RESUMO
OBJECTIVES: This study investigated the sharing of drug preparation equipment as a possible route of hepatitis C virus (HCV) transmission. METHODS: HCV seroconversion was measured in a cohort of 317 injection drug users who tested negative for HCV antibody at recruitment. RESULTS: Cumulative HCV incidence was 16.7% per year. Among those who did not share syringes, HCV seroconversion was associated with sharing drug cookers and filtration cotton (adjusted risk ratio = 5.9; 95% confidence interval = 1.1, 31.7); 54% of HCV infections in injection drug users who did not share syringes were attributable to cooker/cotton sharing. CONCLUSIONS: Among injection drug users who do not share syringes, an important proportion of HCV infections may be attributed to cooker/cotton sharing.
Assuntos
Contaminação de Equipamentos , Hepatite C/transmissão , Abuso de Substâncias por Via Intravenosa/virologia , Adolescente , Adulto , Feminino , Seguimentos , Hepatite C/epidemiologia , Hepatite C/prevenção & controle , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Washington/epidemiologiaRESUMO
OBJECTIVE: Nonrandomized comparisons of the incidence of HIV and hepatitis B and C between injection drug users (IDUs) who do and do not attend voluntary needle-exchange programs may be subject to bias. To explore possible sources of bias, we examined characteristics associated with voluntarily beginning or ceasing to participate in the Seattle needle exchange. METHODS: In a cohort of 2,879 IDUs, a standardized questionnaire measured characteristics present at enrollment. We examined the relation of these characteristics to the proportion of IDUs who began to use the program during the ensuing 12-month follow-up period and to the proportion of current exchangers who dropped out during that period of time. RESULTS: Of the 494 never-exchangers at baseline, 32% attended the exchange program during follow-up; those who reported sharing syringes or who were homeless at enrollment were more likely to become new exchange users (adjusted risk ratio [ARR] for becoming an exchange user = 1.8 for those who shared syringes, and ARR = 2.2 for those who were homeless). Of 1,274 current exchangers, 16% stopped using the exchange during followup, with daily injectors (ARR = 0.6) and those who reported backloading (ARR = 0.6) being relatively less likely to drop out of the exchange. CONCLUSIONS: The analysis suggests that IDUs participating in needle-exchange programs at a given point in time may include a particularly high proportion of those injectors whose pattern of drug use puts them at elevated risk of blood-borne viral infections.
Assuntos
Programas de Troca de Agulhas/normas , Variações Dependentes do Observador , Abuso de Substâncias por Via Intravenosa/psicologia , Adulto , Análise de Variância , Estudos de Coortes , Fatores de Confusão Epidemiológicos , Demografia , Estudos de Avaliação como Assunto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Uso Comum de Agulhas e Seringas , Fatores Socioeconômicos , WashingtonRESUMO
To measure the effect of trimethoprim-sulfamethoxazole (TMP-SMX) in preventing bacterial illness, Pneumocystis carinii pneumonia (PCP), and death in people with AIDS, we conducted a retrospective medical record review of 1078 persons who were observed for 3 years on average who attended nine outpatient facilities in Seattle, Washington between January 1990 and April 1996. We calculated relative risk estimates to measure the protective effect of TMP-SMX on the development of major bacterial illnesses, PCP, and death. Use of TMP-SMX decreased the risk of PCP (relative risk [RR] = 0.23; 95% confidence interval [CI], 0.14-0.36) and deaths not attributable to PCP (RR = 0.59; 95% CI, 0.47-0.73). Prevention of major bacterial illnesses of known etiology was of borderline significance (RR = 0.77; 95% CI, 0.57-1.05) and became statistically significant with the addition of patients with infections of unknown etiology (RR = 0.77; 95% CI 0.61-0.97). Use of TMP-SMX PCP prophylaxis significantly reduced the risks of death and of PCP and was associated with a trend toward reduced risk of major bacterial infections.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Infecções Bacterianas/prevenção & controle , Pneumonia por Pneumocystis/prevenção & controle , Combinação Trimetoprima e Sulfametoxazol/farmacologia , Infecções Oportunistas Relacionadas com a AIDS/complicações , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/mortalidade , Adulto , Infecções Bacterianas/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/prevenção & controle , Pneumonia por Pneumocystis/complicações , Estudos Retrospectivos , Fatores de RiscoRESUMO
Health professionals in Washington State were surveyed in 1993 to assess acquired immunodeficiency syndrome (AIDS) reporting knowledge, attitudes, and practices. Seventy-five percent responded. Two thirds of previous reporters were informed about the 1993 AIDS case definition and reporting requirements, but 32 percent had neglected to report. Forty-eight percent were concerned about confidentiality of reported cases. Half favored human immunodeficiency virus reporting and 21 percent opposed it. In order to promote complete and timely AIDS reporting, current and future reporters need ongoing education on reporting requirements and methods. The importance of AIDS surveillance data for community planning as well as assurance of protection of confidentiality should be emphasized.
