The AIDS epidemic

Recent Advances in PROTAC-Based Antiviral Strategies

Numerous mysteries of cell and molecular biology have been resolved through extensive research into intracellular processes, which has also resulted in the development of innovative technologies for the treatment of infectious and non-infectious diseases. Some of the deadliest diseases, accounting for a staggering number of deaths, have been caused by viruses. Conventional antiviral therapies have been unable to achieve a feat in combating viral infections. As a result, the healthcare system has come under tremendous pressure globally. Therefore, there is an urgent need to discover and develop newer therapeutic approaches against viruses. One such innovative approach that has recently garnered attention in the research world and can be exploited for developing antiviral therapeutic strategies is the PROteolysis TArgeting Chimeras (PROTAC) technology, in which heterobifunctional compounds are employed for the selective degradation of target proteins by the intracellular protein degradation machinery. This review covers the most recent advancements in PROTAC technology, its diversity and mode of action, and how it can be applied to open up new possibilities for creating cutting-edge antiviral treatments and vaccines.

Patients With Epilepsy Who Underwent Epilepsy Surgery During the COVID-19 Pandemic Showed Less Depressive Tendencies

Introduction: Our hypothesis in this study was that differences might exist between patients with epilepsy (PWE) who underwent epilepsy surgery before and within the period of the coronavirus disease 2019 (COVID-19) pandemic. The purpose of this study was to compare results of the Zung Self-Rating Depression Scale (SDS) between PWE who underwent epilepsy surgery before and during the pandemic period. Methods: Participants were PWE who underwent open cranial epilepsy surgery between February 2019 and February 2021 in our hospital. Patients who underwent surgery in the first half of this period, between February 2019 and January 2020, were defined as the pre-pandemic period group (pre-Group) and those treated in the second half, between February 2020 and February 2021, were categorized as the pandemic period group (within-Group). All patients completed the SDS before surgery, and scores were compared between groups. Results: SDS score was significantly higher in the pre-Group than in the within-Group (p = 0.037). Other factors, including age (p = 0.51), sex (p = 0.558), epilepsy duration from onset to SDS score evaluation (p = 0.190), seizure frequency (p = 0.794), number of anti-seizure medications (p = 0.787), and intelligence quotient (p = 0.871) did not differ significantly between groups. Conclusion: SDS score was higher in the pre-pandemic group than in the within-pandemic group, which may indicate that PWE with less-positive outlooks may be less likely to seek medical attention during stressful periods.

An alternative methodology for the prediction of adherence to anti HIV treatment

Background

Successful treatment of HIV-positive patients is fundamental to controlling the progression to AIDS. Causes of treatment failure are either related to drug resistance and/or insufficient drug levels in the blood. Severe side effects, coupled with the intense nature of many regimens, can lead to treatment fatigue and consequently to periodic or permanent non-adherence. Although non-adherence is a recognised problem in HIV treatment, it is still poorly detected in both clinical practice and research and often based on unreliable information such as self-reports, or in a research setting, Medication Events Monitoring System caps or prescription refill rates. To meet the need for having objective information on adherence, we propose a method using viral load and HIV genome sequence data to identify non-adherence amongst patients.

Presentation of the hypothesis

With non-adherence operationally defined as a sharp increase in viral load in the absence of mutation, it is hypothesised that periods of non-adherence can be identified retrospectively based on the observed relationship between changes in viral load and mutation.

Testing the hypothesis

Spikes in the viral load (VL) can be identified from time periods over which VL rises above the undetectable level to a point at which the VL decreases by a threshold amount. The presence of mutations can be established by comparing each sequence to a reference sequence and by comparing sequences in pairs taken sequentially in time, in order to identify changes within the sequences at or around 'treatment change events'. Observed spikes in VL measurements without mutation in the corresponding sequence data then serve as a proxy indicator of non-adherence.

Implications of the hypothesis

It is envisaged that the validation of the hypothesised approach will serve as a first step on the road to clinical practice. The information inferred from clinical data on adherence would be a crucially important feature of treatment prediction tools provided for practitioners to aid daily practice. In addition, distinct characteristics of biological markers routinely used to assess the state of the disease may be identified in the adherent and non-adherent groups. This latter approach would directly help clinicians to differentiate between non-responding and non-adherent patients.

Risks and issues for the health care worker in the human immunodeficiency virus era

The perception of degree of risk can vary markedly from actual risk. About 5% of the cases of AIDS and HIV infection in the United States have occurred in health care workers, a percentage that has remained stable over time. Nearly all of these infections are related to lifestyle factors, not occupational risk. The rise of occupational transmission is greatest with parenteral injuries. If there is an HIV risk to patients, it appears to be very much smaller than the risk to workers although it has received even more publicity. Apprehension exists concerning the future framework of the medical care delivery system and who will care for whom. The sensitive handling of legitimate fears and the balancing of conflicting risks will continue to be a challenging task in the decades ahead.

