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

The number of AIDS patients over age 60 has risen steadily in the past decade. The number of transfusion-acquired AIDS cases probably has peaked--or will soon peak. Homosexual (or bisexual) behavior remains the predominant risk factor for AIDS until the seventh decade. Disease progression appears to be more rapid in the elderly, although the observed shorter survival time may result from a delay in diagnosis. Symptoms of HIV infection are often nonspecific, such as fatigue, anorexia, weight loss, and decreased physical and cognitive function. The five most common opportunistic infections in older HIV-infected patients are Pneumocystis carinii pneumonia, tuberculosis, Mycobacterium avium complex, herpes zoster, and cytomegalovirus. A number of features of HIV-related dementia may help to distinguish it from Alzheimer's disease.
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PMID:HIV infection in older patients: when to suspect the unexpected. 850 Jul 75

Cytokines may be involved in weight loss and disturbances of metabolism associated with human immunodeficiency virus (HIV) infection. Dietary n-3 fatty acids reduce the production of interleukin-1 (IL-1) and tumor necrosis factor (TNF) by peripheral blood mononuclear cells (PBMC) in normal humans and prevent IL-1 and TNF anorexia in animals. Accordingly, we studied the nutritional and metabolic effects of a 10-week trial of dietary fish oil (MaxEPA 18 g/day) in men with weight loss due to acquired immune deficiency syndrome (AIDS). Twenty men were enrolled, and 16 completed the 10-week supplementation period. Prior weight loss was 13.7 +/- 1.8 kg(17.4 +/- 1.6% body weight, means +/- SE). Food intake, body composition, blood chemistries, serum cytokine concentrations, in vitro production of IL-1 and TNF by PBMC, and clinical course were followed. A subset of subjects (n=12) underwent stable isotope infusions to measure de novo hepatic lipogenesis (DNL), an in vivo metabolic index that is influenced by cytokine presence and has previously been found to be elevated in AIDS. An unsupplemented group of men with AIDS wasting (10.4 +/- 2.4 kg weight loss, 13.1 +/- 2.2% body weight) was monitored for 10 weeks as controls. Baseline food intake (2,395 +/- 177 kcal/day and 95.1 +/- 7.2 g protein/day), body weight, percent fat, and fat-free mass were unchanged over the 10-week supplementation period. Serum triglycerides were reduced in hypertriglyceridemic subjects, confirming compliance with fish oil supplementation and suggesting that their hypertriglyceridemia was at least in part due to overproduction. Serum TNF and IL-1 were undetectable before or after fish oil supplementation. Serum interferon alpha (IFN) was measurable but did not change. In vitro production of IL-1 and TNF by PBMC was markedly reduced both at baseline and after fish oil supplementation in this population, even in the presence of new AIDS complications, compared with normal controls. The metabolic measurement DNL fell and weight was gained (2.1 +/- 1.3 kg) in subjects who did not develop new AIDS-related complications, but further increases in DNL and further weight loss were observed in subjects who developed a new AIDS complication (p<0.05 for interaction between new complication and change in DNL). No changes in body weight, food intake, serum triglycerides, serum cytokines, or DNL were observed in the unsupplemented group. We conclude that fish oil is a weak anticytokine agent that is unable to overcome the metabolic and nutritional consequences of acute AIDS-related complications but may exert a clinical anticytokine effect in stable AIDS patients. Cytokine production by PBMC is not a useful or reliable marker of in vivo cytokine activity in AIDS patients with weight loss. In contrast, an integrative functional index that is sensitive to cytokine presence in tissues (hepatic DNL) correlated with clinical response. These findings are relevant to the design of future studies of more potent anticytokine agents, such as thalidomide.
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PMID:Effects of dietary n-3 fatty acid supplementation in men with weight loss associated with the acquired immune deficiency syndrome: Relation to indices of cytokine production. 860 62

Patients with advanced cancer or AIDS are frequently bothered by anorexia, decreased food intake, fatigue, weight loss, muscle wasting, and a decline in functional status. Nutritional support may afford these patients a better, although not longer life. Available interventions include nutrition counseling, homemade or commercial food supplements, appetite stimulants, enteral nutrition, and parenteral nutrition. Conservative cost estimates for these interventions range from $52/month for homemade supplements to $8,400/month for home parenteral nutrition. Clinicians need to be familiar with the benefits, risks, and costs of these therapies in order to suggest appropriate options.
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PMID:Costs and benefits of nutrition support in cancer. 860 60

