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

We have investigated the genetic diversity and potential mosaic genomes of HIV-1 during the early part of the HIV-1 epidemic among commercial sex workers (CSWs) in Kinshasa, Democratic Republic of Congo (formerly Zaire). Serologic analysis revealed that 27 (28.7%) of the 94 specimens were seropositive by both peptide and whole-virus lysate EIAs and that 24 were positive by molecular screening assays, using generic primers that can detect all known groups of HIV-1. Phylogenetic analyses of the gag(p24), C2V3, and gp41 regions of these 24 specimens showed that all were group M; none of them had any evidence of group O, N, or SIVcpz-like sequences. On the basis of env sequence analysis, the 24 group M specimens were classified as subtypes G (37.5%), A (21%), F1 (12.5%), CRF01_AE (8%), D (4%), and H (4%); 3 (12.5%) were unclassifiable (U). Similar analysis of the gag(p24) region revealed that the majority of infections were subtype A; however, one-third of the specimens were subtype G. Parallel analysis of gag(p24) and env regions revealed discordant subtypes in many specimens that may reflect possible dual and/or recombinant viruses. These data suggest a predominance of subtype G (both pure G and recombinant CRF02_AG) during the early part of the epidemic in Kinshasa. Infections with group N or SIVcpz-like viruses were not present among these CSWs in Kinshasa.
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PMID:Predominance of HIV type 1 subtype G among commercial sex workers from Kinshasa, Democratic Republic of Congo. 1124 22

Tracheoesophageal fistula arising secondary to Mycobacterium tuberculous infection in AIDS patients is extremely rare. We describe a case with a fistula lesion that initially failed to close using a four-drug antituberculosis regimen. The original lesion closed following placement of an esophageal stent. However, the stent migrated, causing an iatrogenic tracheoesophageal fistula that needed surgical repair. Tracheoesophageal fistula (TEF) is an uncommon clinical condition, most frequently arising as a sequelae to esophageal malignancy. Iatrogenic injury to the membraneous trachea secondary to cuffed endotracheal or tracheostomy tubes in the presence of an in-dwelling nasogastric tube and corrosive burns, accounts for most of the remainder of occurring fistulas. Infections such as candidiasis, syphilis, and tuberculosis are also known to cause this condition. We report stent migration with perforation and subsequent TEF formation in an HIV-positive patient who originally had stent placement for a tuberculous tracheoesophageal fistula.
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PMID:Tracheoesophageal fistula in AIDS: stent versus primary repair. 1136 47

Infections of the liver and biliary tract are common during the course of AIDS. A variety of viral, bacterial, fungal, and other opportunistic infections can present with hepatobiliary involvement as either the primary site of infection or secondary to a disseminated process. Coinfection with hepatitis B and C are particularly common due to the shared means of transmission of these viruses with HIV. The typical presenting features of hepatobiliary infections are right upper quadrant (RUQ) pain and abnormal liver function tests. Initial evaluation should include an RUQ ultrasonogram, which will usually identify abnormalities in the biliary tract and may demonstrate some parenchymal abnormalities as well. A liver biopsy is necessary to determine the etiology of focal hepatic lesions or opportunistic infections within hepatic parenchyma when other less invasive tests are negative or inconclusive. Special stains and culture techniques are required to identify specific organisms in the biopsy specimen. HIV-related biliary disorders include acalculous cholecystitis, which is a potentially serious condition requiring prompt recognition and gallbladder decompression. AIDS-cholangiopathy is a form of cholangitis involving the intra- and/or extrahepatic biliary tree. Endoscopic retrograde cholangio-pancreatography (ERCP) is the test of choice, demonstrating the stricturing, dilatation, and beading of bile ducts seen in this condition. Endoscopic sphincterotomy of the papilla of Vater may provide symptomatic relief for patients with papillary stenosis. Opportunistic infections of the pancreas have been reported. Evaluation should include a computerized tomogram of the abdomen and possible pancreatic tissue aspiration or biopsy. Management of pancreatitis is supportive.
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PMID:Hepatobiliary and pancreatic infections in AIDS: Part one. 1136 70