Detection of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus in donor eyes using polymerase chain reaction

Detection of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) in donor eyes was performed. DNAs were extracted from the uvea, and they were amplified using the polymerase chain reaction (PCR). Amplified viral DNAs were detected with liquid hybridisation and chemiluminescent assay in which no radioactive materials were used. This method was shown to have a sensitivity limit of fewer than 10 copies of HIV, making it much more sensitive than the current techniques employed in eye banks. The method was applied to 120 donor eyes, including four from donors seropositive for HBV. The HBV gene was detected in one case in which the donor's blood had not been tested for HBV. HIV and HCV genes were not detected in any of the samples. The assay could be an effective screening test for the detection of these viruses in eye bank eyes.

Quo vadis: perinatal AIDS issues--2004

The HIV problem will inexorably increase over the next decade, with an increasing proportionate impact upon women and children over the next decade. HIV will become endemic, essentially worldwide. Some regions in the developed world may be relatively spared if current trends continue. This may reduce the willingness to expend necessary resources, particularly if trends toward increasing isolationism continue. There are already signs of a world becoming "bored" with AIDS and the chronicity of a difficult problem. This engenders an atmosphere ripe for increasing discrimination, with the development of loopholes in protective legislation. Already in the United States, some lawsuits concerning health care access among employees have been decided in the employer's favor, permitting them to restrict access to health insurance, despite other regulations which might have protected such workers. Similarly, some HIV-infected health care workers have been dismissed or lost their privileges in the 1990s, despite passage of the Americans with Disabilities Act as well as preceding legislation. It remains to be seen how society will cope with these complicated issues. The view of AIDS in 2004 presented above is pessimistic. There are some important rays of hope. Recent innovative vaccine work and new theoretical models may put us on the road to success, both with preventive and therapeutic vaccines. In particular, the first success in eliciting protection against vaginal HIV exposure, albeit partial, was reported in mid 1993. In a simian immunodeficiency virus (SIV) in vivo experimental model, cellular immunity to SIV was induced in macaques without their developing any signs of SIV infection. These macaques after rechallenge with low-dose SIV remained free of detectable SIV, so there may be an element of protection associated with specific cellular immune responses to immunodeficiency viruses. However, very high-dose SIV rechallenge experiments in similar macaques still led to acquisition of active SIV infection, suggesting that any such protection was only partial. It is also possible that cellular immune protection may be of varying efficacy against different types of exposure, particularly parenteral versus mucosal (such as sexual) exposures. There is also reason for specific optimism concerning interventions that might directly reduce the risk of perinatal transmission. Data from studies of twins suggest that a substantial proportion of perinatal transmission does not occur until after labor has commenced. Thus, caesarian sections may potentially reduce the risk of transmission to the fetus in some cases.(ABSTRACT TRUNCATED AT 400 WORDS)

Entangled epidemics: cocaine use and HIV disease

Over the past decade, two epidemics have had a severe impact on public health in this country. These health problems involve cocaine abuse and AIDS (or HIV disease). The processes of these two conditions are clearly not independent of each other and may be quite complex. Understanding of this relationship has been hampered by a myriad of social, biological and behavioral variables that are entangled with the basic cocaine-HIV association. This article presents a paradigm for discussion of the interaction between cocaine exposure and HIV disease based on three mechanisms: the relationship between cocaine exposure and increased opportunity for HIV exposure, the direct role that cocaine plays in altering susceptibility to HIV infection, and the influence that cocaine use has on the progression of HIV disease. The goal of this structured approach is to enhance conceptual understanding of the cocaine-HIV relationship while recognizing the complexity of the issue and the limitations of current research efforts. This model will serve as a framework for the discussion of implications for future research, clinical practice, and public policy.

Prevalence of human immunodeficiency virus (HIV) antibody among apparently healthy pregnant women in Nigeria

OBJECTIVE

To determine the prevalence of human immunodeficiency virus (HIV) in pregnancy in our community.

METHOD

A prospective study on 250 pregnant women currently attending the antenatal clinic at the Lagos University Teaching Hospital was carried out in 1991.

RESULT

Results obtained showed that of the 250 pregnant women screened only two (0.8%) were seropositive for HIV. This indicates the risk of vertical or materno-fetal HIV transmission in our community and underscores the need for urgency for prospective monitoring of infants born to HIV seropositive women.

CONCLUSION

Although the prevalence rate of HIV seropositivity amongst the otherwise healthy Nigerian pregnant women is only 0.8%, we advocate universal screening of HIV during pregnancy.

