To assess the human immunodeficiency virus epidemic among American Indians and Alaska Natives (AI/AN), we examined acquired immunodeficiency syndrome (AIDS) case and seroprevalence data through December 1990. While AI/AN had a low 1990 reported AIDS case rate (4.0/100,000), the increase in diagnosed cases adjusted for reporting delays from 1989 to 1990 was higher (23.1%) among AI/AN than any other racial/ethnic group. Seroprevalence data for military applicants have documented higher rates for AI/AN than for either Whites or Asian/Pacific Islanders.
We performed an anonymous seroprevalence survey of human immunodeficiency virus (HIV) type 1 infection through HIV antibody testing of blood samples from 22,512 women aged 15 to 44 years receiving prenatal care in British Columbia and the Yukon Territory from Mar. 15 to Sept. 30, 1989. Of the samples six were confirmed to be HIV positive; this yielded a crude overall seroprevalence rate of 2.7 per 10,000 pregnant women (95% confidence interval [CI] 1.0 to 5.8). All of the positive samples were from women 20 to 29 years of age; four were from Vancouver, one was from Victoria, and one was from elsewhere. The highest seroprevalence rates were among women aged 15 to 29 years in Vancouver and Victoria (7.2 and 9.4 per 10,000 pregnant women respectively). Thus, 1 in 1300 pregnant women in that age group in the metropolitan areas of British Columbia was HIV positive. Application of seroprevalence rates to the total female population in British Columbia and the Yukon Territory revealed that as many as 401 women had HIV infection in 1989. Our estimates likely represent the minimum. As a subset of women of childbearing age pregnant women are likely at lowest risk of HIV infection, and so the true number of women 15 to 44 years of age with HIV infection is probably several times higher. Our study has provided a baseline assessment and will be repeated annually to analyse trends in HIV seroprevalence among pregnant women in British Columbia and the Yukon Territory.
North-Western Regional Scientific Methodological Center for Prevention and Control of AIDS, Public Organization Vozvrashcheniye (Return), St. Petersburg, Russia.
The data on the study of the spread of HIV infection among injecting drug users in St. Petersburg, carried out by the method of the random testing of blood remaining in used syringes, are presented. Injecting drug users visiting buses working in accordance with the program "Buses for Assistance to Drug Addicts" were chosen as a study group. The exchange of syringes was one of the elements of this program. The work was carried out in two areas with a high concentration of drug users. The eluates from syringes used by 300 persons were studied. The average rate of the spread of HIV in the cohort under study was 12%. The results were indicative of a high degree of the spread of HIV among injecting drug users in St. Petersburg. Epidemiological patrol surveillance proved to be an effective method for the evaluation of the epidemiological situation in a highly inaccessible group of the population.
For the first time a nosocomial focus of HIV infection was established. Out of 83,000 inhabitants of the Kalmyck ASSR who underwent planned examination in the course of epidemiological investigation, 65 cases of HIV infection were detected and all of them were traced to the focus of hospital infection (56 children and 9 adults: 1 man and 8 women; of these, 7 women contacted the infection from their infected children in the process of breast feeding). The children were infected during their stay in two hospitals of Elista where they received multiple intravenous and intramuscular injections. The infection spread from the infant department of the regional pediatric hospital to 4 more departments and to the infectious diseases hospital. Transmission of this infection was maintained for several months by the use of nonsterile syringes in parenteral manipulations.
A matched-pair, cross-sectional study of lymphocyte and serological parameters associated with acquired immune deficiency syndrome (AIDS) in 189 randomly chosen, ostensibly healthy adult Haitian immigrants residing in Montreal matched for sex, age (within 5 years), and neighborhood of residence to 189 non-Haitian (Caucasian) controls was done in 1983-1984. Three years later (1986-1987), 41 of the Haitian study subjects and 83 of the non-Haitian controls participated in a follow-up study centered on lymphocyte parameters. A significantly greater number of Haitians than controls had produced antibodies to Toxoplasma gondii. In addition, a greater percentage of the Haitians than the controls were also producing antibodies to two other opportunistic pathogens frequently encountered in AIDS, cytomegalovirus and hepatitis B virus, implying that the Haitians in general had had greater exposure to a variety of infectious agents than had the controls. A few study participants were producing antibodies against two viruses that are related to the human immunodeficiency virus-type 1 (HIV-1), the human T-cell lymphotropic viruses I and II (HTLV-I and -II). Two Haitians and one control were producing antibodies against HTLV-I. One study subject and four controls were HTLV-II seropositive. The most interesting and surprising finding was that four (2.1%) of the Haitian study subjects but none of the controls were seropositive for HIV-1. These individuals, two of whom were women and two men, were asymptomatic. Although their individual lymphocyte parameter values fell in the normal range, as a group they had statistically significantly lower average values for their lymphocyte parameters than did the HIV-seronegative Haitian study objects.(ABSTRACT TRUNCATED AT 250 WORDS)
The paper provides an epidemiological characterization of HIV infection spread in a Russia's large region with more than 10 million people. The epidemiological findings show that the significant onset of HIV infection occurred among the population in this region in mid 1988. Homosexuals and bisexuals are prevalent among the HIV-infected, sexual contact is the main mode of HIV transmission. In addition to delivery of HIV infection from foreign countries, there are cases of local transmission. The clinical evidence indicates that most HIV-infected people are asymptomatic. Herpes viruses, Mycobacteria tuberculosis, Toxoplasma and fungi are common among causative agents of AIDS-related infections.
In order to study differences in progression to Acquired Immunodeficiency Syndrome (AIDS) between risk groups, 205 homosexual men and 185 intravenous drug users (IVDUs) were followed from diagnosed seropositivity for Human Immunodeficiency Virus Type-1 (HIV) for a mean period of 46 months (range 1-88 months). Seven (4%) IVDUs and 55 homosexual men (27%) were diagnosed with AIDS during the follow-up period. The probability of being AIDS-free four years after diagnosed HIV positivity was 0.96 for IVDUs (SE 0.02) and 0.73 (SE 0.04) for homosexual men (p
HIV antigen detection kits are available from a number of commercial sources. Abbott, Coulter, and Du Pont antigen kits were used to test 661 sera collected sequentially from 65 members of the Toronto Sexual Contact Study (TSCS). The sera had been collected at 3-month intervals over 4 years from nine persistently HIV-seronegative men, 14 seroconverters, and 42 seroprevalent participants. Antigen was not detected in any seronegative men. Two of 14 seroconverters were antigen positive in the specimen immediately preceding seroconversion (by all kits). Antigen was detected in 22 of 56 seropositive participants; of these, 16 of 22 demonstrated the emergence of antigen during observation. Discrepancies were noted in the time of detection of antigen (ranging from 3 months to more than 3 years) in nine participants. Although overall concordance among all kits for all specimens appears high (95.4%), when the bias introduced by testing multiple specimens from the same patient is removed, the lower bound of concordance among all three kits is estimated to be 80%. Similarly, after correction, the upper and lower bound of estimates of sensitivity are Abbott 96, 92%; Coulter 88, 63%; and Du Pont 88, 58%. There are significant differences in the performance characteristics of these commercial products for the detection of HIV antigen in serum.
