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Biomedical subjects

J F Brundage

Publications and source records attributed to J F Brundage.

At least 37 records · Page 2Linked to original sources
PubMed1995

HIV-1 seroconversion and risk behaviors among young men in the US army. The Seroconversion Risk Factor Study Group.

OBJECTIVES: This study sought to examine risk factors associated with human immunodeficiency virus type 1 (HIV-1) seroconversion among active-duty men in the US Army. METHODS: One hundred twenty-eight men with documented HIV-1 seroconversion between 1988 and 1991 were matched to control subjects on demographic variables. Risk factor information was collected for the seroconversion period. RESULTS: Forty-nine case subjects and no control subjects reported same-gender sex; this includes 34 case subjects who also reported sex with women. Seventy case and 118 control subjects reported no risk factors other than heterosexual intercourse. Among heterosexuals, excess risk was noted for men who had sex with women in risk categories defined by the Centers for Disease Control and Prevention (odds ratio = 10.0; 95% confidence interval = 1.3, 78.1). Significant trends of increasing risk for seroconversion were found with increasing numbers of female partners, nonsteady partners, and partners with whom sex occurred on the first day of acquaintance. CONCLUSIONS: In this population, the major risk factor for HIV-1 seroconversion was same-gender sex. Among heterosexuals, sex with anonymous or causal partners increased this risk. Intervention programs should emphasize the risk of indiscriminate partner selection in addition to "safe sex" practices.

Adult↗
PubMed1994

The incidence of HIV infection among men in the United States Army Reserve Components, 1985-1991.

OBJECTIVE: To evaluate the incidence of HIV infection among men in the Army Reserve Components (RC) in the United States. METHODS: A prospective follow-up evaluating HIV seroconversions among men in the RC. Men who were initially seronegative were followed over time and periodically retested. The duration of follow-up was measured for each individual. Date of seroconversion was estimated to be the mid-point between last negative and first positive test. Demographic characteristics were evaluated for association with seroconversion, and incidence density between 1985 and 1991 was examined. RESULTS: We followed 733,622 RC men for 1,988,622 person-years between 1985 and 1991, and identified 534 seroconversions. Demographic correlates of risk included racial/ethnic minorities, age between 20 and 34 years, never having married, residence in an area with a low median income, and residence in metropolitan areas with high incidence of AIDS. Among most of these groups, the incidence density did not change substantially or significantly from the period 1985-1987 to 1991. CONCLUSIONS: The patterns of HIV infection are generally similar to those for reported AIDS cases. The incidence density over time is consistent with projections that AIDS incidence will plateau in the United States in the mid- to late-1990s.

Adolescent↗
PubMed1994

HIV infection among women in the Army Reserve Components.

There is little information regarding the extent of HIV infection among women. Since late 1985, members of the Army Reserve Components have been routinely tested for HIV, providing an opportunity to measure directly the prevalence and incidence density of infection in a military-associated population with limited military contact. We evaluated the prevalence among 122,195 women, and directly measured the incidence density among 96,001 women followed for 247,872 person-years. The overall prevalence was 0.65 (per 1000), and the incidence density was 0.12 (per 1000 person years follow-up). Several demographically defined groups, including minority women, had elevated levels of infection. The incidence densities of infection between early and late in the testing program were compared, and no evidence of acceleration or deceleration was observed.

Adolescent↗
PubMed1992

Broad and persistent effects of benzathine penicillin G in the prevention of febrile, acute respiratory disease.

After an outbreak of acute rheumatic fever at a US Army training installation, a benzathine penicillin G prophylaxis program was instituted. Surveillance data were analyzed to measure rates of febrile, acute respiratory disease (ARD) among trainees before and after prophylaxis was begun. Annual admissions for ARD decreased from 1927 to 690 (-64.2%) after benzathine penicillin G prophylaxis was begun. Admissions with throat cultures positive for Streptococcus pyogenes fell from 595 to 63 (-89.4%), a reduction that accounted only for a minority (43%) of the total 1237 "prevented" admissions. Temporal changes in disease rates at other installations where drug was not administered were also analyzed. Only a small decrease in the number of annual ARD admissions (-6.3%) was observed at other training installations. These findings support a hypothesis that benzathine penicillin G has a broad effect in the prevention of ARD that extends beyond the simple elimination of group A streptococcal infection.

