Michael Marmor, Ph.D.

Viewing Pornography Depicting Unprotected Anal Intercourse: Are There Implications for HIV Prevention Among Men Who Have Sex with Men?
Stein D; Silvera R; Hagerty R; Marmor M
2011 Jul 14;:?-? #, Archives of sexual behaviour
We used an Internet-based questionnaire to investigate whether viewing pornography depicting unprotected anal intercourse (UAI) was associated with engaging in UAI in a sample of 821 non-monogamous men who have sex with men (MSM). In the 3 months prior to interview, 77.2% viewed pornography depicting UAI, 42.6% engaged in insertive UAI, and 38.9% engaged in receptive UAI. Polytomous logistic regression of the 751 subjects who provided data on pornography viewing showed significantly elevated odds ratios for having engaged in receptive UAI, insertive UAI, and both receptive and insertive UAI associated with increasing percentage of pornography viewed that depicted UAI. We also found independently significant associations of engaging in UAI with age, use of inhalant nitrites, and HIV status. Although the data cannot establish causality, our findings indicate that viewing pornography depicting UAI and engaging in UAI are correlated. Further research is needed to determine if this observation may have utility for HIV prevention
— id: 135287, year: 2011, vol: , page: ?, stat: Journal Article,

Evidence of dysregulation of dendritic cells in primary HIV infection
Sabado, Rachel Lubong; O'Brien, Meagan; Subedi, Abhignya; Qin, Li; Hu, Nan; Taylor, Elizabeth; Dibben, Oliver; Stacey, Andrea; Fellay, Jacques; Shianna, Kevin V; Siegal, Frederick; Shodell, Michael; Shah, Kokila; Larsson, Marie; Lifson, Jeffrey; Nadas, Arthur; Marmor, Michael; Hutt, Richard; Margolis, David; Garmon, Donald; Markowitz, Martin; Valentine, Fred; Borrow, Persephone; Bhardwaj, Nina
2010 Nov 11;116(19):3839-3852, Blood
Myeloid and plasmacytoid dendritic cells (DCs) are important mediators of both innate and adaptive immunity against pathogens such as HIV. During the course of HIV infection, blood DC numbers fall substantially. In the present study, we sought to determine how early in HIV infection the reduction occurs and whether the remaining DC subsets maintain functional capacity. We find that both myeloid DC and plasmacytoid DC levels decline very early during acute HIV in-fection. Despite the initial reduction in numbers, those DCs that remain in circulation retain their function and are able to stimulate allogeneic T-cell responses, and up-regulate maturation markers plus produce cytokines/chemokines in response to stimulation with TLR7/8 agonists. Notably, DCs from HIV-infected subjects produced significantly higher levels of cytokines/chemokines in response to stimulation with TLR7/8 agonists than DCs from uninfected controls. Further examination of gene expression profiles indicated in vivo activation, either directly or indirectly, of DCs during HIV infection. Taken together, our data demonstrate that despite the reduction in circulating DC numbers, those that remain in the blood display hyperfunctionality and implicates a possible role for DCs in promoting chronic immune activation
— id: 114507, year: 2010, vol: 116, page: 3839, stat: Journal Article,

The Development and Implementation of an Outreach Program to Identify Acute and Recent HIV Infections in New York City
Silvera, Richard; Stein, Dylan; Hutt, Richard; Hagerty, Robert; Daskalakis, Demetre; Valentine, Fred; Marmor, Michael
2010 ;4:76-83, Open AIDS journal
INTRODUCTION: Since 2004, the authors have been operating First Call NYU, an outreach program to identify acute and recent HIV infections, also called primary HIV infections, among targeted at-risk communities in the New York City (NYC) metropolitan area. MATERIALS AND METHODOLOGY: First Call NYU employed mass media advertising campaigns, outreach to healthcare providers in NYC, and Internet-based efforts including search engine optimization (SEO) and Internet-based advertising to achieve these goals. RESULTS: Between October 2004 and October 2008, 571 individuals were screened through this program, leading to 446 unique, in-person screening visits. 47 primary HIV infections, including 14 acute and 33 recent HIV infections, were identified. DISCUSSION: Internet and traditional recruitment methods can be used to increase self-referrals for screening following possible exposure to HIV. CONCLUSION: Community education of at-risk groups, with the goal of increased self-diagnosis of possible acute HIV infection, may be a useful addition to traditional efforts to identify such individuals
— id: 109049, year: 2010, vol: 4, page: 76, stat: Journal Article,

Implementation of HIV testing at 2 New York City bathhouses: from pilot to clinical service
Daskalakis, Demetre; Silvera, Richard; Bernstein, Kyle; Stein, Dylan; Hagerty, Robert; Hutt, Richard; Maillard, Alith; Borkowsky, William; Aberg, Judith; Valentine, Fred; Marmor, Michael
2009 Jun 1;48(11):1609-1616, Clinical infectious diseases
BACKGROUND: Commercial sex venues (e.g., bathhouses) that cater to men who have sex with men (MSM) continue to function in most urban areas. These venues present a challenge to developing strategies to prevent the spread of the human immunodeficiency virus (HIV), but they also provide opportunities for interventions to reduce the risk and rate of disease transmission. Several cities in the United States have developed programs that offer HIV testing in these venues. Similar programs have not existed before in New York City. METHODS: A pilot HIV testing program was implemented at 2 New York City bathhouses. Testing included rapid HIV testing, the use of the serologic testing algorithm for recent HIV seroconversion, and pooled plasma HIV viral load to detect and date incident and acute HIV infections. In addition to HIV tests, behavioral and demographic data were collected from 493 presumed HIV-negative participants. RESULTS: The pilot program recruited MSM who were at high risk for HIV infection. Of the 493 men tested, 20 (4%) were found to be positive for HIV, and 8 (40%) of these 20 men demonstrated evidence of acute or recent HIV infection. The program tested men often not tested in more traditional medical settings. Significant disparities were demonstrated in the testing habits of MSM who reported having sex with women and had not disclosed same-sex activities to their caregivers. CONCLUSIONS: Bathhouse-based testing for HIV infection can be implemented in New York City and would include a population of MSM who are at high risk for HIV infection. Because of the high rate of recent HIV infection, expanded testing in these venues may be a good strategy to reduce the forward transmission of HIV in this highly sexually active population
— id: 98009, year: 2009, vol: 48, page: 1609, stat: Journal Article,

Characteristics of a residential and working community with diverse exposure to World Trade Center dust, gas, and fumes
Reibman, Joan; Liu, Mengling; Cheng, Qinyi; Liautaud, Sybille; Rogers, Linda; Lau, Stephanie; Berger, Kenneth I; Goldring, Roberta M; Marmor, Michael; Fernandez-Beros, Maria Elena; Tonorezos, Emily S; Caplan-Shaw, Caralee E; Gonzalez, Jaime; Filner, Joshua; Walter, Dawn; Kyng, Kymara; Rom, William N
2009 May;51(5):534-541, Journal of occupational & environmental medicine
OBJECTIVE: To describe physical symptoms in those local residents, local workers, and cleanup workers who were enrolled in a treatment program and had reported symptoms and exposure to the dust, gas, and fumes released with the destruction of the World Trade Center (WTC) on September 11, 2001. METHODS: Symptomatic individuals underwent standardized evaluation and subsequent treatment. RESULTS: One thousand eight hundred ninety-eight individuals participated in the WTC Environmental Health Center between September 2005 and May 2008. Upper and lower respiratory symptoms that began after September 11, 2001 and persisted at the time of examination were common in each exposure population. Many (31%) had spirometry measurements below the lower limit of normal. CONCLUSIONS: Residents and local workers as well as those with work-associated exposure to WTC dust have new and persistent respiratory symptoms with lung function abnormalities 5 or more years after the WTC destruction
— id: 98897, year: 2009, vol: 51, page: 534, stat: Journal Article,

Condom use and male homosexual pornography
Silvera, Richard; Stein, Dylan J; Hagerty, Robert; Marmor, Michael
2009 Oct;99(10):1732-1733, American journal of public health. AJPH
— id: 135288, year: 2009, vol: 99, page: 1732, stat: Journal Article,

Efficacy assessment of a cell-mediated immunity HIV-1 vaccine (the Step Study): a double-blind, randomised, placebo-controlled, test-of-concept trial
Buchbinder, Susan P; Mehrotra, Devan V; Duerr, Ann; Fitzgerald, Daniel W; Mogg, Robin; Li, David; Gilbert, Peter B; Lama, Javier R; Marmor, Michael; Del Rio, Carlos; McElrath, M Juliana; Casimiro, Danilo R; Gottesdiener, Keith M; Chodakewitz, Jeffrey A; Corey, Lawrence; Robertson, Michael N
2008 Nov 29;372(9653):1881-1893, Lancet
BACKGROUND: Observational data and non-human primate challenge studies suggest that cell-mediated immune responses might provide control of HIV replication. The Step Study directly assessed the efficacy of a cell-mediated immunity vaccine to protect against HIV-1 infection or change in early plasma HIV-1 levels. METHODS: We undertook a double-blind, phase II, test-of-concept study at 34 sites in North America, the Caribbean, South America, and Australia. We randomly assigned 3000 HIV-1-seronegative participants by computer-generated assignments to receive three injections of MRKAd5 HIV-1 gag/pol/nef vaccine (n=1494) or placebo (n=1506). Randomisation was prestratified by sex, adenovirus type 5 (Ad5) antibody titre at baseline, and study site. Primary objective was a reduction in HIV-1 acquisition rates (tested every 6 months) or a decrease in HIV-1 viral-load setpoint (early plasma HIV-1 RNA measured 3 months after HIV-1 diagnosis). Analyses were per protocol and modified intention to treat. The study was stopped early because it unexpectedly met the prespecified futility boundaries at the first interim analysis. This study is registered with ClinicalTrials.gov, number NCT00095576. FINDINGS: In a prespecified interim analysis in participants with baseline Ad5 antibody titre 200 or less, 24 (3%) of 741 vaccine recipients became HIV-1 infected versus 21 (3%) of 762 placebo recipients (hazard ratio [HR] 1.2 [95% CI 0.6-2.2]). All but one infection occurred in men. The corresponding geometric mean plasma HIV-1 RNA was comparable in infected male vaccine and placebo recipients (4.61 vs 4.41 log(10) copies per mL, one tailed p value for potential benefit 0.66). The vaccine elicited interferon-gamma ELISPOT responses in 75% (267) of the 25% random sample of all vaccine recipients (including both low and high Ad5 antibody titres) on whose specimens this testing was done (n=354). In exploratory analyses of all study volunteers, irrespective of baseline Ad5 antibody titre, the HR of HIV-1 infection between vaccine and placebo recipients was higher in Ad5 seropositive men (HR 2.3 [95% CI 1.2-4.3]) and uncircumcised men (3.8 [1.5-9.3]), but was not increased in Ad5 seronegative (1.0 [0.5-1.9]) or circumcised (1.0 [0.6-1.7]) men. INTERPRETATION: This cell-mediated immunity vaccine did not prevent HIV-1 infection or reduce early viral level. Mechanisms for insufficient efficacy of the vaccine and the increased HIV-1 infection rates in subgroups of vaccine recipients are being explored
— id: 91965, year: 2008, vol: 372, page: 1881, stat: Journal Article,

Re: Letter to the editor on "Bias in clinical intervention research"
Marmor, Michael; Belitskaya-Levy, Ilana; Arslan, Alan A
2008 Feb 15;167(4):500-501, American journal of epidemiology
— id: 91966, year: 2008, vol: 167, page: 500, stat: Journal Article,

Comparative evaluation of refractive surgery candidates with Placido topography, Orbscan II, Pentacam, and wavefront analysis
Nilforoushan, Mohammad-Reza; Speaker, Mark; Marmor, Michael; Abramson, Jodi; Tullo, William; Morschauser, Dana; Latkany, Robert
2008 Apr;34(4):623-631, Journal of cateract & refractive surgery
PURPOSE: To study the role of the Pentacam (Oculus), Orbscan II (Bausch & Lomb), and WaveScan (Visx) in evaluating topographic features identified as risk factors for ectasia after laser in situ keratomileusis to identify parameters that may be important in interpreting elevation topography and wavefront data when screening refractive surgery candidates. SETTING: Private practice, New York, New York, USA. METHODS: One hundred forty-five eyes of 75 consecutive patients were evaluated for refractive surgery by ultrasound pachymetry (Humphrey Atlas), videokeratography, WaveScan, Orbscan II, and Pentacam. Eyes were classified as normal or suspect based on the Rabinowitz criteria for keratoconus suspect on Placido disk-based videokeratography. Forty-six parameters were evaluated in a comparison of topographically normal eyes and eyes that met the criteria for keratoconus suspect. RESULTS: The suspect group had thinner pachymetry, multiple distinguishing characteristics on the anterior and posterior corneal surfaces by elevation topography, and larger amounts of coma by wavefront analysis. Multivariable regression analysis identified the following as the strongest predictors of a suspect Placido topography: Pentacam, thinner pachymetry and larger differences between the highest and lowest points on the posterior elevation; Orbscan II, higher anterior maximum elevation, horizontal location of the thinnest point on the pachymetry map, and larger differences between the highest and lowest points on the posterior elevation. CONCLUSION: Several parameters provided by the Pentacam, Orbscan II, WaveScan, and pachymetry were statistically correlated with keratoconus suspect, defined by higher asymmetry and steeper curvature on Placido topography
— id: 95368, year: 2008, vol: 34, page: 623, stat: Journal Article,

Safety and immunogenicity of a replication-incompetent adenovirus type 5 HIV-1 clade B gag/pol/nef vaccine in healthy adults
Priddy, Frances H; Brown, Deborah; Kublin, James; Monahan, Kathleen; Wright, David P; Lalezari, Jacob; Santiago, Steven; Marmor, Michael; Lally, Michelle; Novak, Richard M; Brown, Stephen J; Kulkarni, Priya; Dubey, Sheri A; Kierstead, Lisa S; Casimiro, Danilo R; Mogg, Robin; DiNubile, Mark J; Shiver, John W; Leavitt, Randi Y; Robertson, Michael N; Mehrotra, Devan V; Quirk, Erin
2008 Jun 1;46(11):1769-1781, Clinical infectious diseases
BACKGROUND: The safety and immunogenicity of the MRK adenovirus type 5 human immunodeficiency virus type 1 clade B gag/pol/nef vaccine, a replication-incompetent adenovirus type 5-vectored vaccine designed to elicit cell-mediated immunity against conserved human immunodeficiency virus proteins, was assessed in a phase 1 trial. METHODS: Healthy adults not infected with human immunodeficiency virus were enrolled in a multicenter, dose-escalating, blind, placebo-controlled study to evaluate a 3-dose homologous prime-boost regimen of the trivalent MRK adenovirus type 5 human immunodeficiency virus type 1 vaccine containing from 3 x 10(6) to 1 x 10(11) viral particles per 1-mL dose administered on day 1, during week 4 and during week 26. Adverse events were recorded for 29 days after each intradeltoid injection. The primary immunogenicity end point was the proportion of study participants with a positive unfractionated Gag-, Pol-, or Nef-specific interferon-gamma enzyme-linked immunosorbent spot response measured 4 weeks after administration of the last dose. RESULTS: Of 259 randomized individuals, 257 (99%) received > or = 1 dose of vaccine or placebo and were included in the safety analyses. Enzyme-linked immunosorbent spot results were available for 217 study participants (84%) at week 30. No serious vaccine-related adverse events occurred. No study participant discontinued participation because of vaccine-related adverse events. The frequency of injection-site reactions was dose dependent. Vaccine doses of > or = 3 x 10(9) viral particles elicited positive enzyme-linked immunosorbent spot responses to > or = 1 vaccine component in > 60% of recipients. High baseline antibody titers against adenovirus type 5 diminished enzyme-linked immunosorbent spot responses at all doses except the 3 x 10(10) viral particle dose. CONCLUSIONS: The vaccine was generally well tolerated and induced cell-mediated immune responses against human immunodeficiency virus type 1 peptides in most healthy adults. Despite these findings, vaccination in a proof-of-concept trial with use of this vaccine was discontinued because of lack of efficacy
— id: 95367, year: 2008, vol: 46, page: 1769, stat: Journal Article,

Asthma is inversely associated with Helicobacter pylori status in an urban population
Reibman, Joan; Marmor, Michael; Filner, Joshua; Fernandez-Beros, Maria-Elena; Rogers, Linda; Perez-Perez, Guillermo I; Blaser, Martin J
2008 ;3(12):e4060-e4060, PLoS ONE
BACKGROUND: Microbial exposures have been suggested to confer protection from allergic disorders and reduced exposures to gastrointestinal microbiota have been proposed as an explanation for the increase in asthma prevalence. Since the general prevalence of Helicobacter pylori has been decreasing, we hypothesized that H. pylori serostatus would be inversely related to the presence of asthma. METHODS: Adults were recruited to participate in the New York University (NYU)/Bellevue Asthma Registry in New York City. Adult asthma cases (N = 318) and controls (N = 208) were identified and serum IgG antibodies to H. pylori whole cell antigens or the immunodominant CagA antigen were measured. RESULTS: As expected, the asthma cases and controls differed with respect to atopy and lung function. Seropositivity to H. pylori or CagA antigen was present in 47.1% of the total case and control study population. Asthma was inversely associated with CagA seropositivity (OR = 0.57, 95% CI = 0.36-0.89). Median age of onset of asthma (doctor's diagnosis) was older (21 years) among individuals with CagA+ strains than among H. pylori- individuals (11 years) (p = 0.006). CONCLUSION: These data are consistent with the hypothesis that colonization with CagA+ H. pylori strains is inversely associated with asthma and is associated with an older age of asthma onset in an urban population. The data suggest H. pylori as a marker for protection
— id: 91964, year: 2008, vol: 3, page: e4060, stat: Journal Article,

