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HIV Medicine 2007
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1. Introduction

Bernd Sebastian Kamps and Christian Hoffmann

The first reports of homosexual patients suffering from previously rare diseases such as pneumocystis pneumonia and Kaposi's sarcoma were published in May 1981 (Centers for Disease Control 1981a, 1981b, 1981c). It soon became clear that the new disease affected other population groups as well, when the first cases were reported in injecting drug users. However, it took almost two years until, in 1983, the human immunodeficiency virus type I (HIV-1) was defined as the primary cause of the acquired immunodeficiency syndrome (Barré-Sinoussi 1983, Broder 1984, Gallo 1984).

Almost 25 years have now elapsed. Twenty-five years, in which HIV infection has changed from a fatal condition to a manageable chronic illness. Twenty-five years, in which the development of antiretroviral therapy (ART) has been one of the dramatic advances in the history of medicine. However, for the vast majority of people living with HIV/AIDS, ART is still light years away - largely inaccessible in resource-poor countries where HIV continues to devastate families, communities and societies, especially the poor and the socially marginalized.

In the following 800 pages, we present a comprehensive overview of the treatment of HIV infection and its complications. As in previous years, all chapters have been thoroughly revised, and most parts of the book were available on the Internet (www.HIVMedicine.com) months before they were printed here. The philosophy that governs the publication of HIV Medicine 2006 has recently been published at www.freemedicalinformation.com. We firmly believe that that is the way medical textbooks should be handled in the 21st century.

Transmission routes

There are several ways in which someone can become infected with HIV. These transmission routes are well defined (see also Chapter "Post-Exposure Prophylaxis"). HIV infection can be transmitted through:

  • unprotected sexual intercourse with an infected partner;

  • injection or transfusion of contaminated blood or blood products (infection through artificial insemination, skin grafts and organ transplants is also possible);

  • sharing unsterilized injection equipment that has been previously used by someone who is infected;

  • maternofetal transmission (during pregnancy, at birth, and through breastfeeding).

Occupational infections of healthcare or laboratory workers may occur; however, a 1995 study estimated that although 600,000 to 800,000 needlestick injuries occurred among healthcare workers every year in the USA, occupational infection was not frequent. The risk of occupational HIV transmission from contaminated needles to healthcare workers was found to be 0.3 % in case series performed prior to the availability of potent ART.

There are sometimes concerns that there may be alternative routes of HIV transmission. It must be explicitly stated that HIV is NOT transmitted by mosquitoes, flies, fleas, bees, or wasps. HIV is NOT transmitted through casual every day contact. No case of HIV infection has been documented to arise from contact with non-bloody saliva or tears. Since HIV is not transmitted by saliva, it is not possible to contract it through sharing a glass, a fork, a sandwich, or fruit (Friedland 1986, Castro 1988, Friedland 1990). In the opinion of leading experts, exposure of intact skin to HIV-contaminated body fluids (e.g. blood) is not sufficient to transfer the virus.

Sexual intercourse

Unprotected sexual intercourse is the most important transmission route of HIV infection worldwide. Although receptive anal sex is estimated to produce the highest risk of infection, infection after a single insertive contact has also been described. The presence of other sexually transmitted diseases markedly increases the risk of becoming infected with HIV.

The lower the viral load, the less infectious the patient. A prospective study of 415 HIV-discordant couples in Uganda showed that of 90 new infections occurring over a period of up to 30 months, none was from an infected partner with a viral load below 1,500 copies/ml. The risk of infection increased with every log of viral load by a factor of 2.45 (Quinn 2000). It should be noted that the levels of viral load in blood and other body fluids do not always correlate with one another. Thus, individual risk remains difficult to estimate. In addition, HIV-infected patients are not protected from superinfection with new viral strains.

The higher the viral load, the more infectious the patient. This is especially true for patients during acute HIV infection. During acute HIV-1 infection, the virus replicates extensively in the absence of any detectable adaptive immune response, reaching levels of over 100 million copies of HIV-1 RNA/ml (see Chapter "Acute HIV-1 infection").

Intravenous drug use

Sharing unsterilized injection equipment that has been previously used by someone who is infected is an important route of HIV transmission in many countries with a high prevalence of intravenous drug users. In contrast to the accidental needlestick injury (see also Chapter "Post-Exposure Prophylaxis"), the risk of transmission through sharing injection equipment is far higher: the intravenous drug user ensures the proper positioning of the needle by aspiration of blood.

