Advanced Stages Of Human Immunodeficiency Virus Infection Research Articles

Natural type 1 interferon producing cells in HIV infection

Natural type 1 interferon producing cells (IPCs) are in the first line of defense against infectious pathogens. Besides the known properties of type 1 interferons in inhibiting human immunodeficiency virus (HIV) replication, the recent characterization of human IPCs and the possibility to purify them for in vitro studies has greatly accelerated the study of their role in HIV infection. The blood IPC numbers and function are decreased in HIV primary infection and in advanced stages of HIV infection. Loss of circulating IPCs correlates with a high HIV viral load and the occurrence of opportunistic infections. Moreover, HIV can directly infect IPCs in vitro, providing a potential explanation for their in vivo depletion. Thus, the balance between IPCs and HIV replication might be critical in determining the control or progression of HIV infection.

HIV disease: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

HIV disease: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

Tuberculous meningitis. Clinical characteristics and comparison with cryptococcal meningitis in patients with human immunodeficiency virus infection.

To determine the prevalence and causes of meningitis in patients with human immunodeficiency virus (HIV) infection. A prospective study of HIV-associated neurologic complications carried out from 1988 to 1992. A tertiary care university hospital in Madrid, Spain. PATIENTS. A total of 142 patients, 65% of whom were injecting drug users. Thirty-six episodes of meningitis were diagnosed in 33 patients (23%). Of these, 17 cases (47%) were tuberculous meningitis (5 definite and 12 probable) and 7 (19%) corresponded to cryptococcal meningitis. Comparative studies of the tuberculous and cryptococcal meningitis cases showed injecting drug use as the most common form of HIV transmission in the tuberculous meningitis (P = .03) and a lower mean CD4+ cell count in the cryptococcal meningitis group (P = .02). Tuberculous meningitis was the prime type of meningitis, which was associated with HIV transmission by injecting drug use. Cryptococcal meningitis appears in more advanced stages of HIV infection, which determines its characteristic presentation.

Comparison of zidovudine and zidovudine-thymostimulin in the long-term treatment of patients with asymptomatic human immunodeficiency virus infection and persistent generalized lymphadenopathy

Given the positive results of the TP1-AZT Multicenter Study (TAMS), a second stage of the study was undertaken. The goal of this second study was to confirm the therapeutic efficacy and clinical and immunologic effects of the combination of low-dose zidovudine (AZT) and thymostimulin (TP1) in a larger number of patients infected with human immunodeficiency virus (HIV) belonging to Centers for Disease Control and Prevention (CDC) group 2 (patients with asymptomatic HIV infection) and group 3 (patients with persistent generalized lymphadenopathy). A total of 248 HIV-positive patients were divided into two groups. Group A consisted of 123 CDC group 2 patients and group B consisted of 125 CDC group 3 patients. Each group was divided into two subgroups according to pharmacologic therapy. Subgroups A1 (n = 62) and B1 (n = 61) were treated with AZT (500 mg/d); subgroups A2 (n = 61) and B2 (n = 64) were treated with AZT (500 mg/d) + TP1 (70 mg/d intramuscularly for 1 week and then 70 mg intramuscularly three times per week). Clinical evaluations and routine hematochemical tests were checked every 15 days during the first month, every month during the following 2 months, and then every 3 months up to the end of the follow-up period (17 ± 3 months). In group A, a significant increase in T cells, subset CD4+, was observed in the group treated with AZT + TP1: this difference was statistically significant compared with both the pretreatment values (+7.6%, P < 0.001) and the AZT-treated group (+13.5%, P < 0.001). At the end of the follow-up period, a significant difference in the white blood cell (WBC) count between groups A1 and A2 was noted (+15% in group A2 [P < 0.001 vs baseline values], and −28% in group A1 [ P < 0.001 vs baseline values and P < 0.001 vs group A2]). Oral candidiasis was the only opportunistic infection observed in the group A patients. None of the patients in the two group A subgroups progressed to acquired immunodeficiency syndrome (AIDS). In group B, a significant increase in T cells, subset CD4+, was observed in patients treated with AZT + TP1; the difference was statistically significant compared with both the pretreatment values (+9.3%, P < 0.001) and the AZT-treated group (+13.7%, P < 0.001). In the AZT-treated group, a significant myelodepression was observed. At the end of the follow-up period, a difference was noted between groups B1 and B2 in blood cell counts, with a significant increase seen in the AZT + TP1-treated group (red blood cells, +8.1%, P < 0.001; WBC, +15%, P < 0.001; and platelets, +30%, P < 0.001). Opportunistic infections were observed in 14 (22.9%) patients in group B1 and 9 (14.1%) patients in group B2 (relative risk ratio, 0.64; 95% confidence interval, 0.27–0.82; P < 0.001). Progression to AIDS was observed in five (8.2%) patients in group B1 and two (3.1%) patients in group B2 (relative risk ratio, 0.40; 95% confidence interval, 0.22–0.70; P < 0.05). These results suggest that the combination of AZT and TP1 may be useful in the early stages of HIV infection, particularly in HIV-positive patients with levels of CD4+ T cells ⩾400/mm 3 and <600/mm 3. AZT + TP1 significantly improved cell-mediated immunity parameters and decreased the incidence of opportunistic infections. In the more advanced stages of HIV infection, AZT + TP1 may have a positive effect on immunologic and hematologic parameters and reduce the myelodepressive effect of long-term treatment with AZT.

