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

HIV disease has reached epidemic proportions in Africa over the last decade and is severely stretching the health services of the many poor countries of the region. Increased sepsis during fracture surgery and the late infection of implants impels us to rethink many standard methods of treatment. Musculoskeletal infections, including tropical pyomyositis and long bone haematogenous osteomyelitis, are now common manifestations of advanced HIV disease in adults. Despite their severe infections, such patients may survive for more than 5 years and certainly cannot be written off as terminally ill. Treatment is often prolonged and, in the case of osteomyelitis, may necessitate amputation. These patients now occupy many of the available orthopaedic beds.
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PMID:Viral infections: musculoskeletal infection in the human immunodeficiency virus (HIV) infected patient. 772 75

Despite the increasing number of patients with the human immunodeficiency virus (HIV) infection, surgical experience with these patients remains limited. A retrospective review over a 9 year period (January 1985 to December 1993) was undertaken to determine the indications, operative management, pathologic findings and outcome of major abdominal surgery in these patients. A total of 51 procedures were performed in 45 patients; 30 patients had acquired immunodeficiency syndrome (AIDS) and 15 patients had asymptomatic HIV infection. Indications included gastrointestinal bleeding, complicated pancreatic pseudocysts, cholelithiasis, bowel obstruction, immune disorders, acute abdomens, elective laparotomy, colostomy formation, menorrhagia and Caesarean section. Pathologic findings directly related to the HIV infection were found in 81% of the AIDS patients and 35% of the asymptomatic HIV infected patients (P < 0.05). These included opportunistic infections, non-Hodgkin's lymphoma, Kaposi's sarcoma, immune disorders, lymphadenopathy and pancreatic pseudocysts. It was noted that AIDS patients had more complications than asymptomatic HIV infected patients with most complications related to chest problems and sepsis (61 vs 7%; P < 0.01). Emergency operations carried a higher complication rate than elective operations though this was not significant. The hospital mortality was 12%. On follow up, 13 of the 25 AIDS patients had died with the median survival of 7 months, while three of the 14 asymptomatic HIV infected patients had died with the median survival of 40 months. Of the remaining patients, the 12 AIDS patients had a median postoperative follow up of 7 months and the 11 asymptomatic HIV infected patients had a median postoperative follow up of 29.5 months.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Abdominal surgery in HIV/AIDS patients: indications, operative management, pathology and outcome. 774 74

We conducted a retrospective cohort study to evaluate the occurrence of bacteremia and associated mortality among hospitalized patients who were seropositive for the human immunodeficiency virus (HIV) and who developed fever and neutropenia following antineoplastic chemotherapy or for other reasons. Review of medical records revealed 224 episodes in 142 patients. Of these episodes, 57% occurred following antineoplastic chemotherapy, and 43% occurred under other circumstances. Members of the chemotherapy group had significantly less-advanced HIV disease, a lower mean absolute-neutrophil-count nadir, and a shorter duration of hospitalization. There was no difference between the two groups in the frequency of bacteremia or mortality due to all causes when they were compared by multivariate analysis. Statistically significant univariate and multivariate predictors of bacteremia included sepsis syndrome and concurrent infection. Predictors of mortality included sepsis syndrome, concurrent infection, bacteremia, and antimicrobial therapy. This study suggests that the cause of neutropenia in HIV-seropositive patients is not a predictor of the outcome of fever and neutropenic episodes. Instead, clinical presentation and concomitant illnesses have a greater impact on outcome for a patient.
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PMID:Outcome for hospitalized patients with fever and neutropenia who are infected with the human immunodeficiency virus. 774 43

A clinical failure of pneumococcal vaccine is reported. A 22 year old African woman was given 23-valent pneumococcal vaccine at her initial presentation with HIV infection. She was asymptomatic and had a CD4+ lymphocyte count above 500 cells/mm3. Eighteen months later she died of meningitis and septicaemia due to Streptococcus pneumoniae type 9 (an antigen included in the 23-valent vaccine). Pneumococcal antibody levels performed on stored blood demonstrated no serological response to the vaccine. This is the first reported case of clinical failure of pneumococcal vaccine in an HIV infected patient who received vaccine whilst at the asymptomatic stage of HIV infection and with relatively intact immune function. The literature pertaining to pneumococcal vaccination in the context of HIV infection was reviewed. Pneumococcal vaccination is recommended for HIV positive patients in the UK by the Departments of Health. It is likely that many physicians are not aware of these recommendations or are concerned about the poor efficacy of the vaccine, and it may consequently be underused in clinical practice. But the potential gain to the HIV positive patient is such that the vaccine should be offered to all HIV positive patients as soon as they present for medical care, irrespective of the stage of HIV disease. Physicians and patients should be aware that the vaccine is not fully protective and that episodes of sepsis, pneumonia and meningitis could still be pneumococcal in origin and should be treated appropriately. Awareness of the substantial risks of pneumococcal disease in HIV infected patients with prompt diagnosis and effective treatment is the most important strategy to decrease morbidity and mortality.
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PMID:Pneumococcal vaccine and HIV infection: report of a vaccine failure and reappraisal of its value in clinical practice. 774 16

