Diagnosis Of Acquired Immunodeficiency Syndrome Research Articles

Migration patterns among Floridians with AIDS, 1993-2007: implications for HIV prevention and care.

To characterize migration patterns among people diagnosed as having and who died of acquired immunodeficiency syndrome (AIDS) from 1993 to 2007 because migrating to a new community can disrupt human immunodeficiency virus/AIDS care delivery and patients' adherence to care and affect migrants' social services and healthcare needs. Florida AIDS surveillance data were used to describe patterns of migration among people diagnosed as having and who died of AIDS from 1993 to 2007. Individual and community characteristics were compared between residence at the time of AIDS diagnosis and residence at the time of death by type of migration. Of 31,816 people in the cohort, 2510 (7.9%) migrated to another county in Florida and 1306 (4.1%) migrated to another state. Interstate migrants were more likely to be men, 20 to 39 years old, non-Hispanic white, and born in the United States, to have had a transmission mode of injection drug use (IDU) or men who have sex with men with IDU (MSM&IDU), and to have been diagnosed before 1999. Intercounty migrants were more likely to be non-Hispanic white, younger than 60 years, have had a transmission mode of MSM, IDU, or MSM&IDU, have higher CD4 counts/percentages, and to have lived in areas with low levels of poverty or low physician density. There was a small net movement from urban to rural areas within the state. A sizable percentage of people, particularly younger people and people with a transmission mode of IDU and IDU&MSM, migrated at least once between the time of their AIDS diagnosis and death. This has important implications for care and treatment, as well as efforts to prevent the disease. Further research is needed to explore barriers and facilitators to access to care upon migration and to assess the need for programs to help people transfer their human immunodeficiency virus/AIDS care, ensuring continuity of care and adherence.

The HIV Epidemic Among Women in the United States: A Persistent Puzzle

The HIV Epidemic Among Women in the United States: A Persistent Puzzle

HIV Infections Attributed to Male-to-Male Sexual Contact—Metropolitan Statistical Areas, United States and Puerto Rico, 2010

Human immunodeficiency virus (HIV) infections attributed to male-to-male sexual contact comprised 64% of the estimated new HIV infections in the United States in 2009. Assessing the geographic distribution of HIV infection by transmission category can help public health programs target prevention resources to men who have sex with men (MSM) in areas where HIV infection from male-to-male sexual contact is most frequent. In 2004, CDC published data on acquired immunodeficiency syndrome diagnoses among MSM and others by metropolitan statistical area (MSA). To examine geographic differences in the prevalence of HIV infection from male-to-male sexual contact among persons aged ≥13 years in the United States and Puerto Rico, CDC estimated the number of HIV infections in persons newly diagnosed in 2010 and analyzed them by transmission category and location. Results indicated that HIV infections attributed to male-to-male sexual contact made up the largest percentage of HIV infections in MSAs (62.1%), smaller metropolitan areas (56.1%), and nonmetropolitan areas (53.7%). Of the 28,851 infections attributed to male-to-male sexual contact, 23,559 (81.7%) were in MSAs, and 11,410 (48.4%) of those infections were in seven MSAs that represented 31.7% (53,169,004 of 167,919,694) of the overall population aged ≥13 years in the MSAs that were assessed. These data support planning for targeted interventions to prevent HIV acquisition and transmission by male-to-male sexual contact among MSM, particularly in those areas most affected.

