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OCR for page 361
Index
A
Acquired immune deficiency syndrome
(AIDS)
age, race, and sex trends, 72
cases by risk group, 70
causes of, 38-42, 60
clinical manifestations, 38, 47, 74-75
coordination of public resources against,
93-94
definition/defining, 7, 37, 46, 48, 63-64,
117, 316-319
diagnosis of, 49, 64, 72
disease presentation, 72-73
doubling time for cases, 70, 71
enteropathic, 75
epidemiologic and natural history studies
of, 66-67
geographic differences in clinical
manifestations, 46, 273
geographic distribution, 71-72
impediments to national involvement
with, 92-93; see also Fear of AIDS
incubation time for, 70
infections associated with, see
Opportunistic infections
international scope of, 29, 73-77; see
also specific countries/regions
involvement of disseminated sites, 45
malignancies associated with, 48, 292
361
media treatment of, 99
mortality, 72-73
National Commission on AIDS, 32-33,
94
natural history of, 44-46, 87
number of cases in U.S., 5, 7
pathogenesis of, 5-6, 141, 188
pattern of spread, 39
PHS plan for prevention and control of,
8-9, 85-86, 88, 91, 93-94, 326-333
projected cases and deaths, 5, 86
psychiatric/psychological problems
posed by, 148-149
remission of, 7, 46
reporting of, see Reporting of AIDS/HIV
infection
resources for dealing with, 92-94; see
also International resources for
fighting AIDS; Private resources for
fighting AIDS; Public resources for
fighting AIDS
risk population trends, 57-63; see also
High-risk groups; and specific
populations
sex education in schools, 11, 102; see
also Public education about AIDS
underreporting of, 14, 64, 88, 118, 159;
see also Epidemiologic surveillance
see also HIV infection; Human
immunodeficiency virus; Pediatric AIDS
OCR for page 362
362 INDEX
Africa
AIDS cofactors in, 45, 52, 75, 190, 273
clinical manifestations of AIDS in, 74-75
heterosexual transmission of HIV in, 75,
90, 202, 269
Kaposi's sarcoma in, 75
onset of AIDS in, 74
maternal-infant transmission of HIV in,
56, 272
parenteral transmission of HIV in, 76,
269-271
prevalence of infection in, 8, 29, 74-76,
269, 272
Agency for International Development, 29,
267-268, 274, 276
AIDS Foundation, 144
AIDS patients
ability to mount antibody reactions to
new antigens, 44
causes of death in, 47
CD4-to-CD8 ratio in, 43
costs of care for, 156-158
denial, 149
depression, 148
drug toxicity, 47, 211-218
equitable access to clinical trials, 100,
220
health care needs of specific
populations, 146-149
immunodeficiency in, 42-43
isolation of retroviruses from, 39
loss of employment by, 168
measure of immunologic impairment in,
43, 213
nervous system diseases, 49
nursing requirements, 144, 160
other infections commonly found in, 39
psychiatric/psychosocial support of,
148-149
T-lymphocyte characteristics, 44
AIDS Project/LA, 144
AIDS-associated retrovirus (ARV), see
Human immunodeficiency virus (HIV)
AIDS-related complex (ARC)
cases in U.S., 7, 70
course of disease, 38
definition/defining, 65
longitudinal studies, 149
national reporting of, 65
progression to AIDS, 7, 46
psychiatric/psychosocial support for
patients, 149-150
symptomatology, 38, 149
see also Human immunodeficiency virus
Albumin, destruction of HIV infectivity in,
Alternative testing sites, 17, 68, 115-116,
131-132
American Red Cross
AIDS education efforts, 102
"Look Back" program, 117
Amyl and butyl nitrites
association with AIDS, 38, 45-46, 51
association with Kaposi's sarcoma, 48,
73
Anal intercourse
receptive, 51-52, 66, 75, 89, 190
risk to insertive partner in, 51
use of condoms in, 97-98
Animal models
chimpanzees, 25, 205, 207-208, 221, 226
in experimental transmission studies, 50
HIV-related viruses in Old World
primates, 205-206
importance in HIV research, 25, 186,
204
lentiviruses of ungulates, 206-207
recommendations regarding, 25, 207-209
strategies for determining experimental
counterparts of human diseases, 204
supplies of test animals, 25, 35, 207-208,
221
Antibodies to HIV
infectiousness of persons having, 40
neutralizing capabilities, 225
in sera from AIDS and ARC patients, 40
time to appearance of, 115
Antibody tests for HIV
availability of, 64
in children, 50
confidentiality of results, 15, 68, 115, 125
controversy over, 113
cutoff pointsin, 114, 116
false negatives, 115-117
false positives, 114, 116
as insurance screening device, 169
level of use, 13
number in U. S. annually, 116
private development of, 61, 113
reduction of risk to blood recipients
through, 54, 113-117
sensitivity and specificity of, 13, 114
techniques, 113
see also Screening for HIV
OCR for page 363