Acute Disease↗
PubMed1992

Prevalence of human T-lymphotropic virus in civilian applicants for the United States Armed Forces.

BACKGROUND: The wide range in human T-lymphotropic virus (HTLV) seroprevalences reported worldwide has made estimates of seroprevalence difficult in unique populations. In this study, the seropositivity of young adult civilian applicants for the US Armed Forces was determined. METHODS: Serum samples from nine geographic regions were screened by an Enzyme-Linked Immunosorbent Assay (ELISA), and repeatedly reactive samples were further tested by Western blot and radioimmunoprecipitation. Specimens were scored as positive when antibody to gag (p24) and env (gp46 or gp68) were detected. RESULTS: Of the 43,750 samples analyzed, 18 were positive for HTLV antibodies. Ten (55%) were from males and eight (45%) were from females. Nine (90%) of the males and seven (87.5%) of the females were Black. Twelve of the positive samples (66.6%) were from the New York City region, which represented only 18.8% of the sample population. CONCLUSIONS: The overall HTLV seroprevalence of civilian applicants for the US Armed forces was 0.41 per 1000. This was higher than the seroprevalence reported for volunteer blood donors.

Adolescent↗
PubMed1992

Predictors of HIV-1 disease progression in early- and late-stage patients: the U.S. Army Natural History Cohort. Military Medical Consortium for Applied Retrovirology.

HIV-infected individuals in both early and late stages of HIV disease were evaluated over 2 years to assess temporal trends and determinants of disease progression. The Walter Reed (WR) staging system was used to categorize patients into an early-stage cohort (WR Stages 1 and 2, N = 1183) and a late-stage cohort (WR Stage 5, N = 260) based on the initial clinical evaluation. Progression was defined as the occurrence of Stage 5 disease or beyond for the early cohort and Stage 6 disease or beyond for the late cohort. The cumulative incidence of progression was 15.7% (137 events) for the early-stage cohort, and 53.7% (85 events) for the late-stage cohort. Baseline CD4+ T lymphocyte (T4) count was the most significant marker of progression: 26% of WR Stage 1 or 2 patients with T4 lymphocytes below 500/mm3 progressed, compared with 12% with T4 lymphocytes at or above 500/mm3. In late-stage individuals, 83% with T4 lymphocytes under 200/mm3 progressed, compared with 27% with T4 lymphocytes at or above 200/mm3. Older age was associated with progression in both early- and late-stage groups. Differences in the rates of disease progression were not significant between blacks and whites or between men and women. Two-year rates of progression among the late-stage patients dropped from 78 to 47% between 1986 and 1988. This contrasted with progression rates in the early-stage cohort, which remained stable: 18% for those entering follow-up in 1986 and 17% for those entering follow-up in 1988. These data indicate a significant slowing of HIV disease progression rates and mortality rates among individuals with late-stage disease that is temporally associated with the increased availability and use of therapies. With control of T4 lymphocyte count, age, and calendar time, neither gender nor race was significantly associated with progression in either early- or late-stage patients.

Adolescent↗
PubMed1992

A brief review of the epidemiology of HIV in the U.S. Army.

The Department of Defense has conducted extensive HIV testing for over 5 years. We summarize the epidemiology of the HIV infection in the total Army. While screening of civilian applicants effectively ensures seronegativity of enlistees, there are approximately 220 new HIV infections each year among active duty soldiers. High-risk demographic groups in the Army include single soldiers, males, those age 25-35, blacks, and Hispanics (including black and Hispanic females). While preventive efforts in the Army should reflect the higher risk experienced by these groups, all soldiers should be made aware of their susceptibility as the epidemic evolves to include more women and heterosexual men.

AIDS Serodiagnosis↗
PubMed1991

The effect of human immunodeficiency virus type 1 antibody status on military applicant aptitude test scores.

