HIV and measures to control infection in general practice.

OBJECTIVE--To assess the impact of HIV on procedures to control infection in general practices. DESIGN--A postal questionnaire survey. SETTING--General practices throughout Britain. SUBJECTS--5359 General practitioners, 3429 (63.9%) of whom returned the questionnaire. MAIN OUTCOME MEASURE--Response to questionnaire on knowledge about HIV and policies for controlling infection. RESULTS--Most doctors (2018) had started to wear gloves when taking blood. Almost half (1510) had not resheathed needles previously but a further 776 had adopted this policy because of HIV. Over half of the doctors did not know or were unsure about the risk of infection from needlestick injuries, and 1759 had no practice policy for controlling infection. CONCLUSIONS--Many doctors are uncertain about measures to control infection in general practice. More information and advice are needed to help doctors develop policies to protect patients and staff.     

BANKER PLANT携带天敌防治害虫的理论基础与应用

滥用农药导致粮食、蔬菜和水果内有毒农药高残留,严重威胁着人民的生命安全;利用生物防治害虫将提供更安全的食品和洁净的环境。Banker植物系统是利用非作物植物饲养及携带天敌的寄主或猎物,再利用天敌的寄主或猎物饲养和释放天敌。这些Banker植物就像是一个‘银行家(Banker)’,连续不断地供应‘货币’(天敌),使天敌从‘银行家’植物上扩散到有害虫的作物上防治害虫,是生物防治发展的一个重要方向。本文系统介绍了利用Banker植物为替代寄主饲养释放天敌防治害虫的最新进展,旨在推动我国更好地开展Banker植物系统及其相关理论与应用的研究。     

The theory and practice of an epidemic control service for the population

The data on the epidemic-control medical care of the population of the Kuznetsk coal fields and on the creation of the specialized system of the epidemiological surveillance of influenza, measles, viral hepatitis, hospital infections are presented. The possibility of using the theory of the self-regulation of the epidemic process in practical work is discussed.     

The principles of pre-epidemic diagnosis in the epidemiological surveillance system for HIV infection

The problem of the general introduction of the principles of the pre-epidemic diagnostics of HIV infection was discussed. These principles should be based on the observation of "model" infections (viral hepatitides B, C, D), multipurpose serological monitoring and sociological methods aimed at obtaining the necessary information. The suggestion that the age and sexual structure of HIV-infected patients would be determined by the route of HIV transmission, prevailing on a given territory, including into infection process adolescents and young women and men was made.     

Comparison of a commercial and an in-house T cell-based assay for the diagnosis of Mycobacterium tuberculosis infection

Identification of individuals with a tuberculosis infection is a very important element for the control of tuberculosis. The currently used tuberculin skin test has poor sensitivity and specificity. Recently, an important advance in tuberculosis diagnosis occurred with the development of in vitro T cell-based IFN-gamma release assays. The aim of this study was to compare a RD1-based in-house ELISPOT-IFN-gamma assay with a commercial (T-SPOT.TB) assay for the diagnosis of tuberculosis infection. The results showed an almost complete concordance between the two assays, confirming that our restricted but highly selected pool of peptides is sufficient to detect tuberculosis infection.     

Morbidity and risk of subsequent diagnosis of HIV: a population based case control study identifying indicator diseases for HIV infection

Background

Early identification of persons with undiagnosed HIV infection is an important health care issue. We examined associations between diseases diagnosed in hospitals and risk of subsequent HIV diagnosis.

Methods

In this population-based case control study, cases were persons with incident HIV infection diagnosed in Denmark between 1 January 1995 and 1 June 2008. Risk-set sampling was used to identify 19 age- and gender-matched population controls for each HIV case, using the HIV diagnosis date as the index date for both cases and controls. Prior hospital diagnoses obtained from Danish medical databases were first categorized into 22 major disease categories (excluding AIDS-defining diseases except tuberculosis) and then subdivided into 161 subcategories, allowing us to examine specific diseases as potential HIV indicators by conditional logistic regression.

Results

The study included 2,036 HIV cases and 35,718 controls. Persons with the following disease categories had a high risk of HIV diagnosis during the subsequent 5-year period: sexually transmitted infections and viral hepatitis (adjusted odds ratio [aOR] = 12.3, 95% CI: 9.60–15.7), hematological diseases (aOR = 4.28, 3.13–5.85), lower respiratory tract infections (aOR = 3.98, 3.14–5.04)), CNS infections (aOR = 3.44, 1.74–6.80), skin infections (aOR = 3.05, 2.47–3.75), other infections (aOR = 4.64, 3.89–5.54), and substance abuse (aOR = 2.60, 2.06–3.29). Several specific diseases were associated with aORs >20 including syphilis, hepatitis A, non “A” viral hepatitis, herpes zoster, candida infection, endocarditis, thrombocytopenia, and opioid abuse.

