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

Almost one third of persons with AIDS acquire retinitis caused by the opportunistic cytomegalovirus (CMV). Both ganciclovir and foscarnet have been approved for treatment of CMV retinitis and are equally effective. However, their side effects are not the same, and each may have a different impact on the overall course of HIV infection and AIDS. The drug chosen should be administered promptly when sight-threatening disease is diagnosed to ensure maximal vision for the longest time.
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PMID:Cytomegalovirus retinitis in persons with AIDS. Selecting therapy for a sight-threatening disease. 781 8

HLA phenotype and immune responses to CMV were studied to determine whether the subset of AIDS patients who developed CMV retinitis were immunogenetically or immunologically predisposed. CMV retinitis develops in approximately 28-35% of AIDS patients and CMV encephalitis develops in 40% of those with retinitis, often leading to death. T-cell proliferation responses to CMV and HIV were assayed prospectively in individuals enrolled in a longitudinal study at the HIV Neurobehavioral Research Center (HNRC) in San Diego. Seventy-three participants, at various stages of disease, have been HLA typed and followed, clinically and immunologically, for up to 5 years. Six HIV infected individuals who eventually developed CMV retinitis, and were assayed prospectively, had a history of low T-cell proliferation to CMV antigens before they were profoundly immunosuppressed. All 10 individuals with CMV retinitis had at least one of three HLA alleles (or combinations): A2B44 (p = 0.02), B51(p = 0.02), or DR7 (p = 0.01) (collective p value = 0.007). Three of the 10 had two or more of these alleles. Of AIDS patients with CD4 counts below 100 and actively at risk for retinitis, 7/15 with A2B44,51, or DR7 have developed retinitis compared to 0/13 without these HLA alleles (relative risk = 23.8). All 4 patients with these alleles who have died, had retinitis. These results suggest that HIV infected individuals with HLA phenotypes A2B44, B51, and DR7 have low T-cell immune responses to CMV and are predisposed to CMV retinitis and encephalitis as immunodeficiency progresses.
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PMID:CMV-specific immune responses and HLA phenotypes of AIDS patients who develop CMV retinitis. HNRC Group. HIV Neurobehavioral Research Center. 787 1

During November 1989 to December 1991 in Senegal, physicians regularly followed 67 HIV infected patients aged 20-76 (46 men and 21 women) who had been admitted to Fann University Hospital in Dakar. The HIV infection had progressed to AIDS in all but one case. 52.33% had ocular lesions, of which the most frequent were cotton-like nodules (14.2%), retinal bleeding and Roth's spots (8.5%), and ophthalmic herpes zoster (8.5%). Most lesions (63%) were located in the retina. Yet, there were no cases of classic retinitis. Among 21 AIDS patients with a known lymphocyte count, 62.5% of those with a CD4 count of less than 200 had a normal ophthalmological examination. Patients with CD4 counts between 0 and 200 had macular edema, hyalitis, cotton-like nodules, retinal uveitis, and microangiopathy, while those with higher CD4 counts had none of these ocular lesions. Patients with CD4 counts greater than 400 had conjunctivitis (one case, Kaposi sarcoma-related conjunctivitis), ophthalmic herpes zoster, and ocular dryness. The only ocular lesion in patients with CD4 counts between 200 and 400 was ophthalmic herpes zoster. 77.14% of HIV infected patients with ocular lesions were infected with HIV-1. The three ophthalmic herpes zoster cases were less than 30 and homosexual. During the two years of follow-up, only one case died. Based on these findings, the authors suggest that ophthalmologists should systematically be involved in the routine care of AIDS patients, particularly by screening for changes in the retina.
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PMID:[Ocular manifestations of AIDS in Dakar]. 788 59

