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Biomedical subjects

R A Coutinho

Publications and source records attributed to R A Coutinho.

At least 19 recordsLinked to original sources
PubMed1992

[AIDS epidemiology in The Netherlands in persons infected through heterosexual contact].

Ten years after the start of the AIDS epidemic in the Netherlands the proportion of persons infected by heterosexual contacts among the total of AIDS cases diagnosed is small (7.4%). Up to December 1991 the cumulative totals of females and males in the Netherlands reported with the diagnosis and infected by heterosexual contact were 55 and 93, respectively. Of the 55 heterosexual females, 69% had the Dutch nationality, of the 93 heterosexual males, 67%. Considerable proportions of the numbers of AIDS patients in this group (males 47%, females 45%) were diagnosed in the four largest cities (Amsterdam, Rotterdam, The Hague and Utrecht). The remaining cases of AIDS diagnosed in this group were scattered throughout the country. Among heterosexual females a gradual increase of the number of AIDS cases diagnosed was observed since 1985. In the males there was no clear trend in the number of diagnoses since 1984. Of the 55 females, 19 originated from an area endemic for AIDS or had had sexual contacts with a person from such a region (34.6%). Among the 93 males this number was 29 (31.2%). Nineteen of the 55 females (34.6%) were known to have sexual contact with a person from the known risk groups. The same held true of 12 males (12.9%). Of the remaining 17 females (30.9%) and 52 males (55.9%) it was only known that they were heterosexual without further risk factors or risk contacts.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1992

[Prevalence of HIV in clients of an outpatient clinic for sexually transmissible diseases and in a group of prostitutes and their clients].

In order to gain insight into the heterosexual spread of HIV infections in Amsterdam, a study was carried out in 1991 among persons attending an outpatient clinic for sexually transmitted diseases (STD) and among a group of prostitutes and prostitutes' clients. Out of 2362 persons attending the STD clinic, 2138 (90.5%) could ultimately be examined for presence of HIV antibodies. The HIV seroprevalence was 4.2% (90/2138); among homosexual males it was 22% (70/324), among heterosexual male intravenous drug users 12% (2/17) and among heterosexual males who never had used i.v. drugs 0.5% (5/997). The HIV seroprevalence among female intravenous drug users was 41% (12/29) and that among females who never had used i.v. drugs it was 0.1% (1/771). Among the heterosexually active subjects (active in the preceding six months, including the groups of bisexual males and intravenous drug users), the seroprevalence amounted to 1.5% (28/1884). HIV antibodies could be demonstrated in 1.5% (3/199) of the prostitutes and in 0.5% (1/213) of prostitutes' clients. However, the one positive male had had homosexual contacts in the past. Out of the total of nine heterosexually infected persons, two originated from the Netherlands, two from Ghana, two from Turkey, one from Nigeria, one from Pakistan and one from the Dominican Republic; six of them had commercial contacts. The heterosexual spread of HIV among the heterosexual population of Amsterdam can for the moment be classified as slight. However, further heterosexual transmission of HIV cannot be excluded, considering the frequency of unprotected sex.

Cohort Studies↗
PubMed1992

The harm reduction approach and risk factors for human immunodeficiency virus (HIV) seroconversion in injecting drug users, Amsterdam.

To assess risk factors for seroconversion to human immunodeficiency virus, the authors studied a cohort of human immunodeficiency virus-seronegative injecting drug users in Amsterdam, the Netherlands, between December 1985 and November 1991. The behaviors of 31 seroconverters were compared with those of 202 seronegative injecting drug users (controls). Three independent risk factors for seroconversion were found in logistic regression: 1) living greater than 10 years in Amsterdam (odds ratio (OR) = 2.45, 95% confidence interval (CI) 1.09-5.53); 2) first injection less than or equal to 2 years ago (OR = 3.43, 95% CI 1.20-9.81); and 3) injecting mainly at home (OR = 0.39, 95% CI 0.18-0.88). No evidence was found that receiving daily methadone treatments at methadone posts and obtaining new needles/syringes via the exchange program were protective. However, the data suggest that exchanging needles may have been protective at the start of this program. Influencing injecting drug users to modify behavior to prevent new infections appears to be very difficult, and it may, therefore, be important to increase preventive efforts targeted at the sexual partners of injecting drug users.

