Human Immunodeficiency Virus Seropositive Patient Research Articles

Successful lung transplantation in an HIV seropositive patient with desquamative interstitial pneumonia: a case report

BackgroundUntil recently, lung transplantation was not considered in patients with human immunodeficiency virus (HIV). HIV seropositive patients with suppressed viral loads can now expect long-term survival with the advent of highly active antiretroviral therapies (HAART); however, HIV remains a relative contraindication to lung transplantation. We describe, to our knowledge, the first HIV seropositive lung transplant recipient in Canada. We also review the literature of previously reported cases of solid-organ transplantation in patients with HIV with a focus on immunosuppression considerations.Case presentationA 48-year old man received a bilateral lung transplant for a diagnosis of desquamative interstitial pneumonia (DIP) attributed to cigarette and cannabis smoking. His control of HIV infection pre-transplant was excellent on HAART, and he had no other contraindications to lung transplantation. The patient underwent bilateral lung transplantation using basiliximab, methylprednisolone, and mycophenolate mofetil (MMF) as induction immunosuppression. He was maintained on MMF, prednisone, and tacrolimus thereafter, and restarted his HAART regimen immediately post-operatively. His post-transplant course was complicated by Grade A1 minimal acute cellular rejection, as well as an enterovirus/rhinovirus graft infection. Despite these complications, his functional status and control of HIV infection remain excellent 24 months post-transplant.ConclusionsOur patient is one of only several HIV seropositive lung transplant recipients reported globally. With growing acceptance of transplantation in this population, there is a need for clarification of prognosis post-transplantation, as well as optimal immunosuppression regimens for these patients. This case report adds to the recent literature that suggests HIV seropositivity should not be considered a contraindication to lung transplantation, and that post-transplant patients with HIV can be managed safely with basiliximab, tacrolimus, MMF and prednisone.

Successful renal retransplantation after graft loss from BK polyomavirus infection in a human immunodeficiency virus‐positive patient

We report the case of a human immunodeficiency virus-seropositive patient whose initial kidney transplant failed because of BK polyomavirus-induced nephropathy, and who underwent a second transplantation 3years later. BK viruria was detected 1day after transplantation. After 1month, BK viremia developed along with a donor-specific antibody. After decreasing tacrolimus and mycophenolic acid and 2 courses of intravenous immunoglobulins, BK viremia and donor-specific antibody permanently disappeared, with stable renal function.

Rhabdomyolysis secondary to diarrhoea induced hypokalemia in a human immunodeficiency virus-seropositive patient

Hypokalemia with rhabdomyolysis caused by diarrhoea is uncommon in human immunodeficiency virus (HIV) infected patients. We report the case of a patient with HIV1 infection who presented with chronic diarrhoea that led to hypokalemia induced rhabdomyolysis and acute kidney injury (AKI). A 32-year-old man, known to be HIV-1 seropositive who was on treatment with tenofovir, lamivudine, lopinavirand ritonavir, presented to the emergency department with 6 months history of diarrhoea and sudden onset of weakness of all 4 limbs of two days duration. On examination limb power was grade 3/5 with hypotonia and diminished reflexes. Laboratory investigations showed severe hypokalemia, low urinary potassium, normal anion-gap metabolic acidosis, markedly increased creatine kinase and mildly increased serum creatinine. He was diagnosed as having diarrhoea induced hypokalemic myopathy leading to rhabdomyolysis and AKI. With potassium supplements, antiprotozoal treatment and adequate hydration he improved significantly and is on regular follow-up. Patients presenting with hypokalemia should be closely monitored for rhabdomyolysis, because outcome is good with early treatment.

Sequential development of psoriasis, alopecia universalis, and vitiligo vulgaris in a human immunodeficiency virus seropositive patient: A unique case report.

Sequential development of psoriasis, alopecia universalis, and vitiligo vulgaris in a human immunodeficiency virus seropositive patient: A unique case report.

Occupational exposure to blood borne viruses among healthcare workers in a tertiary care referral hospital in tehran.

