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

A patient admitted to your unit this morning presents a dauntingly complex clinical picture. Maria DeJesus, 34 years old, has HIV infection, which progressed to AIDS last year with an episode of Pneumocystis carinii pneumonia. She's also experienced recurrent vaginal and esophageal candidiasis and cryptococcal meningitis, and her more recent history includes peripheral neuropathy, causing pain and numbness, as well as cognitive and motor function problems. Her admission was prompted by diarrhea that has persisted despite outpatient treatment. To provide the best care for patients like Ms. DeJesus, you need to understand HIV infection and the diseases associated with it. Yet that's a challenging task, given that the possible manifestations of advanced infection are so many and varied. Though your approach to care is holistic, you may find it helpful to consider the numerous facets of the patient's illness individually. In the following pages, we'll examine how HIV enters the body, infects immune cells, and eventually cripples the immune system. We'll look at some of the more common opportunistic infections preying on people with HIV. And we'll explore the less well-charted territory of complications attributed to HIV infection of the central and peripheral nervous systems.
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PMID:Understanding the devastation of AIDS. 924 79

This study examines case records of adult AIDS and HIV symptomatic patients admitted to the Siriraj Hospital's Department of Medicine during January 1993 and December 1995. The study aims to determine the medical care cost of adult AIDS patients admitted to the observation room, hospital, and HIV and Counseling Clinic and to determine which factors are the most costly. An AIDS diagnosis is determined according to the Thailand Ministry of Health protocols. Costs include medication cost, facility cost, and testing in 1995 baht prices. Government-supplied medicines are not included in the cost. AIDS cases numbered 196, 227, and 182 adult persons in the respective years 1993, 1994, and 1995. The median CD4 lymphocyte count was 59 cells/mm. The median duration of visit was 14 days. AIDS patients occupied 5.4-7% of inpatient admission beds. 17.6-18.8% of patients were readmitted during the year. 26.4% to 33.7% died before discharge. The leading cause of admission was tuberculosis cryptococcal meningitis, pneumocystis carinii pneumonia, diarrhea, salmonellosis, and toxoplasmosis. The number of AIDS cases admitted to the observation room for 2-5 days increased from 572 cases in 1993 to 1205 cases in 1995. However, due to space limitations, only 15% of AIDS patients under observation were admitted to the hospital in 1995. About 600 cases each year were followed up for complications. Medical care costs were 1452 baht/day/patient for admissions; 1509 baht/day/patient in an observation room; and 1132 baht/month/patient for HIV counseling care. The average cost for all adult AIDS patients/year rose from 18,726,176 baht to 26,812,204 baht during 1993-95. Medicine costs almost tripled for treating cryptococcoses. Treatment costs are lower in provincial hospitals. There is a need for the establishment of a referral network, hospice care, and low costs for treatment.
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PMID:The mounting medical care cost for adult AIDS patients at the Faculty of Medicine, Siriraj Hospital: consideration for management. 927 72

We studied 17 consecutive cases of acute polyradiculopathy (PR) diagnosed in HIV-infected patients to investigate the possible causes of this syndrome in our milieu. Sixteen patients presented with lumbosacral PR and one patient had predominantly cervical PR. Electrophysiological study showed a predominantly motor axonal neuropathy in all patients examined. Six patients had a laboratory-confirmed aetiology for the PR: cytomegalovirus (CMV) was isolated from cerebrospinal fluid (CSF) in three cases, meningeal lymphomatosis was diagnosed by CSF cytology in two cases, and one patient had cryptococcal meningitis. Another patient was thought to have acute axonal polyradiculoneuritis associated with HIV infection. CMV and Mycobacterium tuberculosis were the probable agents in four and three patients, respectively. Finally, in three patients a cause could not be foscarnet were effective in the treatment of definite or probable CMV PR. The present study confirms that acute lumbosacral PR in HIV-infected patients must be considered a syndrome with different causes. CMV and M. tuberculosis infections were the most frequent causative agents in our series (41% and 18% of the cases, respectively). Early empirical therapy is often necessary as definite diagnosis may be delayed or never achieved. Our experience suggests that, at least in our milieu, anti-tuberculous drugs should be considered in some cases together with ganciclovir or foscarnet in the empirical therapy for PR in HIV-infected patients.
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PMID:Acute polyradiculopathies in HIV-infected patients. 930 56

