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

Glycoprotein B (gB) is involved in cell to cell transmission of human cytomegalovirus (HCMV) and may be a critical factor in tissue tropism and viral pathogenesis. We analyzed the distribution of the four known gB genotypes of HCMV in 99 HIV-positive patients. 29 patients had HCMV retinitis, and 70 patients had asymptomatic HCMV infection. DNA was isolated from blood, urine, and aqueous humor, and gB genotypes were determined by PCR and restriction analysis. Infections with gB type 1 were less frequent in patients with retinitis than in patients with asymptomatic HCMV infection (17% versus 37%; p = 0.05). Furthermore, the gB type was correlated with dissemination of infection. In patients with HCMV detected in only one compartment (blood or urine) the gB type 1 was found more frequently than in patients with HCMV detected in at least two compartments (p = 0.01). The data show that gB genotypes differ in their association with clinical disease, and indicate that the gB genotype may contribute to the course of HCMV infection.
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PMID:Glycoprotein B genotype of human cytomegalovirus: distribution in HIV-infected patients. 895 71

Cidofovir, (S)-1-[3-hydroxy-2-(phosphonylmethoxy)propyl]cytosine, formerly known as HPMPC, is the first antiviral nucleotide analogue available for the treatment of cytomegalovirus (CMV) retinitis. Because cidofovir does not require viral activation, it has two advantages over nucleoside analogues such as ganciclovir and acyclovir. Cidofovir is active in uninfected cells and may act preemptively, and it may retain activity against ganciclovir-resistant strains. Preclinical studies showed the major toxicity of cidofovir to be dose-, schedule-, and species-dependent nephrotoxicity. These studies also showed that concomitant administration of probenecid protects animal models against cidofovir-induced nephrotoxicity. Two phase I-II studies were undertaken in HIV-positive patients with asymptomatic CMV excretion to evaluate several dose-escalation regimens. Data from both phase I-II studies showed that in patients receiving cidofovir at > or =3 mg/kg, the virologic response rate (> or =2 log reduction in CMV titer) was 93% for urine and 74% for semen. In addition, four treatment modifications were indicated to reduce the incidence of cidofovir-related nephrotoxicity: (a) dose reduction or interruption for changes in renal function; (b) concomitant administration of probenecid; (c) administration of 1 L of normal saline 1 h before infusion of cidofovir; and (d) extension of the dosing interval.
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PMID:Cidofovir: a new therapy for cytomegalovirus retinitis. 905 14

Ocular tuberculosis has traditionally been considered uncommon or anecdotal. Imprecise and variable diagnostic criteria have contributed to the confusion surrounding this topic. The increase in extrapulmonary manifestations of tuberculosis during the AIDS era established the need for a prospective study of ocular involvement in patients with all types of tuberculosis using well-defined criteria. During a 15-month period, 300 cases had culture-proven tuberculosis at our institution. We randomly selected 100 for systematic ophthalmologic evaluation. Our criteria for ocular tuberculosis were divided as follows: certainty (isolation of Mycobacterium tuberculosis from ocular specimens), probability (patients with isolation of M. tuberculosis from extraocular samples, with ocular lesions not attributable to other causes that respond to anti-tuberculous treatment), and possibility (same as probability but follow-up impossible). Ocular tuberculosis was present in 18 patients (18%) of which 10 patients fulfilled probability and 8 patients fulfilled possibility criteria. Eleven of 18 patients had HIV infection. In 11 patients, ocular involvement was asymptomatic. Almost all patients (17/18) had choroiditis, and other ocular lesions included papillitis, retinitis, vitritis, vasculitis, dacryoadenitis, and scleritis. Multivariate analysis showed as risk factors independently predicting ocular involvement in patients with ocular tuberculosis the presence of miliary disease (odd ratio 43.92, p = 0.002), ocular symptoms (odds ratio 6.35, p = 0.0143), and decreased visual acuity (odds ratio 0.04, p = 0.012). We observed an unexpectedly high (18%) incidence of ocular involvement, frequently asymptomatic, in patients with tuberculosis. Miliary disease is a clear predisposing factor in both HIV-infected and noninfected populations. Ocular examination should be routinely considered in patients with proven or suspected tuberculosis.
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PMID:Ocular tuberculosis. A prospective study in a general hospital. 906 88

The management of clinically resistant or relapsing cytomegalovirus (CMV) is an emerging therapeutic challenge in patients with advanced HIV infection. The efficacy and tolerability of ganciclovir-foscarnet association has been evaluated in the treatment of severe CMV disease (retinitis in two subjects, systemic disease in the remaining patient), which proved refractory to prior single drug chemotherapy in two cases out of three. A literature review of all patients receiving associated ganciclovir-foscarnet for the treatment of AIDS-related CMV disease is presented, and current perspectives of the antiviral treatment of CMV infection in the immunocompromised host are discussed.
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PMID:The treatment of AIDS-related cytomegalovirus disease with ganciclovir and foscarnet association. Three case reports. 912 37

Three HIV-seropositive subjects presented with diffuse inferior retinal hemorrhages. The first patient had an inferior hemicentral vein occlusion with subsequent development of an inferior cytomegalovirus retinitis. Two other patients had an inferior 'hemorrhagic' cytomegalovirus retinitis mimicking a venous occlusion, with the retinitis being subtle in 1 patient. We speculate that: (1) venous occlusion may predispose to cytomegalovirus infection of the retina by stasis and ischemic loss of endothelium; (2) early cytomegalovirus infection of the large retinal veins may give the picture of a hemorrhagic retinopathy in a subset of patients with cytomegalovirus retinitis. The differential diagnoses of hemorrhagic retinopathy in HIV-seropositive subjects include: cytomegalovirus retinitis, retinal vein occlusion, syphilitic retinitis and retinopathy of severe anemia.
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PMID:Picture resembling hemicentral retinal vein occlusion in the acquired immunodeficiency syndrome: is it related to cytomegalovirus? 914 55

