Asymptomatic Human Immunodeficiency Virus Patients Research Articles

The impact of asymptomatic human immunodeficiency virus (HIV)-positive disease status on inpatient complications following total joint arthroplasty: a propensity score-matched analysis.

The number of patients with asymptomatic human immunodeficiency virus (AHIV) is increasing as the efficacy of antiretroviral therapy improves. While there is research on operative risks associated with having HIV, there is a lack of literature describing the impact of well-controlled HIV on postoperative complications. This study seeks to elucidate the impact of AHIV on postoperative outcomes after total hip (THA) and knee (TKA) arthroplasty. The Nationwide Inpatient Sample was retrospectively reviewed for patients undergoing TKA and THA from 2005 to 2013. Subjects were subdivided into those with AHIV and those without HIV (non-HIV). Patient demographics, hospital-related parameters, and postoperative complications were all collected. One-to-one propensity score-matching, Chi-square analysis, and multivariate logistical regressions were performed to compare both cohorts. There were no significant differences between AHIV and non-HIV patients undergoing TKA or THA in terms of sex, age, insurance status, or total costs (all, p ≥ 0.081). AHIV patients had longer lengths of stay (4.0days) than non-HIV patients after both TKA (3.3days) and THA (3.1days) (p ≤ 0.011). Both TKA groups had similar postoperative complication rates (p > 0.081). AHIV patients undergoing THA exhibited an increased rate of overall surgical complications compared non-HIV patients (0 vs. 4.5%, p = 0.043). AHIV was not associated with increased complications following both procedures. Despite lengthier hospital stays among AHIV patients, baseline AHIV was not associated with adverse outcomes following TKA and THA. This adds to the literature and warrants further research into the impact of asymptomatic, well-controlled HIV infection on postoperative outcomes following total joint arthroplasty.

Intrinsic Apoptotic Pathway Genes of Circulating Blood Neutrophils Triggered during HIV Infection and Remained Stimulated in ART Patients.

The intrinsic apoptotic pathway of neutrophils in Human Immunodeficiency Virus (HIV) infection results in spontaneous neutrophil death. There is a scarcity of data regarding the gene expression of an intrinsic apoptotic pathway of neutrophils in HIV patients. The objective of this study was to observe the differential expression of some important genes involved in the intrinsic apoptotic pathway of HIV patients, including those who were receiving antiretroviral therapy (ART). Blood samples were collected from asymptomatic, symptomatic, HIV, ART receivers HIV patients, and healthy individuals. Total RNA was extracted from neutrophils and subjected to quantitative real-time PCR assay. CD4+T cells and an automated complete blood count were performed. Among the asymptomatic, symptomatic, and ART receivers HIV patients (n=20 in each group), median CD4+T counts were 633, 98, and 565 cells/ml, and the length of HIV infection in months (±SD) was 24.06±21.36, 62.05±25.51, and 69.2±39.67, respectively. Compared with healthy controls, intrinsic apoptotic pathway genes, i.e., BAX, BIM, Caspase-3, Caspase-9, MCL-1, and Calpain-1, were upregulated to 1.21±0.33, 1.8±0.25, 1.24±0.46, 1.54±0.21, 1.88±0.30, and 5.85±1.34 fold in the asymptomatic group, and even more significantly, i.e., 1.51±0.43, 2.09±1.13, 1.85±1.22, 1.72±0.85, 2.26±1.34, and 7.88±3.31 fold in symptomatic patients, respectively. Despite CD4+ T-cell levels increased in the ART receiver group, these genes did not approach the level of healthy or asymptomatic and remained significantly upregulated. The genes involved in the intrinsic apoptotic pathway in circulating neutrophils during HIV infection were stimulated in vivo, and ART reduced the expression of those upregulated genes but did not return to the level of asymptomatic or healthy individuals.

Association of Micronutrients with Tuberculosis Development in HIV Infected Patients.