Maternofetal

In the absence of any intervention, an estimated 15-30 % of mothers with HIV infection will transmit the infection during pregnancy and delivery. In approximately 75 % of these cases, HIV is transmitted during late pregnancy or during delivery. About 10 % of vertical HIV infections occur before the third trimester, and 10-15 % are caused by breastfeeding.

In Western countries, perinatal (vertical) HIV infection has become rare since the introduction of antiretroviral transmission prophylaxis and elective cesarean section. For more details, see Chapter "Pregnancy and HIV".

Injection or transfusion of contaminated blood products

In most Western countries, administration or transfusion of HIV-contaminated blood or blood products has become a rare event. With current testing methods (for details see also Chapter "HIV Testing"), the risk of acquiring HIV from a unit of transfused blood is about 1:1,000,000. However, while Western European countries, the United States, Australia, Canada, and Japan have strict and mandatory screening of donated blood for HIV, not all countries do.

Natural history

The "natural history" described in the following refers to HIV infection in the absence of HAART.

The acute viral syndrome of "primary" HIV infection (which is defined as the time period from initial infection with HIV to the development of an antibody response) shows symptoms that often resemble those of mononucleosis. These appear within days to weeks following exposure to HIV (see Chapter "Acute HIV-1 Infection"). However, clinical signs and symptoms may not occur in all patients. During acute HIV infection, there is usually a high plasma viremia and frequently a marked decrease in CD4+ T-cells. The CD4+ T-cell count later increases again, normally to levels inferior to the pre-infection values (see Figure 1).

After the acute infection, equilibrium between viral replication and the host immune response is usually reached, and many infected individuals may have no clinical manifestations of HIV infection for years. Even in the absence of antiretroviral treatment, this period of clinical latency may last 8-10 years or more. However, the term "latency period" may be misleading, given the incredibly high turnover of the virus and the relentless daily destruction of CD4+ T-cells.

At the end of the "latency period", a number of symptoms or illnesses may appear which do not fulfill the definition of AIDS. These include slight immunological, dermatological, hematological and neurological signs. Many of them are listed in the Category B of the CDC classification system (see Table 1). Constitutional symptoms, such as fever, weight loss, night sweats, and diarrhea may also develop. In this situation, the level of 200 CD4+ T-cells/µl is an important cut-off, below which the risk of many AIDS-defining illnesses increases, among them several opportunistic infections and certain neoplasms (see Table 1). Above 200 CD4+ T-cells/µl, most AIDS-defining illnesses are rare events (see also Chapter "AIDS").

However, the course of infection may vary dramatically, and in some cases, the progression to AIDS occurs rapidly. Host factors mainly determine whether or not an HIV-infected individual rapidly develops clinically overt immunodeficiency, or whether this individual belongs to the group of long-term non-progressors, who represent about 5 % of all infected patients (for details, see "Pathogenesis of HIV-1 Infection").

CDC classification system

The most widely accepted classification system of HIV infection, initially published by the U.S. Centers for Disease Control and Prevention (CDC) in 1986, is based on certain conditions associated with HIV infection (see Table 1). This classification system was intended for use in conducting public health surveillance and it has been a useful epidemiological tool for many years. In 1993, the CDC classification was revised (CDC 1993b). Since then, the clinical definition of AIDS has been expanded in the USA (not in Europe) to include HIV-infected patients with a CD4+ T-cell count of less than 200 cells/µl or less than 14 % of all lymphocytes, even in the absence of the listed conditions.

Thus, the current CDC classification categorizes persons on the basis of clinical conditions and CD4+ T-lymphocyte counts. There are three clinical categories (A, B, C - see Table 1) and three CD4+ T-lymphocyte categories (1, 2, 3 - see Table 2). For example, a patient with oropharyngeal candidiasis and a CD4+ T-cell count of 250/µl would be classified as B2; someone with asymptomatic infection and a CD4+ T-cell count of 550/µl would be in category A1. Categorization of the CD4+ T-cells should be based on the lowest accurate CD4+ T-cell count ("CD4 nadir") and not on the most recent one.

For children less than 13 years of age, there is a modified and revised classification system for HIV infection (see chapter "Antiretroviral Therapy in Children"). It should also be noted that, besides the CDC classification, the World Health Organization (WHO) has also published a staging system for HIV infection. The WHO classification is an approach for use in resource-limited settings and is widely used in Africa and Asia.