INDEX 363
Antigens, response of CD4 cells to, 44, 197 Blood products
Antiviral agents
alpha interferon, 218
azidothymidine (AZT), 26, 215-216,
219-220
currently being studied, 213-218
development strategies, 181, 188, 211,
218-219
foscarnet, 217
HPA-23, 214-215
ideal characteristics of, 25, 219
mechanism of viral escape from, 194
research recommendations on, 25-26,
219-221
ribavirin, 216-217
suramin, 214, 219
targets for, 184, 186, 211-212, 214
see also Drugs; Vaccines against HIV
Autoimmune reactions due to repeated
exposure to sperm, 39
B
B lymphocytes, function of, 43, 198
Bacterial infections, see Opportunistic
infections
Bathhouses, 59, 128-129
Behavior modification
content of education directed at, 97, 234;
see also Public education about AIDS
by homosexual men, 89, 101, 104
of IV drug users, 89-90, 100, 105-112,
232
ways for inducing, 231-234
Bisexuals, see Homosexual men
Blacks
IV drug use among, 60
pediatric AIDS in, 61
prevalence of AIDS among, 72, 102
Blood donation
autologous transfusion, 117
directed, 117
during preantibody phase of HIV
infection, 54
lack of risk in, 98, 115
limiting use of blood to research
(self-deferral), 14, 115
Red Cross "Look Back" program, 117
Blood donors
alternative testing sites, 17, 68, 115-116,
131-132
risk to hemophiliacs from, 60
screening of, 61
self-exclusion of, 53, 61, 115, 270
AIDS cases attributable to, 70
clotting factors, 54, 60
HIV transmission through, 53
packed red blood cells, 53-54
risk factors in HIV transmission
through, 6, 53-54, 115
screening of, 53
Blood transfusion recipients
number of AIDS cases in, 60-61, 70-71
reduction of risk to, 6, 54
Blood transfusions
heterosexual transmission and, 90
IIIV transmission through, 30, 40, 53, 62
risks of HIV transmission through, 76,
269-270, 309-313
Bovine leukemia virus, 223
C
California
expenditures for AIDS prevention, 18,
131-132
pediatric AIDS in, 61
seropositivity among homosexuals in, 69
Cancers occurring in HIV-infected
persons, 48, 292, 318
Candidiasis (oral and esophageal), 73, 150,
284
Caprine arthritis-encephalitis virus, 206,
223-224
Casual contact, evidence against
transmission by, 6, 50-51, 98, 271
CD4 cells
depletion by HIV, 43-44, 195-196
function of, 43
CD8 cells, correction of defective
cytotoxic activities of, 197
Central nervous system (CNS)
cellular localization of HIV, 211, 295-296
drug penetration of, 215
infections and malignancies related to
AIDS, 49
unanswered questions on HIV infection
of, 49
Children, see Infants and children
Cofactors in AIDS
in Africa, 45, 52, 75, 190, 273
correlates with disease development, 193
forms of, 45
in Haitians, 66
history of sexually transmitted diseases,
51, 66, 70, 75
in IV drug users, 69, 89, 106-107
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364 INDEX
nitrites, 38, 45-46, 51
recommended studies of, 201, 273
tissue trauma, 52, 66, 75, 190-191
Colorado, HIV reporting requirements, 65
Condoms
education about, 10, 101, 202
effectiveness in inhibiting HIV
transmission, 97-98, 101, 202
Confidentiality
in outpatient settings, 143
protection of, 125, 129-130
in reporting of ARC, 65
of results of HIV antibody tests, 15, 68,
119, 125
Contact tracing and notification, 13, 119-120
Costs, see Health care costs
Cryptococcal disease, 49, 73, 285
Cryptosporidiosis, 73, 283-284
Cytomegalovirus (CMV)
association with incidence of Kaposi's
sarcoma, 48
condoms to inhibit transmission, 97
role in AIDS, 39, 46, 73, 287-288
treatment, 288
D
Deaths
causes of, in AIDS patients, 7, 47
cumulative, projections of, 86
from pediatric AIDS, 61
underreporting of, 73
Dementia
care for AIDS patients with, 147, 148
severity in HIV-infected persons, 49
Developing countries
health improvement assistance to,
265-266
immunization problems in, 262-262
pediatric AIDS in, 56, 262
scope of HIV infection in, 8
Diagnosis of AIDS
change in methods, 72
difficulties in, 49, 64
international development of tools and
training for, 267-268
reliability of, internationally, 262
Discrimination
against homosexuals, 59, 133- 134
countermeasures, 19, 134-135
due to misinformation, 19, 98
in employment, housing, and social
services access, 19, 133-134
laws against, 134
refusal to bury victims, 118
see also Social stigma
DNA
flow of genetic information from RNA
to, in retroviruses, 41
unintegrated, in HIV, 185, 195
Drug abuse education in schools, 102
Drug abuse treatment programs
financing for, 171
focus of, 108
methadone maintenance, 107-109, 232
planning for, 103
Drugs
access to, by AIDS patients, 100
design of, 182, 210
evaluation in humans, 26, 212-213
evaluation in vitro, 212, 214
gamma interferon, 197
