Reinhold Müller

Imprisonment: a risk factor for HIV infection counteracting education and prevention programmes for intravenous drug users.

Objectives: To examine changes of risk behaviour and its determinants as well as risk factors for HIV infection in intravenous drug users (IVDU) with particular attention to imprisonment and its risk patterns. Setting: In 1993 a multisite cross‐sectional study was carried out by standardized questionnaires and blood/saliva samples in which 612 IVDU from Berlin were enrolled. Results: Multifactorial analysis revealed that the most important risk factor for HIV infection was needle‐sharing in prison. In total, 353 IVDU (58%) reported reduced risk behaviour; changes related more to injection behaviour than sexual practices (91 versus 68%). Important determinants for needle‐sharing during the last 6 months were intravenous drug use in prison, duration of drug‐taking history, and knowledge of a negative HIV test. The most frequently reported reasons for current needle‐sharing were having shared needles with only one regular partner (45%) and imprisonment (26%). Conclusion: Information campaigns and other prevention measures appear to have produced risk awareness in IVDU, and as a consequence, a reduction in risk behaviour. The situation in prisons (no sterile injecting equipment, no effective disinfectants), however, is counteractive to prevention measures implemented outside prisons. An important task for future strategies should be to enable IVDU to avoid HIV transmission while in prisons.

Prevalence and determinants of anti-HCV seropositivity and of HCV genotype among intravenous drug users in Berlin.

A cross-sectional study was carried out to identify risk factors for seropositivity for antibodies against hepatitis C virus (HCV) and to assess to the distribution and determinants of HCV genotypes among intravenous drug users (IVDUs). The study population consisted of 405 IVDUs. Serum specimens were tested for seromarkers for HCV, for human immunodeficiency virus (HIV), for hepatitis B virus (HBV) and for syphilis. HCV RNA determination by polymerase chain reaction (PCR) and virus typing were performed in a subsample of anti-HCV-positive specimens (n=135). Of the IVDUs, 83% were anti-HCV-positive, 18% HIV-infected, and 58% HBV (anti-HBc)-positive. Longer duration of intravenous drug use, syringe sharing in prison, and higher number of IDVU sex partners were independent risk factors for anti-HCV positivity. GCV RNA was detected in 76% of anti-HCV-positive IVDUs. HCV genotypes 1 (49%) and 3 (44%) were most commonly found. All the type 3 isolates were identified as subtype 3a, and 95% of the type 1 isolates as subtype 1b. In logistic regression analysis, HCV type 3a viraemia was significantly associated with lack of HIV infection and a higher number of sex partners. The results indicate that preventive measures are needed to reduce syringe sharing among IVDUs in prisons. Sexual contacts with other IVDUs may play a role in the HCV epidemic among IVDUs. In Germany, HCV type 3a infection appears to be much more common among IVDUs than among other HCV risk groups such as transfusion recipients or haemophiliacs.

Noninvasive measurement of left ventricular filling pressures by means of transmitral pulsed Doppler ultrasound

In 54 consecutive patients, ages 59 +/- 11 years, the transmitral diastolic flow velocity profile was derived by means of pulsed Doppler echocardiography simultaneously with right-sided heart catheterization. In 30 of them, ages 57 +/- 10 years, left-sided heart catheterization was performed at the same time. The sample volume was positioned exactly in the mitral anulus plane, bisecting the anulus. The ratio of the time-velocity integrals of the A wave (atrial contraction) and E wave (early filling) was calculated (A/E ratio of integrals). Linear regression analysis showed a highly significant linear correlation of the A/E ratio of integrals with regard to left ventricular (LV) end-diastolic pressure (r = 0.98, p less than 0.001) and pulmonary capillary wedge pressure (r = 0.98, p less than 0.001). The A/E ratio of integrals also correlated with other hemodynamic parameters, such as cardiac output (r = -0.73, p less than 0.001), cardiac index (r = -0.74, p less than 0.001) and stroke volume index (r = -0.65, p less than 0.001). For 19 additional patients, ages 55 +/- 8 years, the values of LV end-diastolic pressure and pulmonary capillary wedge pressure were calculated by means of the corresponding formulas from the first data set. The correlation between the calculated and invasively measured LV filling pressures expressed in terms of intraclass correlation coefficients shows highly significant correlations for both LV end-diastolic pressure (intraclass correlation coefficient = 0.99, p less than 0.001) and pulmonary capillary wedge pressure (intraclass correlation coefficient = 0.99, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

HIV infection in intravenous drug abusers in Berlin: Risk factors and time trends