Fever of uncertain origin in patients infected with the human immunodeficiency virus.

To assess the frequency and etiology of fever of uncertain origin (FUO) in patients infected with the human immunodeficiency virus (HIV) and to evaluate the yield of diagnostic procedures used in their evaluation, we reviewed the clinical charts of all patients admitted to an AIDS unit during a 15-month period. FUO was defined by the endurance of a fever (temperature, > 38.2 degrees C) for at least 4 weeks before admission and the uncertainty of diagnosis after 3 days, despite appropriate investigation. Of 580 patients evaluated, 50 (8.2%) had FUO. Patients with FUO were at advanced stages of HIV infection (median CD4+ cell count, 71/mm3), and a vast majority (84%) had previously diagnosed AIDS. A cause of the fever was identified for 44 patients (88%), and infections accounted for 82% of all cases. Tuberculosis (42%), visceral leishmaniasis (14%), and disseminated Mycobacterium avium complex infection (14%) were the most frequent diagnoses. Examination of lymph node aspirates, bone marrow biopsy, and culture of clinical specimens for mycobacteria were the procedures with the highest diagnostic yield. Among 6 patients with fever of no identified etiology, 4 died while febrile, and fever was self-limited in the other 2 patients. FUO is common among patients with advanced HIV infection. Since a cause, usually infection, can be identified in most patients, long-lasting fever should not be attributed to HIV itself.

A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. European Study Group on Heterosexual Transmission of HIV.

Worldwide, the predominant mode of human immunodeficiency virus (HIV) transmission is heterosexual intercourse, but the risk of heterosexual transmission and the effectiveness of measures to prevent it are not well defined. We conducted a prospective study of HIV-negative subjects whose only risk of HIV infection was a stable heterosexual relationship with an HIV-infected partner. Every six months the subjects were interviewed, tested for HIV, and counseled about safe sexual practices. A total of 304 HIV-negative subjects (196 women and 108 men) were followed for an average of 20 months. During the study, 130 couples (42.8 percent) ended their sexual relationships, most often because of the HIV-infected partner's illness or death. Of the 256 couples who continued to have sexual relations for more than three months after enrollment in the study, only 124 (48.4 percent) used condoms consistently for vaginal and anal intercourse. Among these couples, none of the seronegative partners became infected with HIV, despite a total of about 15,000 episodes of intercourse. Among the 121 couples who used condoms inconsistently, the rate of seroconversion was 4.8 per 100 person-years (95 percent confidence interval, 2.5 to 8.4). Eleven couples refused to answer questions about condom use. The risk of transmission increased with advanced stages of HIV infection in the index partners (P < 0.02) and with genital infection in the HIV-negative partners (P < 0.04). Withdrawal to avoid ejaculation in the vagina had a protective effect in uninfected women (P < 0.02). Consistent use of condoms for heterosexual intercourse is highly effective in preventing the transmission of HIV. Among couples not using condoms regularly, the risk of HIV transmission varies widely.

