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P Alcabes

Publications and source records attributed to P Alcabes.

34 records · Page 2Linked to original sources
PubMed1993

CD4+ lymphocyte level and rate of decline as predictors of AIDS in intravenous drug users with HIV infection.

OBJECTIVE: To examine the relationship between rate of loss of CD4+ T lymphocytes and risk of AIDS in HIV-infected intravenous drug users (IVDU) enrolled in a methadone program in the Bronx, New York. DESIGN: Serial CD4 percentages (CD4%) among lymphocytes before AIDS diagnosis were recorded at approximately 6-month intervals for 190 HIV-antibody-positive subjects. METHODS: A nested case-control study was performed, in which all subjects who developed AIDS were compared with those who remained AIDS-free. The relationship between CD4% decline and AIDS risk was evaluated using proportional-hazards regression. RESULTS: Analyses that used a single baseline CD4% measurement to adjust for CD4+ lymphocyte count suggested that both low (1-5 CD4% per semester) and high (> 5 CD4% per semester) rates of decline might be related to AIDS risk: relative risks were 1.83 and 1.44, although the 95% confidence intervals (Cl) included 1.0 in each case. Adjustment for current level of CD4% eliminated the association between low rates of CD4% decline and AIDS risk, but not that between high rates of decline and AIDS risk (adjusted relative risk, 1.80; 95% Cl, 0.57-5.70). Serial observations showed that a rate of decline of CD4% > 5 per semester was a significant predictor of AIDS risk after controlling for level of CD4% achieved (adjusted relative risk, 3.58; 95% Cl, 1.07-11.95). CONCLUSIONS: IVDU who develop AIDS have a greater rate of CD4 cell loss than subjects who remain AIDS-free. A low rate of CD4+ lymphocyte depletion is not an important predictor of the immediate onset of AIDS in HIV-infected IVDU, compared with CD4+ lymphocyte level, but a high rate of CD4+ decline can be.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Characteristics of suicides by inmates in an urban jail.

OBJECTIVE: The authors' goals were to describe the characteristics of suicides committed by inmates in custody of the New York City Department of Correction between 1980 and 1988. METHODS: Data on suicides were collected from records of the jail health services, the municipal medical examiner's office, and the city's prison death review board, as well as from reports of the New York State Commission of Correction and other documents. RESULTS: The authors identified 48 suicides committed by inmates during the study period. Forty-two percent of the suicides occurred within the first 30 days of incarceration, and 50 percent occurred within three days of a court appearance. More than 90 percent of suicides were by hanging. Ninety-one percent of suicides took place in cells in which the inmate was housed alone. Fifty-two percent of the inmates who committed suicide had a major psychiatric diagnosis, and 46 percent had a history of inpatient or outpatient psychiatric care. CONCLUSIONS: The authors recommend that all inmates with a psychiatric history or potential suicidality be identified and linked with ongoing mental health services while incarcerated, that potentially suicidal inmates never be housed alone in a cell, and that correctional staff be trained to recognize potentially self-destructive inmates and to prevent suicide.

Adolescent↗
PubMed1993

Anergy compromises screening for tuberculosis in high-risk populations.

Anergy may occur in groups at high risk for tuberculosis, compromising tuberculin skin testing. Within New York City's correctional system, anergy prevalence was 25% among opiate users referred to detoxification programs and 3% in the general population. Correlates of anergy were recent weight loss and needle sharing. The high prevalence of anergy among opiate users compromises the utility of tuberculosis screening and suggests the need for routine chest x-rays to detect pulmonary tuberculosis in some high-risk-populations.

Adult↗
PubMed1992

Clinical manifestations and predictors of disease progression in drug users with human immunodeficiency virus infection.

