1514
41 8°C for 60-155 min using a radiant heat device. When patients reach target temperature the chamber air temperature ranges from 43 to 45°C; maximum skin-surface temperature is routinely 42-43°C. None of our hyperthermia treatments has resulted in clinical or laboratory evidence of rhabdomyolysis or other significant clinical toxicity ;2 serum electrolytes, creatinine, aspartate transaminase, and creatinine phosphokinase have always remained normal. In the rhabdomyolysis patient reported by Cook et al, it is probable that maximum core and surface temperatures were well below those routinely attained in our patients, the outside temperature being at most 344°C. Thus, we find it difficult to attribute this patient’s rhabdomyolysis to temperature elevation alone. Indeed, rhabdomyolysis during or following severe febrile illnesses is probably not related to temperature elevation by itself; other factors must be involved-eg, vascular hypoperfusion and/or hypoxia plus fever. This man had pain, swelling, and diffuse calcifications only in his arm muscles, after prolonged work with his arms, so trauma as a cause for the rhabdomyolysis is plausible. Departments of Human Oncology, Medicine, and Neurological Surgery, Clinical Sciences Center, University of Wisconsin, Madison, Wisconsin 53792, USA
Primary Health Care Centre University of Lund, Horby, Sweden
in
JUSTIN D. COHEN
Horby, GORAN
G. JONSSON
H. IAN ROBINS
HI, Dennis WH, Neville AJ, et al. A nontoxic system for 41 8°C whole body hyperthermia. results of a phase I study using a radiant heat device. Cancer Res 1985; 45: 3937-44
1. Robins
Oral treatment of late borreliosis with roxithromycin plus co-trimoxazole SIR,—Dr Gasser and Dr Dusleag report (Nov 10, p 1189) successful treatment of a man with Borrelia burgdorferi infection with a combination of roxithromyin and co-trimoxazole and advocate this as a useful oral therapy for late Lyme borreliosis. They state that co-trimoxazole is effective treatment against Treponema pallidum, which is incorrect; co-trimoxazole has no activity against this organism. As Gasser and Dusleag point-out, the new macrolide roxithromycin shows both activity against the spirochaete B burgdorferi and excellent penetration through the blood-brain barrier. Additional benefit from co-trimoxazole in this case is therefore questionable; trials to determine whether roxithromycin alone is suitable oral therapy for late Lyme borreliosis are needed. Department of Genitourinary Medicine, City Hospital, Nottingham NG5 1 PB, UK 1. Wellcome Medical Division
*% of all visits t% of all positives t% of all positive women
Between July, 1987, and July, 1990, 11 838 new clients had sought advice from OeAH (table). 582 (4-92%) were found to be HIV-1 antibody positive (Abbott ELISA, confirmed by western blot and immunofluorescence tests). During those 3 years there was a slight fall in the total number of clients per half-year who enrolled at OeAH for the first time. The percentage of newly diagnosed HIV-1 seropositivity also decreased. By contrast, a significant increase in seropositivity in females was observed (p 003; x2 test for linear trend). Among female clients there was a significant increase in those with heterosexual HIV-1transmission (p=002). The questionnaires showed that heterosexual HIV-1transmission was associated with sexual contact with known HIV-1 seropositive partners (30%), with partners in AIDS high-incidence groups but of unknown serological status (33%, mainly drug users), and with =
Departments of Human Oncology, Medicine, Neurology, and Veterinary Medicine, University of Wisconsin Clinical Sciences Center, Madison, Wisconsin
HIV-1 SEROPOSITIVITY AMONG CLIENTS SEEN FOR FIRST TIME
C. A. BOWMAN
Septrin data sheet. ABPI data sheet 1990-91. London Data Pharm, 1990: 1882-88.
compendium
Heterosexual transmission of HIV-1 in women in Austria SIR,-Oesterreichische AIDS-HILFE (OeAH), a private foundation, offers anonymous voluntary testing for HIV-1, counselling, and medical information free of charge to the general public. Starting in 1985 with one counselling site in Vienna, OeAH has since 1987 had centres in seven of Austria’s nine state capitals. The centres are not in clinics or doctors’ offices. Since July, 1987, OeAH has had a standardised nationwide computer-based documentation system for all counselling contacts. Besides HIV-1 serostatus, classic risk categories (sexual behaviour, intravenous drug use, haemophilia, transfusions) and occupational risk have been recorded. Intravenous drug use is defmed by an admission of the illicit injection of drugs at least once, even when needle sharing is denied.
