Distribution of HIV type 1 infection in childbearing women in California.

The incidence of acquired immunodeficiency syndrome (AIDS) is increasing among California heterosexuals and children. To assess human immunodeficiency virus (HIV)-1 infection in childbearing women, we conducted a blinded serosurvey of newborns. Dried blood specimens taken from 99% of California births during the third quarter of 1988 (n = 135,808) and linked only to maternal demographic categories were tested for HIV-1 antibody by enzyme immunoassay and confirmed by Western blot. Period prevalence of HIV-1 infection was 7.4 per 10,000 childbearing women. Prevalence was highest for Black women and was also elevated for Hispanic and San Francisco Bay Area women. Findings suggest that California Hispanic women will make up an increasing proportion of new AIDS cases.

Human T-cell lymphotrophic virus in California's injection drug users.

Human T-cell lymphotrophic virus I (HTLV-I) and human T-cell lymphotrophic virus II (HTLV-II) are closely related retroviruses that are highly prevalent in injection drug users (IDUs). The bulk of infection in this group probably occurs with HTLV-II, with a lower prevalence of HTLV-I. HTLV-I is known to cause adult T-cell leukemia/lymphoma and tropical spastic paraparesis. HTLV-II has not been proven to cause any human pathology, but may be immunosuppressive and is almost indistinguishable serologically from HTLV-I. As with human immunodeficiency virus (HIV), infection with these viruses is likely to be lifelong and the disease may have a latent period of many years. Unlike HIV, HTLV-I and/or HTLV-II are not likely to be transmitted from mother to child prenatally, and usually require breast-feeding for vertical transmission. It is likely that HTLV-I and/or HTLV-II has been prevalent in IDUs for far longer than the HIV epidemic. HTLV-I and/or HTLV-II are relevant to the AIDS epidemic in that they may function as biologic markers of behavioral risk status for HIV infection in IDUs or their sexual partners, and they may accelerate the course of HIV infection in persons coinfected with HTLV-I and/or HTLV-II and HIV. Coinfection will be more likely as the HIV epidemic progresses. Pregnant addicts entering outpatient methadone maintenance treatment in San Francisco County or Contra Costa County during 1990 were found to have an HTLV-II prevalence of 21% (n = 24). Important issues in counseling infected methadone patients are described.

Anemia and spontaneous preterm birth.

The association between anemia during pregnancy and spontaneous preterm birth was studied with a two-stage case-control design in a large, multiethnic cohort. Results of all hematologic measurements were abstracted from the prenatal and delivery records of 1706 of the 26,901 women in the cohort. Among women delivered of infants at term, mean hematocrit value was low during the early phase of the second trimester, stable until near term, then reached a maximum at 40 weeks' gestation. The mean hematocrit value of black women was consistently lower than that of Asian, Mexican, and white women. Anemia (hematocrit value less than the tenth percentile for ethnic group and duration of pregnancy) at any time during the second trimester was positively associated with subsequent spontaneous preterm birth (odds ratio, 1.9; 95% confidence interval, 1.3 to 2.8). Compared with white women, the odds ratios for preterm birth were 2.0 (95% confidence interval, 1.6 to 2.4) for black, 1.2 (95% confidence interval, 0.9 to 1.6) for Asian, and 1.2 (95% confidence interval, 1.0 to 1.5) for Mexican women. Adjustment for second-trimester anemia had minimal influence on the odds ratios. We conclude that anemia during the second trimester was associated with preterm birth. However, it does not account for the large ethnic differences in preterm birth.

HIV antibody seroprevalence among prisoners entering the California correctional system.

A cross-sectional blind study was conducted in the spring of 1988 to estimate the extent of human immunodeficiency virus (HIV) infection among inmates entering the California correctional system. Of the 6,834 inmates receiving entrance physical examinations during the study period, 6,179 (90.4%) had serum tested for the presence of HIV antibodies after routine blood work was completed and personal identifiers were removed. Seroprevalence was 2.5% (95% confidence interval, 2.1% to 3.0%) among the 5,372 men tested and 3.1% (95% confidence interval, 2.1% to 4.5%) among the 807 women tested. Seroprevalence was more than twice as high among men arrested in the San Francisco Bay Area as in those arrested elsewhere in the state. The regional differences in HIV seroprevalence observed among entering inmates mirror infection rates reported among intravenous drug users from the same regions.

Underreporting of minority AIDS deaths in San Francisco Bay area, 1985-86.

A disproportionately high number of AIDS cases in the United States involve members of racial minorities. Even so, AIDS deaths of minority members may be undercounted. The completeness of reporting of AIDS deaths to the California AIDS Registry (ARS) among Hispanics, blacks, and whites in 1985 and 1986 from the San Francisco Bay Area was investigated. Death certificates listing AIDS as a cause of death or associated condition were identified and cross-checked with cases reported to ARS, current to December 1988. Death certificates were checked by hand for racial or ethnic classification using a definition of Hispanic based on information available on certificates. Three causes of undercounting in ARS were identified: a death was not reported as an AIDS case at all, an AIDS case was reported to ARS but the person was listed as still living, or an AIDS death was reported to ARS with a different racial or ethnic classification. The proportion of cases not reported at all was similar for all three racial-ethnic groups (5-8 percent). The proportion of deaths reported for persons listed in the registry as still living was 12 percent for Hispanics and 9 percent for blacks, compared with 5 percent for whites. For Hispanics, under-counting was largely due to ethnic misclassification. Twenty percent of Hispanics had been counted as white in the AIDS registry. In comparison, 4 percent of blacks and 1 percent of whites were misclassified by race. AIDS deaths among blacks and Hispanics may be undercounted, even in an area with good AIDS surveillance systems. This suggests that overrepresentation of minorities among AIDS cases in the United States may be even greater than indicated by current reporting data.

A cost-based decision analysis for Chlamydia screening in California family planning clinics.

Antibody-based methods for the diagnosis of Chlamydia trachomatis infection of the cervix have recently made population screening programs possible for this epidemic and frequently asymptomatic problem. We constructed a decision model, using medical care costs as utilities, to determine the total costs of screening and of not screening in California state-funded family planning clinics, and to determine the prevalence of infection at which such screening could be expected to pay for itself. A net savings of $6 million would be realized in the first year, with annual savings eventually increasing to over $13 million, from the prevention of chlamydia-associated pelvic inflammatory disease and other long-term sequelae such as tubal infertility and ectopic pregnancy. Over $60 million could be saved in the first five years of such a statewide screening program. In populations with infection prevalence of 2% or more, such screening will pay for itself and can be considered "cost-effective." Screening of asymptomatic women for chlamydia should be carried out in most American family planning clinics.