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Query: UMLS:C0001175 (AIDS)
 120,706 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An AIDS patient with multiple opportunistic infections (Candida, Pneumocystis carinii and Isospora belli) was identified at the University Hospital, Kuala Lumpur. The patient presented with profuse diarrhoea associated with lethargy, anorexia and weight loss. Routine stool examination showed Isospora belli oocysts. The infection responded to treatment with trimethroprim-sulfamethoxazole but relapse occurred 8 weeks later. This represents the first documented case of isosporiasis to occur in an AIDS patient in Malaysia.
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PMID:Human isosporiasis in an AIDS patient--report of first case in Malaysia. 818 53

A 33-year-old, HIV-1 positive, white, homosexual man was hospitalized in May, 1991, because of fever, cough, skin eruptions, anorexia, and weight loss during the previous 2 months. In October, 1990, he had traveled in Sumatra. On examination he was ill, tachypneic, normotensive with a temperature of 39.1 degrees Celsius. The spleen was substantially enlarged. Laboratory investigations showed: ALAT 72 U/I (normal 23 U/1), LDH 508 U/1 (normal 275 U/1). A bronchoscopy with bronchoalveolar lavage revealed yeast cells. Gastroscopy showed an ulcer in the hypopharynx and an erosion in the stomach. Biopsies of this ulcer demonstrated the presence of Penicillium marneffei. Biopsies of the liver showed the same organism. The patient was treated with amphotericin B induction therapy (1 dd 0.5 mg/kg for 21 days, total dose of 730 mg) in combination with flucytosine (3 dd 2500 mg, total dose 142 g in 19 days). In the following 2 weeks the temperature became normal, and the dyspnea and the skin eruptions disappeared, except for the mollusca contagiosa. The spleen diminished by 50%. LDH and ALAT became normal. Oral maintenance therapy followed with fluconazole (the first 3 months 400 mg daily, followed by 200 mg a day). 24 months later, no recurrence had been observed. Case 2 was a 28-year-old, HIV-infected, homosexual man, born in Suriname, who was hospitalized in October, 1991, with prolonged fever, dyspnea, and a painful throat. In March, 1991, he had traveled in rural Thailand. AIDS was diagnosed on the basis of cerebral toxoplasmosis in August, 1991. A biopsy of the ulcer in the oropharynx showed an active aspecific inflammation and also P. marneffei. Treatment with amphotericin B intravenously (0.5 mg/kg, total dose 1052 mg in 32 days) was commenced. The lesions in the oral cavity and throat, the lymph nodes, and the shortness of breath disappeared within a few days. Ten months later he died from emaciation caused by cryptosporidiosis.
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PMID:Disseminated Penicillium marneffei infection as an imported disease in HIV-1 infected patients. Description of two cases and a review of the literature. 820 1

This study was designed to examine the effects of a pre-existing, clinically asymptomatic feline immunodeficiency virus (FIV) infection on a primary challenge with Toxoplasma gondii. Parenteral challenge of FIV-infected cats with tachyzoites of the ME49 strain of T. gondii caused a precipitous drop in all lymphocytes (CD4+, CD8+, and B cells) and generalized severe toxoplasmosis. The predominant postmortem lesions included acute and often fatal interstitial pneumonia, dominated histologically by macrophages, and multifocal to coalescing hepatic necrosis. Immunohistochemistry revealed numerous T. gondii antigen and tachyzoites in macrophages and other cell types in the lung lesions. The proliferative response of peripheral blood mononuclear cells to specific (T. gondii antigen) and nonspecific (Concanavalin A) mitogens was defective in the dually infected cats, suggesting marked immunosuppression. In contrast to the dually infected cats, cats infected only with T. gondii developed a transient, mild clinical disease characterized by anorexia, lethargy, and multifocal chorioretinitis. Lymphocyte changes in T. gondii-infected cats included an early pan-lymphopenia followed by reestablishment of all lymphocyte subset profiles. These cats also showed a reduced proliferative response to Concanavalin A at 1 week after challenge, but a measurable in vivo response to T. gondii antigens, as evidenced by in vitro lymphocyte proliferation in the absence of a mitogenic stimulus. These results show that infection of cats with FIV-NCSU, markedly enhances their susceptibility to a primary T. gondii infection and provides a model to study the mechanisms of the underlying immunological defect(s) occurring early after HIV infection that may predispose individuals to development of acquired immunodeficiency syndrome and associated diseases.
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PMID:Feline immunodeficiency virus predisposes cats to acute generalized toxoplasmosis. 823 62

