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

A retrospective review of paediatric patients treated for acute burn injuries and receiving blood/blood products between 1978 and 1985, identified 52 patients at risk for HIV infection. Over 50 per cent of the identified population had received 3 or more units of blood/blood products during their acute hospital stay. A total of 214 patients (36.8 per cent) have been tested for HIV seroconversions: five tested HIV positive by ELISA and four were confirmed by Western Blot, yielding a 1.9 per cent incidence. The four confirmed patients received 2-9 total body blood volume turnovers during their postburn period in hospital. At 4 years post-exposure, two patients show active disease, one is currently asymptomatic and one has died from AIDS-related sepsis.
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PMID:Incidence of HIV seroconversion in paediatric burn patients. 164 68

A case is described of an HIV+ man who was successfully treated for Hodgkin's lymphoma, but who later developed non-Hodgkin's lymphoma 3 years later when his immune system became suppressed. The patient was 22 years old when he presented with fever, asthenia, weight loss, and cervical lymphadenopathy. With Hodgkin's lymphoma he also had positive serology for HIV and hepatitis B. He was treated with alternate courses of MOPP and ABVD chemotherapy. In 1990 he again appeared with high fever, progressive cervical, axillary and inguinal lymphadenopathy, with hilar and mediastinal lymph node enlargement on x-ray. CD4 lymphocytes were 577/cubic mm, and the CD4/CD8 ratio was 0.57 (normal 1.8). His cervical lymph node biopsy was classified as non-B non-T large-cell anaplastic lymphoma which was EBV-positive. A Western Blot was positive for small amounts of p24 and p18 antigens. The man was treated with MACOP-B chemotherapy, with some results, but died of sepsis 6 weeks later. The relationships between Hodgkins and non-Hodgkin's lymphoma, the timing of the neoplasm in the course of HIV infection, and the possible re-activation of hepatitis virus were discussed.
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PMID:Non-Hodgkin's lymphoma after prolonged remission of Hodgkin's disease in an HIV-infected patient. 166 42

The influence of glucocorticosteroids (GKS) therapy on clinical status, T4 lymphocyte count in peripheral blood and T4/T8 lymphocyte ratio was investigated in five HIV infected patients: two were asymptomatic, while three had clinically overt disease. The reasons for GKS therapy were: thrombocytopenia in two patients, pancytopenia in two and sepsis with severe endocarditis in one. No influence of GKS on the clinical course of HIV infection was observed. The prospective determinations of T4 lymphocyte count and T4/T8 lymphocyte ratio were relatively constant in two cases, in one case increased and in two patients, one of whom had AIDS, a decrease in both parameters was observed. It seems that GKS therapy does not seriously influence the course of HIV infection in most patients and can be instituted without risk of severe worsening of the immune status.
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PMID:[Influence of therapy with glucocorticosteroids on clinical status, t4 lymphocyte count and t4/t8 lymphocyte ratio in people infected with AIDS]. 168 96

Cytokines including interferon (IFN) and tumor necrosis factor (TNF) are potent modulators of immune processes. They are synthesized in response to microbial infections and inflammation. TNF and IFN interact with other cytokines to elicit differentiation and cellular responses of specific target cells. In view of their multiple biological effects, we have postulated that dysregulation of IFN and TNF may contribute to the pathogenesis of HIV infection. Here, we review data showing that the expression of IFN-alpha receptors is down-regulated in patients with AIDS. As a consequence, HIV-infected cultured cells and cells from AIDS patients show hyporesponsiveness to IFN action. This could contribute to mechanisms by which HIV evades the antiviral activity of IFN-alpha in HIV-infected cells and raise the question of the usefulness of IFN-alpha in the treatment of end-stage AIDS. TNF is a major mediator of inflammation and sepsis and also is capable of inducing the replication of HIV. TNF synthesis and its receptor expression are upregulated by the acid-labile IFN-alpha subtype present in the sera of HIV-infected individuals. In addition, the acid-labile IFN present in AIDS sera may contribute to the pathophysiological changes in sepsis by rendering the cells from AIDS patients hypersensitive to endotoxin stimulation resulting in further synthesis of TNF. Thus aberrant regulation of these cytokines and their cognate receptors are likely contributing factors to the pathogenesis of AIDS.
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PMID:The role of interferon and tumor necrosis factor in the pathogenesis of AIDS. 170 66

The management of the haemophilias has been improved by the advent of potent consistent clotting factor replacement therapy. The previously lethal major complications such as intracerebral haemorrhage are now rare, and the infective complications of treatment, most notably hepatitis and AIDS, are now potentially preventable with the new synthetic products. There is also the prospect of 'cure' by gene insertion therapy. Advanced arthropathy has been minimized but not prevented by early effective treatment of haemarthroses, and there is a diminishing legacy of severely affected patients many of whom may require joint replacement surgery. The present group of such patients has a high prevalence of HIV-1 infection and an increased risk of joint sepsis. The available avenues of treatment for the subacute stage of the arthropathy have not been particularly effective, emphasizing the need to prevent recurrent bleeding. The development of a multidisciplinary team-management approach in centres of expertise has been a significant factor in the improved longevity, life satisfaction and preserved mobility now available to most haemophiliacs.
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PMID:Musculoskeletal disorders in the haemophilias. 175 80