Assuntos
Síndrome da Imunodeficiência Adquirida , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Vigilância da População , Humanos , Profissionais Controladores de Infecções , Médicos , Inquéritos e Questionários , WashingtonRESUMO
Many potential routes of bovine leukemia virus (BLV) transmission are reviewed in this article. Vertical transmission, in utero, or through colostrum and milk, accounts for a relatively small proportion of infections. Iatrogenic horizontal transmission, through procedures permitting the transfer of blood between cattle, has been shown to be a major route of transmission in most settings. Contact transmission stems from a mixture of natural sources of blood, exudates, and tissues that enter the body through mucosal surfaces or broken skin. Careful analysis of management procedures and environmental conditions present in individual dairy and beef herds affords the greatest opportunity to develop effective BLV prevention programs.
Assuntos
Transmissão de Doença Infecciosa/veterinária , Leucose Enzoótica Bovina/transmissão , Transmissão Vertical de Doenças Infecciosas/veterinária , Vírus da Leucemia Bovina , Criação de Animais Domésticos/métodos , Animais , Anticorpos Antivirais/análise , Anticorpos Antivirais/imunologia , Bovinos , Colostro/virologia , Leucose Enzoótica Bovina/epidemiologia , Leucose Enzoótica Bovina/prevenção & controle , Feminino , Abrigo para Animais , Incidência , Vírus da Leucemia Bovina/imunologia , Vírus da Leucemia Bovina/isolamento & purificação , Masculino , Leite/virologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Fatores de Risco , Vacinas Virais/imunologia , Vacinas Virais/normasRESUMO
In summary, studies reported to date have largely failed to demonstrate human infection with animal and poultry retroviruses or an association between human diseases and these viruses. A number of studies, most of them serologic, have attempted to demonstrate human infection with these viruses. The lack of antibodies in apparently exposed groups of persons suggests an absence of infection. However, another possible explanation is that humans may be immunologically unresponsive to infection with these viruses. Although attempts to infect normal human cells in vitro with many of these viruses have not been reported, BLV and BIV appear to grow poorly or not at all. On the other hand, ALSV subgroup D infect and transform human cells in vitro. However, the production of infectious virus in vitro has been low or nonexistent. This may explain the absence of antibodies in human populations. Furthermore, many of the methods used to detect infection, either directly or indirectly, have either low sensitivity or problems with specificity. Several epidemiologic studies have tried to show a relationship between human and animal leukemia or lymphoma. In many of these studies the actual exposure to retroviruses is unknown and exposure to animals may merely represent exposure to other risk factors that are more important but were either not considered or are undefined; alternatively, a common exposure may be responsible for malignancy in humans and animals with no interspecies relationship. Based on the reported studies, these viruses appear unlikely to be responsible for any significant occurrence of human disease, particularly lymphoid malignancies. Although a definitive statement of no risk to human health is probably unwarranted, the evidence to date indicates that the risk is low and perhaps nonexistent. Thus, no specific public health recommendations regarding retrovirus-infected animals or poultry are warranted at this time.
Assuntos
Contaminação de Alimentos , Saúde Pública , Infecções por Retroviridae/epidemiologia , Retroviridae/isolamento & purificação , Animais , Western Blotting , Bovinos , Ovos/virologia , Ensaio de Imunoadsorção Enzimática , Contaminação de Alimentos/prevenção & controle , Cabras , Humanos , Incidência , Carne/virologia , Leite/virologia , Aves Domésticas , Retroviridae/imunologia , Infecções por Retroviridae/diagnóstico , Infecções por Retroviridae/prevenção & controle , Ovinos , SuínosRESUMO
OBJECTIVE: The purpose of this study was to assess the effect of psychiatric comorbidity on specific measures of hospital utilization, including length of stay, among hospitalized AIDS patients. METHOD: Data collection involved medical record abstraction for AIDS patients admitted to any one of 19 hospitals in Washington State during 1990. Psychiatric comorbidity was defined by the presence of an ICD-9 code reflecting psychiatric illness. Medical/surgical admissions of AIDS patients with psychiatric diagnoses were compared to those of AIDS patients without psychiatric diagnoses on measures of mean length of stay for the first admission in 1990, total number of hospitalizations in 1990, and total number of hospital days in 1990. Medical morbidity was addressed using CD4+ cell count and current and previous AIDS-defining illnesses as markers of disease severity. RESULTS: Of 357 patients hospitalized with AIDS, 49 (14%) had at least one psychiatric diagnosis. Patients with psychiatric illness were hospitalized an average of 6.6 days longer than AIDS patients without such illnesses. Differences in medical morbidity did not account for the longer length of stay. CONCLUSIONS: Psychiatric comorbidity increased the average length of stay among hospitalized AIDS patients. Future research needs to address the possible effects of this phenomenon on quality and cost of care received by AIDS patients.
