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

We report a case of collapsing variant of FSGS. An 82-year-old man without HIV-1 infection or a history of intravenous drug abuse was admitted to our hospital with the chief complaints of acute onset of generalized edema and loss of appetite. Laboratory findings were consistent with nephrotic syndrome. He developed acute renal insufficiency. Initially, we suspected minimal change nephrotic syndrome and started steroid pulse therapy but the nephrotic syndrome was refractory and a renal biopsy was performed. The pathologic findings were judged to be consistent with a collapsing variant of focal segmental glomerulosclerosis (FSGS). This form was described by Weiss et al. in 1986 as a clinically and pathologically distinct variant of FSGS. Valeri et al. further reported that the incidence of this idiopathic collapsing type of FSGS which is devoid of evidence of HIV-1 infection or intravenous drug abuse has progressively increased over the past two decades. They reported that cyclosporin is effective for the treatment of this type of FSGS with a remission rate of about 30%. The present case also had a nearly complete remission after 2 month-cyclosporin treatment. In Japan, no adult case of this type of FSGS has been reported according to our review of the literature.
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PMID:[A case of collapsing variant of FSGS]. 1077 75

Microsporidia have been recognized as emerging opportunistic agents affecting multiple organs. Intestinal microsporidiosis caused by Enterocytozoon bieneusi and Encephalitozoon intestinalis is a common disease which is associated with gastrointestinal symptoms, particularly in AIDS patients. So far, information on the frequency of this enteric disease in Thailand is not available. Therefore, the present study was undertaken to investigate the prevalence of intestinal microsporidiosis in HIV infected persons with chronic diarrhea. From 1995 to 1996, multiple diarrheal stool specimens were received and examined for the presence of the organism using Weber's modified trichrome staining method and transmission electron microscopy for confirmation. Twenty-two of 66 patients (33.3%) were positive for microsporidia which appeared as pink-red spores of 0.8-1.2 x 0.7-0.9 microm with the characteristic transverse or oblique band representing the coiled polar filament. Clinical features of these patients included chronic diarrhea (100%), weight loss (100%), abdominal pain (77%), fever (36%), vomiting (36%) and anorexia (18%). Transmission electron microscopic examination of fecal specimens from the 22 patients with positive staining results revealed E. bieneusi in 18 cases.
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PMID:Intestinal microsporidiosis in HIV infected patients with chronic diarrhea in Thailand. 1077 62

Denutrition is frequent among HIV-infected (HIV+) adults in sub-Saharan Africa. One of the risk factors for denutrition is a reduction in dietary intake. Eating disorders may be partly responsible for such decreases in food intake. We prospectively analyzed the frequency, associated factors and progression of anorexia, dysphagia and food aversion in a cohort of 330 HIV-infected adults included in a trial of early chemoprophylaxis with cotrimoxazole in Abidjan, Ivory Coast. Patients were followed-up by means of scheduled monthly visits. Eating disorders were assessed using a standardized questionnaire after 6, 12 and 18 months of follow-up. After six months of follow-up, 28% of the patients reported anorexia, 9% dysphagia and 28% food aversion. Multivariate analysis showed that anorexia was significantly more frequent in women than in men (odds ratio (OR) = 2.0 [95% confidence interval: 1.2-3.5]) and in patients with a CD4+ lymphocyte count < 200/mm3 (OR = 1.8 [1.0-3.5]). The risk of dysphagia was also higher for women than for men (OR = 1.8 [1.0-3.5]). The risk of dysphagia was also higher for women than for men (OR = 3.3 [1.3-8.4]). Patients with < 200 CD4+ lymphocytes/mm3 were more likely than those with CD4+ lymphocyte counts of over 200 to suffer food aversion (OR = 1.8 [1.1-3.0]). We analyzed the progression of dietary problems during follow-up and found that anorexia and dysphygia tended to disappear from one evaluation to the next whereas the number of patients reporting food aversion tended to increase. For patients reporting anorexia at the 6-month evaluation, significantly more women than men reported the persistence of anorexia at the 12-month evaluation (16% versus 5%; p = 0.03). Among patients with dysphagia at six months, those with a CD4+ lymphocyte count below 200/mm3 were much more likely than those with a CD4+ count above 200 to report persistent dysphagia at the 12-month evaluation (7% versus 0%; p = 0. 02, Fischer's exact test). For patients with no dietary problems after six months, those taking cotrimoxazole were significantly more likely than those of the placebo group to report food aversion at the 12-month evaluation (21% versus 8%; p = 0.01). We found that dietary problems were associated more with the stage of immunodeficiency that with socioeconomic factors, with the exception of sex, which was associated with several outcomes. These data stress the importance of detecting these frequent dietary problems as part of the overall clinical management of HIV+ adults in Africa, and of providing affected individuals with early nutritional counseling.
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PMID:[Nutrition problems experienced by adults infected with the human immunodeficiency virus in Abidjan (Ivory Coast)]. 1082 57