A study of health care workers exposed to HIV-contaminated blood indicates that preventive zidovudine (AZT, Retrovir) therapy helped protect them from infection. The abstract for this unpublished study, conducted by the Centers for Disease Control and Prevention (CDC), was presented in a poster session at the recent Second National Conference on Human Retroviruses and Related Infections in Washington, DC. Although CDC officials and needlestick experts use caution in interpreting the study, it is the strongest evidence to date that AZT has a protective effect. The study, the first case-controlled one of its kind, tried to identify risk factors for seroconversion among 23 health care workers who were infected by needlestick injuries, and 679 health care workers who were exposed to HIV by needlestick injury but who did not become infected. The CDC has remained neutral in its recommendations for exposed health care workers. Stating that it neither supports nor discourages preventive therapy, the guidelines do recommend that health care workers use any available data to help make their decision.
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PMID:Finding suggests AZT therapy may help prevent occupational HIV infection. 1136 45

As many as 12 percent of HIV-infected homosexual men in the United States could remain AIDS-free for 20 years after seroconversion, and the median length of survival for children with AIDS may now be as high as eight years, according to several new studies presented at a national conference. At the Second National Conference on Human Retroviruses and Related Infections in Washington, D.C., researchers estimated that the percentage of long-term survivors in the United States is about 5-10 percent. Director of the National Institute of Allergy and Infectious Diseases, Anthony Fauci, MD, reported that immune system cells, also called CD8 cells, may be more efficient than antiretroviral therapy in repressing HIV infection, as reported in the January 26, 1995 issue of the New England Journal of Medicine. Interleukin-2, a natural protein that induces CD8 cells to suppress the virus, is showing promising preliminary results. Another study, published in the December 1994 issue of AIDS Research and Human Retroviruses, suggests that a women infected with the virus thirteen years ago through a blood transfusion but who has little trace of the virus in her blood, is able to suppress all HIV viruses that infected her and only defective, slow-growing viruses have remained within her white cells. Another study suggests that ongoing high-risk behavior might be associated with rapid progression and that people might be superinfected with more pathogenic virus.
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PMID:Researchers seek clues to long-term survival. 1136 48

Protease inhibitors were the dominating topic at the Second National Conference on Human Retroviruses and Related Infections, held January 29 through February 2, 1995. Currently, seventeen protease inhibitors are in development, most falling into three categories: C2 symmetrics, transition state analogs, and cyclic ureas. Dr. Martin Markowitz, of the Aaron Diamond AIDS Research Center, believes that combination therapies may be possible with protease inhibitors now in clinical trials. Unfortunately, there is some concern, based on Searle's SC-52151 inability to penetrate cellular targets, that alpha1 A-glycoprotein binding problems could haunt the development of protease compounds. Another potential problem overshadowing efforts in protease inhibitor development is resistance. While long-term resistance is of some concern, Markowitz suggests that stringing a steady combination of protease inhibitors could keep the virus permanently subdued. No consensus exists on which of two HIV therapies (high dose monotherapy or drug combinations) is best to pursue. It is believed resistance would be less likely with a combination of antivirals, but, as Dr. Noel Roberts of Hoffman-La Roche contends, resistance is inevitable and agents should be taken as long as they are effective. So far, saquinavir leads the pack in successfully advancing through the phase studies. Abbott's ABT-538 and Merck's L-524 are also showing beneficial effects on viral load. Both companies are pursuing aggressive trial strategies.
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PMID:Protease developers skirmish over possible pitfalls. 1136 9

