Acquired Immunodeficiency Syndrome Disease Research Articles

Analisis Hasil Pemeriksaan Viral Load Dan CD4 Pada Penderita HIV Di RSUD Pandan Arang Boyolali Periode Tahun 2022

Acquired Immunodeficiency Syndrome disease cause HIV. This disease damages the body's immune system known as CD4. CD4 lymphocyte count is associated with disease progression, increased opportunism, and mortality. Laboratory examination required to determine the CD4 count using this method flowcytometry, and test viralload PCR method. The of research is analyze results of viralload and CD4 in HIV sufferers at RSUD Boyolali . Quantitative research method with analytical descriptive design. Data univariate and bivariate with the chi-square test to see the magnitude of relationship between the independent variables and HIV infection. total of 94 patients in 2022 showed several normal and abnormal results, where values ​​were normal viralload <10,000copy/ml low, >100,000copy/ml high, and <40copy/ml not detected. Normal CD4 results 410 – 1,600 cells/ml and low <500 cells/ml. CD4 research results and viralload normal 43 (46%) patients, CD4 results and viralload abnormal in about 9 (9%), and 1% of patients with normal CD4 countsviral load abnormal patient has not received treatment. CD4 examination uses the method flowcytometry whereas viral load using the PCR method and blood plasma samples. There is relationship viralload method PCR dan CD4 method flowcytrometry with significance value of 0.013. Further research needs to be carried out using experimental methods.

Utilization of antiviral for HIV prevention

Acquired immunodeficiency disease syndrome (AIDS) and AIDS-related illnesses continue to cause a public and economic burden on any given community. Different preventive strategies have been reported, which vary in their effectiveness and safety to limit human immunodeficiency virus (HIV) transmission, the causative virus of AIDS. Antiretroviral therapy (ART) is the main agent used for HIV treatment, and it has been used as a prevention method, or prophylaxis, to prevent HIV transmission. This review was conducted to evaluate clinical trials, and updated recommendations for preventing HIV infection for individuals at risk using ART. We reviewed the literature, and six studies responded to our inclusion criteria. Most of the recent studies that used ART seemed effective in preventing HIV infection among seronegative individuals. Further studies on a larger and different population are recommended to ensure the best preventive methods against HIV.

Selected genes of Human herpesvirus-8 associated Kaposi's sarcoma among patients with Human Immunodeficiency Virus-1 and Acquired Immunodeficiency Disease Syndrome.

IntroductionKaposi's sarcoma (KS) is a kind of cancer that causes flat or raised lesions containing Human herpes virus 8 (HHV8). The KS lesions are common among immunosuppressed HIV patients. Highly Active Antiretroviral (HHART) treats and prevents the development of KS. The objective of this study was to determine the presence of K1 and K15 (predominant alleles) genes in Kaposi's sarcoma-associated herpes virus (KSHV) among immunosuppressed patients due to HIV-1.MethodsThis was a cross-sectional descriptive study where consecutive sampling technique was adopted to pick archived tissue blocks from the Thematic Unit of Anatomic Pathology, Department of Human Pathology, College of Health Sciences, University of Nairobi and Department of Laboratory Medicine, Histology Section, Kenyatta National Hospital.ResultsUpon staining 81 tissue blocks with H & E, 84% (68/81) were diagnosed as KS and 16% (13/81) as KS-like. The K1 and K15 (P) genes were both detected at 88.9% (72/81) in the tissue blocks, with 95.8% (69/72) detection from KS and 4.2% (3/72) from the KS-like.ConclusionThe K1 and K15 (P) genes of KSHV were present among the immunosuppressed patients with Human Immunodeficiency Virus (HIV)-1. It is important to carry out K1 and K15 (P) genes detection on tissues that are diagnosed as KS or KS-like by histology technique.