Adult↗
PubMed1992

[Estimate of the number of HIV-infected intravenous drug users in Amsterdam].

By combining data collected through a cohort study among injecting drug users (IDUs), which started December 1985, with data on the number of notified cases of AIDS, the cumulative number of HIV-infected IDUs residing in Amsterdam was estimated. The estimated cumulative incidence of HIV-infection among IDUs in Amsterdam on 1 July 1991 was about 1050. By 1 July 1991 90 of these cases had been diagnosed with AIDS, while an estimated 150-200 cases died before AIDS had been diagnosed. The prevalence of IDUs residing in Amsterdam who were still alive and free of AIDS on 1 July 1991 was estimated to be about 750-800. Because of untimely deaths, only a limited number of these HIV-infected IDUs can be expected to be diagnosed with AIDS in the future. The prevalence on 1 July 1991 of HIV-infected IDUs being alive and free of (diagnosed) AIDS and living elsewhere in the Netherlands is estimated at about 500.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Prevalence of human papillomavirus infections among heterosexual men and women with multiple sexual partners.

A prospective study of 65 men and 111 women with multiple heterosexual partners was designed to assess the prevalence and potential risk factors of genital human papillomavirus (HPV) infections. In addition, the HPV reservoir in genital, rectal, and oral mucosa was examined. The specimens for the detection of HPV DNA were taken from different sites such as the urethra and coronal sulcus (men), cervix and labia minora (women), anus, rectum, tongue, and buccal mucosa (both men and women). Women underwent speculum examination and colposcopic evaluation of the anogenital region, and a smear for routine cytological classification was also taken. In men, the anogenital region was examined clinically and colposcopically. The polymerase chain reaction (PCR) was used for the detection of HPV types 6/11, 16, 18, and 33. A high prevalence of HPV infection at one or more sites was detected, in 32% of the male and in 23% of the female participants. Seventeen percent of the male distal urethral specimens were positive for HPV DNA. From the female cervical specimens 14% were found positive. Ten proctal specimens (five men and five women) were positive for HPV DNA without any discernible lesion. The persons from whom these samples were taken denied anal insertive intercourse. No oral manifestation of HPV infection was detected. In both men and women a difference between HPV DNA-positive and -negative persons was not found in relation to known risk factors associated HPV infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Simultaneous passive and active immunization against hepatitis A.

The serum antibody response to simultaneous administration of immune globulin (Ig) and an inactivated hepatitis A vaccine was investigated in healthy volunteers who had been tested and found free of hepatitis A virus. One hundred and forty nine subjects were randomly allocated into three groups. Group 1 received three doses of hepatitis A vaccine at 0, 1 and 6 months, group 2 received 5 ml of Ig and group 3 received a combination of Ig and vaccine. In group 3 the seropositivity rate measured by enzyme-linked immunosorbent assay was 100% at day 5, month 1 and 2, 96% at month 6 and again 100% at month 7. In the group that received vaccine alone the seroconversion rates were 0, 96, 100, 98 and 100 respectively. The geometric mean titres in subjects who received passive/active immunization were about twofold lower than in subjects who received vaccine alone, indicating interference of Ig with the immune response. Despite this, the data show that simultaneous administration of hepatitis A vaccine and Ig confers both immediate protection via Ig administration and long-term vaccine-induced protection. As the antibody levels reached are about twofold lower compared to that after administration of hepatitis A vaccine alone, a booster dose may be required sooner, than if the vaccine were administered alone.

Adult↗
PubMed1992

Viral phenotype and immune response in primary human immunodeficiency virus type 1 infection.