Epidemiology

New estimations have recently resulted in substantial changes in estimates of numbers of persons living with HIV worldwide (UNAIDS 2007). The estimated number of persons living with HIV worldwide is now assumed to be 33.2 million, a reduction of 16% compared with the estimate published in 2006 (Table 3).

The prevalence and incidence of HIV/AIDS vary considerably from continent to continent, from country to country, from region to region. Several countries in sub-Saharan Africa report infection rates of 30 %, especially in urban areas. In other countries, HIV prevalence still remains low. However, low national prevalence rates can be misleading. They often disguise serious epidemics that are initially concentrated in certain localities or among specific population groups and that threaten to spill over into the wider population.

The joint United Nations program on HIV/AIDS (UNAIDS) provides by far the best and most comprehensive overview. The annual AIDS epidemic update of UNAIDS reports on the latest developments in the global HIV/AIDS epidemic. With maps and regional summaries, it provides the most recent estimates of the epidemic's scope and explores new trends in the epidemic's evolution. It can be found at the Website http://www.unaids.org/. Table 1 provides an overview of the devastating situation of the HIV pandemic.

Conclusion

HIV cannot be transmitted as easily as the influenza virus. Compared to other viral diseases, the prevention of HIV infection is therefore easier. In rich countries, individuals who don't want to be infected with HIV may protect themselves and avoid HIV infection. The same people will not be able to avoid the influenza virus of the next pandemia.

HIV infection has become a treatable disease - at least in countries that can afford widespread health coverage. The following chapters describe how patients should be managed in these countries.

Outside these havens of material well-being, things have not changed since the early years of the HIV epidemic 25 years ago. Many people live in a world where no medical progress seems to have been made. This is a shameful situation, and future generations will hopefully do better than we did.

 

References
  1. Ammann AJ, Cowan MJ, Wara DW, et al. Acquired immunodeficiency in an infant: possible transmission by means of blood products. Lancet 1983, 1: 956-8. http://amedeo.com/lit.php?id=6132270

  2. Andreani T, Modigliani R, le Charpentier Y, et al. Acquired immunodeficiency with intestinal cryptosporidiosis: possible transmission by Haitian whole blood. Lancet 1983, 1: 1187-91. http://amedeo.com/lit.php?id=6133990

  3. Armbruster C, Kriwanek S, Vorbach H. Gender-specific differences in the natural history, clinical features, and socioeconomic status of HIV-infected patients: experience of a treatment centre in Vienna. Wien Klin Wochenschr 2000, 112: 754-60. http://amedeo.com/lit.php?id=11042904

  4. Barre-Sinoussi F, Chermann JC, Rey F, et al. Isolation of a T-lymphotropic retrovirus from a patient at risk for AIDS. Science 1983, 220: 868-71. http://amedeo.com/lit.php?id=6189183

  5. Bobat R, Moodley D, Coutsoudis A, Coovadia H, Gouws E. The early natural history of vertically transmitted HIV-1 infection in African children from Durban, South Africa. Ann Trop Paediatr 1998,, 18: 187-96. http://amedeo.com/lit.php?id=9924555

  6. Bowen PA 2nd, Lobel SA, Caruana RJ, et al. Transmission of HIV by transplantation: clinical aspects and time course analysis of viral antigenemia and antibody production. Ann Intern Med 1988, 108: 46-8. http://amedeo.com/lit.php?id=3276264

  7. Broder S, Gallo RC. A pathogenic retrovirus (HTLV-III) linked to AIDS. N Engl J Med 1984, 311:1292-7.
  8. Burger H, Weiser B, Robinson WS, et al. Transmission of lymphadenopathy-associated virus/human T lymphotropic virus type III in sexual partners. Seropositivity does not predict infectivity in all cases. Am J Med 1986, 81: 5-10. http://amedeo.com/lit.php?id=3014878

  9. Calzavara L, Burchell AN, Major C, et al. Increases in HIV incidence among men who have sex with men undergoing repeat diagnostic HIV testing in Ontario, Canada. AIDS 2002, 16: 1655-61. http://amedeo.com/lit.php?id=12172087

  10. Castro KG, Lieb S, Jaffe HW, et al. Transmission of HIV in Belle Glade, Florida: lessons for other communities in the United States. Science 1988, 239: 193-7. http://amedeo.com/lit.php?id=3336781