A comparison of human immunodeficiency virus (HIV) seropositivity and hepatitis B surface antigenemia (HBs Ag) among the same group of apparently healthy pregnant women in Lagos, Nigeria: a preliminary report

Two hundred and fifty apparently healthy pregnant women attending the Obstetrics and Gynecology Clinic of the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria were screened for a comparison of the prevalence of HIV seropositivity and hepatitis B surface antigenemia (HBs Ag) amongst them. The Karpas AIDS cell test for HIV seropositivity and Bioman Hepatitis test kits were used as described by the manufacturers. HIV seropositive cases were confirmed using the Western blot test. Results revealed that out of the 250 pregnant women screened, 2 (0.8%) and 11 (4.4%) were HIV-1 and HBs Ag seropositive, respectively. However, the same 2 pregnant women now constituting 2 (18.2%) of the 11 HBs Ag positive pregnant women were simultaneously HIV-1 seropositive. Antibody to HIV-2 was not recorded in all HIV seropositive cases. This is the first report on the simultaneous prevalence of HBs Ag and HIV seropositivity among apparently healthy pregnant women in Lagos, Nigeria.

HIV infection and the healthcare worker

The perception of degree of risk can vary markedly from actual risk. About 5% of the cases of AIDS and HIV infection in the United States have occurred in healthcare workers, a percentage that has remained stable over time. Nearly all of these infections are related to lifestyle factors, not occupational risk. The risk to patients appears to be very much smaller, but has received even more publicity. Apprehension exists concerning the future framework of our medical care delivery system and who will care for whom. The sensitive handling of legitimate fears and the minimization and balancing of conflicting risks will be a challenging task in the decades ahead.

Detection of human immunodeficiency virus type 1 antibody by using commercially available whole-cell viral lysate, synthetic peptide, and recombinant protein enzyme immunoassay systems

A total of 575 serum specimens received for human immunodeficiency virus type 1 (HIV-1) antibody determination were tested prospectively by enzyme immunoassay with a whole-cell viral lysate (VL) (Genetic Systems Corp.), a synthetic peptide (SP) (United Biomedical, Inc.), and a recombinant protein (RCP) (Syva Co.). Concordance of all three antigens was noted for 559 of 575 (97.2%) specimens tested. Of the specimens tested, 90 (15.7%) were positive and 469 (84.3%) were negative. Retrospective testing by SP and RCP of 86 specimens indeterminate for HIV-1 antibody by VL, Western blot (immunoblot), and immunofluorescence was also performed. The results of both phases of this study indicate that the specificity of the three antigens is RCP greater than SP greater than VL. As noted from the prospective phase, the sensitivities of the antigens appear to be equivalent, indicating that the RCP and SP systems could be used in place of, or to confirm, a VL enzyme immunoassay screening test.

Sexually transmitted diseases in the elderly--issues and recommendations

The incidence of sexually transmitted disease (STD) in the elderly population is significant for both newly acquired disease and for residual complications from preceding infections. Every health-care practitioner needs to assume responsibility for the primary prevention of STDs, which focuses on avoiding infection. Primary health education is imperative in the presence of an escalation of sexually transmitted infection for which there is no known curative therapy. The sexual history is an integral component of the routine data base for all geriatric patients. Diagnosis of AIDS in the generally low risk elderly population may be unexpected. Health-care practitioners must be aware of its many forms of presentation.

Biopsychosocial approach to the human immunodeficiency virus epidemic. A clinician's primer

The human immunodeficiency virus (HIV) epidemic has created a multidimensional crisis that is challenging the health care system. Individuals with or without risk behaviors have anxieties about acquired immunodeficiency syndrome (AIDS) and need support and counseling. Once symptoms of HIV infection develop, crisis intervention and support need to be integrated into ongoing medical care. A biopsychosocial approach enables persons with AIDS to develop strategies for coping, to improve adherence, and to prevent transmission and suicide. Persons with AIDS are confronted with severe illnesses, neuropsychiatric disorders, discrimination, and death. Each person deserves the best medical and psychologic care available and the services of other disciplines where indicated. Caregivers, anxious about contagion, are devastated by the complexity, severity, and multiplicity of the illnesses that comprise AIDS and the lack of adequate resources to combat the epidemic. AIDS is a paradigm of a medical illness that requires a biopsychosocial approach. Psychiatric sequelae complicate the HIV epidemic, affecting both the uninfected and infected. The psychiatric manifestations of the uninfected include anxiety, phobia, factitious disorder, delusions, and Munchausen's AIDS. Psychiatric disorders associated with HIV infection include organic mental disorders, substance abuse disorder, affective disorders, adjustment disorders, anxiety disorders, and personality disorders. The consultation-liaison (C-L) psychiatrist is in a unique position to clarify and treat the psychiatric complications and to provide leadership for multidisciplinary programs. The biopsychosocial approach enables persons with HIV infection, their loved ones, and caregivers to meet the challenges of the HIV epidemic with compassion, optimism, and dignity.