hope offered by, 8, 95, 214-219
interleukin-2, 197
research recommendations, 23-25,
219-221
toxicity during treatment of AIDS
patients, 47
see also Antiviral agents
E
Education, see Public education about
AIDS
Encephalitis, subacute, in AIDS patients,
49, 293-294
Enzyme-linked immunosorbent assays
(ELISA), 113-114
Epidemic
dimensions of, 7, 8, 57-77
future course of, 8-9, 85-92
long-term prospects, 91-92
projections by U.S. Public Health
Service, 85-92
spread of, within and outside high-risk
groups, 89-91
status of, 5-8
ways to alter course of, 9-19, 95-135
Epidemiologic research
approaches to, 24
case-control studies, 66-67
centers for, 66
costs of, 66
on improved serologic and virologic
tests, 203-204
on natural history of HIV infection, 24,
200-202
populations selected for, 65-68
OCR for page 365
INDEX 365
prospective cohort studies, 15, 24, 67,
105, 124, 201
serologic surveys, 67-68
on transmission of HIV, 202-203
value of, 66, 105
Epidemiologic surveillance
of blood donors, 86
of clinical manifestations of HIV
infection, 67
definition of AIDS for, 7, 37-38, 63-64,
316-319
difficulties in, 68, 87
for evidence of association between
immune globulins and AIDS cases, 55
functions of, 117
of general population, 86
of high-risk groups, 24
of military applicants, 87
recommended approaches to, 14,
199-200, 273
serologic, 67-68
success of, 63, 96
see also Reporting of AIDS/HIV
infection; Screening for HIV
Epstein-Barr virus, role in AIDS, 39, 198
Equine infectious anemia virus, 224
Ethical issues
clinical trials of drugs, 213, 220
in drug abuse treatment to reduce HIV
transmission, 109
durable power of attorney, 154
in health care financing, 153
obligation to care for HIV-infected
persons, 20, 153-155
obligations of at-risk individuals, 20, 153
terminal care decisions, 20-21, 154-155
Europe
pattern of AIDS in, 76-77
Western, concerted action by, 263, 269
Expenditures, state, for AIDS prevention,
17, 131
F
Fear of AIDS
effects of, 12, 59, 108, 148
reducing, 99, 100, 234-236
Feline leukemia virus (FeLV), 222
Female circumcision, 75, 271
Flnancmg
see Funding; Health care financing
Florida, pediatric AIDS in, 61
Funding
for AIDS/HIV research, 28, 238-249
for alternative testing sites, 116
for CDC, 130, 239-240
current levels, 103, 130, 239, 241
determining appropriate levels of, 131,
244-248
distribution of, 244
for drug research, 218
for epidemiologic studies, 67
for federal and state agencies, 131- 132,
240
of home-, community-, and
hospice-based care, 163
mechanisms for, 16-17, 130, 239-244
needs, 131-132, 247-248
private sources of, 132, 240-241
for public health measures, 16-19, 112,
130-133; see also Public education
about AIDS
recommendations for, 15-19, 28, 31,
33-34, 133, 162, 208, 248-249, 276-277
for social science research, 231
for treatment of IV drug users, 171
U.S. contributions internationally,
274-275
see also Health care financing
G
Gamma globulin, risk of HIV transmission
from, 53
Gay Men's Health Crisis, 134, 144, 149
Genital mutilation, see Female
. .
circumcision
Genital ulcers, relation between HIV
infection and, 45, 52, 76
H
Haiti
pattern of AIDS in, 76
transmission of HIV in, 261
Haitians
factors associated with AIDS in, 66
heterosexual transmission of HIV by,
66-67, 70, 261
pediatric AIDS in, 62
proportion of AIDS cases among, 70-71
Health care
AIDS units/teams, 20
bed needs, 160-161
community-based, 20, 143-145
coordination of, 19, 145
dedicated AIDS clinics, 142
demonstration projects, 17, 162
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366 INDEX
ethical issues in, 153-155
facilities needed for AIDS patient
hospitalization, 160-161
home hospice care, 143, 144, 163
home nursing services, 143-144
in hospitals, 19, 141-142
infection control precautions, 157
length of inpatient stay, 156
needs of specific patient populations, 20,
146-148
outpatient, 20, 142-143, 171
planning of patients' discharges from
hospital, 142
recommendations for, 19-20, 34, 145-146
staff requirements, 20, 157
strains on, 19, 21-22, 49, 139
terminal, 20, 154-155
voluntary agencies providing, 20, 144,
149
see also Psychiatric/psychosocial
support
Health care costs
for ARC patients, 158-159
average lifetime cost per AIDS case, 12,
109
direct, for AIDS patients, 21, 156-158
equity in sharing, 172
factors contributing to, 21-22
for HIV-related conditions, 21-22,
155-162
hospital, 156-158
implications of projected AIDS cases,
159-160
indirect, Of HIV-related conditions,
20-21, 159
prevalence-based estimates, 156
recommended research on, 22
reduction of, 142
for seropositive individuals, 158-159