  11. Centers for Disease Control (1981c). Follow-up on Kaposi's sarcoma and Pneumocystis pneumonia. MMWR Morb Mortal Wkly Rep 1981, 30: 409-10.
  12. Centers for Disease Control (1981b). Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men--New York City and California. MMWR Morb Mortal Wkly Rep 1981, 30: 305-8.
  13. Centers for Disease Control (1981a). Pneumocystis pneumonia--Los Angeles. MMWR Morb Mortal Wkly Rep 1981, 30: 250-2. Volltext: http://hiv.net/link.php?id=144

  14. Centers for Disease Control (1982a). epidemiologic notes and reports persistent, generalized lymphadenopathy among homosexual males. MMWR Morb Mortal Wkly Rep 1982, 31: 249. http://hiv.net/link.php?id=145

  15. Centers for Disease Control (1982b). epidemiologic notes and reports update on kaposi's sarcoma and opportunistic infections in previously healthy persons -- United States. MMWR Morb Mortal Wkly Rep 1982, 31: 294. http://hiv.net/link.php?id=146

  16. Centers for Disease Control (1982c). A Cluster of Kaposi's Sarcoma and Pneumocystis carinii Pneumonia among Homosexual Male Residents of Los Angeles and range Counties, California. MMWR Morb Mortal Wkly Rep 1982, 31: 305. http://hiv.net/link.php?id=147

  17. Centers for Disease Control (1982d). Opportunistic Infections and Kaposi's Sarcoma among Haitians in the United States. MMWR Morb Mortal Wkly Rep 1982, 31: 353. http://hiv.net/link.php?id=148

  18. Centers for Disease Control (1982e). Epidemiologic Notes and Reports Pneumocystis carinii Pneumonia among Persons with Hemophilia A. MMWR Morb Mortal Wkly Rep 1982, 31: 365. http://hiv.net/link.php?id=149

  19. Centers for Disease Control (1982f). Update on Acquired Immune Deficiency Syndrome (AIDS) among Patients with Hemophilia A. MMWR Morb Mortal Wkly Rep 1982, 31: 644. http://hiv.net/link.php?id=151

  20. Centers for Disease Control (1982g). Epidemiologic Notes and Reports Possible Transfusion- Associated Acquired Immune Deficiency Syndrome (AIDS) - California. MMWR Morb Mortal Wkly Rep 1982, 31, 652. http://hiv.net/link.php?id=150

  21. Centers for Disease Control (1982h). Unexplained Immunodeficiency and Opportunistic Infections in Infants -- New York, New Jersey, California. MMWR Morb Mortal Wkly Rep 1982, 31: 665. http://hiv.net/link.php?id=152

  22. Centers for Disease Control (1982i). Epidemiologic Notes and Reports Immunodeficiency among Female Sexual Partners of Males with Acquired Immune Deficiency Syndrome (AIDS) -- New York. MMWR Morb Mortal Wkly Rep 1982, 31, 697. http://hiv.net/link.php?id=154

  23. Centers for Disease Control (1982j). Acquired Immune Deficiency Syndrome (AIDS) in Prison Inmates -- New York, New Jersey. MMWR Morb Mortal Wkly Rep 1982, 31: 700. http://hiv.net/link.php?id=153

  24. Centers for Disease Control (1983). Current Trends Acquired Immunodeficiency Syndrome (AIDS) Update. MMWR Morb Mortal Wkly Rep 1983, 33: 309-11. Volltext: http://hiv.net/link.php?id=143

  25. Centers for Disease Control (1985a). Provisional Public Health Service inter-agency recommendations for screening donated blood and plasma for antibody to the virus causing acquired immunodeficiency syndrome. MMWR Morb Mortal Wkly Rep 1985, 34: 1-5. http://hiv.net/link.php?id=157

  26. Centers for Disease Control (1985b). International Notes Update: Acquired Immunodeficiency Syndrome - Europe. MMWR Morb Mortal Wkly Rep 1985, 34: 147. http://hiv.net/link.php?id=156

  27. Centers for Disease Control (1985c). Current Trends Update: Acquired Immunodeficiency Syndrome -- United States. MMWR Morb Mortal Wkly Rep 1985, 34: 245. http://hiv.net/link.php?id=155