promiscuity (30%). Heterosexual transmission ofHIV-1is thus increasing in Austria, slowly but steadily. Although our data are not strictly population based, as would be achieved by screening of Guthrie cards,’ and not community specific, as they would be if derived from antenatal screening in clinics,2.3 our data do provide some insight into the temporal pattern of the HIV-1epidemic in Austria. This pattern is a valuable indicator of "where and how fast" the epidemic is headed.’.4 Intravenous drug users constitute a high percentage of Austrian AIDS patients,s a fact which may support the spread of HIV-1 within the heterosexual population. Osterreichische AIDS-Hilfe, A-1070 Vienna, Austria
FRANZ PIRIBAUER
Department of Dermatology and Venereology, University of Innsbruck
ROBERT ZANGERLE
1. Howard
LC, Hawkins DA, Marwood R, et al. Transmission of human immunodeficiency virus by heterosexual contact with reference to antenatal screening. Br J Obstet Gynaecol 1989; 96: 135-39. 2. Banatvala JE, Chrystie IL, Palmer SJ, Kenney A Retrospective study of HIV, hepatitis B, and HTLV-1 infection at a London antenatal clinic. Lancet 1990; 335: 859-60 3. Heath RB, Gnnt PCA, Hardiman AE. Anonymous testing of women attending antenatal clinics for evidence of infection with HIV. Lancet 1988; i: 1394 4. Editorial. Anonymous HIV testing. Lancet 1990; 335: 575-76. 5. Fuchs D, Hausen A, Reibnegger G, et al. AIDS incidence rates in Austria. Wien Klin Wochenschr 1989; 101: 388-90.
No evidence for HIV-2 infection in Uganda SIR,-"Slim" disease was first recognised in 1982 in Rakai district of Uganda, on the shores of Lake Victoria. It has since been confirmed as a local presentation of AIDS.’ HIV-1has now spread to all parts of Uganda. HIV-2 can also cause AIDS; this virus is endemic in parts of West and Central Africa but has been reported less frequently elsewhere. At the Uganda Virus Research Institute, 2000 randomly selected sera received during 1987 for HIV-1testing were screened for HIV-2 without yielding a single case (unpublished). We reasoned that since HIV-1appeared first in Uganda in Rakai District, this might also be the case for HIV-2. Sera collected in Rakai district between December, 1988, and April, 1989, were assayed for antibodies to HIV-1 and HIV-2. Although 3 samples were reactive to both viruses, none were reactive to HIV-2 alone.2
41 8°C for 60-155 min using a radiant heat device. When patients reach target temperature the chamber air temperature ranges from 43 to 45°C; maximum skin-surface temperature is routinely 42-43°C. None of our hyperthermia treatments has resulted in clinical or laboratory evidence of rhabdomyolysis or other significant clinical toxicity ;2 serum electrolytes, creatinine, aspartate transaminase, and creatinine phosphokinase have always remained normal. In the rhabdomyolysis patient reported by Cook et al, it is probable that maximum core and surface temperatures were well below those routinely attained in our patients, the outside temperature being at most 344°C. Thus, we find it difficult to attribute this patient’s rhabdomyolysis to temperature elevation alone. Indeed, rhabdomyolysis during or following severe febrile illnesses is probably not related to temperature elevation by itself; other factors must be involved-eg, vascular hypoperfusion and/or hypoxia plus fever. This man had pain, swelling, and diffuse calcifications only in his arm muscles, after prolonged work with his arms, so trauma as a cause for the rhabdomyolysis is plausible. Departments of Human Oncology, Medicine, and Neurological Surgery, Clinical Sciences Center, University of Wisconsin, Madison, Wisconsin 53792, USA
Primary Health Care Centre University of Lund, Horby, Sweden
in
JUSTIN D. COHEN
Horby, GORAN
G. JONSSON
H. IAN ROBINS
HI, Dennis WH, Neville AJ, et al. A nontoxic system for 41 8°C whole body hyperthermia. results of a phase I study using a radiant heat device. Cancer Res 1985; 45: 3937-44
1. Robins
Oral treatment of late borreliosis with roxithromycin plus co-trimoxazole SIR,—Dr Gasser and Dr Dusleag report (Nov 10, p 1189) successful treatment of a man with Borrelia burgdorferi infection with a combination of roxithromyin and co-trimoxazole and advocate this as a useful oral therapy for late Lyme borreliosis. They state that co-trimoxazole is effective treatment against Treponema pallidum, which is incorrect; co-trimoxazole has no activity against this organism. As Gasser and Dusleag point-out, the new macrolide roxithromycin shows both activity against the spirochaete B burgdorferi and excellent penetration through the blood-brain barrier. Additional benefit from co-trimoxazole in this case is therefore questionable; trials to determine whether roxithromycin alone is suitable oral therapy for late Lyme borreliosis are needed. Department of Genitourinary Medicine, City Hospital, Nottingham NG5 1 PB, UK 1. Wellcome Medical Division