type-of-patient factor in, 157
Health care financing
analogies, end-stage renal disease
(ESRD), 166-167, 170-171
for drug abuse treatment, 171
eligibility for, 163, 171
ethical issues in, 153
for individuals with HIV-associated
conditions, 22-23, 162-173
issues and problems, 161-162
Medi-Cal reimbursements, 164
Medicaid, 22, 144, 162-164, 172
Medicare, 22, 165
recommendations for, 22-23, 34, 172-173
reduction of, 142
reimbursement for hospice care, 144
Social Security Disability program, 163,
165
sources of, 162-165
see also Funding; Health insurance
Health care personnel
AIDS specialists, 140
burnout of, 141
HIV exposure through accidental
needlesticks, 54, 62, 271
labor force in U.S., 62
nursing staff and nurse practitioners, 142
prospective studies of, 62
psychological stress in, 147
risk of infection among, 62-63, 153
seropositivity in, 62
training of, 20, 141
Health care planning, major problems, 85,
87
Health insurance
antidiscrimination laws governing, 169
costs of, 168
ethical issues relating to, 166-171
inadequate coverage, 22, 165-166
incentives to seek care, 171
last-resort coverage, 170
limitations on coverage, 144
misperceptions about coverage, 170
policy issues, 171-172
public versus private, 171 - 172
recommendations regarding, 172-173
screening devices for, 169
Health Resources and Services
Administration, 145
Helper/inducer cells, see CD4 cells
Hemodialysis units, transmission of HIV
through, 55, 203
Hemophiliacs
first cases of AIDS in, 60
heterosexual contacts of, 61
HIV transmission; to, 54, 57, 60
'ife expectancy of, 60
number of AIDS cases in, 70
seropositivity rate in, 60
Hepatitis B virus
similarities between HIV and, 39, 55, 62,
91, 97
Herpes simplex, 49, 73, 287
Herpes zoster, 287
Heterosexual contacts
anal intercourse in Africa, 52
populations at risk, 61
projections of AIDS cases from, 86
proportion of AIDS cases from, 71
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INDEX 367
Heterosexual transmission
in Africa, 30, 75
from men to women, 57
risk outside U.S., 70
sources of, 90, 105
from women to men, 52, 57
see also Sexual transmission
Heterosexuals
education of, about AIDS, 101
number of AIDS cases in, 70
High-risk groups
current, 6, 37, 57
disease trends by, 70-71
factors in HIV transmission, 57
largest, in U.S., 57-58
nondiagnostic infections in, 288-289
projections concerning, 86-87
psychiatric/psychosocial support,
151-152
self-exclusion of blood donors, 53, 61
spread of epidemic within and outside,
89-91
see also specific populations
. .
ilspanlcs
pediatric AIDS in, 61
prevalence of AIDS among, 72, 102
HIV infection
antibody appearance after, 115
asymptomatic period, 6, 7, 15, 65, 92,
126, 150-151
cancers associated with, 48
cellular route to, 191-192
of chimpanzees, 191, 205
classification system for, 64-65, 320-324
clinical manifestations of, 7, 46-50, 65,
281-299
clinical staging system for, 64
earliest events in, 45, 191
geographical differences in epidemiology
of, 73-77
groups at high risk, see High-risk
groups; and specific populations
immune system response to, 42-44,
191-193
immunologic consequences or, 4Z,
193-198
international scope of, 8, 28-29, 73-77,
261-263; see also specific countries/
regions
interruption of, 183-187
national resources for dealing with, 92-94
natural history of, 23-24, 189-204
necrologic complications associated
with, 49, 147-148, 210-211, 292-297
number of viral particles needed to
initiate, 45
pathogenesis of, 74
persistence of, 92, 113, 192, 194, 209,
211
preantibody phase of, 54
prevalence of, 69-70, 74-76, 89-90, 105,
107
progression to AIDS or ARC, 7, 57, 87,
95
receptor for, 43-44
recommendations for research on, 23-27
198-203
reduction of risk of, 53-54
risk factors in, 6; see also Cofactors in
AIDS
similarities to hepatitis B virus, 39, 55,
62, 91
spread of, 62, 66-68, 75, 90-91, 107
symptoms of, 42, 49
treatment for, 8, 140, 198-199, 209-211
in women, 10, 57
see also Human immunodeficiency virus
(HIV)
Hodgkin's disease, 48, 291-292
Homosexual men
attitudes about testing, 124
behavior modification, 89, 101, 104
discrimination against, 59
education of, about AIDS, 10-11, 101
estimated U.S. population, 58
Hodgkin's disease in, 291-292
incidence of Kaposi's sarcoma in, 47
Kinsey report regarding, 58
number of AIDS cases in, 70
progression from seropositivity to
clinical AIDS in, 45
projections of HIV infection among, 7,
89
prospective cohort studies of, 67, 69,
149- 150
recruiting of, for studies, 67
risk factors for HIV infection in, 51, 66
serologic surveys of, 67
seropositivity among, 69, 104
spread of epidemic through, 30, 89, 269
