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A Noone

Publications and source records attributed to A Noone.

At least 37 records · Page 2Linked to original sources
PubMed1996

AIDS defining diseases in the UK: the impact of PCP prophylaxis and twelve years of change.

We examined all reports of adult AIDS cases made to the 2 national surveillance centres in the UK for changes in AIDS defining conditions between January 1982 and September 1994. Differences and changes among persons diagnosed since January 1988 who had and had not been aware of their HIV infection prior to their AIDS diagnosis were of particular interest. Pneumocystis carinii pneumonia (PCP) is the AIDS defining disease most often reported at the initial AIDS diagnosis. Its proportion of all AIDS cases has increased significantly between January 1982 and December 1987 and decreased markedly thereafter. Since January 1988 a significant decrease in the proportion of cases diagnosed with cryptosporidial infection was also observed while increases were observed in the proportion of cases diagnosed with: HIV wasting (chi(1)(2) = 5.56) PML (chi(1)(2) = 19.47), mycobacterium avium complex (chi(1)(2) = 35.76) and pulmonary tuberculosis (chi(1)(2) = 144.0). For cases diagnosed between January 1988 and September 1994, PCP was more likely to be diagnosed in patients previously unaware of their HIV infection (P < 0.01) as was extrapulmonary TB (P < 0.01). In contrast, the following diseases were more likely to be diagnosed in patients already aware of their HIV infection prior to the diagnosis of AIDS: oesophageal candidiasis (P < 0.001), HIV wasting (P = 0.07), mycobacterium avium complex (P = 0.0001), cytomegalovirus disease (P < 0.001), HIV encephalopathy (P = 0.0009) and cryptosporidial infection (P = 0.02). Prophylaxis and anti-retroviral therapy appear to have had a significant impact on the temporal changes of the most frequently diagnosed AIDS diseases. While PCP prophylaxis has substantially reduced the likelihood of a PCP diagnosis at AIDS, the corresponding increase in other opportunistic infections suggests that there may be a need for improved prophylaxis for these conditions.

AIDS Dementia Complex↗
PubMed1995

The Health of the Nation target on syringe sharing: a role for routine surveillance in assessing progress and targeting interventions.

The Health of the Nation initiative in the United Kingdom includes a target aimed at reducing the proportion of current injecting drug users who share syringes. The PHLS Collaborative Survey of Salivary Antibodies to HIV and Hepatitis B core in injecting drug users is a comprehensive and national surveillance mechanism which routinely collects data that can be used to monitor progress toward this target. Nineteen per cent of injecting drug users (353/1876) in 1992 and 18% (375/2138) in 1993 shared previously used injecting equipment (difference of -1.3%, 95% Cl -3.7%, 1.1%). Only with further years of data collection will it be possible to tell if this decline represents a real change in behaviour. There was a substantial reduction in the proportion of sharers who received previously used needles and syringes from more than one person, from 45% (138/305) in 1992 to 27% (81/298) in 1993 (fall of 18%, 95% Cl 11%, 26%). This decline could indicate a real reduction in risk behaviour that is not reflected in the target. Monitoring this aspect of sharing could be an important supplementary measure. Women were more likely to have share (adjusted OR = 1.87, 95% Cl 1.53, 2.28) and the likelihood of sharing declined with age (adjusted OR of each 5-year age band = 0.75, 95% Cl 0.72, 0.79). Particular attention should be given to interventions which aim to reduce sharing among women and young people. Clients of agencies at which the main service provided was syringe exchange were less likely to have shared than attenders of other types of agencies (adjusted OR = 0.69, 95% Cl 0.51, 0.93). This suggests that syringe exchange schemes play a role in reducing the transmission of HIV infection.

Adolescent↗
PubMed1995

An investigation assessing the fraction of human immunodeficiency virus infection attributable to ethnic group variations in risk.

