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

Since the beginning of the acquired immunodeficiency syndrome (AIDS) epidemic in the early 1980s, several malignant conditions have been recognised to be associated with this syndrome which affect up to 40% of AIDS patients at some stage of their illness. They include Kaposi's sarcoma, systemic non-Hodgkin's lymphoma, primary central nervous system lymphoma and invasive cervical cancer. Kaposi's sarcoma and primary central nervous system lymphoma were tumours rarely seen below the age of 50 prior to the epidemic and therefore were recognised early to be AIDS-related conditions. However, systemic non-Hodgkin's lymphoma and invasive cervical cancer were only recognised when sufficient epidemiological evidence became available to indicate an increased incidence of these conditions amongst the HIV-infected population. In the presence of immunosuppression, the biological behaviour of these conditions are significantly altered with a more advanced stage at presentation, a more aggressive disease course and poorer responses to treatment. There is evidence that in each of these malignant conditions, an additional viral infection may be responsible for their pathogenesis. Kaposi's sarcoma-associated herpes virus is implicated in the development of Kaposi's sarcoma, Epstein-Barr virus in systemic non-Hodgkin's lymphoma as well as primary central nervous system lymphoma and human papilloma virus in invasive cervical cancer. Developing effective treatment strategies with minimal toxicity for these patients remains the greatest challenge as they often have serious coexisting illnesses and tolerate chemotherapy poorly because of insufficient bone marrow function reserve.
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PMID:Oncological problems in AIDS--a review of the clinical features and management. 887 5

Brain mass lesions (BML) occurred in 10% of patients infected by the human immunodeficiency virus (HIV), as expression of severe and sometimes treatable diseases. However, the management of them is not well established. We analyzed, retrospectively, 26 brain biopsies (22 estereotaxic) in patients with HIV infection and BML to know their usefulness and safety. The inclusion criteria were: Failure of the anti-Toxoplasma empirical treatment, atypical scan appearance for toxoplasmosis, or severe neurological picture. Brain biopsy yielded a diagnosis in 19 patients (73.1%): Progressive multifocal leukoencephalopathy (n = 8; 30.8%), primary central nervous system lymphoma (n = 6; 23.1%), mycobacteriosis (n = 2; 7.7%), toxoplasmosis (n = 2; 7.7%), criptococcosis (n = 1), cryptosporidiosis (n = 1) and HIV-encephalitis (n = 1). In one case there was a multiple diagnosis: mycobacteriosis, toxoplasmosis, and lymphoma. Brain biopsy results decided a change in therapy in 65.4%, the resolution or improvement of the neurological process in 30.8%, and the determination of the prognosis in 30.8%. In 8 cases (30.7%) there were biopsy complications, with secondary mortality in one. Brain biopsy of BML in HIV-infected patients is a diagnostic method with a high overall diagnostic rentability and uncommon non reversible complications, offering the possibility to prescribe a specific and potentially curative treatment.
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PMID:[Usefulness of cerebral biopsy in focal cerebral lesions in patients with human immunodeficiency virus infection]. 908 92

Chance of opportunistic infections in hospitals is increasing year by year, because of the steady increase in the number of compromised hosts. Opportunistic infections in the nervous system include fungal, protozoal, bacterial and viral infections. Cytomegalovirus and herpes virus (HSV1 and HSV2) cause encephalitis, myelitis and radiculoneuritis. Varicella-zoster virus (VZV) often causes herpes zoster, which sometimes disseminates when immunodeficiency is severe. VZV also causes encephalitis. Progressive multifocal leukoencephalopathy (PML) is caused by JC virus in severely compromised hosts. HIV encephalopathy or AIDS dementia complex is one of late stage complications of HIV infection. Prevalence of PML and HIV encephalopathy among AIDS patients tend to increase as other opportunistic infections became controllable recently. Primary CNS lymphoma in immunocompromised hosts is supposed to be caused by EB virus and/or Kaposi's sarcoma-associated herpes virus (KSHV, HHV8). In this sense, CNS lymphoma and Kaposi's sarcoma can be defined as virus infection-related condition.
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PMID:[Virus-related neurological disorders complicating in compromised hosts]. 910

