Cases reported "HIV Infections"

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1/47. HIV surveillance: a dynamic, not static, process to assure accurate local data.

    BACKGROUND AND OBJECTIVES: Accurate human immunodeficiency virus (HIV) surveillance data is critical for the allocation of resources for care services and community prevention planning efforts. GOAL OF THIS STUDY: To validate HIV status of women and assess risk factor information on all persons reported with either heterosexual transmission or no identifiable risk factor. STUDY DESIGN: The surveillance database is updated continually as additional information is received on all cases allowing continual monitoring of pregnant and nonpregnant women. Repeated queries of various record systems were employed to validate or reclassify reported heterosexual or no identifiable risk factor information for both men and women. RESULTS: Four pregnant women (24%) and one nonpregnant woman (0.4%) initially meeting HIV surveillance criteria were demonstrated not to be infected. risk factors were validated or reclassified for 77 (58%) patients initially reported with heterosexual transmission or no identifiable risk. CONCLUSION: HIV surveillance should be a dynamic process and continual updating of case reports provides the most accurate information on which to base service and prevention decisions.
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2/47. nevirapine induced opiate withdrawal among injection drug users with HIV infection receiving methadone.

    BACKGROUND: Pharmacokinetic interactions complicate and potentially compromise the use of antiretroviral and other HIV therapeutic agents in patients with HIV disease. This may be particularly so among those receiving treatment for substance abuse. OBJECTIVE: We describe seven cases of opiate withdrawal among patients receiving chronic methadone maintenance therapy following initiation of therapy with the non-nucleoside reverse transcriptase inhibitor, nevirapine. DESIGN: Retrospective chart review. RESULTS: In all seven patients, due to the lack of prior information regarding a significant pharmacokinetic interaction between these agents, the possibility of opiate withdrawal was not anticipated. Three patients, for whom methadone levels were available at the time of development of opiate withdrawal symptoms, had subtherapeutic methadone levels. In each case, a marked escalation in methadone dose was required to counteract the development of withdrawal symptoms and allow continuation of antiretroviral therapy. Three patients continued nevirapine with methadone administered at an increased dose; however, four chose to discontinue nevirapine. CONCLUSION: To maximize HIV therapeutic benefit among opiate users, information is needed about pharmacokinetic interactions between antiretrovirals and therapies for substance abuse.
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3/47. HIV counselling--a luxury or necessity?

    WHO and UNAIDS have consistently promoted HIV counselling as a routine part of HIV testing in developing countries. Nevertheless, in many countries counselling is not considered a crucial accompaniment of testing services, and patients are tested without access to counselling during and after testing. Thus, information on the need for and results of counselling is needed to convince policy-makers and service managers to give greater priority to the development of counselling services. This qualitative study describes informational, social and emotional needs and problems of newly diagnosed seropositive patients attending public health services in zimbabwe. Their basic factual information on HIV/AIDS was reasonable, but many patients equalled HIV to AIDS and conceptualized their infection as 'social and physical death'. This seriously impeded their capacity to use knowledge of their test results in a constructive way, and stimulated coping by denial and/or secrecy about their HIV status. These avoidant coping strategies discouraged clients from using condoms, seeking social support and taking measures to protect their vulnerable health. The complex and changing nature of clients' needs indicates that common short-cuts in counselling (e.g. giving brief information before and after the HIV test) are seriously flawed as a strategy to prepare clients for effective coping. Comprehensive pre- and post-test counselling are an essential preparation for coping effectively during and immediately after testing. Availability of supportive counselling beyond this first phase is essential to assist clients with needs and problems which will appear over time. Development of counselling interventions should be guided by research into their effectiveness and by national policy guidelines. Replacing fear-inducing HIV campaigns with interactive, constructive information about HIV prevention and care will increase the preparedness of the community as a whole for effective living with HIV.
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4/47. Experiences of breastfeeding and vulnerability among a group of HIV-positive women in Durban, south africa.

    While international guidelines are currently being drawn up about HIV and infant feeding practices, and national and regional guidelines are under discussion in south africa, there have been remarkably few studies that have sought to elicit HIV-positive mothers' experiences of breastfeeding and of paediatric infection. There is an urgent need to document this 'grass roots' knowledge in different sites, and for this data to be used to inform policy development, and for advocacy and counselling purposes. This qualitative investigation reports on the experiences and decisions taken around breastfeeding by a peer support group of 13 HIV-positive mothers meeting at King Edward VIII Hospital, Durban. In this study, the particular focus of information-giving and decision-making as to breast or formula feed is concerned with the impact on individual HIV-positive women and their babies. The most significant finding is that at no stage during their pregnancy were any of these mothers given information about the risks of HIV transmission through breastmilk. The study data were elicited in an in-depth group discussion, and individual women were invited to re-enact their stories in a follow-up discussion for clarification purposes. The women also discussed how they dealt with problems surrounding confidentiality in cases where few have been able to disclose their status to the extended family. There have been renewed calls for further investment in counsellors, with an enhanced role for community activists as peer educators. While there are severe resource constraints and low morale among many overworked nurses, one of the general problems in hospital settings remains the vertical health paradigm. This does not accommodate women's experiences, preferences, social networks and lay knowledge, and inhibits many women from becoming full participants in decisions affecting their own and their family's health.
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5/47. Home-based treatment for children and families affected by HIV and AIDS. Dealing with stigma, secrecy, disclosure, and loss.

