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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty-eight HIV-seropositive individuals--11 asymptomatic cases, 8 with lymphadenopathy syndrome (LAS), and 9 with AIDS--were investigated. Clinical staging of the AIDS dementia complex was done in the 9 AIDS patients. The catecholamine metabolites 3-methoxy-4-hydroxyphenylglycol (MHPG) and homovanillic acid (HVA) in CSF were determined in all the HIV patients and in 20 healthy volunteers. The CSF MHPG levels did not differ significantly between healthy subjects and HIV-infected patients at any stage of the infection. The CSF concentrations of HVA differed between the groups only during the AIDS stage. The mean CSF HVA value in the AIDS patients was 42% lower than in the healthy subjects and significantly lower than in any other stage of HIV infection (P less than .01). Patients with signs of the AIDS dementia complex had reduced CSF HVA levels, but there was no clear relationship between HVA concentration and stage of the AIDS dementia complex.
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PMID:Cerebrospinal fluid catecholamine metabolites in HIV-infected patients. 185 86

Progressive dementia has been described in AIDS patients as the most significant neurologic complication, related to HIV-1 infection directly rather than to opportunistic infections. As the virus seems to enter brain early in the course of infection, incipient dementia or subclinical cognitive impairment have been assumed to occur in otherwise asymptomatic HIV-1 seropositive individuals. A review of relevant neuropsychological studies indicates that this suspicion receives no support in large well-controlled studies. The natural history of AIDS dementia is still not clearly delineated, but encephalopathy seems to develop only with or after systemic immunosuppression.
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PMID:[HIV infection and the development of dementia]. 186 63

The most current statistics show that in South Africa there have been 430 people diagnosed with AIDS, half of whom have died. It is estimated that the number of HIV infections doubles every 8-8.5 months and projections indicate that by 1996 60% of the work force will be HIV positive. These facts pose serious medical and legal problems. Informed consent for HIV testing confidentiality of the patients, and the health care workers right to refuse treatment of AIDS patients are but 3 of the problems. There is no general agreement to screen all patients who enter hospitals since the time between infection and seropositivity is so long, typically up to 42 weeks. The case is stronger for mental patients since a certain percentage will be suffering from AIDS dementia and could pose a threat to the other patients. According to South African law there is no general duty to treat or right to treatment, so it is at the discretion of private practitioners. Informed consent must be obtained from a patient before medical treatment can be allowed, although, in South Africa, this can be overridden in cases of a threat to public health. There is still debate about whether AIDS constitutes such a risk. Also there are provisions that legally limit the amount of information that must be given to obtain informed consent, as in the taking of a blood sample used for multiple blood tests. Information does not have to be given to the patient to protect 3rd parties or to gather scientific data. So there is debate whether HIV screening could be put in the scientific data gathering category, or it could be considered part of other routine blood tests done to determine the general health of the patient, all without specifically informing the patients that they are being screened for HIV. AIDS will likely lead to an increase in laws that favor virginity, marriage, and monogamy as well as laws that decreases people's privacy rights. In the US this is already occurring as the issue of confidentiality and the right to privacy are being narrowed.
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PMID:AIDS: some medico-legal aspects. 188 64

Bacterial lipopolysaccharides (LPS) or endotoxins are potent triggers of the cytokine (CK) cascade. These CKs are immune mediators which produce many biological effects and could play a detrimental rather than beneficial role in the host. In this review emphasis will be placed on the participation of two CKs, tumor necrosis factor [TNF-alpha and interleukin (IL-1) beta], in the pathogenetic development of HIV infection. We have found that TNF and IL-1 circulate in exaggerated amounts in the blood of HIV-infected subjects from the earliest phases of infection. Furthermore, we have observed a strict correlation between plasma LPS and IL-1 beta levels, thus indicating that endotoxins could account for the production of CKs in the course of HIV infection. Finally, the demyelinating role of TNF-alpha either in experimental models or in the course of AIDS dementia complex is outlined.
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PMID:HIV-infection and in vivo lipopolysaccharide-induced release of cytokines. An amplified mechanism of damage to the host. 189 85