Periodontal disease in HIV‐infected patients in relation to lymphocyte subsets and specific micro‐organisms

Visible plaque index (VPI), gingival bleeding index (GBI) and pocket depth (PD) were analyzed in relation to potential periodontal pathogenic microorganisms and peripheral numbers of T4+ and T8+ lymphocyte subsets in 10 patients with human immunodeficiency virus (HIV) infection, 10 patients with AIDS related complex (ARC) and 10 patients with acquired immune deficiency syndrome (AIDS). 10 healthy persons served as controls. Periodontal disease in patients with more advanced stages of HIV infection were related to the severity of the systemic disease, and to decreasing numbers of T4+ lymphocytes in peripheral blood, but not to VPI or the occurrence of periodontal pathogenic micro-organisms.

Musculoskeletal Manifestations of Infection with Human Immunodeficiency Virus

Musculoskeletal manifestations and autoimmune phenomena are recently recognized complications of infection with human immunodeficiency virus (HIV). Patients with HIV infection share several clinical and serologic features with patients with systemic lupus erythematosus and Sjögren's syndrome; these similarities may lead to diagnostic confusion. The significance of the presence of different types of autoantibodies in HIV-infected patients is still uncertain and may reflect polyclonal B cell activation. Musculoskeletal complications--particularly arthritis, arthralgia, and myalgia--are common in advanced stages of HIV infection. Clinical characteristics and serologic findings support the premise that most of the musculoskeletal complications (e.g., Reiter's syndrome, psoriatic arthritis, acquired immunodeficiency syndrome-associated arthritis and arthralgias) are reactive in nature--either a direct consequence of HIV infection or a result of various opportunistic infections. The possibility of HIV infection should be considered in all patients with conditions suggesting reactive arthritis. Further studies are needed to define the full spectrum and frequency of these musculoskeletal abnormalities.

Opportunistic Infections with Coronavirus-Like Particles in Patients Infected with the Human Immunodeficiency Virus?

From 35 patients infected with Human Immunodeficiency Virus (HIV) and belonging to various risk groups, 60 stool specimens were examined for the presence of Coronavirus-like particles (CVLP) using electron microscopy. CVLP were detected in 5 (8%) stool samples from 5 different patients (14%). Only one of the patients had diarrhoea. The five patients with CVLP-positive stools were all at advanced stages of HIV infection. The remarkable discrepancy between our data and another study, reporting a rate of 50% CVLP-positive HIV patients, most of them persistently shedding the virus, is discussed.

Increased levels of soluble CD8 molecule in the serum of patients with acquired immunodeficiency syndrome (AIDS) and AIDS-related disorders