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Hospitalização , Tempo de Internação , Transtornos Mentais/epidemiologia , Síndrome da Imunodeficiência Adquirida/terapia , Adulto , Linfócitos T CD4-Positivos/imunologia , Comorbidade , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Contagem de Leucócitos , Masculino , Transtornos Mentais/terapia , Admissão do Paciente/estatística & dados numéricos , Índice de Gravidade de Doença , Washington/epidemiologiaRESUMO
Time to progression to an AIDS-defining disease or death was analyzed for residents of King County, Washington State, with selected class IV non-AIDS diagnoses. Relative to people with constitutional symptoms, the risk of progression to an AIDS-defining diagnosis was 1.4 [95% confidence interval (CI), 0.8-2.2), 1.6 (95% CI, 1.0-2.5), and 2.1 (95% CI, 1.3-3.5) times greater for people with a diagnosis of oral hairy leukoplakia, oral candidiasis, and multiple diseases, respectively. Relative to subjects with CD4 counts of > or = 200, the risk of progression to AIDS was greater for subjects with CD4 counts < 200; relative risks ranged from 2.3 (95% CI, 0.8-6.6) for subjects with constitutional symptoms and CD4 counts < 200 to 6.7 (95% CI, 3.3-13.6) for subjects diagnosed with oral hairy leukoplakia and CD4 counts > 200. However, the statistical test for interaction between CD4 count and diagnostic group was not significant (p = 0.62). Our findings are in general agreement with results from previous cohort studies and suggest the utility of surveillance databases for natural history studies of the course of HIV illness.
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Candidíase Bucal/complicações , Infecções por HIV/complicações , Leucoplasia Pilosa/complicações , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/mortalidade , Adulto , Linfócitos T CD4-Positivos , Bases de Dados Factuais , Herpes Zoster/complicações , Homossexualidade , Humanos , Contagem de Leucócitos , Masculino , Estudos Retrospectivos , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/complicações , Trombocitopenia/complicações , Washington/epidemiologiaRESUMO
To evaluate whether uncircumcised status is correlated with acquisition of human immunodeficiency virus (HIV), 502 homosexual men were surveyed; 85% were circumcised. HIV infection was significantly associated with uncircumcised status (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.2, 3.8), nonwhite race, intravenous drug use, sexual contact with an intravenous drug user, number of male partners, frequency of unprotected receptive anal intercourse, and with history of genital herpes, anal herpes, or syphilis. Uncircumcised status was significantly associated with older age, nonwhite race, and history of syphilis; it was inversely associated with intravenous drug use. Using logistic regression analysis, the adjusted OR for the association between HIV infection and uncircumcised status was 2.0 (95% CI, 1.0, 4.0). Uncircumcised homosexual men had 2-fold increased risk of HIV infection. The role of circumcision as an intervention strategy to reduce sexual transmission of HIV warrants consideration.
Assuntos
Circuncisão Masculina , Infecções por HIV/epidemiologia , Adolescente , Adulto , Idoso , Western Blotting , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Infecções por HIV/transmissão , Homossexualidade , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Fatores de RiscoRESUMO
Survival analysis was performed for AIDS cases diagnosed in Washington state from 1982 through 1989 and reported through October 31, 1991. No difference in survival time among diagnosis years 1987, 1988, and 1989 (p = 0.29) was found. Since September 1987, survival time was longest for cases with human immunodeficiency virus (HIV) wasting syndrome and HIV encephalopathy. Adjusted risk for death was significantly lower for these cases relative to all other cases (relative risk, 0.5; 95% confidence interval, 0.4-0.6). Explanations for the absence of continuing increase in survival time between 1987 and 1989 include changes in the frequency and timing of anti-HIV therapy. Longer survival time among cases diagnosed with HIV wasting or HIV encephalopathy is likely due to diagnosis earlier in the course of HIV disease. These results emphasize how changes over time in the definition of AIDS and evolving therapeutic standards may affect assessment of survival time when using surveillance data.