From December 1990 to December 1993, 130 patients who had a lesion localized to the spinal cord were admitted to the Tikur Anbessa Hospital, Department of Internal Medicine, Addis Ababa. These patients accounted for 18.0% of all neurological admission to this department. The male/male female ratio was 1:8:1; the mean age was 40 years for these patients; 52% were from Addis Ababa City and 48% of them were coming from the rest of the country. Paraparesis or paraplegia (77%) and quadriparesis or quadriplegia (23%) were the commonest presenting complaints. Sensory level, sphincter dysfunction and bedsores were found in 70%, 54% and 14% of the cases respectively. Tuberculous spondylitis was found to be the leading cause accounting for 35 (26.9%), and HIV-1 myelopathies was the second common type accounting for 22 (16.9%) of spinal cord disease. Metastatic cord compression, tropical spastic paraparesis, (progressive non compressive myelopathy), cervical spondylosis, primary cord tumours and transverse myelitis were also not uncommon. Death related to sepsis or other causes were documented in 14 (10.8%). Follow-up was arranged on discharge, and only 45 (38.8%) patients were able to attend at least once the neurology referral clinic. Myelopathy is an important neurological disease and currently HIV-1 associated myelopathy has become the second important presumed cause.
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PMID:Myelopathies in Ethiopia. 778 55

Between June 1986 and October 1992, disseminated toxoplasmosis was diagnosed in 16 AIDS patients. 13 cases were diagnosed at autopsy where multiple organ involvement was documented in all 13. Three patients were diagnosed intra vitam. All 3 survived with appropriate treatment. Clinical features indicative of disseminated toxoplasmosis were: fever of unknown origin between 39 degrees and 40 degrees C in 16 cases, clinical signs suggestive of sepsis or septic shock in 15, with progression to multiorgan failure in 10, disseminated intravascular coagulopathy in 6, confusion, disorientation or apathy in 13 and lack of a systemic pneumocystis carinii prophylaxis in all 16. Typical laboratory markers were: CD4 cell counts below 100 x 10(6)/l in 16 cases, elevation of serum lactic dehydrogenase in 16 and creatine phosphokinase (in 4/6), normal or only slightly elevated C-reactive protein (in 9/11), positive Toxoplasma gondii IgG antibodies in 15/16 and negative IgM antibodies in all 16. Lesions indicative of cerebral toxoplasmosis were visualized on cranial computerized tomography in only 3/10 evaluated patients. In patients with advanced HIV infection presenting with a systemic illness, including the clinical and laboratory features described above, systemic Toxoplasma gondii infection must be included in the differential diagnosis. In these patients, specific and if warranted, invasive diagnostic procedures followed by early vigorous therapeutic intervention should be considered.
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PMID:Disseminated toxoplasmosis in AIDS patients--report of 16 cases. 778 18

Whereas the risk of infant mortality is nine times higher in the least developed countries as compared to industrialized countries, the risk of maternal mortality is often more than 100 times higher. Approximately 75% of the 500,000 maternal deaths which occur each year are attributed to hemorrhage, sepsis, toxemia, obstructed labor, and the complications of unsafe abortion. Appropriate prenatal care would 1) prevent or detect and treat life- and health-threatening abnormalities; 2) prepare the mother for the demands of labor and motherhood and counsel her on diet, exercise, rest, and drug treatment; 3) prepare the mother psychologically and emotionally for child-bearing; and 4) provide general health screening. Special attention should be paid to complications, postpartum hemorrhage, reduction of low birth weight, resuscitation techniques for the newborn, and hygiene. The reduction in maternal and infant deaths will require an intersectoral approach and will benefit from the following: 1) giving high priority to maternal and infant deaths; 2) increasing the use of contraceptives and promoting safe and legal abortion; 3) providing HIV prevention education; 4) promoting the importance of prenatal care; 5) disseminating information about family planning; 6) improving health training programs; 7) developing health education campaigns; 8) using appropriate health care technologies; 9) strengthening community-based maternal health and delivery systems; 10) organizing operational research and evaluation procedures; 11) involving nurses and traditional birth attendants in existing health services; and 12) mobilizing and involving the community in all health programs.
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PMID:Safe motherhood: with whom the responsibility rests? 783 76

