Presence and prognostic significance of antilymphocyte antibodies in symptomatic and asymptomatic human immunodeficiency virus infection

Article Abstract:

There are over 100,000 people with AIDS in the United States, and an additional 1,000,000 who are thought to be infected with human immunodeficiency virus (HIV), the AIDS virus. It would be important to better understand the complex sequence of events which cause infected but apparently healthy individuals to develop symptoms of immune deficiency. Previous research has demonstrated that 88 percent of AIDS patients had antibodies in their blood which reacted with lymphocytes, key cells in the body's immune defenses. Furthermore, only 8 percent of patients with diseases unrelated to AIDS had antilymphocyte antibodies (ALA). To determine if the presence of these antibodies might be an indicator of disease progression, ALA titers were measured in 61 patients with AIDS-related complex (ARC) who were then followed-up for 18 to 30 months. AIDS-related complex is a condition in which symptoms of HIV infection have begun to emerge, but the syndrome of immune deficiency has not yet appeared. In addition, 85 apparently healthy HIV-positive homosexual men were tested, as well as 50 patients with disease unrelated to AIDS. Of the patients with ARC, 46 had elevated antilymphocyte antibodies. Thirty-one of these developed AIDS during the follow-up period, while none of the 15 patients without elevated ALA developed AIDS. Among the apparently healthy HIV-infected men, five showed signs of disease progression during the follow-up; three progressed to ARC and two to AIDS. All five of these individuals had elevated levels of ALA. The results indicate that there is a clear correlation between the levels of antilymphocyte antibodies and the progression of disease in HIV-infected patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Autoantibodies, Prognosis, HIV (Viruses), HIV, AIDS (Disease), AIDS-related complex

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Cost containment and quality of life: An experiment in compassion for physicians

Article Abstract:

Health plans that utilize managed-care models often employ the patient's primary care physician as a 'gatekeeper,' someone who allows or denies the patient the option of seeing a subspecialist or being hospitalized or using an emergency room or urgent care facility in evening hours. A study was performed to examine the specific function of the gatekeeper in regulating the use of an emergency room at night by enrollees in Arizona's Medicaid plan. The frequency of use of the emergency room, the average cost per visit, and the gatekeeper's satisfaction with the system were compared over a two year period. During the first year, the gatekeeper was telephoned at all hours of the night to approve the use of the emergency room, while during the second year of the study, that requirement was waived, and the emergency room was free to treat the patients at night without prior approval. The overall rate of emergency room visits decreased in the second year of the study, as did the average cost of the visits. An urgent-care center, available to treat less serious problems, opened during the second year of the study, and that may have contributed to the decreased frequency of the visits and their costs. The physicians involved were considerably more satisfied with the second year of the study, when they were not disturbed at night to approve emergency room use. Thus, it appears from this study that strict gatekeeping policies at night do not have a measurable difference on emergency room utilization, but that opening urgent-care centers might decrease the use of the costly emergency department for minor problems. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Usage, Surveys, Emergency medical services, Emergency medical personnel

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