Blood Dendritic Cell Subsets in Early HIV Infection
Sabado, RL; O'Brien, M; Subedi, A; Taylor, E; Hutt, R; Haggerty, R; Marmor, M; Margolis, D; Valentine, F; Borrow, P; Bhardwaj, N
2008 OCT ;24(1):84-85, AIDS research & human retroviruses
— id: 91419, year: 2008, vol: 24, page: 84, stat: Journal Article,

Resistance to HIV infection
Marmor, M; Hertzmark, K; Thomas, S M; Halkitis, P N; Vogler, M
2006 Jan;83(1):5-17, Journal of urban health
The biological correlates of an effective immune response that could contain or prevent HIV infection remain elusive despite substantial scientific accomplishments in understanding the interactions among the virus, the individual and the community. The observation that some individuals appear to possess resistance to HIV infection or its consequences has generated a host of epidemiologic investigations to identify biological or behavioral characteristics of these individuals. These data might hold the keys to developing appropriate strategies for mimicking the effective responses of those who appear immune. In this paper we review genetic mechanisms including the role of chemokines and their receptors, cytokines, host genetic immune response to HIV infection, local immune response correlating with behavioral variables, co-infection and immune based mechanisms that have been elucidated so far. We offer suggestions for how to use these observations as platforms for future research to further understand natural resistance to HIV infection through cohort studies, population genotype sampling, mathematical modeling of virus-host interactions and behavioral analyses
— id: 64482, year: 2006, vol: 83, page: 5, stat: Journal Article,

Slippery road conditions and fatal motor vehicle crashes in the northeastern United States, 1998-2002
Marmor, Michael; Marmor, Nicholas E
2006 May;96(5):914-920, American journal of public health. AJPH
OBJECTIVES: We investigated risk factors for fatal motor vehicle crashes on slippery roads in the Northeastern United States, 1998-2002. METHODS: We analyzed data from the Fatality Analysis Reporting System of the National Highway Traffic Safety Administration. RESULTS: Rates of crashes on slippery roads, and ratios of crashes on slippery roads to crashes on dry roads, were greatest among the youngest drivers. Among those aged 16 to 19 years, logistic regression analysis showed significant, independent risks associated with excessive speed for conditions (odds ratio [OR]=1.38), time of day (OR=1.80 for 5:00 to 9:00 am vs 10:00 am to 2:00 pm), time of year (OR=6.17 for January vs July), type of road (OR=1.27 for rural vs urban roads ), and age (OR=1.19 for those aged 16 to 17 years vs those aged 18 to 19 years). Licensure from states with graduated licensing programs was protective against crashes attributed to swerving on slippery roads (adjusted OR = 0.63). Risk factors among drivers older than 19 years were similar but peaked at different times of day and included increased risks for women compared with men. CONCLUSIONS: Driver training programs need to better address hazards presented by slippery roads
— id: 64457, year: 2006, vol: 96, page: 914, stat: Journal Article,

CCR5 expression and duration of high risk sexual activity among HIV-seronegative men who have sex with men
Thomas, Susan M; Tse, Doris B; Ketner, D Scott; Rochford, Gemma; Meyer, Daniel A; Zade, David D; Halkitis, Perry N; Nadas, Arthur; Borkowsky, William; Marmor, Michael
2006 Sep 11;20(14):1879-1883, AIDS
OBJECTIVES:: To test the hypothesis that in comparison with those with shorter risk duration, individuals with longer HIV risk duration would have reduced susceptibility to HIV-1 infection as measured by CCR5 expression, and to evaluate whether variation in CCR5 expression could be explained by known genetic polymorphisms. DESIGN AND METHODS:: A cross-sectional study of HIV-1 exposed but uninfected men who have sex with men. The risk duration was estimated from self-reported years since first receptive anal intercourse. CCR5 expression on peripheral blood CD4+ monocytes and T cells was determined by flow cytometry. The CCR5-Delta32 mutation and polymorphisms in the CCR5 promoter and CCR2 as well as the copy number of CCL3L1 were analyzed by polymerase chain reaction. Plasma levels of MIP-1alpha (CCL3), MIP-1beta (CCL4) and RANTES (CCL5) were also measured. As risk duration varied with age, analyses were restricted to 67 individuals aged 30-49 years. RESULTS:: Multiple linear regression analyses, adjusted for age and race, showed a significant negative association between HIV risk duration and CCR5 expression on monocytes (P = 0.01), and in a separate model, a similar negative association with CCR5 expression on T cells (P = 0.03). Low CCR5 expression was attributable mainly to CCR5-Delta32 heterozygosity and the CCR5-59029G allele. CONCLUSIONS:: We confirmed a role for reduced CCR5 expression in HIV-1 resistance. CCR5-Delta32 heterozygosity and the CCR5-59029G allele were significant predictors of low CCR5 expression. Individuals with high CCR5 expression who resisted infection despite long HIV risk duration form an interesting group within which to search for additional mechanisms of resistance to HIV infection
— id: 68188, year: 2006, vol: 20, page: 1879, stat: Journal Article,

HIV sexual risk behavior over 36 months of follow-up in the world's first HIV vaccine efficacy trial
Bartholow, Bradford N; Buchbinder, Susan; Celum, Connie; Goli, Vamshidar; Koblin, Beryl; Para, Michael; Marmor, Michael; Novak, Richard M; Mayer, Kenneth; Creticos, Catherine; Orozco-Cronin, Patti; Popovic, Vladimir; Mastro, Timothy D
2005 May 1;39(1):90-101, Journal of acquired immune deficiency syndromes. JAIDS
Increased risk behavior among participants in HIV vaccine efficacy trials has been a concern. This study evaluated HIV sexual risk behavior among 5095 HIV-negative men who have sex with men (MSM) and 308 women enrolled in a randomized, double-blind, placebo-controlled efficacy trial of a bivalent rgp120 vaccine at 61 sites, primarily in North America. Sexual risk behavior data were collected at baseline and semiannually for 36 months. Overall, sexual risk behavior did not exceed baseline levels during the trial. Among MSM, younger age (< or =30 years), perceived assignment to vaccine, and nonblack race were associated with an increased probability of unprotected anal sex. Among women, unprotected vaginal sex initially decreased but was statistically equivalent to baseline by 24 months, whereas unprotected vaginal sex with HIV-infected partners decreased from baseline, where it remained throughout the trial. HIV sexual risk behavior did not increase among trial participants; however, it was substantial throughout the trial. Consistently high levels of risk behavior and the association of these behaviors to perceived assignment and demographic variables underscore the need for vigilant HIV risk reduction counseling, informed consent, and educational processes in the context of HIV vaccine efficacy trials
— id: 91968, year: 2005, vol: 39, page: 90, stat: Journal Article,

Distribution of CCR2-64I and SDF1-3'A alleles and HIV status in 7 ethnic populations of Cameroon
Ma, Liying; Marmor, Michael; Zhong, Ping; Ewane, Leonard; Su, Bing; Nyambi, Phillipe
2005 Sep 1;40(1):89-95, Journal of acquired immune deficiency syndromes. JAIDS
Limited information is available on the prevalence among rural Africans of host genetic polymorphisms conferring resistance to HIV-1 infection or slowing HIV disease progression. We report the allelic frequencies of the AIDS-related polymorphisms CCR2-64I, SDF1-3'A, and CCR5-Delta32 in 321 volunteers from 7 ethnic groups in Cameroon. Allelic frequencies differed among the 7 ethnic groups, ranging from 10.8% to 31.3% for CCR2-64I and 0.0% to 7.1% for SDF1-3'A. No CCR5-Delta32 alleles were found. HIV seroprevalence was 6.9% in the total population and peaked at younger ages in girls and women than in boys and men. Among 15- to 54-year-olds, HIV seroprevalence varied from 2.0% to 11.1% among the village populations. Conditional logistic regression analysis using data from boys and men aged 15 to 54 years showed the number of CCR2-64I alleles to be a significant risk factor for HIV seropositivity (odds ratio per allele adjusted for age and matched on ethnic group = 6.3, 95% confidence interval: 1.3-30.3); this association was not found in women. The findings are consistent with the hypothesis that CCR2-64I alleles may delay HIV disease progression without affecting susceptibility to infection among men. We did not observe this relation among women, and other factors, such as multiple pregnancies or maternal stressors (eg, breastfeeding), may have masked any protective effect of CCR2-64I alleles. Further study of this issue among women is warranted. SDF1-3'A did not differ between HIV-seropositive and HIV-seronegative individuals but was associated with increasing age among HIV-seronegative women, suggesting a protective effect against HIV-1 infection
— id: 78872, year: 2005, vol: 40, page: 89, stat: Journal Article,

Seroprevalence of Helicobacter pylori in New York City populations originating in East Asia
Perez-Perez, Guillermo Ignacio; Olivares, Asalia Zuni; Foo, F Yeong; Foo, Sun; Neusy, Andre J; Ng, Christopher; Holzman, Robert S; Marmor, Michael; Blaser, Martin J
2005 Sep;82(3):510-516, Journal of urban health
Helicobacter pylori prevalence is higher in developing countries than in industrialized countries, and within the latter, higher among immigrants than among nativeborn residents. Using a point-prevalence survey, we sought to identify risk factors for H. pylori seropositivity in US urban East Asian-born populations. At a clinic in New York City, we consecutively enrolled 194 East Asian-born adults, who then responded to a survey and provided a blood sample. Assays were performed to detect IgG antibodies against whole cell (WC) and cytotoxin associated gene A (CagA) antigens of H. pylori. For this group (mean age 50.2+/-14.7 years), the mean period of residence in the United States was 11.9+/-7.7 years. The total H. pylori seroprevalence was 70.1%, with highest (81.4%) in Fujianese immigrants. Multiple logistic regression analysis indicated an independent association of H. pylori seropositivity with Fujianese origin [odds ratios (OR) =2.3, 95% confidence interval (95% CI) =1.05-5.0] and inverse associations with period in the United States (OR per year of residency in the United States =0.95, 95% CI =0.91-0.99) and with a history of dyspepsia (OR for a history of stomach pain =0.52, 95% CI =0.3-1.0). We conclude that H. pylori is highly prevalent among recent East Asian immigrants, especially among Fujianese. The protective effects of history of dyspepsia and duration in the United States suggest that these may be markers for antibiotic therapies.
— id: 58190, year: 2005, vol: 82, page: 510, stat: Journal Article,

Beliefs about HIV non-infection and risky sexual behavior among MSM
Halkitis, Perry N; Zade, David D; Shrem, Michael; Marmor, Michael
2004 Oct;16(5):448-458, AIDS education & prevention
As part of a larger investigation examining genetic immunity to HIV, we undertook a cross-sectional investigation of 97 HIV-seronegative men who have sex with men (MSM). Our aim was to better understand the factors to which these men attributed their HIV serostatus and to relate these attributions to sexual risk taking. Three beliefs were related to sexual risk taking with HIV-negative/status unknown casual partners: (a) medication treatment advances, (b) the low probability related to HIV transmission, and (c) a healthy immune system, capable of resisting infection. A multivariate regression model suggested that use of recreational drugs, in combination with the belief that treatment advances reduce the risk of HIV seroconversion, in part, may explain the frequency with which individuals engage in unprotected anal receptive intercourse. Our findings suggest that MSM who intentionally engage in unprotected anal sex may be influenced by perceptions that medical advances have mitigated the threat of HIV and corroborate previous studies depicting an intimate relationship between illicit drug use and sexual risk taking
— id: 56109, year: 2004, vol: 16, page: 448, stat: Journal Article,

Recruitment and Baseline Epidemiologic Profile of Participants in the First Phase 3 HIV Vaccine Efficacy Trial
Harro, Clayton D; Judson, Franklyn N; Gorse, Geoffrey J; Mayer, Kenneth H; Kostman, Jay R; Brown, Stephen J; Koblin, Beryl; Marmor, Michael; Bartholow, Bradford N; Popovic, Vladimir
2004 Nov 1;37(3):1385-1392, Journal of acquired immune deficiency syndromes. JAIDS
OBJECTIVE:: To describe recruitment and baseline epidemiologic characteristics of volunteers in the first phase 3 placebo-controlled trial of a recombinant gp120 HIV vaccine (AIDSVAX B/B). METHODS:: Volunteers were gay/bisexual men or women at risk for sexually transmitted HIV infection. Recruitment strategies, demographics, and risk factors were assessed. HIV status was determined by standard HIV-1 antibody assays. Seronegative/viremic HIV infection at enrollment was determined using the HIV-1 nucleic acid test. RESULTS:: From June 1998 through October 1999, 5417 of 7185 volunteers screened were enrolled at 61 sites in the United States, Canada, and The Netherlands. Successful recruitment methods included distribution of study information at gay venues, advertising and media coverage, and referrals from volunteers. Most volunteers were altruistically motivated, men (98%), young (median, 36 years), white (83%), well educated (61% college education or more), and at high risk for HIV during the 6 months before enrollment. At baseline, 14 were HIV infected (12 were seronegative but viremic; 2 were seropositive and viremic). CONCLUSION:: Men and women at high risk for sexually transmitted HIV infection were successfully recruited for the first phase 3 HIV vaccine efficacy trial. Knowledge of recruitment and baseline epidemiologic characteristics of participants in this trial will provide valuable guidance for designing and conducting future trials
— id: 56110, year: 2004, vol: 37, page: 1385, stat: Journal Article,

Coronary artery disease and opioid use
Marmor, Michael; Penn, Arthur; Widmer, Kyle; Levin, Richard I; Maslansky, Robert
2004 Jun 15;93(10):1295-1297, American journal of cardiology
Over the past 20 years, we have observed a paucity of morbidity and mortality due to cardiovascular disease among drug users in a methadone maintenance clinic. The present study investigated whether long-term exposure to opiates or opioids is associated with decreased severity of coronary artery disease (CAD) by comparing 98 decedents with methadone or opiates (M/O) in their blood at autopsy with 97 frequency-matched decedents without M/O. Severe CAD was found significantly less often in M/O-positive decedents (5 of 98) than in M/O-negative decedents (16 of 97). Multiple logistic regression analysis contrasting those with moderate or severe CAD to those with no or mild CAD yielded an odds ratio of 0.43 (95% confidence interval 0.20 to 0.94) for M/O positivity after adjustment for potential confounding. Long-term opiate exposure thus may mitigate CAD severity and its often fatal consequences
— id: 46186, year: 2004, vol: 93, page: 1295, stat: Journal Article,

Douching practices among women at high risk of HIV infection in the United States: implications for microbicide testing and use
Koblin, Beryl A; Mayer, Kenneth; Mwatha, Anthony; Brown-Peterside, Pamela; Holt, Renee; Marmor, Michael; Smith, Carrol; Chiasson, Mary Ann
2002 Jul;29(7):406-410, Sexually transmitted diseases
BACKGROUND: Douching may interfere with determination of microbicide safety and effectiveness. This practice has not been adequately studied among women at risk of HIV infection. GOAL: This study assessed douching practices among women at risk of HIV infection in the United States. STUDY DESIGN: Data were collected on douching practices, sexually transmitted diseases, birth control, use of spermicidal products, and sexual risk behaviors among HIV antibody-negative women. RESULTS: Of 623 women, 70.2% had recently douched. Most women had been told that douching was not healthy. No associations were found between recent douching and measures of risk behaviors, except number of male partners. Recent douching was associated with being aged 26 to 30 years, compared with being 18 to 25 years of age (odds ratio [OR] = 2.2), black (OR = 3.0), or sterilized (OR = 2.0); having 5 or more male partners (OR = 4.4); and being told that douching is unhealthy (OR = 0.4). CONCLUSIONS: Recent douching was very common. The high prevalence of douching has implications for the design of microbicide trials and prevention interventions
— id: 135289, year: 2002, vol: 29, page: 406, stat: Journal Article,

Assessment of optic disc anatomy and nerve fiber layer thickness in ocular hypertensive subjects with normal short-wavelength automated perimetry
Mistlberger, Andrea; Liebmann, Jeffrey M; Greenfield, David S; Hoh, Sek-Tien; Ishikawa, Hiroshi; Marmor, Michael; Ritch, Robert
2002 Jul;109(7):1362-1366, Ophthalmology
PURPOSE: To compare optic disc topography and nerve fiber layer thickness in ocular hypertensive eyes and normal subjects. DESIGN: Prospective, case-controlled study. PARTICIPANTS AND CONTROLS: One eye in each of 20 normal and 27 ocular hypertensive patients was enrolled. METHODS: Consecutive normal and ocular hypertensive patients were enrolled. Each patient underwent complete ophthalmic examination, achromatic automated perimetry, short-wavelength automated perimetry, confocal scanning laser ophthalmoscopy, confocal scanning laser polarimetry, and optical coherence tomography. The intraocular pressure was 21 mmHg or less for normal subjects and at least 25 mmHg on two separate occasions in ocular hypertensive eyes. Structural parameters were compared between the two groups. Eyes with evidence of glaucomatous optic neuropathy, achromatic visual field loss, or evidence of focal visual field injury during short-wavelength automated perimetry were excluded. MAIN OUTCOME MEASURES: Optic nerve head topography and nerve fiber layer thickness. RESULTS: The three imaging technologies could not detect differences in optic disc or nerve fiber layer anatomy between the two groups. Ocular hypertensive eyes had a greater corrected pattern standard deviation than normal eyes during short-wavelength automated perimetry (P = 0.04). CONCLUSIONS: Ocular hypertensive eyes with normal achromatic automated perimetry and short-wavelength automated perimetry could not be distinguished from normal subjects with confocal scanning laser ophthalmoscopy, confocal scanning laser polarimetry, and optical coherence tomography
— id: 148306, year: 2002, vol: 109, page: 1362, stat: Journal Article,