Monocyte functional studies in asymptomatic, human immunodeficiency disease virus (HIV)-infected individuals

Various aspects of monocyte-associated function were evaluated in the peripheral blood mononuclear cells of male homosexuals who were infected with the human immunodeficiency disease virus (HIV). The functional assessments included indomethacin-sensitive regulation of blastogenesis and lymphokine-activated killer (LAK)-cell induction, chemiluminescent responses of mononuclear leukocytes to opsonized zymosan, and the expression of HLA-DR antigen on CD-14-positive monocytes. The results obtained demonstrate that each of these functions is abnormal in asymptomatic individuals who have HIV core antigen (p24) in their circulation. These results suggest that monocyte abnormalities which could contribute to immune dysfunction in HIV-infected patients can be detected early during the course of HIV infection and are associated with the expression of serum HIV antigen.

A report of cytomegalovirus cystitis and a review of other genitourinary manifestations of the acquired immune deficiency syndrome

We report a case of symptomatic cytomegalovirus cystitis associated with the acquired immune deficiency syndrome related complex. The diagnosis of the acquired immune deficiency syndrome was established by bladder biopsy. The hematuria resolved after systemic acyclovir therapy. The other known urological manifestations of the acquired immune deficiency syndrome are discussed.

Human immunodeficiency virus infection in multi-transfused patients with thalassaemia major

We investigated the incidence, clinical and immunological characteristics of human immuno-deficiency virus (HIV) infection in a group of multi-transfused patients with thalassaemia major who were exposed to transfusion-associated HIV infection. Seropositivity to HIV by Western blot and immunofluorescence analysis was detected in 26 out of 590 patients. At a follow up 21-40 months later, none of these seropositive patients had developed acquired immuno-deficiency syndrome (AIDS), and six manifested the AIDS related complex (ARC). ARC was unusually mild and consisted of moderate laterocervical and submandibular lymph node enlargement associated with hypergammaglobulinaemia and a reduced CD4/CD8 ratio resulting from the decreased number of CD4 lymphocytes. These findings suggest that multi-transfused patients with thalassaemia major are relatively resistant to the development of severe manifestations of HIV infection, presumably because their immune status is relatively better preserved than that of other infected populations. Longer follow up is, however, necessary to determine whether the incidence of AIDS will be lower in this population or whether overt AIDS merely takes longer to develop.

Strengths and weaknesses in methods for identifying the causative agent(s) of acquired immunodeficiency syndrome (AIDS)

Human immunodeficiency virus (HIV) is a cytoplasmic retrovirus which is transmitted via body fluids, especially through blood products and sexual contact, and is the causative agent of the acquired immunodeficiency syndrome (AIDS). Only about 5 to 10% of the patients infected with HIV contract AIDS; the great majority of infected people either develop a less aggressive condition (AIDS-related complex) or appear healthy. All persons infected with HIV may transmit the virus. In order to protect the national blood supply and to help in diagnosis, tests have been developed to identify infected persons. These include viral isolation techniques, enzyme-linked immunosorbent assay (ELISA), immunofluorescent assay (IFA), radioimmune precipitation (RIP) assay, Western blot, and, most recently, antigen identification and gene probes. Although the sensitivity and specificity among these methods varies, all are susceptible to false-positive and/or false-negative results. In order to understand the reasons for fragility in methodologies, it is necessary to appreciate several basic concepts related to the biochemistry, biology, pathophysiology, and genetic characteristics of HIV and related viruses. The purpose of this review is to present the strengths and weaknesses of each method, with emphasis on peculiar viral characteristics that lead to methodological defects or efficacies.

AIDS and public health

After briefly stating the significance of acquired immunodeficiency syndrome (AIDS) for public health, this paper considers programs or proposals to control the spread of AIDS in the following eight general areas: (a) education; (b) distribution of sterile needles; (c) screening and treatment of blood, blood products, and other tissues; (d) voluntary and mandatory screening of persons for evidence of infection; (e) reporting; (f) contact tracing; (g) isolation and other restrictions on freedom of movement or association; and (h) physical marking of persons with AIDS. Significant moral issues within each of these areas are discussed, and the overall justifiability of various proposals is examined.

Visualization of human helper T lymphocyte differentiation antigen in primate brain

The differentiation antigen T4 is present on the helper/inducer subset of T cells. In the acquired immune deficiency syndrome (AIDS), this lymphocyte subset is selectively depleted by HTLV-III/LAV virus which apparently uses the T4 antigen as a viral receptor. The autoradiographic visualization of the T4 antigen on sections of squirrel monkey brain shown here reveals a heterogeneous pattern with clustering in the same emotion-mediating regions of the brain that are usually enriched with neuropeptide receptors. Immunoprecipitates of cell membranes from primate brain indicate that an antigen very similar to T4 is present on brain and T4+ T lymphocytes. Since patients with AIDS frequently develop complications of the central nervous system and HTLV-III/LAV sequences have been found in the brain, these data suggest that direct infection of some brain cells with HTLV-III/LAV occurs via a mechanism involving the T4 antigen complex similar to that proposed for lymphocyte infection. In view of the brain sites found to express the T4-like antigen, the behavioral changes and mood shifts observed in AIDS patients may result from localized viral replication.