New highly active antiretroviral therapies are boosting the blood absolute CD4+ counts of many patients with AIDS and are decreasing the prevalence of AIDS-related opportunistic infections. Nevertheless, the prevention, diagnosis, and treatment of opportunistic infections remain important features of management of HIV infection. In recent years, significant advances have been made in the prevention and treatment of opportunistic diseases such as Pneumocystis carinii pneumonia, Cytomegalovirus retinitis, disseminated Mycobacterium avium-intracellulare infection, and mucosal candidiasis. Tuberculosis, cryptococcal meningitis, herpes simplex virus infection, shingles, and infectious enteritis also continue to be troublesome. Kaposi's sarcoma may be the newest AIDS-related opportunistic infection to be identified. The immune system effects of highly active antiretroviral therapy are as yet poorly understood. Therefore, an aggressive approach to diagnosis and treatment of opportunistic infections remains mandatory, and patients receiving antiretroviral therapy should continue to adhere to recommendations for prophylaxis against such infections.
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PMID:Preventing and treating major opportunistic infections in AIDS. What's new and what's still true. 933 1

The frequency of intracerebral mass lesions (ICML) in patients with human immunodeficiency virus (HIV) infection and cryptococcal meningitis (CM) is not well established. Cryptococcoma seems to be a rare affliction. The objective of this study was to analyze the etiology of ICML in patients with HIV infection and CM. The methodology was a retrospective review of cases diagnosed in two Spanish hospitals between September 1988 and April 1995. Eighteen cases of CM were identified. Computed tomography was performed on presentation in 17 cases. Only one patient had ICML, which progressed while on antifungal treatment and regressed when anti-Toxoplasma treatment was established. During follow-up, two additional patients developed ICML and were successfully treated as toxoplasmosis. Overall, 3 out of 17 patients (18%) developed ICML and all three were cured when anti-Toxoplasma treatment was implemented. In our study, cerebral toxoplasmosis was the only presumed cause of ICML. In areas of high prevalence of toxoplasmosis, ICML in patients with CM may not be cryptococcomas. Consequently, in these areas of high prevalence, a trial of toxo-therapy should be strongly considered for patients with CM and ICML.
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PMID:Intracerebral mass lesions in patients with human immunodeficiency virus infection and cryptococcal meningitis. 940 12

The clinical use of fluconazole in dosages > or = 800 mg/day has been reported in about 900 patients against candidemia, oropharyngeal candidiasis and cryptococcal meningitis in HIV-infected patients as well as for initial therapy of endemic mycoses. Especially in patients with life-threatening infections caused by Candida spp., Cryptococcus neoformans and Coccidioides immitis, the results of a limited number of dose-finding trials with non-neutropenic and HIV-infected patients show dose-dependent response rates. These findings strongly advocate the application of high dose-fluconazole; their evaluation, however, still awaits final clarification. The good safety profile for dosages up to 2000 mg/day and the linear, predictable pharmacokinetics up to 1600 mg/day indicate the excellent tolerability of fluconazole in the clinical situation which justifies prospective, randomized clinical trials with treatment groups as homogeneous as possible for further evaluation of the optimum dosage and duration of treatment.
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PMID:[High-dose therapy with fluconazole > or = 800 mg/day. Review]. 941 11