HIV infection in rural villages of Cameroon
Nyambi, Phillipe; Zekeng, Leopold; Kenfack, Henriette; Tongo, Marcel; Nanfack, Aubin; Nkombe, Innocent; Ndonko, Flavien; Shang, Judith; Burda, Sherri; Mbah, Henry; Agyingi, Lucy; Zhong, Ping; Nadas, Arthur; Zolla-Pazner, Susan; Marmor, Michael
2002 Dec 15;31(5):506-513, Journal of acquired immune deficiency syndromes. JAIDS
OBJECTIVE: To evaluate HIV-1 antibody seroprevalence and risk factors for HIV seropositivity in rural areas of Cameroon. METHOD: The prevalences of HIV antibodies in 53 villages in rural Cameroon visited during May-October 2000 were determined with an HIV1/2 rapid assay, standard ELISA, and western blot. Demographic data and risk factors were elicited via face-to-face interviews with a structured questionnaire. RESULTS: HIV seroprevalence was 5.8% (243/4156, 95% confidence interval [CI] = 5.1-6.6) overall, 6.3% (151/2394, 95% CI = 5.4-7.4) among females and 5.2% (92/1762, 95% CI = 4.3-6.4) among males. HIV seroprevalence among persons aged 15 - 70 years did not differ significantly by province (5.6% in Center, 4.5% in East, 6.9% in South, and 5.8% in South-West) ( =.10). Analysis of age- and gender-standardized prevalence by village across provinces indicated a near-significant difference (nonparametric Wilcoxon signed rank test, =.06), with highest prevalence in South-West, followed by South, Center, and East. Multivariate analysis revealed that single women were significantly more likely to be HIV seropositive than were married or widowed women. Women with a history of sexual relations while traveling were at significantly increased risk of HIV seropositivity (OR adjusted for age and marital status = 2.4, 95% CI = 1.4-9.7). Among men, those who reported ever having a sexually transmitted disease were at significantly increased risk of HIV-seropositivity (OR adjusted for age = 1.8, 95% CI = 1.1-2.8). CONCLUSION: We have documented a wide range of HIV prevalences among rural villages of Cameroon. Age, marital status (in women) and sexual risk factors appear to be associated with HIV infection in this setting
— id: 39352, year: 2002, vol: 31, page: 506, stat: Journal Article,

Case-crossover study of partner and situational factors for unprotected sex
Seage, George R 3rd; Holte, Sarah; Gross, Michael; Koblin, Beryl; Marmor, Michael; Mayer, Kenneth H; Lenderking, William R
2002 Dec 1;31(4):432-439, Journal of acquired immune deficiency syndromes. JAIDS
OBJECTIVES: To identify situational and partner characteristics associated with unprotected sex among women at risk for HIV infection. METHODS: The most recent unprotected and protected sexual encounters were compared using a case-crossover design among 1,647 women enrolled in a prospective cohort study conducted in six U.S. cities. Information collected via audio computer-assisted self-interview included detailed situational and partner characteristics for participants' most recent sexual encounters, with and without condom use. Paired odds ratios (ORs) and 95% confidence intervals were calculated for situational or partner characteristics that may differ between unprotected and protected sexual encounters, using conditional logistic regression. RESULTS: In the adjusted analysis, partner age of older than 40 years (OR = 2.42), partner type (OR = 2.45 for a 'steady' partner), partner use of alcohol (OR = 1.67) and drugs within 2 hours (OR = 1.42) of the sexual encounter, time since the encounters (OR = 0.41, 0.33, and 0.19), and exchange of sex for money or drugs (OR = 0.68) remained significantly associated with women's most recent unprotected sexual encounter. CONCLUSIONS: Considerations related to partner and relationship characteristics should provide information for the development of interventions for women
— id: 42273, year: 2002, vol: 31, page: 432, stat: Journal Article,

Safety and immunogenicity of a canarypox-vectored human immunodeficiency virus Type 1 vaccine with or without gp120: a phase 2 study in higher- and lower-risk volunteers
Belshe RB; Stevens C; Gorse GJ; Buchbinder S; Weinhold K; Sheppard H; Stablein D; Self S; McNamara J; Frey S; Flores J; Excler JL; Klein M; Habib RE; Duliege AM; Harro C; Corey L; Keefer M; Mulligan M; Wright P; Celum C; Judson F; Mayer K; McKirnan D; Marmor M; Woody G
2001 May 1;183(9):1343-1352, Journal of infectious diseases
Live attenuated viral vectors that express human immunodeficiency virus (HIV) antigens are being developed as potential vaccines to prevent HIV infection. The first phase 2 trial with a canarypox vector (vCP205, which expresses gp120, p55, and protease) was conducted in 435 volunteers with and without gp120 boosting, to expand the safety database and to compare the immunogenicity of the vector in volunteers who were at higher risk with that in volunteers at lower risk for HIV infection. Neutralizing antibodies to the MN strain were stimulated in 94% of volunteers given vCP205 plus gp120 and in 56% of volunteers given vCP205 alone. CD8(+) cytotoxic T lymphocyte cells developed at some time point in 33% of volunteers given vCP205, with or without gp120. Phase 3 field trials with these or similar vaccines are needed, to determine whether efficacy in preventing HIV infection or in slowing disease progression among vaccinees who become infected is associated with the level and types of immune responses that were induced by the vaccines in this study
— id: 42269, year: 2001, vol: 183, page: 1343, stat: Journal Article,

Early human immunodeficiency virus (HIV) infection in the HIV Network for Prevention Trials Vaccine Preparedness Cohort: risk behaviors, symptoms, and early plasma and genital tract virus load
Celum CL; Buchbinder SP; Donnell D; Douglas JM Jr; Mayer K; Koblin B; Marmor M; Bozeman S; Grant RM; Flores J; Sheppard HW
2001 Jan 1;183(1):23-35, Journal of infectious diseases
Risk behaviors, symptoms, and virologic characteristics were studied among 103 human immunodeficiency virus (HIV) seroconverters in vaccine preparedness cohorts during 1995-1998. Overall, 83% of subjects were men who had sex with men; most reported multiple risk episodes and symptoms (84%, > or =1 symptom) during seroconversion. Acute HIV was diagnosed in only 8 of 50 who sought medical care. Median initial pretreatment plasma virus load was 25,800 copies/mL (range, undetectable-262,000 copies/mL) a mean of 4 months after seroconversion, and 9.7% had nucleoside-associated mutations; none had multidrug resistance. Semen virus load was more variable, 1.3 log(10) lower and modestly correlated (r=.28; 95% confidence interval, 0.16-0.42) with plasma among untreated men. When the plasma RNA level was <5000 copies/mL, 32% of untreated men, 13% on nucleoside regimens, and 7% on protease inhibitor-containing regimens had detectable seminal RNA. Acute HIV was seldom diagnosed, representing missed opportunities for early treatment and prevention. Most subjects had several relatively stable virus loads before initiation of antiretrovirals, indicating feasibility of assessing HIV vaccines on virus set point in efficacy trials
— id: 42271, year: 2001, vol: 183, page: 23, stat: Journal Article,

Homozygous and heterozygous CCR5-Delta32 genotypes are associated with resistance to HIV infection
Marmor M; Sheppard HW; Donnell D; Bozeman S; Celum C; Buchbinder S; Koblin B; Seage GR 3rd
2001 Aug 15;27(5):472-481, Journal of acquired immune deficiency syndromes. JAIDS
OBJECTIVE: To investigate evidence for resistance to HIV-1 infection associated with the heterozygous genotype CCR5-+/Delta32 and with the homozygous genotype CCR5-Delta32/Delta32, which results in a nonfunctional CCR5 receptor. DESIGN: Cohort study of initially HIV-seronegative high-risk individuals from eight different cities. Enrollment data were analyzed to investigate the association of demographic factors and risk behaviors with CCR5 genotypes on the assumption that increased genotype prevalence among persons with histories of longer or more intensive exposure to HIV would indicate HIV resistance associated with that genotype. Longitudinal data were analyzed to investigate the association of HIV seroincidence with CCR5 genotypes. The cohort of 2996 individuals included 1892 men who have sex with men (MSM), 474 male injection drug users (IDUs), 347 women at heterosexual risk, and 283 female IDUs. MEASUREMENTS: CCR5 genotype, HIV serostatus, demographic factors, and risk behaviors during the 6 months before enrollment, followed by measurement of HIV seroincidence during the subsequent 18 months (for men) and 24 months (for women). RESULTS: Forty (1.3%) subjects were homozygous CCR5-Delta32/Delta32 and 387 (12.9%) were heterozygous CCR5-+/Delta32. All but 1 CCR5-Delta32/Delta32 individuals and 51 CCR5-+/Delta32 individuals were Caucasian. Among 1531 Caucasian MSM, CCR5-+/Delta32 individuals were present more frequently (22.3%) among those reporting unprotected receptive anal intercourse than among those not reporting this risk (15.9%) (p =.002), suggesting a selective advantage of the heterozygous genotype. CCR5-+/Delta32 individuals also had a significantly reduced relative risk of HIV seroconversion adjusted for unprotected receptive anal intercourse compared with CCR5-/+ individuals (relative risk = 0.30, 95% confidence interval [CI]: 0.08-0.97). CCR5-Delta32/Delta32 prevalence among Caucasian MSM was significantly associated with age among subjects recruited from high HIV seroprevalence cities (New York City and San Francisco) (odds ratio [OR] for each decade increase in age = 2.57, CI: 1.56-4.21) but not among those recruited from lower HIV prevalence sites (Boston, Chicago, Philadelphia, Seattle, and Providence/Pawtucket, Rhode Island) (OR = 1.20, CI: 0.75-1.89). CONCLUSIONS: Cross-sectional and longitudinal analyses indicated that among high-risk HIV seronegative MSM, CCR5-+/Delta32 and CCR5-Delta32/Delta32 are associated with protection against HIV infection. These findings imply that strategies aimed at reducing susceptibility to HIV infection by blocking CCR5 receptor sites need not seek blockage of all receptor sites to achieve an imperfect but substantial degree of protection
— id: 26700, year: 2001, vol: 27, page: 472, stat: Journal Article,

Are US populations appropriate for trials of human immunodeficiency virus vaccine? The HIVNET Vaccine Preparedness Study
Seage GR 3rd; Holte SE; Metzger D; Koblin BA; Gross M; Celum C; Marmor M; Woody G; Mayer KH; Stevens C; Judson FN; McKirnan D; Sheon A; Self S; Buchbinder SP
2001 Apr 1;153(7):619-627, American journal of epidemiology
Questions exist about whether testing of preventive human immunodeficiency virus (HIV)-1 vaccines, which will require rapid recruitment and retention of cohorts with high HIV-1 seroincidence, is feasible in the United States. A prospective cohort study was conducted in 1995-1997 among 4,892 persons at high risk for HIV infection in nine US cities. At 18 months, with an 88% retention rate, 90 incident HIV-1 infections were observed (1.31/100 person-years (PY), 95% confidence interval (CI): 1.06, 1.61). HIV-1 seroincidence rates varied significantly by baseline eligibility criteria--1.55/100 PY among men who had sex with men, 0.38/100 PY among male intravenous drug users, 1.24/100 PY among female intravenous drug users, and 1.13/100 PY among women at heterosexual risk-and by enrollment site, from 0.48/100 PY to 2.18/100 PY. HIV-1 incidence was highest among those men who had sex with men who reported unprotected anal intercourse (2.01/100 PY, 95% CI: 1.54, 2.63), participants who were definitely willing to enroll in an HIV vaccine trial (1.96/100 PY, 95% CI: 1.41, 2.73), and women who used crack cocaine (1.62/100 PY, 95% CI: 0.92, 2.85). Therefore, cohorts with HIV-1 seroincidence rates appropriate for HIV-1 vaccine trials can be recruited, enrolled, and retained
— id: 42270, year: 2001, vol: 153, page: 619, stat: Journal Article,

Slow diffusion of home HIV-specimen collection: provider concerns at odds with client preferences
Spielberg F; Critchlow C; Vittinghoff E; Gross M; Doherty-Iddings P; Scotti R; Judson FN; Marmor M; Buchbinder S
2001 Jan;28(1):51-57, Sexually transmitted diseases
BACKGROUND: Home specimen collection and telephone counseling (HSCTC) may be a convenient new method for detection of HIV infection among cohorts at high-risk for HIV. GOAL: To evaluate attitudes about HSCTC among participants, HIV counselors, and community advisory board members associated with a national multisite study of persons at high risk for HIV. STUDY DESIGN: Twelve focus groups and surveys were conducted at six sites among 126 counselors, community advisory board members, and cohort participants. RESULTS: Staff and community advisory board members raised concerns about the acceptability, feasibility, safety, and effectiveness of HSCTC. In contrast, participants (92%) reported a willingness to collect blood and oral samples on a frequent basis, and preferred telephone (73%) to office-based counseling. CONCLUSION: Home specimen collection and telephone counseling appear to be preferred by study participants at high risk of HIV infection. Staff and community advisory board members had stronger reservations than prospective users
— id: 42272, year: 2001, vol: 28, page: 51, stat: Journal Article,

The contribution of recently acquired Mycobacterium tuberculosis infection to the New York City tuberculosis epidemic, 1989-1993 [In Process Citation]
Davidow AL; Alcabes P; Marmor M
2000 Jul;11(4):394-401, Epidemiology
Current theory in the molecular epidemiology of tuberculosis holds that tuberculosis cases harboring Mycobacterium tuberculosis strains with a common deoxyribonucleic acid (DNA) fingerprint are the result of recent M. tuberculosis transmission. Here we propose a mathematical approach independent of DNA fingerprinting to estimating the percentage of recent transmissions responsible for current tuberculosis incidence. The 'short-term reproductive number' of tuberculosis is defined as the average number of tuberculosis cases developing within 1 year of infection. Multiplying the short-term reproductive number by the number of tuberculosis cases in each year and dividing by the subsequent year's tuberculosis case burden equals the proportion of tuberculosis cases in the subsequent year that are due to recent transmission. We carried out separate calculations for human immunodeficiency virus (HIV)-negative and HIV-positive tuberculosis cases. We applied the model to pulmonary (infectious) tuberculosis cases diagnosed in New York City during 1989-1993, using tuberculosis and AIDS surveillance data. Model-based estimates of the proportion of tuberculosis due to recent transmission were lower than estimates based on DNA fingerprints. Reconciliation of these divergent estimates may require the re-estimation of model parameters from data collected de novo, additional model development, and further advances in DNA fingerprinting methods
— id: 9089, year: 2000, vol: 11, page: 394, stat: Journal Article,

HIV incidence among injection drug users in New York City, 1992-1997: evidence for a declining epidemic
Des Jarlais DC; Marmor M; Friedmann P; Titus S; Aviles E; Deren S; Torian L; Glebatis D; Murrill C; Monterroso E; Friedman SR
2000 Mar;90(3):352-359, American journal of public health. AJPH
OBJECTIVES: We assessed recent (1992-1997) HIV incidence in the large HIV epidemic among injection drug users in New York City. METHODS: Data were compiled from 10 separate studies (N = 4979), including 6 cohort studies, 2 'repeat service user' studies, and 2 analyses of voluntary HIV testing and counseling services within drug treatment programs. RESULTS: In the 10 studies, 52 seroconversions were found in 6344 person-years at risk. The observed incidence rates among the 10 studies were all within a narrow range, from 0 per 100 person-years at risk to 2.96 per 100 person-years at risk. In 9 of the 10 studies, the observed incidence rate was less than 2 per 100 person-years at risk. The weighted average incidence rate was 0.7 per 100 person-years at risk. CONCLUSIONS: The recent incidence rate in New York City is quite low for a high-seroprevalence population of injection drug users. The very large HIV epidemic among injection drug users in New York City appears to have entered a 'declining phase,' characterized by low incidence and declining prevalence. The data suggest that very large high-seroprevalence HIV epidemics may be 'reversed.'
— id: 27854, year: 2000, vol: 90, page: 352, stat: Journal Article,

Anal sex among HIV-seronegative women at high risk of HIV exposure. The HIVNET Vaccine Preparedness Study 2 Protocol Team
Gross M; Holte SE; Marmor M; Mwatha A; Koblin BA; Mayer KH
2000 Aug 1;24(4):393-398, Journal of acquired immune deficiency syndromes. JAIDS
To assess the prevalence and the sociodemographic and behavioral correlates of anal sex in a cohort of HIV-seronegative U.S. women at high risk of HIV exposure, we administered a risk assessment using audio computer-assisted self-interview (A-CASI). Of 1268 sexually active women, 432 (32%) reported anal sex in the previous 6 months. Compared with women who did not report anal sex, those who did had more unprotected vaginal sex (median of 11 versus 7 episodes; p <. 001) and a higher proportion of unprotected sexual (vaginal plus anal) episodes (median of 0.90 versus 0.81; p =.01). Anal sex was reported by higher proportions of women who did not always use condoms, who used crack in the past year, who were </=35 years of age, with no formal education beyond high school, who had had a diagnosed sexually transmitted disease in the previous year, a primary male sex partner, and a male sex partner with a history of injecting use. Women were more likely to report anal sex by A-CASI than during interviewer-administered risk assessments (odds ratio [OR], 9.00; 95% confidence interval [CI], 1.14-71.0). A less biased method of ascertainment may account for the large proportion of women reporting anal sex. Given increased vaginal risk among women reporting anal sex, the relative importance of anal sex in heterosexual transmission merits further study. Behavioral and biomedical prevention strategies effective for anal as well as vaginal sex are needed
— id: 42268, year: 2000, vol: 24, page: 393, stat: Journal Article,