Human immunodeficiency virus (HIV)
antibodies to, 40, 115, 192
antibody testing of donated blood, see
Antibody tests for HIV
cytopathic effects of, 43-44, 195-197, 210
depletion of CD4 cells by, 43-44,
195-196, 210
discovery, 188
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368 INDEX
earliest indicators of transmission, 44
entry into body, 45, 50-57
entry into cell, 184
envelope glycoprotein, 183, 196, 210,
225, 227
etiologic role in AIDS, 40
evolution of, 92
genes involved in replication, 178-180,
184-186
genomic variation, 225
host cells for, 45, 191, 193-194, 210-211
infectiousness of, 153
interaction between CD4 molecule and,
44-45, 195-196
isolation from body fluids, 40, 51, 189
life cycle, 180, 183
mutation of, 183, 186, 226
nervous system involvement, 49, 211,
295-296
organ damage by, 194
origin, 74
propagation of, 40
receptor for initiation of viral infection,
43, 179, 183, 199
replication of, 179-181, 185, 210, 216
replication sites, 45
research recommendations on, 23, 26-28,
188-189
serologic reactivity with, 40
structural and functional constituents,
181-182
syncytia formation by, 195
transmission modes, 6, 50-57; see also
Casual contact; Maternal-infant
transmission; Parenteral transmission:
Sexual transmission
unintegrated DNA in, 185, 195
variation in shedding of, 51
viral classification of, 41
virion structure, 182
Human T-cell lymphotropic virus type I
(HTLV-I), 41, 223
Human T-cell lymphotropic virus type II
(HTLV-II), 41
Human T-cell lymphotropic virus type III
(HTLV-III), see Human
immunodeficiency virus
Human T-cell lymphotropic virus type IV
(HTLV-IV), 42, 224
I
Immune globulins, HIV transmission from,
55
Immune overload from repeated infections,
39
Immune system
cellular, 192-193, 226
composition and function of, 42-43
response to HIV, 191-193
Immunocompromised state
in AIDS patients with Kaposi's sarcoma,
47
causes of, 37
results, 42
susceptibility to live-virus vaccines, 122,
226-227
Immunodeficiency, 196, 197, 210
Immunofluorescent assays, 114
Infants and children
foster care for, 147
health care needs of, 146
of IV drug users, 62
projections of HIV infection in, 91
schooling of infected individuals, 16, 130
time to development of AIDS in, 56
see also Pediatric AIDS
Infection, see HIV infection; Oppo:rtun~stic
infections
Infectious diseases, 50, 96, 266
Insect vectors, lack of evidence for, 6, 30,
271
Institutionalized populations
compulsory testing among, 16, 128, 130
health care for, 16, 147-148
International efforts, U.S. contribution to,
30-31, 35, 274-276
International issues
development of tools and training for
diagnosis, 267-268
diagnostic reliability, 262
prevalence of AIDS, 28-29, 261-263
rationale for U.S. involvement to control
AIDS, 29, 264-268
risk of HIV infection, 29-30, 268-272
risks of exposure through blood
transfusions, 269-270
scope of HIV infection, 28-29, 261-263
International research
cofactor investigations, 273
of perinatal and heterosexual
transmission, 272
opportunities for, 30-31, 266-267, 272-273
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INDEX 369
International resources for fighting AIDS
organizations, 29-31, 35, 263-264,
267-270
recommendations, 30-31, 276-277
U.S. contribution to, 274-276
Intravenous drug users
AIDS occurrence in, 59, 70
behavior modification in, 100, 102,
105-112
biases in studies of, 69
demographic data on, 59-60
distribution of sterile needles and
syringes for, 13, 34, 108-110
factors related to HIV infection of, 69,
89, 106-107
health care needs of, 146
HIV transmission mode in, 52-53
international risks of HIV transmission,
270
prevalence of HIV infection, 69, 89-90,
105, 107
prevention of HIV infection, 12-13, 100,
102, 105-112
projections of HIV infection, 7, 89-90
recruiting for studies, 69
representation in prison populations, 60
risk to offspring of, 62
sharing of injection equipment, 30,
52-53, 100, 107, 270
spread of HIV through, 107
stereotypes of, 107-108
viral dose factor in risk to, 55
see also Drug abuse treatment programs
Isospori bell), 284
Italy, seropositivity among drug users in,
77
K
Kaposi's sarcoma
AIDS-associated outbreaks, 37
of central nervous system, 49
cofactors, 73
death from, 47, 73, 75
definition, 47
diagnosis, 48, 64
health care costs, 157
in homosexual men, 47, 66, 198, 273
in non-AIDS populations, 189-190
reporting of, 73
role in AIDS, 198, 273, 289
L
Legal issues
closing and regulation of facilities,
128-129
compulsory public health measures,
126-129
Consolidated Omnibus Budget
Reconciliation Act of 1985, 160
criminal sanctions for transmitting
AIDS, 127
health-insurance-related, 169