The authors conducted a population-based study to attempt to estimate the effect of human immunodeficiency virus type 1 (HIV-1) seropositivity on Armed Services Vocational Aptitude Battery test scores in otherwise healthy individuals with early HIV-1 infection. The Armed Services Vocational Aptitude Battery is a 10-test written multiple aptitude battery administered to all civilian applicants for military enlistment prior to serologic screening for HIV-1 antibodies. A total of 975,489 induction testing records containing both Armed Services Vocational Aptitude Battery and HIV-1 results from October 1985 through March 1987 were examined. An analysis data set (n = 7,698) was constructed by choosing five controls for each of the 1,283 HIV-1-positive cases, matched on five-digit ZIP code, and a multiple linear regression analysis was performed to control for demographic and other factors that might influence test scores. Years of education was the strongest predictor of test scores, raising an applicant's score on a composite test nearly 0.16 standard deviation per year. The HIV-1-positive effect on the composite score was -0.09 standard deviation (99% confidence interval -0.17 to -0.02). Separate regressions on each component test within the battery showed HIV-1 effects between -0.39 and +0.06 standard deviation. The two Armed Services Vocational Aptitude Battery component tests felt a priori to be the most sensitive to HIV-1-positive status showed the least decrease with seropositivity. Much of the variability in test scores was not predicted by either HIV-1 serostatus or the demographic and other factors included in the model. There appeared to be little evidence of a strong HIV-1 effect.

Aptitude Tests↗
PubMed1991

A phase I evaluation of the safety and immunogenicity of vaccination with recombinant gp160 in patients with early human immunodeficiency virus infection. Military Medical Consortium for Applied Retroviral Research.

BACKGROUND: Despite multiple antiviral humoral and cellular immune responses, infection with the human immunodeficiency virus (HIV) results in a progressively debilitating disease. We hypothesized that a more effective immune response could be generated by post-infection vaccination with HIV-specific antigens. METHODS: We performed a phase I trial of the safety and immunogenicity of a vaccine prepared from molecularly cloned envelope protein, gp160, in 30 volunteer subjects with HIV infection in Walter Reed stage 1 or 2. The vaccine was administered either on days 0, 30, and 120 or on days 0, 30, 60, 120, 150, and 180. HIV-specific humoral and cellular immune responses were measured; local and systemic reactions to vaccination, including general measures of immune function, were monitored. RESULTS: In 19 of the 30 subjects both humoral and cellular immunity to HIV envelope proteins increased in response to vaccination with gp160. Seroconversion to selected envelope epitopes was observed, as were new T-cell proliferative responses to gp160. Response was associated with the CD4 cell count determined before vaccination (13 of 16 subjects [81 percent] with greater than 600 cells per milliliter responded, as compared with 6 of 14 [43 percent] with less than or equal to 600 cells per milliliter; P = 0.07) and with the number of injections administered (87 percent of subjects randomly assigned to receive six injections responded, as compared with 40 percent of those assigned to three injections; P = 0.02). Local reactions at the site of injection were mild. There were no adverse systemic reactions, including diminution of general in vitro or in vivo cellular immune function. After 10 months of follow-up, the mean CD4 count had not decreased in the 19 subjects who responded, but it had decreased by 7.3 percent in the 11 who did not respond. CONCLUSIONS: This gp160 vaccine is safe and immunogenic in volunteer patients with early HIV infection. Although it is too early to know whether this approach will be clinically useful, further scientific and therapeutic evaluation of HIV-specific vaccine therapy is warranted. Similar vaccines may prove to be effective for other chronic infections.

Adolescent↗
PubMed1991

HIV infection among members of the US Army Reserve Components with medical and health occupations.

Over 58,000 members of the US Army Reserve Components tested for human immunodeficiency virus (HIV) antibody had military or civilian medical occupations. The availability of HIV status and occupational information permits the assessment of prevalence and incidence of infection in this population. Levels of infection were not higher among women or among currently married men with medical occupations compared with those with nonmedical occupations. Prevalence and incidence were elevated among never-married men with either military or civilian medical occupations compared with never-married men with nonmedical occupations. Based on reported civilian occupation, male registered nurses and men with other medical occupations, excluding physicians and dentists, had a significantly higher prevalence of infection than men with nonmedical occupations. The patterns of infection suggest that the higher levels of infection found among never-married men with medical occupations may not be entirely due to occupational exposure. These findings may have applications in the design and interpretation of results of health care worker HIV surveillance programs.

