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N A Merriman

Publications and source records attributed to N A Merriman.

6 recordsLinked to original sources
PubMed1999

Misdiagnosis of HIV infection by HIV-1 plasma viral load testing: a case series.

BACKGROUND: The availability of sensitive assays for plasma HIV viral load and the trend toward earlier and more aggressive treatment of HIV infection has led to the inappropriate use of these assays as primary tools for the diagnosis of acute HIV infection. OBJECTIVE: To describe limitations in the use of plasma viral load testing for the diagnosis of HIV infection. DESIGN: Case series. SETTING: Academic medical centers in Providence, Rhode Island, and Worcester, Massachusetts. PATIENTS: Three persons in whom HIV infection was falsely diagnosed by plasma viral load testing. MEASUREMENTS: Laboratory measures and clinical outcomes. RESULTS: Two cases of false-positive results obtained by using branched-chain DNA plasma viral load assays and one case of a false-positive result obtained by using reverse transcriptase-polymerase chain reaction plasma viral load assay are reported. All three plasma viral load tests yielded positive results with low values (1254 copies/mL, 1574 copies/mL, and 1300 copies/mL). Infection with HIV was initially diagnosed in all three patients, but each patient subsequently tested negative by HIV-1 enzyme-linked immunosorbent assay and repeated plasma viral load testing. CONCLUSION: Physicians should exercise caution when using plasma viral load assays to detect primary HIV infection, particularly when the pretest probability of infection is low.

Adult↗
PubMed1999

Use of cerebrospinal fluid shunt for the management of elevated intracranial pressure in a patient with active AIDS-related cryptococcal meningitis.

Persistently elevated intracranial pressure (ICP) is one of the most accurate predictors of a poor prognosis in patients with AIDS-related cryptococcal meningitis. We present a severe case of persistent cryptococcal meningitis in a patient with advanced AIDS, complicated by elevation of ICP. A ventriculoperitoneal shunt was placed that successfully lowered the ICP and alleviated the associated symptoms. The elevated ICP secondary to AIDS-related cryptococcal meningitis should be treated aggressively. Despite the risk of shunt complications, cerebrospinal fluid shunts can be considered in these patients if they do not respond to other treatment.

AIDS-Related Opportunistic Infections↗
PubMed1999

Reduction in recidivism of incarcerated women through primary care, peer counseling, and discharge planning.

Prior to release from the Rhode Island state prison, women at the highest risk for reincarceration and HIV infection are assigned to the Women's HIV/Prison Prevention Program (WHPPP), a discharge program designed to reduce the likelihood of reincarceration and HIV infection. Candidates for the WHPPP must meet at least one of three criteria: intravenous drug use or crack use, commercial sex work, or a history of prison recidivism with poor educational history and poor employment prospects. While incarcerated, the program participant develops a relationship with a physician and a social worker and establishes an individualized discharge plan. After release, the same physician and social worker continue to work with the client and assist an outreach worker in implementing the discharge plan. Data were collected from questionnaires administered to 78 women enrolled in the WHPPP between 1992 and 1995. The population in this program was primarily composed of ethnic minorities (55%), 25-35 years of age (55%), unmarried (90%), had children (72%), and displayed a variety of HIV risk behaviors. The WHPPP recidivism rates were compared with those of a mostly white (65%), similarly aged (51% were between 25 and 35 years of age) historical control group of all women incarcerated in Rhode Island in 1992. The intervention group demonstrated lower recidivism rates than the historical control group at 3 months (5% versus 18.5%, p = 0.0036) and at 12 months (33% versus 45%, p = 0.06). Assuming that recidivism is a marker for high-risk behavior, participation in the WHPPP was associated with a reduction in recidivism and in the risk of HIV disease in this very high risk group of women.

Adult↗