Primary central nervous system lymphoma (PCNSL), once considered a rare brain neoplasm, has been steadily increasing in incidence mainly due to an enlarging population of immunosuppressed patients. PCNSL has become the second most common brain space occupying lesion in patients with the acquired immunodeficiency syndrome. A rapid diagnosis of this entity may represent weeks to months of survival to immunosuppressed HIV-positive patients. The radiologist now plays an important role in the noninvasive diagnosis and management of this condition through the accurate interpretation of imaging findings provided by CT, MR, and brain SPECT studies. This article focuses on the pathogenesis, clinical manifestations, neuropathology, and imaging characteristics of this brain neoplasm. New accurate imaging algorithms combining the diagnostic information provided by CT, MR, and T1-201 brain SPECT are discussed.
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PMID:Primary central nervous system lymphoma in patients with AIDS. 911 91

With the introduction of increasingly effective antiretroviral agents for the management of AIDS, the life expectancy of appropriately treated patients will continue to lengthen as will the length of time during which infected patients amy develop malignancies, both HIV-related and non-HIV-related. The management of such patients will require careful consideration of the impact of all oncologic therapy on the immune system's ability to hold the virus at bay. Radiation therapy, with its recognized immunosuppressive effects, plays an important role in the management of the major AIDS-defining neoplasms, Kaposi's sarcoma, primary central nervous system lymphoma, and cervical carcinoma, and is used in approximately 50% of patients with non-HIV-related malignancies at some point in the disease course. The judicious use of radiation therapy and proper integration of aggressive antiretroviral therapy can result in control of malignancies without contributing to the rapid progression of HIV disease.
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PMID:Radiation therapy for malignancies in the setting of HIV disease. 915 95

This article is a brief review of the radiologic-pathologic correlation of central nervous lesions occurring in patients with AIDS. The major discussions of the imaging appearance and radiologic differential diagnosis have been presented elsewhere in this issue. Our emphasis is on the gross pathologic correlations that are only possible with autopsy materials. We will illustrate the opportunistic neoplasms such as primary CNS lymphoma. This article also discusses the imaging and pathology of the common opportunistic infections. Toxoplasmosis, an obligate intracellular protozoan, is the most common CNS infection producing a mass lesion in AIDS. However, AIDS encephalitis, a direct infection of the brain by the HIV-1 virus itself, may actually be more prevalent. Other viral infections occurring in AIDS include progressive multifocal leukoencephalopathy. Fungal diseases infecting the central nervous system of AIDS patients include cryptococcus, aspergillosis, and mucormycosis. The primary purpose of this article is to demonstrate how the gross pathology correlates with the radiologic images.
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PMID:Neuroimaging--autopsy correlations in AIDS. 937 71

Cerebellar disorders associated with HIV infection are typically the result of discrete cerebellar lesions resulting from opportunistic infections such as toxoplasmosis and progressive multifocal leukoencephalopathy or primary CNS lymphoma. Clinical symptoms and pathologic abnormalities related to the cerebellum may also be observed with HIV dementia. A primary cerebellar degeneration with HIV has not previously been reported. Ten patients were identified over an 8-year period at five medical centers. All patients had clinical, laboratory, and radiologic evaluations, and three had neuropathologic examinations. Patients presented with progressively unsteady gait, slurred speech, and limb clumsiness. Examination revealed gait ataxia, impaired limb coordination, dysarthria, and abnormal eye movements. Cognition, strength, and sensory function remained normal. CD4 lymphocyte counts varied between 10 and 437 cells/mm3. Neuroimaging studies showed prominent cerebellar atrophy. Neuropathology showed focal degeneration of the cerebellar granular cell layer and unusual focal axonal swellings in the brainstem and spinal cord. Cultures, histopathology, and immunochemical studies showed no conclusive evidence of infection. We report a syndrome of unexplained degeneration of the cerebellum occurring in association with HIV infection.
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PMID:Cerebellar degeneration associated with human immunodeficiency virus infection. 1069 Oct 12