Profile of patients diagnosed with AIDS at age 60 and above in Brazil, from 1980 until June 2009, compared to those diagnosed at age 18 to 59

ObjectivesThe aim of this study was to learn more about people diagnosed with acquired immunodeficiency syndrome (AIDS) at age 60 and above in Brazil, and to compare them with people diagnosed at a younger age. MethodsThis study was based on the analysis of secondary data from the Brazilian AIDS Program. The study population consisted of people diagnosed with AIDS at age 60 and above. The comparison group was comprised of a 20% random sample of people diagnosed at age 18 to 59, frequency-matched by year of diagnosis. Results544,846 cases of AIDS were reported in Brazil from 1980 until June 2009. Over 90% of cases were diagnosed between 18 and 59 years of age, and 13,657 (2.5%) at age 60 and above. The first case of AIDS among the elderly was reported in 1984. The comparison group consisted of 101,528 patients. Gender proportion was similar for both groups, and the proportion of people identified with AIDS after death in the Brazilian Mortality Information System (SIM) was 4% higher among the elderly. Both groups were also similar regarding the region of residence; a markedly higher proportion lived in Southeastern Brazil. Older people were more likely to have lower education and to have contracted AIDS by heterosexual contact, and less likely to be intravenous drug users. Male to female ratio among those diagnosed with AIDS at or above age 60 decreased over the years, in the same way as observed for the whole cohort. Mortality was higher among men in both groups. CD4 category (taken closest to the date of AIDS diagnosis) was very similar in both groups. ConclusionThe characteristics of the epidemic among the elderly show similarities to the younger group considering gender distribution and CD4 category, but differ regarding educational level and exposure category. Also, the elderly were more likely not to have their AIDS condition promptly diagnosed.

Prescription Long-term Opioid Use in HIV-infected Patients

To examine changes the in use of prescription opioids for the management of chronic noncancer pain in human immunodeficiency virus (HIV)-infected patients and to identify patient characteristics associated with long-term use. Long-term prescription opioid use (ie, 120+ days supply or 10+ prescriptions during a year) was assessed between 1997 and 2005 among 6939 HIV-infected Kaiser Permanente members and HIV-uninfected persons in the general health plan memberships. In 2005, 8% of HIV individuals had prevalent long-term opioid use, more than double the prevalence among HIV-uninfected individuals. However, the large increases in use from 1997 to 2005 in the general population were not observed for HIV-infected individuals. The strongest associations with prevalent use among HIV-infected individuals were female sex with a prevalence ratio (PR) of 1.8 (95% CI=1.3, 2.5); Charlson comorbidity score of 2 or more (compared with a score of 0) with a PR of 1.9 (95% CI=1.4, 2.8); injection drug use history with a PR of 1.8 (95% CI=1.3, 2.6); and substance use disorders with a PR of 1.8 (95% CI=1.3, 2.5). CD4, HIV viral load, and acquired immunodeficiency syndrome diagnoses were associated with prevalent opioid use early in the antiretroviral therapy era (1997), but not in 2005. Long-term opioid use for chronic pain has remained stable over time for HIV patients, whereas its use increased in the general population. The prevalence of prescribed opioids in HIV patients was highest for certain subgroups, including women, and those with a comorbidity and substance abuse history.

AIDS-related Gastrointestinal Kaposi Sarcoma in Korea: A Case Report and Review of the Literature

Kaposi sarcoma (KS) is a vascular neoplasm, which is fairly prevalent in acquired immunodeficiency syndrome (AIDS) patients. Mucocutaneous and lymph node involvements are characteristic features of KS in AIDS patients. The involvement of gastrointestinal tract occurs in 40% of KS patients and leads to significant morbidity and mortality. In the highly active antiretroviral therapy (HAART) era, the rate of AIDS related KS has fallen with control of human immunodeficiency virus (HIV) viremia. However, it is still recognized as the primary AIDS-defining illness, and the proportion of AIDS diagnoses made due to KS ranged from 4.1% to 7.5%. In Korea, AIDS-related KS has been report in low rate incidence. Its gastrointestinal involvements are rarely reported. To date, five cases have been recorded in Korea. Herein, we present an additional case of gastrointestinal KS as the AIDS-defining illness and review of the Korean medical literature.