Rehabilitation Act of 1973, 134-135
reporting of seropositivity, 127-128
requests for assistance with, 134
restrictions on sale of sterile drug
paraphernalia, 100
sex education in schools, 102
sodomy laws, 59, 129
vaccine liability, 222, 229-230
see also Discrimination
Lentiviruses
disorders caused by, 41-42, 224
HIV similarities to, 41, 207
of ungulates, 206-207, 223
visna virus, 185, 206, 224
Lymphadenopathy, see Persistent
generalized lymphadenopathy
Lymphadenopathy-associated virus (LAY)
disorders associated with, 42
see Human immunodeficiency virus
Lymphoid interstitial pneumonitis,
chronic, 318
M
Macrophages, function of, 43
Malignancies occurring in AIDS patients,
196, 198, 289-292
Maternal-infant transmission
in Africa, 272
breast-feeding/breast milk, 56, 125, 203
populations at risk for, 62, 90
rate of, 56-57
research needs on, 203
routes of, 56, 62
Meningitis, aseptic, 293
Mitogens, effect of HIV on, 44
Models/modeling
biological, limitations in constructing, 87
of care, 145
of incidence of AIDS, 86-87
uncertainties in, 8-9, 87-88
of vaccine delivery, 226-228
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370 INDEX
Monitoring, see Epidemiologic surveillance
Monkeys, immunodeficiency resembling
AIDS in, 42; see also Simian
immunodeficiency virus (SIV)
Murine leukemia virus, 222-223
Myelopathy in AIDS patients, 49, 294
N
National Commission on AIDS, 32-34, 94
National Institute of Allergy and Infectious
Diseases, 240
National Institutes of Health, funding by
and of, 67, 240-244
Natural killer cells, 43
Needles and other unsterile implements,
HIV infection from, 76, 270-271
Needlesticks, accidental, HIV infection
from, 30, 54-55, 62, 202-203, 271
Netherlands, distribution of sterile
injection equipment in, 110
Neurologic complications
associated with HIV infection, 49
care needs of patients with, 147
clinical and pathologic features of,
292-295
dementia, 49, 147, 148
unsolved problems of, 211, 296-297
New Jersey
pediatric AIDS in, 61, 146
proportion of AIDS cases in IV drug
users, 72
New York City
AIDS case trends in, 71-72, 89, 164
closing and regulation of facilities in, 128
expenditures for AIDS prevention, 131
hospital facility needs, 21-22, 160
pediatric AIDS, 61, 146
public education efforts in, 102
seropositivity rates among IV drug
users, 107
study of Kaposi's sarcoma in
homosexual AIDS patients in, 66
Non-Hodgkin's lymphomas, 48, 291,
318-319
o
Ohio public education efforts, 102
Oncoviruses, 41, 222-223
Opportunistic infections
associated with Hodgkin's disease, 48
associated with non-Hodgkin's
lymphomas, 48
bacterial, 285-287, 317
causes, 46-47, 196, 198
of central nervous system, 49
characteristics in AIDS patients, 47
fungal, 284-285, 317
helminthic, 317
with major role in AIDS epidemic, 37
protozoa!, 281-284, 317
relation to mortality in AIDS patients,
73
treatment, 212
trends in, 72-73
viral, 287-288, 317-318
Oral transmission of AIDS, 56
Oregon public education efforts, 102
p
Pan American Health Organization, 263
Parenteral transmission
accidental needlesticks, 30, 54-55, 62,
202-203
blood transfusions, 53; see also Blood
transfusions; Hemophiliacs
from bloody fecal material, 56
from child to mother, 56
through hemodialysis units, 55
risk outside U.S., 76, 269-270
shared IV injection paraphernalia, 30,
52-53, 100, 107, 270; see also
Intravenous drug users
through unsterile needles and syringes,
76, 270-271
viral dose factor in, 55
Pediatric AIDS
clinical manifestations, 49-50, 61,
297-298
definition, 64-65, 318
demographic data, 61-62
diagnosis, 297-299
immunization problems in developing
countries, 265
international prevalence, 262, 272
number of reported cases, 61
projected cases, 86
time to development in infants, 56
transmission routes, 62
Perinatal transmission, see Maternal-infant
transmission
Peripheral neuropathies, 294-295
Persistent generalized lymphadenopathy
(PGL), 38, 197
Plasma-derived hepatitis B vaccines, 55-56
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INDEX 371
Pneumocystis carinii pneumonia
AIDS-associated outbreaks of, 37
death from, 7
diagnosis, 64
health care costs for, 157
prevalence, 72
symptoms, 281-282
treatment, 47, 216, 282
Poppers, see Amyl and butyl nitrites
Prevention strategies
closing and regulation of facilities,
128-129
condoms, 10, 97-98, 101
isolation and quarantine, 126-128
for IV drug users, their sexual partners,
and offspring, 12-13, 34, 105-110, 112
monitoring effectiveness of, 68
personal hygiene, 98
PHS plan, 326-333
recommendations for, 12-13, 34, 110-112
state expenditures for, 131
viricidal lubricants for vaginal and anal
use, 202