Nineteen individuals were studied for virologic and immunologic events during primary human immunodeficiency virus type 1 (HIV-1) infection. In 16 individuals only non-syncytium-inducing (NSI) isolates were detected; syncytium-inducing (SI) isolates were obtained from 3. Studies of transmitter-recipient pairs indicated that both NSI variants and SI variants were transmitted and that SI variants may be suppressed in the recipient. CD4+ T cells remained in the normal range in 15 of 16 individuals with NSI isolates but rapidly declined in all 3 individuals with SI variants, 1 of whom was treated with zidovudine. The most marked increase in CD8+ T cells and activated CD8+ T cells was observed in individuals with the most pronounced clinical signs of acute HIV-1 infection. Activated CD8+ T cells were only transiently elevated in individuals with SI variants, suggesting that an impaired cellular anti-HIV-1 immune response plays a role in the rapid progression to AIDS.

CD4-Positive T-Lymphocytes↗
PubMed1992

Concordance of human immunodeficiency virus detection by polymerase chain reaction and by serologic assays in a Dutch cohort of seronegative homosexual men.

In three subgroups of a clinically and socially well defined group of Dutch homosexual men, the prevalence of human immunodeficiency virus type 1 (HIV-1) sequences in seronegative blood samples was studied using the polymerase chain reaction (PCR). In 19 seronegative partners of seropositive persons, no HIV-1 sequences were found by PCR in either early (1984/1985) or more recent (1987) samples. In 42 seronegative persons selected by their high risk for HIV-1 infection, none harbored HIV-1 sequences in either early (1985/1986) or late (1989) samples. In 15 people who seroconverted for HIV-1, only 2 samples collected 3 months before seroconversion were PCR-positive. These persons were also HIV antigen-positive at this time. These data suggest that a latent infection greater than 6 months does not occur and that the combination of HIV antibody and HIV antigen tests is appropriate and conclusive in most cases of HIV-1 infection.

Base Sequence↗
PubMed1992

HIV-1 biological phenotype in long-term infected individuals evaluated with an MT-2 cocultivation assay.

OBJECTIVE: We have previously demonstrated that detection of syncytium-inducing (SI) HIV-1 in asymptomatic seropositive individuals is associated with rapid progression to AIDS. In the present study, we sought to develop and evaluate an HIV-1 phenotyping assay for the screening of large numbers of individuals. METHODS: Efficiency of HIV-1 isolation from patient peripheral blood mononuclear cells (PBMC) was studied with donor PBMC or seven different CD4+ T-cell lines as target cells. The biological phenotype of sequential isolates from 20 long-term asymptomatic HIV-1-seropositive individuals was determined by two different assays. RESULTS: Non-SI isolates, efficiently recovered by cocultivation with donor PBMC, were never isolated with T-cell lines as target cells. Direct cocultivation with MT-2 cells, but not with six other CD4+ T-cells, resulted in the efficient recovery of SI isolates. HIV-1 MT-2 tropism and SI capacity were shown to be coupled properties at the clonal level. SI isolates emerged in 10 out of 20 longitudinally-studied individuals. In these long-term infected individuals, appearance of SI isolates was associated with progression to AIDS. CONCLUSIONS: Direct cocultivation of patient PBMC with the MT-2 cell line is a sensitive, specific and convenient method to detect SI isolates. The availability of an assay suitable for the screening of large groups allows further study of the value of HIV-1 biological phenotyping as a prognostic marker.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Increasing morbidity without rise in non-AIDS mortality among HIV-infected intravenous drug users in Amsterdam.