*% of all visits t% of all positives t% of all positive women
Between July, 1987, and July, 1990, 11 838 new clients had sought advice from OeAH (table). 582 (4-92%) were found to be HIV-1 antibody positive (Abbott ELISA, confirmed by western blot and immunofluorescence tests). During those 3 years there was a slight fall in the total number of clients per half-year who enrolled at OeAH for the first time. The percentage of newly diagnosed HIV-1 seropositivity also decreased. By contrast, a significant increase in seropositivity in females was observed (p 003; x2 test for linear trend). Among female clients there was a significant increase in those with heterosexual HIV-1transmission (p=002). The questionnaires showed that heterosexual HIV-1transmission was associated with sexual contact with known HIV-1 seropositive partners (30%), with partners in AIDS high-incidence groups but of unknown serological status (33%, mainly drug users), and with =
Departments of Human Oncology, Medicine, Neurology, and Veterinary Medicine, University of Wisconsin Clinical Sciences Center, Madison, Wisconsin
HIV-1 SEROPOSITIVITY AMONG CLIENTS SEEN FOR FIRST TIME
C. A. BOWMAN
Septrin data sheet. ABPI data sheet 1990-91. London Data Pharm, 1990: 1882-88.
compendium
Heterosexual transmission of HIV-1 in women in Austria SIR,-Oesterreichische AIDS-HILFE (OeAH), a private foundation, offers anonymous voluntary testing for HIV-1, counselling, and medical information free of charge to the general public. Starting in 1985 with one counselling site in Vienna, OeAH has since 1987 had centres in seven of Austria’s nine state capitals. The centres are not in clinics or doctors’ offices. Since July, 1987, OeAH has had a standardised nationwide computer-based documentation system for all counselling contacts. Besides HIV-1 serostatus, classic risk categories (sexual behaviour, intravenous drug use, haemophilia, transfusions) and occupational risk have been recorded. Intravenous drug use is defmed by an admission of the illicit injection of drugs at least once, even when needle sharing is denied.
promiscuity (30%). Heterosexual transmission ofHIV-1is thus increasing in Austria, slowly but steadily. Although our data are not strictly population based, as would be achieved by screening of Guthrie cards,’ and not community specific, as they would be if derived from antenatal screening in clinics,2.3 our data do provide some insight into the temporal pattern of the HIV-1epidemic in Austria. This pattern is a valuable indicator of "where and how fast" the epidemic is headed.’.4 Intravenous drug users constitute a high percentage of Austrian AIDS patients,s a fact which may support the spread of HIV-1 within the heterosexual population. Osterreichische AIDS-Hilfe, A-1070 Vienna, Austria
FRANZ PIRIBAUER
Department of Dermatology and Venereology, University of Innsbruck
ROBERT ZANGERLE
1. Howard
LC, Hawkins DA, Marwood R, et al. Transmission of human immunodeficiency virus by heterosexual contact with reference to antenatal screening. Br J Obstet Gynaecol 1989; 96: 135-39. 2. Banatvala JE, Chrystie IL, Palmer SJ, Kenney A Retrospective study of HIV, hepatitis B, and HTLV-1 infection at a London antenatal clinic. Lancet 1990; 335: 859-60 3. Heath RB, Gnnt PCA, Hardiman AE. Anonymous testing of women attending antenatal clinics for evidence of infection with HIV. Lancet 1988; i: 1394 4. Editorial. Anonymous HIV testing. Lancet 1990; 335: 575-76. 5. Fuchs D, Hausen A, Reibnegger G, et al. AIDS incidence rates in Austria. Wien Klin Wochenschr 1989; 101: 388-90.
No evidence for HIV-2 infection in Uganda SIR,-"Slim" disease was first recognised in 1982 in Rakai district of Uganda, on the shores of Lake Victoria. It has since been confirmed as a local presentation of AIDS.’ HIV-1has now spread to all parts of Uganda. HIV-2 can also cause AIDS; this virus is endemic in parts of West and Central Africa but has been reported less frequently elsewhere. At the Uganda Virus Research Institute, 2000 randomly selected sera received during 1987 for HIV-1testing were screened for HIV-2 without yielding a single case (unpublished). We reasoned that since HIV-1appeared first in Uganda in Rakai District, this might also be the case for HIV-2. Sera collected in Rakai district between December, 1988, and April, 1989, were assayed for antibodies to HIV-1 and HIV-2. Although 3 samples were reactive to both viruses, none were reactive to HIV-2 alone.2
