Document OEX5v2MEEgbnYEBqRd8XD3M4v

JUL-13-2001 FRI 04:09 PM FAX MO, P, 18 THE LANCET cancers attributable to asbestos showed radiological abnormalities, most of which were small opacities. However, the chest radiographs used in this analysis were often taken many yean before death and some workers may subsequently have developed fibrosis. Our results are consistent with a hospital-based case-control study in which an excess risk of lung cancer was observed in patients with an occupational history of asbestos exposure but no pulmonary fibrosis.*1* M there is an association between asbestos and lung cancer without fibrosis, it is of interest for both scientific and practical reasons. From a scientific standpoint, it may suggest that asbestos Is not carcinogenic solely because it ft fibrogenic, although the absence of small opacities on the chest radiograph does not exclude flbrotlc change at a microscopic level. More importantly, ftom a practical point of view, it indicates that asbestos exposures which, do not cause small opacities on the chest radiograph may nonetheless increase the risk of lung cancer, and this need* to be considered by those responsible for industrial hygiene and compensation of workers with asbestosrelated iung disease. Ttw mtiywu lupportMl by a Ream ftom the Health and Safety toitCMlhra. References i MriDoirald JC, McDonald AO. Mesothelioma as an tacts* ofisfctsta* impest, tot Pew ft, Sdmeldsrinsa M, cdn. QinnriftoiMors of occupation*! ameer. Banbury report 9, Cold Spring Heritor, 1981; 75-W. Pi Vos Irvine H. Lament DW, Hole Df, Gliiis CR, Asbestos in lima cancer in the west of Scotland. BMJ J 993; 306:1503-06, 3 Doll R. Peto R. The catuo* of cancer. Oxford; Oxford Ucivairity Prate, 1981; 1238-45. 4 Office of Population Censuses and Surveys. Cancer srafisili*; rnistranone. England and Wales. Series MSI so 26. . 5 Meredith SfC, McDonald JC, Wortt-rdatcd respiratory Stoesit is the United Kingdom, 1989-1992; a report on the SWORD project, QtaMtA 1994(44: 183-89. 6 totcraationul Labour Office. Quiddinos for tha w* cf the 1LO initmidonal elawifieadon of radiographs of pnettmoeoajorst (sevised edition); occupational safety and health series no 2. Gmeva; International Labour Office, 1980. 7 McDonald AD, McDonald JC. Malignant mesothelioma is North America. Cimorr 1980; 46: 1650-54. 8 Liddell PDK. Radiological asiasement of pneum&conionc opaoties, SrJf tod Med 1977; 34: 85-94. 9 Mcleod TC, Carrington CB, Guentler EA, Diffuse MSersUrM disease: # new scheme ftr description, /ia&ototy 1983} 149:333-43. 10 KJptn HM, Lilia R, Smukl Y, Valciulw JA, Salitofni. Pulmonary fibrosis to asbestos insulation workers with iung cane#n a mdioiogica! and bistepathologital evaluation. BrJJntl Mxl 1983; 44t 96-jOO, 11 Bsctdak* MR. The epidemiology of wbeelos, to: lidded D, Mills, K, ed*. Mineral ffirare and heal*. Boca Raton: CRC Press, 1991:105, 12 Staples CA, Gamsu G, Ray CS, Webb WR, High maotoden computed tumography and lung function ffi asbestos-exposed w-ifkera with normal chest radiographs. Am ftwjw Dit 1989; 1.39* 1302-08. 13 Hughes JM, WcUl H. Asbyatosis as a precursor of wbestos-wtsted lung cancer rerulta ofa prospective mortality study, BrJjndMui 1991; 48: 29-33. 14 Sluia-Crtosor GK, BwuldeahoOtt BN. Rcbtior. t-eween asbestos and bronchial caaeor in amphibole asbestos mlato. MrJ todMed I98S: 4fe 537-49. 15 Liddell PDK, McDonald JC. Radiological findings a* predictor* of enortajiry in Quebec atbeato* wOrksra. BrJ hut Atof 1080* 37:257-61. 14 Mcrtischnlg M, Newell DJ, Barnsley WR, Cowan WK, Feinraann BL, Oliver E. Unsuspected oaposute to asbestos and breaedtegetsk o*tsr. SMJ1977; it 756-59. HIV I subtypes and male-to-femaie transmission in Thailand Chalyos Kunanusont, tgordis M Foy, Joan H Krei$s, Supachai Rerks-Ngarm, Praphan Ptianuphak, Smvanse Raktham, Chou-Pong Pau, Nancy L Young SomiMy we examined the risk faotore for heterosexual transmission of HIV In a case-control study of couples In Thailand. 90 HIV-positive men and their regular sex partners were enrolled at the Immune clinic, Chuiaiongkern Hospital, where 92% of male Index cases had HIV-I serotype A [subtype }. Most index cases had acquired HIV through sexual intercourse. 95 couples were enrolled at 15 detoxification clinics, where 7954 of them had HlV-l serotype 8 {subtype 8). Moat men had acquired HiV through injecting drug use (1DU), Afiw Bfefetoo, Department of Cwnmunleebfe Dboose Control, MMttiy of PubHe tfoetth, Neotheburi 11000, Thailand CC Kunanusont mb, S Rerks-Ngsrm Mbit University of Washington, -Seattle, USA [H M Foy kd, C Kunanuscnt, J K Krais* msth); Cfcdatontiwn Heepltail, Bangkok, Thailand (P pnanuphs* mo); Ban**** ANtrapoKten Administration (S Raktham wo); Centres tor &be<u Control end Prevention, Attonte, USA (C-PPauMp); eod theH(V/AlPSOotlelnrtlofl, Nontbaburi CHLYPungkiYCJiWSri . CofTc*pnr)dnc to; Or Chffiyo* Kunanusont ' iSSst-it..' .f'r The HIV seroconoordance rate was higher in the Immune clinic (6914) than in the IDU clinics {49% overall, and 21% after excluding female partners who were IDUs) (p*r0-01). The rate was also higher among couples in whom the male index case was infected with serotype A (subtype E) compared with serotype B (subtype B) [70% vs 52%, OR 2-1, 96% Ci 1-2-4-2). When we excluded couples in whom the female was also an IDU, the difference in concordance rates was even more pronounced (70% vs 26%, OR 6-8, 95% Cl 2-7-L7-6), Viral factors or subjects' characteristics may have contributed to the concordance rates, in a multivariate logistic regression analysis, HIV-i serotype A (subtype E) of male partners (adjusted OR 34, 95% Cl l-1-9-0) and history of IDU in female partners (adjusted OR 4-8, $5% Cl 1-4-15-9) remained independently associated with HIV seroconcordance. This study suggests that HIV-1 subtype i may be associated with higher risk of heterosexual transmission than subtype B. If so, the predominance of subtype E In Thailand may have contributed to the rapid spread of the HIV epidemto. Lsnoat 1995: 345:1078-83