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

The pattern of the development of opportunistic infections (OIs) in HIV-infected patients was evaluated, based on a cohort of 1,530 patients enrolled in two AIDS Clinical Trials Group anti-retroviral studies. We quantified the increase in risk of OIs associated with the occurrence of a previous OI. This assessment was based on the observed event rates of the more common AIDS-defining OIs: Pneumocystis carinii pneumonia (PCP), Mycobacterium avium complex (MAC), cytomegalovirus (CMV), and a systemic mycosis. Additionally, for each OI, we assessed the relative risks associated with a history of prior OIs, changes in CD4 levels, and baseline prognostic factors. We found that the occurrence of each of these OIs increased the risk of subsequent OIs, even after adjusting for the CD4 count. Specifically, the occurrence of PCP significantly increased the risk of MAC and CMV, and somewhat increased the risk of systemic mycoses. Diagnosis with MAC was associated with an increased risk of subsequent CMV, whereas the occurrence of CMV increased the risk of MAC. Finally, once patients were diagnosed with a systemic mycosis, they were at a somewhat increased risk of subsequently developing MAC or CMV. Although current practice for determining the timing and initiation of prophylactic therapies relies chiefly on CD4 count, the occurrence of specific AIDS-defining OIs in patients with HIV infection should also be taken into account in making decisions regarding prophylaxis strategies.
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PMID:Patterns of opportunistic infections in patients with HIV infection. 862 59

Pulmonary disease is a major source of morbidity and mortality in HIV-infected persons. Pneumocystis carinii pneumonia has decreased substantially during the last eight years, but in the United States it remains the most common disorder that announces the onset of AIDS. In contrast, tuberculosis is by far the most important AIDS-associated indicator disease in developing countries. Community-acquired acute bacterial pneumonia is a common HIV-linked complication throughout the world; pneumonia occurs at all levels of immune suppression but increases in frequency as CD4 counts decrease. Fungal infections mainly afflict persons who live or have lived in the various endemic areas. AIDS-related Kaposi's sarcoma and lymphoma generally do not involve the lungs until the malignancies are advanced. The increasing use of successful chemoprophylaxis against many important HIV-associated infections is increasing the incidence of other end-stage complications such as cytomegalovirus and disseminated MAC disease.
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PMID:Pulmonary complications of HIV infection. 871 66

Superficial mycotic infections such as seborrheic dermatitis, tinea pedis, tinea corporis, and onychomycosis are common in patients infected with human immunodeficiency virus (HIV). In communities where HIV infections are frequent, some of these clinical presentations serve as markers of the stage of HIV infection. The diagnosis of superficial fungal infection in HIV-positive patients may be difficult because of atypical clinical manifestations. Therefore, to ensure a correct diagnosis, skin scrapings should be collected for potassium hydroxide preparations and cultures. Most forms of dermatophytosis in HIV-positive patients respond well to many topical antifungal agents, such as azoles, terbinafine, and ciclopirox olamine. If the disease is chronic and extensive, then ketoconazole, fluconazole, and itraconazole are each effective.
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PMID:Common superficial fungal infections in patients with AIDS. 872 40

1. The population pharmacokinetics of fluconazole have been investigated in 113 male subjects with HIV infection and AIDS. Plasma concentration-time data (between 1 and 17 observations per dose) were collected from individuals as part of a pharmacokinetic investigation (13 subjects) or during routine fluconazole therapy (100 subjects) for the treatment or prophylaxis of fungal infection. 2. A one-compartment pharmacokinetic model was used to describe the disposition of fluconazole after oral and intravenous infusion doses. Population pharmacokinetic parameters were generated using the NONMEM and P-PHARM computer programs. 3. The population estimates (calculated using NONMEM) of fluconazole clearance and volume of distribution were 0.78 l h-1 and 47.61, respectively. The intersubject variability for these parameters was 41% and 8%, respectively. The model-dependent estimate of the extent of absorption was 0.99 with an intersubject variability of 6%. Mean population estimates generated by NONMEM and P-PHARM were in close agreement. 4. Examination of the relationship between patient covariates and pharmacokinetic parameters indicated that intersubject variability in fluconazole clearance could in part be explained by the severity of disease (as indicated by CD4 + T-lymphocyte count) and renal function (indicated by estimated creatinine clearance). Other pharmacokinetic parameters were unaffected by these covariates. 5. Fluconazole clearance (estimated using NONMEM) in subjects with a CD4 + T-lymphocyte count less than and greater than 200 cells mm3 was 0.73 l h-1 (95% CI; 0.64-0.82 l h-1) and 0.99 l h-1 (95% CI; 0.86-1.12 l h-1), respectively. The regression model for fluconazole clearance that accounted for changes in renal function and disease severity was CL (l h-1) = 0.25 (33%) + 0.0057 (32%) x CLcr (in ml min-1) + 0.00068 (10%) x CD4 cell count (in cells mm-3) where intersubject variability (expressed as %CV) is shown in brackets. 6. Based on pharmacokinetic considerations a reduction in the dose of fluconazole would appear to be warranted in people with HIV infection who are seriously ill or who have compromised renal function. However, the emergence of resistance to fluconazole must also be considered when thinking of dosage adjustments.
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PMID:Pharmacokinetics of fluconazole in people with HIV infection: a population analysis. 873 Sep 74

