- Email: [email protected]
The increasing prevalence of human immunodeficiency virus infection in urban adolescents: A five year study
46
JOURNAL OF ADOLESCENT HEALTH Vol. 14, No. 1
ABSTIWCTS OF PAPERS PRESENTED
RESEARCH PRESENTATIONS:
Session V
IW4UNODEFICIENCY VIRUS THE IPCREASING PREVALENCE OF HUMAN INFECTION IN URBAN ADOLESCENTS: A FIVE YEAR SPUDY. L.J. D’Angelo, M.D., M.P.H., P.R. Getson, Ph.D., C.O. Brasseux, B.A.,
E. Stallings, H. Guagliardo, Ph.D., N. Shaffer, M.D. Children's National Medical Center, Washington, D.C. and Centers for Disease Control, Atlanta, Ga. To determine whether HIV infection is increasing among adolescent patients seen for ambulatory care at an urban pediatric hospital, through a blinded, unlinked, and anonymous protocol approved by participating institutional review boards, we tested all discardedblood specimens from patients ages 1321 in five separate time periods (TPl-5) obtained between 10/l/87 and No patient had a specimen tested more than once in each time 6/00/92. "New cases" were identified by eliminating previously positive period. individuals on basis of birthdate. The Rsrulte, A total of 15,431 subject specimens were tested. overall cumulative prevalence of HIV seropositivity was 9.27/1000 (12.7/1000 males, 7.79/1000 females). # Seropositive/lOOO Age (Years)
studv
peri4
TPl TP3 TP5
9% . 2.25
2% . 5.93
3.06
20.39
. Y=% 13.70 32.95
Total
4.03 7.92 19.44
analyzed by stiparate time periods, statistically significant When increases in overall prevalence of infection were seen between Time Period 1 (Tel) and Time Period 5 (TPS) (4.03/1000, 95% C.I.= 2.26 to 6.65 in TPl; The rates also increased in TPS). 19.44/1000. 95% C.I.= 14.55 to 25.41 significantly in both males (from 2.44 to 23.84/1000) and in females (from 4.82 to 17.84/1000). When stratified by age, increases were most notable in older adolescents (18-21 yrs.) where rates of seropositivity increased from 3.70/1000 to 32.95/1000. When only "new cases" were considered the overall that HIV prevalence still increased from 4.03 to 10.19/1000. We conclude infection is well established in our ambulatory urban adolescent population. Special initiatives at preventing the spread of this infection are needed urgently. a
Neville &Golden X.D.,nargaret R.Pamnerechlag M.D., M.Eim Oh M.D., Maureen Gelling R.N.,Mar8ha Sturdevant M.D., Siya Ara8 n.o.,Sol Neuhoff LO., Wilson oumornay B.S., Pat Roblin A.S., Dept. of Ped., Schneider Children'8 Hoap.,New Wyde Park, WY,Albert Einstein college of md.; SUNY Health Science Ctr.at Brooklyn; Brookdale Hoop. Wed. Ctr.,Brooklyn, NY and Childrnn'o Ho8pita1, Univerhty of Alabama at Birmingham, AL. Sexually active adolelcente have the higheet rate8 of genital infaction with B (ct). Standerd treatment regimen= recomend a 7 day cour8e oi! doxycyelinm (PC). Compliance with multiple do80 regimes-m irr poor, mp8cially with adoleacent8. Thm pharmacokinetice of atithromycin (AZ), a new aralide antibiotic with a prolonged half life and good in vitro activity again& Ct, make 8ingle do80 treatment fea8ible. We comp8red Al to DC in the tr8at8Mnt Of 8irty-five, non-pregnant adOle8Cent women aged 19-20 year8 (mean 17.5) with culture-confirmed chlamydial cervicitis or urethritie.Subject8 were enrolled at 3 sites (2 in Ny and 1 in AA). After written infonrmd consent was obtained, oubjecte were randomly allsignedto receive either A9 1 gm PO eingle do8e (N-40) or doatycycline 100 mg 30 bid for 7 day8 (N-25) . Endocervical culture8 iOr Ct, urinalynia, complete blood counte, and serum chemistrie8 including liver function test8 were obtained at ba8eline and 1, 2 and 4 wke after treatment wa8 bsgun. The bacteriologic responmm to treatment i8 8hown below: 8 with negative Ct culture8 Wko after RX Wk 1 Wk 2 Wk 4 AZ b 92%(22/24) 948(29/31) 958(36/38) DC 25 9%(20/21) 1001(16/16) 8Bt(21/24) Eight 8UbjOCt8 (4 Al, 4 DC) were culture po8itivo at follow up and were retreated with Dc. stx (3 At, 3DC) admitted to sexual contact with an Untreated partner and were probably reinfected. Ga8trointeetinal eide effect8 occured in lo/25 (408) of 8ubject8 who receivedOC and in 9/4G (22.51)of those who received AS, p=PS. Trah8ientelevationa of traneamina8es were found Ln 18% of those who receiv8d A8 and 168 of those who received DC. We conclude that in adole8cent women wLth genital Ct infection, single dose AZ is as effective and eafe a8 a 7 day courme of DC.