Considerable speculation and a recent publication has suggested that much of the human immunodeficiency virus (HIV-1) infection in the subset of the UK population represented by women having babies in Metropolitan London is substantially imported from Africa. Other data are supportive of this hypothesis. Ades et al. (1992) concluded that the fraction of HIV seroprevalence, identified in a large London-based study using neonatal blood from the dried blood spots on Guthrie cards, attributable to mothers born in Africa was 92.4% with 95% CI: 82-100%. This is an important observation which requires confirmation. This paper reports on an attempt to do this with closely similar methodology using the Unlinked Anonymous Survey (UAS) of HIV-1 seroprevalence in pregnant women attending antenatal centres, together with data from the Office of Population Censuses and Surveys (OPCS) on the country of origins of mothers delivering in 1991 at the 15 London centres included in the UAS. As in Ades' analysis there appeared to be a strong association between centre prevalences and the proportions of women of African origin delivering at those centres. This was consistent with a high fraction of seroprevalence attributable to such women, but it was also clear that the assumptions required for the estimation of the attributable fractions were not fully met. Analyses modified to justify the assumptions produced attributable fraction estimates ranging from 44% to 96% with lower 95% confidence limits 20% or less.(ABSTRACT TRUNCATED AT 250 WORDS)

Africa↗
PubMed1995

Pneumococcal vaccine and HIV infection: report of a vaccine failure and reappraisal of its value in clinical practice.

A clinical failure of pneumococcal vaccine is reported. A 22 year old African woman was given 23-valent pneumococcal vaccine at her initial presentation with HIV infection. She was asymptomatic and had a CD4+ lymphocyte count above 500 cells/mm3. Eighteen months later she died of meningitis and septicaemia due to Streptococcus pneumoniae type 9 (an antigen included in the 23-valent vaccine). Pneumococcal antibody levels performed on stored blood demonstrated no serological response to the vaccine. This is the first reported case of clinical failure of pneumococcal vaccine in an HIV infected patient who received vaccine whilst at the asymptomatic stage of HIV infection and with relatively intact immune function. The literature pertaining to pneumococcal vaccination in the context of HIV infection was reviewed. Pneumococcal vaccination is recommended for HIV positive patients in the UK by the Departments of Health. It is likely that many physicians are not aware of these recommendations or are concerned about the poor efficacy of the vaccine, and it may consequently be underused in clinical practice. But the potential gain to the HIV positive patient is such that the vaccine should be offered to all HIV positive patients as soon as they present for medical care, irrespective of the stage of HIV disease. Physicians and patients should be aware that the vaccine is not fully protective and that episodes of sepsis, pneumonia and meningitis could still be pneumococcal in origin and should be treated appropriately. Awareness of the substantial risks of pneumococcal disease in HIV infected patients with prompt diagnosis and effective treatment is the most important strategy to decrease morbidity and mortality.

Adult↗
PubMed1994

Surveillance of HTLV infection in England and Wales: 1986-1992.

The epidemiology of infection with human T cell leukaemia/lymphoma virus (HTLV) types I and II in England and Wales between 1986 and 1992 has been studied. Two sources of data have been reviewed: reports of cases of infection received by the PHLS Communicable Disease Surveillance Centre, and information about people infected with HTLV-I and II provided on laboratory request forms sent to the Virus Reference Division of the PHLS Central Public Health Laboratory. Most patients were of Caribbean origin. The age and sex distribution of people with disease associated with HTLV-I and II in England and Wales resembles that previously recorded in the Caribbean. The data suggest that the prevalence of disease associated with HTLV infection is low in England and Wales, but case ascertainment may be incomplete.

Adult↗
PubMed1993

HIV infection in injecting drug users attending centres in England and Wales, 1990-1991.