Urologic manifestations of AIDS

A retrospective analysis of 60 patients with Acquired Immune Deficiency Syndrome (AIDS) seen between 1981-1985 was performed to determine the genitourinary manifestations of this disease. Twenty-two per cent were found to have significant proteinuria, while 7 per cent had nephrotic syndrome which was associated with an extremely rapid demise. Renal insufficiency occurred in 27 per cent and renal biopsy results, when abnormal, revealed focal and segmental glomerulosclerosis. Pyuria was found in 52 per cent of patients, and urinary tract infections occurred in 20 per cent. Atypical pathogens including Candida, Salmonella, Acinetobacter calcoaticus, and cytomegalovirus were encountered.

Scabies epidemiology, Kauai, Hawaii, 1981-1985

The demography of scabies was studied in the sole dermatology practice on the island of Kauai, Hawaii, over a 50-month period. Scabies was observed far more frequently in whites and Hawaiians than in Japanese and Filipinos. Within the white ethnic group, scabies was most frequently diagnosed in persons between 15 and 44 years old, while in Hawaiians, the disease was most common in the 0-14-year age group. It is possible that learned or acquired behavior patterns may play a significant role in contracting the disease.

Techniques for reversing the failure of empathy towards AIDS patients

Educating the general population and health care workers about the acquired immunodeficiency syndrome (AIDS) is of paramount importance. There is a need to address the many fears and anxieties concerning this dreaded illness. Experience has shown that simple information-giving alone does little to allay the panic in the general population and in hospital personnel. The paper offers a psychodynamic explanation of the origins of the irrational fear and anxieties around AIDS patients and why information alone does not help the anxieties hospital workers experience. We have suggested a training program using group process and videotape techniques which can address the underlying fears and concerns about AIDS patients. These sessions can help hospital staff to deliver more empathic care to this patient group.

The costs of hospital-based medical care for patients with the acquired immunodeficiency syndrome

The costs which were incurred by patients for hospital-based care during the time from the diagnosis of the acquired immunodeficiency syndrome (AIDS) to death, range from pounds 6838 in London, England, to US$147,000 in Atlanta, USA. In 1986, a study was undertaken in Sydney to calculate the costs of the hospital-based treatment of patients with AIDS. The medical records of 39 patients who had received all their treatment at one institution were analysed retrospectively, and data were collected on their survival, hospitalizations, investigations and treatments. The mean survival time of the 39 patients was 7.2 months; during this time they had a mean of 4.0 hospital admissions that accounted for an average total stay of 34.6 days. In addition, they made, on average, 9.4 outpatient visits. There was a significant difference in the duration of hospitalization between those who presented with an opportunistic infection and those who presented with a malignancy (38.3 days and 22.4 days, respectively; P = 0.01). The mean cost for hospital-based care was $A22,332 (range, $A4229-$A58,398), of which 95% of costs were incurred for inpatient care. The mean cost of care of those who presented with an opportunistic infection was significantly higher than that of those who presented with a malignancy, but there was no difference according to the age at the time of diagnosis. If the predictions of 3000 cases of AIDS in Australia by 1991 are realized, such cases will represent--conservatively--an additional cost to the community of $A58.5 million. This study emphasizes the need for health authorities to plan for the future financial impact of the hospital-based treatment of patients with AIDS.

Antibody to a synthetic oligopeptide in subjects at risk for human immunodeficiency virus infection

Detection of antibodies to human immunodeficiency virus (HIV) by enzyme-linked immunosorbent assay (ELISA) is the accepted method to screen blood products at risk to transmit infection. The presence of antibodies to HIV in 565 serum specimens from 274 patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex, symptomatic and asymptomatic subjects at risk for AIDS, and controls was determined with an ELISA that incorporates synthetic peptides (designated E32/E34) representing sequences in the envelope glycoprotein gp41. Of 105 specimens from patients with AIDS or AIDS-related complex, 3 specimens that were negative by commercially licensed ELISA and immunoblot test were similarly unreactive in the E32/E34 ELISA. For homosexual men with generalized lymphadenopathy, 186 specimens were positive by the E32/E34 ELISA and 63 specimens were negative. In comparison, with the licensed ELISA, 184 of these samples were positive and 65 samples were negative. The two samples that were positive in the E32/E34 ELISA but not the commercial kit were also positive by immunoblotting. Sequential sera from one individual who apparently underwent seroconversion according to the commercial assays were all positive by E32/E34 ELISA and immunoblotting. Thus, the ELISA with synthetic peptides is an extremely sensitive and specific test of antibody response to HIV and has not yet yielded a negative result with a Western blot (immunoblot)-confirmed antibody-positive serum.