CD4+ T Cell Surface CCR5 Density and Virus Load in Persons Infected with Human Immunodeficiency Virus Type 1
Marmor M; Krowka J; Goldberg JD
2000 Oct;182(4):1284-1285, Journal of infectious diseases
— id: 11507, year: 2000, vol: 182, page: 1284, stat: Journal Article,

Drug injection rates and needle-exchange use in New York City, 1991-1996 [In Process Citation]
Marmor M; Shore RE; Titus S; Chen X; Des Jarlais DC
2000 Sep;77(3):359-368, Journal of urban health
Objectives included (1) to develop methods for identifying injection drug users with accelerating injection habits so they might be referred to counseling and treatment and (2) to investigate behavioral correlates of accelerating injection habits, including syringe-exchange program utilization. Data on drug use, enrollment in methadone maintenance, and demographic variables were obtained from 328 subjects who were seronegative for human immunodeficiency virus (HIV) who attended anywhere from 4 to 11 quarterly study visits for interview, HIV pretest counseling and risk reduction counseling, and blood donation for HIV antibody testing. Subjects were recalled 2 weeks after each study visit to receive their results and post-test counseling. We characterized subjects according to their patterns of drug injection as accelerating, decelerating, or stable, using intraindividual regression analyses and categorization rules, and by syringe-exchange use as consistent users, sporadic users, or nonusers. The present subjects included 52% with decelerating, 29% with stable, and 19% with accelerating rates of drug injection. There were 128 subjects (39%) who were categorized as consistent users of syringe-exchange programs, 84 (25%) were categorized as sporadic users, and 116 (35%) were categorized as nonusers. All syringe-exchange groups showed significantly decelerating drug injection. Rates of decline were significantly less, however, among consistent syringe-exchange users than sporadic or nonusers of syringe exchanges. Categorical analysis also showed significant differences among groups, with 30% of consistent syringe-exchange program users having accelerating rates of drug injection compared to 9% of nonusers and 17% of sporadic users. That consistent syringe-exchange users included a larger proportion of individuals whose drug habits were accelerating than did sporadic users or nonusers of syringe exchanges suggests a need for improved identification and counseling of such subjects by syringe-exchange program staff. The present statistical approaches may be of value in targeting such efforts. The ability of a syringe-exchange program to attract a disproportionate share of drug users with accelerating rates of drug injection underscores the importance of these programs to HIV prevention efforts
— id: 9088, year: 2000, vol: 77, page: 359, stat: Journal Article,

Modulators of activated motivation event-specific condom use by drug injectors who have used condoms to prevent HIV/AIDS
Friedman SR; Chapman TF; Perlis TE; Sotheran JL; Rockwell R; Paone D; Marmor M; Des Jarlais DC
1999 ;3(2):85-98, AIDS & behavior
Since sexual transmission of HIV among and from drug injectors is a frequent source of infection, condom use by them is important for prevention. This paper focuses on predictors of condom use at last sex by drug injectors with 'activated motivation,' that is, by those who already are trying to use condoms to reduce HIV risk. Principal subjects are 1,240 drug injectors who report activated motivation to use condoms to prevent HIV and who had had sex within 6 months before the interview. Many used condoms at last sexual event with primary partners (65%) and with casual partners (80%). Condom use with primary partners increased over time, and was higher among those who knew they were HIV-positive or who talked about AIDS with sexual partners, but was lower among those who knew they were HIV-negative, who were Black, Hispanic, women, younger, or high school graduates, or who used crack with their partners at the sexual event. Condom use with casual partners was lower among women, older drug injectors, and those who were high on alcohol along with their partners, and tended to be more likely among those who know they are infected. Condom use with both primary and casual partners was greater with partners who did not themselves inject drugs. Programs should urge drug injectors who are trying to use condoms to avoid HIV transmission that having sex while using psychoactive substances may be a barrier to their doing so even if they want to use condoms and have done so in the past. Finally, research should be conducted to determine if persons with activated motivation should receive HIV prevention assistance that is different from that offered those who lack risk-reduction motivation or those who want to reduce their risk behaviors, but have been unable to implement the desired changes
— id: 42284, year: 1999, vol: 3, page: 85, stat: Journal Article,

Non-injection substance use correlates with risky sex among men having sex with men: data from HIVNET
Woody GE; Donnell D; Seage GR; Metzger D; Marmor M; Koblin BA; Buchbinder S; Gross M; Stone B; Judson FN
1999 Feb 1;53(3):197-205, Drug & alcohol dependence
Associations between substance use and sexual behavior were examined among 3220 seronegative men who have sex with men (MSM) in a HIV vaccine preparedness study. Relationships between current and past substance use and current sexual risk were evaluated using crude odds ratios and logistic regression to adjust for confounding variables. Heroin and injection drug use were uncommon (< 2%). Substances most often used were alcohol (89%), marijuana (49%), nitrite inhalants (29%), amphetamines or similarly acting stimulants (21%), cocaine 14% and hallucinogens (14%). Increased adjusted odds for unprotected sex were significantly associated with current heavy alcohol use (OR 1.66; CI 1.18, 2.33), past alcohol problems (OR 1.25; CI 1.05, 1.48), and current drug use (OR 1.26; CI 1.08, 1.48). When associations with specific drugs and nitrite inhalants were examined separately, current use of cocaine and other stimulants (OR 1.25; CI 1.01, 1.55), hallucinogens (OR 1.40; CI 1.10, 1.77), and nitrite inhalants (some (OR 1.61; CI 1.35, 1.92); heavy (OR 2.18; CI 1.48, 3.20)), were independently associated with unprotected sex. Those with past drug use or past heavy alcohol use but not currently using demonstrated no increase in sexual risk, suggesting an important role for substance-focused interventions in risk reduction efforts among MSM
— id: 57084, year: 1999, vol: 53, page: 197, stat: Journal Article,

Declining seroprevalence in a very large HIV epidemic: injecting drug users in New York City, 1991 to 1996
Des Jarlais DC; Perlis T; Friedman SR; Deren S; Chapman T; Sotheran JL; Tortu S; Beardsley M; Paone D; Torian LV; Beatrice ST; DeBernardo E; Monterroso E; Marmor M
1998 Dec;88(12):1801-1806, American journal of public health. AJPH
OBJECTIVES: This study assessed recent trends in HIV seroprevalence among injecting drug users in New York City. METHODS: We analyzed temporal trends in HIV seroprevalence from 1991 through 1996 in 5 studies of injecting drug users recruited from a detoxification program, a methadone maintenance program, research storefronts in the Lower East Side and Harlem areas, and a citywide network of sexually transmitted disease clinics. A total of 11,334 serum samples were tested. RESULTS: From 1991 through 1996, HIV seroprevalence declined substantially among subjects in all 5 studies: from 53% to 36% in the detoxification program, from 45% to 29% in the methadone program, from 44% to 22% at the Lower East Side storefront, from 48% to 21% at the Harlem storefront, and from 30% to 21% in the sexually transmitted disease clinics (all P < .002 by chi 2 tests for trend). CONCLUSIONS: The reductions in HIV seroprevalence seen among injecting drug users in New York City from 1991 through 1996 indicate a new phase in this large HIV epidemic. Potential explanatory factors include the loss of HIV-seropositive individuals through disability and death and lower rates of risk behavior leading to low HIV incidence
— id: 57132, year: 1998, vol: 88, page: 1801, stat: Journal Article,

HIV vaccine trials
Des Jarlais DC; Vanischseni S; Marmor M; Kitayaporn D
1998 Mar 6;279(5356):1433-1434, Science
— id: 30804, year: 1998, vol: 279, page: 1433, stat: Journal Article,

Readiness of high-risk populations in the HIV Network for Prevention Trials to participate in HIV vaccine efficacy trials in the United States
Koblin BA; Heagerty P; Sheon A; Buchbinder S; Celum C; Douglas JM; Gross M; Marmor M; Mayer K; Metzger D; Seage G
1998 May 7;12(7):785-793, AIDS
OBJECTIVE: To determine the willingness of populations at high risk of HIV-1 infection to participate in HIV vaccine efficacy trials, determine factors influencing decision-making, and evaluate knowledge levels of vaccine trial concepts. DESIGN: Cross-sectional study. METHODS: HIV-1-negative homosexual men, male and female injecting drug users and non-injecting women at heterosexual risk were recruited in eight cities in the United States (n=4892). RESULTS: A substantial proportion of the study population (77%) would definitely (27%) or probably (50%) be willing to participate in a randomized vaccine efficacy trial. Increased willingness was associated with high-risk behaviors, lower education level, being uninsured or covered by public insurance, and not having been in a previous vaccine preparedness study. Altruism and a desire for protection from the vaccine were major motivators for participation. Major concerns included positive HIV-1 antibody test due to vaccine, safety of the vaccine, and possible problems with insurance or foreign travel. Baseline knowledge of vaccine trial concepts was low. CONCLUSIONS: It is likely that high-risk volunteers will be willing to enroll in HIV vaccine efficacy trials. A variety of participant and community educational strategies are needed to address participant concerns, and to ensure understanding of key concepts prior to giving consent for participation
— id: 7630, year: 1998, vol: 12, page: 785, stat: Journal Article,

Geographic diversity in tuberculosis trends and directly observed therapy, New York City, 1991 to 1994
Davidow AL; Marmor M; Alcabes P
1997 Nov;156(5):1495-1500, American journal of respiratory & critical care medicine
The New York City tuberculosis (TB) case rate declined from 1991 to 1994 following more than a decade of increases. The present study investigated TB trends in New York City neighborhoods and their association with neighborhood-specific rates of application of directly observed therapy (DOT). Using Poisson regression models, TB trends in each of New York City's 30 health districts were classified as increasing, decreasing, or stable, as indicated respectively by significant positive, negative, or nonsignificant regression coefficient. Case counts increased in four health districts, decreased in 10, and were stable in 16. Decreasing TB was associated with a higher rate of application of DOT. TB cases among foreign-born persons increased in 12 health districts and were stable in 18, whereas cases among persons born in the United States decreased in 19 and were stable in 11 districts. Among the foreign-born, increasing TB was not associated with a lesser rate of application of DOT. These data provide some support for the role of DOT in containing TB, but also suggest that the application of DOT among foreign-born residents is less effective than among United States-born residents. This may be due to a greater proportion of TB cases among the foreign-born being due to reactivation of TB rather than new infection
— id: 8324, year: 1997, vol: 156, page: 1495, stat: Journal Article,

"Why I am not infected with HIV": implications for long-term HIV risk reduction and HIV vaccine trials
Des Jarlais DC; Vanichseni S; Marmor M; Buavirat A; Titus S; Raktham S; Friedmann P; Kitayaporn D; Wolfe H; Friedman SR; Mastro TD
1997 Dec 15;16(5):393-399, Journal of acquired immune deficiency syndromes & human retrovirology
OBJECTIVE: To describe beliefs about remaining HIV-seronegative in injecting drug users in two high-seroprevalence cities, and to consider implications of these beliefs for ongoing risk reduction efforts and for HIV vaccine efficacy trials. DESIGN: Cross-sectional survey with open- and closed-ended questions. SUBJECTS: 58 HIV-seronegative injecting drug users participating in HIV vaccine preparation cohort studies in New York City, New York, U.S.A., and Bangkok, Thailand. MAJOR FINDINGS: Large majorities of subjects in Bangkok (90%) and in New York (89%) believed their 'own efforts' to practice safer injection methods and safer sex were very important in avoiding HIV infection. More Bangkok subjects (30%) believed that they would 'probably' become infected with HIV in the future than New York subjects (4%). Three percent of Bangkok subjects and 70% of New York subjects believed 'having an immune system strong enough to avoid becoming infected with HIV despite exposure to the virus' was very important in avoiding HIV infection. This belief in New York subjects was associated with having previously engaged in high-risk behaviors (i.e., sharing injection equipment, unprotected sex, or both) with partners known to be HIV-seropositive. CONCLUSIONS: Risk reduction programming for high-HIV-seroprevalence populations and within HIV vaccine trials should address not only specific HIV risk behaviors, but also the complex belief systems about avoiding HIV infection that develop within such groups. The person's 'own efforts/self-efficacy' appears to be central in the psychology of risk reduction. Members of some high-risk populations may overestimate greatly the frequency of any possible natural immunity to becoming infected with HIV. Prevention programs for these populations will need to address explicitly the probabilistic nature of HIV transmission
— id: 7548, year: 1997, vol: 16, page: 393, stat: Journal Article,

Low serum thiol levels predict shorter times-to-death among HIV-infected injecting drug users
Marmor M; Alcabes P; Titus S; Frenkel K; Krasinski K; Penn A; Pero RW
1997 Sep;11(11):1389-1393, AIDS
OBJECTIVES: To investigate whether serum thiol levels are altered by HIV disease, and whether low serum thiols predict time to death among HIV-infected injecting drug users (IDU). DESIGN: A cross-sectional study of serum thiol levels among 13 HIV-seronegative IDU, 116 HIV-seropositive IDU, and 17 HIV-seropositive IDU with a history of AIDS, and a cohort study of the 133 HIV-infected IDU who took part in the cross-sectional study. METHODS: Subjects were recruited from a methadone-maintenance treatment program during 1990-1991. Total serum thiols were determined spectrophotometrically at enrolment; low serum thiols were defined as those with an absorbance at 412 nm < or = 0.46. Deaths through 31 December 1993 were determined from the National Death Index (NDI). Twenty-six HIV-seropositive subjects died during follow up; death certificates, which were obtained for 23 subjects, indicated AIDS or HIV infection for 20. Product-limit estimation was used to calculate survival. Multivariate analyses employed Cox proportional-hazards regression. RESULTS: Analysis of cross-sectional data showed that serum thiols did not differ significantly among HIV-free subjects, HIV-infected subjects, and HIV-infected subjects with a history of AIDS. Cohort analysis, adjusted for age, revealed that persons with those with high serum thiols (relative hazard = 2.83; 95% confidence interval (CI), 1.15, 6.97); a significant interaction between low serum thiols and a history of AIDS was associated with a relative hazard of 5.65 (95% CI, 1.22-2.61). CONCLUSIONS: Among HIV-infected persons, low serum thiols, especially in concert with a history of AIDS, predict mortality risk. These findings support the hypothesis that oxidative stress is critical to the pathogenesis of HIV infection
— id: 7212, year: 1997, vol: 11, page: 1389, stat: Journal Article,

Reexamination of human T cell lymphotropic virus (HTLV-I/II) prevalence
Zucker-Franklin D; Pancake BA; Marmor M; Legler PM
1997 Jun 10;94(12):6403-6407, Proceedings of the National Academy of Sciences of the United States of America
In the United States, blood donors are being screened for infection with human T cell lymphotropic viruses I and II (HTLV-I/II) by serologic means, which detect antibodies to the structural proteins of these viruses. Because patients with mycosis fungoides (MF) usually do not have such antibodies even though their cells harbor HTLV-I Tax and/or pol proviral sequences, it was questioned whether the prevalence of HTLV infection among healthy blood donors may also be underestimated by current means of testing. To examine this possibility, a study on specimens of relatives of mycosis fungoides patients (MFR) was begun. In addition, to collect data more expeditiously, a cohort of former injection drug users (IDUs) was tested by routine serologic methods, as well as by PCR/Southern blot analysis for Tax, pol, and gag proviral sequences and Western blot analysis for antibodies to the Tax gene product. To date, 6/8 MFRs and 42/81 (51.8%) of HIV-negative IDUs proved to be positive for HTLV, whereas routine serology identified none of the MFR and only 18/81 (22.2%) of the IDUs. Among the latter test subjects, the incidence of HTLV-I also proved to be 10 times higher than expected. Therefore, it is likely that among healthy blood donors infection with HTLV-I/II is more prevalent than is currently assumed. Since Tax is the transforming sequence of HTLV-I/II, testing for Tax sequences and antibodies to its gene product may be desirable in blood transfusion and tissue donor facilities
— id: 57010, year: 1997, vol: 94, page: 6403, stat: Journal Article,

Time trends in tuberculosis case rates for New York City
Davidow, AL; Marmor, M
1996 JUN 1 ;143(11):201-201, American journal of epidemiology
— id: 52884, year: 1996, vol: 143, page: 201, stat: Journal Article,

