Disease In HIV-positive Patients Research Articles

AIDS-related airway disease.

To our knowledge, the importance of airway disease in HIV-positive patients has been infrequently noted. This deficit likely reflects a combination of factors including lack of familiarity with recent changes in clinical and epidemiologic patterns of pulmonary manifestations of HIV infection and documented limitations of chest radiography for identifying and differentiating airway disease from other causes of pulmonary disease in HIV-positive patients. Familiarity with the imaging findings for these various entities should facilitate prompt diagnosis and treatment. The accuracy of CT in detecting airway disease [55-59] is well established and should be of value in excluding more common diseases that may be initially confused with airway abnormalities [60, 61]. Small airways disease, in particular, which may be occult or mimic an interstitial infiltrate on chest radiography, can be recognized with CT as likely representing infectious bronchitis or bronchiolitis. Patients with findings suggesting bacterial infections may benefit from empiric antibiotic therapy. CT also may be valuable for differentiating between various noninfectious pulmonary diseases, allowing a presumptive diagnosis of parenchymal Kaposi's sarcoma in the appropriate clinical context. In distinction, by detecting localized endobronchial or parenchymal abnormalities in patients with mycobacterial or fungal infections or lymphoma, CT may be valuable for deciding between various invasive methods of obtaining either histologic or bacteriologic diagnoses.

Is death inevitable with multiresistant TB plus HIV infection?

Tuberculosis (TB) remains the commonest infectious disease with almost 8 million new cases and 3 million deaths annually. 1 Drobniewski FA Pozniak AL Uttley AHC Tuberculosis and AIDS. J Med Microbiol. 1995; 43: 85-91 Crossref PubMed Scopus (26) Google Scholar Multidrug-resistant Mycobacterium tuberculosis disease (MDRTB)—ie, resistance to at least isoniazid and rifampicin–is increasing mainly because of patient non-compliance and poorly supervised treatment programmes. Outbreaks of MDRTB among patients co-infected with HIV in hospitals and other institutions 2 AnonNosocomial transmission of multidrug-resistant TB among HIV infected persons–Florida and New York, 1988–91. MMWR. 1991; 40: 585-591 PubMed Google Scholar , 3 Small PM Shafer RW Hopewall PC et al. Exogenous reinfection with multi-drug resistant Mycobacterium tuberculosis in patients with advanced HIV infection. N Engl J Med. 1993; 328: 1137-1144 Crossref PubMed Scopus (478) Google Scholar reawakened international concern over the public health threat posed by such organisms. Miller's 1996 Lancet review of respiratory diseases in HIV-positive patients 4 Miller R HIV-associated respiratory disease. Lancet. 1996; 348: 307-312 Summary Full Text Full Text PDF PubMed Scopus (69) Google Scholar emphasised the poor prognosis of MDRTB in such patients, citing the work of Small et al, who demonstrated a median survival of only 2 months. 3 Small PM Shafer RW Hopewall PC et al. Exogenous reinfection with multi-drug resistant Mycobacterium tuberculosis in patients with advanced HIV infection. N Engl J Med. 1993; 328: 1137-1144 Crossref PubMed Scopus (478) Google Scholar

Skin lesions in HIV-positive and HIV-negative patients in south India.

Various dermatologic conditions have been reported to occur with increased frequency in human immunodeficiency virus (HIV)-positive individuals, but there are only a few studies comparing the prevalences of skin diseases in HIV-positive patients with those in matched HIV-negative controls. Skin lesions in 129 HIV-positive patients and 258 HIV-negative controls were studied prospectively over an 18-month period from October 1991 to March 1993. Oral candida, tinea cruris, and ichthyosis were significantly more common in HIV-positive patients compared to controls. Several other dermatologic conditions were found only in the HIV-positive group. The pattern of skin lesions in Indian patients with HIV infection may be different from that in the West.

