Fatal Disseminated Cryptococcus as the Initial Presentation of HIV Infection in the Era of Highly Active Antiretroviral Therapy

Abstract:  Despite the availability of highly active antiretroviral treatment, many HIV-positive patients still present for the first time with a low CD4 count or an acquired immune deficiency syndrome (AIDS) defining illness. This may be due to patients' refusal to be tested for HIV, delay in seeking medical treatment, or the misdiagnosis of an AIDS-associated condition. We present a 39-year-old African American male with undiagnosed HIV, who died shortly after arrival to the emergency room. An autopsy was performed at the Dallas County Medical Examiners' Office, and the cause of death was determined to be disseminated cryptococcosis. Further investigation at autopsy revealed HIV 1/2 antibody positivity and HIV western blot positivity. This case demonstrates the importance of considering complications of HIV as a cause of death, even when the patient has no prior history.     

艾滋病患者保外就医问题探讨——对"重庆艾滋女保外就医卖淫事件"的反思

当前,伴随着艾滋病病毒感染者和病人数量的上升,艾滋病患者违法犯罪逐渐成为社会广泛关注的问题。实践中对艾滋病罪犯和艾滋病吸毒人员进行保外就医的做法影响社会公众的安全感,严重威胁社会秩序稳定。艾滋病患者原则上不应适用保外就医;对于违法犯罪的艾滋病患者,应建立专门监管场所进行集中关押和治疗。在现有条件下,对保外就医的艾滋病患者,应形成监所监狱、检察机关、公安机关、基层组织各负其责、齐抓共管的监管体系。     

Postmortem Detection of Hepatitis B,C, and Human Immunodeficiency Virus Genomes in Blood Samples from Drug‐Related Deaths in Denmark*

Abstract: Blood‐borne viral infections are widespread among injecting drug users; however, it is difficult to include these patients in serological surveys. Therefore, we developed a national surveillance program based on postmortem testing of persons whose deaths were drug related. Blood collected at autopsy was tested for anti‐HBc, anti‐HBs, anti‐hepatits C virus (HCV), or anti‐human immunodeficiency virus (HIV) antibodies using commercial kits. Subsets of seropositive samples were screened for viral genomes using sensitive in‐house and commercial polymerase chain reaction (PCR) assays. Hepatitis B virus (HBV) DNA was detected in 20% (3/15) of anti‐HBc‐positive/anti‐HBs‐negative samples, HCV RNA was found in 64% (16/25) of anti‐HCV‐positive samples, and HIV RNA was detected in 40% (6/15) of anti‐HIV‐positive samples. The postmortem and antemortem prevalences of HBV DNA and HCV RNA were similar. Postmortem HIV RNA testing was less sensitive than antemortem testing. Thus, postmortem PCR analysis for HBV and HBC infection is feasible and relevant for demonstrating ongoing infections at death or for transmission analysis during outbreaks.     

Partner Abuse and HIV Infection: Implications for Psychosocial Adjustment in African American Women

A prospective study of the effects of partner abuse among HIV-infected and noninfected African American women (N = 137) revealed that there were both concurrent and longitudinal effects of abuse on several indices of psychosocial adjustment. Specifically, higher levels of both verbal and physical abuse were found among the HIV-infected group. In addition, the effects of abuse on suicidal ideation were significantly stronger among the HIV-infected group (n = 53) than among their demographically similar noninfected counterparts (n = 84), resulting in significant HIV status by partner abuse interactions. The findings of this study advance our understanding of intimate relationships with regard to partner abuse by examining a group of women at high-risk for abuse, yet understudied in both the HIV/AIDS and relationship literatures.     

History of Traumatic Abuse and HIV Risk Behaviorsin Severely Mentally Ill Substance Abusing Adults

Epidemiological studies in the United States estimate HIV seroprevalence rates ranging between 4% and 23% for serious mentally ill adults (SMIA; i.e., schizophrenia, bipolar disorder, and other chronic disorders with psychotic features), with substantially greater estimates for risky sexual behaviors. Among the most consistent factors linked to HIV risk in non-SMIA populations is a history of emotional, physical, or sexual abuse. The current study examined the intersection of abuse history and HIV sexual risk behavior in SMIAs with a group of men (n = 64) and women (n = 115) recruited from eight geographically diverse and representative clinical sites around Florida. A cross-sectional interview revealed a high prevalence of alcohol and other drugs problems, as well as a history of emotional, physical, or sexual abuse in 75% of the participants, with 68% of these reporting multiple types of abuse. Compared to nonabused counterparts, those with a history of abuse reported significantly greater: (a) lifetime and current psychiatric symptoms, (b) recent unprotected sexual intercourse, and (c) crack cocaine, heroin, and marijuana use. No gender differences were detected in the associations of abuse history and sexual risk behaviors. These results underscore the need for HIV prevention efforts targeted to SMIAs and the critical importance of addressing abuse history in interventions with this underserved population.     