Human immunodeficiency virus (HIV) infection associated with weakened immune system due to decreased CD4 T cell count favors development of tuberculosis. Effector immune responses are also associated with micronutrient status due to their prominent role in maintaining immune functions. Micronutrient deficiencies are quite common among HIV patients that further result into compromised immunity thus making the conditions even more favorable for mycobacteria to establish disease. So, current study was designed to assess association of different micronutrients with development of TB in HIV patients. Micronutrient levels were measured in asymptomatic HIV patients who were monitored for the development of TB during follow up period (incident TB) within one month to one year and also in symptomatic microbiologically confirmed HIV-TB patients. Among various micronutrients assessed, levels of ferritin were found to be significantly increased (p < 0.05) with significant decreased zinc (p < 0.05) and selenium (p < 0.05) levels in incident TB group as well as in HIV-TB subjects compared to asymptomatic HIV patients who did not develop TB in the follow up period. Importantly, increased levels of ferritin and decreased levels of selenium were significantly associated with development of tuberculosis in HIV patients.

Detection of Pneumocystis jirovecii by quantitative real-time PCR in oral rinses from Pneumocystis pneumonia asymptomatic human immunodeficiency virus patients

Pneumocystis pneumonia (PCP) is a potentially life-threatening fungal infection usually seen in immunocompromised patients. Pneumocystis jirovecii can be easily detected from oral rinse samples in HIV patients with suspected PCP. In this study, a quantitative real-time PCR assay was used to establish the frequency of detection of P. jirovecii in oral rinses from HIV patients without respiratory symptoms or suspicion of PCP. Two saline oral rinses were collected from 100 ambulant HIV patients and from 60 COPD patients (comparator group). Four HIV patients were positive for P. jirovecii. In three patients, the first sample was positive and in one the second one was positive. One of these patients was on PCP prophylaxis and had a CD4+ count of 76 cells/mm3. The mean CD4+ count for all patients was 527 cells/mm3. All qRT-PCR test results for the COPD patients were negative. No patient developed PCP at six months follow-up. The qRT-PCR assay can be used to detect P. jirovecii DNA in oral rinse samples from HIV patients without evident clinical symptoms, however the oral carriage of this fungus was rare in our cohort of patients. In conclusion, although rare, a positive oral rinse P. jirovecii result may reflect colonisation, in particular in patients with HIV. This needs to be kept in mind when using oral rinses and qRT-PCR in the diagnosis of P. jirovecii infection.

High prevalence at computed coronary tomography of non-calcified plaques in asymptomatic HIV patients treated with HAART: A meta-analysis

IntroductionAsymptomatic patients with human immunodeficiency virus (HIV) infection are at increased risk of vascular disease. Whether asymptomatic HIV patients have increased prevalence or structural differences in coronary artery plaques is not clear. MethodsPubmed, Cochrane and Google Scholar were searched for articles evaluating asymptomatic HIV patients evaluated with coronary computed tomography. The prevalence of coronary stenosis (defined as >30% and >50%), of calcified coronary plaques (CCP) viewed as more ‘stable’ plaques, and of non-calcified coronary plaques (NCP) viewed as more ‘vulnerable’ plaques were the end points of interest. Results9 studies with 1229 HIV patients and 1029 controls were included. No significant differences were detected about baseline cardiovascular risk profile. The prevalence of significant coronary stenosis >30% or >50% did not differ between HIV+ and HIV- patients (42% [37–44] and 46% [35–52] with an Odds Ratio [OR] of 1.38 [0.86–2.20] for >30% stenosis) and (15% [9–21] and 14% [7–22] with an OR of 1.11 [0.81–1.52]), respectively. The prevalence of calcified coronary plaques (CCP) (31% [24–32] and 21% [14–30] with an OR of 1.17 [0.63–2.16]) also did not differ among HIV+ and HIV- patients. On the contrary rates of NCP were >3-fold higher in HIV-positive patients [58% (48–60) and 17% (14–27) with an OR of 3.26 (1–30-8.18)], with an inverse relationship with CD4 cell count at meta-regression (Beta −0.20 [-0.35-0.18], p 0.04). ConclusionAsymptomatic HIV patients present a similar burden of coronary stenosis and calcified coronary artery plaques but significantly higher rates of non-calcific coronary plaques at computed tomography. The association between HIV infection, reduced CD4 cell counts and higher prevalence on non-calcific coronary artery plaques may shed light into the pathogenesis in HIV-associated coronary artery disease, stressing the importance of primary prevention in this population.