Dear Editor, Occupational exposure to blood-borne viruses (BBVs) is a major concern in the health care setting. The BBVs of primary concern are the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Health care workers (HCWs) can be exposed to these viruses through needle-stick and other injuries through contaminated material with blood and other infectious body fluids. Nurses, health technicians, cleaning personnel and physicians are potentially targets for such accidents. The Center for Disease Control and Prevention (CDC) estimates that hospital-based healthcare personnel sustain an estimated 385,000 percutaneous injuries (needle-sticks and other sharp-devices) (1) annually. In Iran, the annual incidence of occupational exposure to BBVs is unknown due to the limited data in this area. The World Health Organization (WHO) estimates that more than two million injuries causes about 66,000 HBV, 16,000 HCV and about 1,000 HIV infections among 35 million HCWs each year (2). The key in reducing accidental exposure to BBVs is through promoting educational awareness of health care staff on suitability of HBV vaccination, in house training courses concerning preventive measures of such accidents and implementing proper postexposure prophylaxis (PEP) and following-up. Here, we reviewed case notes of 193 HCWs accidently exposed to BBVs over four-years, from January 2009 to January 2013. The data were reviewed in Labbafinejad hospital, which is a specialized 231 bed public tertiary care referral hospital with a total number of 915 HCWs who are potentially at accidental risk of acquiring BBVs. The study was approved by the ethics committee in the hospital. The reviewed HCWs cases (193) were classified into 75 nurses, 39 medical doctors, 35 cleaning personnel, 30 medical technicians (17 surgical operation technicians, 10 lab technicians and 3 radiology technicians), 13 nursing students and 1 medical student. In this study, the nurses were in top list of accidental exposure, which is in line with other studies (3, 4). Injuries were categorized as follows; 150 had needle-stick injuries, 22 cases had sharp cuts like scalpel and broken glasses and 21 cases had blood splashes on their eyes. Among these 193 cases, 132 HCWs were exposed to known serologically tested HIV, HBV and HCV negative patients, 24 had exposure to HBsAg positive patient, 5 had exposure to anti-HCV positive patients and two were exposed to HIV seropositive patient (one was co-infected with HCV infection). A total of 30 HCWs had occupational exposures to unknown sero-status patients. Anti-HBs antibody titer of the 24 HCWs, who had HBV exposure, was higher than 200 mIU/mL. Therefore, no intervention was done for them expect one who, despite being vaccinated had low anti-HBs titer. Thus, he was treated with hepatitis B immunoglobulin (HBIG) with another full course of hepatitis B vaccine, as routine schedule. Six patients were exposed to HCV seropositive patients; they underwent lab investigations, the result of that was normal for everyone. In these patients, follow up 2 weeks RT-PCR was negative. Thereafter, 1, 3, 6 months lab investigations were repeated and results were negative. One HCW was exposed to seropositive HIV patient, as the result of which he received PEP for HIV infection and underwent follow up and the result was negative. Another HCW was exposed to seropositive HIV coinfected with HCV. He also received PEP for HIV and underwent follow up lab investigation for HCV infection and lab results were negative. Hence, no further action was advised. PEP therapy has been shown to reduce the risk of transmission of HIV following accidental exposure by 80% (5). In conclusion, avoiding accidental occupational exposure to BBVs is an important safety issue, which can be achieved to some extent by health awareness of the problem and further by strengthening health control measures and providing a safe hospital work environment.

Prevalence of Hepatitis B Surface Antigen (HBsAg) Among HIV Seropositive Patients

Introduction: Human Immunodeficiency Virus (HIV) and Hepatitis B virus (HBV) share the routes of transmission as a consequences infection with Hepatitis B Virus are expected to occur in HIV infected patients. The co-infection of Hepatitis B Virus (HBV) with the Human Immunodeficiency Virus (HIV) have become a major health care catastrophe as it complicates the clinical course, management and therapy for HIV infection. Hence it is important to identify them as early as possible. Aim: The prevalence of HBV co-infection with HIV varies widely across different studies within India and outsides. This study is planned to evaluate the prevalence of HIV-HBV co-infection by HBsAg screening in HIV seropositive patients in our region. Material and Method: A total of 140 HIV seropositive patients were screened for the presence of Hepatitis B virus on the basis of the presence of HBsAg. Result: In patients infected with HIV the prevalence of HBsAg was 7.1% (10/140) wherease in control group it was 1% (5/500). Discussion: Our study documents fairly high rate of Hepatitis B co-infection among HIV seropositive patients suggesting that it should be mandatory to screen every HIV seropositive patient and their sexual partners for co infection with HBV and vice versa for early detection and a simultaneous treatment of hepatitis B co-infection beside HIV infection management to reduce the morbidity, delay mortality and improve quality of life in HIV-AIDS patients.

