Prevalence of anti-HTLV-III in UK risk groups 1984/85

HIV in gay and bisexual men in the United Kingdom: 25 years of public health surveillance

It is more than 25 years since the first case of AIDS was reported in the United Kingdom. In December 1981 a gay man was referred to a London hospital with opportunistic infections indicative of immunosuppression. National surveillance began the following year, in September 1982, with the notification of deaths and clinical reports of AIDS and Kaposi's sarcoma plus laboratory reports of opportunistic infections. Since then epidemiological surveillance systems have evolved, adapting to, and taking advantage of advances in treatments and laboratory techniques. The introduction of the HIV antibody test in 1984 led to the reporting of HIV-positive tests by laboratories and the establishment of an unlinked anonymous survey in 1990 measuring undiagnosed HIV infection among gay men attending sexual health clinics. The widespread use of highly active antiretroviral therapies (HAART) since 1996 has averted many deaths among HIV-positive gay men and has also resulted in a large reduction in AIDS cases. This led to a need for an enumeration of gay men with HIV accessing NHS treatment and care services (1995 onwards), more clinical information on HIV diagnoses for epidemiological surveillance (2000 onwards) and the routine monitoring of drug resistance (2001 onwards). Twenty-five years after the first case of AIDS was reported, gay and bisexual men remain the group at greatest risk of acquiring HIV in the United Kingdom. Latest estimates suggest that in 2004, 26 500 gay and bisexual men were living with HIV in the United Kingdom, a quarter of whom were undiagnosed. In this review, we examine how national surveillance systems have evolved over the past 25 years in response to the changing epidemiology of HIV/AIDS among gay and bisexual men in the United Kingdom as well as advances in laboratory techniques and medical treatments. We also reflect on how they will need to continue evolving to effectively inform health policy in the future.

The management of children born to human immunodeficiency virus seropositive women

Increasing numbers of children born to human immunodeficiency virus (HIV) antibody-positive women are being identified, but guidelines as to their management are lacking. We have therefore established a paediatric counselling and screening clinic for managing such children in Edinburgh. During a period of 3 years, 49 infants and children of 43 HIV seropositive women have been seen. After a median follow-up period of 23 months, four children were found to have clinical evidence of HIV disease which was non-specific and could have been missed had they not been regularly monitored. Thus, close surveillance of infants born to seropositive women is important. Identifying a single clinic where this is done has allowed experience to accumulate on issues beyond the medical management of these infants as well as contributing to the clinical care of infants with symptoms. Based on this experience, we have developed guidelines for managing children born to HIV antibody-positive women.

Surveillance of AIDS in the United Kingdom

The surveillance of cases of the acquired immune deficiency syndrome (AIDS) in the United Kingdom is described and a preliminary analysis made of the 1012 cases that were reported to the end of August 1987. Homosexuals were the largest risk group. For the first time it is possible to present cases by the date of diagnosis and by the regional health authority of residence. The rate of increase of new cases shows no sign of slowing down. One third of patients with AIDS lived in a different regional health authority from that in which their disease had been diagnosed. The geographical distribution varied with the risk group. The commonest presenting clinical feature at diagnosis was Pneumocystis carinii pneumonia. Kaposi's sarcoma was considerably more common among homosexuals than among people in other groups at risk.

Human immunodeficiency virus and drug misuse: the Edinburgh experience

During 1985 many drug abusers who lived in Edinburgh were found to be infected with the human immunodeficiency virus (HIV). As a result an alternative counselling and screening clinic for testing for antibodies to HIV was established for use by drug abusers. Four hundred and forty one patients were counselled in the first year, and over 60% were either drug abusers or their sexual contacts. One hundred and fourteen (26%) patients were positive for HIV antibody, and 100 (88%) of these were current or former drug abusers. The HIV seropositivity rate in drug abusers was 52% but was only 7% in their sexual contacts. Services were provided for these people as well as counselling before and after the test. The cost of this counselling service for the first year was 27,000 pounds or 61.22 pounds per patient. The unexpected mobility of 23% of the Edinburgh drug abusers, particularly to other areas of Britain, suggests that similar services need to be set up elsewhere.

Transmission of human immunodeficiency virus (HIV/HTLV-III/LAV): a review

The literature on the transmission of human immunodeficiency virus (HIV/HTLV-III/LAV) is reviewed. HIV spreads by vertical transmission and by iatrogenic transmission (transfer of blood or blood-containing products), by infected needles among i.v. drug users and, more rarely, among health care workers, but mainly by sexual contact. In Western countries the virus is mainly spread by passive anal intercourse among homosexuals and seldom by heterosexual intercourse. In African countries, however, the virus is mainly spread by heterosexual intercourse, probably because of other, concurring sexually transmitted diseases. Some preventive measures are discussed.

Influence of sexual preference and chronic hepatitis B virus infection on T lymphocyte subsets, natural killer activity, and suppressor cell activity

To determine whether abnormalities of cell-mediated immunity are associated with chronic hepatitis B virus infection or with homosexuality, we studied 15 homo- and 11 heterosexual men with chronic hepatitis B virus infection, as well as 11 homo- and 16 heterosexual apparently healthy men. T lymphocyte subsets, natural killer activity, and suppressor cell activity were determined. Homosexual men had significantly lower peripheral blood T4/T8 ratios resulting from a significant increase in T8-positive (suppressor/cytotoxic) cells, and they also had lower natural killer activity. These effects of homosexuality were independent of chronic hepatitis B virus infection, which caused no significant changes independent of homosexuality, and they were not caused by infection with human immunodeficiency virus (formerly HTLV-III/LAV). Suppressor cell function was unaltered in this study. We conclude that studies of cellular immunity in hepatitis B virus infection must take male sexual preference into account.