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

A case of progressive multifocal leukoencephalopathy (PML) is reported, detected at autopsy of a 30-year-old patient. The clinical picture was characterized by a progressive course of mental deterioration and ingravescent neurological symptoms. The patient was HIV-negative. He died of bronchopneumonia, after a clinical course of 13 months. Autopsy disclosed pulmonary tuberculosis with involvement of regional lymph nodes. In the brain, besides numerous PML-foci of varying age and structure, a pleomorphic astrocytoma was found in the white matter of the right parietal lobe. In the brain stem glial proliferation resembling diffuse gliomatosis was also present. In situ hybridization revealed Papova-virus (JCV) in oligoglial nuclei, but not in neoplastic astrocytes. This is the third report on the concomitant occurrence of PML and glioma in man.
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PMID:Progressive multifocal leukoencephalopathy and gliomas in a HIV-negative patient. 130 Jun 8

Between January-June 1989, researchers evaluated 473 admissions and 100 deaths at the Pulmonary Medicine Service at the University Hospital in Abidjan, Ivory Coast to determine prevalence of HIV-1 and HIV-2 infections, to look at death rates in relation to HIV status, and to examine the pulmonary pathology associated with these infections compared with deaths in HIV negative patients. HIV-1 seroprevalence was 38%, HIV-2 4%, and dual HIV reactive 14%. The death rate for the entire sample was 21%. It was higher in HIV seropositive patients than HIV seronegative patients (27% vs. 14%; relative risk=1.95 times). HIV seropositive patients regardless of HIV group essentially died from the same diseases: 40% from pulmonary tuberculosis (disseminated nonreactive multibacillary pattern), 34% from nonspecific pneumonia, 8% from Pneumocystis pneumonia, 6% from Kaposi's sarcoma, and 4% from lung cancer. Among only HIV-1 seropositive cases, Pneumocystis carinii was the cause of death in only 95 of cases. The leading causes of death for HIV seronegative patients included lung cancer (64%), nonspecific pneumonia (28%), and pulmonary tuberculosis (4%). Researchers should be pressed to develop more sensitive means to diagnosis tuberculosis as well as prophylaxis against reactivation of tuberculosis among HIV seropositive people in Africa. Since Pneumocystis carinii infection is uncommon among HIV seropositive people in Africa, prophylaxis for it is not needed.
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PMID:Pneumocystis carinii pneumonia. An uncommon cause of death in African patients with acquired immunodeficiency syndrome. 131 14

The US Centers for Disease Control (CDC) plan to expand the AIDS surveillance case-definition for the US in december 1992. The definition will add pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer to the list of 23 AIDS-defining diseases, and will classify all HIV-positive adolescents and adults without any of the 26 diseases, but with less than 200 CD4 T lymphocytes/ul, as having AIDS. Accordingly, many more infected individuals will meet the AIDS case-definition. This article briefly discusses the pros and cons of the CDC's action. As severe HIV morbidity increases with better and more drug therapy and prophylaxis, alternative methods of monitoring HIV morbidity are needed to plan health care. While CD4 counts may help plan and provide care, many countries have not developed quality assurances schemes for such measures. Many HIV-infected individuals will be classified as having AIDS for 2 additional years, and the broader definition will not affect patient access in most European nations. Other ways exist to monitor the prevalence of severe HIV morbidity. Other developed countries should also recognize 26 AIDS-defining conditions, yet use CD4 only to classify HIV, and not define AIDS.
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PMID:Changing case-definition for AIDS. 136 Jan 19

CDC has revised the classification system for HIV infection to emphasize the clinical importance of the CD4+ T-lymphocyte count in the categorization of HIV-related clinical conditions. This classification system replaces the system published by CDC in 1986 (1) and is primarily intended for use in public health practice. Consistent with the 1993 revised classification system, CDC has also expanded the AIDS surveillance case definition to include all HIV-infected persons who have < 200 CD4+ T-lymphocytes/microL, or a CD4+ T-lymphocyte percentage of total lymphocytes of < 14. This expansion includes the addition of three clinical conditions--pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer--and retains the 23 clinical conditions in the AIDS surveillance case definition published in 1987 (2); it is to be used by all states for AIDS case reporting effective January 1, 1993.
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PMID:1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. 136 52

