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

The case of a 10.5-year-old girl, who was diagnosed with a case of thalassemia major at the age of 8 months and had been on regular blood transfusions since then, is related. Donor screening for HIV was started in mid-1988, thus she had received unscreened blood for a number of years. In February 1991, she presented with a dry persistent cough, moderate grade continuous fever, and breathlessness on exertion for over 2 weeks. Chest X-ray showed bilateral infiltrations. She was put on penicillin and chloramphenicol with a provisional diagnosis of bronchopneumonia. In March 1991, she had to be hospitalized for impending respiratory failure. After treatment with intravenous fluids and parenteral antimicrobials, her condition stabilized and she was discharged. In April 1991, she was readmitted because of complaints of difficulty in swallowing and weight loss. Her chest signs had persisted and she had developed oropharyngeal candidiasis with ulcerations. She also had alopecia, a generalized lymphadenopathy, digital clubbing, and bilateral parotid enlargement. Candidiasis responded to vigorous therapy with clotrimazole. Fine needle aspiration of lymph node showed a reactive hyperplasia. HIV antibodies were detected in the serum with ELISA and confirmed by Western blot. Immunologic tests showed evidence of severe immunodeficiency. The Multitest CMI, which simultaneously tests delayed skin hypersensitivity to seven common recall antigens, was totally nonreactive. She was classified as having AIDS according to World Health Organization criteria for children under 13 years of age. The diagnosis of lymphocytic interstitial pneumonitis (LIP) was also made based on the symptoms. Oral prednisolone was given 2 mg/kg/day in 3 divided doses for a month. The cough and dyspnea showed great improvement and the parotid swellings disappeared; lymphadenopathy, clubbing, and alopecia, however, persisted. The child was kept on maintenance therapy of prednisolone and on alternate day co-trimoxazole for prophylaxis against Pneumocystis carinii infection.
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PMID:Acquired immunodeficiency syndrome (AIDS) with lymphocytic interstitial pneumonitis (LIP) in a multi transfused child with thalassemia major. 129 97

We present studies on the evolution of HIV-1 infection in 638 hemophilic patients receiving commercial antihemophilic concentrates (CAH) at the Institute of Hematological Research and the Argentine Foundation of Hemophilia between 1983 and 1990. Positive serology for HIV-1 was detected in 30% of the patients studied. Prevalence of HIV-1 infection was higher (about 70%) in the group with severe hemophilia requiring more CAH, but there were no differences between patients with hemophilia A or B. Sexual transmission was demonstrated in 8/64 women (13%) with stable sexual relationship with HIV-1 + hemophilic patients. Three of them became pregnant, and HIV-1 infection was demonstrated in two of the three children. In general, the clinical evolution, as well as the hematologic and immunologic parameters of infected patients were similar to those described for the hemophilic population in other occidental countries. Opportunistic infections were also those observed elsewhere (with predominance of P. carinii pneumonia and disseminated Candida infections). However, the presence of fatal chagasic encephalitis in two of the patients with AIDS is unusual. Thus, central nervous system localization of T. cruzi (which can be observed during the acute period of T. cruzi infection or in immunosuppressed patients), must be considered as a possible severe complication of HIV-1 disease in T. cruzi infected patients.
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PMID:[HIV-1 infection in patients with hemophilia. The Argentinian experience from 1983 to 1990]. 130 88

160 HIV-infected Greek patients were prospectively examined and the oral signs and symptoms recorded. At the time of oral examination, 76 patients were asymptomatic seropositive, 47 were in the ARC stage, and 37 had AIDS. 1 or more oral findings were recorded in 90.6% of the patients, while a total of 33 different lesions were observed. The more common oral lesions (highly suspicious) were candidiasis (61%), hairy leukoplakia (24%), periodontitis (19%), necrotizing gingivitis (11%), and Kaposi's sarcoma (12%). In addition, some unclassified lesions or symptoms (xerostomia--26%, burning mouth syndrome--19%, patchy depapillated tongue--16%, hairy tongue--10%, exfoliative cheilitis--4%) were common, while submandibular and cervical lymph node enlargement were found in 49% of the patients. It is interesting that in 16 patients (10%), the suspicion of HIV infection was based exclusively on oral lesions. The authors' findings show that oral signs and symptoms are common and occasionally early manifestations of HIV infection, and it is in association to those reported in previous studies.
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PMID:Oral signs and symptoms in 160 Greek HIV-infected patients. 131 36