Evaluation of Human Immunodeficiency Virus Infection‐Related Left Ventricular Systolic Dysfunction by Tissue Doppler Strain Echocardiography

Cardiovascular involvement causes significant morbidity and mortality among patients with human immunodeficiency virus (HIV) infection. Since the introduction of highly active antiretroviral treatment (HAART), subtle changes in left ventricular (LV) function, which may be clinically silent, have become more pronounced in HIV patients. Echocardiographic strain imaging (SI) may detect subclinical myocardial dysfunction at an earlier stage compared with conventional echocardiography. The aim of this study was to evaluate tissue Doppler-derived LV strain and strain rate (SR) along with conventional measures of LV function in asymptomatic, stable adult HIV patients on HAART. Twenty-one patients with HIV infection (mean age: 37.8 ± 11.9 years, 11 males) who had no cardiovascular complaints and 27 healthy volunteers (mean age: 40.9 ± 5.8 years, 14 males) were enrolled. Traditional parameters including LV ejection fraction (EF) were measured along with tissue velocity imaging (TVI) and tissue Doppler SI parameters using transthoracic echocardiography. The mean duration of HIV infection was 30.8 ± 25.1 (3-120) months. The mean LVEF in HIV group was within normal limits but lower than controls (64.5% ± 10.2% vs. 72.2% ± 6.4%, P = 0.003). There were no differences in other major traditional measures, as well as TVI parameters between groups. LV systolic strain and SR parameters were impaired indicating subtle LV systolic dysfunction in HIV group. No difference in diastolic function was observed between groups. Left ventricular systolic strain parameters may be utilized to demonstrate subtle LV systolic dysfunction in asymptomatic HIV patients.

SEROPREVALENCE OF ACTIVE Chlamydia trachomatis INFECTION AMONG HIV PATIENTS IN BENIN CITY, NIGERIA

Chlamydia trachomatis infection is the most common sexually transmitted infection world wide and if untreated, facilitates the acquisition or spread of human immunodeficiency virus (HIV) amongst other consequences. This study is aimed at determining the seroprevalence of active Chlamydia trachomatis infection among asymptomatic HIV patients. A total of 143 subjects consisting of 112 HIV (85 on highly active antiretroviral therapy [HAART] and 27 HAART-naive) patients and 31 apparently healthy non – HIV subjects, were recruited for this study. Blood samples were collected from all subjects and plasma obtained, were used to detect IgG antibodies using an enzyme immunoassay kit. CD4+ T-lymphocyte count was determined for the HIV patients using standard technique. The seroprevalence of active Chlamydia trachomatis infection was higher among HIV patients (7.14%) compared with their non – HIV counter part (3.23%). However, the difference was not statistically significant (P = 0.7062). Active Chlamydia trachomatis infection was not detected among HAART – naive HIV patients, but was only observed among HIV patients on HARRT (9.41%). Seroprevalence of active Chlamydia trachomatis infection did not differ significantly among both gender of the study subjects (P &gt; 0.05). Active Chlamydia trachomatis infection did not differ significantly, (P = 0.5784) between HIV patients with CD4 count &lt; 200 cells/?L (4.35%) and those with CD4 count &gt; 200cells/?L (11.29%). An overall seroprevalence of 6.29% of active Chlamydia trachomatis infection was observed in this study. Among HIV patients, active Chlamydia trachomatis infection was observed only among HIV patients on HAART. Further studies are needed to determine the effect of active Chlamydia trachomatis infection among HIV patients on HAART

Psychiatric morbidity in asymptomatic human immunodeficiency virus patients

Background:Psychiatric morbidity in human immunodeficiency virus (HIV) patients is being studied all over the world. There is paucity of Indian literature particularly in asymptomatic HIV individuals.Aim:The aim of the following study is to establish the prevalence and the determinants of psychiatric morbidity in asymptomatic HIV patients.Materials and Methods:A cross-sectional study was undertaken to assess psychiatric morbidity as per ICD-10 dacryocystorhinostomy criteria in 100 consecutive asymptomatic seropositive HIV patients and an equal number of age, sex, education, economic and marital status matched HIV seronegative control. All subjects were assessed with the general health questionnaire (GHQ), mini mental status examination, hospital anxiety and depression scale (HADS) and sensation seeking scale (SSS) and the scores were analyzed statistically.Results:Asymptomatic HIV positive patients had significantly higher GHQ caseness and depression but not anxiety on HADS as compared to HIV seronegative controls. On SSS asymptomatic HIV seropositive subjects showed significant higher scores in thrill and adventure seeking, experience seeking and boredom susceptibility as compared to controls. HIV seropositive patients had significantly higher incidence of total psychiatric morbidity. Among the individual disorders, alcohol dependence syndrome, sexual dysfunction and adjustment disorder were significantly increased compared with HIV seronegative controls.Conclusion:Psychiatric morbidity is higher in asymptomatic HIV patients when compared to HIV seronegative controls. Among the individual disorders, alcohol dependence syndrome, sexual dysfunction and adjustment disorder were significantly increased compared with HIV seronegative controls. High sensation seeking and substance abuse found in HIV seropositive patients may play a vital role in engaging in high-risk behavior resulting in this dreaded illness.