OBJECTIVE: To monitor trends in HIV infection and associated risk behaviours in injecting drug users (IDU) in England and Wales. DESIGN: Ongoing voluntary unlinked anonymous cross-sectional survey. METHOD: IDU attending centres in 1990 and 1991 were invited to complete a brief questionnaire requesting demographic and behavioural information, and to provide a saliva sample to be tested for antibodies to HIV and to the core antigen of hepatitis B virus (HBV). RESULTS: In 1990, 1.2% (19 out of 1543) of samples from 33 centres, and in 1991 1.8% (25 out of 1417) of samples from 37 centres contained antibody to HIV. Antibody t9 HBV core-antigen was found in 33 and 31% of IDU in 1990 and 1991, respectively. The prevalence of HIV infection in IDU attending centres in London (4.2%) was higher than in those attending centres elsewhere (0.8%). The prevalence of HIV infection in 1991 varied between individual centres from 0 to 10.6%, and at many centres outside London no IDU were infected with HIV. In the same year the prevalence of past infection with HBV varied from 14 to 54%, and IDU who had evidence of HBV infection were found among attenders in nearly all centres. The prevalences of sharing injecting equipment and risky sexual behaviour were high at many centres. The prevalence of HIV infection was higher in IDU who had started to inject in 1985 or earlier, than in those who started injecting later. In each year, approximately half the IDU surveyed reported having had a voluntary confidential HIV-antibody test, and the prevalence of HIV infection was five times higher in those tested than in those who had not been tested. CONCLUSIONS: HIV prevalence in IDU attending centres in England and Wales was low in 1990-1991. There is some indication that IDU have modified their injecting or sexual behaviour, but even at existing reduced levels of risk behaviour, transmission can occur in HIV is introduced into previously unexposed groups.

Adolescent↗
PubMed1993

Changing incidence of Pneumocystis carinii pneumonia as initial AIDS defining disease in the United Kingdom.

OBJECTIVE: To determine whether the incidence of Pneumocystis carinii pneumonia (PCP) as the initial AIDS-defining disease in adult AIDS cases in the United Kingdom is changing over time and to examine factors likely to affect it. SUBJECTS AND METHODS: A total of 4419 adult AIDS cases diagnosed in the United Kingdom between January 1989 and December 1992 were analysed using logistic regression models. An initial diagnosis of PCP was used as the outcome variable and the possible effects of age, sex, exposure category, ethnic group, half year of diagnosis, geographical area of report, and whether or not the individuals had been aware of their HIV infection when AIDS was diagnosed was examined. RESULTS: A significant decline in PCP incidence was observed over time. Incidence of PCP declined among subjects who had been aware of their infection for 9 months or more before AIDS diagnosis. There was no evidence of a change in PCP incidence over time for subjects who had had HIV infection diagnosed 3 or less months before an AIDS diagnosis. Individuals who had been aware of their HIV infection, individuals reported from the Thames health regions, and non-white patients were much less likely to have had a diagnosis of PCP. CONCLUSIONS: The decline of PCP incidence in subjects aware of their serostatus, and therefore more likely to have received primary prophylaxis, suggests that they may have benefited from this treatment. Our findings provide evidence of the value of an early HIV diagnosis and confirmation of the beneficial effects of primary prophylaxis for PCP.

AIDS-Related Opportunistic Infections↗
PubMed1992

Heterosexually acquired HIV-1 infection: cases reported in England, Wales and Northern Ireland, 1985 to 1991.

By the end of 1991, there had been 417 reports of AIDS and 1620 reports of HIV-1 infection in persons in England, Wales and Northern Ireland who probably acquired their infection through sexual intercourse between men and women. Between 1986 and 1991, the proportion of AIDS cases attributable to heterosexual transmission increased from 2% to 14% and of diagnosed HIV-1 infections from 4% to 23%. Reported HIV-1 infections inadequately reflect the extent of infection as only individuals choosing to be tested can be reported. HIV-1 infection acquired during heterosexual intercourse may be the result of transmission from partners who were infected by routes other than heterosexual transmission (first generation transmission) or of transmission from infected partners who were themselves infected through heterosexual intercourse (second generation transmission). Of the 417 cases in which AIDS was acquired through heterosexual intercourse, 42 (10%) were categorised as due to first generation transmission, 328 (79%) as second generation transmission--abroad, and 47 (11%) as second generation transmission--UK. Transmission categories could be allocated to 1438 of the 1620 reports of HIV infection: 17% were categorised as first generation, 74% as second generation--abroad, and 9% as second generation--UK. Heterosexual transmission of HIV infection is increasing, both in individuals acquiring their infection abroad as well as those who become infected in the United Kingdom.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Second generation heterosexual transmission of HIV-1 infection.