HIV incidence among injecting drug users in New York City syringe-exchange programmes
Des Jarlais DC; Marmor M; Paone D; Titus S; Shi Q; Perlis T; Jose B; Friedman SR
1996 Oct 12;348(9033):987-991, Lancet
BACKGROUND: There have been no studies showing that participation in programmes which provide legal access to drug-injection equipment leads to individual-level protection against incident HIV infection. We have compared HIV incidence among injecting drug users participating in syringe-exchange programmes in New York City with that among non-participants. METHODS: We used meta-analytic techniques to combine HIV incidence data from injecting drug users in three studies: the Syringe Exchange Evaluation (n = 280), in which multiple interviews and saliva samples were collected from participants at exchange sites; the Vaccine Preparedness initiative cohort (n = 133 continuing exchanges and 188 non-exchangers, in which participants were interviewed and tested for HIV every 3 months; and very-high-seroprevalence cities in the National AIDS Demonstration Research (NADR) programme (n = 1029), in which street-recruited individuals were interviewed and tested for HIV every 6 months. In practice, participants in the NADR study had not used syringe exchanges. FINDINGS: HIV incidence among continuing exchange-users in the Syringe Exchange Evaluation was 1.58 per 100 person-years at risk (95% CI 0.54, 4.65) and among continuing exchange-users in the Vaccine Preparedness Initiative it was 1.38 per 100 person-years at risk (0.23, 4.57). Incidence among non-users of the exchange in the Vaccine Preparedness Initiative was 5.26 per 100 person-years at risk (2.41, 11.49), and in the NADR cities, 6.23 per 100 person-years at risk (4.4, 8.6). In a pooled-data, multivariate proportional-hazards analysis, not using the exchanges was associated with a hazard ratio of 3.35 (95% CI 1.29, 8.65) for incident HIV infection compared with using the exchanges. INTERPRETATION: We observed an individual-level protective effect against HIV infection associated with participation in a syringe-exchange programme. Sterile injection equipment should be legally provided to reduce the risk of HIV infection in persons who inject illicit drugs
— id: 9095, year: 1996, vol: 348, page: 987, stat: Journal Article,

Weight loss associated with HIV seroconversion among injection-drug users
Marmor M; Titus S; Harrison C; Cord-Cruz EA; Shore RE; Vogler M; Krasinski K; Mildvan D; Des Jarlais DC
1996 Aug 15;12(5):514-518, Journal of acquired immune deficiency syndromes & human retrovirology
To describe symptoms associated with human immunodeficiency virus (HIV) seroconversion, we studied a cohort of 366 injection-drug users (IDUs) with a study design that included recall every 3 months to collect symptom histories using a structured questionnaire. Eleven HIV seroconversions were observed in 621.5 person years at risk (PYAR), equivalent to 1.8 seroconversions/100 PYAR. Cox regression analysis showed age < or = 35 years to be a significant risk factor for HIV seroconversion after controlling for gender, race, and the frequency of drug injection. An embedded case-control analysis then compared symptom histories of HIV seroconverters with those of age-(+/- 5 years) and visit number-matched controls who remained HIV seronegative for > or = 3 months longer than the HIV-seroconverters. Multivariate case-control analysis adjusted for injection frequency yielded significant associations of HIV seroconversion with histories of weight loss > or = 4.5 kg (seven of 11 cases; odds ratio [OR] = 11.6, 95% confidence interval [CI] 3.1, 43.1) and oral ulcers (three of 11 cases; OR = 7.6, 95% CI = 1.2, 48.2) in the 3 months before the subjects' first HIV-seropositive study visit. We conclude that histories of recent symptoms reported by HIV-seroconverting IDUs differ from those reported by non-HIV-seroconverting IDUs, and weight loss may be particularly common among IDUs experiencing primary HIV infection
— id: 9096, year: 1996, vol: 12, page: 514, stat: Journal Article,

Determination of the true prevalence of infection with the human T-cell lymphotropic viruses (HTLV-I/II) may require a combination of biomolecular and serological analyses
Pancake BA; Zucker-Franklin D; Marmor M; Legler PM
1996 Nov;108(6):444-448, Proceedings of the Association of American Physicians
Infection with the human T-cell lymphotropic virus types I and II (HTLV-I/II) usually is determined by tests that detect antibodies to the viral structural proteins. However, recent studies revealed that patients with mycosis fungoides have proviral DNA sequences related to the HTLV transactivating-transforming gene tax, without having antibodies to the virus. These results raised the possibility that the prevalence of HTLV infection in the general population of the United States also may be underestimated. To reassess the prevalence of HTLV-I/II infection effectively, a population at increased risk for infection (i.e., a cohort of injection drug users [IDUs]) was studied. Paired sera and peripheral blood mononuclear cells (PBMCs) from 81 IDUs were subjected to testing by Western blot analysis for antibodies to the viral structural proteins gag and env and by polymerase chain reaction (PCR) Southern analysis to detect gag, pol and tax proviral DNA sequences. Western blot assays showed 1 of 81 IDUs to be positive for HTLV-I, 14 to be positive for antibodies to HTLV-II, and 3 to be HTLV-serotype indeterminate. When whole-cell lysates of PBMCs from these individuals were subjected to PCR and Southern analysis. 39 of 81 were found to have HTLV-related sequences. A total of nine IDUs were found to be infected with HTLV-I, a figure nearly 10 times higher than that estimated by serology alone. Bio-molecular analysis showed HTLV-II-specific proviral sequences in 21 IDUs. Three individuals were seropositive for HTLV-II but lacked PCR evidence of gag, pol and tax sequences. Thus, the overall prevalence of HTLV infection among this cohort was 59% (43 of 81) (i.e., more than twice the frequency predicted by serology, 18 of 81 or 22%). These results indicate that it may be necessary to incorporate biomolecular as well as serological methodologies to identify all persons infected with these retroviruses
— id: 9094, year: 1996, vol: 108, page: 444, stat: Journal Article,

Determination of the true prevalence of infection with the human T cell lymphotropic viruses (HTLV-I/II) may reouire a combination of biomolecular and serologic analyses
Pancake, BA; ZuckerFranklin, D; Marmor, M
1996 MAR ;44(3):A250-A250, Journal of investigative medicine
— id: 52956, year: 1996, vol: 44, page: A250, stat: Journal Article,

Methadone maintenance and other factors associated with intraindividual temporal trends in injection-drug use
Shore RE; Marmor M; Titus S; Des Jarlais DC
1996 May-Jun;13(3):241-248, Journal of substance abuse treatment
The objective of this study was to determine what sociodemographic, lifestyle, or drug-related characteristics predict temporal changes in self reported drug injection frequencies among HIV-seronegative injection-drug users (IDUs) who were being given HIV testing and risk reduction counseling. The 277 subjects were given 4-11 quarterly interviews including detailed history of drug use and other HIV risk factors, HIV risk reduction counseling, and venipuncture for HIV antibody testing. A regression slope of change over time in drug injection frequency was calculated for each subject, and categories were created of decreasing temporal slope, increasing slope, relapse (decrease initially, then increase), or no substantial change. Only 44% of subjects decreased their drug injection frequencies despite repetitive HIV testing and counseling. In multivariate logistic analyses, decreasing temporal trends were associated with consistent enrollment in methadone maintenance (p < .1), whereas increasing trends conversely were associated with inconsistent enrollment (p < .01) and also with an absence of crack use (p < .01). Relapses were significantly associated with needle sharing with multiple partners and a low frequency of smoking. The data suggest that methadone maintenance facilitates a positive response to HIV risk reduction counseling. However, the fact that only a minority of subjects displayed a decreasing temporal trend in drug injection frequencies emphasizes the need for improved therapeutic and counseling techniques
— id: 8429, year: 1996, vol: 13, page: 241, stat: Journal Article,

Risk factors for choroidal neovascularization in young patients: a case-control study
Derosa, J T; Yannuzzi, L A; Marmor, M; Fotino, M; Sorenson, J A; Spaide, R F
1995 1996;91(3):207-222, Documenta ophthalmologica
A pair-matched, case-control design was used to study exposure to Histoplasma capsulatum and other environmental factors, and to determine various host characteristics including human leukocyte antigen (HLA) typings in 94 young patients with macular choroidal neovascularization (CNV) and in 94 controls with other eye diseases. Patients with two types of retinal patterns were studied: Type I, or those with CNV with one or no chorioretinal atrophic spots in the posterior pole or periphery (n = 51), and Type II, or those with CNV and 2 or more chorioretinal atrophic spots (n = 43). Our purpose was to explore whether these two variants of idiopathic CNV have different and distinguishable epidemiologies which may or may not be related to prior exposure to Histoplasma. We found that histoplasmin skin tests were negative in all but two Type I cases. The combination of the HLA-B7 and HLA-DR2 markers (but not either marker alone) was significantly increased in Type I cases. Among Type II cases, HLA-B7, HLA-DR2, HLA-DQ1, a positive histoplasmin skin test, myopic refractive error, prior residence in a histoplasmosis endemic area, occupations involving exposure to animals, and hypertension were all significantly increased. Histoplasmin skin test responses were positive in 18 Type II cases (45%). In the multivariate analysis, only DR2 and the combined presence of DQ1 and a positive histoplasmin skin test remained predictive of Type II disease. Our findings suggest that histoplasmin sensitivity is associated with some, but not all, cases of Type II disease. However, histoplasmin sensitivity appears to have no relationship to Type I disease. HLA factors may play a role in both disease types, possibly by producing a modified immune response to Histoplasma and/or other unidentified agents
— id: 103468, year: 1995, vol: 91, page: 207, stat: Journal Article,

Evidence for an effect of human leukocyte antigens on susceptibility to Kaposi's sarcoma related to charge and peptide-binding properties of class I molecules
Marmor M; Winchester R; Zeleniuch-Jacquotte A; Weiss SH; Krasinski K; Saxinger WC; Friedman-Kien A; William DC; Demopoulos R
1995 Oct;9(10):1194-1195, AIDS
— id: 9091, year: 1995, vol: 9, page: 1194, stat: Journal Article,

Community based heroin addicts who turn to experimental treatment rather than conventional care
Michaels J; Galanter M; Resnick R; Marmor M; Lifshutz H; Perrone R
1995 ;14(2):33-42, Journal of addictive diseases
In this paper we report on a community based sample of heroin addicts not in addiction treatment who responded to the offer of experimental treatment (buprenorphine) for heroin addition. Comparison to a sample of methadone maintenance clients from the same geographic area reveals that on average the community sample began heroin use later, attained a higher level of education, and were most likely to have had a significant cohabitation relationship. The methadone maintenance sample, on the other hand, reported significantly greater regular use of drugs of abuse other than heroin. Each group may represent a different subgroup drawn from the heterogeneous heroin-addicted population. Implications for improved recruitment into treatment and enhanced treatment design are drawn from these findings
— id: 6936, year: 1995, vol: 14, page: 33, stat: Journal Article,

Progress in identifying clinical relevance of inhibition, stimulation and measurements of poly ADP-ribosylation
Pero RW; Olsson A; Sheng Y; Hua J; Moller C; Kjellen E; Killander D; Marmor M
1995 ;77(5):385-393, Biochimie
Our laboratory, in collaboration with Oxigene Inc, has been involved in identifying commercially feasible clinical applications of measurement or modulation of ADP-ribosylation as a core technology. For this purpose a pivotal regulatory role for ADP-ribosylation in the repair of DNA lesions leading to cytotoxic as well as mutagenic events has been hypothesized. A new class of DNA repair inhibitors, the N-substituted benzamides, has been identified which can react with radiation to produce reactive intermediates that oxidize thiol amino acids. Their proposed mechanisms of action are two-fold: ie they can interact with radiation: i) to directly enhance DNA damage; and ii) to react with thiols in the zinc finger DNA binding domain of poly ADP-ribosyl transferase to inhibit DNA repair and thereby increase DNA damage. Sensamide, a clinically relevant formulation of metoclopramide which is an N-substituted benzamide, has indicated enhancement of tumor response and survival in patients with inoperable squamous cell carcinoma of the lung when it was administered as a radiosensitizer in a phase I/II trial and compared to historical controls. A mechanism of endogenous regulation of human mononuclear leucocyte ADP-ribosylation has been identified to be HOCl/N-chloramine production via the oxidative burst of phagocytes. HOCl/N-chloramines are potent oxidants of thiol-containing proteins. Quantitative estimation of N-chloramine sensitive plasma thiols has been identified as an effective surrogate measure of leucocyte poly ADPRT.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 9092, year: 1995, vol: 77, page: 385, stat: Journal Article,

Tuberculosis knowledge among New York City injection drug users
Wolfe H; Marmor M; Maslansky R; Nichols S; Simberkoff M; Des Jarlais D; Moss A
1995 Jul;85(7):985-988, American journal of public health. AJPH
Structured interviews measuring tuberculosis knowledge were administered to 494 New York City injection drug users, 31% of whom reported a history of having a reactive tuberculin skin test. Medical records review of a subsample confirmed the validity of self-reported data. Most respondents understood the mechanisms of tuberculosis transmission. Three fourths of the subjects did not fully understand the distinction between a reactive skin test and active tuberculosis, but those who reported a history of skin test reactivity were twice as likely to understand this distinction. Forty percent of subjects did not understand the importance of medication adherence. Misunderstandings, based on a recent lack of tuberculosis education, may contribute to the fear and confusion that interfere with efforts to control tuberculosis
— id: 56800, year: 1995, vol: 85, page: 985, stat: Journal Article,

Continuity and change within an HIV epidemic. Injecting drug users in New York City, 1984 through 1992 [see comments]
Des Jarlais DC; Friedman SR; Sotheran JL; Wenston J; Marmor M; Yancovitz SR; Frank B; Beatrice S; Mildvan D
1994 Jan 12;271(2):121-127, JAMA
OBJECTIVES--To examine trends in acquired immunodeficiency syndrome (AIDS) risk behavior and human immunodeficiency virus (HIV) seroprevalence among injecting drug users (IDUs) in New York City from 1984 through 1992. DESIGN AND SETTING--Comparisons were made between two surveys of IDUs at the same hospital-based New York City drug abuse detoxification program: 141 IDUs in 1984 and 974 IDUs in 1990 through 1992. National Death Registry, New York City Health Department, and drug treatment program records were also used. PARTICIPANTS--Persons attending detoxification program randomly selected for participation. Eligibility was based on injection within previous 2 months; 99% acceptance rates were obtained. Participants in the 1984 and 1990 through 1992 surveys were 66% and 79% men, 21% and 19% white, 33% and 34% African American, and 45% and 46% Latin American, respectively. INTERVENTIONS--Community-based AIDS prevention programs, including underground syringe exchanges. MAIN OUTCOME MEASURES--Acquired immunodeficiency syndrome risk behaviors; HIV serostatus; CD4+ cell counts; death rates among 1984 subjects; and injection and intranasal routes of drug administration. RESULTS--The HIV seroprevalence remained stable at slightly more than 50%. Mean CD4+ cell counts declined from 0.716 x 10(9)/L (716/microL) to 0.575 x 10(9)/L (P < .009). Annual death rate among 1984 subjects was 3%, with a significantly higher rate among HIV-seropositive subjects (relative risk, 2.57; 95% exact binomial confidence interval, 1.12 to 6.61). Large-scale declines were observed in AIDS risk behaviors, eg, use of potentially contaminated syringes declined from 51% to 7% of injections (P < .001). Recent additional risk reduction was associated with use of the underground syringe exchanges. Intranasal heroin use was the primary route of drug administration for 46% of heroin admissions to New York City drug treatment programs. CONCLUSIONS--The HIV seroprevalence has remained stable among this population of New York City IDUs for almost a decade. Continuation of current trends should lead to further reduction in HIV transmission, although reversal of the trend to intranasal use could lead to substantially increased transmission
— id: 9097, year: 1994, vol: 271, page: 121, stat: Journal Article,

Estimation of time since infection using longitudinal disease-marker data
Dubin N; Berman S; Marmor M; Tindall B; Des Jarlais D; Kim M
1994 Feb 15;13(3):231-244, Statistics in medicine
We propose a method to estimate the usually unknown time since infection for individuals infected with human immunodeficiency virus type 1 (HIV-1). If we assume the time since infection has an exponential prior distribution, then under the model the conditional distribution of time since infection, given the CD4 level at the time of the first positive HIV-1 antibody test, is a truncated normal density. We applied the method to prevalent cohort data both from intravenous drug users and from homosexual/bisexual men. For the intravenous drug users the estimated mean time since infection was 15.0 months from infection at a presumed mean CD4 level of 1060 cells/ml to first positive antibody test at a CD4 level of 597 cells/ml, which was the average CD4 at enrollment for infected subjects. For the homosexual/bisexual men the estimated mean time since infection was 16.7 months from infection at a presumed mean CD4 level of 699 cells/ml to first positive antibody test at an average CD4 level of 577 cells/ml. We performed a validation study using initially seronegative subjects in these cohorts who seroconverted to HIV-1-positive antibody status during the follow-up period. For the intravenous drug users, data were too few to provide definitive verification of the method. In the cohort of homosexual/bisexual men, however, there was a total of 70 seroconverters with relevant data. Among them, the median absolute difference between the midpoint of the known seroconversion interval and the estimated mean infection date was 4.6 months, conditional on CD4-lymphocyte measurements taken approximately 18 months subsequent to infection. Conditional on CD4 approximately 30 months after infection, this median difference increased modestly to 8.2 months. Our analysis suggested that the underlying mathematical model tends to overestimate short times since infection and underestimate long times since infection. We consider potential corrective modifications to the model
— id: 6360, year: 1994, vol: 13, page: 231, stat: Journal Article,

Reversal learning tasks may provide rapid determination of cognitive deficits in lead-exposed children
Evans HL; Daniel SA; Marmor M
1994 Sep-Oct;16(5):471-477, Neurotoxicology & teratology
An historical cohort study of twins, aged 6 to 15 years, found reduced cognitive performance related to subclinical exposure to lead (Pb) much earlier in life. Pairs of twins discordant for blood Pb (low-Pb twins ranged from 30-50 micrograms/dl and high-Pb twins ranged from 43-80 micrograms/dl) exhibited reduced learning of a computer-administered visual discrimination and reversal by the twin having the higher exposure. There was no evidence that sensory or motor impairment contributed to the cognitive deficit. Performance of a reference group indicated that test's validity for age-related cognitive development and the method's suitability for children of varying socio-economic or racial status. Because the reversal learning approach required only one 20-min test session and was powerful enough to document Pb-related deficits in a small sample (n = 8), it may indicate a practical method for obtaining early evidence of environmentally induced developmental delays. An advantage of the test is that it can be used with both humans and animals. Tests capable of direct comparison of behavioral data from humans and animals can guide the search for behavioral and biological mechanisms in experiments that can be done only with animals. They also can augment the clinical procedures currently used
— id: 6611, year: 1994, vol: 16, page: 471, stat: Journal Article,