Bacillary angiomatosis is known to be caused by a rickettsial organism; Rochalimaea henselae. This causative agent has been compared with different microorganisms and clinical conditions that appear in similar settings buy have been clearly differentiated from them; e.i. Cat-scratch disease (Afipia felis), Bartonella bacilliformis, other Rochalimaea sp., Kaposi's sarcoma, Lobular capillary hemangioma, Angiosarcoma, and Epithelioid hemangioma. Clinically the bacillary angiomatosis (BA) skin lesions vary from a single lesion to thousands. The cutaneous lesion appears as a bright-red round papule, subcutaneous nodule, or as a cellulitic plaque. When the lesion is biopsied it tends to blanch-out, bleed, and cause pain. The patient might present with signs and symptoms of chills, headaches, fever, malaise, and anorexia with or without weight loss. The extracutaneous lesions found in BA tend to be from multiple organs affecting from the oral lesions to anal mucosal lesions to widespread visceral lesions. The sites of preference for BA lesion manifestation tend to be the liver, spleen, lymph nodes, and bone. To diagnose bacillary angiomatosis the physician should prepare a differential diagnosis based primarily on its histopathological and clinical characteristics. To confirm the results from the stain, electron microscopy can identify the bacillus and pin-point the diagnosis of bacillary angiomatosis. The lesions presented by BA respond well to therapy with erythromycin 500 mg four times daily for a duration of 2 weeks to 2 months. In case of intolerance to erythromycin the second line of drug that successfully treats the BA bacillus is doxycyline. If relapses of the BA lesion recur, then a prolonged antibiotic therapy is necessary and in AIDS patients the duration may be extended as life-long suppressive therapy.
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PMID:Bacillary angiomatosis: microbiology, histopathology, clinical presentation, diagnosis and management. 870 69

Between October 1991 and October 1993, 17 AIDS patients (14 intravenous drug users, 3 sexually acquired) were commenced on percutaneous endoscopic gastrostomy (PEG) feeding in St James's Hospital. Indications were progressive weight loss related to severe anorexia, persistent oesophageal candidiasis (5) and absence of gag reflex (1). Two patients requested PEG tube removal after one week because of crampy abdominal pain without peritonitis. Five patients died from AIDS related infections within 6 weeks of PEG insertion. Ten patients were followed up for > 2 months (mean 5.2 months, range 2.5-15.5 months). In these 10 patients, 1 patient developed a PEG site infection which responded to topical antibiotics. There were no other complications. There was a significant (P < 0.001) increase in energy and protein intake at 2 months. Variant degrees of weight gain occurred in all patients (mean 2.6 kg) (P < 0.01). Small but significant increases in other anthropometric variables occurred. Patients who died within 6 weeks of PEG insertion were older, and had a lower serum albumin than the group who survived > 2 months (P < 0.01). A self-administered questionnaire demonstrated that the majority of patients found PEG feeding acceptable and preferable to nasogastric (NG) feeding.
Int J STD AIDS
PMID:An evaluation of percutaneous endoscopic gastrostomy feeding in AIDS. 873 34

Following exposure of the rectal or vaginal mucosa to cell-free SIVsmmPBj14, four male and two female pig-tailed macaques developed a characteristic acute disease, including mucoid diarrhea, lymphopenia, and anorexia. Two macaques infected by the rectal route died within 14 days, and one female died of an AIDS-like disease at five months after inoculation. The three other animals have survived more than nine months, but all are exhibiting lymphadenopathy, thrombocytopenia, and progressive declines in percentages and numbers of CD4+ lymphocytes.
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PMID:AIDS-like disease following mucosal infection of pig-tailed macaques with SIVsmmPBj14. 875 Oct 48