Evaluation of oral manifestations and oral health status among pediatric human immunodeficiency virus patients-under anti-retroviral therapy: A cross-sectional study

Introduction: The human immunodeficiency virus (HIV) acquired immunodeficiency syndrome disease has evolved to become a social and economic catastrophe, with far-reaching implications affecting every phase of life of the diseased individual. Data on adults and children diagnosed with HIV infection are useful for determining populations needing prevention and treatment services. Oral lesions may be the presenting symptoms of HIV infection and may differ entirely from those manifested in the adult population. Aim and Objective: We aimed to evaluate the prevalence of HIV related oral lesions among pediatric HIV patients and to assess the oral health status of HIV infected children residing in a selected childcare facility in Puducherry. Materials and Methods: A cross-sectional study was conducted during September 2015 in child care facility for HIV infected children located in Puducherry U.T, India. All children <18 years, who are diagnosed with HIV infection and are put on anti-retroviral therapy (ART) or pre-ART care, were included in the study. After obtaining informed consent from the care-givers and assent of the children, they were interviewed and examined by a team comprising a qualified dental surgeon and a trained physician. Results: Majority of the children were under first-line ART (73%) and were on ART for more than 4 years. The CD4 count of 23 (52.3) was between 500–1000 cells/μL. The recent viral load assay in 32 (72.7) patients was <150/not detected. Tooth decay was the most common oral manifestation with 28 (63.6) being affected. Nonspecific lymphadenopathy 26 (59.1) was the most common coexisting systemic illness. Conclusion: This study proves that constant surveillance by monitoring the general health status, CD4 counts, viral load coupled with stringent ART care has improved the overall quality of life of these children and consequently resulted in lesser oral manifestations.

Mycological Profile of Sputum of HIV Positive Patients with Lower Respiratory Tract Infection and its Correlation with CD4+ T Lymphocyte Count.

Fungal respiratory infections are important cause of mortality and morbidity among HIV positive individuals. They account for up to 70% of illness in Acquired Immunodeficiency Disease Syndrome cases (AIDS). The range of illness varies from asymptomatic mucosal candidiasis to overwhelming disseminated infections. In these patients dissemination of fungus leads to very serious outcomes hence, it is important to have the knowledge of prevailing profile of fungus causing infections, so that it can be treated at the onset. Low CD4+ T lymphocyte count is an excellent indicator of decreased immunity and can also be helpful to predict opportunistic fungal respiratory infections and other complications. To define the fungal aetiology of lower respiratory tract infections in HIV positive patients and to correlate the occurrence of different fungi with CD4+ T lymphocyte count. This was a cross sectional study conducted between May 2014 to April 2015, on 180 treatment naive HIV seropositive patients with lower respiratory tract infections attending the Integrated Counselling and Testing Centre, SMS Medical College, Jaipur, Rajasthan. Early morning expectorated and induced sputum samples were collected and processed for isolation and identification of fungal species. CD4+ T lymphocyte count estimation was done by BD FACS Calibur. Fungal species were isolated from 155 (86.1%) patients. The most common isolate was Candida albicans (31.7%), followed by Aspergillus niger (17.7%) and Aspergillus flavus (10%). The fungal species were most commonly isolated from patients with CD4+ T lymphocyte cell less than 200 cells/μl. Fungal infections were seen in 86.1% of HIV positive patients with lower respiratory tract infections hence, high level of clinical suspicion for fungal aetiology of respiratory infections in HIV positive patients should be kept in mind.

Key role of human leukocyte antigen in modulating human immunodeficiency virus progression: An overview of the possible applications.