  28. Centers for Disease Control (1986). Recommendations for preventing transmission of infection with human T-lymphotropic virus type III/lymphadenopathy-associated virus during invasive procedures. CDC, Department of Health and Human Services. Ann Intern Med 1986, 104: 824-5. http://amedeo.com/lit.php?id=3010783

  29. Centers for Disease Control (1990). Possible transmission of HIV to a patient during an invasive dental procedure. MMWR 1990, 39: 489-93. http://hiv.net/link.php?id=158

  30. Centers for Disease Control (1991a). Current trends preliminary analysis: HIV serosurvey of orthopedic surgeons, 1991. MMWR Morb Mortal Wkly Rep 1991, 40: 309-12. http://hiv.net/link.php?id=168
  31. Centers for Disease Control (1991b). Update: Transmission of HIV infection during invasive dental procedures - Florida. MMWR 1991, 40: 377-81. http://hiv.net/link.php?id=159

  32. Centers for Disease Control (1993a). Investigations of persons treated by HIV-infected health-care workers -- United States. MMWR Morb Mortal Wkly Rep 1993, 42: 329-31. http://hiv.net/link.php?id=169

  33. Centers for Disease Control (1993b). 1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults. MMWR 1992, 41(RR-17). http://hiv.net/link.php?id=184

  34. Centers for Disease Control (1994). HIV transmission in household settings - United States. MMWR 1994, 43: 353-6. http://hiv.net/link.php?id=160

  35. Centers for Disease Control. (1995). HIV transmission in a dialysis center. MMWR 1995, 44: 404-12. http://hiv.net/link.php?id=161

  36. Ciesielski C, Marianos D, Ou CY, et al: Transmission of HIV in a dental practice. Ann Intern Med 1992, 116: 798 -805. http://amedeo.com/lit.php?id=1567094

  37. Consensus Statement on Antiretroviral Treatment for AIDS in Poor Countries by Individual Members of the Faculty of Harvard University. 2001. http://hiv.net/link.php?id=182

  38. Cowan MJ, Hellmann D, Chudwin D, et al. Maternal transmission of AIDS. Pediatrics 1984, 73: 382-6. http://amedeo.com/lit.php?id=6608091

  39. Deschamps MM, Fitzgerald DW, Pape JW, Johnson WD Jr. HIV infection in Haiti: natural history and disease progression. AIDS 2000, 14: 2515-21. http://amedeo.com/lit.php?id=11101063

  40. Easterbrook PJ, Ives N, Waters A, et al. The natural history and clinical significance of intermittent viraemia in patients with initial viral suppression to < 400 copies/ml. AIDS 2002, 16: 1521-7. http://amedeo.com/lit.php?id=12131190

  41. European Study Group On Heterosexual Transmission Of HIV Comparison of female to male and male to female transmission of HIV in 563 stable couples. Br Med J 1992, 304: 809-13. http://amedeo.com/lit.php?id=1392708

  42. Friedland G, Kahl P, Saltzman B, et al. Additional evidence for lack of transmission of HIV infection by close interpersonal (casual) contact. AIDS 1990, 4: 639-44. http://amedeo.com/lit.php?id=2118767

  43. Friedland GH, Saltzman BR, Rogers MF, et al. Lack of transmission of HTLV-III/LAV infection to household contacts of patients with AIDS or AIDS-related complex with oral candidiasis. N Engl J Med 1986, 314:344-9. http://amedeo.com/lit.php?id=3456076

  44. Gallo RC, Salahuddin SZ, Popovic M, et al. Frequent detection and isolation of cytopathic retroviruses (HTLV-III) from patients with AIDS and at risk for AIDS. Science 1984, 224: 500-3. http://amedeo.com/lit.php?id=6200936

  45. Gottlieb MS, Schroff R, Schanker HM, et al. Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men: evidence of a new acquired cellular immunodeficiency. N Engl J Med 1981, 305:1425-31. http://amedeo.com/lit.php?id=6272109

  46. Groopman JE, Sarngadharan MG, Salahuddin SZ, et al. Apparent transmission of human T-cell leukemia virus type III to a heterosexual woman with the AIDS. Ann Intern Med 1985, 102: 63-6. http://amedeo.com/lit.php?id=2981497

  47. Hammer SM, Turmen T, Vareldzis B, Perriens J. Antiretroviral guidelines for resource-limited settings: The WHO's public health approach. Nat Med 2002, 8: 649-50.
  48. Harris C, Small CB, Klein RS, et al. Immunodeficiency in female sexual partners of men with the AIDS. N Engl J Med 1983, 308: 1181-4. http://amedeo.com/lit.php?id=6221192