BACKGROUND AND METHODS: To examine the clinical course of human immunodeficiency virus (HIV) infection in injection-drug users, we conducted a prospective study of a cohort of patients in a methadone-treatment program in New York City from July 1985 through December 1990. The patients underwent standardized evaluations at base line and semiannually thereafter and received on-site primary medical care. Rates of progression to the acquired immunodeficiency syndrome (AIDS) and major outcomes before the development of AIDS were examined by univariate analyses; the risk of AIDS was also assessed by product-limit survival analysis and proportional-hazards regression. RESULTS: Of 318 HIV-seropositive patients who did not yet have AIDS (171 men and 147 women), 90 were black, 179 were Hispanic, and 49 were white; the median age was 33 years. Over a median of 3.0 years of follow-up, 55 (17 percent) received a diagnosis of AIDS (incidence per 100 person-years, 5.8). Major outcomes before the development of AIDS included oral candidiasis (incidence per 100 person-years, 11.2), pyogenic bacterial infections including pneumonia and sepsis (8.0), pulmonary tuberculosis (1.2), multiple constitutional symptoms (13.6), and herpes zoster (1.3). There were 41 deaths from AIDS, and 13 seropositive patients without AIDS (4.1 percent) died of bacterial infections, as compared with only 1 of 411 seronegative patients studied (P < 0.001). The incidence of AIDS was 62 percent lower among those who took zidovudine than among those who did not (P = 0.02). In the multivariate analysis, progression to AIDS was best predicted by low numbers and percentages of CD4+ lymphocytes, nonuse of zidovudine, and the presence of oral candidiasis, bacterial infections, or tuberculosis. There was no consistent relation between progression to disease and the continued use of injection drugs. CONCLUSIONS: HIV-infected injection-drug users have progression to AIDS at rates comparable to those of other HIV-infected groups, but they have substantial pre-AIDS morbidity and mortality, particularly from bacterial infections, which also appear to predict disease progression.

AIDS-Related Opportunistic Infections↗
PubMed1992

Characteristics of intravenous drug users by history of arrest and treatment for drug use.

Typically, intravenous drug users are studied by drawing samples from drug treatment programs, from the criminal justice system, or by outreach into the street community via anthropological or ethnographic methods. Among 1405 subjects recruited through extensive community outreach, 46% reported no history of treatment for drug abuse and 16% said they had not been arrested in the preceding 10 years; 130 (9%) reported neither history. A history of arrest was higher among men and those with a history of: treatment for drug abuse, low educational attainment, having received public assistance, and unemployment. A history of drug treatment was higher among women and those of an older age with a history of: arrest, having received public assistance, and a greater duration and intensity of intravenous drug use. Intravenous drug users who had neither a history of arrest since 1977 nor of drug treatment were more likely to be women and more educated, to have not received public assistance, and to inject less than weekly. These data indicate that characteristics of intravenous drug users differ by history of arrest and treatment, substantiating reports of heterogeneity among intravenous drug users.

Black or African American↗
PubMed1992

Correlates of human immunodeficiency virus infection in intravenous drug users: are treatment-program samples misleading?

Using a community-based sample of 1632 intravenous drug users in Baltimore, Maryland, USA, this study evaluated a possible selection bias faced when studying risk factors for human immunodeficiency virus, type 1 (HIV-1) in intravenous drug users drawn solely from treatment programs. Consenting subjects, recruited by extensive distribution of brochures and word-of-mouth, underwent confidential interviews about drug use behaviors in a setting that was independent of community service agencies. Of 1632 subjects, 275 (17%) were currently enrolled in treatment programs. These subjects were similar in many respects to those not currently in treatment, including HIV-1 seroprevalence; however, they differed in that those not in treatment were more likely to be male, younger and black than those currently in treatment, and to have started injecting drugs more recently. However, associations between HIV-1 seropositivity and a series of demographic and drug-using characteristics were mostly similar in direction and magnitude among subjects currently in treatment and those not in treatment. These results suggest that one-time samples of drug users enrolled in treatment programs do not necessarily present a misleading picture of correlates of HIV-1 seropositivity.

Adult↗
PubMed1992

Homelessness and indicators of mental illness among inmates in New York City's correctional system.

