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

Human cytomegalovirus (CMV) has several possible roles in the pathogenesis of AIDS. CMV causes a number of clinical syndromes, including retinitis, pneumonitis, and gastroenteritis in patients infected with human immunodeficiency virus type 1 (HIV-1). In addition, CMV may potentiate the cellular immunodeficiency observed in patients with HIV infection either directly or through enhancement of HIV replication. Finally, CMV may predispose the host to bacterial or fungal infection by compromising the integrity of mucosal barriers to infection. Therapy with ganciclovir for CMV infection may result in a decrease in morbidity related to the virus, but problems with drug toxicity and resistance to the agent mandate the development of additional therapeutic approaches.
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PMID:Cytomegalovirus in the setting of infection with human immunodeficiency virus. 164 83

Nine patients with active ocular or optic nerve involvement by syphilis who also had concurrent human immunodeficiency virus type-1 (HIV-1) infection are described. The ocular manifestations of syphilis led to the discovery of HIV-1 seropositivity in four of nine cases. Fifteen eyes were affected. Ocular manifestations were: iridocyclitis in three eyes, vitreitis in one eye, retinitis or neuroretinitis in five eyes, papillitis in two eyes, optic perineuritis in two eyes, and retrobulbar optic neuritis in two eyes. Three patients diagnosed with acquired immune deficiency syndrome (AIDS) had the worst initial visual acuities. Six of nine patients had evidence of concomitant central nervous syndrome (CNS) involvement with syphilis. Benzathine penicillin was administered intramuscularly to three patients. All three had relapses. Seven of nine patients treated intravenously with high-dose penicillin had dramatic responses to therapy with improvement in vision and serologies and no evidence of relapse. Regimens accepted for the treatment of neurosyphilis appear to be adequate for the treatment of ocular syphilis in HIV-1-infected patients though further long-term follow-up will be required.
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PMID:The ocular manifestations of syphilis in the human immunodeficiency virus type 1-infected host. 232 8

We examined retinal tissue from eight human immunodeficiency virus type 1 (HIV-1) seropositive patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex for evidence of dual infection with HIV-1 and cytomegalovirus. Culture demonstrated simultaneous infection with HIV-1 and cytomegalovirus in two of 13 retinal specimens. This was confirmed by both immunofluorescence and immunohistochemical staining. Moreover, coinfection of individual cells with cytomegalovirus and HIV-1 was observed by immunohistochemical staining. Infection of retina with cytomegalovirus or HIV-1 alone occurred in one and six of the 13 retinal specimens, respectively. HIV-1 antigens were present on scattered cells in all layers of the retina and on retinal vascular endothelium. HIV-1 was isolated from retinal tissue derived from eyes both with and without gross ocular lesions. Cytomegalovirus antigens were found in all layers of the retina, but not on vascular endothelial cells. The atypically rapid clinical progression of retinitis in one of the patients with dual HIV-1 and cytomegalovirus infection suggests the possibility that interactions between these two viruses may influence retinal disease in patients with AIDS.
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PMID:Dual infection of retina with human immunodeficiency virus type 1 and cytomegalovirus. 253 19

In patients with the typical features of intraocular cytomegalovirus infection endothelial precipitates were identified that had a characteristic morphology, which included subtle, non-pigmented linear deposits with reticular arrangement that can spread diffusely over the corneal endothelium without preference for the inferior quadrants. The appearance of these precipitates was comparable to heterocromic cyclitis. Specular microscopy identified lymphocytes and macrophages on the endothelial layer. The present observations are based on five case reports of necrotizing retinitis, typical for intraocular cytomegalovirus infection, in connection with the atypical endothelial precipitates. In four of the five patients reported, HIV-infection was confirmed. In one patient with serologically confirmed cytomegalovirus infection (however without HIV-infection), a diagnostic work-up of the aqueous humor was carried out. Local production of specific antibodies against cytomegalovirus was identified in the aqueous humor. Topical treatment with antiviral and/or steroidal drugs was unsuccessful. The antiviral drug gancyclovir was applied systemically in two patients, but there was no impact on the corneal precipitates described. No intravitreal therapy was given. If these endothelial changes can be regarded as pathognomonic for cytomegalovirus infection, thorough slit lamp examination may be important for diagnosis of the presence of or the reactivation of cytomegalovirus infection in the eye. So far, no correlation has been found between the time course of corneal/endothelial precipitation and necrotizing retinitis.
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PMID:[Endothelial precipitates and cytomegalovirus infection]. 254 2

The ocular complications of acquired immune deficiency syndrome (AIDS) include: (1) a noninfectious microangiopathy, most often seen in the retina, consisting of cotton-wool spots with or without intraretinal hemorrhages and other microvascular abnormalities; (2) opportunistic ocular infections, primarily cytomegalovirus (CMV) retinitis; (3) conjunctival, eyelid, or orbital involvement by those neoplasms seen in patients with AIDS (i.e., Kaposi's sarcoma and lymphoma); and (4) neuro-ophthalmic lesions. In a series of 200 AIDS patients evaluated clinically, AIDS retinopathy was present in 66.5%. Sixty-four percent had cotton-wool spots, and 12% had intraretinal hemorrhages. Cytomegalovirus retinitis was diagnosed in 28% of AIDS patients. Neuro-ophthalmic lesions were found in 8% of all AIDS patients and were present in 33% of those patients with cryptococcal meningitis. Acquired immune deficiency syndrome retinopathy was present in 40% of 35 patients with the AIDS-related complex (ARC) and in 1.3% of 232 patients with asymptomatic human immunodeficiency virus (HIV) infection, evaluated photographically. These results suggest that the prevalence of AIDS retinopathy increases with increasing severity of HIV infection, and that CMV retinitis presents a significant vision-threatening problem in AIDS patients.
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PMID:Ocular manifestations of acquired immune deficiency syndrome. 254 83