Cytodiagnosis of cutaneous histoplasmosis in HIV positive patient initially presenting with multiple umbilicated disseminated skin nodules

Histoplasmosis is usually an opportunistic fungal infection in patients with defective cell mediated immunity, and has been considered as one of the acquired immunodeficiency syndrome (AIDS) defining illness. However, cutaneous involvement in human immunodeficiency virus (HIV) positive patients is less common, and very rarely can be the initial presenting symptom for the diagnosis of AIDS. We present here an unusual case of multiple diffuse cutaneous nodular lesions predominantly in face, trunk, and upper extremities diagnosed initially on aspiration cytology as histoplasmosis. Subsequent serological test revealed positivity for HIV 1 and 2, along with a low CD4 count and low CD4:CD3 ratio. The cytomorphological features were further corroborated by histology and histochemical stains. Hence, cutaneous histoplasmosis can cause multiple wide spread nodular or umbilicated lesions in AIDS patients as the initial presentation. Fine needle aspiration cytology (FNAC) is a rapid, cost effective tool for diagnosis of the fungi from such lesions and initiating work up for immunocompromised states including AIDS.

AIDS Morbidity and Mortality in Brazilian Children Before and After Highly Active Antiretroviral Treatment Implementation

The objective of this study was to analyze regional trends over time of acquired immunodeficiency syndrome (AIDS) cases and deaths in Brazilian children, before and after implementation of free access to highly active antiretroviral treatment (HAART). We performed a nation-wide study with an ecologic design and a time-series analysis of AIDS incidence and mortality rates in children (0-12 years of age), using polynomial regression models. Data were obtained from official national databases on age group, residence region, and year of AIDS diagnosis and death (1984-2008). Between 1984 and 2008, 14,314 (2.7%) AIDS cases and 5041 deaths (2.3% of all AIDS-related deaths) were reported in Brazilian children. Incidence after 1996 was reduced by 23%, as compared with the pre-HAART era. The mortality rate observed in the HAART era was reduced by 63.6%. There was a significant reduction in the incidence in the Southeast and Central-West regions (P < 0.001), but the less industrialized North region showed an increase in the pre-HAART era (P < 0.001), and the Northeast region showed a stabilization trend (P < 0.001). In the South region, the incidence of AIDS increased in the 0 to 4 years subgroup. A reduction of AIDS mortality in the Southeast (P < 0.001), South, and Central-West regions (P < 0.001) was seen, but the Northeast and North regions maintained an increasing mortality trend (P < 0.001). Despite the overall reduction in AIDS-related cases and deaths among children in Brazil since HAART, marked regional differences continue to exist. These reflect structural factors, different transmission dynamics, and operational issues. There is a need for improving the health service network with special emphasis on the less developed regions.

Efficacy of an Emergency Department-Based HIV Screening Program in the Deep South

Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) continue to be a significant public health concern in the United States. It disproportionately affects persons in the Deep South of the United States, specifically African Americans. This is a descriptive report of an Emergency Department (ED)-based HIV screening program in the Deep South using the 2006 Centers for Disease Control and Prevention (CDC) recommendations for rapid testing and opt-out consent. Between May 2008 and March 2010, patients presenting for medical care to the ED Monday through Friday between 10 AM: and 10 PM: were approached for HIV screening. Patients were eligible for screening if they were 18 or older, had no previous history of positive HIV tests, were English-Speaking, and were not incarcerated, medically unstable, or otherwise able to decline testing. All patients were tested using the OraQuick® rapid HIV 1/2 antibody test. Patients with non-reactive results were referred to community anonymous testing sites for further testing. Patients with reactive results had confirmatory Western blot and CD4 counts drawn and were brought back to the ED for disclosure of the results. All patients with confirmed HIV positive via reactive Western blot were referred to the hospital-based infectious disease clinic or county health department. We tested 7,616 patients out of 8,922 approached. The overall test acceptance rate was 85.4%. 91.0% of patients tested were African American. The most common reason for refusal was recent HIV test. 1.7% of patients tested were confirmed HIV positive via Western blot. 95.2% of patients testing HIV positive were African American. The average CD4 count for patients testing positive was 276 cells/μl, with 42.0% of patients having CD4 counts ≤200 μl, consistent with an AIDS diagnosis. 88.4% of patients who had reactive oral swabs returned for Western blot results and 75.0% of patients attended their first clinic visit. We have been able to successfully carry out an ED-based HIV screening program in a resource-poor urban teaching facility in the Deep South. We define our success based on our relatively high test acceptance rate and high rate of attendance at first clinic visit. Our patient population has a relatively high undocumented HIV prevalence and are at advanced stage of disease at the time of diagnosis.