OBJECTIVE: We determined pneumonia, endocarditis, hospitalizations and death rates in a group of HIV-infected and non-infected IVDU recruited at low-threshold methadone programmes in Amsterdam, The Netherlands to examine the influence of HIV infection on morbidity and non-AIDS mortality in intravenous drug users (IVDU) without AIDS. DESIGN: A prospective epidemiologic study among HIV-infected and non-infected IVDU in Amsterdam. SETTING: We analysed patients attending the Municipal Health Service of Amsterdam. PATIENTS: The patient group consisted of 197 HIV-seropositive IVDU and 193 HIV-seronegative IVDU as controls. MAIN OUTCOME MEASURES: We analysed incidence rates per person-year of bacterial pneumonia; hospitalizations and non-AIDS mortality; and relative risks for HIV-infected IVDU compared to non-infected IVDU. RESULTS: The incidence of bacterial pneumonia rose from 0.1 in 1986 to 0.29 in 1989 in HIV-infected IVDU. The overall relative risk for this group was 4.0 (95% confidence interval, 1.7-9.7) compared with non-infected controls. HIV-infected IVDU were more frequently hospitalized for bacterial pneumonia than non-infected IVDU (50 versus 13%). In contrast, non-AIDS mortality rates remained stable for both HIV-infected and non-infected IVDU. HIV seropositivity was not found to be an independent risk factor for non-AIDS mortality. CONCLUSION: We found a high and rising incidence of bacterial pneumonia among HIV-infected IVDU in Amsterdam without any consequential rise in non-AIDS mortality. This contrasts with reports from studies conducted in New York City, New York, USA, where bacterial pneumonia-related mortality has been found to increase markedly, coincident with the AIDS epidemic. Early detection of bacterial pneumonia and easy access to both inpatient and outpatient medical care may be important factors in preventing early death due to common bacterial pathogens in IVDU without AIDS.

Adult↗
PubMed1992

Orogenital sex and the transmission of HIV among homosexual men.

OBJECTIVE: To investigate the possibility of orogenital transmission of HIV. DESIGN: Cohort study on HIV infection among homosexual men. SETTING: The Municipal Health Service, Amsterdam, The Netherlands. PATIENTS, PARTICIPANTS: Homosexual men for whom the date of HIV seroconversion was known (n = 102) were included in our study. MAIN OUTCOME MEASURES: Data on the sexual behaviour of our subjects in the 6-9 months preceding HIV seroconversion were collected. In order to identify those men who consistently denied practising receptive anogenital intercourse, information was retrieved from written questionnaires and from face-to-face interviews. RESULTS: Receptive anogenital intercourse in the 6-9 months before seroconversion was denied by 20 seroconverters in their written questionnaires. However, in face-to-face interviews, 11 men later reported this sexual practice. CONCLUSIONS: Orogenital transmission of HIV appears to occur, but its frequency may be overestimated because of reluctance to report the practice of receptive anogenital intercourse.

Adult↗
PubMed1992

Biphasic rate of CD4+ cell count decline during progression to AIDS correlates with HIV-1 phenotype.

OBJECTIVE: To determine the kinetics of decline of CD4+ lymphocytes in HIV-1-infected asymptomatic homosexual men. METHODS: CD4+ lymphocytes were enumerated in a cohort of 187 HIV-1-infected initially asymptomatic homosexual men seen at 3-month intervals over 5 years. During follow-up, 45 men progressed to AIDS (excluding cases presenting with Kaposi's sarcoma). Correlation between rate of CD4+ cell decline and presence of a particular HIV-1 biological phenotype was analysed in 43 participants. RESULTS: CD4+ cell counts declined slowly and continuously in HIV-1-seropositive men who remained asymptomatic during follow-up. A biphasic CD4+ cell count decline was observed in the group who developed AIDS: the decline was slow and steady (5.6 x 10(6)/l per month, similar to that observed in the asymptomatic group) until 18 months before AIDS diagnosis, but became three to five times faster thereafter. Rapid CD4+ cell decline was significantly related to syncytium-inducing, fast-replicating HIV-1 isolates; during the period of slow and steady CD4+ cell count decline, non-syncytium-inducing isolates were predominant. CONCLUSIONS: At an average of 18 months preceding AIDS diagnosis, a three to fivefold increase in the rate of loss of CD4+ lymphocytes occurs, and may be related to the appearance of a more virulent HIV-1 phenotype.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Detection of HIV antibodies in saliva as a tool for epidemiological studies.