Increased expression of transforming growth factor beta isoforms and basic fibroblast growth factor in complex hyperplasia and adenocarcinoma of the endometrium: evidence for paracrine and autocrine action
Gold LI; Saxena B; Mittal KR; Marmor M; Goswami S; Nachtigall L; Korc M; Demopoulos RI
1994 May 1;54(9):2347-2358, Cancer research
Endometrial carcinoma is associated with antecedent simple and complex hyperplasia, and the endometrium is a target tissue for the action of cytokines and growth factors. Transforming growth factor (TGF)-beta s are potent cellular growth and differentiation regulatory factors. Therefore, we investigated the potential role for TGF-beta s in the normal proliferative endometrium and its possible involvement in the transition to complex hyperplasia and progression to endometrial carcinoma. The angiogenic and mitogenic growth factor, basic fibroblast growth factor, was used for comparison. Differential TGF-beta isoform-specific immunoreactivity was observed in the normal endometrium, which is composed of glandular and stromal cells. There was an increase in TGF-beta 3 but not TGF-beta 1 or TGF-beta 2 in the glandular epithelium from the proliferative to the secretory phase of the menstrual cycle. Immunostaining for TGF-beta 2 was more intense in the stroma than the glands. In contrast, TGF-beta 1 and TGF-beta 3 were near equal intensity in these two endometrial compartments, TGF-beta 3 being the most intense. The glandular epithelium demonstrated a statistically significant stepwise increase in the expression of all three TGF-beta s progressing from the normal proliferative endometrium to simple hyperplasia and on to complex hyperplasia. However, the stromal cells maintained approximately the same level of immunoreactivity for TGF-beta in all these samples. In comparing proliferative endometrium with complex hyperplasia, there was a 5.1-, 3.4-, and 2.6-fold increase in immunostaining in the glands for TGF-beta 1, TGF-beta 2, and TGF-beta 3, respectively (P < or = 0.001). There was no further increase in immunoreactivity with progression from preneoplastic complex hyperplasia to carcinoma. Immunoreactive basic fibroblast growth factor was slight in normal endometrium and simple hyperplasia. There was a 4.6- and 4.2-fold increase in immunostaining observed in complex hyperplasia compared with proliferative endometrium in the glandular (P < or = 0.0054) and stromal (P < or = 0.0053) cells, respectively, with no further increase in carcinoma. By in situ hybridization, an increase in mRNA for all TGF-beta isoforms paralleled TGF-beta immunoreactivity. However, in contrast to the increased immunostaining in the glands in complex hyperplasia, there was remarkably more mRNA in the stromal cell compartment. The discordant expression of mRNA and protein was only observed in the pathological endometrium since both were more highly expressed in the stromal cells in normal proliferative endometrium.(ABSTRACT TRUNCATED AT 400 WORDS)
— id: 6386, year: 1994, vol: 54, page: 2347, stat: Journal Article,

Preparations for AIDS vaccine trials. Retention, behavior change, and HIV-seroconversion among injecting drug users (IDUs) and sexual partners of IDUs
Marmor M; Titus S; Wolfe H; Krasinski K; Maslansky R; Simberkoff M; Beatrice S; Nichols S; Des Jarlais DC
1994 ;10 Suppl 2:S207-S213, AIDS research & human retroviruses
The likelihood that subjects in human immunodeficiency virus (HIV) vaccine efficacy trials will alter their behavioral risks for HIV infection over time must be considered in evaluating the feasibility of such trials and in estimating the necessary sample sizes to be enrolled. Potential subjects for future vaccine efficacy trials include injecting drug users (IDUs) and others who may be difficult to retain in studies and who may alter HIV-risk-related behaviors substantially over time. We have investigated behavior change, retention, and HIV seroconversion among 577 New York City resident IDUs and sexual partners of IDUs enlisted between July 1 and December 31, 1992. We attempted to see all subjects every 3 months for interviews, blood donation and HIV testing. We were able to retain 68% of subjects in the study through the third scheduled recall at 7.5-10.5 months after enlistment. HIV seroconversion through March 1, 1994, was 1.33/100 person-years at risk. There was a significant inverse relationship between HIV seroconversion and retention at the 9-month recall after adjusting for age, gender, and the amount of locator information provided by subjects at enlistment. Among subjects seen at each of the scheduled visits at 3, 6, and 9 months after enrollment, modest but statistically significant behavior changes that reduced risk were observed in self-reported drug injection frequency, heroin injection frequency, sexual contact with IDUs, and sharing of needles/syringes. The magnitude of these changes in risk, however, was small and may be transient. The behavior changes observed to date do not appear to be large enough to substantially alter calculations of sample sizes needed in future HIV vaccine efficacy trials
— id: 13032, year: 1994, vol: 10 Suppl 2, page: S207, stat: Journal Article,

Tuberculosis knowledge among New York City (NYC) injecting drug users (IDUs) and sexual partners of IDUs
Marmor M; Wolfe H; Des Jarlais D; A. Moss A
1994 ;1994(2):438-438, Problems of drug dependence
[NIDA Research monograph ; #153]
— id: 70463, year: 1994, vol: 1994, page: 438, stat: Journal Article,

Knowledge and practices among injecting-drug users of bleach use for equipment disinfection - New York City
Marmor M; Wolfe H; Titus S; Des Jarlais DC
1994 ;42:439, 445-446, MMWR
— id: 9336, year: 1994, vol: 42, page: 439, 445, stat: Journal Article,

HIV-1 among inner city dually diagnosed inpatients
Silberstein C; Galanter M; Marmor M; Lifshutz H; Krasinski K; Franco H
1994 ;20(1):101-113, American journal of drug & alcohol abuse
The objectives of this study were to investigate HIV-1 seroprevalence and risk factors, disease progression, and awareness of HIV-1 serostatus in a population of inner city, substance using, psychiatric inpatients. To pursue these goals, we tested 118 (103 M, 15 F) dually diagnosed, acute care inpatients for HIV-1 antibodies and administered structured interviews. Twenty-seven (23%, including 24 M and 3 F) of the subjects were HIV-1 seropositive. Seropositivity was twice as great among intravenous drug users and men who had sex with other men as among patients not belonging to either of these two groups. Logistic regression analysis among male subjects revealed a significantly elevated HIV-1 risk associated with a primary diagnosis of depression (odds ratio adjusted for age, race, and presence of an AIDS risk behavior = 4.2, 95% confidence interval = 1.1, 16.5; p = 0.04). Less than half of the seropositives knew their HIV-1 status prior to this study, one had AIDS and four had two or more constitutional symptoms of AIDS. The high rate of seropositivity in this indigent, dually diagnosed population presents challenges to the health-care community. That few individuals had HIV-1 related symptoms may have implications for other treatment settings
— id: 9098, year: 1994, vol: 20, page: 101, stat: Journal Article,

Bleach use and HIV seroconversion among New York City injection drug users
Titus S; Marmor M; Des Jarlais D; Kim M; Wolfe H; Beatrice S
1994 Jul;7(7):700-704, Journal of acquired immune deficiency syndrome
We employed a nested case-control study design to evaluate the efficacy of bleach-cleaning of needles and syringes among injecting drug users (IDUs) as a means of preventing human immunodeficiency virus (HIV) infection. Sixteen HIV-seroconverters who responded to bleach use questions and who reported injecting with shared or used equipment in the 6 months prior to their first positive visit were compared with 89 controls. Controls had remained HIV-seronegative at two or more visits, reported injecting with shared or used equipment, responded to bleach-cleaning questions, and were seen at recall visits +/- 6 months from the date of seroconversion of the index case. Risk factors associated with HIV seroconversion in univariate analyses were a history of sexual intercourse with an HIV-infected partner and the frequency of speedball (mixed heroin and cocaine) injections. After adjusting for confounders, we found no evidence that bleach use protected against HIV infection
— id: 56597, year: 1994, vol: 7, page: 700, stat: Journal Article,

HIV risk-related sexual behaviors among heterosexuals in New York City: associations with race, sex, and intravenous drug use
Kim MY; Marmor M; Dubin N; Wolfe H
1993 Mar;7(3):409-414, AIDS
OBJECTIVE: To investigate the relationship between heterosexual behaviors associated with HIV infection and ethnicity, sex, and intravenous drug use. METHODS: Subjects were recruited from Bellevue Hospital Center, New York City between 1986 and 1989, and interviewed about sexual behaviors and intravenous drug use. Analyses were based on 1561 black, white, or Hispanic individuals who reported having sexual contact with a member of the opposite sex. RESULTS: Twenty-seven per cent of the study population were black, 43% Hispanic, and 31% white. Blacks were more likely than whites or Hispanics to have initiated sexual intercourse at an early age, and to have had a sexually transmitted disease. Sex with a female drug user was more common among white men, and contact with a prostitute more frequent among Hispanic men. Among the women, Hispanics had fewer sexual risk factors overall than whites or blacks. Use of barrier contraceptives was uniformly low across all ethnic groups. Intravenous drug use was significantly associated with sexual risk-taking. Women were more likely than men to have an intravenous drug-using (IVDU) sexual partner. CONCLUSIONS: The large prevalence of high-risk sexual practices observed in this study emphasizes the continuing need to target AIDS prevention programs at those at highest risk of heterosexually transmitted HIV: racial minorities, IVDU, and their sexual partners
— id: 57306, year: 1993, vol: 7, page: 409, stat: Journal Article,

Tuberculosis beliefs among New York City injecting drug users
Wolfe H; Marmor M; Moss A; Des Jarlais D
1993 Jun 26;341(8861):1658-1659, Lancet
— id: 9101, year: 1993, vol: 341, page: 1658, stat: Journal Article,

Crack cocaine use in a cohort of methadone maintenance patients
Des Jarlais DC; Wenston J; Friedman SR; Sotheran JL; Maslansky R; Marmor M
1992 Fall;9(4):319-325, Journal of substance abuse treatment
We examined crack use in a cohort of methadone patients originally enrolled in 1984-86. Crack use questions were added to the study in 1987. Of the 494 methadone patients originally enrolled, 228 subjects remained in methadone and were re-interviewed in 1987-88, and 234 remained in methadone and were re-interviewed in 1988-89. Approximately one-quarter of the subjects were using crack at each of the 1987-88 and 1988-89 data collection points, and only 3% of the subjects were using crack at daily or greater frequencies at each of the 1987-88 and 1988-89 interviews. Concurrent crack use was associated with (a) the number of noninjected drugs being used; (b) the number of IV drug-using sexual partners; (c) drug injection; and (d) the use of nonheroin opiates. Persistent crack use, defined as use in both 1987-88 and 1988-89, was associated with previous noninjected drug use and previous suicide attempts. While the potential problem of crack use among methadone patients should not be minimized, it appears that, compared to illicit drug injectors not in treatment, being in methadone maintenance may offer a protective effect against crack use
— id: 9104, year: 1992, vol: 9, page: 319, stat: Journal Article,

Implications of the revised surveillance definition: AIDS among New York City drug users [see comments]
Des Jarlais DC; Wenston J; Friedman SR; Sotheran JL; Maslansky R; Marmor M; Yancovitz S; Beatrice S
1992 Nov;82(11):1531-1533, American journal of public health. AJPH
The Centers for Disease Control (CDC) has proposed revising the AIDS surveillance definition to include any HIV-seropositive person with a CD4 cell count of less than 200 cells per microliter. Based on a study of persons receiving treatment for HIV infection, this new definition would lead to an estimated 50% increase in the number of persons recognized as living with AIDS. Among 440 HIV-seropositive research subjects recruited from drug treatment programs and through street outreach in New York City, 59 met this definition, yet only 25% of those had been reported to the New York City AIDS registry. The new definition, if combined with HIV and T-cell testing at drug treatment and street outreach programs, could thus yield very large increases in the number of injecting drug users meeting the new surveillance definition of AIDS
— id: 9102, year: 1992, vol: 82, page: 1531, stat: Journal Article,

HLA-B35 is associated with accelerated progression to AIDS
Itescu S; Mathur-Wagh U; Skovron ML; Brancato LJ; Marmor M; Zeleniuch-Jacquotte A; Winchester R
1992 ;5(1):37-45, Journal of acquired immune deficiency syndrome
To investigate the influence of HLA specificities on the rate of progression and outcome of human immunodeficiency virus (HIV) infection, we performed (a) a case-control study in 1989-1990 of HIV-seropositive individuals stratified by both risk behavior and ethnic background, (b) a longitudinal cohort study of HIV-infected male homosexuals enrolled in 1981-1982, and (c) an analysis of individuals with a diffuse infiltrative CD8 lymphocytosis syndrome. In the case-control study, there was a significantly higher frequency of HLA-B35 among intravenous drug users, but not homosexuals, who developed illnesses meeting the case definition for AIDS compared with asymptomatic HIV-positive controls, regardless of ethnic status. In the longitudinal study, HLA-B35-positive homosexuals had a significantly increased rate of progression to AIDS and decreased survival over a 7-year period compared with those without this specificity. Finally, there was a significantly decreased frequency of HLA-B35 in individuals with the diffuse infiltrative lymphocytosis syndrome, a clinically and genetically distinctive disorder occurring in HIV infection in which a low rate of progression to opportunistic infections was found. The high rate of salivary and lacrimal gland lymphoma in this group suggests that there is dissociation between the presence of HLA-B35 and the development of particular AIDS-defining conditions. We conclude that HLA-B35 is a risk factor for more rapid progression to AIDS, particularly opportunistic infections and Kaposi's sarcoma, operating in groups with high rates of newly acquired HIV infections such as New York City male homosexuals in 1981-1982, and intravenous drug users in 1989-1990.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 9103, year: 1992, vol: 5, page: 37, stat: Journal Article,

CD4% is the best predictor of development of AIDS in a cohort of HIV-infected homosexual men [see comments]
Burcham J; Marmor M; Dubin N; Tindall B; Cooper DA; Berry G; Penny R
1991 Apr;5(4):365-372, AIDS
To determine the relationships between individuals' baseline T-cell subsets, their rates of change with time, and AIDS-free survival time, data were collected at 6-monthly intervals from 379 HIV-seropositive homosexual Sydney men, of whom 31 developed AIDS during the 3-year observation period. Both CD4% and rate of change of CD4% in an individual had significant prognostic value in determining AIDS-free survival time. Compared with subjects whose CD4% remained stable, subjects whose CD4% dropped by 7% or more in a year had a relative hazard of 35.1 (95% confidence interval = 11.7-105.6, P less than 0.001) of developing AIDS. Increasing CD4% had a significant protective effect, reducing the risk of developing AIDS. CD4%, CD4 cell count and CD4: CD8 ratios showed steeper declines in subjects who were later diagnosed with AIDS than in those who remained AIDS-free. The rates of immunological change in AIDS-free seroconverters and seropositives were similar, despite indeterminate differences in durations of infections. In the multivariate Cox regression analysis, baseline CD4%, the rate of change of CD4%, and baseline lymphocyte count were associated with AIDS-free survival time. Baseline CD4% had greater prognostic value than baseline CD4 cell count. Baseline CD8%, baseline CD8 count, their rates of change and their mean square errors were not independently significant in this analysis. These findings are important for clinicians monitoring HIV infection in an individual and for entry criteria and monitoring procedures in clinical trials. They also have implications for resource-poor settings; prognosis based on CD4% can be made with a flow cytometer without a full blood count.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 9109, year: 1991, vol: 5, page: 365, stat: Journal Article,

Self-destructing (non-reusable) syringes [news]
Marmor M; Hartsock P
1991 Aug 17;338(8764):438-439, Lancet
— id: 9106, year: 1991, vol: 338, page: 438, stat: Journal Article,

Sex, drugs, and HIV infection in a New York City hospital outpatient population
Marmor M; Krasinski K; Sanchez M; Cohen H; Dubin N; Weiss L; Manning A; Bebenroth D; Saphier N; Harrison C; et al
1990 ;3(4):307-318, Journal of acquired immune deficiency syndrome
Persons attending outpatient clinics at Bellevue Hospital Center in Manhattan, New York City were invited to be tested for antibodies to human immunodeficiency virus (HIV). In pretest counseling, males were asked if they had injected nonprescription drugs or engaged in sex with other men since January 1, 1977; if so, they were asked not to participate and were referred elsewhere for testing. Face-to-face interviews and HIV testing were completed for 1,119 subjects with no prior indication of HIV seropositivity. Willingness to participate in the study was significantly greater among women than men and among younger than older persons. After exclusion of two subjects with indeterminate HIV serology, seroprevalence was 6.3% (70/1,117) overall, 7.1% (26/368) among men, and 5.9% (44/749) among women. HIV seropositivity among female i.v. drug users was 37% (27/74). Among heterosexuals without other HIV risk factors, estimated seroprevalences were 2.7% (25/924) overall, 3.3% (10/305) among males, and 2.4% (15/619) among females. Among heterosexual men, the data suggested associations of HIV seropositivity with sex with prostitutes and sex with numerous partners. Multiple logistic regression analysis indicated that significant predictors of HIV infection among women were a history of sexual contact with a male intravenous drug user, recent last use of intravenous drugs, and long duration of residence in New York City. Sexual intercourse with persons from AIDS risk groups was reported by 11% of men and 18% of women. The modal method of birth control reported by both men and women was 'no method'
— id: 9112, year: 1990, vol: 3, page: 307, stat: Journal Article,