Epidemiologic Differences between Native-Born and Foreign-Born Black People Diagnosed with HIV Infection in 33 U.S. States, 2001–2007

Few studies have examined the extent to which foreign-born people contribute to the human immunodeficiency virus (HIV) epidemic among non-Hispanic black people in the U.S. We sought to determine differences in the epidemiology of HIV infection among native- and foreign-born black people, using data from the national HIV surveillance system of the Centers for Disease Control and Prevention. We estimated the number of HIV infections among black adults and adolescents diagnosed from 2001 to 2007 in 33 U.S. states. We compared annual HIV diagnosis rates, distributions of demographic characteristics and HIV-transmission risk factors, late diagnoses of HIV infection, and survival after an acquired immunodeficiency syndrome (AIDS) diagnosis for native- and foreign-born black people. From 2001 to 2007, an estimated 100,013 black adults and adolescents were diagnosed with HIV infection in 33 U.S. states, for which country-of-birth information was available. Of these, 11.7% were foreign-born, with most from the Caribbean (54.1%) and Africa (41.5%). Annual HIV diagnoses decreased by 5.5% per year (95% confidence interval [CI] -5.9, -5.0) among native-born black people. Decreases were small among foreign-born black people (-1.3%; 95% CI -2.6, -0.1), who were more likely to be female, have HIV infection attributable to high-risk heterosexual contact, be diagnosed with AIDS within 12 months of HIV diagnosis, and survive one year and three years after an AIDS diagnosis. The epidemiology of HIV infection differs for foreign-born black individuals compared with their native-born counterparts in the U.S. These data can be used to develop culturally appropriate and relevant HIV-prevention interventions.

Cytokine signaling pathway polymorphisms and AIDS-related non-Hodgkin lymphoma risk in the multicenter AIDS cohort study

Cytokine stimulation of B-cell proliferation may be an important causative mechanism for acquired immunodeficiency syndrome (AIDS)-related non-Hodgkin lymphoma (NHL). The Epstein-Barr virus (EBV) may be a co-factor, particularly for primary central nervous system (CNS) tumors, which are uniformly EBV-positive in the setting of AIDS. Thus, we examined associations of genetic variation in IL10 and related cytokine-signaling molecules (IL10RA, CXCL12, IL13, IL4, IL4R, CCL5 and BCL6) with AIDS-related NHL risk and evaluated differences between primary CNS and systemic tumors. We compared 160 Multicenter AIDS Cohort Study (MACS) participants with incident lymphomas, of which 90 followed another AIDS diagnosis, to HIV-1-seropositive controls matched on duration of lymphoma-free survival post-HIV-1 infection (N = 160) or post-AIDS diagnosis (N = 90). We fit conditional logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Carriage of at least one copy of the T allele for the IL10 rs1800871 (as compared to no copies) was associated with decreased AIDS-NHL risk specific to lymphomas arising from the CNS (CC vs. CT/TT: OR = 0.3; 95% CI 0.1, 0.7) but not systemically (CC vs. CT/TT: OR = 1.0; 95% CI 0.5, 1.9) (Pheterogeneity = 0.03). Carriage of two copies of the 'low IL10' haplotype rs1800896_A/rs1800871_T/rs1800872_A was associated with decreased lymphoma risk that varied by number of copies (Ptrend = 0.02). None of the ORs for the other studied polymorphisms was significantly different from 1.0. Excessive IL10 response to HIV-1 infection may be associated with increased risk of NHL, particularly in the CNS. IL10 dysregulation may be an important causative pathway for EBV-related lymphomagenesis.

