Nancy L Van Devanter

Abstract

Objective: To define the prevalence of cervical intraepithelial neoplasia (CIN), the validity of Papanicolaou tests, and the associations between CIN and risk factors for cervical disease in human immunodeficiency virus (HIV)-infected women. Methods: In this cross-sectional study, we enrolled 398 HIV-seropositive and 357 HIV-seronegative women from two HIV-AIDS clinics, two sexually transmitted disease clinics, a methadone clinic, and a clinic for participants in an HIV heterosexual transmission study. Each woman was interviewed and underwent a cytologic and colposcopic evaluation, and was tested for human papillomavirus (HPV) DNA. Results: Eighty (20%) of the 398 HIV-seropositive women compared to 15 (4%) of the 357 seronegative women had colposcopically confirmed CIN (odds ratio 5.7; P <.001). No invasive cancers were found. The sensitivity and specificity of Papanicolaou tests in seropositive women were 81 and 87%, respectively. By multiple logistic regression analysis using a model that included behavioral and biologic risk factors for CIN, CIN was independently associated with HPV infection (odds ratio 9.8), HIV infection (odds ratio 3.5), CD4+ T-lymphocyte count less than 200 cells/μL (odds ratio 2.7), and age greater than 34 years (odds ratio 2.0). Conclusions: Cervical intraepithelial neoplasia is a common finding in HIV-infected women. However, the results of this study suggest that Papanicolaou tests should be effective for detecting cervical disease in this population.

Abstract

Objectives. Understanding more about the psychological state of persons notified of human immunodeficiency virus (HIV) infection is critical for designing notification and counseling programs that will have the most positive effect. Methods. The subjects were blood donors who had been notified of HIV infection by the New York Blood Center. A nurse elicited a medical history, performed a limited medical examination, and asked the subjects to complete a questionnaire that included questions about drug use, sexual behavior, and psychological characteristics. The subjects completed another questionnaire approximately 2 weeks later. Results. The average depressive symptom scores for both men and women were substantially higher than scores typically found in representative population samples. More than a quarter of the men and more than a third of the women reported seeking psychological or psychiatric services in the first few weeks following notification. Conclusions. Anticipating and meeting individuals' psychological needs may be necessary if HIV screening programs are to address effectively the needs of persons infected with HIV.

Abstract

Background. To learn more about how people who did not volunteer for testing react to information about HIV infection, we assessed short-term behavior changes in HIV-positive blood donors. Methods. Blood donors who were notified at the New York Blood Center that they were HIV positive were asked to participate in a study. A nurse elicited a medical history, performed a limited medical examination, and asked participants to complete a questionnaire that included questions about drug use, sexual behavior, and psychological characteristics. Participants were asked to return in 2 weeks to complete another questionnaire. Results. Many fewer men and women reported engaging in unsafe sexual behaviors in the 2 weeks preceding the follow-up visit than had reported such behaviors prior to notification. These changes were greater than those other investigators have reported, but about 40% of the participants still reported unsafe sexual activity at the follow-up interview. Conclusions. To make nonvolunteer screening programs for HIV infection more effective in reducing the spread of HIV infection, we need to learn more about how to help people change their high-risk behaviors.

Abstract

HIV-2 is endemic in West Africa but rare elsewhere. In the USA there have been 18 reported cases of HIV-2 infection; most identified people have been West Africans. We recently diagnosed the first case of HIV-2 infection in a native-born US citizen, a woman whose serum was found to be reactive to anti-HIV-1 enzyme immunoassay (EIA) when she attempted to donate blood in 1986. Although both HIV-1- and HIV-2-specific EIAs were reactive, the anti-HIV-2 Western blot (WB) was positive, while the anti-HIV-1 WB was positive or indeterminate on different occasions. Synthetic peptide testing was reactive for HIV-2 but not HIV-1. HIV-2 DNA was detected using the polymerase chain reaction procedure. Although she had travelled to West Africa, it is unclear how she became infected with HIV-2.

Abstract

This paper describes the sociodemographic characteristics of people who donated blood to the New York Blood Center between April 1985 and February 1988 and tested positive for antibodies to HIV. Information on HIV-related risk factors and knowledge of blood screening is presented for seropositive donors who participated in an evaluation study. The most commonly reported risk factor among men was sexual contact with another man, and many of the male seropositive donors reported sex with an intravenous (IV) drug user or use of IV drugs. The proportion of men reporting sexual contact with another man decreased over the period of the study, and the proportion reporting use of IV drugs or sex with an IV drug user increased. Awareness of blood screening for HIV antibodies increased over the study period. The greatest increase was among those donating for transfusion, but only about a quarter of seropositive donors used the confidential unit exclusion (CUE) process.

Abstract

The development of a structured psychoeducational support group model for blood donors who tested positive for human immunodeficiency virus Type I antibody is described. Salient group therapy techniques and educational content are discussed, issues of group structure are identified, and the need for support of clinicians is highlighted. 1990 American Orthopsychiatric Association

Abstract

We compared clinical outcomes of 65 hospitalized patients receiving clindamycin before and 59 after a sudden hospital wide shift in dosing schedules for this drug from 600 mg every 6 hours to 600 mg every 8 hours. Outcomes studied included the efficacy of antibiotic treatment, length of febrile period, and frequency of adverse effects. We also compared and controlled for patient characteristics such as age, sex, presence of multiple diagnoses, length of therapy, and concurrent use of other antibiotics. There were no differences in measured clinical outcomes between the two groups. Treatment was successful in 87% of both groups. The average number of febrile days was 5.1 in the first group and 3.9 in the second (P<.05). Patients on 6-hourly therapy experienced a 12% rate of antibioticrelated adverse effects vs. 5% for the 8-hourly group (P<.05). These data support the clinical rationale and safety of a hospitalwide reduction in the frequency of clindamycin dosing. In addition to considerable pharmacy and nursing time saved, this change also saved$40,000 annually in antibiotic costs.

Abstract

This paper describes the sociodemographic and behavioral characteristics of 173 blood donors who were confirmed by Western blot tests to have antibodies to human immunodeficiency virus (HIV), the etiologic agent for acquired immunodeficiency syndrome (AIDS). Seropositive donors were predominately young, unmarried, and male, and major risk factors could be identified for almost all donors. However, more than 20 per cent of the study participants were women, and many participants were not aware that they were at risk of infection. The heterogeneity of the study population, the lack of awareness among many subjects of risk factors and self-exclusion procedures and the high level of distress among many subjects after notification, emphasize the need for intensive, well-designed education and support programs.