In 1985, at a WHO workshop on AIDS in Bangui, Central African Republic, a clinical case definition of AIDS was developed for developing countries. This 1st definition contained 4 major criteria (chronic asthenia, major weight loss, chronic fever, and chronic diarrhea) and 6 minor criteria (chronic cough, persistent lymphadenopathy, herpes zoster, recurrent herpetic infection, pruritic dermatitis, and oropharyngeal candidiasis). Kaposi's sarcoma and cryptococcal meningitis were sufficient by themselves for the diagnosis of AIDS. In children, the temporary definition of AIDS consisted of 3 major clinical criteria (weight loss and/or abnormally slow growth, chronic diarrhea lasting more than 1 month, and fever lasting more than 1 month), and 6 secondary clinical criteria (generalized lymphadenopathy, oropharyngeal candidiasis, repeated common infections such as otitis and pharyngitis, persistent cough, generalized pruritic dermatitis, and confirmed maternal HIV infection). The revised Bangui definition was evaluated in 174 adult patients hospitalized at the Mama Yemo Hospital of Kinshasa, Zaire. 46% of 174 patients met the criteria of the WHO/Bangui definition. Overall, the sensitivity of the definition for HIV-1 infection was 59%, the specificity was 90%, and the positive predictive value (PPV) was 74%. However, the clinical case definition of African AIDS lacks specificity when it is applied to patients suffering from cachectic syndromes. The Bangui definition was also evaluated at the pediatric ward of Mama Yemo Hospital with 159 hospitalized children whose mean age was 33 months. 21 (13%) were infected by HIV-1. The sensitivity of the definition was 35%, its specificity was 86%, and its PPV was 26%. Although the specificity was relatively high, the low values of sensitivity and PPV underline the weakness of the Bangui clinical case definition for diagnosing pediatric AIDS cases.
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PMID:World Health Organization clinical case definition for AIDS in Africa: an analysis of evaluations. 133 10

Physicians examined the records of 47 adults with visceral leishmaniasis (VL) and HIV-1 infection who were patients at 3 urban teaching hospitals in the Andalucia region in southern Spain between January 1986 and November 1991. They wanted to identify the clinical, biological, and epidemiological features of VL in HIV-1 positive patients. 96% of the cases were diagnosed with both infections during the last 2 years of the study period and 79% between January and November 1991. All the patients had risk factors for HIV infection (65.9% IV drug use, 21.3% sexual contact, and 12.8% blood transfusion). 70% exhibited the classic symptoms of VL (fever, enlarged liver and spleen, and depressed counts of blood cells). Most patients were already very immunocompromised when VL was diagnosed. 87% had a total lymphocyte count of less than 1000 x 1 million/1 and a CD4 lymphocyte count of less than 200 x 1 million/1. In fact, 66% had full blown AIDS prior to diagnosis of VL. VL was the first severe infection in 10 cases. 68% also suffered from opportunistic infections, especially candidiasis, extrapulmonary tuberculosis, and Pneumocystis carinii pneumonia. Microscopic examination of Leishmania amastiogotes in tissue samples led to a diagnosis in 94% of cases, isolation of motile amastigotes in culture of bone marrow aspirate in 2%, and microscopic and culture in 4%. Just 46% completed a full course of treatment (pentavalent antimony, allopurinol, and/or pentamidine). Only 38% had a microbiological response. Immunofluorescence detected sizeable titers (1:40) of antileishmanial antibodies in just 31% of cases. 17% experienced clear clinical improvement. Physicians in endemic areas should consider VL in every HIV-1 infected patient with fever, hepatosplenomegaly, or hematological abnormalities to avoid underdiagnosis of leishmaniasis.
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PMID:Visceral leishmaniasis in HIV-1-infected individuals: a common opportunistic infection in Spain? 136 80

Oral manifestations of HIV infection in children include oral candidiasis, herpetic stomatitis, oral hairy leukoplakia, parotid gland swelling, and other bacterial, viral and mycotic infections. The frequency and natural history of those disorders are not fully defined. The purpose of this work is to inform the oral findings in 57 HIV infected children studied at the Hospital Infantil de Mexico. All 57 patients presented nonspecific gingivitis; however it was not feasible to associate it with the HIV infection; in 28 oral candidiasis was observed, and in 3 cases herpetic stomatitis was documented. Oral candidiasis was found regardless the patient's sex, age, clinical stage, treatment, and mode of transmission of the HIV infection. It has been considered that oral candidiasis is a good marker of immunodeficiency; however, in our patients this correlation was not observed. Also, other HIV-associated oral manifestations were not observed in these cases. The severity and rapid clinical course presented by our patients, may explain both, the lack of correlation between candidiasis and immunodeficiency as well as the absence of other lesions.
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PMID:[Oral manifestations in HIV positive children]. 138 84