The objective of this study was to describe the prevalence and course of depressive symptoms before AIDS in HIV-infected homosexual men. A descriptive and comparative analysis of data from HIV-infected and -uninfected homosexual men in the Multicenter AIDS Cohort Study was performed. The Center for Epidemiologic Studies Depression Scale (CES-D) was the primary measure of depressive symptoms. The prevalence of depressive symptoms and CES-D caseness estimates in the AIDS-free HIV-infected homosexual men were stable over time. Small differences between HIV seropositive and seronegative men were detected on the CES-D and on three of its subscales. These were mostly accounted for by less hope, and by more fearfulness, insomnia, and anorexia in the seropositive cohort. We concluded that there does not appear to be an overall increase in depressive symptoms in HIV-infected homosexual men from the time of infection until prior to AIDS. However, this group of men consistently report specific depressive symptoms more often. Implications of these findings for the clinical care of HIV-infected patients is discussed.
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PMID:Depressive symptoms over the course of HIV infection before AIDS. 876 69

Our purpose in conducting this descriptive study was to assess the health-related concerns and experiences of a sample of employed perimenopausal women in Alexandria, Egypt. In addition, we explored their help-seeking behavior and their perception of symptoms. We interviewed two hundred working women ages 40-60 years, 42% of whom were nurses, using a semistructured interview form as well as Koos's list of symptoms. The commonly mentioned concerns, in order of frequency, were chronic headaches, chronic fatigue, transportation and phone communication problems, financial problems, job dissatisfaction, backaches, hypertension, kidney disease and gall bladder disease, gastritis/indigestion, menstrual disturbances, arthritis, AIDS, and hepatitis B. With respect to the problems experienced by the women in the past 6 months, there was a high self-reported prevalence of headaches, fatigue, transportation and communication problems, backaches, job dissatisfaction, dissatisfaction with health insurance, financial problems, menstrual disturbances, gastritis/indigestion, gall bladder disease, anxiety, disturbed sleep, and hypertension. Women attempted to manage their problems mainly by taking over-the-counter drugs and self-prescribing (75.5%), doing nothing or using traditional remedies (56.5%), and going to a doctor or health insurance office (40%). Symptoms perceived by the majority of the women as not needing medical attention included loss of appetite, persistent backache, bleeding gums, chronic fatigue, persistent headaches, and loss of weight. The influence of education and occupation on women's perceptions and practices is discussed.
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PMID:Health-related concerns and experiences of employed perimenopausal women in Alexandria, Egypt. 885 19

Cryptosporidial oocyst infection is a common cause of diarrhea in patients with AIDS. Concomitant symptoms can include crampy abdominal pain, nausea, vomiting, and anorexia. Esophagogastroduodenoscopy is then useful for delineating potentially treatable pathogens. We report a case of cryptosporidial duodenitis with characteristic endoscopic findings, biopsy correlate, and a review of the current literature. The endoscopic appearance illustrated strongly suggests proximal small bowel mucosal involvement with cryptosporidial oocysts.
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PMID:Endoscopic appearance of cryptosporidial duodenitis. 885 57

Failure to downregulate resting energy expenditure (REE) as an adaption to anorexia or malabsorption is often stated as the major cause of weight loss in individuals with AIDS. In a prospective study, REE was compared with weight changes in HIV-infected patients. The impact of altered body composition on REE was reassessed by critical review of the literature. Patients were 65 male HIV-infected patients, 28 with recent weight loss (WL), and 37 who were weight stable (WS); 50/65 patients had AIDS, and 29/65 had acute infections; 29 male healthy persons served as controls. Indirect calorimetry, prospective intake protocol, and bioelectrical impedance analysis were performed. Absolute REE was lower in WL patients than in controls (1459 +/- 309 versus 1711 +/- 151 kcal/d, p < 0.001) and in WS patients (1625 +/- 402 kcal/d, p < 0.05). REE/kg body cell mass (BCM) was higher in WL and WS than in controls (both p < 0.01) due to lower BCM in both patient groups (p < 0.001). REE (%Harris-Benedict) was not different among the three groups. Weight changes around the measurement were not correlated to REE (r2 = 0.0008, p = 0.82). REE was independent of diarrhea, acute infection, fever, or caloric intake. REE had a stronger correlation to body weight and to Harris-Benedict's prediction than to fat-free mass or BCM. REE explains < 1% of weight changes. Many patients can downregulate REE as an adaption to anorexia and/or malabsorption. Higher REE/kg BCM does not signify hypermetabolism at the cellular level but can be explained by the maintenance of energy-consuming visceral tissue within the BCM during BCM loss.
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PMID:Resting energy expenditure, weight loss, and altered body composition in HIV infection. 887 75


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