The literature on zygomycotic infection in HIV-positive patients is reviewed. A total of 28 patients have been reported. The risk factor for HIV infection was known in 22 of these and was sexual transmission in only six patients and intravenous (i.v.) drug use in 16 (73%). In the latter group, it is likely that i.v. drug injection was the entry route of the zygomycotic infection. The most prevalent clinical presentations of zygomycosis in the i.v. drug-using HIV-positive patients were cerebral, cutaneoarticular and renal (accounting for 88% of presentations in total). These presentations were much less common (18%) in a cohort of 116 patients belonging to the conventional risk groups for zygomycosis (HIV negative and no i.v. drug use). The isolated cerebral localization is the typical presentation of zygomycosis in HIV-negative i.v. drug users.
Mycoses
PMID:Zygomycosis in HIV-positive patients: a review of the literature. 876 98

The first case of Port-a-cath-related disseminated fusariosis in an HIV-infected patient is presented. Antifungal treatment with liposomal amphotericin B (AmBisome) in a dose of 2 mg kg-1 day-1 for 14 days was successful.
Mycoses
PMID:Port-a-cath-related Fusarium oxysporum infection in an HIV-infected patient: treatment with liposomal amphotericin B. 876 4

From the viewpoint of 40 years of experience in the field of medical mycology with the help of current topics the competence of the medical mycologist for evaluation of a presence of fungi in the home and hospital environment is commented. The topics considered are as follows: 1. The HIV-infected person and the habitat of Cr. neoformans; the predisposition for cryptococcosis and the CD4 lymphocyte count. 2. Invasive aspergillosis after heart transplantation; by exemplary cooperation between the heart surgeon and the medical mycologist it could be demonstrated that the frequently fatal invasive aspergillosis can be avoided. 3. Attention is drawn to the currently most interesting habitats of fungi in the home environment, i.e., biological waste and compost. It has been shown that among the various fungi, the causative agents of systemic mycoses may also be found.
Mycoses 1996
PMID:[Fungi in the home and hospital environment]. 876 65

Case report on a lethal meningo-encephalitis due to Cryptococcus neoformans in a 14-year-old girl without serious immunodeficiency inclusive HIV-infection. The detection of high quantities of cells of Cryptococcus neoformans (about 10,000/ml) and high levels of Cryptococcus antigen (up to 1:2048) in the cerebrospinal fluid are remarkable. The patient was treated with a triple combination of amphotericin B, flucytosine and fluconazole. After 18 days the cerebrospinal fluid was sterile. Nevertheless considerable lesions of the brain arised. The patient died from the Cryptococcus infection on day 74 of the antimycotic therapy. Cryptococcosis should be included into the differential diagnosis of the chronic lymphocytic pleocytosis of the cerebrospinal fluid connected with symptoms of intracranial pressure and ocular symptoms.
Mycoses 1996
PMID:[Lethal meningeal encephalitis from Cryptococcus neoformans var. neoformans in a girl without serious immunodeficiency]. 876 79

The encapsulated yeast, Cryptococcus neoformans, causes life-threatening meningoencephalitis in immunocompromised humans, especially in AIDS patients. Fatality and relapse rates remain quite high despite aggressive therapy. A conjugate vaccine composed of the cryptococcal capsular glucuronoxylomannan covalently coupled to tetanus toxoid (GXM-TT) was constructed and evaluated. The vaccine elicited high levels of capsular antibodies in mice by active and passive immunizations and conferred 70-80% protection against a moderate challenge with 10(3) C, neoformans. Monitoring of serum GXM and anti-GXM antibody levels and of incidence of cryptococcal isolation from various organs of mice suggested that presence of vaccine-induced antibodies during the first 4-6 weeks of infection is critical for clearance of cryptococci from various organs, for limiting serum GXM titers from reaching immunosuppressive levels and ultimately for survival. GXM-TT is the first defined fungal vaccine to confer antibody-mediated protection against a systemic mycosis in an animal model. GXM-TT is being evaluated for safety and immunogenicity in healthy and HIV-infected human volunteers at the National Institutes of Health.
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PMID:Preclinical efficacy of a glucuronoxylomannan-tetanus toxoid conjugate vaccine of Cryptococcus neoformans in a murine model. 884 25

In India, physicians examined and screened 100 AIDS patients aged 12-55 admitted to Government General Hospital in Madras for opportunistic infections as part of a study to document the characteristics of AIDS patients in Tamil Nadu State. 58% were 21-30 years old. The male/female ratio was 2:1. 94% had acquired HIV via heterosexual intercourse. 81% of all patients had multiple sex partners and unprotected penetrative sex. Around 66% had more than one opportunistic infection. The most common opportunistic infection was tuberculosis (61%), especially pulmonary tuberculosis (46%), followed by oral candidiasis (41%), cryptosporidial diarrhea (16%), and fungal infection of the skin (16%). The tuberculosis in most AIDS patients was reactivation of previously acquired tuberculosis. All tuberculosis patients responded well to standard treatment. The most common organism causing opportunistic infections was Staphylococcus pyogenes. Obstacles to acquiring more information about characteristics of these AIDS patients included the taboo of talking about sex and limited laboratory facilities. Clinicians should consider HIV in the differential diagnosis and management of all persons with tuberculosis.
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PMID:Spectrum of opportunistic infections among AIDS patients in Tamil Nadu, India. 884 6


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