Diagnosing sexually transmitted diseases in HIV-positive patients.

Diagnosing sexually transmitted diseases in HIV-positive patients.

Carcinoma of the lung in HIV-positive patients: findings on chest radiographs and CT scans.

Several recent clinical studies have described an association between HIV seropositivity and lung cancer. The purpose of this study was to describe the spectrum of imaging findings in HIV-positive patients who had proved carcinoma of the lung. In particular, we attempted to define the role of CT in diagnosing HIV-associated lung cancer. The study population consisted of 23 HIV-positive patients from two institutions who had lung cancer diagnosed between 1989 and 1993. All patients had both chest radiographs and CT scans. The group included 19 men and four women with a mean age of 42 years. The diagnosis of lung cancer was confirmed by bronchoscopy in eight patients, by pleural fluid aspiration or pleural biopsy in seven, by percutaneous needle biopsy of a lung lesion in three, by biopsy of an extrathoracic site in four, and by thoracotomy in one. Two thoracic radiologists retrospectively evaluated the chest radiographs and CT scans to identify parenchymal masses, lymphadenopathy, pleural disease, chest wall or mediastinal invasion, and metastatic lesions. Fifteen (65%) of the 23 patients had a central or peripheral mass or nodule. Eight (35%) had extensive pleural disease, either as an isolated finding or in combination with other abnormalities. CT scans showed the malignant lesion underlying the extensive pleural disease in all but one case. All patients with extensive pleural disease had adenocarcinoma. No patient in the study was considered a candidate for resection on the basis of clinical and radiologic evaluation. Lung cancer in HIV-positive patients manifested most often on chest radiographs as a central or peripheral mass or nodule. Extensive pleural disease in the absence of an apparent primary lesion was the second most common major manifestation. Lung cancer therefore merits serious consideration in the differential diagnosis of extensive pleural disease in HIV-positive patients. CT was most useful in evaluating malignant lesions associated with extensive pleural disease.

Radiographic Findings in HIV-Positive Patients With Sensitive and Resistant Tuberculosis

To facilitate early recognition of multi-drug resistant (MDR) Mycobacterium tuberculosis (MTB) disease in HIV-positive patients we evaluated the chest x-ray films of 72 patients in a tertiary care center in New York City. Thirty-three patients had sensitive MTB, 3 had single-drug resistant (SDR) MTB, and 36 patients had multi-drug resistant (MDR) MTB. All chest x-ray films were reviewed and correlated with drug sensitivities, additional diagnostic results, and clinical courses. There were no significant radiographic differences among the 3 groups on initial presentation (p > 0.05). Cavities were found in 12 patients, upper lobe disease in 23, lower lobe disease in 15, possible intrathoracic lymphadenopathy in 30, diffuse infiltrates in 12, pleural effusion in 13, and a miliary pattern in 3 patients. Normal chest x-ray films were found in ten patients. After 2 weeks of therapy, 20 out of 35 MDR-MTB patients developed new effusions, possible intrathoracic lymphadenopathy, or worsening infiltrates. With deterioration, the probability of MDR MTB was 95 percent in our case control study. Thus, it would be reasonable to adjust antituberculosis therapy in HIV-positive patients with deteriorating conditions shown on chest x-ray films after 2 weeks of therapy.

Otologic Neurotologic Manifestations of HIV‐Related Disease

Human immunodeficiency virus (HIV), the causative agent of acquired immunodeficiency syndrome (AIDS), has reached worldwide epidemic proportions and is increasing. Otologists, neurotologists, and audiologists practicing in metropolitan centers in North America can expect to encounter patients with HIV-related illnesses, including patients with AIDS-related complex (ARC) and AIDS. Five representative cases are presented: chronic otitis media, facial palsy, Gradenigo's syndrome with facial paralysis, otosyphilis, and Kaposi sarcoma of the mastoid. The common link in all cases was HIV infection. This presentation discusses the management of several HIV-infected patients with otologic and neurotologic findings. HIV infection has extended to all parts of North America. The worldwide incidence is increasing. As the epidemic continues to unfold, new challenges to both the diagnosis and treatment of otologic and neurotologic disease in HIV-positive patients will confront the audiologist and otolaryngologist. Recommendations for the safety of the examining audiologist and treating physician are given.