Authors’ Response

To the Editor: We thank Ms. Daniels for her comments1 on our analysis of late diagnosis of human immunodeficiency virus (HIV) among young men in North Carolina (NC) published earlier in this journal.2 Although the Centers for Disease Control and Prevention classifies late diagnosis in the manner suggested by Ms. Daniels, which includes a 1-year postdiagnosis window for acquired immunodeficiency syndrome (AIDS) progression,3 there are various categorizations to identify persons testing late. In a recent review of studies of late diagnosis of HIV and late presentation into care in industrialized counties, Girardi et al.4 documented that the definitions of late diagnosis used in the reviewed studies included concurrent diagnosis of HIV and AIDS,5,6 as well as an AIDS diagnosis within a month7 or 6 months8 of HIV diagnosis. Different classifications of late diagnosis answer different research questions and have different biases associated with them. We recognize that our conservative categorization of late diagnosis as persons with an AIDS diagnosis at first HIV test identified those persons most disenfranchised from testing. Although this classification may have missed some persons who progressed to AIDS soon after diagnosis, it also eliminated loss to follow-up and the resulting misclassification bias. For example, some persons relocate to different states after an HIV diagnosis.9,10 For persons who moved from NC after HIV diagnosis, we would not have access to their HIV disease status 1 year later. Consequently, for those who progressed to an AIDS diagnosis within the next year, we would have falsely categorized them as having an early diagnosis. It is possible that persons who had the desire and means to move from NC were different from those who stayed, by demographic characteristics and risk behaviors. If so, this would have biased our results. Additionally, because disease progression after HIV diagnosis is partially dependent on HIV treatment, classifications of late diagnosis that include a follow-up period answer research questions about access to testing and access to care. Using our stringent classification, our research eliminated any heterogeneity in HIV treatment and focused on HIV testing. We echo Ms. Daniels’ call for increasing access to HIV testing for all populations. However, as communities implement the Centers for Disease Control and Prevention’s revised guidelines for HIV testing of adults, adolescents, and pregnant women,11 it will be essential to monitor late diagnosis to ensure that testing opportunities are both reaching and being accepted by all populations. As we noted, targeted testing interventions can reduce specific health inequalities. Universal testing policies will take steps toward reducing the overall prevalence of disease and morbidity of late diagnosis. For those interested in reducing health disparities, identifying and reaching out to disenfranchised populations is imperative.

An Unusual Cause of Central Retinal Artery Occlusion: Acquired Immunodeficiency Syndrome

In patients with acquired immunodeficiency syndrome (AIDS), disturbances in the circulation of retinal vessels are mostly encountered at the microvascular level. Rarely observed large retinal vessel occlusions frequently affect retinal veins. A 32-year-old woman was admitted to the authors' clinic with sudden loss of vision. Her clinical and ophthalmologic examinations and laboratory tests were carried out and the results were evaluated. The patient's history revealed a diagnosis of AIDS established 5 years ago. Her corrected visual acuity was limited to light perception in the right eye and 20/60 in the left eye. There was afferent pupillary defect in the right eye. Posterior segment examination demonstrated central retinal artery occlusion in the right eye and cotton-wool spots in the left eye. The clinical examination and laboratory test results did not reveal any comorbid disease state that can contribute to this presentation. As thrombi may develop in patients with human immunodeficiency virus infection, they should be closely followed up for the development of vasoocclusive disease.