Host and viral factors deeply influence the human immunodeficiency virus (HIV) disease progression. Among them human leukocyte antigen (HLA) locus plays a key role at different levels. In fact, genes of the HLA locus have shown the peculiar capability to modulate both innate and adaptive immune responses. In particular, HLA class I molecules are recognized by CD8(+) T-cells and natural killers (NK) cells towards the interaction with T cell receptor (TCR) and Killer Immunoglobulin Receptor (KIR) 3DL1 respectively. Polymorphisms within the different HLA alleles generate structural changes in HLA class I peptide-binding pockets. Amino acid changes in the peptide-binding pocket lead to the presentation of a different set of peptides to T and NK cells. This review summarizes the role of HLA in HIV progression toward acquired immunodeficiency disease syndrome and its receptors. Recently, many studies have been focused on determining the HLA binding-peptides. The novel use of immune-informatics tools, from the prediction of the HLA-bound peptides to the modification of the HLA-receptor complexes, is considered. A better knowledge of HLA peptide presentation and recognition are allowing new strategies for immune response manipulation to be applied against HIV virus.

Perceptions and outlook towards HIV/AIDS among reproductive age group of urban slum population

Background: Acquired Immunodeficiency Disease Syndrome (AIDS) has evolved into a pandemic affecting millions of people worldwide. The global HIV/AIDS epidemic has had a major detrimental impact on high risk group and general population leading to morbidity and mortality. Aims & Objective: To assess the perceptions and attitude among reproductive age group of urban slum population towards HIV/AIDS. Materials and Methods: This was a Community Based Cross Sectional Study carried out in the urban slums, field practice area of Community Medicine attached to a tertiary care hospital. The study was conducted by interviewing general population in the reproductive age group for four months in the urban slums using pre-designed and pre-tested proforma. Results: A total of 188 were interviewed. Out of which 48.94% were more than 35 years of age. 51.59% were housewives and belonged to middle class families. 80.85% were aware about sexual transmission and 67.18% opined that it can be prevented by using condoms. Literates were more aware about HIV/AIDS, when compared to illiterates, which was statistically significant (p<0.05). However, majority of them lacked the knowledge of risks associated with breastfeeding by HIV positive mothers. Conclusion: Thus, impetus has to be laid upon awareness and counselling regarding HIV/AIDS at all levels of health care. Integrated Counselling Testing Centres (ICTC) should be made available at all the hospitals, so as to heighten the knowledge of facilities available at a negligible cost, to lead safer and better life.

Association of Hematological Profile of Human Immunodeficiency Virus-Positive Patients with Clinicoimmunologic Stages of the Disease

Aim:This work was carried out to study the hematologic profile of human immunodeficiency virus (HIV)-positive patients and its association with the clinicoimmunologic stage of the disease.Materials and Methods:A total of 187 patients with HIV, whether symptomatic or asymptomatic, diagnosed by enzyme-linked immunosorbent assay (ELISA) method according to the National AIDS Control Organization (NACO) guidelines were included in this study. Patients in the study population were divided into two groups: (1) Group A (antiretroviral therapy (ART) included patients receiving ART [ART-Y]) and (2) Group B included treatment naïve patients (ART-N). The patients were tested for hemoglobin (Hb), total red blood cells (RBC) count, RBC indices, reticulocyte count, packed cell volume (PCV), total lymphocyte counts(TLC), differential leukocyte counts (DLC), platelet count, and erythrocyte sedimentation rate (ESR). Cut-off values were determined as Hb < 10 g/dl, platelet count < 1.5 lakh/cumm, and TLC < 4,000/cumm. The group or categorical data were tested for statistical significance using Chi-square test and Z-test. The difference was reported as significant if P < 0.05.Results:(1) Anemia (predominantly normocytic normochromic) was prevalent in 40.1%, with slightly higher prevalence in those not receiving ART. It occurred with high frequency in patients with immunological (42.05%) and clinical acquired immunodeficiency disease syndrome (AIDS) (70.58%) compared with those who had an asymptomatic HIV infection with CD4 > 200/μl (28.57%). Patients on zidovudine (AZT) therapy had 34.6% anemia with increased mean corpuscular volume (MCV). (2) Thrombocytopenia was seen in 3.74% patients (higher percentage in untreated patients). (3) Leucopenia was observed in 5.88% in ART-Y (Group A) and 8.14% in ART-N (Group B) patients. (4) Pancytopenia was found in 1.6% patients.