The medical records of 114 consecutive HIV-infected patients with oropharyngeal and esophageal candidiasis, in whom esophagoscopy was performed, were reviewed. Esophageal candidiasis and isolated oral candidiasis were found in 75% and 25% of patients, respectively. Esophageal candidiasis was the AIDS-defining illness in 65 patients and dysphagia was the commonest symptom, but asymptomatic Candida esophagitis was observed in 43% of them. Symptoms were present in six patients with oropharyngeal candidiasis; three of them had a normal esophagoscopy and the other three had acute nonfungal esophagitis. Invasive fungal esophagitis was confirmed by biopsy in 47/74 patients (64%). The patients with esophageal candidiasis had lower CD4+ cell counts (129/microliter) and CD4:CD8 ratios (0.23) than those with oropharyngeal candidiasis (CD4 179/microliter; CD4:CD8 0.35). Thirty-six patients with esophageal candidiasis were treated with fluconazole, 100 mg/daily, for 28 days, and another 34 patients received the same dose for 10 days. A similar efficacy was seen in both regimens, but a higher incidence of oropharyngeal fungal colonization and liver dysfunction was observed in the longer therapy (p < 0.001). We conclude that asymptomatic C. esophagitis is common in HIV-infected patients. Patients with oropharyngeal candidiasis may complain of esophageal symptoms; it could be due to superficial C. infection or another not-identified opportunistic infection. More severe immunologic impairment was required to develop esophageal candidiasis than oropharyngeal candidiasis. A short course of 10 days of fluconazole therapy could be the standard regimen for the treatment of C. esophagitis in AIDS.
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PMID:Clinical, endoscopic, immunologic, and therapeutic aspects of oropharyngeal and esophageal candidiasis in HIV-infected patients: a survey of 114 cases. 144 39

The first sign of HIV infection may be an unusual or rapidly progressive condition of the oral cavity, including malignancies such as Kaposi's sarcoma. Early diagnosis of these oral conditions can lead to early diagnosis of HIV infection and subsequent treatment with antiretroviral agents that may improve the prognosis. This illustrated review outlines the presenting signs and symptoms of the most common oral manifestations of the AIDS virus, including hairy leukoplakia, candidiasis, Kaposi's sarcoma, periodontal disease, salivary gland disease, necrotizing stomatitis, and infection with herpes and human papillomavirus.
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PMID:Recognizing the oral manifestations of AIDS. 144 78

In 1990, among pregnant women .1% tested positive for HIV antibodies in Amsterdam compared to 24.5% in Lusaka, Zambia. During 1990 and 1991 data were collected from 231 patients fulfilling the WHO clinical criteria for the diagnosis of AIDS in 3 hospitals of Sesheke, a rural Zambian district. 46.3% of the group was male and 53.7% was female, and the mean age of women was significantly lower than that of men (25.2 vs. 31.1 years, p 0.001). A total of 185 patients could be tested for HIV-1 antibodies using ELISA-Welcozyme and HIVCECK-Du Pont. There were 141 (81.6%) positive results, 19 (10.3%) negative results, and in 15 (8.1%) cases the outcome was not clear. Seroprevalence figures for HIV-1 in the same period were 16% for blood donors and 41% for patients attending the clinic for sexually transmitted diseases. Most patients with AIDS in Sesheke district present with a wasting syndrome, and in these cases, tuberculosis (TB), whose incidence has increased dramatically, has to be excluded. Loss of more than 10% of body weight was the most common symptom followed by chronic cough lasting for more than 1 month, fever persisting for more than 1 month, and chronic diarrhea lasting for more than 1 more. Chronic coughing was more frequent among adults than among children (P 0.001). Weight loss, chronic diarrhea, persistent coughing, generalized lymphadenopathy, generalized dermatitis, and oropharyngeal candidiasis occurred among both adults and children equally often. Only 4 patients (18%) and extrapulmonary TB in 10 patients (4%). In the district there was no registration system for the dead and the follow-up of AIDS patients were not organized well, but as of January 1, 1992, from hospital records it was established that 74 patients out of the 231 studied were decreased. The outlook for the population in Sesheke and Zambia is dim in light of the current high seroprevalence rate.
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PMID:[AIDS in a Zambian district]. 147 Feb 44

The lymphocyte responsiveness to leishmanial antigens and its influence on the course of cutaneous leishmaniasis was studied in a patient with AIDS-associated American cutaneous leishmaniasis caused by Leishmania braziliensis. The patient had cutaneous disseminated erythematous papules or nodules and mucosal lesions as well as moniliasis and weight loss. The patient had a poor delayed-type hypersensitivity to leishmanial antigens, showing 3 mm of induration. The cellular immune responses were studied in vitro by lymphocyte proliferative assays induced by leishmanial antigens and concanavalin A. The T cell phenotypes were analysed by flow cytometry. The peripheral blood mononuclear cells before proliferation showed an inversion of the CD4/CD8 ratio (0.28:1). The lymphoproliferative responses to antigen and mitogen were very low (indices < 2.5). The blast-like cell phenotypes after antigen stimulation in culture were: CD3+ 44.8%, CD4+ 7.53% and CD8+ 17.45%. In AIDS patients the decrease in the pool of CD4+ cells, and consequent diminution of the CD4/CD8 ratio, produced by HIV infection provokes a generalized immune depression. The patient's disseminated clinical picture was probably related to the inability of his T cell-mediated immune responses to control the spread of Leishmania infection.
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PMID:Cellular and humoral immune responses of a patient with American cutaneous leishmaniasis and AIDS. 147 17


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