Biomedical subjects

L Lessner

Publications and source records attributed to L Lessner.

6 recordsLinked to original sources

PubMed1994

Trends in survival among persons with acquired immunodeficiency syndrome in New York City. The experience of the first decade of the epidemic.

This study examined survival trends among the 23,324 cases of acquired immunodeficiency syndrome (AIDS) meeting the Centers for Disease Control (CDC) definition that were diagnosed and reported to the New York City Department of Health from the beginning of the epidemic in 1980 through June 1989. The survival patterns of 20,760 individuals who survived for at least 1 calendar month beyond diagnosis were analyzed; all survival analyses were truncated at December 1, 1990, 17 months after the last diagnosis. Persons who died during the same month in which they were diagnosed ("zero" survivors) were excluded. Cases were examined by race/ethnicity, sex, age at diagnosis, calendar period of diagnosis, transmission category, CDC AIDS case definition (prior to and after the 1987 change in the AIDS case definition), and nature of diagnosis. Results of two- and three-way categorical analysis and logistic regression analysis are reported. Overall median survival time was 13.7 months (14.0 for males and 12.0 for females). Survival was better for whites than for blacks and Hispanics and was better for men who had sex with men than for injecting drug users. Each of the seven demographic and risk behavior factors was independently associated with survival. Trends in survival during three time periods indicated that survival is improving among all groups examined.

Acquired Immunodeficiency Syndrome↗

PubMed1993

Insight into the infection dynamics of the AIDS epidemic: a birth cohort analysis of New York City AIDS mortality.

The authors analyzed the secular trends of New York City acquired immunodeficiency syndrome (AIDS) mortality from 1980 through the first quarter of 1991 using birth cohort techniques to provide insight into reasons for temporal changes in growth of the epidemic. By disaggregating AIDS mortality data into composite birth cohorts, the authors determined that the slowing in the growth of the epidemic is a result of a leveling or decline in AIDS deaths in male birth cohorts born before 1950 and a continued growth in younger male and all female birth cohorts. This phenomenon is believed to largely reflect earlier human immunodeficiency virus type 1 (HIV-1) infection patterns associated with age-related risk behaviors; however, to some lesser extent, it could also reflect age-related host factors or therapies that may influence the time from HIV-1 infection to death. The findings support the hypothesis that the early infection dynamics of the epidemic were differentially related to age and sex, which resulted in a diffusion of infection from older to younger cohorts and from males to females over time. The future growth of the epidemic will largely depend upon the infection patterns of younger birth cohorts. This method of analyzing AIDS incidence or mortality data may contribute to a better understanding of earlier patterns of HIV-1 infection within a defined population, which will be useful for targeting prevention efforts and improving AIDS forecasting methods.

Acquired Immunodeficiency Syndrome↗

PubMed1991

Newborn seroprevalence study: methods and results.

For the 28-month period, November 30, 1987 through March 31, 1990, 653,117 blood specimens obtained on all newborn infants in New York State for detection of metabolic disorders were also analyzed for HIV serologic status. The overall seroprevalence rate was 0.66 percent: 1.24 percent in New York City and 0.17 percent in New York State exclusive of New York City. Rates of seropositivity were highest in the Bronx (1.72 percent) and Manhattan (1.59 percent). Outside of New York City, HIV seropositivity was concentrated in certain areas. Sixty-four zip codes with two or more seropositives and an HIV seroprevalence rate twice the average outside of New York City contained 65 percent of the HIV seropositives but only 16 percent of the newborns tested. Newborn seropositivity increased with maternal age. In New York City, the seroprevalence rates increased from 0.16 percent (1 in 624) for 14-year-olds to 1.41 percent (1 in 71) for 24-year-olds, a ninefold rise. This survey has provided the impetus for a number of preventive initiatives.

Adolescent↗

PubMed1991

Geographic distribution of newborn HIV seroprevalence in relation to four sociodemographic variables.

The geographic distribution of newborn human immunodeficiency virus seroprevalence at zip code level was compared with the distribution of four sociodemographic variables. For New York City significant univariate correlations were found between HIV and low birthweight, drug use (as measured by hospital discharges), maternal education less than 12 years, and race/ethnicity. Less significant correlations were found for New York State exclusive of New York City. For New York City a model comprising low birthweight and all drug discharges was shown by multiple regression analysis to be most strongly associated with HIV status (r2 = .77). Elsewhere a model comprising race/ethnicity (percent Black, percent Hispanic) and cocaine drug discharges had the best, but less strong association (r2 = .39). However, because of intercorrelations, race/ethnicity added little when the other variables were included first. Knowledge of the geographic association between HIV seroprevalence and sociodemographic status can be useful in designing and focusing prevention efforts in areas at highest risk for future HIV/AIDS activity.

Analysis of Variance↗

PubMed1991

Projection of AIDS incidence in women in New York State.

The results of the Newborn HIV Seroprevalence Study in New York State for 1988 were used to estimate the number of human immunodeficiency virus (HIV)-infected women of childbearing age in 1988. The estimate was accomplished for each of 80 age, racial/ethnic, and geographic strata by dividing the number of seropositive newborns by the 1988 estimated fertility rate. Summing across strata yielded a total of 23,430 infected women age 15 to 44 years in 1988. From this estimate a tree model was used to estimate the number of women infected during 1981-88. Back calculation was used to distribute these infections over time, and the selected incubation distribution was used to estimate future AIDS cases for this population: 8,295 cases by 1993.

Acquired Immunodeficiency Syndrome↗

PubMed1991

HIV infection among women entering the New York State correctional system.

Human immunodeficiency virus infection is the leading medical problem among prison inmates in several states. In 1988 a blinded seroprevalence study was conducted on 480 New York female prison entrants to determine the prevalence of and risk factors for HIV infection in this population. Ninety (18.8 percent) women were HIV-seropositive. Seroprevalence was highest among women ages 30-39 (25.0 percent) and varied by ethnicity (Hispanics, 29.4 percent; Blacks, 14.4 percent; Whites, 7.1 percent) and residence (New York City, 23.8 percent; Upstate, 5.1 percent). Nearly half (44.9 percent) of the 136 acknowledged intravenous drug users and one-third (33.8 percent) of the 71 women with a positive syphilis serology were HIV-seropositive. There was no difference in fertility histories between seropositive and seronegative women, and two of 21 pregnant women were seropositive. This study led to increased clinical and prevention services for this high-risk population.

Acquired Immunodeficiency Syndrome↗