Majority of AIDS patients experience visual loss due to AIDS-associated retinitis or commonly known as CMV retinitis. It has been reported that CMV infection of the retina is a late manifestation of AIDS and a poor prognostic sign. The etiology and mechanism(s) involved in the development of AIDS-associated retinitis is currently unknown. It is of critical importance to understand the pathobiology of this disease process in order to develop a rational approach to therapeutic intervention. We have determined the frequency and proximity of simultaneous occurrence of HIV-1 and HHV-6 in retinal tissues of AIDS patients in the absence of CMV infection. Active infection of HIV-1 has been identified in the retinal tissues of 30-60% of AIDS patients analyzed. HHV-6 antigens and transcripts were detectable in about 50% of HIV-1 positive retinas. Most significant finding of our studies is the presence of HIV-1 and HHV-6 antigens and transcriptional activity in retinal tissue in the absence of CMV infection. These observations suggest that HIV-1 in association with HHV-6 may predispose certain retinal cells to other opportunistic agents such as CMV in late stages of AIDS-associated retinitis.
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PMID:Possible role of HHV-6 in the development of AIDS retinitis. 789 79

Human immunodeficiency virus infection is the first major pandemic of the 20th century. At present, almost 10 million people are known to be infected with this virus, and it is estimated that by the year 2000, approximately 40 million people will be infected. Transmission of this deadly infection is predominantly by sexual contact. Individuals infected with this virus pass through several predictable stages with progressive decrease in circulating CD4+ T cells. During the advanced stage, these patients develop various opportunistic infections or malignancies, or both. It is this advanced stage that was first recognized as AIDS, which has a 100% mortality rate. The opportunistic organisms that can involve the eye in patients with AIDS include cytomegalovirus, herpes zoster, Toxoplasma gondii, Mycobacterium tuberculosis, Cryptococcus neoformans, Mycobacterium avium-intracellulare, Pneumocystis carinii, Histoplasma capsulatum, Candida, and others. Intraocular lesions from these agents often represent disseminated infections. Visual morbidity occurs secondary to retinitis due to cytomegalovirus, herpes zoster, or Toxoplasma gondii. Anti-viral agents such as ganciclovir or foscarnet are effective against cytomegalovirus infection. The role of the ophthalmologist in the diagnosis and management of AIDS is becoming increasingly important. Not only does the eye reflect systemic disease, but ocular involvement may often precede systemic manifestations. In the AIDS patient, the ophthalmologist thus has an opportunity to make not only a slight-saving, but also life-saving diagnosis of disseminated opportunistic infections.
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PMID:Acquired immunodeficiency syndrome and its ocular complications. 792 32

An open prospective trial of combined ganciclovir and foscarnet therapy for 3 weeks was initiated in 14 episodes of severe CMV-disease in 13 HIV-infected patients (all CDC class IV, age 30-42, median 34 years, CD4+ cell count 0-80, median 10/microliters). In seven episodes of gastrointestinal disease (five colitis, two esophagitis) remission of symptoms and mucosal changes was achieved in five. In seven episodes of retinitis, scarring was achieved in six. Renal toxicity was seen in two patients, moderate hematologic toxicity in eight patients. Overall efficacy was comparable to monotherapy; no new toxicities were seen with the combination of these two drugs.
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PMID:Foscarnet and ganciclovir combination therapy for CMV disease in HIV-infected patients. 792 16

Cytomegalovirus (CMV) infection is a substantial cause of morbidity and mortality among immunocompromised patients. It may present with a mild, self-limited syndrome, retinitis, colitis, or invasive disease with pneumonitis, hepatitis, and bone marrow suppression. We review another, less common manifestation of CMV disease: CMV-associated vasculitis. CMV may productively infect vascular endothelial cells (25), causing a local vasculitis (3, 14, 19) and ischemia. Alternatively, the host immune response to cells expressing viral antigen may be the stimulus for vasculitis (12, 53). Since there are no pathognomonic appearances to mucosal or cutaneous lesions, biopsy of accessible sites is critical for diagnosis and expeditious initiation of appropriate antiviral therapy. The CMV-associated vasculitides represent a broad spectrum of diseases, with GI vasculitis in nontransplant recipients having the best prognosis. Cutaneous vasculitis associated with CMV seems to be a more fulminant disease, with the majority of cases having a fatal outcome. These differences likely reflect the degree of viral burden and the state of immune competence. Additionally, since the virus itself is immunosuppressive, host defenses may be further compromised by the infection. Although a large collective experience assessing the impact of ganciclovir and foscarnet is not currently available, both the prompt initiation of antiviral treatment and a concurrent reduction in any immunosuppressive regimen, including steroids, should be undertaken since these therapeutic strategies have clearly improved outcome for other CMV syndromes (22, 34, 55). As the number of recipients rises and the HIV pandemic spreads we are likely to see an increase in the number of cases of vasculitis associated with CMV infection.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cytomegalovirus vasculitis. Case reports and review of the literature. 793 9