Human immunodeficiency virus (HIV), is able to replicate in many human cells such as helper lymphocytes, monocytes/macrophages and glial cells. Monocytes/macrophages must be considered an important reservoir of HIV in vivo and a producer of cytokines such as Interleukin-1 (IL1) and tumor necrosis factor (TNF). These substances lead to an autocrine feedback loop that produces an increased virus replication and a secondary induction of other cytokines such as Interleukin 6 (IL6) and granulocyte-macrophage colony stimulating factor (GM-CSF). These cytokines all together may be responsible for many clinical aspects of the disease such as headache, fever, anorexia, subtle cognitive changes, motor disfunctions and cachexia. The future strategies in the treatment of AIDS must be a combination of drugs acting on different points of viral replication and with synergistic potential. Omega 3 polyunsaturated fatty acids (omega-3) can be considered a candidate for their pleiotropic effects on immunological and metabolic systems. In particular, their use is considered for their ability to decrease IL1 and TNF production by monocytes/macrophages, as demonstrated by many authors. The decreased induction of these cytokines and consequently of IL6 and acute phase proteins may have beneficial effects on many clinical manifestations of AIDS such as cachexia.
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PMID:Omega-3 fatty acids as coadjuvant treatment in AIDS. 828 91

Anorexia and involuntary weight loss are prevalent problems in oncology and AIDS patients. Cytokines are suspected but not proven causes of cachexia. Megestrol acetate has been found to increase appetite, food intake, and weight in randomized, placebo-controlled trials in patients with advanced malignancies and in patients with AIDS. This hormone derivative probably has both central nervous system and peripheral metabolic effects. No significant effect on survival has been demonstrated in these trials. The optimal dose for appetite enhancement is unknown; we have chosen 320 mg/d as our initial dose. Megestrol acetate is usually well tolerated, and it may be helpful in the symptomatic and palliative therapy of patients with anorexia and weight loss.
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PMID:Treatment of anorexia with megestrol acetate. 803 64

Anorexia and weight loss are frequent complications of cancer and AIDS. Assessment of dietary records and nutritional requirements in patients with decreased food intake and weight loss will assist the dietitian, nurse, or physician in initially addressing the problem. Patients may respond well to nutritional counseling and food supplements, but persistent severe anorexia is common. Various pharmacologic strategies to reverse anorexia and weight loss have been tested, including corticosteroids, anabolic steroids, cyproheptadine, hydrazine sulfate, dronabinol, and megestrol acetate. Dronabinol was recently found to improve appetite in AIDS patients. Megestrol acetate is so far the only agent associated with improvements in appetite and weight in patients with cancer and AIDS. Enteral and parenteral nutrition may be helpful in selected patients with gastrointestinal obstruction or dysfunction, but it is not generally indicated in patients with end-stage disease.
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PMID:Clinical approaches to nutritional support in cancer. 836 79

The medical records of all 420 patients attending an outpatient clinic between June 1990 and June 1991 were retrospectively reviewed for causes of weight loss. Of the 121 (29%) patients who had lost weight, the majority had a clear contributing cause; opportunistic infections (n = 57), psychosocial factors (n = 20), drug related problems (n = 9). Unexplained weight loss (n = 35) was more likely to have occurred in those patients with a better preserved immune system and most of these had symptoms suggestive of an unconfirmed infection or had local oral lesions associated with a loss of appetite. Unexplained weight loss associated with HIV infection is uncommon.
Int J STD AIDS
PMID:Causes of weight loss in human immunodeficiency virus infection. 839 6