HIV/AIDS Diagnoses Among Blacks—Florida, 1999-2004

In 2004, Florida accounted for 11% of the total number of acquired immunodeficiency syndrome (AIDS) cases in the United States, ranking third behind New York and California. Florida also had the second-highest reported AIDS diagnosis rate (behind New York). During 2004, non-Hispanic blacks accounted for 14% of the Florida population but 52% of the 77,421 persons in Florida living with human immunodeficiency virus (HIV)/AIDS. This report describes trends in diagnoses of HIV/AIDS cases that occurred among blacks during 1999-2004 and were reported to the Florida Department of Health. These data indicate that, during 1999-2004, the annual rate of HIV/AIDS diagnosis among blacks decreased more than the rates among other racial/ethnic groups. To examine possible explanations for this decline, HIV/AIDS diagnosis rate trends were compared with trends in gonorrhea diagnosis and publicly funded HIV testing in Florida. The results indicated that gonorrhea diagnosis rates also decreased among blacks in Florida during 1999-2004, whereas the number of HIV tests increased. These findings suggest that HIV/AIDS diagnoses in blacks might be associated with a reduction in high-risk sexual behavior and that the decline was not the result of less testing.

Non-Hodgkin's Lymphoma among Patients Infected with Human Immunodeficiency Virus: The Experience of a Single Center in Brazil

The relative risk of non-Hodgkin's lymphoma (NHL) among patients infected with human immunodeficiency virus (HIV) is elevated compared with the general population. We describe a retrospective study of 78 HIV-infected patients with NHL treated between 1999 and 2006 at the Infectology Institute, a reference center for HIV treatment in São Paulo, Brazil. All patients were treated with standard CHOP therapy (cyclophosphamide, doxorubicin, vincristine, and prednisone). An evaluation of treatment response was available for 48 (61.5%) of the patients who completed initial treatment. Twenty-three patients (47.9%) achieved a complete response (CR), 3 (6.3%) achieved a partial response, and 22 (45.8%) failed to respond to treatment. Of the 30 patients (38.5%) who were not available for response evaluation, 23 died of sepsis during treatment, 5 abandoned treatment, and 2 are still under treatment. After a median follow-up of 3 years, the overall survival rate for all patients is 20.5%. A univariate analysis showed a significant CR rate in patients with respect to the following factors: no acquired immunodeficiency syndrome (AIDS) diagnosis prior to the lymphoma, disease stage of I to II, and an International Prognostic Index (IPI) of low or low-intermediate risk. A multivariate analysis indicated that only a previous AIDS diagnosis and the IPI were significantly related to the CR rate. A median disease-free survival (DFS) time for the patients who achieved a CR was not reached, with a mean survival time of 73 months and a 3-year DFS rate of 77.5%. Our results provide additional information regarding HIV-related lymphoma in Brazil.

Determinants of Progression to AIDS or Death After HIV Diagnosis, United States, 1996 to 2001

The aim of the study is to determine factors associated with disease progression after human immunodeficiency virus (HIV) infection diagnosis. We applied generalized linear models with Poisson errors to obtain adjusted relative excess risk for death for persons diagnosed with acquired immunodeficiency syndrome (AIDS) or HIV infection (with or without concurrent AIDS) during 1996 to 2001. We examined differences in time between HIV diagnosis and AIDS by using standardized Kaplan-Meier survival methods. Relative excess risk for death within 3 years after AIDS diagnosis was significantly greater for non-Hispanic blacks (1.15; 95% confidence interval [CI], 1.12-1.18), American Indians (1.33; 95% CI, 1.16-1.52), and Hispanics (1.16; 95% CI, 1.13-1.20) compared with whites. Risk for death also was greater among injection drug users (men, 1.50; 95% CI, 1.46-1.54; women, 1.57; 95% CI, 1.51-1.62) compared with men who have sex with men and among those diagnosed at older ages compared with younger persons. Similar disparities between groups in risk for death were observed from HIV diagnosis. Risk for progression from HIV to AIDS was greater for nonwhites, men, and older persons compared with whites, women, and younger persons, respectively. Interventions should target those at excess risk for death or morbidity to ensure access to quality care and adherence to treatment to slow disease progression.