Data from three cross-sectional samples of inmates in the New York City correctional system (N = 299, 236, and 151) were analyzed to determine the prevalence of homelessness among detainees. One-fourth to one-third of each sample had been homeless at some time during the two months before arrest, and 20 percent of the primary sample of 299 inmates had been homeless the night before arrest. Further analysis of the primary sample showed that homelessness was strongly associated with mental illness: 50 percent of those who had ever been homeless during the past three years responded positively to at least one mental illness screening question, compared with 25 percent of the never-homeless inmates. More than a third of the ever-homeless group had received mental health treatment, compared with a fifth of those who had never been homeless.

Adult↗
PubMed1989

Compliance with isoniazid prophylaxis in jail.

The incidence of tuberculosis in New York City has risen dramatically in the last decade, an increase that has also been seen in the incarcerated population on Rikers Island, New York City's principal jail. We have investigated the establishment and maintenance of compliance with isoniazid prophylaxis in this population. Factors affecting compliance were studied in a sample of young men who were found to be tubercullin-reactive at the time of their incarceration. Compliance was quantified by determining the number of doses taken divided by the total number of available doses. Mean compliance for the 74 subjects was 37.5%. Two factors were important determinants of compliance: (1) the building where the inmate was incarcerated and (2) his knowledge of tuberculoses and the isoniazed regimen. The influence of the housing unit on compliance suggests that administrative responses to prison overcrowding, an increasingly prevalent condition in the nation's jails and prisons, may have an unintended and detrimental effect on medical care and public health.

Adolescent↗
PubMed1988

An outbreak of Salmonella gastroenteritis in an urban jail.

An outbreak of gastroenteritis in New York City's largest jail involved 145 cases over a two-month period. The outbreak was unusual in that two Salmonella strains (serogroups B and D) were involved. Management of the outbreak involved screening kitchen workers by culture of stool samples, and education regarding personal hygiene. Obstacles to investigation and management of the outbreak arose out of the special nature of the jail environment; these included jurisdictional problems and high turnover of the inmate population.

Disease Outbreaks↗
PubMedDate not supplied

Identification of a W variant outbreak of Mycobacterium tuberculosis via population-based molecular epidemiology.

CONTEXT: Typing of Mycobacterium tuberculosis could provide a more sensitive means of identifying outbreaks than use of conventional surveillance techniques alone. Variants of the New York City W strain of M tuberculosis were identified in New Jersey. OBJECTIVE: To describe the spread of the W family of M tuberculosis strains in New Jersey identified by molecular typing and surveillance data. DESIGN: Population-based cross-sectional study. SETTING AND SUBJECTS: All incident culture-positive tuberculosis cases reported in New Jersey from January 1996 to September 1998, for which the W family was defined by insertion sequence (IS) IS6110 DNA fingerprinting, polymorphic GC-rich repetitive sequence (PGRS) typing, spacer oligotyping (spoligotyping), and variable number tandem repeat (VNTR) analysis. MAIN OUTCOME MEASURE: Identification and characterization of W family clones supplemented by surveillance data. RESULTS: Isolates from 1207 cases were analyzed, of which 68 isolates (6%) belonged to the W family based on IS6110 and spoligotype hybridization patterns. The IS6110 hybridization patterns or fingerprints revealed that43 patients (designated group A) shared a unique banding motif not present in other W family isolates. Strains collected from the remaining 25 patients (designated group B), while related to W, displayed a variety of IS6110 patterns and did not share this motif. The PGRS and VNTR typing confirmed the division of the W family into groups A and B and again showed group A strains to be closely related and group B strains to be more diverse. The demographic characteristics of individuals from groups A and B were specific and defined. Group A patients were more likely than group B patients to be US born (91 % vs 24%, P<.001), black (76% vs 16%, P<.001), human immunodeficiency virus positive (40% vs 0%, P = .007), and residents of urban northeast New Jersey counties (P<.001). Patients with group B strains were primarily non-US born, of Asian descent, and more dispersed throughout New Jersey. No outbreak had been detected using conventional surveillance alone. CONCLUSIONS: The implementation of multiple molecular techniques in conjunction with surveillance data enabled us to identify a previously undetected outbreak in a defined geographical setting. The outbreak isolates comprise members of a distinct branch of the W family phylogenetic lineage. The use of molecular strain typing provides a proactive approach that may be used to initiate, and not just augment, traditional surveillance outbreak investigations.

