- Email: [email protected]
Survival after diagnosis of AIDS, United States
652
ABSTRACTS (ACE)
METHODS: The HIV1/2 rapid assay, standard ELISA, and Western blot were used to determine the prevalence of HIV antibodies in 73 rural villages located in 6 of the 10 provinces of Cameroon, Africa during 2000–2001. Information regarding demographic data and risk factors was obtained using structured questionnaires during face-to-face interviews. RESULTS: Odds ratios (ORs) significantly different from the null value of 1.0 were associated with: (a) age, with 25–39 years old women at risk of HIV-seropositivity compared to 15–24 year old women (OR Z 1.83, 95% CI Z 1.24–2.70); (b) education, (OR for women with a primary school education Z 1.94, 95% CI Z 1.24– 3.04), compared to illiterate women; and (c) marital status (OR for married women compared to single women Z 0.44, 95% CI Z 0.30–0.66). In addition, significant odds ratios for HIV-seropositivity were associated with the geographic location of the villages. After adjustment for other variables (OR per degree increase in latitude Z 0.18, 95% CI Z 0.06–0.55; OR per degree increase in longitude Z 0.57, 95% CI Z 0.39–0.84, OR for the interaction between latitude and longitude Z 1.16, 95% CI Z 1.05–1.28) indicating decreased risk with increasing distance from Cameroon’s Atlantic coastline, and with increasing distance from the equator. CONCLUSION: Our findings thus suggest geographic patterns of HIV-seroprevalence, the knowledge of which may be helpful in targeting treatment and prevention activities in that country.
P62 SURVIVAL AFTER DIAGNOSIS OF AIDS, UNITED STATES HI Hall1, K McDavid1, Q Ling1, A Sloggett2, 1Division of HIV/ AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 2Center for Population Studies, London School of Hygiene & Tropical Medicine, London, England PURPOSE: Some studies suggest racial/ethnic minorities and women have less access to highly active antiretroviral therapy (HAART), which can slow progression from AIDS diagnosis to death. We examined differences in survival among demographic subgroups of persons (aged >13 years) diagnosed with AIDS after HAART became widely available (1996). METHODS: AIDS cases diagnosed during 1996–2001 in 50 states and the District of Columbia were followed up through 2002. Three-year relative survival proportions were calculated by race/ ethnicity, sex, 10-year age groups, transmission category, AIDS diagnosis year, and CD4 count at or within 6 month after AIDS diagnosis. Relative survival adjusts for normal expected survival in the general population, which was obtained from life tables calculated using U.S. death certificate information. We applied a generalized linear model with Poisson distribution to obtain relative excess hazards for race/ethnicity and sex while adjusting for the other covariates. RESULTS: Three-year relative survival was significantly lower for non-Hispanic black (80.2%; 95% CI 80.0, 80.5), American Indian (80.9%; 78.0, 83.4), and Hispanic persons (83.2%; 82.8, 83.5) compared with whites (84.9%; 84.6, 85.1). Survival among Asians (84.9%; 83.2, 86.4) was similar to whites. Survival was
AEP Vol. 15, No. 8 September 2005: 630–665
somewhat lower for women (81.3%; 81.0, 81.6) than men (82.7%; 82.6, 82.9). Survival was also lower for all transmission categories compared with men who have sex with men, those diagnosed at older ages compared with younger persons, and those diagnosed at lower CD4 counts compared with those with higher CD4 counts. Survival improved with later years of AIDS diagnosis (1996–1999). Multivariate relative survival models confirmed the poorer survival for blacks, American Indians, women, and older persons after adjustment for other covariates. CONCLUSIONS: Among persons with AIDS, certain minority groups, women, and older persons have poorer 3-year survival than their counterparts. These groups may lack adequate access to treatment to slow disease progression.