Demonstration of antibodies to the surface (anti-p41) and core proteins (anti-p24) of the human immunodeficiency virus (HIV) in individuals positive for anti-HIV

Diagnosis of infection with the human immunodeficiency virus (HIV) relies on the demonstration of antibody to this virus. Occasionally, the combined analysis of sera using ELISA and western blot reveals false-positive results. We have compared a newly developed test to detect antibodies to the core (anti-p24) and surface (anti-p41) proteins of HIV with the established tests described above. Anti-p24 and anti-p41 were negative in three individuals positive for anti-HIV by ELISA and immunoblot; they had a low risk to acquire HIV infection and were clinically and immunologically normal and suspected false positive previously. In 62 individuals at risk, anti-p41 was always positive while anti-p24 was negative in 24/62 individuals including all but one patient with AIDS. The data indicate that this new test may replace the western blot as a reliable, widely available, and standardized confirmatory assay. In addition, preliminary evidence needs to be confirmed that quantitative analysis of anti-p24 might be of prognostic value in the course of HIV infection.

Serologic markers after the transplantation of corneas from donors infected with human immunodeficiency virus

Four corneas from two cadavers that later had positive test results on enzyme-linked immunosorbent assays and Western blot analysis for antibodies against the human immunodeficiency virus were inadvertently transplanted to recipients who were without known risk of human immunodeficiency virus infection. We performed serial studies of serologic markers of human immunodeficiency virus infection in the cornea recipients and assayed reverse transcriptase levels of their mixed lymphocyte cultures. The four cornea transplant recipients were followed up for 130, 152, 397, and 440 days, respectively, and the results on all serologic tests and reverse transcriptase assays remain negative.

Acquired immunodeficiency syndrome (AIDS)

The Acquired Immunodeficiency Syndrome (AIDS), caused by the human immunodeficiency virus (HIV), also called the human T-lymphotropic virus type III/lymphadenopathy-associated virus [HTLV-III/LAV], has affected over 23,000 people; more than half of those with the disease have died. The actual case fatality rate approaches 100%. AIDS affects all groups and classes of people, although some are at special risk. Distribution of the disease is worldwide. The illness' effects on the body are widespread; of special interest are the ophthalmologic manifestations. The eye may be infected by various viruses (cytomegalovirus, varicella-zoster virus, herpes simplex virus or HIV itself), toxoplasma gondii, candida sp, cryptococcus neoformans, M. tuberculosis, or M. avium-intracellulare. Kaposi's sarcoma may affect the eye as well. Retinal vascular abnormalities (e.g., cotton-wool spots, vasculitis) are not uncommon in AIDS. The syndrome may present with neuro-ophthalmologic manifestations. No effective treatment for the illness is currently available, although several hold promise and there is hope for an AIDS vaccine. Prevention of infection through reduction of risks appears to be the only defense against AIDS at this time.

Screening cornea donors for antibodies against human immunodeficiency virus. Efficacy of ELISA testing of cadaveric sera and aqueous humor

Coded cadaveric sera from 35 patients with acquired immunodeficiency syndrome (AIDS), from 45 cadavers at high risk of human immunodeficiency virus (HIV) infection, and from 262 cadavers without known signs or risk of AIDS were assessed using three commercially available enzyme-linked immunosorbent assays (ELISA) kits and Western blot analysis. Greater than 94% sensitivity and 99% specificity was achieved with each of the ELISA test kits using cadaveric sera. The Western blot method gave 97.1% sensitivity compared with the autopsy-proven diagnosis of AIDS. Positive results were obtained on sera from AIDS cadavers even if the time of blood draw was delayed 35 hours from death and the time of sera preparation was delayed up to 176 days. False-negative or false-positive ELISA results did not appear to correlate with hemolysis or any parameter of sera preparation. In contrast to the high sensitivity in testing sera, only 16 to 26% of aqueous humor samples from AIDS cadavers were ELISA-positive and 79% were positive by Western blot. These results indicate that three commercially available ELISA test kits are an effective means of screening cadaveric sera for antibodies to HIV, but that aqueous humor cannot be reliably substituted for cadaveric sera to screen potential cornea donors by an ELISA assay.