Adult↗
PubMedDate not supplied

Social support for HIV-infected mothers: relation to HIV care seeking.

A cross-sectional survey was conducted to identify sources of social support for 92 HIV-seropositive mothers and to examine the relationship between social support and initiation of health care after a positive test for HIV antibody. Main outcome measures were self-reported source and amount of social support and length of time between the first positive HIV antibody test and the first visit for HIV care. Results indicated that HIV-infected mothers frequently delay seeking medical care and report attenuated social support networks. A limited program of HIV counseling and testing during pregnancy is unlikely to ensure that they will enter the healthcare system.

Adult↗
PubMedDate not supplied

High risk of active tuberculosis in HIV-infected drug users with cutaneous anergy.

OBJECTIVES: To determine the incidence of active tuberculosis in human immunodeficiency virus (HIV)-seropositive and HIV-seronegative drug injectors with cutaneous anergy and to examine the effectiveness of isoniazid chemoprophylaxis in preventing tuberculosis among drug injectors with positive tuberculin test results. DESIGN AND SETTING: Prospective observational study linked to an ongoing study of HIV infection within a New York City (NY) methadone program; subjects also underwent routine intradermal tuberculin testing and multiple-antigen delayed-type hypersensitivity skin testing. The 31-month study period ended December 31, 1990. METHODS: Anergic subjects and tuberculin reactors who were HIV seropositive were compared by HIV disease status and CD4+ T-lymphocyte levels. Tuberculosis incidence was calculated for anergics (none treated with isoniazid) and for treated and untreated tuberculin reactors, by HIV serological status. RESULTS: Among those seropositive for HIV, anergic subjects had more advanced HIV disease and fewer CD4+ cells (median 0.33 vs 0.56 x 10(9)/L, P less than .01) compared with tuberculin reactors, although neither clinical status nor CD4+ cell counts consistently predicted anergy. Five (7.6%) of 68 anergic subjects who were HIV seropositive and none of 52 anergic subjects who were HIV seronegative (n = 18) or of unknown (n = 34) HIV serological status developed active tuberculosis during the study period (P less than .05). The tuberculosis incidence rate among anergic subjects who were HIV seropositive was 6.6 cases per 100 person-years (95% confidence interval [Cl], 2.1 to 15.3). Of 25 HIV-seropositive tuberculin reactors who did not receive or complete 12 months of isoniazid prophylaxis, tuberculosis incidence was 9.7 cases per 100 person-years (95% Cl, 2.6 to 24.7; P = 0.56, compared with the rate among anergic HIV seropositives); there were no cases of tuberculosis in 53.4 person-years of follow-up for 27 HIV-seropositive tuberculin reactors who received 12 months of prophylaxis (rate difference between treated and untreated groups, 9.7 cases per 100 person-years, 95% Cl, 1.3 to 18.0). CONCLUSION: Drug injectors with cutaneous anergy who are seropositive for HIV are at high risk of active tuberculosis, similar to that among untreated HIV-seropositive tuberculin reactors. A decreased incidence of active tuberculosis was seen in HIV-seropositive tuberculin reactors receiving 12 months of isoniazid chemoprophylaxis, compared with untreated or partially treated subjects. These results support the routine use of delayed-type hypersensitivity testing to accompany tuberculin testing for drug injectors with known or suspected HIV infection, and consideration of isoniazid prophylaxis for anergic as well as tuberculin-reactive subjects who are HIV seropositive, in populations with a high prevalence of coexisting HIV and Mycobacterium tuberculosis infection.

HIV Infections↗