P63 BIOLOGIC INTERACTIONS BETWEEN HELMINTH SPECIES IN ANEMIA AE Ezeamama, ST McGarvey, LP Acosta, JD Kurtis, RM Olveda, JF Friedman, Dept. of Comm. Health, Int’l. Health Inst., Brown University, Providence, RI, Dept. of Immunology, Research. Inst. of Trop. Med., Manila, The Philippines OBJECTIVE: To quantify the extent of biologic interactions between helminth species in their effects on anemia in school age children. METHODS: Three stools were collected and each was read in duplicate by the Kato-Katz method. Current WHO criteria, based on number of eggs per gram (EPG) of stool for each helminth to quantify infection burden for ascaris, hookworm, trichuris and Schistosomiasis japonicum infections. Intensity categories of intensity: uninfected, low, and moderate/high (M+) intensity were defined for each species and interactions were assessed at M+ intensity. Anemia was defined as hemoglobin ! 11 mg/dl. Logistic regression models clustered by household units were used to quantify the effect of pairs of coinfection on anemia. Odds ratios (OR) and 95 % confidence intervals were estimated to estimate the impact of joint infections on anemia. The index of synergy (SI) and other measures of interaction were also estimated. RESULTS: Joint infections of hookworm and S. japonicum was associated with especially high risk of anemia (OR Z 13.2, 95% CI: 3.82–45.5) as was concurrent infections of hookworm and trichuris (OR Z 5.34, 95% CI: 1.76–16.2). As much as 60% and 22% of anemia observed in children with joint infectios of hookworm and S. japonicum, hookworm and trichuris respectively was found to be attributable to the synergy between these species. Antagonisitic interactions were noted for joint infections of hookworm and ascaris (SI Z 0.084, 95% CI Z 0.015–0.53) and for coinfection of S. japonicum and ascaris (SI Z 0.056, 95% CI Z 0.01–0.23). CONCLUSION: Synergistic and antagonistic interactions between pairs of concurrent helminth species infections are demonstrated in their effects on anemia. Putative mechanisms of effect are discussed and the importance of coherent analytic frame work for analysis of public health relevant interactions are stressed.
ABSTRACTS (ACE)
METHODS: The HIV1/2 rapid assay, standard ELISA, and Western blot were used to determine the prevalence of HIV antibodies in 73 rural villages located in 6 of the 10 provinces of Cameroon, Africa during 2000–2001. Information regarding demographic data and risk factors was obtained using structured questionnaires during face-to-face interviews. RESULTS: Odds ratios (ORs) significantly different from the null value of 1.0 were associated with: (a) age, with 25–39 years old women at risk of HIV-seropositivity compared to 15–24 year old women (OR Z 1.83, 95% CI Z 1.24–2.70); (b) education, (OR for women with a primary school education Z 1.94, 95% CI Z 1.24– 3.04), compared to illiterate women; and (c) marital status (OR for married women compared to single women Z 0.44, 95% CI Z 0.30–0.66). In addition, significant odds ratios for HIV-seropositivity were associated with the geographic location of the villages. After adjustment for other variables (OR per degree increase in latitude Z 0.18, 95% CI Z 0.06–0.55; OR per degree increase in longitude Z 0.57, 95% CI Z 0.39–0.84, OR for the interaction between latitude and longitude Z 1.16, 95% CI Z 1.05–1.28) indicating decreased risk with increasing distance from Cameroon’s Atlantic coastline, and with increasing distance from the equator. CONCLUSION: Our findings thus suggest geographic patterns of HIV-seroprevalence, the knowledge of which may be helpful in targeting treatment and prevention activities in that country.
