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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper examines patterns of psychological adjustment in a small sample of asymptomatic HIV antibody positive men. Comparison is made with data available on male cancer patients. HIV positive men reported greater degrees of anxious preoccupation and hopelessness, and lower levels of the more adaptive 'fighting spirit' response. In HIV-infected men, depression correlated positively with frequency of high risk sexual practices.
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PMID:Relationships between mental adjustment to HIV diagnosis, psychological morbidity and sexual behaviour. 177 59

HIV-infected subjects at various stages of illness but without opportunistic cerebral disease were evaluated using a comprehensive, cognitively-based neuropsychological protocol and measures of levels of depression and anxiety. The data indicated a prominent attentional disorder among impaired subjects; however, language, visual-spatial and memory functioning were not deficient. There was also evidence suggesting executive function deficit. Depression contributed a small additional component in differentiating the groups. These findings help to specify the nature of the cognitive disturbance associated with HIV encephalopathy and are consistent with the pathological effects of primary infection of the brain by HIV. In addition, they provide a specific basis for ameliorative treatment with psychostimulant medication.
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PMID:Cognitive impairment in HIV infection. 181 32

46 subjects infected with human immunodeficiency virus (HIV) were followed up to determine psychiatric morbidity, both prior to and after information regarding their HIV status was revealed to them. Among these patients, 4 had AIDS syndrome while 42 individuals were HIV carriers. The preinformation morbidity in the AIDS group included 2 individuals who presented with delirium and 1 with an adjustment disorder. The psychiatric diagnosis among the HIV carriers revealed 1 patient with major depression, 4 with adjustment disorders, and 4 with alcohol dependence syndrome. The additional morbidity after the diagnosis was revealed and included major depression and adjustment disorders which could be managed by psychological intervention and counseling in most instance. The individual who later developed major depression committed suicide. The study, though preliminary in nature, suggests that it may be beneficial to include psychiatric management as past of the general care of individuals with HIV infection.
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PMID:Psychiatric morbidity in HIV infected individuals. 185 20

Patients at various stages of human immunodeficiency virus (HIV) infection require rehabilitation services. These patients present problems for each of the disciplines in a rehabilitation team, and all team members must confront the psychosocial and ethical issues involved with the disease. Patients with HIV infection may have polyneuropathy with multisystem involvement, including dysphagia, autonomic dysfunction, respiratory failure, bowel and bladder dysfunction, generalized weakness, a painful sensory neuropathy, and depression. Guidelines are presented for determining if inpatient rehabilitation or other settings are appropriate. Case management is a valuable strategy for the rehabilitation of patients with this complicated disorder.
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PMID:Human immunodeficiency virus infection and diffuse polyneuropathy. Implications for rehabilitation medicine. 186 48

A combination of oral zidovudine (250 mg twice daily) and subcutaneous interferon-alpha (10 x 10(6) units daily) was evaluated for clinical, antiretroviral, and immunological efficacy and for side effects in 17 patients with AIDS-related Kaposi's sarcoma. Fifteen patients were evaluable. During the study period of 12 weeks, tumor responses were complete in two patients and partial in two patients (27% major response rate). Minimal responses were seen in two patients (40% overall response rate). An anti-HIV effect (reduction of serum p24 antigen by 70% or more) was observed in seven of ten evaluable patients who were initially antigenemic. CD4 lymphocyte counts remained unchanged. In six patients who had either a tumor response or a marked decline of HIV antigenemia, the treatment was continued between 12 and 59 weeks beyond the study period. Two of four patients with tumor regression at 12 weeks had an additional tumor response in this period despite prior dose reduction of interferon due to toxicity. Late progression of KS was eventually observed in four of six patients on prolonged treatment. The responsiveness of Kaposi's sarcoma seen in this study in patients with low CD4 counts and prior constitutional symptoms (fever, weight loss) was unexpected and needs further confirmation by larger patient groups. Dose-limiting toxicities were bone marrow depression (severe anemia in four and neutropenia with anemia in two patients), subjective adverse experiences (fever, fatigue, myalgia; four patients) and both (two patients).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Combined treatment with zidovudine and lymphoblast interferon-alpha in patients with HIV-related Kaposi's sarcoma. 190 99

It is evident that human immunodeficiency virus (HIV) infection is one of the most serious public health issues in decades. HIV infection compromises cell-mediated immunity which ultimately may result in the acquired immunodeficiency syndrome (AIDS). AIDS, to date, remains an incurable and progressively fatal disorder. HIV infection is spreading beyond the originally identified high-prevalence groups of gay/bisexual males, intravenous drug abusers, and recipients of infected blood or blood products. Today, more and more heterosexual males, women, adolescents, and children have been infected with this lethal virus. This report addresses some of the psychiatric complications associated with HIV infection and discusses the diagnostic and clinical management challenges that clinicians must face as they deal with the increasing population of HIV-infected patients. Depression, anxiety, psychosis, delirium, and dementia are commonly encountered disorders associated with HIV spectrum disorders which must be accurately identified and can be effectively managed with psychopharmacological interventions.
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PMID:Psychopharmacotherapy of psychiatric syndromes in asymptomatic and symptomatic HIV infection. 192 28