An Unusual Case of Osteonecrosis and Spontaneous Tooth Exfoliation Following Trigeminal Herpes Zoster in a HIV Seropositive Patient

Oral lesions associated with human immunodeficiency virus (HIV) are often the first overt clinical features of HIV infection. Reports of HIV-associated herpes zoster infection with alveolar bone necrosis and spontaneous tooth exfoliation are extremely rare, with only four cases reported in the literature. The exact mechanism of osteonecrosis induced by herpes zoster infection remains uncertain. An altered oral environment, decreased host immunity, or immune reconstitution inflammatory syndrome (IRIS) could further compromise the viable periodontal status, leading to alveolar bone necrosis and tooth exfoliation. We report a case of herpes zoster infection involving two divisions of the trigeminal nerve in an HIV-seropositive patient who further manifested with mandibular and maxillary osteonecrosis and spontaneous mandibular and maxillary tooth exfoliation. The occurrence of such infection in immunosuppressed individuals, its etiopathogenesis, and associated clinical features are briefly reviewed and discussed.

Meningitis caused by Rhodotorula mucilaginosa in human immunodeficiency virus seropositive patient

Rhodotorula species may be responsible for systemic infection in immunocompromised patients. Meningitis by Rhodotorula species in human immunodeficiency virus (HIV) infected persons has been reported previously. We report a case of meningitis caused by Rhodotorula mucilaginosa in a 36-year-old HIV seropositive male patient who presented with fever, altered sensorium and features of meningeal irritation i.e. neck rigidity. The Cerebrospinal fluid (CSF) cell counts were high, showing 150 cells/mm3, with 60% lymphocytes and 40% polymorphs, and protein content of 100 mg%; glucose was 60 mg%. The diagnosis was confirmed by culture on Sabouraud's Dextrose agar. The patient was treated successfully with intensive Amphotericin B (1 mg/kg), for two weeks, followed by oral Itraconazole (400 mg daily), for a period of two months. The patient was started on anti retroviral therapy. He did not show any relapse of the symptoms when the last follow up was done six months after the date of discharge.

Dermatomyositis in a human immunodeficiency virus infected person

It is interesting to study an autoimmune condition like dermatomyositis (DM) in the setting of immunosuppression due to human immunodeficiency virus (HIV) infection. An HIV seropositive female aged 30 years, presented with a nonitchy rash over the face, breathlessness, diarrhoea and difficulty in raising her hands above her head. A heliotrope rash around the eyes, Gottron's papules and proximal muscle weakness were found to be present. C reactive protein, erythrocyte sedimentation rate and lactate dehydrogenase levels were raised, but creatinine phosphokinase and anti-nuclear antibody profile were normal. Her HIV serostatus was confirmed by Western blotting, keeping in mind the potential for false positive HIV serology in an autoimmune disorder. Her CD4 count was 379 cells/mm3. An X-ray of the chest showed bilateral pleural effusion with raised pleural fluid adenosine deaminase levels. Clinical findings and laboratory investigations favored the diagnosis of DM and HIV infection with tuberculous effusion in an HIV seropositive patient. She was treated with antibiotics, four-drug anti-tubercular treatment, systemic steroids and later, antiretroviral treatment. Chances of a false positive antibody test for HIV should be considered in a patient having an autoimmune disease such as DM.