A 1-year prospective audit of 2233 operations performed by one general surgical unit in a Central African teaching hospital is presented. In addition to the usual 'general surgical' procedures, operations also included emergency craniotomy, reconstructive surgery for open fractures, and hysterectomy. There were 37 (1.7%) postoperative deaths and 45 other deaths in non-operated patients. Ten of 14 deaths due to sepsis in the 20-40-year age group were associated with HIV infection. The implications for teaching and training of surgical specialists in the tropics are discussed.
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PMID:Audit of 'surgery in general' in an African teaching hospital. 177 10

Cytomegalovirus (CMV) retinitis is the most common cause of blindness in patients infected with human immunodeficiency virus (HIV). Ganciclovir, a guanosine nucleoside, has been found to be effective in the short-term treatment of CMV retinitis and in the delay of progression to recurrence of the disease. However, ganciclovir has no intrinsic activity against HIV, and patients with the acquired immune deficiency syndrome often require treatment with zidovudine, the only currently approved therapy for HIV infection. Both agents have been associated with dose-limiting granulocytopenia in such patients, and death from sepsis in the setting of profound decreases in absolute granulocyte counts has been reported. However, recent investigation suggests that with careful patient selection and monitoring, relatively safe concomitant therapy may be possible. This article reviews the toxicity issues that influence the decision to employ concomitant therapy with ganciclovir and zidovudine. An approach to dosing ganciclovir, including a schema for modifying or interrupting the zidovudine dosage based on hematologic status, is also presented. A prospective study is presently under way to determine whether combined therapy in selected patients leads to prolonged survival and a decreased incidence of recurrence of active CMV retinitis.
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PMID:Concomitant ganciclovir and zidovudine treatment for cytomegalovirus retinitis in patients with HIV infection: an approach to treatment. 184 17

The cases of three HIV-positive men with generalized psoriasis and staphylococcal sepsis are reported. In each case the skin appeared to be the source of infection. While the patients received antibiotic therapy, the psoriatic plaques resolved despite minimal or no topical treatment.
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PMID:Staphylococcal sepsis in HIV antibody seropositive psoriasis patients. 186 86

Patients with the acquired immune deficiency syndrome (AIDS) frequently develop hepatic dysfunction. Although hepatic injury may indirectly result from malnutrition, hypotension, administered medications, sepsis, or other conditions, the hepatic injury is frequently due to opportunistic hepatic infection, directly related to AIDS. Infection with Mycobacterium avium intracellulare typically occurs in patients with advanced immunocompromise and with systemic symptoms due to widely disseminated infection. In contrast, hepatic tuberculosis often occurs with less advanced immunocompromise. Cytomegaloviral infection may produce a hepatitis. Cytomegaloviral and cryptosporidial infections have been implicated as causes of acalculous cholecystitis and of a secondary sclerosing cholangitis. About 10-20% of patients with AIDS have chronic hepatitis B infection. These patients tend to develop minimal hepatic inflammation and necrosis. The clinical findings in patients with hepatic cryptococcal infection are usually due to concomitant extrahepatic infection. Hepatic histoplasmosis usually develops as part of a widely disseminated infection with systemic symptoms. Hepatic involvement by Kaposi's sarcoma is rarely documented ante mortem because an unguided liver biopsy is an insensitive diagnostic procedure. Patients with non-Hodgkin's lymphoma of the liver typically have lymphadenopathy, hepatomegaly, and systemic symptoms. As a pragmatic approach, patients with liver dysfunction and HIV-related disease should have a sonographic or computerized tomographic examination of the liver. Patients with dilated bile ducts should undergo endoscopic retrograde cholangiopancreatography because opportunistic infection may produce biliary obstruction. Patients with a focal hepatic lesion should be considered for a guided liver biopsy. Patients with a significantly elevated serum alkaline phosphatase level should be considered for a percutaneous liver biopsy. When performed for these indications, liver biopsy will demonstrate a significant disease involving the liver in about 50% of patients with AIDS and in about 25% of patients who are HIV seropositive but who are not known to have AIDS. The clinical impact of a diagnostic biopsy is blunted by a lack of efficacious therapy for many opportunistic infections.
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PMID:Hepatobiliary manifestations of the acquired immune deficiency syndrome. 198 33

The banking of femoral heads from patients who undergo total hip arthroplasty provides a valuable resource for orthopedic surgery. Quality assurance of the banked bone used in clinical procedures requires documented policies for screening, procuring, storing and distributing. Potential donors are screened at the time of donation for malignant disease, possible communicable disease, sepsis and high-risk life-styles. After negative culture results are confirmed and appropriate documentation has been completed, the bone is frozen at -70 degrees C. A quarantine period of 90 days follows. The donor is followed up 90 days or more postoperatively. At that time written consent is obtained for donation of the recovered tissue to the bone bank and for serology testing for human immunodeficiency virus (HIV-1) antibody, hepatitis B surface antigen (HBsAG), hepatitis B core antibody (HBcAb) and syphilis, and the donor is rescreened for contraindications. This protocol meets or exceeds all existing standards. The combination of obtaining consent and serology testing at 90 days streamlines the logistics of banking bone from surgical donors.
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PMID:A simplified protocol for banking bone from surgical donors requiring a 90-day quarantine and an HIV-1 antibody test. 186 83


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