  49. Hubert JB, Burgard M, Dussaix E, et al. Natural history of serum HIV-1 RNA levels in 330 patients with a known date of infection. AIDS 2000, 14: 123-31. http://amedeo.com/lit.php?id=10708282

  50. Jean SS, Pape JW, Verdier RI, et al. The natural history of HIV 1 infection in Haitian infants. Pediatr Infect Dis J 1999, 18: 58-63. http://amedeo.com/lit.php?id=9951982

  51. Kamradt T, Niese D, Brackmann HH, et al. Heterosexual transmission of HIV in hemophiliacs. Klin Wochenschr 1990, 68:1203-7. http://amedeo.com/lit.php?id=1981245

  52. Kreiss JK, Kitchen LW, Prince HE, Kasper CK, Essex M. Antibody to human T-lymphotropic virus type III in wives of hemophiliacs. Evidence for heterosexual transmission. Ann Intern Med 1985, 102: 623-6. http://amedeo.com/lit.php?id=2984972

  53. Kumarasamy N, Solomon S, Flanigan TP, Hemalatha R, Thyagarajan SP, Mayer KH. Natural history of HIV disease in southern India. Clin Infect Dis 2003, 36: 79-85. http://amedeo.com/lit.php?id=12491206
  54. Lackritz EM, Satten GA, Aberle-Grasse J, et al. Estimated risk of transmission of the HIV by screened blood in the United States. N Engl J Med 1995, 333: 1721-5. http://amedeo.com/lit.php?id=7491134

  55. Lee CA. The natural history of HIV disease in haemophilia. Blood Rev 1998, 12: 135-44. http://amedeo.com/lit.php?id=9745883

  56. Lyles RH, Munoz A, Yamashita TE, et al. Natural history of HIV type 1 viremia after seroconversion and proximal to AIDS in a large cohort of homosexual men. Multicenter AIDS Cohort Study. J Infect Dis 2000, 181: 872-80. http://amedeo.com/lit.php?id=10720507

  57. MacKellar DA, Valleroy LA, Secura GM, et al. Repeat HIV testing, risk behaviors, and HIV seroconversion among young men who have sex with men: a call to monitor and improve the practice of prevention. J Acquir Immune Defic Syndr 2002, 29: 76-85. http://amedeo.com/lit.php?id=11782594

  58. Masur H, Michelis MA, Greene JB, et al. An outbreak of community-acquired Pneumocystis carinii pneumonia: initial manifestation of cellular immune dysfunction. N Engl J Med 1981, 305:1431-8. http://amedeo.com/lit.php?id=6975437

  59. Melbye M, Biggar RJ, Ebbesen P, et al. Seroepidemiology of HTLV-III antibody in Danish homosexual men: prevalence, transmission, and disease outcome. Br Med J 1984, 289: 573-5. http://amedeo.com/lit.php?id=6087972

  60. Melbye M, Njelesani EK, Bayley A, et al. Evidence for heterosexual transmission and clinical manifestations of HIV infection and related conditions in Lusaka, Zambia. Lancet 1986, 2:1113-5. http://amedeo.com/lit.php?id=2877269

  61. Moore RD, Chaisson RE. Natural history of HIV infection in the era of combination antiretroviral therapy. AIDS 1999, 13: 1933-42. http://amedeo.com/lit.php?id=10513653

  62. Murphy DA, Mitchell R, Vermund SH, Futterman D. Factors associated with HIV testing among HIV-positive and HIV-negative high-risk adolescents: the REACH Study. Pediatrics 2002, 110: e36. http://amedeo.com/lit.php?id=12205286

  63. Padian N, Marquis L, Francis DP, et al. Male-to-female transmission of HIV. JAMA 1987, 258: 788-90. http://amedeo.com/lit.php?id=3475478

  64. Paul-Ehrlich-Institut, Bundesamt für Sera und Impfstoffe. Sicherheit der HIV-1-Diagnostika. http://www.pei.de/themen/hivdiasa.htm

  65. Peterman TA, Stoneburner RL, Allen JR, Jaffe HW, Curran JW. Risk of HIV transmission from heterosexual adults with transfusion-associated infections. JAMA 1988, 259: 55-8. http://amedeo.com/lit.php?id=3334772