Abnormalities of thyroid hormone levels have been reported in the acquired immunodeficiency syndrome (AIDS), but there has been debate as to whether they are appropriate for the clinical status of the patients. Inappropriate maintenance of circulating 3,3',5-triiodothyronine (T3) levels could contribute to weight loss. Although many patients with AIDS have a history of wasting, recent data indicate that prolonged periods of stable weight occur in AIDS and that short-term weight loss is present in a subset of patients with anorexia, many of whom have active secondary infection (AIDS-SI). Therefore we analyzed thyroid hormone levels in a cohort of subjects that have been characterized in terms of recent weight loss and caloric intake. Asymptomatic patients with human immunodeficiency virus infection (HIV+) had short-term stable weights, normal caloric intake, and normal serum T3 levels. In AIDS, average short-term weight was stable, caloric intake was normal, and T3 levels were decreased by 19%. In AIDS-SI, both short-term weight loss and anorexia were significant, and this group showed a 45% decrease in T3 levels. The free T3 (FT3) index was decreased by 30% in AIDS and by 50% in AIDS-SI. Free thyroxine (FT4) levels were decreased while thyroxine-binding globulin (TBG) capacity was increased in HIV+ and AIDS; TBG sialylation was unchanged. Thyrotropin (TSH) levels were slightly increased in AIDS, although levels remained within the normal range. 3,3',5'-triiodothyronine (rT3) levels were decreased in HIV+, AIDS, and AIDS-SI. Thus asymptomatic patients with HIV infection whose weight is stable maintain normal T3 levels.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Indices of thyroid function and weight loss in human immunodeficiency virus infection and the acquired immunodeficiency syndrome. 841 39

One hundred and eighteen consecutively identified AIDS patients, 88 of whom received zidovudine (1000-1200 mg/day), were followed for 1 year to investigate prospectively the relationship between zidovudine and myopathy. Clinical and biochemical evidence of proximal myopathy was seen in 7 of 41 patients (17%) who had been receiving zidovudine for more than 270 days, but in none of those on short-term therapy and in none of the controls. Serum creatine kinase levels rose a mean of 76 days (range 34-187) before the onset of clinical signs. Creatine kinase returned to normal within 4 weeks of cessation of zidovudine and strength returned within 8 weeks, though loss of muscle bulk persisted. Chronic malaise, anorexia and nausea accompanied the myopathy and remitted within 8 weeks of stopping zidovudine. Muscle histology in four patients with myopathy showed fibre size variation with atrophic, necrotic and degenerating fibres and an absence of inflammation. Ultrastructural studies showed glycogen-packed sarcoplasm, lipid droplets and grossly giant mitochondria. These abnormalities improved substantially after stopping zidovudine. Similar but less marked changes were seen in a zidovudine treated patient without myopathy, but were absent in one AIDS patient not taking the drug. Long-term zidovudine therapy is associated with a mitochondrial myopathy and the constitutional features suggest that it is part of a wider disorder affecting cellular function in other tissues.
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PMID:Mitochondrial myopathy associated with chronic zidovudine therapy in AIDS. 843 50

Patients with HIV-infection often exhibit progressive loss of weight and poor nutritional status. The problems, which may appear during all stages of the HIV-infection, may be explained by low intake of food or selected nutrients as a result of anorexia and eating problems, and by impaired gastro-intestinal function and increased metabolic rate following secondary to opportunistic infections or the HIV-infection itself. The extent of weight loss and depletion of body cell mass is discussed in relation to the possible effect on development of the disease and time of death in AIDS-patients. Compromising on nutritional status may have a negative effect on the outcome of treatment, and may lead to malnutrition-related immune depression and rates of infection. Nutrition issues are of vital importance to HIV-infected persons. Although nutrition does not promise of a "magic bullet", dietary counselling and nutritional intervention may prevent cachexia and alleviate some symptoms of the disease.
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PMID:[Nutritional counseling to patients with HIV infection. Can nutritional intervention prevent, expose or relieve symptoms in HIV-positive persons?]. 844 78


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