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Biomedical subjects

C B Christiansen

Publications and source records attributed to C B Christiansen.

At least 19 recordsLinked to original sources

[Population screening for HIV in Sisimiut, Greenland].

INTRODUCTION: In the years 1985-1998, 91 HIV-positive persons were diagnosed in Greenland, resulting in an incidence of HIV infection three times higher in Greenland than in Denmark. Of these cases 25% were diagnosed in Sisimiut, which, however, only comprises 10% of the total population of Greenland. In spite of an active HIV case-tracing programme at the Health Centre, there was a fear of unknown HIV-positives in the town. Therefore, the Health Centre initiated an HIV screening campaign among all adults and school children in the town of Sisimiut and two adjacent settlements. MATERIAL AND METHODS: The screening campaign was carried out in the weeks 46 and 47 in November 1998 by the staff at the Health Centre. All participants filled out a questionnaire concerning demographic variables, and had blood samples drawn. For adults the campaign mainly took place in the community centre and the large work places, and for the children at the schools. Blood samples were tested for antibodies against HIV 1 and 2 at Statens Serum Institut using ELISA tests and confirmatory Western Blot. RESULTS: Of the total population of 4807, 2858 persons took part in the screening campaign (participation rate 59%). Among adults the participation rate was 50%, and for children aged 6-17 years the rate was 86%. Four HIV-positive persons were tested positive. Of these three were already known HIV-positives, and the last person was highly suspect of HIV infection. DISCUSSION: There is no evidence of widespread HIV infection in Sisimiut. No unknown groups of HIV-positive persons were identified. Thus, the intensive case-tracing programme as carried out by the Health Centre seems effective.

Adolescent↗

9-year HIV-2-associated mortality in an urban community in Bissau, west Africa.

BACKGROUND: Community studies with 1-3 years of follow-up have reported four to five times higher mortality in HIV-2-infected than in uninfected adults. In a cohort study of HIV-1, an increasing difference in mortality rates of HIV-1-infected and uninfected individuals is expected over time, because of rising mortality with advancing HIV-1 infection. We therefore investigated long-term survival of HIV-2-infected adults. METHODS: Adults enrolled in 1987 in a community study of HIV-2 infection in Guinea-Bissau were followed up with serological surveys in 1989 and 1992. Survival was assessed in 1995, 9 years after enrollment. FINDINGS: The annual incidence of HIV-2 was 0.7% for adults and tended to be higher for older individuals than for participants aged 15-44 years (relative risk 3.21 [95% CI 0.91-11.37]). With control for age, HIV-2-infected adults had twice as high mortality as uninfected individuals (mortality ratio 2.32 [1.18-4.57]); the mortality ratio was highest in the first year of the study (4.50 [1.31-15.43]). The difference between infected and uninfected individuals was stronger for adults under 45 years of age (mortality ratio 4.72 [1.86-11.97]) than for older people (1.35 [0.51-3.56]). HIV-2-infected individuals living with an infected spouse had significantly higher mortality than HIV-2-infected individuals living with an uninfected spouse (p = 0.027). INTERPRETATION: HIV-2-associated mortality is not increasing with length of follow-up. Mortality in HIV-2-infected adults is only twice as high as that in uninfected individuals. In the majority of adults, HIV-2 has no effect on survival.

Acquired Immunodeficiency Syndrome↗

Markers of sexually transmitted diseases in seminal fluid of male clients of female sex workers.

OBJECTIVES: To screen for certain STD markers in a group of male clients of female sex workers. METHOD: Condoms with seminal fluid were collected at 10 "massage parlours" in Copenhagen. The seminal fluid samples were examined for HIV antibodies, markers of hepatitis B virus (HBV), Chlamydia trachomatis, and Mycoplasma genitalium. RESULTS: All samples (n = 332) were negative for HIV antibodies. Out of 327 samples examined for HBV markers 32 (9.8%) were positive for HBV core antibodies, one of which was also positive for HBV antigen. C trachomatis could be demonstrated in six out of 122 (4.9%) samples and M genitalium in one out of 122 samples. CONCLUSIONS: The finding of a C trachomatis prevalence of 4.9% is considerable higher than expected in men with a presumed age of 35-55 years. The demonstration of a prevalence of HBV markers of 9.8% indicates that these clients have an increased risk of HBV infection, a finding that further consolidates the recommendation of HBV vaccination of sex workers. As shown in this study, STD transmission in commercial sex may also have the client as the source.

Adult↗

EBV-positive primary central nervous system lymphomas in monozygote twins with common variable immunodeficiency and suspected multiple sclerosis.

Common variable immunodeficiency represents the most frequently occurring primary immunodeficiency disorder and is usually detected sporadically in patients with no family history of immunodeficiency. We present the case stories of two monozygote twins, who following a period of decreasing serum immunoglobulins developed primary central nervous system lymphomas. One twin had clinical and paraclinical features mimicking multiple sclerosis. Immunohistochemical investigations on biopsy tissue showed expression of the bcl-2 and p53 gene products, and Epstein-Barr virus (EBV) encoded small RNA's (EBER) indicating latent infection were detected in lymphoma cells using in situ hybridisation techniques. The pathogenetic role of EBV in oncogenesis is discussed.

Adult↗

[Infection with human immunodeficiency virus type 2--HIV-2].

The majority of patients with HIV-2 infection come from West Africa or have had sexual contact with a person from there, as HIV-2 is prevalent in this area. HIV-2 is phylogenetically closer related to SIVsm and SIVmac than to HIV-1. HIV-2 is mainly transmitted by heterosexual contact, whereas the risk of mother-to-child infection is very low. Nine cases of HIV-2 infection have been diagnosed in Denmark. Out of these, seven are from West Africa and two have been infected in Denmark by individuals from West Africa.