Altogether 155 patients with a newly detected positive reaction to HIV (a human immunodeficiency virus) were investigated in the Republic of Burundi. Chest x-ray was done in 80 of them. Pulmonary tuberculosis was diagnosed in 2 of them, pneumonia (chronic, interstitial and bronchial)--in 15. Enhancement and deformity of lung marking were detected in 45 patients (coincidence with clinical signs of acute bronchitis was found but in 5 of them). A conclusion has been made of interstitial pneumonias being typical of HIV-infected patients and of frequent enhancement of lung marking in the preclinical stage of AIDS.
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PMID:[Radiologic pulmonary manifestations in patients with HIV virus infection]. 136 94

Evidence from many countries suggests an association of human immunodeficiency virus (HIV) infection and tuberculosis of major public health significance. In order to begin assessing the impact of HIV on tuberculosis in Kenya, we have determined the HIV-1 seroprevalence among tuberculosis patients and compared the clinical characteristics of tuberculosis in HIV-positive and HIV-negative patients in two cross-sectional studies at the Infectious Disease Hospital (IDH) and the Ngaira Avenue Chest Clinic (NACC), Nairobi, Kenya. The diagnosis in 92% of all patients with pulmonary tuberculosis was confirmed by culture. The remainder were diagnosed on histological, clinical or radiological grounds. HIV seroprevalence among tuberculosis patients at IDH was 26.5% (52/196) compared to 9.2% (18/195) at NACC (P less than 0.001). There was no association between numbers of streptomycin injections in the previous 5 years and HIV infection. Positive sputum smear rates in HIV-positive patients were slightly lower than in HIV-negative patients at both study sites (71% vs 83% at IDH and 73% vs 82% at NACC) but the difference was not significant. Only Mycobacterium tuberculosis was isolated. Miliary disease was not associated with HIV infection. Persistent diarrhoea, oral candidiasis, generalized itchy rash, herpes zoster and generalized lymphadenopathy were all associated with HIV infection, but 46% (95% CI:38-54%) of all HIV-positive patients had none of the clinical features listed in the WHO Clinical Criteria for the Diagnosis of AIDS, apart from fever, cough and weight loss. Stevens-Johnson Syndrome was reported in 7/52 (13%) patients with HIV infection, and in 4/144 (3%) patients without (RR 4.85, 95% CI: 1.45-15.88).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cross-sectional survey of HIV infection among patients with tuberculosis in Nairobi, Kenya. 138 70

We analyze serum samples from 70 patients with pulmonary tuberculosis and 50 healthy individuals. The antigenic activity (IgG) against protein purified antigen (PPD) and antigen 60 (A60) from M. tuberculosis. Thirteen patients were also HIV infected, and three patients had AIDS defined by the presence of disseminated tuberculosis. The test using antigen alone showed a 77% sensitivity and 74% specificity when PPD is used. When A60 was used, both values improved (81% sensitivity, 94% specificity). The use of a combined test (PPD and A60) improves the sensitivity (89%) but reduces the specificity (82%). The HIV infected patients showed similar responses to those of other patients. The combined use of different antigens might be useful for diagnosing tuberculosis.
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PMID:[Antigenic response against PPD and antigen 60 in tubercular patients: single antigen versus the combined test]. 139 Sep 96