Sixty-seven patients with different stages of human immunodeficiency virus (HIV) infection (47 CDC group IV, 20 CDC groups II or III) were followed prospectively for a median of 18 months with neurological examination, magnetic resonance imaging (MRI), and computerized tomography (CT) to evaluate the incidence of the AIDS dementia complex (CDC definition) and other neurological complications. Ten patients developed CNS opportunistic infection or malignancy. Among the remaining 57 patients, 12 of 37 (32%) belonging to CDC group IV, and 1 of 20 (5%) belonging to CDC groups II/III developed the AIDS dementia complex (p = 0.03). MRI white matter lesions occurred in 32% of CDC group IV patients and 5% of CDC groups II/III patients (p = 0.03). The corresponding figures for brain atrophy at CT were 71% and 30% (p less than 0.01) and for neurologic signs 49% and 20% (p = 0.06). The development of the AIDS dementia complex was significantly associated with the occurrence of MRI white matter lesions and a CD4 cell count of less than 200 x 10(6)/l, whereas it was not statistical significantly associated with brain atrophy at baseline. It is concluded that the AIDS dementia complex is a common feature of late stage HIV infection. Brain atrophy occurs in a large percentage of HIV infected patients, but the clinical significance of this atrophy is not clear.
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PMID:Central nervous system involvement in human immunodeficiency virus disease. A prospective study including neurological examination, computerized tomography, and magnetic resonance imaging. 191 36

Infection with the human immunodeficiency virus (HIV-1) often produces a set of neuropsychiatric dysfunctions which have been termed the AIDS dementia complex. This complex appears due to the infection of brain cells by HIV-1. If so, brain cells might be expected to contain a binding site for the same viral envelope glycoprotein that enables HIV-1 to bind to other cells (e.g. CD4+ T-cells), gp120. The present study shows that the cells of the brain-derived U-138MG, U-373MG, SK-N-MC and SK-N-SH cell lines bind gp120 in an inhibitable fashion. Binding of gp120 to these cells is inhibited by the dyes Aurintricarboxylic acid (ATA) and Evans blue (EB), which are known to inhibit specific gp120 and HIV-1 binding, and block HIV-1 infection, in CD4-expressing cells. Binding is not inhibited by Aurin, a dye related to ATA but lacking its anti-HIV effects. As expected, anti-CD4 antibodies are ineffective in blocking gp120 binding to brain-derived cells. These results suggest that human brain-derived cells possess a specific binding site for gp120 that is not the CD4 antigen.
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PMID:Brain-derived cells contain a specific binding site for Gp120 which is not the CD4 antigen. 193 87

Hallmarks of central nervous system (CNS) disease in AIDS patients are headaches, fever, subtle cognitive changes, abnormal reflexes, and ataxia. Dementia and severe sensory and motor dysfunction characterize more severe disease. Autoimmune-like peripheral neuropathies, cerebrovascular disease, and brain tumors are also observed. Histological changes include inflammation, astrocytosis, microglial nodule formation, and diffuse de- or dysmyelination. Focal demyelination can also be seen. It is clear that AIDS-associated neurological diseases are correlated with greater levels of HIV-1 antigen or genome in tissues. In AIDS dementia, macrophages and microglial cells of the CNS are the predominant cell types infected and producing HIV-1. However, manifestations of the disease make it unlikely that direct infection by HIV-1 is responsible. It seems more likely that the effects are mediated through secretion of viral proteins or viral induction of cytokines that bind to glial cells and neurons. HIV-1 induction of such cytokines as interleukin 1 (IL 1) and tumor necrosis factor-alpha (TNF alpha) may lead to an autocrine feedback loop involving further productive virus replication and induction of other cytokines such as interleukin 6 (IL 6) and granulocyte-macrophage colony-stimulating factor (GMCSF). Interleukin 1 and TNF alpha in combination with IL 6 and GMCSF could account for many clinical and histopathological findings in AIDS nervous system diseases. As HIV-1 infected patients produce elevated levels of IL 1, TNF alpha, and IL 6, it will be important to make a formal connection between the presence of these factors in the CNS, which are all products of activated macrophages, astroglia, and microglia, their in vivo induction directly by virus or indirectly by virus-induced intermediates, and the clinical and pathological conditions seen in the nervous system in this disease.
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PMID:HIV-1, macrophages, glial cells, and cytokines in AIDS nervous system disease. 206 87