Recurrence of cervical dysplasia in the human immunodeficiency virus–seropositive patient

Abstract Objective: To determine the severity of cervical dysplasia in the human immunodeficiency virus (HIV)-seropositive patient, to evaluate standard treatment modalities, and to determine recurrence rates based on immune status by CD4 counts. Methods: Forty-six patients with HIV-positive status and cervical dysplasia were followed from 1995 to 2000. Patients with cervical intraepithelial dysplasia (CIN) I or greater at any time during the study period were included. Patients with less than CIN I were excluded. Forty-six HIV-negative women served as controls. Results: All patients were monitored by colposcopy and appropriate biopsies during the 24-month study period. Of the 46 patients with HIV-positive status, 3 had colposcopy only, 19 were monitored with biopsies, 10 received cervical conization, 5 underwent LEETZ, 5 had a hysterectomy, and 1 had cryotherapy. For patients with further intervention, recurrence rates included 9 of 10 (90%) following cervical conization, 5 of 5 (100%) following LEETZ, 3 of 5 (60%) after hysterectomy (by cuff biopsy), and 1 of 1 (100%) following cryotherapy. Recurrence rates for the patients receiving conization were significantly higher in patients with CD4 counts below 200. Recurrence rates were significantly lower in the control population. Conclusion: Recurrence of dysplasia is common in HIV-positive patients despite multiple treatments. The disease in these patients is clearly different than it is in HIV-negative women. More aggressive treatment and follow-up are indicated.

Treatment modalities for molluscum contagiosum

: Molluscum contagiosum (MC) is caused by a poxvirus which produces cutaneous lesions which appear as small, firm, umbilicated papules. In general, there are three clinical presentations of MC: the childhood variety due to casual contact; the sexually transmitted variety in adults; and the aggressive form seen in patients infected with the human immunodeficiency virus (HIV). Removal of MC lesions is usually straightforward in the first two presentations and can include mechanical removal with a blade or curette, cryosurgery, podophyllin or podophyllotoxin, cantharidin, various acids or retinoids. In the HIV seropositive patient such treatments are usually inadequate due to the very large number of lesions and the rapid recurrence after mechanical removal. Combination therapy has been more successful in such cases especially if treatment includes such experimental antiviral/immunomodulatory agents as imiquimod or cidofovir.

The family physician and the human immunodeficiency virus seropositive patient

To characterize a subject who is HIV positive and closely observed in the consultation of clinical immunology (Santo António General Hospital), from a demographic and socio-economic point of view; to determine the percentage of these subjects who have a family doctor; how often they go to a family doctor; the reasons for a more frequent visit to the doctor; if there has been any alteration in the reasons for consulting the family doctor after establishing the diagnosis of HIV infection; who made the diagnosis of HIV infection; to evaluate, from these patient's point of view, if there has been any alteration in the family doctor's attitude or vice versa after the diagnosis. CHARACTERISATION OF THE STUDY: A descriptive, transversal study was carried out from 30/01/97 to 13/03/1997. A questionnaire with twenty-two questions was used in a personal interview of a random sample of 100 patients observed in the Consultation of Clinical Immunology at Santo António General Hospital and represented 40% of the population studied. One hundred patients answered the questionnaire, 73 were male and 27 female, with an mean age of 34.73 years. The majority were single, representing 44% of the random sample, 33% had completed primary education (or equivalent), and 28% had attended secondary school (complete or incomplete), 35% of the subjects were employed and 34% unemployed. In what concerns area of residence, the majority live in the metropolitan area of Oporto. The majority of the patients (85%) had a family doctor. Nevertheless, 1/3 had never paid a visit to their doctor and, as for the others, the majority rarely did. After the diagnosis of HIV infection, the reasons that led patients to see their doctors were merely administrative (prescriptions--24.56%, sick leave--21.05%). On the other hand, before the diagnosis, health problems were their major concern and priority (27.54%). The diagnosis was made in equal proportion (28%) by the hospital services and by institutions providing health care for drug addicts. In most cases, from the patient's point of view, there had not been any change in the family doctor's attitude after the diagnosis of HIV infection and vice versa. Although the majority of the subjects have a family doctor, their demand is very low, therefore, there is a waste of opportunities in terms of primary, secondary and tertiary medical care.