RE: "An autopsy of epidemiologic methods: The case of "poppers" in the early epidemic of the acquired immunodeficiency syndrome (AIDS)" (letter)
Marmor, M; Dubin, N
1990 Jan;131(1):195-196, American journal of epidemiology
— id: 32116, year: 1990, vol: 131, page: 195, stat: Journal Article,

Incidence and risk factors for human immunodeficiency virus seroconversion in a cohort of Sydney homosexual men [see comments]
Burcham JL; Tindall B; Marmor M; Cooper DA; Berry G; Penny R
1989 Jun 5;150(11):634-639, Medical journal of Australia
By means of prospective cohort data from the Sydney AIDS Project, we report on 55 homosexual or bisexual men who have become infected with human immunodeficiency virus (HIV), as measured by the development of serum HIV antibodies (seroconversion). We have compared the sexual practices, recreational drug abuse, history of sexually-transmissible diseases, and antecedent immunological findings of the men who seroconverted with those of 588 subjects who persistently remained seronegative in the same time-period. The cumulative incidence rate of HIV infection over the three years of observation was 8.5%. The cumulative incidence rate ranged from less than 1% for the six months before August 1, 1984, to a peak of 5% in the six months before August 1, 1985. Of those subjects for whom we had data for the period of seroconversion, all but two of the subjects who seroconverted admitted to a recognized high-risk sexual practice in the six months before the first visit at which they were found to be seropositive. Univariate analysis found that men who seroconverted were significantly more likely to have had a greater number of recent sexual partners (relative risk per partner, 1.02; P less than 0.001), to have engaged in receptive anal intercourse (incidence rate ratio, 3.1; 95% confidence interval [CI], 1.3-7.6; P = 0.01) and to have used nitrite inhalant (incidence rate ratio, 2.6; 95% CI, 1.2-5.9; P = 0.02) and amphetamine (incidence rate ratio, 4.8; 95% CI, 2.2-10.5; P less than 0.001) drugs. The men who seroconverted were significantly (incidence rate ratio, 2.7; 95% CI, 1.2-6.1; P = 0.014) more likely to have antecedent T-suppressor-cell counts of greater than 800 cells/microL. Factors that retained significance in multivariate analysis were the number of recent sexual partners, recent amphetamine abuse and a T-suppressor-cell count of greater than 800 cells/microL
— id: 9113, year: 1989, vol: 150, page: 634, stat: Journal Article,

HIV-1 infection among intravenous drug users in Manhattan, New York City, from 1977 through 1987 [see comments]
Des Jarlais DC; Friedman SR; Novick DM; Sotheran JL; Thomas P; Yancovitz SR; Mildvan D; Weber J; Kreek MJ; Maslansky R; Spira T; Marmor M
1989 Feb 17;261(7):1008-1012, JAMA
Intravenous drug users are the second largest group to develop the acquired immunodeficiency syndrome, and they are the primary source for heterosexual and perinatal transmission in the United States and Europe. Understanding long-term trends in the spread of human immunodeficiency virus among intravenous drug users is critical to controlling the acquired immunodeficiency syndrome epidemic. Acquired immunodeficiency syndrome surveillance data and seroprevalence studies of drug treatment program entrants are used to trace seroprevalence trends among intravenous drug users in the borough of Manhattan. The virus entered this drug-using group during the mid-1970s and spread rapidly in 1979 through 1983. From 1984 through 1987, the seroprevalence rate stabilized between 55% and 60%--well below hepatitis B seroprevalence rates. This relatively constant rate is attributed to new infections, new seronegative persons beginning drug injection, seropositive persons leaving drug injection, and increasing conscious risk reduction
— id: 9331, year: 1989, vol: 261, page: 1008, stat: Journal Article,

PREVALENCE, PERSISTENCE AND SEQUELAE OF HIV P24 ANTIGEN IN A COHORT OF INTRAVENOUS DRUG-USERS
Jarlais, DCD; Mildvan, D; Yancovitz, S; Allain, JP; Leuther, M; Friedman, SR; Marmor, M; Beatrice, S; Elsadr, W
1988 May-Jun;61(3):280-281, Yale journal of biology & medicine
— id: 31451, year: 1988, vol: 61, page: 280, stat: Journal Article,

Mortality among bearing plant workers exposed to metalworking fluids and abrasives
Silverstein M; Park R; Marmor M; Maizlish N; Mirer F
1988 Sep;30(9):706-714, Journal of occupational medicine
Epidemiologic studies have reported associations between gastrointestinal cancer mortality and exposure to cutting fluids and abrasives in metal machining and precision grinding operations. Two previous studies found excess stomach cancer among workers exposed to water-based cutting fluids in bearing plants. This study reports similar findings in a third and larger population. Cause of death and work histories were determined for 1,766 bearing plant workers who died between Jan 1, 1950 and June 30, 1982. Mortality odds ratios (SMOR) and proportional mortality ratios (PMR) revealed significant excesses of gastrointestinal malignancies. The proportional mortality excess for stomach cancer among white men was greatest among those with more than 10 years' exposure in the major grinding group (PMR = 13/3.8 = 3.39; P less than .001). The SMOR by logistic regression for stomach cancer among white men was 2.3 (P = .02) for 25 years' grinding experience. For cancer of the pancreas among white men, there were significant associations with both machining and grinding jobs in straight oil (SMOR = 9.9 and 3.2, respectively, for 25 years duration). These findings could not be explained by confounding due to the ethnic background of the decedents. This study confirms previous evidence that grinding operations using water-based cutting fluids increase the risk for stomach cancer and provides moderate evidence that exposures to straight oil-cutting fluids increase the risk for cancer of the pancreas. There were indications, meriting further investigation, that non-malignant liver disease is associated with cutting fluid exposures and that lung cancer is associated with oil smoke from operations such as forging or heat treating
— id: 9116, year: 1988, vol: 30, page: 706, stat: Journal Article,

A larger spectrum of severe HIV-1--related disease in intravenous drug users in New York City
Stoneburner RL; Des Jarlais DC; Benezra D; Gorelkin L; Sotheran JL; Friedman SR; Schultz S; Marmor M; Mildvan D; Maslansky R
1988 Nov 11;242(4880):916-919, Science
Increasing mortality in intravenous (IV) drug users not reported to surveillance as acquired immunodeficiency syndrome (AIDS) has occurred in New York City coincident with the AIDS epidemic. From 1981 to 1986, narcotics-related deaths increased on average 32% per year from 492 in 1981 to 1996 in 1986. This increase included deaths from AIDS increasing from 0 to 905 and deaths from other causes, many of which were infectious diseases, increasing from 492 to 1091. Investigations of these deaths suggest a causal association with human immunodeficiency virus (HIV) infection. These deaths may represent a spectrum of HIV-related disease that has not been identified through AIDS surveillance and has resulted in a large underestimation of the impact of AIDS on IV drug users and blacks and Hispanics
— id: 9115, year: 1988, vol: 242, page: 916, stat: Journal Article,

Methadone maintenance and behavior by intravenous drug users that can transmit HIV
Abdul-Quader AS; Friedman SR; Des Jarlais D; Marmor M; Maslansky R; Bartelme S
1987 ;14:425-434, Contemporary drug problems
— id: 9335, year: 1987, vol: 14, page: 425, stat: Journal Article,

Development of AIDS, HIV seroconversion, and potential co-factors for T4 cell loss in a cohort of intravenous drug users
Des Jarlais DC; Friedman SR; Marmor M; Cohen H; Mildvan D; Yancovitz S; Mathur U; el-Sadr W; Spira TJ; Garber J; et al
1987 Jul;1(2):105-111, AIDS
A cohort of 334 intravenous (IV) drug users from New York City drug treatment programs were followed over a mean 9-month period. Among the 165 who were seropositive at enlistment, four developed clinical AIDS, for an annual rate of 3%. Elevated IgA was a significant predictor of developing AIDS. Among 72 subjects who were initially seronegative and who were re-interviewed, four were seropositive at follow-up, for a seroconversion rate of 7% per year among seronegatives. Among seropositive subjects who did not develop AIDS or fatal AIDS related complex (ARC), continued drug injection was associated with rate of T4 cell loss, and there was a non-significant trend for males to lose T4 cells more rapidly than females. While it was not possible to distinguish the mechanism underlying the relationship between continued drug injection and T4 cell loss, seropositive IV drug users should be warned that continued injection may lead to increased HIV-related immunosuppression as well as, if injection equipment is shared, risking viral transmission to others
— id: 9117, year: 1987, vol: 1, page: 105, stat: Journal Article,

Four-year prospective study of homosexual men: correlation of immunologic abnormalities, clinical status, and serology to human immunodeficiency virus
el-Sadr W; Marmor M; Zolla-Pazner S; Stahl RE; Lyden R; William D; D'Onofrio S; Weiss SH; Saxinger WC
1987 Apr;155(4):789-793, Journal of infectious diseases
— id: 9120, year: 1987, vol: 155, page: 789, stat: Journal Article,

Risk factors for infection with human immunodeficiency virus among intravenous drug abusers in New York City
Marmor M; Des Jarlais DC; Cohen H; Friedman SR; Beatrice ST; Dubin N; el-Sadr W; Mildvan D; Yancovitz S; Mathur U; et al
1987 May;1(1):39-44, AIDS
We report here the results of a survey of 308 intravenous drug abusers recruited from hospital-based methadone maintenance or drug detoxification programmes located in Manhattan, New York City. Complete interviews and serological analyses for antibodies to human immunodeficiency virus (HIV) using both enzyme-linked immunosorbent and Western blot assays were obtained from 290 (94%) of the subjects. HIV antibodies were found by both assays in 147 (50.7%) of the tested subjects; conflicting results were found in three (1%) of the subjects; and negative results on both tests were found in 140 (48.3%) of the subjects. Logistic regression analysis identified significant relative risks for HIV infection associated with the frequency of drug injection and the proportion of injections in 'shooting galleries'. Additional risk among men was associated with a history of homosexual relations. Traditional efforts taken by subjects to clean syringes between uses, such as washing with water or alcohol, showed no evidence of being protective. Programmes aimed at prevention of HIV infection should focus on reducing use of shooting galleries and sharing of needles and syringes as well as reducing intravenous drug abuse generally
— id: 9119, year: 1987, vol: 1, page: 39, stat: Journal Article,

Toxocara canis infection of children: epidemiologic and neuropsychologic findings
Marmor M; Glickman L; Shofer F; Faich LA; Rosenberg C; Cornblatt B; Friedman S
1987 May;77(5):554-559, American journal of public health. AJPH
Sera from 4,652 children whose blood was submitted to the New York City Department of Health for lead analysis were tested for antibodies to Toxocara canis using an enzyme-linked immunosorbent assay (ELISA). Standardized to the age distribution of the study population, T. canis seropositivity (inverse titers greater than or equal to 16) was 5.7 per cent in males and 5.1 per cent in females. T. canis antibody titers and lead exposures as measured by Centers for Disease Control lead classes were positively correlated. Children who were seropositive to T. canis (cases) were compared to seronegatives (controls) matched on age (+/- 6 months), sex, time-of-screening (+/- 3 months) and CDC lead class. Logistic regression analysis of 155 case-control pairs demonstrated elevated relative risks (RRs) for geophagia (RR = 3.14; 95% CI = 1.75, 5.64) and having had a litter of puppies in the home (RR = 5.22; 95% CI = 1.63, 16.71). Compared to controls, cases had increased eosinophil counts, serum immunoglobulin E concentrations, and anti-hemagglutinin-A titers. Small deficits in cases compared to controls were found in performance on several neuropsychological tests after adjustment for potential confounders including case-control differences in race, socioeconomic status, and current blood lead concentrations. The study thus confirmed that T. canis infection is common in urban children and suggested that infection may be associated with adverse neuropsychological effects.
— id: 9118, year: 1987, vol: 77, page: 554, stat: Journal Article,

Serum IgD elevation is an early marker of B cell activation during infection with the human immunodeficiency viruses
Mizuma H; Zolla-Pazner S; Litwin S; el-Sadr W; Sharpe S; Zehr B; Weiss S; Saxinger WC; Marmor M
1987 Apr;68(1):5-14, Clinical & experimental immunology
Serum IgD levels in individuals infected with the human immunodeficiency viruses (HIV) were studied as a means of monitoring the character and timing of B cell activation in individuals with this infection. Significantly increased levels of IgD were characteristic of homosexual men who were HIV seropositive but asymptomatic or mildly symptomatic. The hyper IgD globulinaemia became progressively more pronounced in patients with increasingly severe infection and reached its most marked level in patients with AIDS-related complex (ARC). In ARC patients, IgD levels were increased 8.8-fold above normal which was disproportionately greater than the 2.4-fold increase in IgG, the 1.8-fold increase in IgA and the 1.6-fold increase in IgM. IgD levels declined in AIDS patients (although remained elevated compared to controls). The data suggest that an unusual type of B cell activation is responsible for the unique pattern of hypergammaglobulinaemia seen in this disease and that the B cell activation occurs early in the pathogenesis of HIV infection, often before development of symptoms, and continues throughout the course of infection
— id: 9121, year: 1987, vol: 68, page: 5, stat: Journal Article,

Nonrandom development of immunologic abnormalities after infection with human immunodeficiency virus: implications for immunologic classification of the disease
Zolla-Pazner S; Des Jarlais DC; Friedman SR; Spira TJ; Marmor M; Holzman R; Mildvan D; Yancovitz S; Mathur-Wagh U; Garber J; et al
1987 Aug;84(15):5404-5408, Proceedings of the National Academy of Sciences of the United States of America
Blood specimens from 165 intravenous drug users who were seropositive for the human immunodeficiency virus (HIV), from 158 seropositive homosexual men with lymphadenopathy, and from 77 patients with acquired immunodeficiency syndrome (AIDS) were assessed immunologically. Immunologic parameters were analyzed by the Guttman scalogram technique to determine if immunologic abnormalities occurred in a nonrandom pattern. The following four patterns emerged: (i) seropositivity for HIV with no immunologic abnormalities; (ii) seropositivity for HIV with a depressed T4/T8 cell ratio; (iii) seropositivity with a depressed T4/T8 cell ratio and T4-cell depletion; and (iv) seropositivity with a depressed T4/T8 cell ratio, T4-cell depletion, and lymphopenia. Ninety-two to 100% of subjects in each of the three groups of patients were found \'to scale\' because the abnormalities occurred in the cumulative, ordered fashion described. This nonrandom occurrence of abnormalities indicates an ordered progression of immunologic abnormalities in individuals infected with HIV, a finding useful in the staging of both symptomatic and asymptomatic HIV-seropositive subjects.
— id: 9305, year: 1987, vol: 84, page: 5404, stat: Journal Article,

A stage model of HTLV-III LAV infection in intravenous drug users
Des Jarlais DC; Friedman SR; Spira TJ; Zolla-Pazner S; Marmor M; Holzman R; Mildvan D; Yancovitz S; Mathur-Wagh U; Garber J; et al
1986 ;67:328-334, NIDA research monograph series
— id: 9123, year: 1986, vol: 67, page: 328, stat: Journal Article,

Possible female-to-female transmission of human immunodeficiency virus
Marmor M; Weiss LR; Lyden M; Weiss SH; Saxinger WC; Spira TJ; Feorino PM
1986 Dec;105(6):969-969, Annals of internal medicine
— id: 9122, year: 1986, vol: 105, page: 969, stat: Journal Article,

Containing the AIDS epidemic
Marmor, M; Lyden, M; Grossman, R
1985 ;254(15):2059-2059, JAMA
— id: 30836, year: 1985, vol: 254, page: 2059, stat: Journal Article,

Kaposi's sarcoma among four different AIDS risk groups
De Jarlais DC; Marmor M; Thomas P; Chamberland M; Zolla-Pazner S; Sencer DJ
1984 Apr 26;310(17):1119-1119, New England journal of medicine
— id: 9127, year: 1984, vol: 310, page: 1119, stat: Journal Article,

Antibodies to a retrovirus etiologically associated with Acquired Immunodeficiency Syndrome (AIDS) in populations with increased incidences of the syndrome
Des Jarlais DC; Marmor M; Cohen H; Yancovitz S; Garber J; Friedman S; et al
1984 ;33:377-379, MMWR
— id: 9334, year: 1984, vol: 33, page: 377, stat: Journal Article,

Epidemic Kaposi's sarcoma and sexual practices among male homosexuals
Marmor M
AIDS: the Epidemic of Kaposi's Sarcoma and Opportunistic Infections New York : Masson Publishing, 1984,
— id: 2527, year: 1984, vol: , page: 291, stat: Chapter,

Risk factors
Marmor M
AIDS, A Basic Guide For Clinicians Copenhagen: Munksgaard; 1984,
— id: 2528, year: 1984, vol: , page: 42, stat: Chapter,

The epidemic of acquired immunodeficiency syndrome (AIDS) and suggestions for its control in drug abusers
Marmor M; Des Jarlais DC; Friedman SR; Lyden M; el-Sadr W
1984 ;1(4):237-247, Journal of substance abuse treatment
Intravenous (IV) users of illicit drugs have accounted for 17% of AIDS cases seen in the United States. Previous research has shown that more than half of IV drug abusers entering a drug detoxification program in New York City had serologic evidence of exposure to the virus believed to cause AIDS. Spread of AIDS among drug abusers presumably occurs by transmission of the virus via shared needles, works, or drug-containing solutions. Secondary spread of AIDS from IV drug abusers to others may occur by venereal transmission or by perinatal transmission to infants. In this article, relevant characteristics of the AIDS epidemic are presented to assist the staff of drug treatment programs in their work with IV drug abusers. Suggestions regarding the education of drug treatment personnel and the dissemination of information about AIDS to drug abusers and their families are offered. Fact sheets on AIDS for drug treatment and prison staff, and for drug abusers with and without the disease are presented. Finally, possible approaches to the prevention of AIDS in drug users are discussed.
— id: 9130, year: 1984, vol: 1, page: 237, stat: Journal Article,