In forty patients at early and advanced stages of HIV infection (Walter Reed stages I-IV) regional cerebral blood flow was determined by 99mTc-HMPAO SPECT, comparing the results with CT and MRI findings. All patients with HIV encephalopathy (AIDS dementia complex) had pathologic SPECT results (multilocular, patchy uptake defects), but also in earlier and even earliest stages of HIV infection positive SPECT findings were observed. Compared to functional SPECT imaging, morphologically orientated methods (CT, MRI) were insensitive in detecting HIV-induced foci: more than 50% of the patients with pathologic SPECT findings had negative CT or MRI scans. Most patients in advanced Walter Reed stages had neurological abnormalities accompanied by positive SPECT. Subtle alterations of HMPAO uptake were observed even in a few cases of early HIV infection without neurological CNS symptoms. The data presented suggest that HMPAO SPECT is highly sensitive in the detection of altered brain perfusion not only in advanced but also early stages of HIV infection. Changes in regional cerebral blood flow are present before noticeable structural defects may be observed. Thus, it is suggested to use HMPAO SPECT in the evaluation and monitoring of patients with, and particularly at risk for, HIV encephalopathy.
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PMID:Functional and morphological findings in early and advanced stages of HIV infection: a comparison of 99mTc-HMPAO SPECT with CT and MRI studies. 207 86

The encephalopathy resulting from direct infection of the brain by human immunodeficiency virus (HIV), which correlates clinically with the AIDS dementia complex, has been reported as being localized to the white matter where it induces myelin loss, gliosis and perivascular infiltration by mononuclear macrophages and multinucleated giant cells. Damage to the cortical grey matter in HIV encephalopathy was investigated in nine randomly selected HIV-positive cases with or without clinical or morphological evidence of encephalopathy and in five age-matched controls, using routine histology and immunohistochemical methods [glial fibrillary acidic protein (GFAP), microglia and HIV antibodies]. Increased numbers of GFAP-expressing astrocytes and Ricinus communis agglutinin 1-120-expressing microglial cells were found in all the HIV-positive cases (including asymptomatic) and their severity could be correlated with the severity of the encephalopathy in the white matter; the increase in number of cells expressing GFAP was diffuse and the intensity of the staining higher than that of microglial cells. The subpial region was the most severely involved. It is suggested that involvement of the cortical grey matter is more common in HIV infection than previously suspected and that clinical evidence of a dementing process in AIDS is not necessarily due only to white matter lesions.
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PMID:The involvement of the cerebral cortex in human immunodeficiency virus encephalopathy: a morphological and immunohistochemical study. 208 94

We evaluated the incidence of AIDS dementia complex (ADC) in groups of patients who acquired infection through different risk behaviours, and attempted to evaluate the possible role of zidovudine (AZT) treatment in preventing or delaying the onset of ADC. The Italian National AIDS Registry was used to study patients with AIDS for whom ADC was reported as an index disease. Relative risk of presenting ADC between different patient categories has been determined. Logistic regression was used to analyse temporal trends in the proportion of AIDS cases presenting with ADC. Of the 6466 cases reported between August '87 and August '90, ADC was seen in 640 (9.9%). I. V. drug addicts had twice the risk (estimated odds ratio: 1.9; 95% confidence interval: 1.5-2.6, p less than 0.001), compared to homo/bisexuals, of presenting with ADC. There is significant evidence (p less than 0.0001) that after a progressive increase in the period '87-'89, it began a definite decrease in the monthly proportion of ADC cases, starting August '89. AZT was introduced in Italy in July 1987 for patients with AIDS or advanced ARC. The incidence of AIDS dementia complex at the moment of AIDS diagnosis in our population of patients, began to decline 24 months after the introduction of systematic AZT treatment in Italy. This could have been due to inhibition of HIV replication in the Central Nervous System among patients who initiated AZT-treatment before developing full-blown AIDS.
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PMID:[Decrease in notifications of AIDS dementia complex in 1989-1990 in Italy: possible role of the early treatment with zidovudine]. 209 87


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