WHO guidelines on blood transfusions,
269-270
see also Public education about AIDS;
Vaccines against AIDS
Private resources for fighting AIDS, list of,
315
Projections
of AIDS cases, 5, 85-92
bases for, 88, 90
empirical models of incidence of, 86-87
international, 261-263; see also specific
countries/regions
problems in making, 86-89
Prostitutes, transmission of AIDS by, 65,
75 77, 90, 269
Psychiatric/psychosocial support
for AIDS patients, 20, 148-149
for ARC patients, 20, 149-150
for asymptomatic seropositive patients,
150-151
for denial, 149
for depression, 148
for seronegative individuals in high-risk
groups, 151-152
Psychosocial effects
of knowledge of antibody status,
122-123, 149
ostracism, 149
recommendations regarding, 152-153,
234-236
Public education about AIDS
aims of, 71, 98, 100
assessing efficacy of, 68, 104-105
communication of scientific results, 189
content of, 10, 97-100, 102, 233
"dirty words" issue, 99
funding for, 11, 15-19, 101, 103, 112
media costs for, 17-18
recommendations for, 9-12, 18, 33,
110-112
responsibility for, 102- 104
sex education in schools, 11, 102
success of, 101
targets of, 10-11, 100-103, 233
for youth, 101-102, 108
Public health measures
blood banking, 115-117
closing and regulation of facilities, 128-129
compulsory, 15-16, 126-129
contact tracing and notification, 13,
119-120
factors complicating, 112-113
among institutionalized populations, 128,
130, 147-148
isolation or quarantine, 15, 126-128, 130
mandatory screening, 120-122; see also
Screening for HIV
recommendations on, 13-16, 33, 124,
129-130
reporting schemes, 118-119; see also
Reporting of AIDS/HIV infection
surveillance, 117-118; see also
Epidemiologic surveillance
tests for HIV infection, 113-114; see also
Antibody tests for HIV
voluntary testing, 122-126; see also
Testing/tests for HIV
Public resources for fighting AIDS
coordination of, 93-94
extent of, 92
listof,314-315
noninvolvement, 92-93
Pyogenic infections, 287
Q
Quarantine, 126-128
R
Reporting of AIDS/HIV infection
asymptomatic, 65
Colorado program for, 65, 118
delays in, 88
mandatory, 65, 117
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372 INDEX
passive, 63
recommendations on, 24, 199-200
responsibility for, 63
schemes for, 117-119
state laws and regulations for, 14, 63-64
Reporting of ARC, 65
Research, see Epidemiologic research;
International research
Research needs, 177-249; see also specific
subject areas
Retroviruses
diseases caused by, 41
features of, 40-41
human, 39; see also Human
. ~ . .
1mmuno~ ~etlclency virus
isolation of, 39, 209
from nonhuman primates, see Simian
immunodeficiency virus
replication by, 179-181
species harboring, 39
structure of, 178-179
subfamilies of, 41-42; see also
Lentiviruses; Oncoviruses;
Spumiviruses
transmission of genetic information by,
41
type D primate, 223
Reverse transcriptase
in cultures of T lymphocytes from AIDS
patients, 39
inhibition of, 213-217
role in HIV, 41, 180, 184, 212
RNA, transmission of genetic information
by retroviruses, 41
Robert Wood Johnson Foundation, 145
S
Saliva, HIV virus isolated from, 51
Salmonella infections, 286
San Francisco
AIDS case trends in, 71-72, 164
Bay Area Lawyers for Individual
Freedom, 134
closing and regulation of facilities, 128
community-based AIDS care, 143
expenditures for AIDS prevention, 131
homosexual population, 58
hospital facility needs in, 160
seropositivity among homosexuals in,
69, 104
Scarification, 75, 271
Scotland, seropositivity among drug users
in, 77
Screening for HIV
of asymptomatic persons, 44
of blood, 13, 53
of blood donors, 68
compared with genetic screening, 121
confidentiality in, 15, 68, 119, 125
mandatory, 14-15, 112, 120-122
of military inductees, 68, 121-122
premarital, 121
sites for, 68
of subgroups, 14-15, 120-121
of women in high-risk categories, 57,
125-126
Semen, HIV isolated from, 51
Seroconversion
time between transmission and, 44-45
see also HIV infection
Serologic testing, see Antibody tests for
HIV; Screening for HIV; Testing/tests
for HIV
Seronegativity in infected individuals, 191
Seropositive individuals
anxiety and depression in, 150
costs of care for, 158-159
psychiatric/psychosocial support for,
150-151
Seropositivity
among African men and women, 52
in health care personnel, 62
in hemophiliacs, 60
in homosexuals, 69, 89, 104
in husbands of women with
transfusion-associated AIDS, 52
in military recruit applicants, 68
in recipients of HIV-infected blood, 53
Sexual behavior, see Behavior
modification
Sexual transmission of HIV
age distributions indicative of, 52
artificial insemination, 190
case-control studies of, 51