P62 SURVIVAL AFTER DIAGNOSIS OF AIDS, UNITED STATES HI Hall1, K McDavid1, Q Ling1, A Sloggett2, 1Division of HIV/ AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 2Center for Population Studies, London School of Hygiene & Tropical Medicine, London, England PURPOSE: Some studies suggest racial/ethnic minorities and women have less access to highly active antiretroviral therapy (HAART), which can slow progression from AIDS diagnosis to death. We examined differences in survival among demographic subgroups of persons (aged >13 years) diagnosed with AIDS after HAART became widely available (1996). METHODS: AIDS cases diagnosed during 1996–2001 in 50 states and the District of Columbia were followed up through 2002. Three-year relative survival proportions were calculated by race/ ethnicity, sex, 10-year age groups, transmission category, AIDS diagnosis year, and CD4 count at or within 6 month after AIDS diagnosis. Relative survival adjusts for normal expected survival in the general population, which was obtained from life tables calculated using U.S. death certificate information. We applied a generalized linear model with Poisson distribution to obtain relative excess hazards for race/ethnicity and sex while adjusting for the other covariates. RESULTS: Three-year relative survival was significantly lower for non-Hispanic black (80.2%; 95% CI 80.0, 80.5), American Indian (80.9%; 78.0, 83.4), and Hispanic persons (83.2%; 82.8, 83.5) compared with whites (84.9%; 84.6, 85.1). Survival among Asians (84.9%; 83.2, 86.4) was similar to whites. Survival was
AEP Vol. 15, No. 8 September 2005: 630–665
somewhat lower for women (81.3%; 81.0, 81.6) than men (82.7%; 82.6, 82.9). Survival was also lower for all transmission categories compared with men who have sex with men, those diagnosed at older ages compared with younger persons, and those diagnosed at lower CD4 counts compared with those with higher CD4 counts. Survival improved with later years of AIDS diagnosis (1996–1999). Multivariate relative survival models confirmed the poorer survival for blacks, American Indians, women, and older persons after adjustment for other covariates. CONCLUSIONS: Among persons with AIDS, certain minority groups, women, and older persons have poorer 3-year survival than their counterparts. These groups may lack adequate access to treatment to slow disease progression.
P63 BIOLOGIC INTERACTIONS BETWEEN HELMINTH SPECIES IN ANEMIA AE Ezeamama, ST McGarvey, LP Acosta, JD Kurtis, RM Olveda, JF Friedman, Dept. of Comm. Health, Int’l. Health Inst., Brown University, Providence, RI, Dept. of Immunology, Research. Inst. of Trop. Med., Manila, The Philippines OBJECTIVE: To quantify the extent of biologic interactions between helminth species in their effects on anemia in school age children. METHODS: Three stools were collected and each was read in duplicate by the Kato-Katz method. Current WHO criteria, based on number of eggs per gram (EPG) of stool for each helminth to quantify infection burden for ascaris, hookworm, trichuris and Schistosomiasis japonicum infections. Intensity categories of intensity: uninfected, low, and moderate/high (M+) intensity were defined for each species and interactions were assessed at M+ intensity. Anemia was defined as hemoglobin ! 11 mg/dl. Logistic regression models clustered by household units were used to quantify the effect of pairs of coinfection on anemia. Odds ratios (OR) and 95 % confidence intervals were estimated to estimate the impact of joint infections on anemia. The index of synergy (SI) and other measures of interaction were also estimated. RESULTS: Joint infections of hookworm and S. japonicum was associated with especially high risk of anemia (OR Z 13.2, 95% CI: 3.82–45.5) as was concurrent infections of hookworm and trichuris (OR Z 5.34, 95% CI: 1.76–16.2). As much as 60% and 22% of anemia observed in children with joint infectios of hookworm and S. japonicum, hookworm and trichuris respectively was found to be attributable to the synergy between these species. Antagonisitic interactions were noted for joint infections of hookworm and ascaris (SI Z 0.084, 95% CI Z 0.015–0.53) and for coinfection of S. japonicum and ascaris (SI Z 0.056, 95% CI Z 0.01–0.23). CONCLUSION: Synergistic and antagonistic interactions between pairs of concurrent helminth species infections are demonstrated in their effects on anemia. Putative mechanisms of effect are discussed and the importance of coherent analytic frame work for analysis of public health relevant interactions are stressed.