Human herpesvirus 6 (HHV-6) was discovered in 1986. This novel virus is genetically related to cytomegalovirus. HHV-6 mainly infects T lymphocytes but its tropism appears to be much wider and probably involves some epithelial cells. Two HHV-6 variants, designated as A and B, can be distinguished by genetical and immunological analysis. HHV-6 infection is ubiquitous and widespread; it occurs most often during infancy and it is life-long. During primary infection, HHV-6 is the causative agent of exanthem subitum and fever episodes without rash in infants. HHV-6 is suspected to be the causative agent of opportunistic infections such as pneumonitis and retinitis in immunocompromised subjects. Its role in human immunodeficiency virus infection, lymphomas and chronic fatigue syndrome is controversial. In vitro, HHV-6 is sensitive to ganciclovir and foscarnet.
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PMID:[A new virus: the human herpesvirus 6]. 793 95

Ten to forty percent of the patients with acquired immunodeficiency syndrome (AIDS) develop sight- or life-threatening cytomegalovirus (CMV) infections. In some patients with AIDS, CMV is detected in the bronchoalveolar lavage fluid (BALF), urine, and other specimens, even when there are no symptoms of CMV disease. An indicator of active CMV infection is needed to facilitate the diagnosis of CMV disease in patients with AIDS or HIV infection and the evaluation of the efficacy of subsequent treatment. The present study was conducted during the period from 1993 to 1994. The subjects consisted of three patients with AIDS and a confirmed diagnosis of CMV disease (one case of retinitis, one case of gastrointestinal disease and one case of pneumonia), and five HIV-positive patients in whom CMV associated disease was ruled out. Those patients were monitored occasionally for the following parameters of active CMV infection and disease: expression of CMV antigen in the nucleus of polymorphonuclear leukocyte (CMV antigenemia), as it was determined with a monoclonal antibody against a lower matrix protein (p65); infectious CMV detected by shell vial method; CMV DNA detected by PCR; anti-CMV antibody titer; and histological findings. CMV p65 antigen was detected in the leukocytes of both the peripheral blood and BALF during the early phase of CMV disease in three out of three cases of the CMV disease group, and this antigen became negative in two out of two cases who responded to the therapy. All the five patients in the CMV-related-disease-negative group were negative for CMV antigenemia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Detection of cytomegalovirus (CMV) antigen for rapid diagnosis and monitoring of CMV diseases in AIDS]. 796 1

Cytomegalovirus (CMV) causes severe necrotizing retinitis in patients with the acquired immune deficiency syndrome (AIDS) and other herpesviruses have been implicated in the acute retinal necrosis syndrome (ARN), seen in both the immunocompetent and the immunosuppressed. At present the diagnosis of viral retinitis relies solely on clinical appearances. In order to assess whether the detection of herpesvirus-specific DNA in cell-free vitreous biopsy samples could be useful in the early diagnosis of viral retinitis, vitreous fluid samples were taken from 100 patients. Fifty patients had AIDS as defined by the Centers for Disease Control, (MMWR 36 (suppl 1S):1S-15S, 1987) and retinal disease. The remainder were not known to be HIV infected and had no clinical evidence of retinal infection. Each sample was tested for the presence of CMV, herpes simplex virus 1 (HSV-1), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), and human herpesvirus 6 (HHV6), by amplification of viral DNA using a sensitive and specific nested polymerase chain reaction (PCR). The presence of detectable CMV or VZV DNA was clearly associated with clinical disease whereas the presence of HSV-1, EBV, and HHV6 sequences were not. Clinical discrimination between CMV- and VZV-associated retinitis was greatly enhanced when the PCR results were taken into consideration.
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PMID:Vitreous fluid sampling and viral genome detection for the diagnosis of viral retinitis in patients with AIDS. 796 43


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