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Biomedical subjects

B Donovan

Publications and source records attributed to B Donovan.

At least 19 recordsLinked to original sources
PubMed1992

Bullous impetigo in homosexual men--a risk marker for HIV-1 infection?

OBJECTIVE: To determine the incidence of bullous impetigo in a group of homosexual men at high risk of HIV-1 infection. DESIGN: A longitudinal descriptive study (1984-9). SETTING: A private primary care and STD clinic in Sydney, Australia. SUBJECTS: 88 homosexual men documented to seroconvert to HIV-1, and 37 homosexual controls who had practised unprotected anal intercourse with another man known to be HIV-1 positive but who remained HIV-1 negative. MAIN OUTCOME MEASURE: Incidence of bullous impetigo. RESULTS: The crude annual incidence of bullous impetigo was 0.015 in subjects while they remained HIV-1 negative (10 cases) and 0.045 in early HIV-1 positive subjects (2 cases). Overall, 9% of the HIV-1 seroconverters and 9% of the HIV-1 negative controls were documented as suffering bullous impetigo over a mean of 29.2 and 39.3 months, respectively. CONCLUSIONS: Bullous impetigo in an adult could prove to be a clinical indication that a person is either infected with HIV-1 or is in close (possibly sexual) contact with a person with HIV-1 infection. If true, the recognition of bullous impetigo could provide an opportunity for behavioural intervention to limit the spread of HIV-1.

Australia↗
PubMed1991

Heterosexual gonorrhoea in central Sydney: implications for HIV control.

Gonorrhoea is a sexually transmissible disease (STD) characteristic of a core group of individuals and their contacts. From the experience of a Sydney STD clinic, as well as local and national population-based reports, trends in heterosexually acquired gonorrhoea in Australia over a decade were examined. An overall decline of 90% in case numbers between 1981 and 1989 was found, with an average yearly decline of 30%. The improved compliance with condom use by Sydney prostitutes and their clients could have been a major factor. This occurred in an environment of peer and public education about AIDS and the decriminalisation of prostitution. Improved health professional training and public access to specialist STD services against a background of demographic changes may also have contributed. However a persistent "seeding" of penicillinase-producing strains of gonorrhoea from Southeast Asia through men not using condoms was detected. These data have potential implications for the importation of heterosexually acquired human immunodeficiency virus infection into Australia.

Acquired Immunodeficiency Syndrome↗
PubMed1991

A study of the relationship between tensile testing of condoms and breakage in use.

The ability of the condom wall to maintain its integrity throughout sexual intercourse is critical to its role in halting the spread of major sexually transmissible pathogens including the human immunodeficiency virus. There are three principal in vitro performance tests applied to condoms: a test for freedom from holes, an inflation test, and tensile testing. In this study we subjected condoms that had broken in use to tensile tests in order to determine any correlation between their in vivo and in vitro performance. Condoms which had broken in use showed similar tensile properties to those which had not. All passed all tensile test criteria. Thus, the inclusion of tensile testing in National Standards for condoms is not sufficient to insure strong products.

Contraceptive Devices, Male↗
PubMed1991

The influence of human immunodeficiency virus type 1 infection on the development of the hepatitis B virus carrier state.

To assess the influence of human immunodeficiency virus type 1 (HIV-1) infection on the natural history of acute hepatitis B virus (HBV) infection, a study was undertaken of the clinical records of all 77 homosexual men with documented seroconversion to anti-hepatitis B core antibody (anti-HBc) between visits to either of two Sydney clinics between 1985 and 1989. HIV-1-seropositive subjects developed chronic HBV infection (positive for hepatitis B surface antigen [HBsAg] greater than 6 months) more frequently (7/31, 23%) than HIV-1-seronegative ones (2/46, 4%; P = .026). HIV-positive subjects who cleared HBsAg had significantly more circulating CD4+ lymphocytes (mean, 547 x 10(6)/l) than those who did not (352 x 10(6)/l, P less than .005). A subset of subjects who acquired both viruses between visits had an even higher rate of chronic infection (4/10, 40%). Icteric illnesses were reported more frequently by HIV-1-seronegative (11/46, 24%) than -seropositive subjects (3/31, 10%; P = .20). These findings indicate a potential for an increased reservoir of HBV infection in the community as a consequence of the HIV-1 epidemic.

Acute Disease↗
PubMed1990

Anti-sperm antibodies in homosexual men: prevalence and correlation with sexual behaviour.