Dentists↗
PubMed1991

Trends of HIV seroconversion among young adults in the US Army, 1985 to 1989. US Army Retrovirus Research Group.

Because soldiers in the US Army are recurrently tested for the presence of antibody to the human immunodeficiency virus (HIV), HIV seroconversion rates can be directly measured. From November 1985 through October 1989, 429 HIV seroconversions were detected among 718,780 soldiers who contributed 1,088,447 person-years of follow-up time (HIV seroconversion rate, 0.39 per 1000 person-years). Period-specific seroconversion rates declined significantly from 0.49 per 1000 person-years (November 1985 through October 1987) to 0.33 per 1000 person-years (November 1987 through October 1988) to 0.29 per 1000 person-years (November 1988 through October 1989). The HIV seroconversion risk among active-duty soldiers was significantly associated with race/ethnic group, age, gender, and marital status. Based on these trends, we estimate that approximately 220 soldiers (95% confidence interval, 160 to 297 soldiers) were infected with HIV during 1989 and 1990, with potentially fewer in future years.

Adolescent↗
PubMed1991

Inpatient morbidity among HIV-infected male soldiers prior to their diagnosis of HIV infection.

BACKGROUND: A natural history study of human immunodeficiency virus (HIV) disease was carried out among 1575 HIV-infected US Army men and 6220 demographically similar uninfected soldiers. Inpatient morbidity occurring up to 8 years prior to the date of HIV infection diagnosis among those men who became HIV infected was evaluated for both groups. METHODS: Incidence density rates were calculated for hospital admissions. Poisson regression was used to assess the trend in hospital admissions among those subsequently diagnosed with HIV infection. Prevalence ratios for discharge diagnoses were also calculated. RESULTS: Sixteen diagnoses/diagnosis categories occurred statistically more frequently among subsequently HIV diagnosed individuals than among those who remained uninfected. Among these were hepatitis B and abscess of anal/rectal region (6 to 8 years prior to HIV infection diagnosis); unspecified viral infection, enlarged lymph nodes, syphilis (3 to 5 years prior to HIV infection diagnosis); and diagnoses suggestive of acute retroviral syndrome (1 to 2 years prior to HIV infection diagnosis). CONCLUSIONS: Data such as these may provide useful information to HIV surveillance efforts regarding patterns of morbidity experienced prior to HIV infection as well as to health care providers regarding patients at high risk for becoming infected with HIV.

Adult↗
PubMed1991

Safety and immunogenicity of multiple conventional immunizations administered during early HIV infection.

Twenty-one asymptomatic adults who had recently received multiple polysaccharide, live viral, and protein-derived vaccines were identified as being infected with human immunodeficiency virus (HIV). The mean subject age was 24 years (range 18-33); 20 of 21 (95%) were male. The mean T4 count was 523/mm3 with a mean T4/T8 ratio of 0.6. Serologic responses to immunization with meningococcus group C, adenovirus types 4 and 7, tetanus, and diphtheria were evaluated for the HIV seropositive subjects and were compared with the responses of similarly vaccinated age-, sex-, and race-matched HIV-seronegative controls. Significantly fewer (p less than 0.03) HIV subjects responded to meningococcus C (bactericidal antibody) and adenovirus 4 (neutralizing antibody) vaccines than did normals; the HIV-infected subjects who did respond produced functional antibody comparable to that of normals. Booster responses of HIV subjects to tetanus and diphtheria were comparable to those of normals. HIV-infected vaccine nonresponders did not differ from HIV-infected responders in total white blood cell, T4, T4/T8, total serum IgG, or delayed-type hypersensitivity skin test reactivity. All HIV subjects had negative cultures for live vaccine viruses (rubella, measles, adenovirus, and poliovirus). Postimmunization, no clinically apparent adverse reactions to vaccination were detected.

Adult↗
PubMed1991

The dynamics of CD4+ T-lymphocyte decline in HIV-infected individuals: a Markov modeling approach.