Data on 887 AIDS cases in Zimbabwe were collected at the District Hospital in Hurungwe, Zimbabwe, from 1986-89 before the official notification system included this disease. The number of cases increased from 19 in 1986 to 290 in 1987, 433 in 1988, and 145 in the first 3 months of 1989. The female male ratio in adults were 1.4. There were 102 children under 5 with AIDS and the 5 children aged 5-15, who were all female. The presenting signs and symptoms were most often persistent generalized lymphadenopathy, chest infection, herpes zoster, chronic STDs, and chronic diarrhea with weight loss. There were 44 cases of HIV-positive pulmonary tuberculosis; 8 patients being treated for tuberculosis developed Stevens-Johnson syndrome. Of patients, overall, with herpes zoster, 89% were HIV-positive, of those with oral thrush, 83% were HIV-positive, of those with generalized lymphadenopathy, 76% were HIV-positive, and of those with weight loss and chronic diarrhea, 70% were HIV-positive. The Hurungwe District lies along the road from harare to Lusaka, Zambia, where long-distant truck drivers frequently interact with the locally mobile population. The authors suggest that herpes zoster, with its ease of diagnosis, be used as a tool to follow the spread of HIV.
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PMID:Pattern of HIV-infection in Hurungwe district, Mashonaland West, Zimbabwe. 139 93

This article reviews the clinical aspects and diagnosis of HIV-associated tuberculosis in developing countries, and summaries WHO's recommendations for treatment. According to WHO estimates (early 1992) over 4 million persons worldwide have been infected with HIV and tuberculosis; 95% of them are in the developing countries. Clinical features of HIV-associated pulmonary tuberculosis in adults are frequently atypical, particularly in the late stage of HIV infection, with non-cavitary disease, lower lobe infiltrates, hilar lymphadenopathy, and pleural effusion. More typical post-primary tuberculosis with upper lobe infiltrates and cavitations is seen in the earlier stages of HIV infection. Extrapulmonary tuberculosis is reported more frequently, despite the difficulties in diagnosing it. WHO's recent guidelines recommend 6-month short-course chemotherapy with isoniazid, rifampicin, pyrazinamide, and ethambutol for patients with HIV-associated tuberculosis. The older 12-month regimen without rifampicin is much less effective. Streptomycin should not be used, because of the risk of transmitting blood-borne pathogens through contaminated needles. Thioacetazone should be abandoned, because of severe averse reactions observed among HIV-infected patients. The roles of preventive chemotherapy and BCG vaccination for prevention of tuberculosis are also briefly discussed. (author's)
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PMID:HIV-associated tuberculosis in developing countries: clinical features, diagnosis, and treatment. 139 86

The efficacy of bronchoscopy for the diagnosis of tuberculosis in patients infected with human immunodeficiency virus (HIV) has not been systematically evaluated. We therefore compared the diagnostic yield of bronchoscopy in 67 HIV-infected and 45 non-HIV-infected patients with culture-proven pulmonary tuberculosis. In all cases, acid-fast smears of sputum were negative or not obtained prior to bronchoscopy. Prebronchoscopic sputum culture yielded Mycobacterium tuberculosis in 34 (89 percent) of 38 HIV-infected patients and 26 (93 percent) of 28 non-HIV-infected patients from whom specimens were obtained. Bronchoscopy provided an early diagnosis of tuberculosis (positive acid-fast smear or granulomata on biopsy) in 23 (34 percent) of the HIV-infected patients and 20 (44 percent) of the patients without HIV infection. The sensitivities of the acid-fast smear and of mycobacterial culture of bronchoscopic specimens and postbronchoscopic sputum were similar in patients with or without HIV infection. In HIV-infected patients, granulomatous inflammation was noted on transbronchial biopsy in 11 (19 percent) of 59 patients with HIV infection, compared to 16 (43 percent) of 37 patients without HIV infection (p = 0.01). Nevertheless, transbronchial biopsy provided the exclusive means for an early diagnosis of tuberculosis in six (10 percent) of 59 HIV-infected patients. We conclude that the yield of bronchoscopy for the diagnosis of pulmonary tuberculosis in HIV-infected patients is similar to that in patients without HIV infection, and that transbronchial biopsy provides incremental diagnostic information not available from evaluation of sputum or bronchoalveolar lavage fluid.
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PMID:Yield of bronchoscopy for the diagnosis of tuberculosis in patients with human immunodeficiency virus infection. 139 40


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