Scientists at the Ninth International Symposium on Infections in the Immunocompromised Host offered evidence that the rate of HIV disease progression may be determined by how vigorously host defenses are mobilized in the first weeks of infection. Others report on the use of thalidomide or IL-10 for curtailing or suppressing tumor necrosis factor alpha in coincident HIV and tuberculosis patients. The success of shoring up weakened host defenses against the onslaught of opportunistic pathogens, such as mycobacterium avium complex, is also addressed, as are thoughts on using fluconazole to treat fungal infection in HIV-positive patients and the danger of creating a drug-resistant strain of Candida. Recent trial data are discussed in response to questions about prophylaxis and treatment of opportunistic pathogens such as cytomegalovirus (CMV) and Mycobacterium avium complex (MAC). It is suggested that scientists are close to refining assays for CMV, and perhaps MAC, that will allow clinicians to predict which patients have a substantially increased risk of cytomegalovirus or MAC disease. However, it is warned that prophylaxis of opportunistic infections should only be considered as a stop-gap measure, not a way of preventing AIDS.
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PMID:Or is it the host, sir? 1136 95

The second annual National Conference on Human Retroviruses and Related Infections was held in Washington, D.C., January 29-February 2, 1995. Lectures addressed such topics as viral dynamics, United States AIDS epidemiology, immunopathogenesis, antiretroviral therapy, and HIV vaccines. Symposia were held on the interactivity of sexually transmitted diseases (STDs) and AIDS, the causes leading to long-term nonprogressors, and factors causing individuals to be exposed but uninfected. Oral presentations reviewed the following: 1) a study on the efficacy of oral ganciclovir for prevention of CMV disease in CMV-seropositive, HIV-infected individuals with CD4 counts of 50 or less; 2) data supporting rifabutin prophylaxis against MAC infection once the CD4 count is below 100; 3) the safety of the screened blood supply in the United States; 4) ACTG 063, a study examining the use of AZT with and without acyclovir; 5) perinatal transmission; and 6) four independent studies examining the efficacy of 3TC (lamivudine) as part of a combination of antiretroviral drugs in HIV-infected patients who were both AZT-naive and AZT-experienced.
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PMID:Second National Conference on Human Retroviruses. Good news, bad news, and no news. 1137 Jun 57

Bloodstream infections are a frequent complication in human immunodeficiency virus (HIV)-infected adults in Africa and usually associated with a poor prognosis. We evaluated bloodstream infections across a decade in 3 prospective cross-sectional surveys of consecutive medical admissions to the Kenyatta National Hospital, Nairobi, Kenya. Participants received standard clinical care throughout. In 1988-1989, 29.5% (28 of 95) of HIV-positive patients had bloodstream infections, compared with 31.9% (46 of 144) in 1992 and 21.3% (43 of 197) in 1997. Bacteremia and mycobacteremia were significantly associated with HIV infection. Infections with Mycobacterium tuberculosis, non-typhi species of Salmonella (NTS), and Streptococcus pneumoniae predominated. Fungemia exclusively due to Cryptococcus neoformans was uncommon. Clinical features at presentation remained similar. Significant improvements in the survival rate were recorded among patients with NTS bacteremia (20%-83%; P<.01) and mycobacteremia (0%-73%; P<.01). Standard clinical management can improve outcomes in resource-poor settings.
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PMID:Trends in bloodstream infections among human immunodeficiency virus-infected adults admitted to a hospital in Nairobi, Kenya, during the last decade. 1141 86

The current era of effective antiretroviral therapy has led to a marked reduction in opportunistic infections (OIs) in those countries where such therapies are available. Opportunistic fungal infections are no exception, and the incidence of such infections is now 20% to 25% of that seen in the mid-1990s. Infections associated with very advanced HIV disease, such as azole-resistant candidiasis and aspergillosis, are also rarely seen, reflecting the improvement in immune function. Indeed, the most common issue now is whether patients who have had a systemic mycosis require life-long therapy as had been recommended. Preliminary data from small studies suggest that as with other OIs, it may be possible to stop suppressive therapy in patients with a history of mycosis whose CD4+ lymphocyte count rises with antiretroviral therapy. Thus, it appears that the future of HIV-associated mycoses is linked to the future of effective treatment for HIV itself.
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PMID:The changing face of mycoses in patients with HIV/AIDS. 1149 9


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