We modeled the decline of CD4+ T-lymphocytes (T4 cells) in HIV-infected individuals with a continuous-time Markov process. The model partitions the HIV infection period into six progressive T4-cell count intervals (states), followed by a seventh state: a definitive HIV-infection end point, i.e., AIDS diagnosis or Walter Reed stage 6 (opportunistic infections). The Markov model was used to estimate the state-specific progression rates from data as functions of important progression cofactors. We applied the model to data on 1,796 HIV-positive individuals in the U.S. Army. The estimated mean waiting time from seroconversion to when the T4-cell count persistently drops below 500/mm3, but is greater than 349/mm3, is 4.1 years, and the waiting time to a T4-cell count of less than 200/mm3 is estimated at 8.0 years. The estimated rate of T4-cell decline was higher for HIV-infected individuals with initially high numbers of T4 cells, but the estimated rate of decline remains relatively uniform when the T4-cell count dropped persistently below 500/mm3. The opportunistic infection incubation period, i.e., the time from seroconversion to opportunistic infection diagnosis, is estimated at 9.6 years. Age is found to be an important cofactor. The estimated mean opportunistic infection incubation periods are 11.1, 10.0, and 8.9 years for the youngest (less than or equal to 25 years old), the middle (26-30 years old), and the oldest (greater than 30 years old) age groups, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1991

HIV infection among members of the Army Reserve components residing in New York City.

A total of 10,722 members of the US Army Reserve and Army National Guard residing within the five boroughs of New York City (NYC) were tested for antibody to human immunodeficiency virus (HIV). The crude prevalence in NYC was found to be 10.6 per 1,000, compared with a national prevalence of 1.6 per 1,000. The highest prevalences were found among Blacks and Hispanics, males, and among those aged 30-39 years. Patterns of infection were found to be similar to those found among heterosexual and drug abusing populations. Prevalence was highest in the Bronx and varied by less than twofold over all boroughs. Comparisons with reported cases of acquired immunodeficiency syndrome (AIDS) in New York City indicated differences in the demographic and geographic characteristics of the current epidemic of AIDS and HIV infection among members of the Army Reserve components.

Adult↗
PubMed1991

Epidemiology of HIV infection and AIDS in the United States.

HIV-1 disease has been recognized as a distinct clinical entity for fewer than 10 years. Yet during that time, the virus has spread around the world and affects people of virtually all ages, genders, sexual behaviors, and geographic regions. In the United States, there have been more than 140,000 individuals diagnosed with AIDS, the clinical end stage of HIV-1 disease, and it is projected that AIDS incidence will accelerate through at least 1993. In the early years of the infection epidemic in the United States, the virus spread rapidly and insidiously, predominantly among homosexual men, intravenous drug users, people with hemophilia, and recipients of infected blood products. Since then, the epidemic has been propagated concurrently with epidemics of drug use (intravenous and noninjectable) and sexually transmitted diseases such as syphilis. Since its beginning, HIV-1 has disproportionately affected members of racial and ethnic minorities, particularly in large cities, where transmission takes place sexually, parenterally, and perinatally. The epidemic of HIV-1 has spread outside of traditional urban epicenters and is more significantly affecting adolescents, women, and heterosexuals. There is a great need for renewed and refocused infection-prevention efforts. Projections of resource and medical service needs should be based on up-to-date and accurate assessments of infection epidemic parameters, including infection prevalence, incidence, and acceleration (changes in epidemic velocity over time) rates.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Human immunodeficiency virus infections in teenagers. Seroprevalence among applicants for US military service. The Walter Reed Retrovirus Research Group.

Between October 15, 1985, and March 31, 1989, serum specimens from 1 141 164 teenaged youths (aged less than 20 years) who applied for entry into the US military were tested for antibodies to the human immunodeficiency virus. Overall, 393 teenaged applicants were found to be seropositive (prevalence, 0.34 per 1000). Prevalences varied markedly in different geographic locales: less than 0.1 per 1000 throughout the north-central states, compared with greater than 2 per 1000 in urban counties in Maryland, Texas, New York, and the District of Columbia. Overall, rates among teenaged males (345/991 445; prevalence, 0.35 per 1000) and teenaged females (48/150 013; prevalence, 0.32 per 1000) were comparable. The prevalence among black teenaged applicants (1.06 per 1000) was greater than that among white (0.18 per 1000) or Hispanic (0.31 per 1000) teenaged applicants. Infections with the human immunodeficiency virus are not rare among teenaged Americans.

Adolescent↗