SummaryTo investigate the epidemiology of HIV infection among intravenous drug abusers (IVDA) in Berlin (West), from October 1984 to October 1988, 741 heterosexual IVDA were recruited from facilities for drug treatment and counseling. In this group 22.8% were seropositive for antibodies against HIV, representing 21.1% of the females and 23.5% of the males. Seroprevalences of hepatitis B, hepatitis A, and lues were 67.7%, 40.1%, and 4.0%, respectively. Seropositivity for HIV antibodies correlated with positive seromarkers for hepatitis B and A, and with certain behavioral and social features such as sharing of injection equipment, imprisonment, and intravenous drug use in prison. The crude time trend of HIV seroprevalence shows an increase from 17.1% in those subjects who discontinued i.v. drug abuse in 1983 or earlier to 31.5% in 1985, and a decrease over the past 3 years to 14.1% in 1988. After adjusting for temporary changes in the study group, the estimated HIV seroprevalence odds show an almost steady increase and were significantly higher for those who were injecting drugs in 1987 and 1988 compared with those who stopped i.v. drug use before 1984. Thus IVDA with a persistent risk profile are at a still-increasing risk of acquiring HIV infection.

Behavioral characteristics and laboratory parameters in homo- and bisexual men in West Berlin: An evaluation of five years of testing and counselling on AIDS

SummarySera of 1980 homo- and bisexual men who visited the Landesinstitut für Tropenmedizin Berlin (West) between April 1983 and December 1987 were tested for HIV antibodies; 24.3% were positive.Of HIV-antibody-positive men, 78.9% reported both active and passive anal intercourse, 58.8%, rectal enemas, and 53.3%, use of butyl nitrite. There was a sexual partner with known positive HIV-antibody status or AIDS in 33.9%, and in 32.4% there was a history of sexual activity in the USA. In the year before the test, 18.8% had had more than 50 partners. All these behavioral characteristics were found to be significantly correlated to HIV antibodies.We noted a substantial reduction of high-risk behavior from 1983 to 1987. The most important behavioral factor for HIV infection in 1983 and 1984 was sexual activity in the USA, and from 1984 to 1987, the numbers of lifetime partners.Persons infected with HIV were significantly more often carriers of antibodies against HAV, HBV, CMV, EBV, and syphilis. Prevalence of antibodies against HIV, HAV, HBV, and syphilis increased with age, duration of homosexual practice, and the number of partners. Overall crude prevalence rates of HIV antibodies, anti-HBc, anti-HAV, and antibodies to syphilis declined during the observation period.Clinical findings such as fever, oral lesions, and lymphadenopathy syndrome (LAS) were found to be highly indicative of HIV infection. Lower hemoglobin values, a reduced white cell count, and hyperimmunoglobulinemia were significantly more frequent in subjects with HIV antibodies.

Determinants of current HIV risk behaviour among injecting drug users in Warsaw, Poland

Of the injecting drug users (IDUs), 24% had borrowed, and 37% had passed on syringes in the previous 6 months. In logistic regression analysis, current borrowing of syringes was significantly associated with a shorter duration of injecting drug use, a higher number of drug-injecting sex partners in the previous 6 months, and with current lending of syringes. A majority of the IDUs have modified previous HIV risk behaviour but these modifications are insufficient and not sustained over time. Intensified AIDS prevention measures for IDUs in Poland are needed.

HIV infection in prisons. High risk behaviour is common in prisons in Berlin.

EDITOR,—The issue of 4 February provides important further evidence that injecting drug users in prisons are at high risk of acquiring parenterally transmitted diseases. In a recent study among 612 injecting drug users in Berlin 418 reported a history of imprisonment.1 Of these, 202 continued to inject while in prison and 152 of these started sharing needles during their imprisonment. Needle sharing in prison proved to be the most important risk factor for HIV infection as well as a major risk factor for infection with hepatitis B and C viruses (adjusted odds ratio 10.0, 1.7, and 9.8 respectively). …

Activation of Thrombocytes and the Hemostatic System During Maximal Cycle Exercise in Healthy Triathletes

Physical exercise is widely regarded to be important for health. However, heavy physical exertion has been shown to be associated with a higher incidence of myocardial infarction (3, 13, 30). It has also been shown that physical exercise activates fibrinolysis, coagulation and thrombocytes (8, 9, 10, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 26, 27, 28). Methodological problems, such as in vitro activation of platelets, limited the value of earlier studies. Newly developed analytical tests for molecular markers of the hemostatic system (20) and flow-cytometric techniques for the detection of surface antigens on platelets (25) have enabled more detailed insights into the changes of the hemostatic system during exercise.