Conclusions

Targeted testing for HIV in patients diagnosed with diseases associated with HIV may lead to earlier treatment and thereby reduced morbidity, mortality and HIV transmission.     

The strategy for the control of the spread of HIV infection in the city of Novorossiysk

The results of the work of the center for controlling the spread of HIV infection are discussed. The analysis of the epidemiological situation and the work on the projects, envisaging preventive measures among intravenous drug users permitted the realization of educational and behavior-changing programs in the city in 1999. The results of this work demonstrate the effect of various preventive measures, manifested by a decrease in the rate of the spread of HIV infection in the city not only among drug users, but also among other groups of the population.     

Update on the laboratory diagnosis and monitoring of HIV infection

In China, the estimated number of HIV infected cases is approaching one million. Although public education has been initiated for awareness and behavioral modification for this devastating infection, better diagnostic methods are needed to identify infected persons and manage infection. Simple and more accurate diagnostic tools have become available, particularly for early detection and to monitor treatment in those who receive anti-retroviral treatment. In this short review, we summarize some of the common and new methodologies that can be used in clinical laboratories, in the field, or in private laboratories. These range from simple antibody tests to more sophistical methods that are used to monitor disease progression and identify drug resistance. These tools can assist physicians, medical practitioners, and laboratory personnel to select suitable diagnostic tools for the diagnosis, blood screening, monitoring of disease progression, and for detection of drug resistance to anti-retroviral therapies.     

Update on the laboratory diagnosis and monitoring of HIV infection

In China, the estimated number of HIV infected cases is approaching one million. Although public education has been initiated for awareness and behavioral modification for this devastating infection, better diagnostic methods are needed to identify infected persons and manage infection. Simple and more accurate diagnostic tools have become available, particularly for early detection and to monitor treatment in those who receive anti-retroviral treatment. In this short review, we summarize some of the common and new methodologies that can be used in clinical laboratories, in the field, or in private laboratories. These range from simple antibody tests to more sophistical methods that are used to monitor disease progression and identify drug resistance. These tools can assist physicians, medical practitioners, and laboratory personnel to select suitable diagnostic tools for the diagnosis, blood screening, monitoring of disease progression, and for detection of drug resistance to anti-retroviral therapies.     

Update on the laboratory diagnosis and monitoring of HIV infection

DIAGNOSIS OF HIV-1 INFECTION The diagnosis of HIV infection is most commonly ac- complished using tests to detect antibody to HIV using a screening test, followed by a supplemental test for confirmation. However, in many countries, including China, screen…     

Update on the laboratory diagnosis and monitoring of HIV infection

In China, the estimated number of HIV infected cases is approaching one million. Although public education has been initiated for awareness and behavioral modification for this devastating infection, better diagnostic methods are needed to identify infected persons and manage infection. Simple and more accurate diagnostic tools have become available,particularly for early detection and to monitor treatment in those who receive anti-retroviral treatment. In this short review, we summarize some of the common and new methodologies that can be used in clinical laboratories, in the field,or in private laboratories. These range from simple antibody tests to more sophistical methods that are used to monitor disease progression and identify drug resistance. These tools can assist physicians, medical practitioners, and laboratory personnel to select suitable diagnostic tools for the diagnosis, blood screening, monitoring of disease progression, and for detection of drug resistance to anti-retroviral therapies.     

Free anonymous screening consultation and clinical management of HIV infection

In France, since 1988, anonymous and free consultations (called CDAG) have been settled in the country to facilitate an individual and volunteer approach for HIV screening. At the time, there are more than 380 CDAG with newly defined objectives. CDAG are supposed to encourage early screening, facilitate access to precarious persons and persons at risk for sexually transmitted diseases, and reinforce prevention, helping consultants to define a personal preventive strategy. CDAG are also supposed to play a role in prevention of both hepatitis B and C, and syphilis. They may help to link screening and healthcare. Their activity is increasing and the rate of positive test is twice that of private laboratories. Patients consulting those facilities are younger and more at risk than general population. Between 1000 and 2000 HIV positive tests are detected in CDAG each year (11 % of positive tests in the country). The real impact on prevention and screening at the national level is unknown, in part because of anonymity. To improve the characterization of consultants, data collection will be modified in 2004, and a network of selected and volunteer centres will collect continuously more accurate data.     