Lymphomas that occur in patients with human immunodeficiency virus (HIV) infection are predominantly of B-cell origin and subsets show evidence for Epstein-Barr virus (EBV) infection or chromosomal translocations in the c-myc locus. The only subset of lymphoma clearly related to the immunodeficiency caused by HIV infection (similar to transplantation-associated lymphomas) is the EBV+ primary central nervous system lymphoma. The systemic AIDS-related lymphomas (ARLs) represent a complex set of disease processes histologically categorized as large cell or small non-cleaved (Burkitt's-like) lymphomas. Molecular analyses of the ARLs have demonstrated polyclonal lymphomas as likely early representatives of monoclonal immunoglobulin (Ig)-expressing B-cell lymphomas. Variable region analysis of lymphoma-associated Ig has shown evidence for extensive somatic mutation with little evidence for appropriate affinity maturation. These observations suggest that abnormal control of B-cell maturation in response to polyclonal antigenic stimulation may play a central role in the pathogenesis of ARL. The recent finding of clonal HIV integrated within macrophages in a subset of early lymphomas also provides evidence for abnormalities outside the B-cell compartment playing roles in this disease. Overall, ARLs generally appear to be outgrowths of antigen-driven B-cells with significant growth control influence provided by abnormal T-cell and antigen-presenting cell processes.
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PMID:The immunology of AIDS-associated lymphomas. 960 72

A total of 95 patients who presented in 1994 and 1995 with focal brain lesions at a London HIV centre were studied retrospectively. Patients were allocated to "definite" or "presumed" diagnostic categories of toxoplasma encephalitis (TE), primary CNS lymphoma (PCNSL) or progressive multifocal leukoencephalopathy (PML), based on strict criteria. The number in each category was: TE, 20; PCNSL, 9; PML, 7; presumed TE, 12; presumed PCNSL, 8 and presumed PML, 17. There were 20 patients in whom a diagnosis could not be made, and there were three non-HIV diagnoses. Demographic data, features at presentation and routine CSF analysis were not discriminatory in making a diagnosis. Toxoplasma titres were a median of 1:256 in those with TE compared to 1:16 in all other groups (p < 0.001) and those with TE were less likely to be on toxoplasma prophylaxis compared to those with PCNSL (p < 0.002). Survival with TE (median of 446 days) was significantly longer than survival in all other groups. Survival with either confirmed or presumed PML was similar. The problems of diagnosis of focal brain lesions in HIV patients are discussed and a management flow chart for mass lesions is proposed.
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PMID:Management of intracerebral lesions in patients with HIV: a retrospective study with discussion of diagnostic problems. 960 73

Laboratory techniques for the diagnosis of central nervous system (CNS) infections are rapidly improving but at present have limitations that necessitate our guarded enthusiasm. Enteroviruses are the most common infectious agents of viral meningitis for which an etiology can be determined, and it is anticipated that the use of the reverse transcriptase polymerase chain reaction (RT-PCR) technique should significantly improve the identification of the etiologic agent of aseptic meningitis. The combination of the polymerase chain reaction technique with laboratory methods for the determination of intrathecal antibody production to herpes simplex virus and varicella-zoster virus have improved the rapidity with which these viral infections can be diagnosed. The pearls and pitfalls of the use of these laboratory techniques in the diagnosis of viral meningitis, recurrent meningitis, and focal encephalitis are included. Recommendations for the empiric therapy of bacterial meningitis in children and adults have changed because of the emergence of penicillin and cephalosporin-resistant pneumococcal organisms. The currently recommended antibiotics and their dosages are included. The evidence for the efficacy of dexamethasone therapy in bacterial meningitis is provided. Meningitis due to Mycobacterium tuberculosis is increasingly recognized, and the initiation of empiric antituberculous chemotherapy should not await the results of CSF cultures. Toxoplasma encephalitis and primary CNS lymphoma are the most common cause of mass lesions in patients with HIV, and the diagnostic techniques to distinguish between these two infections is reviewed. A short discussion of the best test for the diagnosis of neurosyphilis is provided.
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PMID:Pearls and pitfalls in the diagnosis and management of central nervous system infectious diseases. 960 16


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