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Case Reports: Patients with Acquired Immunodeficiency Disease Syndrome (AIDS) present diagnostic and therapeutic dilemmas to the intensive care physician. In this rare case, we describe a patient presenting with profound meningitis with cerebral sinus thrombosis secondary to Group A streptococcus mastoiditis. A 30 year-old HIV-infected man was brought to the ED because of acute-onset altered mental status. In the emergency department, the patient was stuporous, mumbling words, and combative. Temperature was 103.4 degrees, blood pressure 138/94, respiratory rate 18, and heart rate 145. Physical exam was positive for purulent discharge from left ear, with erythema on posterior wall of the left ear, and nuchal rigidity. The patient was admitted to the intensive care unit after being intubated for airway protection. He received intravenous dexamethasone, vancomycin, ceftriaxone, and acyclovir. A CT of the head without contrast demonstrated under-pneumatized left mastoid air cells, with no evidence of any mass effect. Lumbar puncture showed a cloudy CSF with an opening pressure of >60 cm/H20, with elevated protein, low glucose, high PMNs, and gram stain was negative. The CD4 count was 53. A brain MRI showed extensive left mastoiditis, left cerebellar cerebritis, multiple small acute infarcts in the supratentorial brain, and occlusion of the left transverse and sagital sinus, which was later confirmed by an MRA. He was started on anticoagulation with unfractioned heparin, later bridged to warfarin. The blood and ear drainage cultures grew penicillin-sensitive S. pyogenes, and antibiotics were appropriately managed. Inicidentally, Strongyloides larvae were noted on a stool exam after developing diarrhea, sand the patient was given 2 doses of ivermectin. On Day 6 with appropriate therapy, the patient’s mental status slowly improved and he was extubated. After the initial presentation, HAART was started and a total of six months anticoagulation with warfarin was recommended. The patient completed a total antibiotic course of 6 weeks, with a moderate neurologic recovery requiring aggressive physical therapy and a feeding tube for improved nutrition. Patients with AIDS present with complicated infectious courses. Although the intensivist is concerned with prototypic diseases such as toxoplasmosis, pneumocystis, and mycobacteria; common bacterial illness with sequelae such as group A streptococcus must be ascertained. Although cerebral sinus thrombosis and meningitis is more commonly seen in pediatrics as sequelae from mastoiditis, adult intensive care physicians must be aware of rare presentations in adults among immunocompromised patients.

Epidemiologic Trends of Cancer Diagnoses Among HIV-infected Children in Spain From 1997 to 2008

The introduction of highly active antiretroviral therapy (HAART) has influenced the incidence of cancer in people with human immunodeficiency virus (HIV) infection. The aim of this study was to evaluate changes in the pattern of cancer rates in HIV-infected children on HAART during over a decade of follow-up. We carried out a case-control study. Data were obtained from the records of the minimum basic data set of hospitals in Spain from 1999 to 2008. The epidemiologic trends of cancer diagnoses were evaluated through 3 calendar periods: early-period HAART: 1997-1999, midperiod HAART: 2000-2002, and late-period HAART: 2003-2008). HIV-infected children had higher rates of cancer diagnosis than HIV-negative children (P < 0.001) for both acquired immunodeficiency disease syndrome (AIDS)-defining malignancies (ADM) and non-AIDS-defining malignancies (non-ADM). The highest rates of cancer diagnosis in HIV-positive children were for non-Hodgkin lymphoma, malignant neoplasm of bone and articular cartilage, and Hodgkin lymphoma. When we compared the 3 calendar periods, we found that the rate of ADM diagnoses decreased (from 9.1 to 3.6 to 1.0 cancers per 1000 HIV-children/yr; P < 0.05) and that the rate of non-ADM diagnoses increased (from 0.6 to 5.0 to 8.7 cancers per 1000 HIV-children/yr; P < 0.05). Moreover, the overall rate of cancer diagnoses (ADM plus non-ADM) did not change during the study period (9.7, 8.7, and 9.7 cancers per 1000 HIV-children/yr). HIV-infected children had a dramatic decrease in the rate of ADM diagnoses and an increase in the rate of non-ADM diagnoses. The overall cancer diagnosis rate has not decreased during the past decade and the incidence of cancer still remains high in HIV-infected children in Spain.