Assuntos
Síndrome da Imunodeficiência Adquirida/mortalidade , Complexo AIDS Demência/mortalidade , Adolescente , Adulto , Feminino , Humanos , Masculino , Probabilidade , Modelos de Riscos Proporcionais , Fatores de Risco , Análise de Sobrevida , Fatores de Tempo , Washington/epidemiologiaAssuntos
Leucose Enzoótica Bovina/transmissão , Vírus da Leucemia Bovina , Complicações do Trabalho de Parto/veterinária , Complicações Infecciosas na Gravidez/veterinária , Infecção Puerperal/veterinária , Animais , Anticorpos Antivirais/sangue , Estudos de Casos e Controles , Bovinos , Suscetibilidade a Doenças , Leucose Enzoótica Bovina/imunologia , Feminino , Imunodifusão , Lactação/imunologia , Vírus da Leucemia Bovina/imunologia , Complicações do Trabalho de Parto/imunologia , Razão de Chances , Gravidez , Complicações Infecciosas na Gravidez/imunologia , Infecção Puerperal/imunologia , Fatores de RiscoRESUMO
We surveyed 77 persons with AIDS, their physicians and their social workers during the autumn of 1987 to ascertain health status and to quantify use of health services in Seattle, Washington. Participants included the majority (59%) of persons living with AIDS in the area. Information was gathered regarding demography, health status, functional status, medical history and the use of health services. The validity of self-assessed general health was corroborated by the physician-rated Karnovsky score (kappa = 0.59), by social worker assessment (kappa = 0.41), and by correlation with functional status (r = 0.6-0.8). We found more frequent use of health services (categorized into skilled services, chore services and physician services) among AIDS patients who were dependent in basic and instrumental daily activities, had low income, had poor self-assessed general health, lived alone or lacked an available support person at home. These associations persisted in multivariate analyses, and accounted for 6-23% of the variability in service use. We conclude that health and functional status of persons with AIDS can be estimated via mailed questionnaires and accounts for a modest amount of the variability in use of health services.
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Assistência Ambulatorial/estatística & dados numéricos , Nível de Saúde , Regionalização da Saúde , População Urbana/estatística & dados numéricos , Atividades Cotidianas/classificação , Adulto , Assistência Ambulatorial/economia , Controle de Custos , Mau Uso de Serviços de Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Washington/epidemiologiaRESUMO
Using AIDS surveillance data, we analyzed trends and correlates of outpatients AIDS diagnosis in Oregon and Washington. The proportion of outpatient diagnoses rose from 24% of cases in 1987 to 51% in 1990. Case characteristics associated with outpatient diagnosis included white race, urban residence, and the exposure category of male homosexual/bisexual contact. AIDS-defining conditions associated with outpatient diagnosis included Kaposi's sarcoma, HIV wasting syndrome, and esophageal candidiasis. Completeness and timeliness of reporting was poorer for cases diagnosed as outpatients compared with inpatients. As outpatient diagnosis becomes more common, modified surveillance methods may be needed to ensure complete case finding and consequent reliability of AIDS surveillance information.