Frequent expression of Epstein-Barr virus latent membrane protein-1 in tumour cells of Hodgkin's disease in HIV-positive patients.

Epstein-Barr virus (EBV) is believed to be implicated in the aetiology of non-Hodgkin's lymphomas developing in immunodeficient individuals including AIDS patients. EBV has also been associated with Hodgkin's disease (HD), where the genomes have been demonstrated in the Hodgkin and Reed-Sternberg cells in some of the cases. Recent evidence has shown that EBV genomes are transcribed in these cells, because the EBV-encoded latent membrane protein-1 (LMP-1) can be demonstrated in the tumour cells in about half of the HD cases in HIV-negative patients using immunohistochemistry. LMP-1 is of special interest as a possible oncogenic agent because of its strong transforming capacity in vitro. In this study we have examined the expression of LMP-1 in HD of HIV-positive patients compared with HD in HIV-negative patients. We investigated 18 lymph nodes from 16 HIV-positive patients with HD (eight mixed cellularity, nine nodular sclerosis, one unclassified) using the CS.1-4 anti-LMP-1 monoclonal antibodies, which can usually be applied successfully to archival biopsy material. In each case, 50-90 per cent of the tumour cells were labelled. Staining was excellent for both fixatives used (4 per cent buffered formalin, Bouin's fluid). It is concluded that EBV-encoded LMP-1 is firmly associated with HD of HIV-positive patients. This is most conspicuous in the nodular sclerosing subtype HD in HIV-positive patients, in which 100 per cent were LMP-1 positive as compared with 32 per cent of nodular sclerosis HD in HIV-negative cases in a previously published series. This difference is statistically significant (P < 0.001). The possible biological and clinical significance of this difference should therefore be studied in larger series.

Sputum induction for the diagnosis of pulmonary disease in hiv positive patients

We prospectively compared sputum induction with bronchoalveolar lavage (BAL) in HIV positive patients presenting with acute respiratory episodes and also assessed the effects of using an experienced respiratory physiotherapist on the diagnostic yield from induced sputum. One hundred and fifty-one consecutive patients underwent sputum induction, in 96 the procedure was supervised by nursing and medical staff with no specific expertise (group I); in 55 patients a physiotherapist supervised sputum induction (group 2). Nine patients refused BAL having undergone sputum induction. Of the remaining 142 patients sputum induction failed (no sample expectorated) in 28 patients (25 from group 1 and three from group 2), the sample was inadequate (the material expectorated was not from the lower respiratory tract) in 29, and was adequate in 85 patients. Pneumocystis carinii was diagnosed in 82 patients (51 from group 1 and 31 from group 2). The sensitivity of induced sputum for the diagnosis of P. carinii was 13% and of BAL was 77%. In the subgroup of patients with an adequate induced sputum sample, the sensitivity of induced sputum was 28% and of BAL was 73%. Of the remaining 60 patients, 27 had other diagnoses made by induced sputum and BAL (eight patients), BAL only (15 patients) and induced sputum only (four patients). Eleven patients had bronchitis and responded to oral antibiotics. In 22 patients induced sputum and BAL were negative; alternative diagnoses were established by lung biopsy or by culture of blood, urine or CSF. During sputum induction, 15 patients had nausea and vomiting, eight became dyspnoeic, three had intractable cough and one developed acute bronchoconstriction; 17 patients found the procedure unpleasant. Compared with BAL, induced sputum has a lower diagnostic yield for P. carinii and other pathogens. Use of experienced, dedicated personnel increases the number of successful attempts at sputum induction but does not increase the diagnostic yield. Fibreoptic bronchoscopy and bronchoalveolar lavage remain necessary for patients with negative results from induced sputum and those whose disease course is at variance with the diagnosis made by sputum induction.