The bovine immunodeficiency virus (BIV)/New Zealand (Oryctolagus cuniculus) rabbit model was used to study events that underlie the early and chronic stages of viral replication, routes and time course of viral dissemination and the distribution of the virus in the lymphoid. nonlymphoid and mucosa associated tissues. The results indicated that BIV, a lentivirus with genetic relatedness to the HIV, induced changes of clinical (anorexia, weight loss, muscular wasting, diarrhea, hypoalgesia, torticollis), immunological (recurrent T- and B-cell dysfunctions) and histopathological (lymphadenopathy, splenomegaly) nature that closely parallels those described for cat (Fly), monkey (SIV) and human (HIV) lentiviral diseases. These findings showing that BIV induces both splenomegaly and lymphadenopathy syndromes with associated fatal immune dysfunctions and the ability of the virus to replicate productively at the mucosal surfaces in rabbits, emphasize the importance of the BIV/rabbit system as a good small-animal model for the study of retrovirus-induced AIDS and offers the opportunity to evaluate prophylactic and therapeutic anti-retroviral agents of relevance to HIV-1 as well as the opportunity to study mechanisms of drug resistance phenomena.
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PMID:Bovine immunodeficiency virus in experimentally infected rabbit: tropism for lymphoid and nonlymphoid tissues. 1113 Oct 38

HIV-related weight loss can be broken into four categories: 1) episodic weight loss accompanying acute infections or malignancies; 2) intermittent anorexia; 3) the late, accelerated weight loss phase associated with a 10 -20 percent loss of body weight; and 4) the terminal phase of HIV disease in which weight loss has resulted in cachexia and weakness. Several studies using megestrol acetate to treat advanced breast cancer, HIV-associated cachexia, and AIDS wasting, have demonstrated its association with weight gain. These led to the establishment of two multicenter, randomized, double- blind trials. In the first study patients received either 800 mg/day of Megace (a liquid suspension of megestrol acetate) or placebo; and in the second they received one of three daily doses of Megace (100 mg, 400 mg, or 800 mg) or placebo. Most patients were in the fourth phase of weight loss. Over 50 percent of the enrollees dropped out of the first study. Increased calorie consumption, fat mass and overall weight was observed in the remaining 65 enrollees in the treatment group. The second study, enrolling 271 patients, showed a dose-dependent, step-wise relationship between megestrol acetate administration and weight gain. Overall, megestrol acetate was well tolerated. Patients receiving treatment experienced greater caloric and protein intake, weight gain and subjective sense of well-being. Therefore, a starting dose of 400 mg/day is recommended, to be adjusted after four weeks of therapy. Drug treatment in the earlier stages of weight loss should be considered.
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PMID:Recent results with Megace. 1136 97

Tumor necrosis factor (TNF, cachectin), a cytokine secreted by macrophages and T-cells, mediates inflammatory and immune responses, and is associated with wasting in persons with malignancies or AIDS. In inflammation, TNF attracts and activates neutrophils, stimulating phagocytic function of neutrophils and macrophages. TNF also increases hepatic cell resistance to damaging parasitic effects; enhances endothelial permeability, causing edema; aids in wound healing by stimulating tissue and vascular growth; enhances lymphocytic activity through cytokine activation; acts with interleukin (IL) to produce fever, anorexia, lethargy and sleep; and possesses antitumor activity, particularly against the presumed origin of Kaposi's sarcoma, capillary endothelial cells. The host has an acute phase response (APR) following TNF- and IL-induced immunologic activation. TNF and IL decrease production and activity of lipoprotein lipase (LPL), resulting in reduced uptake and improper storage of fat; and they stimulate anabolism of fatty acids, causing hypertriglyceridemia. This "futile cycling" causes shuttling of fatty acids between adipose tissue and the liver, and use of muscle protein as the main fuel source. This, along with further muscular breakdown due to the increased caloric demands of fever, may affect cachexia. TNF benefits the HIV-infected through selective killing of HIV-infected cells, although effects may be dose and time dependent. The negative effects of TNF may be impeded by anti-cytokine therapy. Possible therapies include dietary N-3 fatty acid (fish oil), an inhibitor of TNF and IL production in vitro; pentoxifylline (Trental), another TNF production inhibitor; anti-TNF monoclonal antibodies; and soluble TNF receptors.
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PMID:Tumor necrosis factor: its role in HIV/AIDS. 1136 96

