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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

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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

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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

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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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INDEX 373 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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374 INDEX 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