Prevalence of serum antibody to the type-specific glycopeptidolipid antigens of Mycobacterium avium in human immunodeficiency virus-positive and -negative individuals

An enzyme-linked immunosorbent assay was constructed by using as antigens the type-specific immunodominant glycopeptidolipids of selected serotypes of Mycobacterium avium. This assay system was used to determine the prevalence of raised antibody levels to these antigens in groups of controls, human immunodeficiency (HIV)-negative and -positive homosexual men, and HIV-negative patients with active M. avium infections as a possible indicator of potential exposure and/or colonization by M. avium in these individuals. The results indicate that while antibody levels were raised in only 2.4% of control individuals, 33% of HIV-negative homosexual men and 44% of HIV-positive patients exhibited raised levels. Moreover, further examination of the HIV-positive group revealed no correlation between antiglycopeptidolipid antibody activity and helper T cell numbers. These data indicate that exposure to M. avium is prevalent among the homosexual male population, regardless of their HIV status. Moreover, the data are suggestive that the emergence of disseminated M. avium disease in HIV-positive patients may sometimes arise from earlier colonization, rather than as a newly acquired infection during terminal immunodeficiency.

The management of anorectal disease in HIV-positive patients

Moderator: Mr. Allen-Mersh: Anorectal disease is the most frequent reason for surgical referral of HIV-positive patients in our hospital [1]. In the UK the incidence of anorectal disease is about 14-fold more common in HIV-positive male homosexuals than in the age and sex-matched general population. This is due to the combination of immune deficiency with the sexually transmitted diseases associated with anoreceptive intercourse. Surgeons within inner city hospitals have gradually learned how to manage these conditions from experience over the past decade of the HIV epidemic. This symposium brings together surgeons from hospitals with large HIV-positive populations to discuss some of the more frequent problems which arise in management of anorectal disease in HIV-positive patients. We start by discussing staff safety when treating HIV-positive patients, and go on to consider management of the more common anorectal conditions associated with these patients.

Color Atlas of AIDS and HIV Disease

Part 1 The AIDS epidemic: epidemiology immunology virology the definition of AIDS the antibody response to HIV the HIV antibody test the origin of HIV the clinical spectrum and classification of HIV disease. Part 2 Clinical manifestation of HIV disease: HIV seroconversion illness, or acute HIV lymphadenopathy weight loss oral cavity disease skin disease ENT problems Kaposi's sarcoma pulmonary disease diseases of the nervous system gastrointestinal disease lymphoma paediatric HIV disease. Part 3: Other sexually transmitted diseases in HIV positive patients. Part 4: Counselling of patients with HIV disease. Part 5: Tranmsmission and prevention of HIV disease. Appendices: 1 - the full definition of AIDS 2 - AIDS in Africa, M.Rolfe.

Prevalence and Clinical Spectrum of Skin Disease in Patients Infected With Human Immunodeficiency Virus

We examined 100 serial patients who were receiving care in a county outpatient immunodeficiency clinic and whose serum was positive by Western blot test for the human immunodeficiency virus (HIV). Skin disorders were found in 92% of these HIV-infected patients, with little difference in prevalence or severity in three clinical categories: patients with the acquired immunodeficiency syndrome, patients with acquired immunodeficiency syndrome-related complex, and those who were asymptomatic. Patients positive for HIV antibodies had significantly more skin disease, with the exception of dermatophytosis, than did a historical control population. A strong association was observed between the use of zidovudine and the absence of infection with Candida albicans. We conclude that there is a high prevalence of skin disease in HIV-positive patients who seek medical care, and that specialists in skin disease should be included in these patients' initial evaluation and continuing care.