流动人口预防和控制艾滋病问题研究

人口流动与艾滋病病毒传播因素相结合,导致艾滋病病毒加速传播。流动人口的素质偏低,医疗卫生条件不良,以及不良行为习惯,加之对流动人口管理的法律法规滞后,实际管理和监测存在缺陷等,使他们对艾滋病存在缺乏正确了解,预防措施不足等问题,为此,要正确认识流动人口中的艾滋病问题,加强立法,强化公安机关和相关部门对流动人口的管理干预等职能,落实对流动人口的有效管理和关怀治疗,从根本上解决防“艾”的瓶颈制约。     

对HIV／AIDS戒毒人员的管理实践

楚雄市公安局戒毒所从1998年开始对戒毒人员中的HIV/AIDS人员实施管理,共隔离管理235人次,分散管理73人次。管理措施主要有共性管理、隔离管理和分散管理。     

输血后艾滋病的司法鉴定

本文综述了近年来输血后艾滋病病毒感染、艾滋病发病情况及其影响因素,强调了按照国家法律,法规,严格控制血液制品进口,采血部门严格筛查,供血单位规范生产,用血医院严把指征,以及受血病人知情理解是避免输血后艾滋病病毒感染和艾滋病法律纠纷的关键。阐述了输血后艾滋病病毒感染及艾滋病发病的司法鉴定工作要点。     

Predicting the Onset of Sexual and Drug Risk Behaviors in HIV-Negative Youths with HIV-Positive Mothers: The Role of Contextual,Self-Regulation,and Social-Interaction Factors

HIV-negative, inner-city adolescents with HIV-infected parents are considered to be at high risk for acquiring HIV themselves. Using a modified theory of health behavior, this study examined the effects of maternal HIV infection and psychosocial variables on the onset of sexual and drug risk behavior in 144 HIV-negative adolescents with and without HIV-positive mothers. Adolescents and their mothers were interviewed when the youths were 10–14 years old and again when they were 13–19 years old. By follow-up, 42% of youths reported the onset of vaginal sex (vs 5% at baseline). Marijuana and alcohol use increased from 6 and 38%, respectively, at baseline to 25 and 60% at follow-up. Among those reporting risk behaviors, 40--50% reported onset prior to 14 years. Youth and family psychosocial variables, but not maternal HIV status, were associated with risk behaviour outcomes. Claude A. Mellins research interests include mental health, psychosocial, and public effects of maternal and pediatric HIV; interventions for HIV-affected families; and adherence. Curtis Dolezal research interests include HIV-related sexual behavior in a variety of populations with a particular emphasis on methodology/measurement issues. Elizabeth Brackis-Cott research interests include impact of HIV/AIDS on the lives of children and families directly affected by the disease. Ouzama Nicholson research interests include international public health and pediatric HIV infection and operational issues in developing effective prevention of mother-to-child transmission of HIV infection and pediatric HIV care programs. Patricia Warne research interests include program development, structural interventions for HIV, and policy. Heino F. L. Meyer-Bahlburg research interests include psychosexual assessment, the development and determinants of sexual risk behavior, and the effects of HIV disease on sexual functioning.     

Disaffection and Revolts in Nigeria During the First World War, 1914–1918

In 2012, roughly 23 million people in sub-Saharan Africa were infected with HIV, the virus that causes AIDS. Religious responses to the disease have ranged from condemnation of people with HIV to the development of innovative AIDS-related services. This article utilises insights from the social movement literature about collective identity, framing, resources, and opportunity structures to interrogate religious mobilisation against HIV/AIDS. It demonstrates that mobilisation cannot be divorced from factors such as state–civil society relations, Africa's dependence on foreign aid, or the continent's poverty. Religious HIV/AIDS activities must be analysed in a conceptual space between a civil society/politics approach and a service-provider/anti-politics framework. That is, religious mobilisation may at times seek to engage the public realm to shape policies, while at other times it may shun politics in its provision of services. Case studies that illustrate these themes and demonstrate the multi-faceted interactions between religion and HIV/AIDS are included.