Biomedical subjects
Publications and source records attributed to C S Petersen.
Acute HIV infection with a papular rash is described in a homosexual man ten weeks after a single episode of orogenital contact (fellatio). The "safe sex" recommendations are discussed.
Two cases of symptom-producing balanoposthitis associated with Human papillomavirus infection are described. These patients had spotty, macular, erythematous rash on the glans penis and prepuce. The symptoms and objective findings resemble those of Candida infection but the diagnosis can be established by histological examination of biopsy from the acetowhite elements.
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Systemic treatment modalities for eradication of multiple therapy resistant genital warts are so far not available. In this study laser treated patients with multiple genital warts received postoperatively either interferon alpha-2b subcutaneously (s.c.) 5 x 10(6) IU or matching placebo three times weekly for four weeks. At the conclusion of the study, 6-8 weeks after discontinuation of therapy, a significantly higher cure rate was found in the group of interferon-treated patients (14 of 27 (52%) patients cured) than among placebo treated patients (5 of 22 (23%) patients cured) (p less than 0.05). The side effects of fever, chills, myalgia, headache and leukopenia occurred more commonly in the interferon treated group than in the placebo group. However, only three of 32 patients discontinued interferon therapy because of side effects. We conclude that the addition of s.c. administered interferon alpha-2b to laser treated patients with chronic therapy resistant genital warts is fairly well tolerated and that it significantly enhances the chance of eliminating the disease.
Cervical biopsy specimens were taken from 55 Pap-smear-negative women with external genital warts in order to diagnose a concomitant cervical human papillomavirus (HPV) infection. HPV-DNA was demonstrated by in situ hybridization in 17 (31%) of the samples: HPV types 16/18 in 9, HPV types 6/11 in 5 and double infection (16/18 and 6/11) in 3. HPV-DNA was found in 10 (43%) of 23 biopsy specimens with koilocytotic atypia and in 5 (29%) of 17 specimens showing chronic inflammatory reaction, whereas only 2 (13%) of 15 women with normal cervical histology had HPV-DNA in the biopsy specimen. Overall histology and in situ hybridization indicated the presence of a cervical HPV infection in at least 30 (55%) of the 55 women examined. Colposcopic examination revealed abnormal acetowhite epithelium in 17 (74%) of 23 women with koilocytosis and/or HPV-DNA positivity, compared with 7 (32%) of 22 HPV-DNA-negative women with histology showing either chronic inflammatory changes or normal epithelium (p less than 0.01). It is concluded that a cervical focus of HPV infection is frequent among Pap-smear-negative women with external genital warts.
A sonicate of Treponema phagedenis biotype Reiter (Reiter treponemes) was used as sorbing agent in parallel with sorbent in the FTA-ABS test. By diluting the Reiter treponemal antigens in approximately 0.5 M NaCl, the Reiter sonicate could be produced in sufficient quantities for its use in routine FTA-ABS. In crossed immunoelectrophoresis against a rabbit anti-Reiter immunoglobulin, 40 Reiter antigens were detectable in the sonicate and only one in the sorbent. The diluted sonicate and the sorbent had similar osmolarity and almost similar pH. FTA-ABS with sonicate and sorbent had similar sensitivity in untreated early and late syphilis. Only in treated early syphilis was non-reactivity usually obtained somewhat earlier with sonicate than with sorbent. Both FTA-ABS with sonicate and sorbent had a specificity near 98%. It is concluded that replacement of sorbent with sonicate in the routine FTA-ABS test would increase the costs without substantial improvements of the test.
The seven makes of condom which are marketed in Denmark were examined for the nonoxynol content with the object of assessing whether the content of nonoxynol in the condoms is sufficient to present HIV spread in connection with use of the condom and assessed in relation to the defects in effectivity (tearing, holes, overflow of semen, sliding off). Compared with the declared content of nonoxynol of 40 mg (100%) per condom, the following nonoxynol quantities could be demonstrated by methanol/water extraction and subsequent high-performance liquid chromatography: One make of condom contained 65%, two 50-55% and four 25-33%. The nonoxynol content was found to be evenly distributed between the outer and inner surface of the condoms. With a theoretical distribution volume of 6 ml (tearing during vaginal coitus), it was found that three of the makes of condoms examined did not achieve the HIV-inhibiting nonoxynol concentration of 0.05%, by means of measuring the quantity of nonoxynol on the distal 5 cm of the condoms. In anal sex, the distribution volume is greater resulting in lower nonoxynol concentrations and thus increased risk for HIV infection. It is concluded that the nonoxynol content in the condoms marketed in Denmark should be increased in order to inactivate HIV in case of condom failure.
Human papilloma virus vulvitis with flat elements resembling leucoplakia may be diagnosed by application of a 5% acetic acid solution and subsequent biopsy and histological examination. The condition causes irritation with dyspareumia and is so frequent that the diagnosis and initial treatment may be undertaken by the general practitioner.
We performed a randomized, double-blind, placebo-controlled trial to assess the efficacy and safety of inosine pranobex (Isoprinosine) [corrected] in the treatment of patients with human immunodeficiency virus (HIV) infection but without manifest acquired immunodeficiency syndrome (AIDS). A total of 866 patients were enrolled in 21 centers in Denmark and Sweden. The patients were stratified in three groups according to their CD4+ cell count and randomly assigned to receive either inosine pranobex (1 g three times a day) (n = 429) or matching placebo (n = 437) for 24 weeks. Of the 831 patients who could be evaluated, AIDS developed in 17 in the placebo group as compared with 2 in the inosine pranobex group (P less than 0.001; odds ratio, 8.6 [95 percent confidence limits, 2.2 and 52.6]). There were no significant differences between the groups with respect to changes in CD4+ cell count or the development of other HIV-related conditions, with the exception of thrush, which developed in fewer patients in the inosine pranobex group (P = 0.05). No serious side effects were observed. We conclude that treatment with inosine pranobex delays progression to AIDS in patients with HIV infection. The duration of this beneficial effect, the optimal dose, and the mode of action of inosine pranobex remain to be clarified.