Lansing poliovirus infection in mice: antibody demonstrable by enzyme-linked immunosorbent assay (ELISA) and immunoprecipitation but not by neutralization

Adult mice infected intracerebrally (i.c) with the Lansing strain of type 2 human poliovirus (HPV2) failed to develop a systemic neutralizing antibody response until 2 months post-infection (p.i). In contrast, an enzyme-linked immunosorbent assay (ELISA) demonstrated an antibody response of IgM and IgG classes beginning at day 1 p.i. with peak levels reached by 5 weeks p.i. This response was slightly greater in paralyzed than in nonparalyzed animals. Immunoprecipitation of poliovirus proteins from cytoplasmic extracts and disrupted purified virion preparations revealed antibodies to three capsid proteins, two capsid precursor proteins, and one nonstructural protein. Finally, neither neutralizing antibody nor definite virus replication was detected after oral, intraperitoneal, or intravenous routes of inoculation. We conclude that the lack of a systemic neutralizing antibody response in mice is probably due to an insufficient amount of infectious virus and consequently viral neutralizing epitopes reaching extraneural lymphoid tissues.

Epidemiology of acquired immunodeficiency syndrome in Australia

Since 1982, when the first case of acquired immunodeficiency syndrome (AIDS) was diagnosed in Australia, a total of 373 cases has been reported to the NHMRC Special Unit in AIDS Epidemiology and Clinical Research to December 19, 1986. Analysis of the data shows that 70% of cases were diagnosed in NSW and of all cases 88% were found to be in homosexual or bisexual men, with the majority aged between 30 and 39 years. Opportunistic infections were found in nearly three-quarters of cases. A mathematical model which has been developed predicts that 1000 cases will have been diagnosed by mid-1988 and nearly that many again in 1990 alone. The absence of a treatment or vaccine, the likelihood that current Australian resources will be inadequate to deal with the predicted number of cases, and the urgent need to establish measures that are aimed at controlling the extent of the disease are emphasized.

AIDS as a social phenomenon

AIDS is an infectious but also a social disease. Next to the major epidemiological question on the natural history of AIDS, important problems have been posed in various fields of social, political, ethical and legal areas extending far beyond traditional medical interest. These create polarization among public, politicians, press and also among physicians. As the situation changes, the gravity of the disease has become more prominent and the consensus on the effectiveness of the means used and proposed is not yet achieved. Social phenomena depend on societal values, the perception of fear and menace of disease to individuals versus perception of the collectivity. Among major risk groups this fear influenced by various ideologies and societal goals, is more pronounced than the response of the society warrant. It is not one of condemnation but of tolerance, and sympathy and has been directed not toward deterring people in engaging in certain kinds of sexual behaviour, but toward doing this with minimum risk. Conflict between the perception of rights (individual versus collective) is bound to grow although it is easy to distinguish in law legitimate epidemiological needs and their possible misuse. The present position of the main risk groups is changing in various ways. The reluctance of society to address openly issues of sexual behaviour has disappeared. There is rapidly accumulating knowledge on the social influence in the spread of the disease, but as yet, scant information on the influence of social factors on the control efforts and effectiveness of preventive behavioural strategies. The effects AIDS will have on the complex social structures in general, on health structures in particular, and on the problems which might shape future attitudes, values and morals cannot be delineated with any degree of precision but only vaguely guessed as the disease progresses now and into the next century.

Histopathology and immunohistology of HTLV-III/LAV related lymphadenopathy and AIDS

Fifty-nine lymph node biopsies from homosexual men with serum antibodies to HTLV-III/LAV were the subject of a detailed histopathological and immunohistochemical study. The histological findings were correlated to the patients clinical status, and the T4/T8 ratios in blood and lymph nodes. Four histological patterns predominated and were defined as follicular hyperplasia (FH), follicular fragmentation (FF), follicular atrophy (FA), and follicular depletion (FD). Immunocytochemical studies indicated that destruction of follicular dendritic cells is related to the initiation of follicular involution from FH to FF, but the possible role of follicular infiltrating T-cells cannot be excluded. Marked individual variations in lymph node angiogenesis increasing during involution were observed, which suggests that the degree of angiogenic host response may predispose for evolution of Kaposi's sarcoma. The majority of the patients with the clinical diagnosis of persistent generalized lymphadenopathy (PGL) were morphologically staged as FH or FF (89%), whereas most of the AIDS patients showed lymph node changes compatible with FA and FD (89%). Patients with AIDS-related complex (ARC) had a wider spectrum of morphological lymph node changes but a majority of cases (62%) were also classified as FA or FD. Clinical follow-up showed progression from PGL to ARC in seven of 21 cases with the FF pattern and only in three of 19 cases with FH, indicating a possible prognostic value in differentiating between FH and FF. Three cases with FD and one with FA progressed to AIDS during the time of observation. T4/T8 ratios in blood and lymph nodes were significantly lower in patients with FD histology compared to patients of the other histological groups. At autopsy, all AIDS cases showed the FD pattern of lymphadenopathy. Autopsy findings in seven patients emphasized the importance of post-mortem studies in clarifying the spectrum of opportunistic diseases, including tumors which afflict the AIDS patients.