Candida colonisation in asymptomatic HIV patients attending a tertiary hospital in Benin City, Nigeria

Background: Candidiasis is the commonest opportunistic fungal infection in patients infected with human immunodeficiency virus (HIV). CD4+ lymphocyte counts have been found to be a marker of HIV disease progression.Aim: This study focused on determining the spectrum of Candida isolates in urine, stool, and oral specimens among HIV patients in a tertiary hospital.Methods: A total of 300 subjects comprising of 200 HIV patients and 100 non-HIV subjects were used for this study. Three samples (urine, stool, and oral swab) were collected from each subject. Each specimen was processed using standard microbiological techniques and emergent Candida isolates were identified with CHROMagar™ Candida and sugar fermentation tests.Results: The overall prevalence of Candida colonisation among HIV patients was 52.5%. HAART-naive patients had a significantly higher prevalence (OR = 3.65; 95% CI = 2.03–6.56; p<0.0001) than their counterpart on highly active antiretroviral therapy (HAART) (OR = 1.99; 95% CI = 1.13–3.50; p=0.0232). Female gender was a significant risk factor for acquiring Candida infection (OR = 3.40; 95% CI = 1.14–10.13; p=0.0289). The effect of age on prevalence of candidiasis was observed among HIV patients on HAART (p=0.0161). A CD4+ count <200 cells/µl was a significant risk factor for acquiring candidal infection only among HAART-naive patients (OR = 4.37; 95% CI = 1.60–11.95; p=0.0042). The five species of Candida recovered from this study were C. albicans, C. krusei, C. parapsilosis, C. tropicalis, and C. glabrata.Conclusion: There is a significant relationship between antiretroviral therapy, CD4+ counts, and the prevalence of candidiasis.

Self-Screening for Neisseria gonorrhoeae and Chlamydia trachomatis in the Human Immunodeficiency Virus Clinic—High Yields and High Acceptability

Despite antiretroviral therapy (ART), incident human immunodeficiency virus (HIV) continues to rise, and sexually transmitted infections (STI) are well known for their part in HIV transmission. National guidelines recommend routine STI screening in HIV-positive individuals, but despite this, reported uptake remains low. We implemented a nurse-led self-screening program for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in asymptomatic HIV patients. Self-collected samples were tested for CT and GC using the GenProbe Aptima Combo 2 assay. Clinical records were reviewed for ART history, CD4 T-cell count, and plasma viral load. A screening service evaluation questionnaire was handed out. During an 8-month period, 976 screens were performed. In all, 143 infections were detected which would have been missed without the screening program. Overall prevalence of infection among men who have sex with men was 17.4%: rectal CT and GC, 9.8% (56/571) and 4.2% (24/571), respectively; urethal CT and GC, 2.6% (16/605) and 1.3% (8/605), respectively; and pharyngeal CT and GC, 1.7% (10/589) and 3.9% (23/589), respectively. Among heterosexual men and women, the rates of CT were 2.1% (3/141) and 1.5% (3/201), and there was no GC. Transient viremia was observed at the time of STI diagnosis in 6 patients on ART. All men who have sex with men and most women found self-swabbing acceptable, and most patients indicated that they would like to be offered testing in future. These findings highlight the need for the introduction of similar screening approaches in HIV clinics. Self-collected specimens using sensitive and specific GC and CT nucleic acid amplification tests are a convenient and acceptable way of testing, and it may address some of the barriers to screening in this population.

