Jan P. Dudley

Human Immunodeficiency Virus Type 1 Infection in Homosexual Men Who Remain Seronegative for Prolonged Periods

Abstract Infection with the human immunodeficiency virus type 1 (HIV-1), as demonstrated by viral cultures, has been described in some patients before antibodies to HIV–1 can be detected, but the duration and frequency of such latent infections are uncertain. We selected prospectively a cohort of 133 seronegative homosexual men who continued to be involved in high-risk sexual activity, and we cultured 225 samples of their peripheral-blood lymphocytes, using mitogen stimulation to activate the integrated HIV-1 genome. HIV-1 was isolated in blood samples from 31 of the 133 men (23 percent), 27 of whom have remained seronegative for up to 36 months after the positive culture. The other four men seroconverted 11 to 17 months after the isolation of HIV-1. In three of them, we studied cryopreserved lymphocytes obtained earlier, using the polymerase chain reaction to amplify small amounts of viral DNA, and we demonstrated that HIV-1 provirus had been present 23, 35, and 35 months before seroconversion. We conclu...

Genetic susceptibility to multiple sclerosis

Previous studies of histocompatibility (HLA) types in multiple sclerosis (MS) families did not provide convincing proof of an HLA-linked susceptibility factor. In 12 families we studied, all MS cases in each family shared at least one chromosome. The probability of this occurring in the absence of genetic linkage is approximately 0.001. The estimated penetrance is 5 percent, implying that the genetic susceptibility factor may be a necessary but not a sufficient cause of MS. Additional studies are needed to identify other differences between affected and unaffected susceptible individuals.

Factor influencing suicide intent in gay and bisexual suicide ideators: differing models for men with and without human immunodeficiency virus.

Of 778 gay and bisexual men (none with acquired immunodeficiency syndrome [AIDS]), 27% (n = 212) reported suicidal ideation over the previous 6 months. Covariance structure models were used to explore predictors of suicide intent among (n = 112) suicide ideators with (n = 100) and without (n = 112) human immunodeficiency virus (HIV). Current AIDS-related stressors (deaths and illnesses and perceived AIDS risk) and past levels of adaptive functioning (social isolation and depression) were significantly more powerful predictors of suicide intent among HIV-positive than among HIV-negative ideators. Biological AIDS risk predicted neither suicide intent, current distress, nor perceived AIDS risk. Pathways to suicide intent appear to be psychologically, rather than biologically, mediated. Among HIV-positive ideators, AIDS-related death and illness events predicted suicide intent but not current distress symptoms. Some suicidal ideation in response to AIDS-related events may be an effort to cope rather than a manifestation of psychological distress.

Onset symptoms as predictors of mortality and disability in multiple sclerosis

Abstract– 941 cases of definite/probable multiple sclerosis living in Los Angeles County, California and King and Pierce Counties, Washington in 1970 who had onset between 1960 and 1969 were followed for mortality and disability through 1980. Early age of onset and residence in Washington State were predictors of less rapid and severe subsequent course. Coordination symptoms at onset were prognostic of rapid progression to disability and/or early death, whereas early motor weakness was significantly predictive only for disability. The presence of sensory symptoms in addition to motor and/or coordination symptoms at onset, however, indicated a better prognosis than coordination and/or motor symptoms alone. This observation and the results of regression analyses indicated that specific groupings of symptoms at onset were more important for predicting course than the number of symptoms present at onset.

Underlying cause of death as recorded for multiple sclerosis patients: Associated factors

The coding of multiple sclerosis (MS) as underlying cause of death (UCD) on the death certificate provides an important epidemiologic resource for both descriptive and analytic studies. However, not all deaths among MS patients will be so coded. We investigated the effect on estimated occurrence of MS and on characteristics of MS patients when only UCD codes are used to identify cases. Of 2329 MS patients living in Los Angeles County (California) or King/Pierce Counties (Washington) in 1970, 438 had died by 1980. Only 53% of the deaths were coded to MS; 47% were attributed to other causes. Based on our comparisons, the use of only MS-coded deaths to describe decedents would: underestimate the age at MS onset; overestimate the female:male ratio; underestimate age at death; and underestimate duration of MS. Also, the percentage of MS-coded deaths decreased with lengthening duration of follow-up of these prevalent cases. The effect of using only UCD codes to report characteristics of decedents with other chronic diseases may well be similar.