Platelet-derived growth factor expression in primary pulmonary hypertension: comparison of HIV seropositive and HIV seronegative patients

Primary pulmonary hypertension (PPH) is characterized by intimal fibrosis and cell proliferation (including fibroblasts, smooth muscle and endothelial cells) in the distal pulmonary arterial tree. Considerable interest has been generated by recent reports of PPH in human immunodeficiency virus (HIV)-1-infected individuals. Although the lack of evidence for a pulmonary artery infection has suggested that in such cases HIV may act through mediator release rather than by direct endothelial infection, the mechanisms underlying HIV-associated PPH remain poorly defined. Platelet-derived growth factor (PDGF) has the ability to induce smooth muscle cell and fibroblast proliferation and migration. Given these considerations, we have attempted to document a possible role for PDGF in PPH occurring in HIV seropositive and seronegative patients. Using semiquantitative polymerase chain reaction (PCR), PDGF A-chain messenger ribonucleic acid (mRNA) expression was analysed in surgical lung biopsies from 13 HIV seronegative patients and one HIV seropositive patient, all displaying severe PPH. In parallel, lung samples from two patients with HIV-1-associated PPH were studied by immunohistochemistry and in situ hybridization. Results were compared to those obtained in three HIV-1-infected individuals with no pulmonary complication (as demonstrated by clinical, radiological, bacteriological, and necropsy findings) and five control lung biopsies. As compared to controls, PDGF A-chain mRNA expression is elevated in lung biopsies from patients displaying PPH (p=0.029). In HIV-1-associated PPH, interstitial perivascular cells expressing PDGF A-chain mRNA and protein could be detected by in situ hybridization and immunohistochemistry, respectively. Platelet-derived growth factor expression is elevated in lung biopsies of patients displaying primary pulmonary hypertension. Growth factors such as platelet-derived growth factor may play a part in the initiation and/or progression of primary pulmonary hypertension.

Depression and Reversible Dementia in an HIV-1 Seropositive Individual: Implications for the Dementia Syndrome of Depression

Abstract Neuropsychological test results for an human immunodeficiency virus (HIV-1) seropositive patient who experienced two episodes of depression with associated compromise of Cognitive function during each of the two periods of depression and following treatment for the depression are presented. The patient recovered between episodes and was tested after recovery from each episode. Results demonstrate that executive functions were disproportionately affected during depressive episodes.

Depression and reversible dementia in an HIV-1 seropositive individual: Implications for the dementia syndrome of depression

Abstract Neuropsychological test results for an human immunodeficiency virus (HIV-1) seropositive patient who experienced two episodes of depression with associated compromise of Cognitive function during each of the two periods of depression and following treatment for the depression are presented. The patient recovered between episodes and was tested after recovery from each episode. Results demonstrate that executive functions were disproportionately affected during depressive episodes.

Minimizing risk of infection using a carbon dioxide laser

The carbon dioxide laser is a surgical device increasingly important to dentistry. The advantages of laser use in the treatment of oral disease have been well documented. Such benefits include bloodless incisions, accurate tissue destruction, reduced pain, minimal swelling, excellent hemostasis, and limited postoperative tissue morbidity. Little information exists currently regarding laser use in the management of medically complex patients, most notably patients with infectious diseases. This article reports the use of the carbon dioxide laser for reducing the risks of disease transmission in the surgical management of an human immunodeficiency virus (HIV) seropositive patient.

Intracerebral hodgkin's disease in a human immunodeficiency virus-seropositive patient

Intracerebral involvement of Hodgkin's disease (HD) is rarely described, with only 42 cases in the literature. Since the outbreak of the acquired immune deficiency syndrome (AIDS) epidemic, there has been an increasing number of human immunodeficiency virus (HIV)-infected (HIV+) persons who have diffuse non-Hodgkin's lymphoma and, more recently, atypical aggressive HD. The authors report the case of a patient with a history of intravenous drug abuse (IVDA) and Stage IVB HD who, after a drug-induced clinical remission, had intracerebral mixed-cellularity HD. This appears to be the first report of intracerebral HD in a person who is HIV+.

Zidovudine removal during plasma exchange

Pharmacokinetics of zidovudine (azidothymidine, AZT) were investigated after oral administration (300 mg every 8 hours) in a human immunodeficiency virus seropositive patient who was also treated with plasma exchange (60 ml/kg). Plasma AZT concentrations were measured using high performance liquid chromatography assay. Plasma exchange clearances reached 1-3.8% of the total clearance. The fraction of AZT removed from separated plasma accounted for only 1% of the administered dose. The contribution of plasma exchange to the elimination of AZT appears to be negligible. Solely on the basis of AZT pharmacokinetic data, no particular dose adjustment appears to be necessary in patients treated with multiple plasma exchanges.