Increased dopaminergic neurotransmission in therapy-naïve asymptomatic HIV patients is not associated with adaptive changes at the dopaminergic synapses

Central dopaminergic (DA) systems are affected during human immunodeficiency virus (HIV) infection. So far, it is believed that they degenerate with progression of HIV disease because deterioration of DA systems is evident in advanced stages of infection. In this manuscript we found that (a) DA levels are increased and DA turnover is decreased in CSF of therapy-naïve HIV patients in asymptomatic infection, (b) DA increase does not modulate the availability of DA transporters and D2-receptors, (c) DA correlates inversely with CD4+ numbers in blood. These findings show activation of central DA systems without development of adaptive responses at DA synapses in asymptomatic HIV infection. It is probable that DA deterioration in advanced stages of HIV infection may derive from increased DA availability in early infection, resulting in DA neurotoxicity. Our findings provide a clue to the synergism between DA medication or drugs of abuse and HIV infection to exacerbate and accelerate HIV neuropsychiatric disease, a central issue in the neurobiology of HIV.

Urinary tract infection among asymptomatic HIV patients in Benin City, Nigeria

The impact of human immunodeficiency virus (HIV) infection and CD4+ count on the prevalence of urinary tract infection (UTI) is studied to determine the prevalence of UTI among HIV and non-HIV subjects. Clean-catch midstream urine and venous blood was collected from 421 subjects comprising 317 HIV patients (89 men, 228 women) and 104 non-HIV subjects (48 men, 56 women). The HIV patients consisted of 101 highly active antiretroviral therapy (HAART)-naive subjects and 216 patients on HAART for three to six months. The HIV patients were asymptomatic and all subjects had no signs or symptom of UTI. Microbial isolates were identified in urine and susceptibility tests were performed. Only HIV patients on HAART had significantly higher prevalence of asymptomatic UTI compared with non-HIV subjects (27.78% vs. 17.31%, OR=1.8376, 95% confidence interval = 1.0198–3.3112, P=0.0411). Among both groups, CD4+ count <200 cells/µL was not associated with asymptomatic UTI. Staphylococcus aureus was the most common uropathogen (27.2%) and nitrofurantoin was the most active antibacterial agent. Most bacterial isolates were resistant to other antibacterial agents used (amoxicillin, amoxicillinclavulanate, gentamicin, co-trimoxazole, tetracycline, nalidixic acid, ciprofloxacin and ofloxacin). Overall prevalence of asymptomatic UTI was 24.94%. HIV patients on HAART had a one- to three-fold higher risk of acquiring UTI. CD4+ count was not associated with asymptomatic UTI

ESTIMATION OF CD4+ AND CD8+ T-LYMPHOCYTES IN HUMAN IMMUNODEFICIENCY VIRUS INFECTION AND ACQUIRED IMMUNODEFICIENCY SYNDROME PATIENTS IN MANIPUR

Purpose: To estimate and stratify CD4+and CD8+T-lymphocyte levels in human immunodeficiency virus (HIV) infected (asymptomatic) and acquired immunodeficiency syndrome (AIDS) patients (symptomatic) and correlate the clinical features of the patients with CD4+ and CD8+ lymphocyte level. Methods: : Between April 2002 and September 2003, a total of 415 HIV seropositive adult patients (297 males and 118 females) attending Regional Institute of Medical Sciences (RIMS) hospitals were tested for CD4+ and CD8+ T-lymphocytes by fluorescent activated cell sorter (FACS) counter (Becton Dickinson). Symptomatic patients were diagnosed as per NACO clinical case definition. Results: Ranges of 0-50, 51-100, 101-200, 201-300, 301-400, 401-500 and above 500 CD4+ T-lymphocyte per microlitre were seen in 68, 52, 101, 73, 47, 31 and 43 patients respectively whereas CD8+ T-lymphocyte ranges of 0-300, 301-600, 601-900, 901-1500, 1501-2000, 2001-3500 per microlitre were seen in 29, 84, 92, 145, 40 and 25 patients respectively. One hundred and fifty patients were asymptomatic and 265 were symptomatic. CD4/CD8 ratio in asymptomatics and symptomatics were 0.13-1.69 and 0.01-0.93 respectively. Tuberculosis and candidiasis occurred in CD4+ T-lymphocyte categories between 0-400 cells per μL in symptomatics. However, cryptosporidiosis, toxoplasmosis, herpes zoster, cryptococcal meningitis, Pneumocystis carinii pneumonia, penicilliosis and cytomegalovirus retinitis were seen in patients having CD4+ T-lymphocyte less than 200 per μL. Conclusions: CD4+ T-lymphocyte was decreased in both asymptomatic and symptomatic HIV patients, The decrease was greater in symptomatics while CD8+ T-lymphocyte was increased in both except advanced stage symptomatics. CD4: CD8 ratio was reversed in both groups. Opportunistic infections correlated with different CD4+ T-lymphocyte categories.