Soluble tumour necrosis factor receptors (sTNF-Rs) play a role as modulators of the biological function of tumour necrosis factor-alpha (TNF-alpha) in an agonist/antagonist pattern. In various pathologic states the production and release of sTNF-Rs may mediate host response and determine the course and outcome of disease by interacting with TNF-alpha and competing with cell surface receptors. The determination of sTNF-Rs in body fluids such as plasma or serum is a new tool to gain information about immune processes and provides valuable insight into a variety of pathological conditions. Regarding its immediate clinical use, sTNF-Rs levels show high accuracy in the follow-up and prognosis of various diseases. In HIV infection and sepsis, sTNF-Rs concentrations strongly correlate with the clinical stage and the progression of disease and can be of predictive value. Determination of sTNF-Rs also gives useful information for monitoring cancer and autoimmune diseases. The information provided is often even superior to that obtained with classical disease markers, probably due to the direct involvement of the "TNF system" in the pathogenetic mechanisms in these patients. The available data imply that the measurement of sTNF-Rs, especially of the sTNF-R 75kD type, is a useful adjunct for quantification of the Th1-type immune response, similar to other immune activation markers such as neopterin and beta 2-microglobulin. Endogenous sTNF-Rs concentrations appear to reflect the activation state of the TNF-alpha/TNF receptor system.
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PMID:Soluble receptors for tumour necrosis factor in clinical laboratory diagnosis. 785 70

In Zambia, 10-15% of urban adults are reported HIV positive, as are over 80% of prostitutes. The HIV seroprevalence rate in a Lusaka hospital's intensive care unit was 21% (27% for surgical and 18% for trauma admissions). HIV-infected patients could be clinically recognized by risk factors or symptoms and signs: weight loss, chronic cough, chronic diarrhea, sepsis, septic arthritis, subacute hematogenous osteomyelitis, a history of sexually transmitted diseases (STDs), death of a spouse or of a child under age 2, recent pregnancy unable to go to term, poor quality or thin hair, appearance of aging beyond years, mental slowness, persistent or unexplained fever, lymphadenopathy, aggressive atypical Kaposi's sarcoma, oral thrush, hairy leukoplakia of the tongue, shingles scars, and scars of maculopapular dermatitis. Common sites for HIV-related sepsis are the female genital tract, anorectum, pleural cavity, soft tissues (e.g., necrotizing fascitis), and bone and joints. Autologous blood transfusion and use of donor blood screened for HIV antibodies, preferably limited to emergencies, would reduce the likelihood of iatrogenic HIV transmission. Surgeons should wear two pairs of gloves, a waterproof gown, and goggles to protect themselves from HIV transmission. If they have skin rashes, cuts, or abrasions on the hands or arms, they should not perform operations. Proper cleaning and disinfection of endoscopes are required. The risk of infection from a needle stick is small ( 0.4%).
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PMID:Surgery, surgical pathology and HIV infection: lessons learned in Zambia. 786 25

To determine the clinical correlates of HIV-1-associated vacuolar myelopathy (VM), we designed a case-control study based on 215 AIDS autopsies in which we examined the spinal cord. We defined a case as an individual dying with AIDS and with VM present at autopsy; we defined a control as an individual dying with AIDS without VM. VM was found in 100 of 215 (46.5%) autopsies, with no apparent temporal trends. A higher number of AIDS-defining illnesses was strongly associated with the likelihood of VM (trend chi-square = 26.52, p < 0.001). Systemic infection with Mycobacterium avium-intracellulare and Pneumocystis carinii pneumonia were each associated with the pathologic findings of VM in both univariate and multivariate models. In the brain, multinucleated giant cells were detected in more cases than in controls (odds ratio = 3.68, 95% CI = 1.73 to 7.47, p < 0.001). The clinical features of HIV-1 dementia were not associated with VM; in contrast, predominantly sensory neuropathy was more common in VM cases than in controls (odds ratio = 5.00, 95% CI = 1.35 to 18.5, p < 0.05). Fifty-six cases with VM had detailed neurologic evaluations, but only 15 (26.8%) had signs and symptoms of myelopathy. The presence of symptomatic myelopathy was related to the pathologic severity: none of 17 cases with grade 1, five of 26 with grade 2, and 10 of 13 with grade 3 had clinical features of myelopathy (trend chi-square = 21.16, p < 0.005). VM is a common neuropathologic finding that is frequently unrecognized during life. The association with the number of systemic illnesses, M avium-intracellulare infection, and P carinii pneumonia suggests that the development of VM is related to the severity of immunosuppression.
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PMID:Clinicopathologic correlations of HIV-1-associated vacuolar myelopathy: an autopsy-based case-control study. 796 77


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