In this study we investigated the serological levels of the soluble form of the CD8 molecule (s-CD8) in 97 human immunodeficiency virus (HIV) seropositive patients. The control groups included 20 normal heterosexual subjects and 19 healthy seronegative subjects belonging to risk groups for AIDS. Our results show that patients with HIV infection have significantly higher levels of s-CD8 U/ml than the control groups. When the patients were further subdivided according to the Centers for Disease Control (CDC) classification, s-CD8 U/ml values were consistently increased in all HIV patients, irre-spective of the CDC stages. No statistically significant correlation was found between the serological levels of s-CD8/ml and the absolute numbers of CD8 lymphocytes/mm 3, in both HIV seropositive patients and control groups. Since in the more advanced stages of HIV infection (IV-A, IV-C1) the decrease in the absolute number of CD8 + cells was not followed by a decrease in s-CD8 levels, it is conceivable that an increased release and/or shedding of s-CD8 per cell might occur in these patients. In fact, when the results were expressed as s-CD8 units per CD8 positive cell (s-CD8/absolute number of CD8), the levels of s-CD8/cell were higher in patients belonging to the IV-A and IV-C1 CDC groups (1.94 U/cell ± 0.33 and 3.39 U/cell ± 0.5, respectively) compared to normal controls ( P < 0.001), HIV seronegative subjects at risk for AIDS ( P < 0.001), and the other patients' groups (II and III CDC groups, respectively, P < 0.001 and P < 0.001). The evidence herein provided that in patients with HIV infection s-CD8 levels are increased suggests a possible pathogenetic role of the cells involved in the release of this molecule.

In vitro susceptibilities and biotypes of Candida albicans isolates from the oral cavities of patients infected with human immunodeficiency virus.

Candida albicans strains were isolated from the oral cavities of 62 human immunodeficiency virus (HIV)-infected patients at different stages of HIV infection. Only patients with persistent generalized lymphadenopathy-acquired immunodeficiency syndrome (AIDS)-related complex or full-blown AIDS showed typical clinical symptoms for oral candidiasis. In general, the microbiological recovery of Candida strains from the oral cavity increased with more advanced stages of HIV infection. The antifungal activity of ketoconazole, itraconazole, nystatin, amphotericin B, and flucytosine against all 62 strains was evaluated by means of a photometer-read broth microdilution method for determination of the 30% inhibitory concentrations of the drugs. The 95% ranges of 30% inhibitory concentrations were as follows: less than or equal to 0.063 to 32 micrograms/ml for ketoconazole, less than or equal to 0.063 to 8 micrograms/ml for itraconazole, 0.5 to 4 micrograms/ml for nystatin, less than or equal to 0.063 to 4 micrograms/ml for amphotericin B, and less than or equal to 0.063 to 8 micrograms/ml for flucytosine. Two strains were resistant to flucytosine, one was resistant to ketoconazole, and three were resistant to itraconazole. Isolates from patients with full-blown AIDS showed significantly less susceptibility to itraconazole, amphotericin B, and flucytosine. Strains were biotyped by using the API 20C carbohydrate assimilation system. The major biotype accounted for 63.9% of the isolates. At repeated evaluation, a change in biotype pattern was seen in 27.3%.

Rheumatic manifestations of human immunodeficiency virus infection

Purpose: The prevalence and characteristics of the rheumatic and extra-rheumatic manifestations of human immunodeficiency virus (HIV) infection were determined in a prospective manner. Patients and methods: One hundred one patients with HIV infection were consecutively interviewed and examined. The prevalence of autoantibodies and their association with rheumatologic symptoms were also determined. Results: The musculoskeletal system was involved in 72 patients. Thirty-five patients had arthralgias, 10 had Reiter's syndrome, two had psoriatic arthritis, two had myositis, and one had vasculitis. Also found were two previously unreported syndromes. The first, occurring in 10 patients, consisted of severe intermittent pain involving less than four joints, without evidence of synovitis, of short duration (two to 24 hours), and requiring therapy (ranging from nonsteroidal anti-inflammatory drugs to narcotics). The second, occurring in 12 patients, consisted of arthritis (oligoarticular in six patients, monoarticular in three patients, and polyarticular in three patients) involving the lower extremities and lasting from one week to six months. The synovial fluid of five patients (three with arthritis, one with Reiter's syndrome, and one with psoriatic arthritis) was sterile and inflammatory. Conclusion: Musculoskeletal complications are common in advanced stages of HIV infection. Persons in a high-risk group for HIV infection who manifest oligoarthritis with or without any other extra-articular manifestation suggestive of Reiter's syndrome or other form of spondyloarthropathy should be tested for HIV.