Strategies to Increase the Oral Bioavailability of Nucleoside Analogs

Nucleoside analogs are first line chemotherapy in various severe diseases: AIDS (acquired immunodeficiency disease syndrome), cytomegalovirus infections, cancer etc. However, most of these compounds suffer from poor bioavailability via oral route. In order to get around this drawback, researchers have imagined many strategies including drug metabolism inhibitors, bio adhesive nanoparticles, amino ester prodrugs, as well as enhancing absorption by increasing drug lipophilicity. This paper illustrated these approaches by developing their application to some nucleoside analogs. Moreover, some of these strategies were very successful and some resulting compounds are now approved by FDA (Food and Drug Administration).

Polymerase chain reaction genotyping of Epstein-Barr virus in scraping samples of the tongue lateral border in HIV-1 seropositive patients

The Epstein-Barr virus (EBV) is the etiological agent of oral hairy leukoplakia (OHL), an oral lesion with important diagnostic and prognostic value in acquired immunodeficiency disease syndrome. The two EBV genotypes, EBV-1 and EBV-2, can be distinguished by divergent gene sequences encoding the EBNA-2, 3A, 3B, and 3C proteins. The purpose of this study was to identify the EBV genotype prevalent in 53 samples of scrapings from the lateral border of the tongue of HIV-1 seropositive patients, with and without OHL, and to correlate the genotypes with presence of clinical or subclinical OHL with the clinic data collected. EBV-1 and EBV-2 were identified through PCR and Nested-PCR based on sequence differences of the EBNA-2 gene. EBV-1 was identified in the 31 samples (15 without OHL, 7 with clinical OHL and 9 with subclinical OHL), EBV-2 in 12 samples (10 without OHL, 1 with clinical and 1 subclinical OHL), and a mixed infection in 10 samples (2 without OHL, 3 with clinical and 5 with subclinical OHL). The presence of EBV-1 was higher in women, but a significant statistical result relating one the EBV genotypes to the development of OHL was not found. We conclude that the oral epithelium in HIV-1 seropositive patients can be infected by EBV-1, EBV-2 or by a mixed viral population.

Pneumocystis jiroveci thyroiditis: report of 15 cases in the literature

The authors review the epidemiology, clinical manifestations, diagnosis and treatment of Pneumocystis jiroveci thyroiditis of 15 cases reported in the medical literature. Patients with acquired immunodeficiency disease syndrome were particularly at risk. P. jiroveci thyroiditis was diagnosed at autopsy as a part of disseminated infection in a substantial number of patients without clinical manifestations and laboratory evidence of thyroid dysfunction. Local signs and symptoms of infection were indistinguishable from other infectious thyroiditis and included neck enlargement with or without cervical pain, sometimes associated with dysphagia and dysphonia, and clinical and laboratory features of hypothyroidism. Antemortem diagnosis of fungal thyroiditis was made by direct microscopy and culture of a fine-needle aspirate in most cases. As most patients with P. jiroveci thyroiditis had disseminated Pneumocystis infection with a delay in diagnosis and treatment, the overall mortality was high. Pneumocystis jiroveci thyroiditis is rare but should be suspected in HIV-infected patients with CD4 count lower than 200 cells micro(-1) on prophylatic inhalatory pentamidine who present with neck enlargement with or without pain, and clinical and laboratory evidence of hypothyroidism.