A sight-threatening cytomegalovirus (CMV) retinitis is often associated with acquired immune deficiency syndrome (AIDS). We report the detection and quantitation of antibodies specific for CMV and human immunodeficiency virus type 1 (HIV-1) in the vitreous fluid and serum of an AIDS patient suffering from bilateral CMV retinitis. The ratio of the concentrations of HIV-1-specific immunoglobulin G (IgG) to total IgG in the vitreous fluid was found to be higher than that of the peripheral blood, indicating a local production of HIV-1-specific IgG synthesis within the ocular compartment. In contrast, CMV-specific IgG levels in serum were found to be higher than that of vitreous fluid, indicating an intact blood-ocular barrier. CMV and HIV were also isolated from the ocular tissues of this patient. These findings are consistent with the hypothesis that CMV retinitis may be associated with HIV-1 infection of the ocular tissues, which evokes an HIV-1-specific humoral immune response locally within the ocular compartment.
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PMID:Intraocular HIV-1-specific IgG synthesis in a patient with CMV retinitis. 256 59

202 patients with HIV infections of different stages [1 (n = 59): symptomless HIV seropositivity, 2 (n = 64): pre-AIDS (LAS = Lymphadenopathy syndrome, ARC = AIDS related complex), 3 (n = 79): AIDS] were prospectively examined. The findings of the first examination were analyzed statistically in a cross-section-study. In 15 AIDS autopsy cases the eyes were examined histopathologically and with immunohistochemical techniques. Patients with stage 1 had only some Sicca syndromes (3%) and neuroophthalmological signs (dyscoria with neurosyphilis) (2%). 14% of the patients with stage 2 had a microvascular retinal syndrome, 11% a Sicca syndrome and 2% neuroophthalmological signs. Among the AIDS patients (stage 3), however, 61% had a microvascular syndrome of the retina, 24% a retinitis resp. choroiditis as an opportunistic infection (in 15% Cytomegalovirus was the causative organism), 16% had neuroophthalmological symptoms, 14% a Sicca syndrome and 5% Kaposi's sarcoma of the eyelids or conjunctiva. The microvascular retinal syndrome was found to be the most sensitive ocular indicator for an advanced stage of HIV infection. Further changes of the anterior eye segments (especially conjunctival vessel abnormalities and precipitates of the corneal endothelium in Cytomegalovirus retinitis) are demonstrated.
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PMID:[Incidence and pathogenesis of ocular symptoms in HIV infection]. 258 39

A case is reported of secondary syphilis with ocular signs in a patient who had antibodies to human immunodeficiency virus (HIV) and hepatitis B infections and from whose urine cytomegalovirus was cultivated. Treatment with penicillin resulted in rapid recovery from his retinitis and uveitis. The case highlights the importance of testing for syphilis in all patients with HIV infection.
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PMID:Syphilitic retinitis in a homosexual man with concurrent HIV infection: case report. 280 82

Between 1984 and 1987 (over two-and-a-half years) 30 hospitalized patients with HIV infections of different degrees of severity were ophthalmologically examined. Ocular involvement was found in 17 patients (approx. 57%). In 16 of these 17 patients with pathologic ophthalmologic findings (approx. 94%), AIDS was already fully developed. Ocular involvement is therefore a sign of poor prognosis. Fourteen patients had a microvascular retinal syndrome and four patients had infectious (chorio-)retinitis (causative organisms: cytomegalovirus in three cases, Cryptococcus neoformans in one). Further findings included sicca syndrome with superficial punctate keratitis in two cases, keratitis in one patient with generalized mucocutaneous candidiasis, Kaposi's sarcoma of the eyelids in two cases, Kaposi's sarcoma of the conjunctiva in one case, papilledema with cryptococcal meningitis in one case, and atypical hordeolum in one case. Morphologic and pathogenetic aspects of the ophthalmologic findings, their importance and course in AIDS patients, and therapeutic problems are discussed.
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PMID:[Eye involvement in AIDS]. 282 96

Viral infections, predominantly those of the herpes virus family, account for up to 16% of all clinically significant infections in AIDS patients. Acyclovir has provided successful treatment in AIDS patients suffering from severe herpes simplex and herpes zoster virus infections. Preliminary results are presented on newly developed acyclovir analogues. Desciclovir, an oral prodrug of acyclovir which is metabolized to acyclovir in vivo, allows treatment of virus infections per os, where high serum levels are needed, e.g. in Epstein-Barr virus infections. BW B759U, another analogue of acyclovir, has been used for the treatment of life-threatening or sight-threatening cytomegalovirus infections in AIDS patients. More than 80% of the patients treated for retinitis experienced stabilization or clinical improvement. Antiviral efficacy was demonstrated in 73% of the patients. Azidothymidine, a nucleoside analogue of thymidine, has been developed specifically to treat the HIV infection. Its antiviral activity is based on inhibition of reverse transcriptase. Phase I studies have demonstrated that azidothymidine is well tolerated. Its ability to cross the blood brain barrier makes it an attractive candidate for treatment of HIV. Trials to determine efficacy are in progress.
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PMID:Management of viral infections in AIDS patients. 303 16


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