The prevalence of human immunodeficiency virus (HIV) infection among Central Americans is increasing. The purpose of this study was to describe the epidemiology of HIV infection among local Central American immigrants in the United States. Medical records of HIV-infected Central Americans treated at Harris County Hospital District (HCHD) facilities, the major source of indigent care in Houston, Texas, were retrospectively reviewed. Between January 1, 1990 and February 28, 1995, 18,156 Central Americans were seen at HCHD facilities, of whom 56 (13 females and 43 males) were identified as HIV-infected (0.3% versus 1.3% of all locally treated patients; P < 0.001, by test of binomial proportions). Most were from Honduras (n = 25) or El Salvador (n = 23). The mean age was 28.7 years, the mean CD4+ lymphocyte count at presentation was 173 cells/mm3, and 36 (64%) had acquired immunodeficiency syndrome (AIDS) at presentation. The 13 women (23% versus 22% for all locally treated HIV patients) were disproportionately Honduran (10 of 25 Hondurans versus 3 of 31 other Central Americans; P = 0.011). The HIV risk factors included heterosexuality in 46%, homosexuality in 29%. and a history of injection drug use in 7% (versus 10%, 57%, and 34%, respectively, for all locally treated HIV patients). The 76 diagnosed opportunistic infections (OIs) included a disproportionately greater number of patients with tuberculosis (n = 14, 33% versus 6% of all locally treated AIDS patients), toxoplasmosis (n = 10, 24% versus 7%), and cryptococcal meningitis (n = 9, 21% versus 7%), and a lower number of patients with pneumocystosis (n = 12, 29% versus 43%) and candida esophagitis (n = 2, 5% versus 16%). Central American immigrants infected with HIV present with relatively advanced disease, and the most frequent OIs are diseases for which effective prophylaxis exists. Targeted HIV screening and early intervention in this group are warranted.
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PMID:Epidemiology of human immunodeficiency virus infection in Central Americans treated in Harris County, Texas Hospital District facilities. 943 May 26

Thirty-seven matched cerebrospinal fluid (CSF) and plasma samples from 34 human immunodeficiency virus type 1 (HIV-1)-infected patients with suspected meningitis were analyzed for levels of HIV-1 RNA and markers of inflammation. Patients with tuberculous (n = 9) or cryptococcal (n = 6) meningitis had the highest CSF virus loads, which in many cases exceeded the levels in plasma, compared with patients with meningococcal meningitis (n = 3), aseptic meningitis (n = 8), tuberculoma (n = 2), or AIDS dementia complex (n = 4) or with normal lumbar punctures (n = 3). CSF virus load correlated significantly with the number of infiltrating lymphocytes (r = .60, P < .001) but not with plasma virus load, the levels of beta2-microglobulin in the CSF, or the integrity of the blood-brain barrier. These data suggest significant intrathecal HIV-1 replication in patients with lymphocytic meningeal infections such as tuberculous and cryptococcal meningitis.
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PMID:High human immunodeficiency virus type 1 RNA load in the cerebrospinal fluid from patients with lymphocytic meningitis. 946 41

Fluconazole dosages greater than 800 mg day-1 have been reported in about 900 patients treated for candidemia, oropharyngeal candidiasis and cryptococcal meningitis in HIV-infected patients, and for initial therapy of endemic mycoses. In patients with life-threatening infections caused by Candida spp., Cryptococcus neoformans and Coccidioides immitis, results of a limited number of dose-finding trials with non-neutropenic and HIV-infected patients show dose-dependent responses. These study results indicate that higher daily doses of fluconazole than are currently approved for these indications are well tolerated and tend to provide better clinical efficacy in selected patient populations. An excellent safety profile of dosages up to 2000 mg day-1 and linear predictable pharmacokinetics up to 1600 mg day-1 appear to justify further clinical investigations to better determine the optimum dosage and duration of treatment.
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PMID:High-dose therapy with fluconazole > or = 800 mg day-1. 947 9

The last part of the review of the neurological syndromes observed among people who are HIV-infected deals with AIDS Dementia Complex, viral (CMV, HSV, VZV) encephalitides and cryptococcal meningitis and other less frequent diseases. Clinical presentation, neuropathology, diagnostic procedures and treatments are described. Diagnostic algorithm for central nervous system diseases in people with HIV is included. The main purpose of the present reviews is to pursue the common ground regarding treatment and diagnostic procedures with consulting neurologists and neurosurgeons for future cooperation in a growing area of HIV related neurology.
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PMID:[Neurological syndromes in HIV patients. Part III -- HIV-related diffuse diseases of the central nervous system]. 951 58


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