Erythematous candidosis in patients with complete dentures and HIV+/AIDS

This investigation was designed to evaluate the frequency of erythematous candidosis (EC) and Candida species, proteinase and phospholipase exoenzyme production, and to compare clinical features in patients with complete dentures and HIV+/Acquired Immunodeficiency Disease Syndrome (AIDS). Fifty-one patients were selected from a total of 285 with EC: denture wearers (n = 30) and HIV+/AIDS (n = 21). The yeast prevalence and the production of exoenzymes, such as proteinase and phospholipase by Candida species were evaluated by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) electrophoresis. The frequency of Candida albicans was significantly higher (P < 0.05) in both groups although other yeast species (Candida glabrata, Candida krusei, Candida parapsilosis, Candida guilliermondi and Candida tropicalis) were also found. Candida albicans showed greater levels of proteinase production in the denture wearers, when compared with the HIV+/AIDS group. There was no difference between groups with regard to phospholipase production. The protein bands presented similar molecular weights, showing the presence of proteinases in both groups. It could be concluded that the clinical manifestation of EC may be related to its proteinase production capacity. Combination therapies using proteinase inhibitors play an important role in inhibiting exoenzyme production by Candida species, mainly C. albicans.

Knowledge and attitude on HIV/AIDS among married women of reproductive age attending a teaching hospital

Acquired immunodeficiency disease syndrome (AIDS) though a disease only about 20 years old now has evolved into a pandemic affecting millions of people worldwide. By the end of 2001 25 million people had already died of AIDS. In India the cumulative number of AIDS cases reported as on June 2002 was 36160 which is supposed to be only the tip of the iceberg. The important characteristic of HIV scenario in India is its heterogenicity the prevalence varying in different states. Pondicherry is among the hardest hit regions. Based on the seroprevalence among antenatal clinic attendees Pondicherry comes under the high prevalence category (=> 1%) indicative of a generalized epidemic. Heterosexual transmission being the commonest route of spread the only way to check its transmission is by increasing awareness regarding the modes of spread and methods of prevention of this disease among people particularly those belonging to the sexually active age groups. In this context this study was conducted to examine the extent of awareness of its determinants as well as the attitude of married women in reproductive age group towards HIV/AIDS in Pondicherry. (excerpt)

A Polymorphism That Reduces RANTES Expression Is Associated with Protection from Death in HIV‐Seropositive Ugandans with Advanced Disease

We investigated the effect of RANTES polymorphisms on human immunodeficiency virus type 1 (HIV-1) disease progression in an urban population of Uganda. HIV-positive individuals homozygous for the INT1.1C polymorphism, which had been associated previously with low RANTES expression, were less likely to die than were those with other genotypes (hazard ratio, 0.53 [95% confidence interval, 0.33-0.83]; P=.007). This report of a non-human leukocyte antigen genetic association with HIV-1 and/or acquired immunodeficiency syndrome disease progression in an African population reveals a genetic effect different from that reported elsewhere for African Americans and may impact therapeutic strategies targeting the RANTES pathway in HIV infection.

X-Linked Agammaglobulinemia

X-linked agammaglobulinemia (XLA) is a primary immunodeficiency caused by mutations in the gene for Bruton tyrosine kinase (BTK) that result in the deficient development of B lymphocytes and hypogammaglobulinemia. Because the disorder is uncommon, no single institution has had sufficient numbers of patients to develop a comprehensive clinical picture of the disorder. Accordingly, a national registry of United States residents with XLA was established in 1999 to provide an updated clinical view of the disorder in a large cohort of patients. A total of 201 patients were registered by 66 physicians. The estimated birth rate for the 10-year period of 1988-1997 was 1/379,000. Infection was the most common initial clinical presentation (85%), followed by a positive family history (41%) and neutropenia (11%). Although the average age of diagnosis was younger in patients with a positive family history (mean, 2.59 yr) than in patients with a negative family history (mean, 5.37 yr) (p < 0.001), only 34.5% of patients with a positive family history at the time of their birth were diagnosed before clinical symptoms developed-that is, based on family history alone. Seventy percent of patients had at least 1 episode of otitis, 62% at least 1 episode of pneumonia, 60% at least 1 episode of sinusitis, 23% at least 1 episode of chronic/recurrent diarrhea, 21% at least 1 episode of conjunctivitis, 18% at least 1 episode of pyoderma and/or cellulitis, 11% at least 1 episode of meningitis/encephalitis, 10% at least 1 episode of sepsis, 8% at least 1 episode of septic arthritis, 6% at least 1 episode of hepatitis, and 3% at least 1 episode of osteomyelitis. Fourteen of 201 (6.9%) patients were dead at the time they were entered in the Registry. However, in a prospective 4 /4-year follow-up of living patients, only 3/80 (3.75%) patients died. Causes of death included disseminated enterovirus infection (n = 6), pulmonary insufficiency (n = 5), adenovirus infection (n = 1), sepsis (n = 1), acquired immunodeficiency disease syndrome (AIDS) (n = 1), myocarditis (n = 1), hepatitis (n = 2), and stem cell transplantation (n = 1).

