Hepatitis B virus infection in patients attending a genitourinary medicine clinic: risk factors and vaccine coverage.

Background: The hepatitis B virus (HBV) immunisation policy in the United Kingdom includes offering vaccines selectively to those at risk by sexual contact. Among genitourinary medicine (GUM) clinic attenders, homosexual men are offered vaccine, but estimates of the vaccine uptake are required to monitor policy and estimate the possible impact on transmission; heterosexuals are not routinely offered vaccine, but this policy might change if the prevalence was found to be high.

Objective: To determine the prevalence of HBV infection and vaccine uptake among patients attending a GUM clinic.

HIV infection alters the production of both type 1 and 2 cytokines but does not induce a polarized type 1 or 2 state.

Objective: To test the T-helper (TH)1/TH2 cytokine paradigm in HIV infection.

Design And Methods: Cytokine profiles in two separate studies of HIV patients and controls are presented: (i) a longitudinal study of HIV patients with CD4 counts > 500 x 10(6)/l tested at three timepoints compared with controls; (ii) a blinded cross-sectional study of controls and patients with high (> 500 x 10(6)/l) and low (< 500 x 10(6)/l) CD4 counts. Peripheral blood mononuclear cells (PBMC) from patients and controls were tested for the production of two type 1 [interleukin (IL)-2, interferon (IFN)-gamma] and two type 2 (IL-4, IL-10) cytokines by enzyme-linked immunosorbent assay.

Interactions between HIV and hepatitis B virus in homosexual men: effects on the natural history of infection.

Objectives: Hepatitis B virus (HBV) and HIV infections share risk-factors; therefore coinfection is common. Interactions have been reported but controlled studies have been limited. Our objective was to study the effect of HIV infection on the natural history of chronic HBV infection and the reverse effect of the HBV carrier state on HIV infection.

Hepatitis B nucleotide sequence analysis: linking an outbreak of acute hepatitis B to contamination of a cryopreservation tank.

An epidemiological investigation indicated that six patients treated in a haematology unit who developed acute hepatitis B may have been infected as a result of contamination of a liquid nitrogen bone marrow storage tank. The clinical details are described elsewhere (Tedder et al., 1995); we describe the virological methods used to support the findings.

Reference ranges and sources of variability of CD4 counts in HIV-seronegative women and men.

Background: CD4 lymphocyte counts are used to monitor immune status in HIV disease. An understanding of the variability of CD4 counts which occurs in the absence of HIV infection is essential to their interpretation. The sources and degree of such variability have not been extensively studied.

Hepatitis B virus surface mutations associated with infection after liver transplantation.

Background/aims: Liver transplantation for chronic liver disease due to hepatitis B virus infection is associated with a high risk of graft infection, graft failure and death. Many centres restrict this procedure to those seronegative for HBV-DNA (by hybridisation assay) and use prophylactic polyclonal human hepatitis B specific immunoglobulin to prevent infection of the graft, despite the very high cost.

Methods: We describe three patients who underwent liver transplantation for chronic HBV-related disease in whom death was due to fibrosing cholestatic hepatitis following graft infection with hepatitis B virus, despite receiving hepatitis B specific immunoglobulin.

Human probability matching behaviour in response to alarms of varying reliability.

The goals of this research were to substantiate the existence of the cry-wolf effect for alarm responses, quantifying its effect on operator performance. A total of 138 undergraduate students performed two blocks of a cognitively demanding psychomotor primary task; at the same time, they were presented with alarms of varying reliabilities (25, 50 and 75% true alarms) and urgencies (green, yellow and red visual alarms presented concurrently with low-, medium- and high-urgency auditory civilian aircraft cockpit alarms). Alarm response frequencies were observed and analysed, and t-tests and repeated-measures MANOVAs were used to assess the effects of increasing alarm reliability on alarm response frequencies, speed and accuracy.

Investigation of hepatitis B virus transmission in a health care setting: application of direct sequence analysis.

An epidemiologically linked cluster of hepatitis B virus (HBV) infections was investigated using HBV DNA amplification by a nested polymerase chain reaction with primers complementary to the region around the immunodominant a determinant of the surface gene, part of the X and core genes, and precore region and direct nucleotide sequence analysis. The cluster, in which 2 persons died of fulminant hepatitis, comprised 1 blood donor, 2 patients, and 2 health care workers. The Kimura two-parameter method was used to compare variance among the cluster with that in the control samples, which were collected from 7 patients infected with the same HBV subtype.

Novel application of a point mutation assay: evidence for transmission of hepatitis B viruses with precore mutations and their detection in infants with fulminant hepatitis B.

Mutations of the precore region of hepatitis B virus (HBV) genome have been associated with fulminant and severe chronic hepatitis. However uncertainty remains about the clinical significance and transmissibility of these mutant strains. A point mutation assay (PMA) was developed to identify qualitatively and quantitatively mutations affecting precore amino acids 1 and 28.

Conservation of precore and core sequences of hepatitis B virus in chronic viral carriers.

Mutations in the precore region of hepatitis B virus (HBV) have been associated with failure of expression of HBV e-antigen (HBeAg), however, the prevalence of these and other mutations in HBV carriers without overt chronic liver disease remains uncertain. Homosexual or bisexual males (n = 65) with chronic HBV infection attending The Middlesex Hospital, London were studied, of whom two had clinical evidence of chronic liver disease. HBV DNA was amplified from 62 of 65 serum samples using nested and double nested polymerase chain reaction (PCR) assays.

Optic neuritis and HIV-1 infection.

A patient is reported who developed acute optic neuritis in the context of severe immunodeficiency associated with HIV-1 infection. The clinical, laboratory, and radiological features are described and the possible associations with syphilis, multiple sclerosis, lymphoma, and HIV-1 infection are discussed.

Multiple prostatic abscesses presenting with urethral discharge.

Prostatic abscess has become less common, is now usually related to urinary tract infection, and is a rare cause of urethral discharge. The case is described of a man with prostatic abscesses caused by Staphylococcus aureus possibly related to recent skin abrasions. Transrectal ultrasound was used to make the diagnosis and to facilitate repeated drainage with a successful outcome.

Failure to deliver hepatitis B vaccine: confessions from a genitourinary medicine clinic.

Objective: To audit hepatitis B immunisation of homosexual or bisexual men in a genitourinary medicine clinic.

Design: Retrospective case note review of all homosexual and bisexual men presenting to a genitourinary clinic as new patients during 12 months in 1988 and follow up review of notes to May 1990.

Setting: One department of genitourinary medicine, Middlesex Hospital.

Hepatitis C virus: evidence for sexual transmission.

Objective: To determined the prevalence of hepatitis C virus infection and associated risk factors in patients attending a genitourinary medicine clinic, as evidence for sexual transmission.

Design: Seroprevalence estimated by reactivity in an enzyme immunoassay for antibodies to C100 protein with supplementary testing with a recombinant immunoblot assay and an assay for hepatitis C virus RNA.

Setting: Outpatient genitourinary medicine clinic in central London.

No effect of zidovudine on hepatitis B virus replication in homosexual men with symptomatic HIV-1 infection.

Zidovudine triphosphate inhibits the hepatitis B virus (HBV) DNA polymerase (DNAp) in vitro. Serial measurements of serum HBV DNAp activity and HBV DNA were made in 14 consecutive male homosexual patients starting zidovudine for symptomatic HIV-1 infection. Median duration of treatment was 15 weeks (range 2-72).