The risk of AIDS: psychologic impact on the hemophilic population

The psychologic impact of the risk of the acquired immune deficiency syndrome (AIDS) was evaluated by questionnaire survey of 116 hemophiliacs, age 16 or older, and 40 mates and 94 parents of hemophiliacs. Although the mean group distress ratings indicate a lessening of emotional discomfort over time, ongoing distress as well as interference with life activities are reported. Parents indicate more distress than either hemophiliacs or mates. Health preoccupation, the fear of being contagious, interference with parent-child intimacy and sexual intimacy between hemophiliac and mate are noted. A significant decrease in the use of clotting factor concentrates for the treatment of bleeding episodes is reported because these products have been linked to the transmission of AIDS. Although the overall hemophilic population is coping effectively with the AIDS risk, some hemophiliacs are at increased risk for psychiatric morbidity, social isolation, hypochondriasis, and medical noncompliance. Increased parental anxiety is likely to lead to over-protective child-rearing practices. Although it examines only the hemophilic population, this study describes stress responses likely to be present in other at risk groups and suggests that specific psychosocial interventions are urgently needed.

AIDS risk reduction recommendations and sexual behavior patterns among gay men: a multifactorial categorical approach to assessing change

A sample of 745 New York City gay men, aged 20-65, were interviewed in 1985 as part of a longitudinal effort to determine the behavioral, psychological, and social impact of the AIDS epidemic on the non-ill but at-risk community. Detailed sexual behavior histories were taken for the year prior to the interview (1984-1985) and the year prior to when respondents first heard about AIDS (mode = July 1981). Parallel questions were asked for each annual time period allowing pre-AIDS/post-AIDS comparisons to be conducted. A multifactorial index of sexual behavior was constructed from three categorical variables: number of different sexual partners, (0, 1, and 2 or more); engaging in sexual contact outside a private home, (0, vs. 1); and engaging in sexual acts considered to be of higher risk for exposure to disease pathogens (0 vs. 1). These three factors, representing aspects of sexual behavior targeted for change by authors of risk reduction educational materials, were combined to form a seven-level typological index of sexual behavior. Analyses are based on comparisons between pre- and post-AIDS time periods on this index. Results indicate that both substantial change and substantial lack of change have occurred in gay male sexual behavior patterns, when sexual behavior measures are scaled to reflect complete abstinence from a particular type of sexual activity, as they are here. Results are discussed in light of previously reported findings on sexual behavior changes and the ambiguity surrounding the question of how much change is needed for significant risk reduction of AIDS.

AIDS and anaesthesia

The Acquired Immune Deficiency Syndrome (AIDS) is a group of conditions which is reaching epidemic proportions. It is caused by a virus new to man, with an as yet poorly understood natural history, ominous prognosis and no known cure. Anaesthetists should be aware of the implications of dealing with increasing numbers of both diagnosed and undiagnosed AIDS patients and asymptomatic carriers in the fields of resuscitation, intensive therapy and theatre anaesthesia. The misunderstanding of AIDS is as extensive as the literature on the subject and a review of the current knowledge of the disease relevant to the anaesthetist is pertinent.

The efficacy of intraoperative autologous transfusion in major orthopedic surgery: a regression analysis

Perioperative blood loss associated with 89 cases of major orthopedic surgery was compared with that of a control group of 89 to determine the effectiveness of intraoperative autologous transfusion. Volume of banked blood transfused and hematocrit change were used to determine total blood loss. The orthopedic cases consisted of cemented "virgin" total hip replacement, cemented virgin tricompartmental knee replacement, and spine fusion. Use of an autotransfusion device (Cell Saver) intraoperatively was associated with significantly smaller volumes of transfused banked blood and significantly smaller hematocrit drops in the groups of patients who underwent total hip replacement or spine fusion, but not in the group of patients who underwent total knee replacement. One potential source of bias in the study stems from the fact that four days were allotted for equilibrium from perioperative blood loss in the hip and knee replacement groups, while, for reasons of data availability, equilibrium time in the spine fusion groups was two days.

Hypothesis: AIDS encephalopathy is due to primary and persistent infection of the brain with a human retrovirus of the lentivirus subfamily

Recent evidence has demonstrated that human T-lymphotropic retroviruses are present in the brain of patients with acquired immunodeficiency syndrome (AIDS). Studies by neuropathological, ultrastructural and nucleic acid hybridization techniques indicate that these human retroviruses are neurotropic as well as lymphotropic. Striking similarities to the animal retroviruses of the lentivirus subfamily provide a rationale to implicate these human retroviruses (lentiviruses) in the pathogenesis of AIDS encephalopathy.