Squamous intraepithelial lesions (SILs) were detected in four (4.5%) smears compared to 53 (33.6%) CYTYC slides. The detection of SIL correlated with the presence of glandular and metaplastic cells in CYTYC preparations, but this association disappeared if only satisfactory specimens were considered. In conclusion, CYTYC Thin-Preps were satisfactory twice as often as conventional smears (P < 0.005) and detected nearly eight times as many SILs (P < 0.005).

Infection with the human immunodeficiency virus: clinical manifestations and their relationship to immune deficiency. A report from the Multicenter AIDS Cohort Study.

In 1984 a large prospective study of gay and bisexual men was begun to elucidate the natural history of the human immunodeficiency virus (HIV) infection. At two successive semiannual examinations, clinical or hematologic abnormalities were found up to 13 times more often among HIV-seropositive men (n = 1611) than HIV-seronegative men (n = 2646). More than 30% of the seropositive participants had persistent generalized lymphadenopathy, independent of T-helper lymphocyte (CD4) counts and most other signs and symptoms. Other clinical manifestations such as thrush, anemia, thrombocytopenia, neutropenia, fever, and fatigue occurred with only slightly reduced CD4 counts (400 to 700/mm3) and appeared to increase exponentially with progressively lower counts. A simple systematically derived clinical index using these manifestations identified more than 70% of the seropositive men with significant T-helper cell depletion. This kind of clinical index may be useful for assessing groups of HIV-infected persons, especially those whose T-lymphocyte numbers and function cannot be readily measured.