The sera of 60 homosexual males were examined for the presence of antibodies to sperm using an indirect immunobead test (IBT). Six of 60 (10%) had antibodies of IgG isotype; in addition two of the six had antibodies of IgA isotype. The presence of antibodies was associated with the practice of unprotected receptive anal intercourse in the previous six months. Antibodies were not found in homosexual men who were celibate, or who practised only oral intercourse during the same period. There was no correlation between the presence of anti-sperm antibodies and antibodies to human immunodeficiency virus (HIV), or numbers of T lymphocytes. These preliminary results lend support to the hypothesis that antigen presentation in the lower gut may be a source of sensitisation against sperm. The possibility that anti-sperm antibodies may be a marker of receptive anal intercourse merits further investigation.

Adult↗
PubMed1990

HIV infection in sexually transmissible disease practice in Sydney: the effects of legislation, public education and changing clinical spectrum.

The experience with human immunodeficiency virus (HIV) infection of a private inner-city sexually transmissible diseases (STD) clinic in Sydney was quantified. Between February 1984 and March 1988, 2073 of the Clinic's patients were tested for antibodies to HIV on 5095 occasions. Of those tested, 538 (26%) were positive for antibodies to HIV: 532 (98.9%) of the seropositives had practised male homosexual intercourse. This is the highest reported seroprevalence of HIV for any primary care service in Australia. Those individuals seropositive because of other risk behaviours were detected by voluntary contact tracing rather than by screening. Female prostitution was not found to be a risk factor for HIV. In general, rates of first HIV antibody tests were adversely affected by threatening legislation, and temporarily stimulated (among lower-risk persons) by a national television campaign. These data suggest that much of the counselling, detection and management of HIV infection in Australia is occurring in private practice, and that STD services (private and public) are at the forefront of the HIV epidemic. This has implications for disease surveillance and control, health services planning and medical education.

Adult↗
PubMed1989

Sexual practices and condom usage in a cohort of homosexual men in relation to human immunodeficiency virus status.

Between January 1, and October 31, 1987, 420 homosexual men who participated in a cohort study of infection with the human immunodeficiency virus (HIV) completed a questionnaire that examined their sexual practices during the previous six months. Of the subjects, 205 (48.8%) men were HIV-seropositive and 215 (51.2%) men were HIV-seronegative. Although there was an appreciable level of condom usage in both groups, 13.5% of the HIV-seronegative men had engaged in unprotected receptive anal intercourse and 6.3% of the HIV-seropositive men had engaged in unprotected insertive anal intercourse. Condom breakage was reported on approximately 6% of occasions by a minority of subjects. Among subjects who were in a relationship with a regular male sexual partner, the most commonly reported sexual practices were deep kissing, mutual masturbation and receptive oral intercourse without ejaculation. No HIV-seronegative man engaged in unprotected receptive and/or insertive anal intercourse, receptive oral intercourse with ejaculation or receptive and/or insertive "fisting" with a regular partner who was HIV-seropositive. No HIV-seropositive man engaged in unprotected insertive anal intercourse to ejaculation with an HIV-seronegative partner, although they did so with partners who were HIV-seropositive or of unknown status. On multivariate analyses the subject's antibody status was found to be associated with receptive anal intercourse with a condom (P = 0.007) and mutual masturbation (P = 0.001), with HIV-seronegative men being more likely to practise either; no significant independent effect was associated with the partner's antibody status. These findings provide important information on the types and levels of sexual practices in a group of homosexual men after the recognition of the acquired immunodeficiency syndrome in this country.

Adult↗
PubMed1989

The effect of concurrent human immunodeficiency virus infection on chronic hepatitis B: a study of 150 homosexual men.

To determine the influence of concurrent human immunodeficiency virus (HIV) infection on chronic hepatitis B virus (HBV) infection, 150 male homosexual chronic hepatitis B surface antigen (HBsAg) carriers were studied. Of these, 82 subjects (55%) tested positive for antibodies to HIV. They were more likely to express hepatitis B "e" antigen (HBeAg) (P less than .001) and HBV-DNA (P less than .0005) in serum than were HIV-seronegative individuals. However, the degree of immune suppression did not influence HBeAg-HBV-DNA expression. In HBeAg-seropositive subjects, concurrent HIV infection was associated with lower serum alanine transferase levels (P less than .001). This effect increased with the degree of immune suppression as determined by CD4+ lymphocyte counts. Conversely, in patients negative for HBeAg, there was a weak trend towards higher alanine transferase levels with concurrent HIV. This study suggests that chronic hepatitis B may be less severe when accompanied by HIV infection; however, greater viral replication may make it more contagious and resistant to antiviral therapy. These data support an immune-mediated pathogenesis for hepatitis B and have implications for its control.

Adult↗
PubMed1989

Hepatitis delta virus in homosexual men in Sydney.