condoms to prevent, 10, 97-98, 101, 202
contact with partners from areas with
high prevalence of AIDS, 51
drug use and, 51, 90
female circumcision and, 75
female to male, 6, 52, 75, 191
genital ulcers and, 45, 52, 76
heterosexual intercourse, 51-52
history of sexually transmitted disease
and, 51, 66, 70, 75, 190
kissing, 51
male to female, 62, 52, 75, 90, 191
manual-rectal intercourse (listing), 51
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mutual masturbation, 51
nitrites and, 51
oral intercourse, 51
oral-genital sex, 51
oral-rectal sex, 51
by prostitutes, 66, 75-77, 90
receptive anal intercourse, 6, 51-52, 66,
75, 89, 190
rectal douching and, 51-52
repeated exposure to infected partners,
52
risk outside U.S., 202, 268-269
scarification and, 75, 271
socioeconomic class and, 75
tissue trauma and, 52, 66, 75
vaginal inoculation, 190-191
vaginal intercourse, 6, 52, 75, 202
see also Heterosexual contacts;
Homosexual men; Prevention
strategies
Shanti Project, 143, 144
Shooting galleries, 53, 107
Simian immunodeficiency virus (SIV), 74,
202, 206, 209, 224
Skin abrasions, HIV infection through, 62
Slim disease, characteristics of, 75
Social science research
approaches to, 233
breaking train of transmission, 231-234;
see also Behavior modification
funding, 231
needs, 27, 34, 230-238
organizing health and social services,
237-238
recommendations for, 27, 34, 238
reducing public fear of AIDS, 234-236
role in AIDS challenge, 231
Social stigma
attached to being tested/test results, 114,
119, 123
complication of public health measures
by, 112
effects of, 19
see also Discrimination
Southeast Asia, pattern of AIDS in, 77,
272
Spain, seropositivity among drug users in,
77
Sperm, autoimmune reactions due to
repeated exposure to, 39
Spumiviruses, disorders caused by, 42
Squamous cell cancers, association with
HIV infection, 48
Suppressor/cytotoxic cells, see CD8 cells
Surveillance, see Epidemiologic
surveillance
T
T lymphocytes
CD4 molecule, 43, 183-184, 191, 196, 199
CD4-to-CD8 ratio in AIDS patients, 43
CD8 molecule, 43
characteristics of, in AIDS patients, 44
culturability of HIV in, 39-40
cytopathic effect of HIV envelope
protein on, 183, 210
functions of, 197
reduction of, in AIDS patients, 43
see also CD4 cells; CD8 cells
T-cell leukemia, 40-41
Tears, HIV isolation from, 51
Testing/tests for HIV
anonymous, 119-120, 124-125
antigen assays, 24
confirmatory, 114, 116
costs of, 17
counseling with, 15, 17
current methods, 304
improvements needed in, 30, 203-204
insurance-related, 169
performance characteristics of, 306-307
recommendations for, 30, 34, 124-125,
129
surrogate blood tests, 169
virologic, 203, 204, 213
voluntary, 15, 122-126
without subject's knowledge, 15, 125
see also Antibody tests for HIV;
Screening for HIV
Thrush, see Candidiasis
Toxoplasma gondii, 49, 73, 282-283
Transmission of AIDS/HIV
breaking train of, 231-234
cellular route, 192
dose factor in, 190
efficiencies of, 190-191
epidemiologic approaches to research,
202-203
erroneous beliefs about, 98
outside the U.S., 29-30
sources of, 190
see also Casual contact; Cofactors in
AIDS; Maternal-infant transmission;
Parenteral transmission; Sexual
transmission
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Treatment strategies, see Antiviral agents;
Drugs; Vaccines against HIV
Tuberculosis, 273, 285-286
U
United States
agencies and organizations with
international responsibilities, 267-268
contribution to international efforts,
30-31, 35, 274-276
foreign policy considerations, 264
health improvement assistance to
developing countries, 264-265
infection risks outside, 268-272
rationale for international involvement to
control AIDS, 264-268
U.S. Public Health Service
AIDS Task Force, 93
funding for, 17, 130- 131
plan for prevention and control of AIDS,
8-9, 85-86, 88, 91, 93-94, 326-333
projections for incidence and prevalence
of AIDS, 85-92
use of information related to antibody
tests, 68
V
Vaccines, animal retrovirus, 222-225
Vaccines against HIV
availability, 26, 92, 95, 113, 229
development approaches, 23, 26-27,
183-184, 192, 221-222, 225-226, 228-229
difficulties in developing, 221, 223, 225
liability and, 222, 229-230
models for delivery of, 226-228
private sector role, 27, 222, 230
research recommendations for, 27,
229-230
testing in humans, 222, 228-229
Viral shedding, variability in, 51
W
Washington, D.C., seropositivity among
homosexuals in, 69
Western blot analysis, use with ELISA
test, 114, 116
World Health Organization, AIDS-related
activities of, 29, 30-31, 35, 263,
269-270, 273-277
Representative terms from entire chapter:
aids patients
