The risk of certain psychiatric disorders appears uniquely elevated in HIV+ men. Since other factors also influence risk, interventions designed to minimize psychopathology during HIV infection should attend to both HIV-related and non-HIV-related risk factors.

This paper is a report on the first phase of a long-term, interdisciplinary project whose goal is to increase the overall effectiveness of physicians' time, and thus the quality of health care, by improving the information exchange between physicians and patients in clinical settings. We are focusing on patients with long-term and chronic conditions, initially on migraine patients, who require periodic interaction with their physicians for effective management of their condition. We are using medical informatics to focus on the information needs of patients, as well as of physicians, and to address problems of information exchange. This requires understanding patients' concerns to design an appropriate system, and using state-of-the-art artificial intelligence techniques to build an interactive explanation system. In contrast to many other knowledge-based systems, our system's design is based on empirical data on actual information needs. We used ethnographic techniques to observe explanations actually given in clinic settings, and to conduct interviews with migraine sufferers and physicians. Our system has an extensive knowledge base that contains both general medical terminology and specific knowledge about migraine, such as common trigger factors and symptoms of migraine, the common therapies, and the most common effects and side effects of those therapies. The system consists of two main components: (a) an interactive history-taking module that collects information from patients prior to each visit, builds a patient model, and summarizes the patients' status for their physicians; and (b) an intelligent explanation module that produces an interactive information sheet containing explanations in everyday language that are tailored to individual patients, and responds intelligently to follow-up questions about topics covered in the information sheet.

Ribavirin, a broad spectrum, non-interferon-inducing virustatic chemotherapeutic agent, demonstrates activity against a wide range of RNA and DNA viruses, including the retrovirus known to cause the acquired immune deficiency syndrome. The drug's proposed mechanism of action, as well as pharmacokinetics are discussed, and preclinical toxicity, safety and clinical efficacy studies are presented. To date, the best success has occurred in the use of ribavirin to treat respiratory syncytial virus infection in infants and young children and to treat influenza A and B virus infections in young adults. Viral infections, particularly viral pneumonia, are often life-threatening in infants with severe combined immunodeficiency disease (SCID), and ribavirin aerosol has been used successfully to treat respiratory syncytial virus and parainfluenza virus infection of immunodeficient children. Special note is taken of ribavirin's clinical benefit in treating severe and life-threatening infections caused by the Lassa fever virus and the significant improvement over either the use of immune plasma or supportive therapy alone. Indeed, ribavirin thus emerges as the first antiviral drug that is able to reduce mortality in a highly lethal systemic disease by more than 90%. Additional studies demonstrate the drug's efficacy in acute viral hepatitis, herpesvirus infections, and measles. Controlled clinical trials are underway to test the drug in patients infected with the AIDS virus.

The neuropsychological defects associated with late stage HIV infection and AIDS have been characterized as being similar to those seen in patients with dementia syndromes of subcortical etiologies. The purpose of this paper is to report on the cross-center replication of the classification of HIV-infected subjects' neuropsychological status based on a discriminant function generated from other HIV-related and unrelated cognitively impaired subjects. Of the HIV-control subjects, 42/46 (91.3%) were classified as "Normal", with only two subjects in each of two "dementia" groups: subcortical and cortical. However, similar to other HIV+ samples, a large proportion (36%) of our HIV-infected subjects were classified as "Subcortical", with 61% classified as "Normal", and one (3%) in the "Cortical" group. These data demonstrate that not only does the cognitive performance of some HIV+ subjects have distinct features relative to that of HIV-control subjects, but that the features are consistent with previous suggestions that such patients have a "Subcortical" pattern of impairment.

The purpose of this study was to determine the nature and extent of neuropsychological abnormalities among HIV-infected individuals and to examine the interrelationships between measures of cognitive functions and the factors that predict neuropsychological abnormalities. The study focused on cross-sectional data gathered in a multidisciplinary research clinic form 200 HIV-infected (HIV +) men and women recruited from primary medical care settings. Composite scores representing six cognitive domains were derived from the neuropsychological test data. Scores of memory, fluency, spatial, and frontal functions could be predicted by independent assessment of participants' verbal and psychomotor speed abilities. Basic verbal ability itself was predicted by education, race, and handedness, whereas speed was predicted by age, CD4+ cell counts, and a lifetime history of major depression. This model of effects is consistent with the hypothesis that psychomotor slowing is central to mild cognitive disorder in HIV infection and that such changes are associated with markers of the severity of systemic infection.