  66. Phair JP. Determinants of the natural history of HIV type 1 infection. J Infect Dis 1999, 179 Suppl 2: S384-6. http://amedeo.com/lit.php?id=10081512

  67. Piot P, Quinn TC, Taelman H, et al. AIDS in a heterosexual population in Zaire. Lancet 1984, 2: 65-9. http://amedeo.com/lit.php?id=6146009

  68. Pitchenik AE, Fischl MA, Spira TJ. AIDS in low-risk patients. Evidence for possible transmission by an asymptomatic carrier. JAMA 1983, 250: 1310-2. http://amedeo.com/lit.php?id=6224028

  69. Pitchenik AE: AIDS in low-risk patients. Evidence for possible transmission by an asymptomatic carrier. JAMA 1983, 250:1310 -2. http://amedeo.com/lit.php?id=6224028

  70. Pokrovsky VV, Eramova EU: Nosocomial outbreak of HIV infection in Elista, USSR. V. International Conference on AIDS 1989, Montreal, Abstract W.A.O.5.
  71. Quinn TC, Mann JM, Curran JW, Piot P. AIDS in Africa: an epidemiologic paradigm. Science 1986, 234: 955-63. http://amedeo.com/lit.php?id=3022379

  72. Redfield RR, Markham PD, Salahuddin SZ, et al. Frequent transmission of HTLV-III among spouses of patients with AIDS-related complex and AIDS. JAMA 1985, 253: 1571-3. http://amedeo.com/lit.php?id=2983127

  73. Redfield RR, Markham PD, Salahuddin SZ, et al. Heterosexually acquired HTLV-III/LAV disease (AIDS-related complex and AIDS). Epidemiologic evidence for female-to-male transmission. JAMA 1985, 254: 2094-6. http://amedeo.com/lit.php?id=2995695

  74. Redfield RR, Wright DC, Tramont EC. The Walter Reed staging classification for HTLV-III/LAV infection. N Engl J Med 1986;314:131-2.
  75. Richtlinien zur Gewinnung von Blut und Blutbestandteilen und zur Anwendung von Blutprodukten (Hämotherapie). Bundesgesundheitsbl - Gesundheitsforsch - Gesundheitsschutz. Springer-Verlag 2000, 43:555-589. http://hiv.net/link.php?id=183

  76. Risk factors for AIDS among Haitians residing in the United States. Evidence of heterosexual transmission. The Collaborative Study Group of AIDS in Haitian-Americans. JAMA 1987, 257: 635-9. http://amedeo.com/lit.php?id=3795445

  77. Rogers AS, Froggatt JW, Townsend T, et al. Investigation of potential HIV transmission to the patients of an HIV-infected surgeon. JAMA 1993, 269: 1795-1801. http://amedeo.com/lit.php?id=8459510

  78. Spira R, Lepage P, Msellati P, et al. Natural history of HIV type 1 infection in children: a five-year prospective study in Rwanda. Mother-to-Child HIV-1 Transmission Study Group. Pediatrics 1999, 104: e56. http://amedeo.com/lit.php?id=10545582

  79. Stewart GJ, Tyler JP, Cunningham AL, et al. Transmission of human T-cell lymphotropic virus type III (HTLV-III) by artificial insemination by donor. Lancet 1985, 2: 581-5. http://amedeo.com/lit.php?id=2863597

  80. UNAIDS. AIDS Epidemic Update 2004. http://hiv.net/link.php?id=227

  81. Vergis EN, Mellors JW. Natural history of HIV-1 infection. Infect Dis Clin North Am 2000, 14: 809-25, v-vi. http://amedeo.com/lit.php?id=11144640

  82. Vogt M, Luthy R, Bircher A, et al. Heterosexual transmission of the acquired immunodeficiency syndrome (AIDS). Dtsch Med Wochenschr 1985, 110: 1483-7. http://amedeo.com/lit.php?id=3875471

  83. Wormser GP, Bittker S, Forseter G, et al. Absence of infectious HIV type 1 in "natural" eccrine sweat. J Infect Dis 1992, 165: 155-8. http://amedeo.com/lit.php?id=1345794

  84. Ziegler JB, Cooper DA, Johnson RO, Gold J. Postnatal transmission of AIDS-associated retrovirus from mother to infant. Lancet 1985, 1:896-8. http://amedeo.com/lit.php?id=2858746

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(15th edition, 818 pages, PDF, 3.7 MB)


     
 

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