JOURNAL OF ADOLESCENT HEALTH Vol. 14, No. 1
ABSTIWCTS OF PAPERS PRESENTED
RESEARCH PRESENTATIONS:
Session V
IW4UNODEFICIENCY VIRUS THE IPCREASING PREVALENCE OF HUMAN INFECTION IN URBAN ADOLESCENTS: A FIVE YEAR SPUDY. L.J. D’Angelo, M.D., M.P.H., P.R. Getson, Ph.D., C.O. Brasseux, B.A.,
E. Stallings, H. Guagliardo, Ph.D., N. Shaffer, M.D. Children's National Medical Center, Washington, D.C. and Centers for Disease Control, Atlanta, Ga. To determine whether HIV infection is increasing among adolescent patients seen for ambulatory care at an urban pediatric hospital, through a blinded, unlinked, and anonymous protocol approved by participating institutional review boards, we tested all discardedblood specimens from patients ages 1321 in five separate time periods (TPl-5) obtained between 10/l/87 and No patient had a specimen tested more than once in each time 6/00/92. "New cases" were identified by eliminating previously positive period. individuals on basis of birthdate. The Rsrulte, A total of 15,431 subject specimens were tested. overall cumulative prevalence of HIV seropositivity was 9.27/1000 (12.7/1000 males, 7.79/1000 females). # Seropositive/lOOO Age (Years)
studv
peri4
TPl TP3 TP5
9% . 2.25
2% . 5.93
3.06
20.39
. Y=% 13.70 32.95
Total
4.03 7.92 19.44
analyzed by stiparate time periods, statistically significant When increases in overall prevalence of infection were seen between Time Period 1 (Tel) and Time Period 5 (TPS) (4.03/1000, 95% C.I.= 2.26 to 6.65 in TPl; The rates also increased in TPS). 19.44/1000. 95% C.I.= 14.55 to 25.41 significantly in both males (from 2.44 to 23.84/1000) and in females (from 4.82 to 17.84/1000). When stratified by age, increases were most notable in older adolescents (18-21 yrs.) where rates of seropositivity increased from 3.70/1000 to 32.95/1000. When only "new cases" were considered the overall that HIV prevalence still increased from 4.03 to 10.19/1000. We conclude infection is well established in our ambulatory urban adolescent population. Special initiatives at preventing the spread of this infection are needed urgently. a
Neville &Golden X.D.,nargaret R.Pamnerechlag M.D., M.Eim Oh M.D., Maureen Gelling R.N.,Mar8ha Sturdevant M.D., Siya Ara8 n.o.,Sol Neuhoff LO., Wilson oumornay B.S., Pat Roblin A.S., Dept. of Ped., Schneider Children'8 Hoap.,New Wyde Park, WY,Albert Einstein college of md.; SUNY Health Science Ctr.at Brooklyn; Brookdale Hoop. Wed. Ctr.,Brooklyn, NY and Childrnn'o Ho8pita1, Univerhty of Alabama at Birmingham, AL. Sexually active adolelcente have the higheet rate8 of genital infaction with B (ct). Standerd treatment regimen= recomend a 7 day cour8e oi! doxycyelinm (PC). Compliance with multiple do80 regimes-m irr poor, mp8cially with adoleacent8. Thm pharmacokinetice of atithromycin (AZ), a new aralide antibiotic with a prolonged half life and good in vitro activity again& Ct, make 8ingle do80 treatment fea8ible. We comp8red Al to DC in the tr8at8Mnt Of 8irty-five, non-pregnant adOle8Cent women aged 19-20 year8 (mean 17.5) with culture-confirmed chlamydial cervicitis or urethritie.Subject8 were enrolled at 3 sites (2 in Ny and 1 in AA). After written infonrmd consent was obtained, oubjecte were randomly allsignedto receive either A9 1 gm PO eingle do8e (N-40) or doatycycline 100 mg 30 bid for 7 day8 (N-25) . Endocervical culture8 iOr Ct, urinalynia, complete blood counte, and serum chemistrie8 including liver function test8 were obtained at ba8eline and 1, 2 and 4 wke after treatment wa8 bsgun. The bacteriologic responmm to treatment i8 8hown below: 8 with negative Ct culture8 Wko after RX Wk 1 Wk 2 Wk 4 AZ b 92%(22/24) 948(29/31) 958(36/38) DC 25 9%(20/21) 1001(16/16) 8Bt(21/24) Eight 8UbjOCt8 (4 Al, 4 DC) were culture po8itivo at follow up and were retreated with Dc. stx (3 At, 3DC) admitted to sexual contact with an Untreated partner and were probably reinfected. Ga8trointeetinal eide effect8 occured in lo/25 (408) of 8ubject8 who receivedOC and in 9/4G (22.51)of those who received AS, p=PS. Trah8ientelevationa of traneamina8es were found Ln 18% of those who receiv8d A8 and 168 of those who received DC. We conclude that in adole8cent women wLth genital Ct infection, single dose AZ is as effective and eafe a8 a 7 day courme of DC.