Acquired Immunodeficiency Syndrome↗

False negative anti-HIV-1/HIV-2 ELISAs in acute HIV-2 infection.

Since HIV-2 was isolated in 1986, only 1 case of acute HIV-2 infection has been reported. We have identified another patient with primary HIV-2 infection. Follow-up samples were requested from the patient due to discrepant results. The HIV-2 infection was confirmed with HIV-2-specific proviral DNA amplification by PCR. The HIV-2 seroconversion panel obtained was used to evaluate the sensitivity of both combined and specific ELISAs currently in use in Europe, and to investigate the Western-blot patterns on both HIV-1-and HIV-2-specific Western blots. The window period was determined to be less than 37 days with the most sensitive assays. A remarkable difference in sensitivity to HIV-2 antibodies in acute HIV-2 infection was found in combined HIV-1/HIV-2 ELISAs. Three out of the 4 combined sandwich ELISAs appeared to be less sensitive than the indirect ELISAs in HIV-2 seroconversion, leading to a prolonged window period. One HIV-2-specific ELISA was also negative on the first sample, but positive on the second sample. In the HIV-2 Western blot, early reaction with HIV-2-specific env and gag proteins was seen, whereas the HIV-1 Western blot on the first sample revealed gag (p24, p55) reactivity only.

AIDS Serodiagnosis↗

[Human T-lymphotrophic virus type I and II--diagnosis and clinical presentation].

Human T-lymphotropic virus type 1, HTLV-I, was the first human oncogenic retrovirus to be isolated in 1978. HTLV-I has previously been called Human T-cell leukaemia virus or Human T-cell lymphoma virus type I. HTLV-I infection is endemic in southwestern Japan, the Caribbean basin, and parts of South America and Africa. HTLV-I is aetiologically associated with adult T-cell leukaemia lymphoma and tropical spastic paraparesis (TSP), also known as HTLV-I-associated myelopathy. HTLV-II was isolated in 1982 and is endemic among some north American Indians. HTLV-II has not been clearly linked to any specific disease. Both viruses are found worldwide, particularly among intravenous drug users (IVDU), and have also been found in blood donors in USA and Europe. HTLV-I/II are transmitted by the same routes as HIV-1: blood-borne via blood transfusions and among IVDUs by sharing contaminated needles, and by mother-to-child transmission, primarily through breast feeding. HTLV-I/II infections are also sexually transmitted and can be transmitted in utero, though less efficiently than HIV-1. The diagnosis of HTLV-I/II infections is based on the detection of antibody to the virus. Due to the high degree of cross reactivity between HTLV-I and HTLV-II, it is difficult by serology to discriminate between the two viruses. Less than 5% of individuals infected with HTLV-I develop symptoms after a latent period, which can last from a few years to several decades. No specific treatment of adult T-cell leukaemia or tropical spastic paraparesis is currently available and no vaccine has yet been developed.

HTLV-I Antibodies↗

[HIV infection in children].

More children will be born infected with HIV in the years to come. Children with early symptoms will come into quick contact with a hospital, while others may be infected for up to ten years without presenting HIV-related symptoms. HIV infection can be diagnosed early with a combination of methods that are currently available (viral culture, ELISA antigen testing), and also with methods that are at present only used in research (DNA and RNA detection with PCR). Together with the clinical picture, it should be possible to have a reliable diagnosis no later than six months after birth. The general development of the children can be followed at frequent out-patient visits, while prophylactic measures can quickly be put into motion when necessary. The course of the illness can be followed and predicted with the help of different laboratory investigations. The medical treatment of HIV positive children follows the pattern of adult HIV positive patients. Children with an increased risk of bacterial infections can receive intravenous immune globulin as prophylaxis. HIV infected children can be given the common vaccinations, but BCG and oral anti-polio vaccine should not be given to children with symptomatic HIV infection. Prophylaxis of vertical transmission of HIV should be aimed at HIV testing of all pregnant women, to prevent this route of transmission. As long as there is no efficient treatment of HIV infection, termination of pregnancy must be recommended early after conception to all HIV positive women. Children born of HIV positive mothers should not be breast-fed.

Acquired Immunodeficiency Syndrome↗

[Diagnosis of HIV-infection].

Different methods have been developed for the diagnosis of HIV infection, i.e. detection of antibodies, antigen and proviral DNA. ELISA methods for detecting HIV-1 antibodies are widely used as screening assays. A sample which is repeatedly positive with ELISA is re-tested with a confirmatory test, e.g. western blot. Antibodies to HIV-1 are not detectable until 2-3 months after infection, but antigens may be detectable during the last weeks of this initial period, though they disappear with the appearance of the antibodies. In the later stages of HIV infection, HIV antigen is again detectable in a proportion of patients. Detection and quantitation of HIV antigen are used as indicators of disease progression and for monitoring the antiviral efficacy of therapeutic interventions. When no antibodies or antigens can be detected in persons suspected of having HIV infection, culture of HIV can be performed. For research purposes, detection of small amounts of proviral DNA can be made with polymerase chain reaction (PCR). The method is not yet applicable in routine diagnosis of HIV infection.

Acquired Immunodeficiency Syndrome↗

Photography in treatment of tympanic membrane perforations.

A photographic method which gives a large image on the film is used for recording perforations of the tympanic membrane and it may be valuable for comparing different methods of closure. A method for the treatment of minor perforations is also briefly mentioned.

Ear Diseases↗