Estimation of CD4+ and CD8+ T-lymphocytes in human immunodeficiency virus infection and acquired immunodeficiency syndrome patients in Manipur

To estimate and stratify CD4 + and CD8 + T-lymphocyte levels in human immunodeficiency virus (HIV) infected (asymptomatic) and acquired immunodeficiency syndrome (AIDS) patients (symptomatic) and correlate the clinical features of the patients with CD4+ and CD8+ lymphocyte level. Between April 2002 and September 2003, a total of 415 HIV seropositive adult patients (297 males and 118 females) attending Regional Institute of Medical Sciences (RIMS) hospitals were tested for CD4+ and CD8+ T-lymphocytes by fluorescent activated cell sorter (FACS) counter (Becton Dickinson). Symptomatic patients were diagnosed as per NACO clinical case definition. Ranges of 0-50, 51-100, 101-200, 201-300, 301-400, 401-500 and above 500 CD4+ T-lymphocyte per microlitre were seen in 68, 52, 101, 73, 47, 31 and 43 patients respectively whereas CD8+ T-lymphocyte ranges of 0-300, 301-600, 601-900, 901-1500, 1501-2000, 2001-3500 per microlitre were seen in 29, 84, 92, 145, 40 and 25 patients respectively. One hundred and fifty patients were asymptomatic and 265 were symptomatic. CD4/CD8 ratio in asymptomatics and symptomatics were 0.13-1.69 and 0.01-0.93 respectively. Tuberculosis and candidiasis occurred in CD4+ T-lymphocyte categories between 0-400 cells per mL in symptomatics. However, cryptosporidiosis, toxoplasmosis, herpes zoster, cryptococcal meningitis, Pneumocystis carinii pneumonia, penicilliosis and cytomegalovirus retinitis were seen in patients having CD4+ T-lymphocyte less than 200 per mL. CD4+ T-lymphocyte was decreased in both asymptomatic and symptomatic HIV patients, The decrease was greater in symptomatics while CD8+ T-lymphocyte was increased in both except advanced stage symptomatics. CD4:CD8 ratio was reversed in both groups. Opportunistic infections correlated with different CD4+ T-lymphocyte categories.

Skin disease: clinical indicator of immune status in human immunodeficiency virus (HIV) infection

Dermatological manifestations are seen at every stage of HIV/AIDS (human immunodeficiency virus), and are often the presenting features. These manifestations not only act as markers but also reflect the underlying immune status. To establish skin diseases as clinical indicators of underlying immune status in HIV disease by estimating and correlating with the CD(4), CD(4) : CD(8) ratio. The CD(4), CD(8), CD(4) : CD(8) ratios were estimated using the fluorescence activated cell sorter (FACS) count system in 20 asymptomatic HIV patients, 80 HIV patients with various skin manifestations and 72 healthy volunteers as the control group. In comparison with the CD(4) cell count of the control group (mean 885/mm(3), standard deviation 331), that of the HIV-positive individuals (mean 409.83/mm(3), standard deviation 263.07) was statistically correlated with low counts (z = 10.099 and P < 0.05). Similarly there was statistical significance with the CD(4) : CD(8) ratio among these two groups. In comparison with the CD(4) cell count of the asymptomatic HIV-positive individuals (mean 620.65/mm(3) and standard deviation 262.065), the CD(4) cell count of the HIV-positive patients with various dermatological manifestations (mean 357.15/mm(3), standard deviation 236.95) was statistically correlated with low counts (z = 4.0978 and P < 0.05). Similarly there was statistical significance with the CD(4) : CD(8) ratio among these two groups. There was an inverse relation between the CD(4) counts and the incidence and severity of skin diseases in the HIV/AIDS patients. Cutaneous manifestations of HIV can be considered as good clinical indicators to predict and access the underlying immune status in resource-poor countries.