Primary HIV infection: molecular approaches in diagnosis and monitoring

OBJECTIVE: The aim of this study was to evaluate, in patients with primary HIV infection (PHI), the modification of HIV molecular parameters (HIV, RNA, and DNA) induced by highly active antiretroviral therapy (HAART) in peripheral blood mononuclear cells (PBMC) and in lymphoid tissue (LNMC). METHODS: Nineteen patients with primary HIV infection, 4 women and 15 men with an average age of 35 years (range 27-62), were included in this study. Ten patients received 4 drugs: zidovudine plus lamivudine plus saquinavir plus ritonavir, 7 patients received 3 drugs: zidovudine plus lamivudine plus saquinavir and 2 patients received a different combination of 3 drugs: zidovudine plus lamivudine plus indinavir. As control group we included 8 patients who had been enrolled in a placebo-controlled trial of zidovudine between 1991 and 1995: four received placebo and 4 were treated with zidovudine alone. Peripheral blood samples and lymphoid tissue obtained by echo-driven fine needle biopsies were drawn to monitor molecular HIV parameters. A quantitative in house PCR method in the HIV gag region was used to monitor viral DNA burden and the NASBA system for viremia. RESULTS: A certain heterogeneity in the baseline values of HIV, DNA, and RNA was observed. Early HAART determined a rapid recovery of the CD4 cell number with normalisation of the CD4/CD8 ratio in most patients. HIV-RNA levels dropped to undetectable levels after a few months of therapy and HIV-DNA was consistently reduced although it never reached undetectable levels. Lymph-node biopsies were well tolerated due to the non-invasive sampling, however an optimisation of the method is needed to improve cell recovery. In the valuable samples the amount of HIV DNA recovered is comparable to that from peripheral blood samples, both at baseline and at follow-up.     

A policy to control the spread of HIV infection

Prevention of transmission of HIV infection is the most important public health concern of the AIDS epidemic. To date, unfortunately, we have failed to contain the epidemic. The increasingly rapid spread of HIV into the IV drug-abusing population and subsequent heterosexual transmission represent a further failure of the public health system. Current organization of the public health programs, especially the lack of independence and adequate financial and personnel support, is an extremely serious problem. More funding may not be the answer, unless there is better organization. Identification of infected individuals and a vigorous education program must be implemented. HIV antibody-positive individuals should be followed carefully in order to evaluate the risk factors for AIDS and efficacy of specific interventions.     

The use of PCR analysis for the diagnosis of HIV infection in infants in the 1st months of life

In this review the data of contemporary studies of dynamic changes in serological and virological markers in the course of HIV infection in infants aged 0-18 months, aimed at finding out the comparative value of different tests made with a view to established exact diagnosis, are discussed. The results of the study of the sensitivity and specificity of the RNA and DNA polymerase chain reaction in the diagnostics of HIV infection in infants during the first months of life, as well as the recommended time of testing, have been analyzed in detail. On the basis of the data presented in this review the author has formulated the scheme of the algorithm for diagnosing HIV infection in infants born of HIV-infected mothers with the following variants of the diagnosis: "possible infection", "seroversion" (marking it possible to exclude the presence of the infection) and "HIV infection". The proposed scheme has the character of recommendation, but under the conditions of the rapid spread of HIV infection with the involvement of infants into the process this scheme may be useful in pediatric practice.     

The testing policy for HIV infection in Ukraine

The policy of the Ministry of Health of the Ukraine since 1987 concerning the control of the spread of HIV infection was analyzed. The main measure for the prophylaxis and epidemiological control of the infection was mass testing for HIV, carried out in accordance with the law adopted in 1991. In 1997 changes and amendments were supplemented to this Law, which legally abolished obligatory testing for HIV. The data on the effective and less effective testing policy are presented. In particular, these data revealed that the irrational testing policy resulted on the fact that only 5% of the whole population of drug addicts were covered by surveillance. Future prospects were shown to include the introduction of the system of "patrol" epidemiological surveillance, the strengthening of the analytical component of epidemiological surveillance, the approval of the new strategic plan of the prophylaxis for AIDS for 1998-2000, as well as the renewal of the normative and methodological basis.