We retrospectively evaluated the role of pp65 antigenemia (AGM) as a marker of cytomegalovirus (CMV) disease and mortality in 241 HIV-infected patients with fever. Of 225 patients in whom CD4 count was available, 189 (84%) had counts below 100/microL and 209 (92.8%) below 200/microL, 149 patients had negative AGM (AGM-) and 92 had positive AGM (AGM+), AGM+ patients were at a more advanced stage of HIV disease, as evaluated by CD4 count (p < 0.001) and prior AIDS diagnosis (p < 0.001). Overall, 29 patients (12%) presented concomitant CMV disease (18 retinitis): 24 (26%) in the AGM+ group and 5 (3.3%) in the AGM- group (p < 0.001). AGM had a negative predictive value of 96.6% but a positive predictive value of 26% which increased to 65% if a cut-off of > 10 CMV-positive cells/10(5) leukocytes was considered. The cumulative rate of future CMV disease at 3 months was 0% in AGM patients, 3% in patients with AGM 1-10/10(5) and 36% in patients with AGM > 10/10(5). In a multivariate analysis, no antiretroviral therapy, AGM+ and CMV disease were independently associated with mortality. The role of AGM as a marker of present CMV disease is limited. However, quantitative AGM may select patients at a high risk of future CMV disease. In addition, AGM may be a marker of shorter survival in severely immunosuppressed HIV-infected patients.
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PMID:pp65 antigenemia as a marker of future CMV disease and mortality in HIV-infected patients. 925 79

AIDS ocular complications have been researched in 70 hospitalised patients in the two main hospitals of Bamako (Mali) during one year (1992-1993). Men were predominant (sex ratio 1.6). HIV1 infections (67%) were most frequent than HIV1 + HIV2 (21.4%) or HIV2 infections (11.4%). Most of the patients were on the WHO's clinical stage III; 34% of them had ocular complications, quite often non infectious: cotonous nodules (10%), vascularitis (5.7%) and retineous haemorrhages (4.3%). Ocular opportunistic infections were rare: only one case of toxoplasmic chorio-retinitis was reported. Ocular complications were observed with all types of HIV. Vascular abnormalities were observed in the stage II or IV of AIDS and seemed, in Bamako, as a serious sign during the AIDS course.
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PMID:[Ophthalmologic complications due to human immunodeficiency virus infection at Bamako (Mali)]. 926 34

Cytomegalovirus (CMV) retinitis, a late complication of infection with HIV, generally leads to blindness if untreated. Although the retinal damage from CMV cannot be reversed, disease progression can be arrested with any one of three antiviral agents, which must be continued indefinitely. Intravenous ganciclovir and foscarnet, the earliest therapies, must be administered every day and require placement of an indwelling catheter. Cidofovir, a newly introduced intravenous antiviral, requires the least frequent administration; after two once-a-week induction doses, maintenance therapy is given only once every other week. However, cidofovir is potentially nephrotoxic and must be coadministered with nephroprotective probenecid and saline hydration. Careful adherence to treatment administration guidelines for cidofovir and probenecid is essential for safe administration of both drugs. Averting and managing adverse reactions to cidofovir and probenecid may present a true nursing challenge; however, with proper patient selection and appropriate use, cidofovir has the potential to greatly enhance the quality of life of a patient with CMV retinitis.
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PMID:Nursing considerations in the use of cidofovir for CMV retinitis in patients with AIDS: report of a roundtable meeting. 929 71

In order to assess the value of quantitative measurement of cytomegalovirus (CMV) antigenaemia as a marker for the guidance of antiviral chemotherapy in the AIDS setting, 33 patients with CMV complications and showing at least 20 pp65-positive polymorphonuclear leucocytes per 2 x 10(5) cells, received either ganciclovir or foscarnet as induction and maintenance therapy. Antigenaemia was assessed every 1-4 weeks. During acute-phase antiviral therapy, a significant decrease of CMV antigenaemia (>50% of pretreatment levels) paralleled clinical improvement in 2-7 weeks in 32 of 33 subjects. In ten of 24 evaluable patients followed up during a further 4-12 months, disease relapses occurred concurrently with an increase of CMV antigenaemia in seven cases, while three cases of relapsing retinitis did not show a significant increase in antigenaemia. All patients with recurrent disease had a favourable response to further treatment, including halted clinical progression and significant decrease in antigenaemia. In HIV-related CMV disease, periodic monitoring of quantitative CMV antigenaemia proves useful in evaluating response to antivirals, in guiding therapeutic management and in predicting disease relapses.
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PMID:Quantitative cytomegalovirus (CMV) antigenaemia during antiviral treatment of AIDS-related CMV disease. 930 1

Out of 180 HIV carriers active cytomegalovirus (CMV) infection was found in 30 patients, in 16 cases the infection manifested clinically. Most of the latter were patients with HIV infection IIIb or IIIc stage against persistent lowering of CD4-lymphocyte count under 100/mm3. Active CMV infection may be determined most significantly by the following criteria: high or moderate concentrations of CMV DNA in the blood, low concentrations of blood CMV DNA in the presence of long-term (at least 3 months) persistence of anti-CMV IgM and isolation of urinary CMV. CMV infection manifested usually as a generalized disease with typical signs of retinitis, myelitis, erosive-ulcerative colitis. Most patients had thrombocytopenia, functionally defective platelets. CNS involvement predicts poor prognosis in CMV-infected HIV carriers.
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PMID:[The diagnosis and clinical characteristics of cytomegalovirus infection in HIV-infected subjects]. 932 98


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