Immunologic abnormalities among male homosexuals in New York City: changes over time
Marmor M; el-Sadr W; Zolla-Pazner S; Lazaro C; Stahl RE; William D
1984 ;437:312-319, Annals of the New York Academy of Sciences
— id: 9129, year: 1984, vol: 437, page: 312, stat: Journal Article,

Kaposi\'s sarcoma in homosexual men. A seroepidemiologic case-control study
Marmor M; Friedman-Kien AE; Zolla-Pazner S; Stahl RE; Rubinstein P; Laubenstein L; William DC; Klein RJ; Spigland I
1984 Jun;100(6):809-815, Annals of internal medicine
The cases of 20 male homosexuals with Kaposi\'s sarcoma and the acquired immunodeficiency syndrome were compared with those of 40 age- and race-matched male homosexual controls. Patients with Kaposi\'s sarcoma had lower OKT4/OKT8 (T-helper/T-suppressor) ratios than controls, due to smaller numbers of OKT4 cells. Serum IgG concentrations and antibody titers to cytomegalovirus in patients exceeded those in controls, but patients had lower antibody titers to Epstein-Barr virus. Logistic regression analysis comparing patients with controls showed significant relative risks for Kaposi\'s sarcoma associated with the number of partners per month in receptive anal-genital intercourse, occasions per month of \' fisting ,\' and cytomegalovirus antibody titers. Cytomegalovirus titers also were inversely correlated with OKT4 cell concentrations in the control group. Significantly greater OKT4 cell concentrations were found at diagnosis in HLA-DR5-positive patients than in HLA-DR5-negative patients. Patients who have HLA-DR5 may express disease at lesser degrees of immunodeficiency than HLA-DR5-negative patients.
— id: 9126, year: 1984, vol: 100, page: 809, stat: Journal Article,

Prevalence of antibody to lymphadenopathy-associated virus among drug-detoxification patients in New York
Spira TJ; Des Jarlais DC; Marmor M; Yancovitz S; Friedman S; Garber J; Cohen H; Cabradilla C; Kalyanaraman VC
1984 Aug 16;311(7):467-468, New England journal of medicine
— id: 9124, year: 1984, vol: 311, page: 467, stat: Journal Article,

The use of beta-2 microglobulin in the diagnosis of AIDS, suspected AIDS, and preclinical AIDS
Zolla-Pazner S; el-Sadr W; William D; Stahl R; Marmor M
1984 ;437:526-529, Annals of the New York Academy of Sciences
— id: 9128, year: 1984, vol: 437, page: 526, stat: Journal Article,

Quantitation of beta 2-microglobulin and other immune characteristics in a prospective study of men at risk for acquired immune deficiency syndrome
Zolla-Pazner S; William D; El-Sadr W; Marmor M; Stahl R
1984 Jun 8;251(22):2951-2955, JAMA
Serum samples from 24 patients with acquired immune deficiency syndrome (AIDS) and from 15 patients with an early or milder form of this disease (\'suspected AIDS\') were found to contain elevated levels of beta 2-microglobulin (beta 2M). Therefore, prospective studies of 40 asymptomatic homosexual men from New York City were undertaken to determine whether quantitation of beta 2M and other immunologic variables was useful in recognizing those in populations at high risk for this disease who have a high probability for experiencing symptoms consistent with AIDS. After 20 to 26 months of follow-up, two of those persons now have AIDS and four have suspected AIDS. All six of these persons had elevated serum beta 2M levels and other immunologic abnormalities when they entered this study. Of those tested, only one other man had an increased level of beta 2M; neither he nor any of the remaining 33 persons in this group developed AIDS.
— id: 9125, year: 1984, vol: 251, page: 2951, stat: Journal Article,

National case-control study of Kaposi\'s sarcoma and Pneumocystis carinii pneumonia in homosexual men: Part 1. Epidemiologic results
Jaffe HW; Choi K; Thomas PA; Haverkos HW; Auerbach DM; Guinan ME; Rogers MF; Spira TJ; Darrow WW; Kramer MA; Friedman SM; Monroe JM; Friedman-Kien AE; Laubenstein LJ; Marmor M; Safai B; Dritz SK; Crispi SJ; Fannin SL; Orkwis JP; Kelter A; Rushing WR; Thacker SB; Curran JW
1983 Aug;99(2):145-151, Annals of internal medicine
To identify risk factors for the occurrence of Kaposi\'s sarcoma and Pneumocystis carinii pneumonia in homosexual men, we conducted a case-control study in New York City, San Francisco, Los Angeles, and Atlanta. Fifty patients (cases) (39 with Kaposi\'s sarcoma, 8 with pneumocystis pneumonia, and 3 with both) and 120 matched homosexual male controls (from sexually transmitted disease clinics and private medical practices) participated in the study. The variable most strongly associated with illness was a larger number of male sex partners per year (median, 61 for patients; 27 and 25 for clinic and private practice controls, respectively). Compared with controls, cases were also more likely to have been exposed to feces during sex, have had syphilis and non-B hepatitis, have been treated for enteric parasites, and have used various illicit substances. Certain aspects of a lifestyle shared by a subgroup of the male homosexual population are associated with an increased risk of Kaposi\'s sarcoma and pneumocystis pneumonia.
— id: 9131, year: 1983, vol: 99, page: 145, stat: Journal Article,

Statistics, T-lymphocyte subpopulations, and haemophilia
Pasternack BS; Marmor M
1983 Jul 16;2(8342):159-159, Lancet
— id: 9132, year: 1983, vol: 2, page: 159, stat: Journal Article,

Kaposi's sarcoma, aplastic pancytopenia, and multiple infections in a homosexual
Sterry W; Marmor M; Konrads A; Steigleder GK
1983 Apr 23;1(8330):924-925, Lancet
— id: 9133, year: 1983, vol: 1, page: 924, stat: Journal Article,

Disseminated Kaposi\'s sarcoma in homosexual men
Friedman-Kien AE; Laubenstein LJ; Rubinstein P; Buimovici-Klein E; Marmor M; Stahl R; Spigland I; Kim KS; Zolla-Pazner S
1982 Jun;96(6 Pt 1):693-700, Annals of internal medicine
Nineteen cases from an epidemic of disseminated Kaposi\'s sarcoma in homosexual men were studied by clinical, virologic, immunologic, and genetic methods. The patients were all male homosexuals ranging in age from 29 to 52 years, with histories of multiple sexually transmitted diseases and exposure to both prescription and recreational drugs. Sites of disease included skin (16 of 19 patients), lymph nodes (13 patients), gastrointestinal tract (12 patients), spleen (three patients), and lung (one patient). Most patients had elevated levels of serum immunoglobins, positive antibody titers to hepatitis A and B virus, cytomegalovirus and Epstein-Barr virus, and impairment of cell-mediated immunologic reactions. The frequency of HLA-DR5 in these patients was significantly elevated. Two of the 19 patients died. Although the precise cause of this epidemic is unknown, it is likely that a genetic predisposition, an acquired immunoregulatory defect, and one or more infectious agents and drugs may be involved.
— id: 9135, year: 1982, vol: 96, page: 693, stat: Journal Article,

Risk factors for Kaposi\'s sarcoma in homosexual men
Marmor M; Friedman-Kien AE; Laubenstein L; Byrum RD; William DC; D'onofrio S; Dubin N
1982 May 15;1(8281):1083-1087, Lancet
An investigation of 20 homosexual men with histologically confirmed Kaposi\'s sarcoma and 40 controls revealed significant associations between Kaposi\'s sarcoma and use of a number of drugs (amyl nitrite, ethyl chloride, cocaine, phencyclidine, methaqualone, and amphetamine), history of mononucleosis, and sexual activity in the year before onset of the disease. Patients with Kaposi\'s sarcoma also reported substantially higher rates of sexually transmitted infections than did controls. Multivariate analysis indicated independent significant associations for amyl nitrite and sexual activity and showed use of phencyclidine, methaqualone, and ethyl chloride to be non-significant. Evaluated at the median exposure for patients, the analysis yielded risk-ratio estimates of 12.3 for amyl nitrite (95% confidence limits 4.2, 35.8) and 2.0 for sexual activity (95% confidence limits 1.3, 3.1).
— id: 9136, year: 1982, vol: 1, page: 1083, stat: Journal Article,

Epizootiologic patterns of diabetes mellitus in dogs
Marmor M; Willeberg P; Glickman LT; Priester WA; Cypess RH; Hurvitz AI
1982 Mar;43(3):465-470, American journal of veterinary research
A case-control study of spontaneous diabetes mellitus in dogs was undertaken, using 2 veterinary data bases. The Veterinary Medical Data Program (VMDP) contained records of 1,019 cases of canine diabetes from 14 university-affiliated veterinary hospitals. The Animal Medical Center (AMC), a private veterinary hospital which has not participated in the VMDP, contained records of 449 diabetes cases. Each data base was analyzed separately, control groups being chosen from all admissions, excluding diabetic animals. Summary odds ratios by sex adjusted for age and breed indicated significantly (P less than 0.05) elevated risks for entire females and neutered females compared with that for entire males. The VMDP data indicated a significantly elevated risk for castrated males, whereas the risk derived from AMC data was not significantly different from 1. Analysis of risks by breed adjusting for age and sex identified Poodles as being at significantly excess risk, and German Shepherd Dogs, Cocker Spaniels, Collies, and Boxers at significantly decreased risk in both data sets. The male-female risk ratio changed with age from 1 at less than 1 year of age to a predominance of females at older ages. In the AMC data base, diabetes was significantly associated with cataracts in dogs of both sexes combined. Diabetes was also significantly associated with benign mammary tumors in female dogs.
— id: 9137, year: 1982, vol: 43, page: 465, stat: Journal Article,

Immunologic abnormalities in homosexual men. Relationship to Kaposi\'s sarcoma
Stahl RE; Friedman-Kien A; Dubin R; Marmor M; Zolla-Pazner S
1982 Aug;73(2):171-178, American journal of medicine
Studies were performed to define the immunologic status of various groups of homosexual men including homosexual men with Kaposi\'s sarcoma, healthy homosexual men who were of similar ages to the homosexual patients with Kaposi\'s sarcoma and homosexual men with hyperplastic lymphadenopathy. Heterosexual men with Kaposi\'s sarcoma were also studied. Immunologic parameters which were examined included serum immunoglobulin levels, enumeration of B cells, T cells, and T-cell subsets, and quantitation of lymphocyte responsive to phytohemagglutinin (PHA) and pokeweed mitogen (PWM). Significant immunologic abnormalities were observed in all three groups of homosexuals studied. These were most severe in the homosexuals with Kaposi\'s sarcoma, somewhat less severe in homosexual men with lymphadenopathy, and least marked but still significant in healthy homosexual men. Heterosexual men with Kaposi\'s sarcoma displayed essentially normal immunologic profiles. The possible etiologic factors underlying the immunologic abnormalities in the male homosexual population studied and the role of an altered immune system in the development of and the fulminant course of Kaposi\'s sarcoma in these patients are discussed.
— id: 9134, year: 1982, vol: 73, page: 171, stat: Journal Article,

IMMUNE ABNORMALITIES IN HOMOSEXUAL MEN WITH KAPOSIS SARCOMA
Stahl, R; Friedmankien, A; Dubin, R; Marmor, M; Zollapazner, S
1982 ;41(4):955-955, Federation Proceedings (Federation of American Societies for Experimental Biology)
— id: 30458, year: 1982, vol: 41, page: 955, stat: Journal Article,

Kaposi's sarcoma and pneumocystis pneumonia among homosexual men--New York City and California
Friedman-Kien A; Laubenstein L; Marmor M; et al.
1981 ;30:305-308, MMWR
— id: 9333, year: 1981, vol: 30, page: 305, stat: Journal Article,

Trends in cancer mortality rates, Bergen County, New Jersey, 1962-75
Marmor M; Sadow M; Green K; Levine LS
1981 Jan-Feb;96(1):80-83, Public health reports
Publication of the \'Atlas of Cancer Mortality for U.S. Counties, 1950-1969\' caused a great deal of concern in counties shown in the Atlas to have had high cancer mortality rates in relation to the United States as a whole. An analysis was made of temporal trends of cancer mortality in Bergen County, a \'high-rate county\' in northeastern New Jersey, by calculating age-adjusted cancer mortality rates by sex and site for Bergen County residents for the period 1962-75. Mortality rates and time rates of change in mortality rates were compared to those in the United States as a whole. Male and female rates for respiratory cancer and male rates for all sites combined increased significantly more quickly in the United States than in Bergen County during the study period. The authors discuss these trends and recommended that recent time-specific mortality rates be furnished to county health commissions on a regular basis.
— id: 9138, year: 1981, vol: 96, page: 80, stat: Journal Article,

The renal excretion of iodine following oral administration of Gastrografin to domestic cats
Allan GS; Wentworth RA; Rendano VT; Meunier PC; Marmor M
1980 Jan-Feb;15(1):47-51, Investigative radiology
Serum and urinary levels of iodine were determined in six cats before and after oral administration of Gastrografin. Iodine was identified by gamma spectrometry after the specimens had been subjected to neutron activation. Peak serum iodine levels, compared to undetectable preadministration levels in five of the six cats, ranged from 8.0 to 50.7 micrograms/ml 1 to 2 hours after Gastrografin administration. Twenty-four hour cumulative urinary excretion of iodine represented 0.9 to 4.08% of this element calculated to be in Gastrografin. Pharmacokinetic analysis of the serum concentrations using the one-compartment open model resulted in an estimate of ka, the fraction of Gastrografin dose absorbed per unit time, of 2.24 hr-1 (95% CL = -5.4, 7.7) and an estimate of ke, the fraction of the dose eliminated per unit time, of 0.10 hr-1 (95 % CL = -0.01, 0.21). Analysis of urinary elimination rates also yielded ke = 0.10 hr-1 (95% CL = 0.01, 0.18). At necropsy the gastrointestinal tract of each cat was normal.
— id: 9330, year: 1980, vol: 15, page: 47, stat: Journal Article,

Air pollution and cancer in Houston, Texas: a causal relationship?
Marmor M
1978 Jun;33(6):275-277, Journal of the American Medical Women's Association
— id: 9140, year: 1978, vol: 33, page: 275, stat: Journal Article,

Heat wave mortality in nursing homes
Marmor M
1978 Aug;17(1):102-115, Environmental research
Patterns of mortality in 11 air-conditioned and 9 un-air-conditioned nursing homes in New York City have been investigated to determine the impacts of heat waves on nursing home occupants and the efficacy of air conditioning in reducing these impacts. During each of four heat waves in 1972 and 1973, the number of deaths in un-air-conditioned nursing homes was significantly greater than the number of deaths expected on the basis of mortality during cooler control periods. In contrast, deaths in air-conditioned nursing homes were not significantly different from expected. The age- and sex-adjusted ratio of relative death rates was 2.29 (95% confidence interval = 1.75-2.98). Approximately 94 excess deaths occurred in the un-air-conditioned nursing homes. On the basis of this research, it is recommended that nursing homes and other institutions for the elderly located in climates like that of New York City be required to provide air conditioning
— id: 9139, year: 1978, vol: 17, page: 102, stat: Journal Article,

Comments on "Cross-sectional time series experiments: Some suggested statistical analyses."
Marmor, GS; Marmor, M
1978 ;85(5):1102-1103, Psychological bulletin
— id: 29667, year: 1978, vol: 85, page: 1102, stat: Journal Article,

Heat wave mortality in New York City, 1949 to 1970
Marmor M
1975 Mar;30(3):130-136, Archives of environmental health
Epidemiological studies have been carried out to search for an influence of air conditioning on patterns of heat wave mortality in New York City. Two models were used to predict total daily summer mortality as a function of temperature; one of the models included heat acclimatization effects. Ratios of the models\' predictions of heat wave mortality to actual mortality were calculated for heat waves occurring during 12 summers in the period 1949 to 1970. Trends in these ratios as a function of time were sought. The analysis suggests that the relative magnitudes of excess mortality during initial summer heat waves may have decreased over the 21-year period. No trend was observed for excess mortality during late summer heat waves.
— id: 9141, year: 1975, vol: 30, page: 130, stat: Journal Article,

E2 enhancement of the 2+1( 0+1 transition in 42Ti
Brown BA; Marmor M; Fossan DB
The Structure of 1f7/2 Nuclei Bologna : Editrice Compositor, 1972,
— id: 2526, year: 1972, vol: , page: 123, stat: Chapter,

Recoil-distance lifetime measurements for states in 30P
Henson SH; Cochavi S; Marmor M; Fossan DB
1971 ;3C:191-198, Physical review. C. Nuclear physics
— id: 9332, year: 1971, vol: 3C, page: 191, stat: Journal Article,

The hyperfine field at 42Ca in ferromagnetic metals and the g-factor at the 3.19 MeV 6+ state
Marmor M; Cochavi S; Fossan DB
Hyperfine interactions in excited nuclei: proceedings of the Conference on Hyperfine Interactions Detected by Nuclear Radiation, held at Rehovot and Jerusalem in Sept. 1970. New York : Gordon and Breach, New York, 1971,
— id: 2525, year: 1971, vol: , page: 83, stat: Chapter,