OBJECTIVE: To evaluate the use of saliva specimens for the detection of HIV antibodies among high-risk groups in epidemiological studies. DESIGN: Testing of saliva specimens collected by different methods from individuals with known HIV status. The most reliable method was examined for its usefulness in a field study among a high-risk group. METHODS: Saliva samples were obtained either by using a cotton-wool roll ('Salivette') or as 'whole saliva'. HIV antibodies were determined using commercial enzyme-linked immunosorbent assays (ELISA). Confirmation was performed using a line immunoassay or an immunoblot assay. RESULTS: In 'Salivette' samples, HIV antibodies were detected by ELISA in seven out of 22 seropositive individuals. In contrast, testing of 'whole saliva' samples from 79 HIV-seropositive and 115 HIV-seronegative individuals resulted in a 100% correlation with HIV serum status. The positive reaction of 20 'whole saliva' specimens was confirmed in a line immunoassay, whereas in an immunoblot assay only seven specimens were positive, one negative, and 12 indeterminate. In an HIV prevalence study among drug users, 395 'whole saliva' samples were tested in two different ELISA. Both assays showed complete agreement in detecting 58 positive and 337 negative samples. All positive samples were confirmed by the line immunoassay. CONCLUSION: Our study demonstrates that 'whole saliva' specimens are a good alternative to blood samples in epidemiological studies of HIV prevalence in high-risk groups.

Adult↗
PubMed1992

Large diurnal variation in CD4 cell count and T-cell function among drug users: implications for clinical practice and epidemiological studies.

OBJECTIVE: To measure diurnal variation in the CD4 cell count and T-cell reactivity of drug users. DESIGN: A prospective epidemiological study among HIV-infected and non-infected drug users attending the Municipal Health Service of Amsterdam, The Netherlands. PATIENTS: Eleven HIV-infected and seven non-infected drug users. MAIN OUTCOME MEASURES: CD4 cell counts and T-cell reactivity three times a day. T-cell subsets and T-cell reactivity were determined from blinded samples within 2 hours. RESULTS: The number of CD4 cells increased by 130 x 10(6)/l (P < 0.05) in HIV-infected intravenous drug users over 8 hours. Following stimulation with anti-CD3 monoclonal antibodies, the T-cell reactivity of HIV-infected drug users rose from 118 to 221 c.p.m. (P < 0.01) over 8 hours. CD4 cell counts of the total study population increased by 37% and T-cell reactivity by 93%. The increase in the number of CD4 cells was more marked among active drug users than among drug users who had not used drugs recently. CONCLUSION: Variation in the CD4 cell count and in T-cell reactivity is large among drug users.

CD4-Positive T-Lymphocytes↗
PubMed1992

Psychopathology, stress and HIV-risk injecting behaviour among drug users.

The relations between psychopathology (or psychological morbidity) and stress (measured by the GHQ-30 and VOEG-13) and HIV-risk injecting behaviour were investigated among 151 and 166 drug users, respectively, participating in a HIV study in Amsterdam, The Netherlands. Scores indicative of psychopathology were obtained by 72% of respondents. Drug users with psychopathology are older, long-term polydrug users and injectors, who experience considerable stress. Drug users in the sample also have higher stress levels than the general population, but, in contrast to the general population, stress does not increase with age. Stress is associated with long-term polydrug use, with cocaine use and with the female sex. Among HIV-positive injecting drug users (IDU's) no positive relation was found between psychopathology or stress and lending of used needles to others. Among HIV-negative IDUs only psychopathology is associated with an increased HIV risk. Our findings suggest that HIV-risk reduction programmes should consider more seriously the role of psychopathology in attempts to persuade drug users to reduce their risks.

Adolescent↗