    The compelling needs of HIV-affected children and families sometimes appear to represent human struggles under the magnifying glass. The multiple assaults on the healthy psychologic development of children through disruptions in caregiving, loss, and abandonment require interventions that are mindful of their mental health needs and longer-term developmental trajectories. An ongoing relationship with a clinical team who can understand and respond to the vicissitudes of the illness and provide calibrated psychotherapeutic and case management services can aid both children and parents in the painful tasks that AIDS presents. Whereas clinically informed case management services can offer respectful and thoughtful concrete help, psychotherapy can offer the opportunity for children to pull together the often fragmented narratives of their family lives and integrate object loss to be free to continue on a normative developmental path. Comprehensive, wraparound home-based services of the type described in this article represent a mostly new tradition in psychiatry, but one that ensures that mental health services are provided to the most vulnerable children and families. For those affected by HIV or AIDS, home-based services can be the key to healthcare and treatment compliance. In addition, when services are well integrated within a community context, such that regular communication with other healthcare providers (AIDS clinics, visiting nurse services, and AIDS care agencies) is ongoing, what is provided constitutes continuity of care in the truest sense.
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6/47. Empowerment: a case study of a grandmother caring for her HIV-positive grandchild.

    A case study methodology is used to explore the meaning and development of empowerment in a grandmother who is the primary caregiver of a child with HIV infection. Empowerment to this grandmother meant being strong, coming to grips with life's challenges, and then moving on. Empowerment developed over the grandmother's life span as a result of developmental and situational experiences such as motherhood, disclosure of the HIV diagnosis, sharing her positive and negative feelings with others, gaining knowledge about HIV, making management decisions, and her increasing sense of spirituality. This grandmother manifests her empowerment through her public commitment to influence others positively about hiv infections through speaking, writing, and leadership in groups. Clinical implications are discussed.
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7/47. confidentiality. 13: The notification of infectious diseases.

    Jenny Rose was a paediatric community nurse who regularly visited a child with a chronic lung condition who was being nursed at home. On one visit she noticed that the child's mother, Jane, appeared to be very pale and thin and was told that the mother had a severe gastric disorder with diarrhoea. From the description of the illness, Jenny thought that Jane might be suffering from typhoid. Jane worked as a cook in a restaurant, was unwilling to seek medical advice and intended going to work that night. Jenny was concerned that Jane could have a serious notifiable infectious disease and therefore be a danger to customers in the restaurant. Jane insisted that Jenny should keep the information confidential. Where does Jenny stand?
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8/47. Resolution of organ-specific complications of human immunodeficiency virus infection in children with use of highly active antiretroviral therapy.

    opportunistic infections are a major source of morbidity and mortality in children and adults infected with human immunodeficiency virus (HIV). In addition, organ-specific complications of HIV infection, such as cardiomyopathy, nephropathy, encephalopathy, and others, contribute substantially to the morbidity and mortality associated with HIV infection. Highly active antiretroviral therapy (HAART) has produced a dramatic decline in the incidence of opportunistic infections among patients with HIV infection. Nevertheless, there is very little information concerning the value of HAART for organ-specific complications of HIV infection. In this report, we describe 3 children with HIV infection in whom the dominant clinical manifestations were cardiomyopathy, red cell aplasia, and nephropathy. HAART produced a decrease in the HIV ribonucleic acid level, an increase in the CD4 cell count, and resolution of the organ-specific complications in all patients. These cases add to our knowledge concerning the benefits of HAART for children with HIV infection.
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9/47. Sequence and peptide-binding motif for a variant of HLA-A*0214 (A*02142) in an hiv-1-resistant individual from the Nairobi Sex Worker cohort.

    As part of the ongoing study of natural hiv-1 resistance in the women of the Nairobi sex workers' study, we have examined a resistance-associated HLA class I allele at the molecular level. Typing by polymerase chain reaction using sequence-specific primers determined that this molecule is closely related to HLA-A*0214, one of a family of HLA-A2 supertype alleles which correlate with hiv-1 resistance in this population. Direct nucleotide sequencing shows that this molecule differs from A*0214, having a silent nucleotide substitution. We therefore propose to designate it HLA-A*02142. We have determined the peptide-binding motif of HLA-A*0214/02142 by peptide elution and bulk Edman degradative sequencing. The resulting motif, X-[Q,V]-X-X-X-K-X-X-[V,L], includes lysine as an anchor at position 6. The data complement available information on the peptide-binding characteristics of this molecule, and will be of use in identifying antigenic peptides from hiv-1 and other pathogens.
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10/47. Nondisclosure of human immunodeficiency virus and hepatitis c virus coinfection in a patient with hemophilia: medical and ethical considerations.

    This article discusses a medical and ethical dilemma: whether to disclose a positive HIV (human immunodeficiency virus)/HCV (hepatitis c virus) coinfection to an adolescent boy without symptoms with hemophilia despite the objections of his parents. An actual case history is presented and the dilemma faced by the medical team is discussed. Numerous family conferences, all excluding the patient, held during the last 5 years discussed the medical team's obligation for full disclosure, the emerging autonomy of the patient, and the potential for medical disaster (e.g., HIV transmission) if full disclosure were not permitted. Despite this, the family did not agree to allow disclosure. The patient and parents assured us of his sexual inactivity. Legal opinion was sought from the university counsel. The dilemmas are multiple. Is there a convincing argument to insist on disclosure of these facts to this patient, particularly when there is ambiguity regarding the appropriateness of HIV and HCV treatment? Does the ethical argument that he is at potential risk for transmitting HIV/HCV outweigh the rights of the family? What are the rights of the rest of the family? What are the rights of the minor? Is it our ethical responsibility to disclose a probably fatal diagnosis?
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