In countries not generally endemic for hepatitis B, homosexual men who are carriers of hepatitis B surface antigen (HBsAg) have to date largely been spared additional delta virus infection. A focus of homosexually acquired delta has, however, recently been identified in California. To assess the prevalence and risk factors for delta virus infection in homosexual men in Sydney, we tested the sera of 204 homosexual men with acute or chronic hepatitis B infection for total antibody to delta and delta antigen. Total antibody to delta was detected in eight men and delta antigen in one other (4.4% of the total). All men with antibody or antigen had intravenous drug use as a risk factor. Overall nine of 22 (40.9%) male homosexual intravenous drug users had serological evidence of delta infection. Delta positive patients tended to be younger, to have engaged in prostitution, to have more severe chronic liver disease, to be more likely to have a symptomatic acute illness, and to be less likely to express hepatitis Be antigen (HBeAg) in their sera. Though the homosexual transmission of delta infection cannot be concluded from this study, the detection of delta markers in nine homosexual men (including four prostitutes) suggests considerable potential for dissemination of this virus homosexually.

Adolescent↗
PubMed1988

The Sydney AIDS Project: development of acquired immunodeficiency syndrome in a group of HIV seropositive homosexual men.

The Sydney AIDS Project is a prospective immunoepidemiological study of 996 homosexual/bisexual men enrolled between February 1984 and January 1985. By January 1987, 32 of 386 homosexual men who were seropositive at enrollment in the study had developed AIDS, yielding a crude progression rate of between 2.8% and 4.2% per annum. Of these subjects, 23 (72%) developed AIDS within 12 months of enrollment. In univariate analysis, the only lifestyle differences between seropositive subjects who progressed to AIDS and those that did not progress were less frequent oral sex activity and more use of marijuana in the three months prior to enrollment. In multivariate analysis, seropositive subjects who progressed to AIDS were more likely to have a lower percentage of CD4+ cells, a higher percentage of CD8+ cells and to have used marijuana in the three months prior to enrollment than the seropositive subjects who did not progress. No HIV seropositive subject who was asymptomatic and had normal T-cell subsets at enrollment had developed AIDS by January 1987. Persistent generalised lymphadenopathy was not associated with progression to AIDS. Although there are a number of lifestyle factors that may be associated with HIV infection, this study did not implicate most of these in the progression of HIV seropositive subjects to end-stage AIDS. We conclude that antecedent changes in T-cell subsets are associated with progression to AIDS and we emphasise the prognostic value of enumeration of T-cell subsets in HIV seropositive persons.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Primary human immunodeficiency virus infection. Clinical and serologic aspects.

The identification of characteristic clinical, serologic, and immunologic responses to primary HIV infection has contributed greatly to our understanding of the natural history of HIV infection. Subjects usually present with a mononucleosis-like illness and during the period of primary infection there is a characteristic four-phase T cell response. Early serologic findings of infection include IgM antibody and free HIV p24 antigen. Tests for mononucleosis yield negative results, but atypical lymphocytosis may be present. We believe there are three primary goals for future research into primary HIV infection: to further define the features of this phase of infection, to develop early intervention strategies effective against HIV, and to further develop and foster education strategies that will prevent primary HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Characterization of the acute clinical illness associated with human immunodeficiency virus infection.

The clinical and serologic features and immune status of 39 homosexual men who had seroconversion to human immunodeficiency virus positivity were compared with 26 homosexual men who remained seronegative during a six-month period. An acute clinical illness occurred in 92.3% of seroconverted subjects and 40% of controls. The duration of illness was significantly greater in the seroconverters than the controls (10 + 4.4 days). A general practitioner was consulted by 87.2% of the seroconverters because of the illness, including 12.8% who were admitted to hospital, compared with 20% of controls. The most frequently reported symptoms in the seroconversion group were fever (76.9%); lethargy and malaise (66.7%); anorexia, sore throat, and myalgias (56.4% each); headaches and arthralgias (48.7% each); weight loss (46.2%); swollen glands (43.5%); retro-orbital pain (38.5%); and dehydration and nausea (30.8% each). Lymphadenopathy developed in 75% of seroconverters compared with 4% of controls. Changes in T-cell subsets were not found in controls, but the number of T4+ cells and the T4+/T8+ ratio decreased significantly in seroconverters.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Effect of a slow-release 5'-aminosalicylic acid preparation on disease activity in Crohn's disease.

A short-term double-blind controlled trial has been performed comparing a slow-release 5'-aminosalicylic acid (5-ASA) tablet (Pentasa) with placebo in the outpatient treatment of mild and moderate active Crohn's colitis. The disease activity was measured objectively by quantitation of the faecal excretion of 111In-labelled autologous granulocytes, which directly reflects gut inflammation. Twelve patients were randomized to receive either Pentasa or placebo. After 10 days of treatment faecal granulocyte excretion fell in all patients receiving 5-ASA, while no consistent change was found in the placebo group. These results suggest that this slow-release preparation of 5-ASA should be tested in larger controlled therapeutic trials over a longer period of time.

Adult↗