The continuing HIV vaccine saga: is a paradigm shift necessary?

As pointed out in previous editorials, the development of an effective vaccine for the Human Immunodeficiency Virus capable of preventing infection, or even one capable of preventing the Acquired Immunodeficiency Disease Syndrome, has eluded investigators for the past 20 years. Now Reche and Keskin and their co-workers have provided evidence that an entirely new approach, based upon modern bioinformatics methods and skillful in vitro immunological experiments, may result in an effective way to prime the T cell immune response of normal individuals against conserved peptide epitopes.

Substance P and Human Immunodeficiency Virus Infection: Psychoneuroimmunology.

Effects on the immune system caused by changes in behavioral state or brain activity are mediated, at least in part, through neuroendocrine-immune pathways. Life stress and depression may be associated with altered blood levels of central nervous system-released neuropeptides, including substance P (SP). SP acts as a neuroregulator or neurotransmitter in the conduction of nociceptive stimuli, and is a modulator of neuroimmunoregulation. This review summarizes current knowledge regarding the role of the neuropeptide, SP, in psychoneuroimmunology, in particular as it relates to human immunodeficiency virus infection and acquired immunodeficiency disease syndrome. The association between depression, anxiety, and stress in HIV-disease progression suggests that neurobiologic and neurophysiologic factors play a role in modulating HIV infection and responses to antiretroviral therapy. Individuals with HIV or AIDS may experience stressful life circumstances that can result in increased symptoms of anxiety, stress, and/or depression. Furthermore, psychological and psychiatric symptoms, which occur in individuals with HIV and AIDS, may be related to the progression of AIDS disease. This review presents evidence from the literature, as well as findings from basic investigations conducted in the authors' laboratories, demonstrating that SP may play an important role in HIV pathophysiology. SP can impact the susceptibility of immune cells to HIV infection and modulate immune cell functions in ways that may affect the course of HIV in infected individuals. Moreover, modulation of SP activity and SP receptor is being explored for its potential as a novel therapeutic approach to the treatment of some psychological and psychiatric disorders and to the design of new anti-HIV therapy.

Emergence of resistance to fluconazole as a cause of failure during treatment of histoplasmosis in patients with acquired immunodeficiency disease syndrome.

In sequential clinical trials of treatment for histoplasmosis in patients with acquired immunodeficiency syndrome, therapy with fluconazole failed in a higher proportion of patients than did therapy with itraconazole. To determine the cause for failure with fluconazole, antifungal susceptibility testing that used modified National Committee on Clinical Laboratory Standards procedures was performed on all baseline and failure isolates. Failure occurred more frequently in patients with baseline isolates with fluconazole minimum inhibitory concentrations (MICs) > or =5 microg/mL versus lower MICs; 29% versus 3%, respectively. There was at least a 4-fold increase in fluconazole MIC in the isolates from 10 (59%) of 17 patients for whom paired pretreatment and failure or relapse isolates were available. Cross-resistance to itraconazole was not seen. In conclusion, fluconazole is less active than itraconazole for Histoplasma capsulatum and induces resistance during therapy, which accounted for treatment failure in some patients.