Cryptococcus gattiiInfection: Characteristics and Epidemiology of Cases Identified in a South African Province with High HIV Seroprevalence, 2002–2004

We describe 46 Cryptococcus gattii-infected persons identified by population-based surveillance conducted in South Africa. Most patients with C. gattii infection presented with meningitis. The mortality rate during hospitalization was 36%. We found no significant differences between persons with and persons without C. gattii infection with regard to clinical presentation, acquired immunodeficiency syndrome diagnosis, concomitant conditions, or prior opportunistic infections. C. gattii isolates had low MICs to the tested antifungal drugs.

Audiological and electrophysiological evaluation of children with acquired immunodeficiency syndrome (AIDS)

We examined the peripheral auditory system and the auditory brainstem pathway of children with Acquired Immunodeficiency Syndrome (AIDS). One hundred and one children, 51 with AIDS diagnosis and 50 normal children were evaluated. Audiological assessment included immittance measures, pure tone and speech audiometry and auditory brainstem response (ABR). The children with AIDS more frequently had abnormal results than did their matched controls, presenting either peripheral or auditory brainstem impairment. We suggest that AIDS be considered a risk factor for peripheral and/or auditory brainstem disorders. Further research should be carried out to investigate the auditory effects of HIV infection along the auditory pathway.

The Survival Benefits of AIDS Treatment in the United States

As widespread adoption of potent combination antiretroviral therapy (ART) reaches its tenth year, our objective was to quantify the cumulative survival benefits of acquired immunodeficiency syndrome (AIDS) care in the United States. We defined eras corresponding to advances in standards of human immunodeficiency virus (HIV) disease care, including opportunistic infection prophylaxis, treatment with ART, and the prevention of mother-to-child transmission (pMTCT) of HIV. Per-person survival benefits for each era were determined using a mathematical simulation model. Published estimates provided the number of adult patients with new diagnoses of AIDS who were receiving care in the United States from 1989 to 2003. Compared with survival associated with untreated HIV disease, per-person survival increased 0.26 years with Pneumocystis jiroveci pneumonia prophylaxis alone. Four eras of increasingly effective ART in addition to prophylaxis resulted in per-person survival increases of 7.81, 11.05, 11.57, and 13.33 years, compared with the absence of treatment. Treatment for patients with AIDS in care in the United States since 1989 yielded a total survival benefit of 2.8 million years. pMTCT averted nearly 2900 infant infections, equivalent to 137,000 additional years of survival benefit. At least 3.0 million years of life have been saved in the United States as a direct result of care of patients with AIDS, highlighting the significant advances made in HIV disease treatment.

Clue to fine‐needle aspiration diagnosis of pleural pneumocystoma: Neovascularization and Langhans' giant cell reaction

Pneumocystis pneumonia is a common component of the acquired immunodeficiency syndrome (AIDS) in the United States. Extrapulmonary pneumocystosis, however, is much less common. Rare cases have been reported in lymph nodes, bone marrow, spleen, pleura, gastrointestinal tract, liver, common bile duct, pancreas, skin, thyroid, and eye. A 39-yr-old man with history of chest wall injuries from gunshot and stabbing presented with multiple pleural masses clinically suspicious of metastatic deposits from an unknown primary. Fine-needle aspiration biopsy of the largest pleural mass revealed extrapulmonary pneumocystis, which led to the diagnosis of AIDS. Similar to the previous reports of pneumocystis mass lesions in extrapulmonary sites, the current case is associated with exuberant vascular proliferation and Langhans' giant cell reaction. Neovascularization and histiocytic influx from the newly formed blood vessels and Langhans' giant cell reaction seem to be a common tissue reaction to the massive deposition of pneumocystis organisms in extrapulmonary sites in patients with AIDS.