A review of data on HIV and depression fails to show any direct cause-and-effect relationships between the two, despite the fact that clinical depression is the most commonly seen psychiatric disorder in patients with HIV infection. Most of the HIV-positive individuals with depressive disorders were found to have a history of depression antedating their infection. Contradicting early reports of unusually high rates of depression among HIV patients, more recent studies show that depression levels are not higher for the seropositive versus the seronegative, nor do the levels increase over time or at different stages of the infection. Persons with HIV may be misdiagnosed as depressed because the somatic symptoms of the illness--fatigue, lethargy, weight loss, loss of appetite, and low libido--are also symptoms of depressive disorders. Practitioners are urged to distinguish loss of interest, per se, from loss of interest in activities due to medical problems. When HIV-infected patients are diagnosed as clinically depressed, they respond as well as seronegative patients to antidepressant medications, such as tricyclic antidepressants, serotonin reuptake inhibitors (SRRI's), and psychostimulants. Brief, focused psychotherapy can prove helpful for assisting HIV-positive patients through times of particular vulnerability: the confirmation of HIV infection, adjusting to the seropositive status, onset of physical symptoms, and a sudden decline in T-cell counts.
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PMID:Depressive disorder and HIV disease: an uncommon association. 1136 50

Unwanted weight loss in people with HIV can be caused by one or more factors simultaneously. A two-pronged approach that addresses the factors causing weight loss and malnutrition, and maintaining or gaining weight is critical. Many opportunistic infections (OIs) can cause diarrhea, but both the drugs used to treat diarrhea and the infections themselves can contribute to weight loss. Lactose intolerance is a common cause of diarrhea in people living with HIV. Because some of the drugs used to treat HIV and OIs are packaged with lactose, it may be necessary to replace the enzymes needed to break down lactose. Appetite loss may also contribute to wasting, and the lack of nutrients from a lost appetite can tax the body and further aggravate the problem. Appetite stimulants, vitamin supplements, or weight gain products that promote the building of protein are possible treatment options. Lean body mass production may require the use of anabolic (protein building) steroids or testosterone replacement therapy. Another wasting intervention option involves recombinant human growth hormone (rHGH), however, unsubstantiated safety concerns have arisen on the use of rHGH, and may require increased monitoring. Finally, counteracting weight loss may require adjusting the elevated levels of an immune system chemical called tumor necrosis factor (TNF) with thalidomide. Because of thalidomide's association with birth defects, sexually active heterosexual women should be advised to use multiple contraceptive mechanisms.
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PMID:Weight loss update. 1136 68

Many people living with HIV use marijuana to manage agitation, spasms, chronic pain, depression, nausea arising from chemotherapy, and loss of appetite. Concerns over the use of marijuana or dronabinol (a pharmaceutical version of tetrahydrocannabinol or THC) include potential contamination from pesticides or other chemicals used in the growing process, and the potential of increasing the likelihood of lung infections. Use of THC is associated with reduced levels of testosterone and may have similar effects on other hormones in women. THC can also interact with other mood-altering medications such as Valium, librium, Xanax, seconal, Nembutal, or phenobarbital, by exaggerating their effect.
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PMID:Medical marijuana and dronabinol. 1136 69

A report is presented of a 48-year-old gay man, HIV-positive for 7 years, who came to the emergency room due to six hours of abdominal pain accompanied by anorexia, nausea, and dry heaves. Initial examination and laboratory tests showed nonspecific bowel gas, and the patient was discharged with instructions to use an enema at home for constipation. After worsening of symptoms, a private physician diagnosed acute abdomen with surgical consultation. A jejunal perforation secondary to B-cell Hodgkin's lymphoma was diagnosed and the patient was treated with low-dose CHOP (cytoxan, adriamycin, vincristine, and prednisone) for four cycles and had his antiretroviral regimen changed.
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PMID:Acute abdomen in an HIV-positive man. 1136 99


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