Two populations with multiple sclerosis

SummaryCross-sectional data from 1,793 cases of definite or probable multiple sclerosis (MS) identified in an extensive population survey in King and Pierce (K-P) Counties, Washington and Los Angeles (LA) County, California, were analyzed. Compared to the U.S. population as a whole, patients were more likely to be divorced and to have more years of schooling. The prevalence of MS was higher for females, and for northern-born, regardless of sex. Reconstructed age-, sex-specific incidence rate estimates for natives of the two areas showed a much higher peak annual incidence occurring in an older age group in K-P than in LA. Earliest symptoms in both areas were numbness in the legs, double vision, and loss of vision in one or both eyes. Weakness in arms, speech difficulties, and urinary incontinence tended to be late symptoms. The overall assessment of disability levels showed more than half of the patients to be fully ambulatory at the time of the first interview, with a somewhat higher proportion of each sex severely disabled in California. The ages of onset tended to be younger in LA than in K-P. The earlier onset of disease and the higher proportion of patients with high disability in Los Angeles County suggest that the course of disease is more malignant in this low-prevalence area.ZusammenfassungEs wurden Durchschnittsdaten von 1793 Fällen definitiver und wahrscheinlicher Multipler Sklerose (MS) analysiert, die in umfangreichen Bevölkerungserhebungen identifiziert wurden, in den Landkreisen King und Pierce (K-P) in Washington und in dem Landkreis Los Angeles (LA). Verglichen mit der Gesamtbevölkerung der Vereinigten Staaten, waren die Patienten häufiger geschieden und hatten mehr Jahre Schulung. Das Auftreten von MS war häufiger bei weiblichen Personen und bei solchen, die im Norden geboren waren, ungeachtet des Geschlechts. Die Schätzungen der Rate der rekonstruierten alters- und geschlechtsspezifischen Fälle für die Einwohner der zwei Gebiete zeigt einen viel höheren Höchstwert von jährlichem Fallauftreten bei den älteren Altersgruppen in K-P als in LA. Erste Symptome in beiden Gegenden waren Gefühllosigkeit in den Beinen, Doppelsichtigkeit und Verlust des Sehvermögens auf einem oder beiden Augen. Schwäche in den Armen, Sprachschwierigkeiten und Harnfluß waren mehr spätere Symptome. Die Gesamtbewertung der Behinderungsstadien zeigte, daß mehr als die Hälfte der Patienten zur Zeit des ersten Interviews völlig ambulant waren, mit einem etwas höheren Anteil an schwer behinderten bei Personen von beiderlei Geschlecht in Kalifornien. Das Alter bei Beginn neigte in LA jünger zu sein als in K-P. Das frühere Anfangsalter der Krankheit und der höhere Anteil von Patienten mit schwerer Behinderung in dem Landkreis Los Angeles weist auf einen bösartigeren Verlauf in diesem Gebiet mit geringer Verbreitung.

Measles antibody titers in multiple sclerosis patients and HLA‐matched and unmatched siblings

Antibody titers to measles, cytomegalovirus, and herpesviruses 1 and 2 were compared for siblings of multiple sclerosis (MS) patients sharing two, one, and no histocompatibility antigen haplotypes with the case. Significant differences were observed only for measles. Titers were significantly lower in siblings sharing no haplotypes with the case. Within case-sibling pairs, the presence of HLA-A3 and/or B7 affected measles antibody titers more than the presence of MS. These findings suggest that the immune response to measles in these sibships is influenced by the presence of HLA-A3 and/or B7 as well as another familial factor.

Role of Heat in Multiple Sclerosis Symptoms in a High- and a Low-Prevalence Area

A significantly higher proportion of Los Angeles County (State of California, USA) multiple sclerosis patient than of King-Pierce Counties (State of Washington, USA) patients, interviewed as part of a

Serum Immune Complex Levels in Multiple Sclerosis Cases and Their Unaffected Siblings

To determine whether the multiple sclerosis susceptibility (MSS) gene has an effect on serum immune complex (IC) levels, we used the solid-phase Clq binding assay to test for the presence of IC in ser