Special considerations for managing suspected human immunodeficiency virus infection and AIDS in patients from developing countries

Article Abstract:

As of January 1990, the World Health Organization received reports of 203,599 persons with AIDS. These cases, from 154 countries, emphasize the global nature of this epidemic. As the human host with human immunodeficiency virus (HIV) infection loses his/her defenses, organisms that are normally under control cause complicating (opportunistic) infections. The renewed virulence of these organisms ultimately leads to conditions that define AIDS, such as Pneumocystis carinii pneumonia, tuberculosis, cytomegalovirus and herpesviruses. Patients diagnosed with these opportunistic infections are often subsequently diagnosed with AIDS. The authors addressed this problem by assessing the potential risk of AIDS and the clinical manifestations consistent with patients' countries of origin. In Africa, most AIDS cases are reported from the central, southern and eastern part of the continent. Another epicenter is located in West Africa. In South America, 77 percent of all cases are reported from Brazil, Haiti, Mexico and the Dominican Republic. By comparison, Asia reported only 464 cases of AIDS, and Japan reported about 100 cases. Because of the nature of AIDS, substantial underreporting is likely. Three major patterns of incidence are described. In the pattern I region, including the US, western Europe, and Australia, HIV transmission occurs predominantly through intravenous drug abuse and homosexual contact. In Latin America, also part of this region, homosexual contact is the usual mode of transmission. In the pattern II region, including sub-Saharan Africa and the Caribbean, heterosexual transmission of HIV predominates. In the pattern III region, including Asia, eastern Europe, the Middle East and North Africa, the pattern of HIV transmission is yet to be discerned. AIDS precipitates exacerbations of pre-existing, but latent or controlled pathogens. The patterns of these diseases are described according to the African, Latin American, and Haitian patterns. The uncommon opportunistic infections that a particular population of AIDS patients develops will reflect the lifetime exposure of those individuals. Consequently, these infections will vary according to the patients' countries of origin. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Risk factors, Environmental aspects, HIV infection, HIV infections, Developing countries, AIDS (Disease), Opportunistic infections

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An outbreak of hepatitis A among cancer patients treated with interleukin-2 and lymphokine-activated killer cells

Article Abstract:

Lymphocytes are white blood cells that are made in lymphoid tissues throughout the body. When exposed to interleukin-2 (a protein, or lymphokine, produced by the immune system), lymphocytes develop the ability to kill tumor cells. These lymphocytes are called lymphokine-activated killer cells (LAK cells). In preliminary studies, LAK cells were reported to have beneficial effects in 25 patients with advanced cancer. In other clinical studies, combinations of interleukin-2 and LAK cells were administered to cancer patients with renal carcinoma, malignant melanoma and colorectal carcinoma. In August 1986, two cases of hepatitis A virus (HAV) infection were identified in patients treated with interleukin-2 and LAK cells at the New England Medical Center. Blood testing revealed five more cases of HAV infection. This prompted an investigation into the mode of HAV transmission. Between July and September of 1986, six different clinical centers reported outbreaks of HAV infection. These infections occurred in cancer patients that had been treated with interleukin-2 and LAK cells. Upon further investigation it was found that the human serum used to make the LAK cells may have been the cause of the HAV outbreak. HAV infection was associated with two different batches of human serum, called X and Y, that were used to prepare the LAK cells. HAV infection was reported in 85 percent of the patients treated with LAK cells made from batch X serum, in 62 percent of patients treated with LAK cells from batch Y, and in 50 percent of the patients exposed to both batches of serum. None of the 24 patients treated with LAK cells prepared from other batches of serum had HAV infection. Batch X and batch Y sera were prepared from the blood of 20 donors. Twelve of the 20 donors were tested for HAV and found to be negative. It is possible that one of the other donors had HAV infected serum that was used in both batches of LAK cells. It is concluded that treatment of patients with LAK cells made using human serum represents a new mode for HAV transmission. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Infection, Hepatitis A virus, Hepatovirus, Cancer, Cancer treatment, Lymphocytes, Lymphokines

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Heterosexual transmission of hepatitis B virus in Belle Glade, Florida

Article Abstract:

Hepatitis B virus (HBV), a virus that infects the liver, is transmitted through infected blood. Although the disease is primarily found among high-risk homosexuals and intravenous drug users, HBV infections are increasing in the heterosexual population at the same time they are decreasing among homosexuals. The agricultural community of Belle Glade, Florida presents a unique opportunity to study the transmission of HBV among heterosexuals, since there is a large number of residents with the AIDS virus who are currently being followed. The risk factors for an HBV infection were determined by interviewing 725 adults and 130 children. In this racially-mixed population HBV infection was present in a total of 26 percent; 9 percent white, 5 percent Hispanic, 30 percent black and 57 percent Haitian. Three percent were children between the age of 2 and 10 and 31 percent were adults older than 17 years. Only 5 percent of the participants who tested positive for HBV were homosexual or IV drug users. Syphilis, which is a marker often used to indicate sexual contact within high-risk groups, was diagnosed in 47 percent of the HBV-positive patients. Patients who had syphilis were 3.1 times more likely to test positive for HBV. Patients with two or more lifetime sexual partners were 3.2 times more likely to contract HBV. The prevalence of HBV among adults was 31 percent, compared with a 7 percent prevalence rate in the general population. On the basis of these results, it is concluded that HBV can be transmitted through heterosexual contact. It is suggested that heterosexuals be considered a high-risk group that could targeted for HBV prevention strategies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sexually transmitted diseases, Florida, Hepatitis B

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