Twenty immunocompetent patients, four females and 16 males, with severe recurrent genital herpes (median number of recurrences the previous year 16, range (8-24] entered an open continuous long-term suppressive treatment with oral acyclovir (ACV) for 12 months. The study included a dose-titration schedule: (ACV, 200 mg x 4/1-3 months, ACV, 400 mg x 2/4-6 months, ACV, 200 mg x 2/7-9 months, and ACV, 400 mg x 1/10-12 months). Patients with recurrences on steps two and three received an alternative dose of ACV, 200 mg x 3. Otherwise patients entered the previous dose-step. Five (20%) of patients were completely free of symptoms (recurrences and abortive lesions) during the four dose-reduction periods. A further nine patients (50%) could be dose-reduced to 200 mg x 3 without symptoms. Isolates from three patients showed a decrease in virus sensitivity after ceasing treatment. In conclusion, 14/20 of treated patients could be dose reduced to 200 mg x 2-3 without selection of HSV strains showing clinically important decreases in sensitivity towards ACV.
A method is described for detection of nonoxynol in condoms, based on methanol-water extraction followed by reverse-phase high-performance liquid chromatography. Using this method, we found that approximately 50% of the nonionic surfactant lubricant nonoxynol migrated into elastomers (rubber latex), resulting in a concentration of nonoxynol insufficient to inhibit human immunodeficiency virus (HIV) (less than 0.05%). In order to minimize the risk of sexual transmission of HIV, and to ensure spermicidal effect and optimal rubber properties, the concentration of nonoxynol in condoms, therefore, should either be increased, or nonoxynol should be packed separately. Further studies are needed to clarify and determine the solubility and migration of nonoxynols into elastomers.
The physico-chemical and immunological properties of six different sorbent preparations used in the FTA-ABS test were studied. Three of the sorbent preparations contained one heat-stable Reiter treponemal antigen when analysed in immunoelectrophoresis against polyspecific rabbit anti-Reiter Ig and human syphilitic serum. Marked differences were also observed in the osmolarity (1,340-2,434 milliosmol) and protein concentration (6.5-43 mg/ml) of the sorbent products. However, there was no difference in the performance of the six preparations in the FTA-ABS test, suggesting that the effect of sorbent is based on an unspecific inhibition of the reaction between anti-treponemal antibodies and Treponema pallidum.
Sixty two patients with refractory genital warts attending a VD-clinic were treated with CO2-laser. Residual warts or new wart formation was observed in 45 of them (72%), two weeks after operation, resulting in an immediate cure rate of 27%. The cure rate obtained was independent of location, duration, and previous treatment of warts. Reoperation with CO2-laser was performed in 12 patients, and all had remaining lesions two weeks after operation. It is concluded that a single CO2-laser treatment often is an insufficient procedure for eradication of disseminated refractory genital warts.
Aggressive and chronic disfiguring large penile warts, where previous treatment had been unsuccessful, were flattened in a non-immunocompromised patient treated with interferon alpha-2b 5 x 10(6) I.U. subcutaneously three times a week. Cessation of therapy resulted in rapid recurrence of lesions, indicating persistence of the viral infection. Systemic interferon therapy, however, was the only remedy that could suppress the disease. Only transient and mild systemic toxicity was observed. Subcutaneously injected interferon alpha-2b should be considered in patients with otherwise therapy resistant large or disseminated genital warts.
Macroscopic visualization of flat vulval warts is usually obtained by application of 3-5% acetic acid for 2-5 min. However, we have recently seen two women with symptoms suggesting the presence of condylomatous vulvitis where the use of 5% acetic acid for 10-15 min. was necessary for aceto-white lesions to develop. In both women, histologic examination indicated the presence of a Human papillomavirus infection. Prolonged application of acetic acid 5% should be considered among women in whom vulval papillomavirus infection is suspected.
With the object of describing how their own health is experienced, the social circumstances and sexual behaviour in anti-HIV-positive homosexual and bisexual men, an anonymous questionnaire to be completed by the recipient was distributed in 1987 in connection with a placebo controlled investigation to assess the value of isoprinosin (Imunovir) in preventing the development of AIDS. 87% participated. Among the total of 85 participants, 78% considered that their health was good, 29% met family members and 75% friends at least once weekly. Fifty patients (65%) felt stressed in their daily lives which was definitely higher than in the normal population. All of the participants had altered their sexual behaviour in a manner which reduced the risk of HIV-transmission but 18 (21%) had had sexual behaviour known to transmit HIV within the past year. This behaviour occurred more frequently in young persons (p = 0.09) and in smokers (p = 0.03). In addition, no connection could be demonstrated between a series of possible determinants for this, which may, however, be due to the limited extent of the material. It is demonstrated that awareness that one is infected with HIV does not eliminate dangerous sexual behaviour in all cases.
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On the basis of two cases of acute HIV infection, diagnosed in two patients who only employed "safe sex", HIV-infection prophylaxis in the high and low risk groups is discussed.