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From 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 Read the entire page →
From page 362... ... 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 Read the entire page →
From page 363... ... , 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) Read the entire page →
From page 364... ... , 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 Read the entire page →
From page 365... ... . 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 Read the entire page →
From page 366... ... 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 Read the entire page →
From page 367... ... . 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) Read the entire page →
From page 368... ... , 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. Read the entire page →
From page 369... ... , 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 Read the entire page →
From page 370... ... , 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 Read the entire page →
From page 371... ... 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 Read the entire page →
From page 372... ... . 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) Read the entire page →
From page 373... ... 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 Read the entire page →
From page 374... ... 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 Read the entire page →

From 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

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From page 362...

... 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

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From page 363...

... , 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)

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From page 364...

... , 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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From page 365...

... . 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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From page 366...

... 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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From page 367...

... . 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)

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From page 368...

... , 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.

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From page 369...

... , 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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From page 370...

... , 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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From page 371...

... 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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From page 372...

... . 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)

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From page 373...

... 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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From page 374...

... 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

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Index Pages 361-374

Index
Pages 361-374