Magnetic resonance spectroscopy of the brain in neurologically asymptomatic HIV-infected patients

The CNS involvement is frequently found in human immunodeficiency virus (HIV) infection. The purpose of our study was to determine whether proton magnetic resonance spectroscopy (MRS) could detect early brain involvement in neurologically asymptomatic HIV-infected patients with normal MR imagings and to find the correlation between MRS and the immune status. We performed MRS in 30 HIV seropositive neurologically asymptomatic patients with normal MRI and compared the MRS findings with 13 controls. A statistically significant reduction in N-acetylaspartate (NAA)/creatine (Cr) and N-acetylaspartate (NAA)/choline (Cho) in both centrum semiovale ( p < 0.005) and thalamic areas ( p < 0.05) was found. There is no statistically significant difference as to choline (Cho)/creatine (Cr) and myoinositol (mI)/creatine (Cr) ratios in both regions. The difference of NAA/Cr was more pronounced in the white matter than in the gray matter. As for the immune status, there was a trend towards correlation between CD4 counts and NAA/Cr but devoid of statistical significance. Our results suggest that MRS is more sensitive than conventional MR imaging in detecting CNS involvement in neurologically asymptomatic HIV patients and may, therefore, be used for early detection of brain damage induced by HIV.

Cerebrospinal fluid analyses in HIV patients: a longitudinal study through six years

The human immunodeficiency virus (HIV) can cause neurological symptoms. It is not known how the the cerebrospinal fluid (CSF) may change during the infection. Thirty‐eight neurologically asymptomatic HIV patients with CD4 lymphocyte count &gt; 280 × 106/1, were included in the prospective study. CSF was analysed once a year for cell count, oligoclonal IgG, IgG index and CSF:S albumin ratio. Cell free CSF was cultivated for HIV isolation. At inclusion, at year three and six, the CSF anti‐HIV antibody synthesis was measured. HIV‐DNA in CSF cells were analysed at inclusion. More than 80% of the patients had abnormal CSF. At consecutive investigations the IgG index and/or CSF:S albumin ratio were unchanged in most of the patients. These findings resemble those seen in MS, neuroborreliosis or neurolues. HIV was isolated in about half of the patients the first four times but in about one‐third of them later on. At inclusion, HIV‐DNA was found in CSF cells in 95% and intrathecal anti‐HIV antibody synthesis in 65% of the patients. The findings did not correlate with the HIV duration, patients' age or the amount of blood CD4 cells. The results speak in favour of the early penetration of HIV in CSF but for its low neurovirulence.

Left ventricular diastolic function in asymptomatic and symptomatic human immunodeficiency virus carriers: an echocardiographic study

Acquired immunodeficiency syndrome (AIDS) is a systemic illness affecting multiple organs, including the heart. Left ventricular (LV) diastolic dysfunction has been reported as the first echocardiographically detectable abnormality in several cardiovascular disorders. We tested the hypothesis that Human Immunodeficiency Virus (HIV) carriers have LV diastolic impairment when studied early in the clinical course of the infection. Doppler echocardiographic and computerized time-motion parameters of LV diastolic function were obtained in 51 HIV patients and in 25 age- and sex-matched healthy controls. The HIV population consisted of 28 totally asymptomatic subjects and 23 patients with incipient AIDS. As compared to controls, the HIV group had similar heart rate, blood pressure level, LV dimensions and fractional shortening, but increased isovolumetric relaxation time (P = 0.03), early filling duration (P < 0.001) and decreased early mitral flow peak velocity (E) (P = 0.02) and EF slope (P < 0.001). HIV patients also showed lower values for posterior wall thinning (PWT, P < 0.01) and peak lengthening velocity of the posterior wall (PVL, P < 0.05), and a trend to a decreased peak rate of LV enlargement in diastole (D+, P = 0.05). Doppler-derived parameters of diastolic function were significantly altered in the asymptomatic HIV group vs controls. The LV diastolic indices were similar in symptomatic and asymptomatic HIV patients except for PWT, which was lower in the symptomatic HIV group (P = 0.04). Since mild and focal wall motion abnormalities were detected in 11 HIV carriers (22%), comparison of LV diastolic indexes between HIV patients and controls was also performed in two subgroups; these included asymptomatic (n = 26) and symptomatic (n = 14) patients with normal contractile state. The two subgroups had abnormalities of diastolic function similar to those of the HIV group as a whole, but with somewhat lower levels of statistical significance. Our data strongly suggest that there is myocardial involvement at the early stage of HIV infection; however, its impact on the clinical course of the disease remains to be clarified.