Assuntos
Síndrome da Imunodeficiência Adquirida/diagnóstico , Pacientes Ambulatoriais , Síndrome da Imunodeficiência Adquirida/epidemiologia , Adulto , Feminino , Humanos , Pacientes Internados , Masculino , Oregon/epidemiologia , Vigilância da População/métodos , Washington/epidemiologiaRESUMO
OBJECTIVE: To describe the spectrum of disease in persons with human immunodeficiency virus (HIV) infection. DESIGN: Retrospective survey of medical records. SETTING: More than 50 clinics, hospitals, and private medical practices in nine US cities. PATIENTS: A total of 626 women and 7008 men 13 years of age or older with HIV infection who received medical care from January 1990 through March 1991 were consecutively enrolled. MAIN OUTCOME MEASURES: Any history of diseases in the 1987 case definition for the acquired immunodeficiency syndrome (AIDS), and during the 12-month period preceding enrollment (baseline period), the occurrence of other major diseases, hospitalizations, and results of CD4+ lymphocyte counts. RESULTS: Thirty-two percent of persons met the 1987 case definition for AIDS. The occurrence of an AIDS-indicator disease during the baseline period ranged from 3% (33/1011) to 46% (1254/2748) among persons with CD4+ lymphocyte counts of 0.50 x 10(9)/L or greater and fewer than 0.20 x 10(9)/L (greater than or equal to 500 and less than 200 CD4+ lymphocytes per microliter), respectively, and, at comparable CD4+ lymphocyte levels, was similar among women compared with men, and among persons who reported intravenous drug use compared with men who reported male-to-male sex. The frequency of one or more other major infectious diseases (eg, other pneumonias, bacterial sepsis, pulmonary tuberculosis) ranged from 6% to 16% among persons with CD4+ lymphocyte counts of 0.50 x 10(9)/L or greater and fewer than 0.20 x 10(9)/L, respectively; these illnesses were also associated with a history of intravenous drug use. Among persons who did not meet the 1987 AIDS case definition, 30% of those with an available CD4+ lymphocyte count had fewer CD4+ cells than 0.20 x 10(9)/L, 8% had one or more major infectious diseases, and 14% had one or more hospital admissions. CONCLUSIONS: For every person with AIDS at these sites, two additional persons with HIV infection were receiving medical care, many of whom had severe immunosuppression and a broad spectrum of serious HIV-related disease.
Assuntos
Infecções por HIV/complicações , Infecções Oportunistas/epidemiologia , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/mortalidade , Adolescente , Adulto , Linfócitos T CD4-Positivos , Candidíase/epidemiologia , Doenças do Esôfago/epidemiologia , Feminino , Infecções por HIV/mortalidade , Hospitalização , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Morbidade , Pneumonia por Pneumocystis/epidemiologia , Vigilância da População , Estudos Retrospectivos , Sarcoma de Kaposi/epidemiologia , Estados Unidos/epidemiologiaRESUMO
To determine whether rectal palpation, using common obstetrical sleeves, serves as a mode of transmission of bovine leukemia virus in dairy cattle, field studies were conducted at 2 dairies. At a commercial dairy, significant difference was not observed in rate of seroconversion in heifers and cows in which the same sleeve or new sleeves were used for palpations. At a university dairy, where cattle were used to teach dairy husbandry and veterinary procedures, significantly (P less than 0.02) greater rate of seroconversion was observed in heifers and cows palpated with unwashed common sleeves than that observed in heifers and cows palpated with sleeves washed between use. Although rectal transmission of bovine leukemia virus under field conditions was documented, it was related to frequency of palpation and age of cattle.
Assuntos
Leucose Enzoótica Bovina/transmissão , Palpação/veterinária , Animais , Anticorpos Antivirais/biossíntese , Anticorpos Antivirais/sangue , Bovinos , Feminino , Inseminação Artificial/veterinária , Vírus da Leucemia Bovina/imunologia , Palpação/efeitos adversos , Paridade , RetoRESUMO
Survival rates of 609 cases of acquired immunodeficiency syndrome (AIDS) in Washington State diagnosed between 1982 and 1987 according to pre-1987 AIDS surveillance definition were analyzed. People with a primary diagnosis of Kaposi's sarcoma survived longer than those with Pneumocystis carinii pneumonia. Both groups survived longer than those with other diagnoses. Median survival increased from 11.3, to 12.5, to 20.8 months for cases diagnosed in or before 1985, during 1986, and during 1987, respectively.
Assuntos
Síndrome da Imunodeficiência Adquirida/mortalidade , Síndrome da Imunodeficiência Adquirida/complicações , Adulto , Estudos de Coortes , Feminino , Homossexualidade , Humanos , Masculino , Pneumonia por Pneumocystis/complicações , Fatores de Risco , Sarcoma de Kaposi/etiologia , Abuso de Substâncias por Via Intravenosa/complicações , Taxa de Sobrevida , Washington/epidemiologiaRESUMO
We analyzed Washington State inpatient hospital utilization for 165 AIDS (acquired immunodeficiency syndrome) cases with 344 hospitalizations from July 1984 through December 1985. We found that mean charges per hospitalization were $9,166 and mean length of stay was 13.3 days. In addition, evaluation of two diagnosis-related groups (DRGs 079 and 398) commonly used for AIDS hospitalizations showed that AIDS hospitalizations were substantially more expensive than non-AIDS hospitalizations within the same diagnosis-related group. AIDS-specific diagnosis-related groups may be necessary to achieve a balance between inpatient charges and reimbursements.