Reports of 217 HIV-1 infected persons have been investigated. Initially, 122 were described as having no identified risk of HIV infection and 95 were described as probably infected through heterosexual intercourse. The sexual partners of 34 of these 95 cases were reported as having acquired their infection heterosexually in the UK but information on the risk status of the sexual partners of the remaining 61 cases was lacking. Telephone follow-up through microbiologists and clinicians resulted in the recategorisation of 132 cases. Interviews were conducted with 22 HIV infected heterosexuals without a major risk for HIV infection, either in themselves or their sexual partners, and who had no evidence of heterosexual exposure outside the UK. Interviews confirmed the categorisation of 15 cases (9 male, 6 female) as due to second generation HIV-1 infection ie, infection acquired through heterosexual intercourse in the UK with a partner who also became infected through heterosexual intercourse. A possible chain of transmission is described involving three of these 15 cases.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Voluntary testing to measure HIV prevalence in sexually transmitted disease clinics.

Voluntary HIV testing was used to study the extent of HIV-1 infection in patients attending sexually transmitted disease (STD) clinics in England and Wales between 1985 and 1990. Homosexual and bisexual men and 10-20% of heterosexual men and women were invited to complete a study record and have an HIV-1 antibody test. The rate of newly diagnosed HIV-1 infection was higher in homosexual and bisexual men than in heterosexual clinic attenders. It was also higher in patients attending clinics in the South East compared with those attending clinics in other regions. From 1988 onwards, HIV infection was identified in heterosexual men and women who did not report behavioural risk factors associated with increased risk of HIV transmission. In the early years of the study, the proportion that agreed to complete a study record and have an HIV-1 antibody test was high in all groups. This proportion declined in those attending clinics in the South East, particularly among heterosexual men and women, less than 50% of whom agreed to take part in the study in 1989 and 1990. The decline in acceptance rate made voluntary testing unsuitable for monitoring trends in HIV infection. Unlinked anonymous HIV testing, which minimises the effect of participation bias, has become the method of choice for monitoring the prevalence of HIV infection.

AIDS Serodiagnosis↗
PubMed1991

Travel, heterosexual intercourse and HIV-1 infection.

One hundred and seventy AIDS cases and 547 HIV-1 antibody positive reports of infection in persons who are presumed to have become infected by sexual intercourse between men and women abroad are reviewed. Eighty three percent of people with AIDS and 99% of HIV-1 infected persons were reported to have been exposed in countries where heterosexual spread of HIV infection is well documented (i.e. WHO patterns II or I/II - see below). African countries were commonly cited. The group that had been exposed heterosexually in pattern II or I/II countries was young, and males slightly outnumbered females. Persons who are presumed to have become infected with HIV-1 through heterosexual contact abroad make up a heterogeneous group of travellers which includes holiday makers, business persons, students, refugees and immigrants. Research is needed to identify travellers whose high risk behaviour makes them vulnerable to HIV-1 infection, and to develop effective health education measures for them.

Acquired Immunodeficiency Syndrome↗
PubMed1989

General practitioners' referrals to specialist outpatient clinics. I. Why general practitioners refer patients to specialist outpatient clinics.

There has been much concern about the wide variations in general practitioners' referral rates and the consequent implications for cost and quality of care. This has led to a call to evaluate the appropriateness and effectiveness of referrals. A collaborative audit of referrals to outpatient clinics was conducted by 127 general practitioners in 33 practices in the Oxford region. Records were kept of 18,754 referrals, which included data on diagnoses and reasons for referral. Overall, 6553 (35.4%) of the referrals were for particular treatments or operations and a further 6475 (34.9%) were for specific investigation or diagnosis. Advice on management was the main reason for referral in 2656 (14.3%) cases, and in 1719 (9.3%) cases the general practitioners wanted the consultants to take over managing their patients. Reassurance of either the general practitioner or the patient was recorded as the main reason in only 762 (4.1%) referrals. There seems to be scope for rationalising the referral process. A programme with three stages for evaluating referrals to outpatient clinics is recommended.

England↗