For many years tuberculosis has been known to occur with greater frequency among persons with disorders that impair host defenses. In most instances these processes interfere with the immune response to Mycobacterium tuberculosis, whereas, in a few, such as silicosis, the probable abnormality is a nonimmune defect in macrophage function. Infection with the human immunodeficiency virus (HIV) causes progressive and ultimately profound depression of both humoral and cell-mediated immunity and, thus, is an extremely potent risk-factor for tuberculosis. Presumably the major effect of HIV infection that predisposes persons to developing tuberculosis is the reduction in circulating T-helper (CD4+) lymphocytes which causes a reduction in cytokine production and a consequent decrease in the functional capabilities of macrophages. However, a number of questions concerning pathogenesis of tuberculosis related to HIV remain. Available data suggest that the magnitude of the risk for developing tuberculosis among persons infected with both HIV and M. tuberculosis is very high, 8% in one prospective study. Because of the epidemic of HIV infection, the progressive downward trend in the incidence of tuberculosis in the United States has reversed and in 1989 there was a 5% increase in the number of cases. Preliminary data for 1990 suggest that there will be an 8 to 10% increase over 1989. Also in the United States approximately 3% of tuberculosis patients have been found to be HIV seropositive. The clinical features of tuberculosis in patients with HIV infection vary depending on the degree of immunosuppression. With mild immunosuppression early in the course of HIV infection tuberculosis presents in a "typical" way with positive tuberculin skin tests, upper lobe cavitary infiltrates on chest film and positive sputum smears and cultures. As the HIV infection progresses, the mode of presentation of tuberculosis becomes more "atypical" with negative skin tests, multiple sites of involvement, chest films showing diffuse noncavitary infiltrates often accompanied by intrathoracic lymphadenopathy. The key to diagnosis is maintaining a high index of suspicion for tuberculosis, especially in patients with advanced HIV disease and including appropriate laboratory examinations in the evaluations of such persons. Regardless of the stage of HIV infection the response to treatment for tuberculosis is generally favorable if it is begun promptly. Standard therapy utilizing isoniazid, rifampin, and pyrazinamide with or without ethambutol have been associated with high rates of cure. Relapse has been uncommon. There has been, however, at least one outbreak of tuberculosis caused by isoniazid and rifampin resistant organisms in which the response to therapy was very poor.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Clinical features, diagnoses, and management of tuberculosis in immunocompromised hosts. 194 27

This study examined the relationship between actual and self-reported neuropsychological deficits, depression, and HIV-1 serostatus. The subjects, who consisted of 479 individuals, 256 who were HIV seronegative (SN) and 233 who were HIV-1 seropositive though still asymptomatic (ASP), were administered a standardized neuropsychological screening battery consisting of measures of attention, motor speed, psychomotor speed, verbal memory, verbal fluency, and depression. To assess subjects' subjective sense of their cognitive status, the Cognitive Failures Questionnaire (CFQ), a 25-item self-report questionnaire, was also administered. The results of MANOVA failed to reveal group differences between the SN and ASP groups on the measures of neuropsychological function. Similarly, the ASP and SN groups did not differ on the number or severity of reported cognitive failures. However, a positive correlation was found between CFQ scores and level of depression. These results do not support the hypothesis that ASP individuals are aware of cognitive decline prior to detection using standard neuropsychologic screening instruments. The data do suggest that the presence of depressed mood, independent of serostatus or actual neuropsychological impairment, is associated with increased cognitive complaints.
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PMID:Metacognition in HIV-1 seropositive asymptomatic individuals: self-ratings versus objective neuropsychological performance. Multicenter AIDS Cohort Study (MACS). 195 33

Of 17 consecutive patients receiving methadone maintenance treatment who had primary or chronic depression, nine (53%) improved in both mood and drug abuse after imipramine treatment. This finding suggests a potential for helping such dual-diagnosis patients reduce drug abuse and associated risk for HIV. Further controlled trials are warranted.
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PMID:Imipramine treatment of methadone maintenance patients with affective disorder and illicit drug use. 201 72

The diagnostic evaluation of dementia is directed toward the identification of treatable causes. It can be facilitated by classification of the dementia into one of four categories: attentional, amnestic, cognitive, and intentional. Intentional dementia reflects dysfunction of frontal lobe systems, components of which include the frontal cortex, basal ganglia, thalamus, limbic structures, and subcortical white matter. Disorders that affect one or more of these components and produce intentional dementia include Binswanger's disease, Parkinson's disease, Huntington's disease, HIV infection, closed head injury, normal pressure hydrocephalus, neoplasms, syphilis, vitamin B12 deficiency, multiple sclerosis, and a number of uncommon degenerative and acquired syndromes. Depression may resemble intentional dementia. Guidelines for diagnosis and management are discussed.
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PMID:Multi-infarct dementia, subcortical dementia, and hydrocephalus. 203 8


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