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

A study over a period of 27 consecutive months showed that among patients seen in a Kinshasa hospital outpatient clinic for rheumatologic diseases, 46.5% sought medical advice for lower back pain. Lumbar arthrosis (74.5%), spondylodiscitis (9.5%) and unilateral sacroiliitis (9%) were the main causes of this complaint. A single patient had osteoporosis and no cases of ankylosing spondylarthritis were seen. Lumbar arthrosis was prevalent among females. Mean age of patients with disk disease was fairly low (43 years). Infectious spondylodiscitis and unilateral sacroiliitis, presumably reactive or infectious in origin, were also more common in women. HIV-infection was found in 44% of patients with spondylodiscitis and in 53% of patients with sacroiliitis. Age of HIV-infected individuals ranged from 21 to 40 years. Bacteriologic studies proved indispensable for determining the cause of these conditions in which leukocyte courts failed to rise. In young individuals in Kinshasa with spondylodiscitis or unilateral sacroiliitis, routine HIV testing is warranted.
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PMID:[Etiologic aspects of low back pain in rheumatic patients in Kinshasa (Zaire). Apropos of 169 cases]. 138 83

A case study is given of a 25-year old woman with rhabdomyolysis associated with HIV infection. The presenting symptoms were a 1-week history of backache, gross swelling of both hands and feet, and weakness and marked pain in most muscle groups; 3 days before admission the urine was black and she was unable to walk. Multiple, firm 1-2 cm lymph nodes were revealed during examination. White blood cell count (WBC) was 22,000/microliter with 12 pc lymphocytes, 7.3 pc monocytes, and 80.5 pc polymorphonuclear leukocytes. Hemoglobin concentration was 15.8 g/deciliter; platelet count was 124,000/microliter with a Westergren ESR of 109 mm/h. An antinuclear antibody test was negative. Serum concentration of urea was 3.8 mmol/liter, creatinine 42 microliter/liter, sodium 128 mmol/liter, and potassium 5.9 mmol/liter. Microscopic examination of urine revealed WBC 100/HPF, red blood cells 20/HBF, and granular casts. The dipstick test showed blood land protein in the urine. Electromyography showed inflammatory myopathy. Creatine Kinase (CK) concentration was 2359 IU/liter and lactate dehydrogenase concentration 1000 IU/liter. Hemolysis was present from clinical or laboratory signs. The patient tested HIV positive by ELISA (Abbott) and Western blot (Dupont). Treatment consisted of administration of 60 mg/day of prednisolone orally. Over 2 weeks, swelling of limbs was reduced and CK concentration was reduced to 931 IU/liter. The patient was discharged and did not keep a follow-up appointment. The patient did not have a history of other predisposing conditions, only HIV infection and persistent muscle weakness and inflammatory myopathy. There is evidence from other patient studies of myopathy associated with HIV infection and polymyositislike illness. In this case study, the patient may have had a acute form of polymyositis, or acute viral myositis such as occurs with echo, influenza, coxsackie, and other viral infections. A detailed viral investigation was not performed. HIV infection may have directly infected myocytes or immunosuppression predisposing to acute myositis by other pathogens. HIV-related muscle disease should include rhabdomyolysis.
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PMID:Rhabdomyolysis associated with human immunodeficiency virus (HIV) infection. 180 50

One year after the diagnosis of HIV infection, a 34-year-old man developed marked but painless swelling of the left parotid of uncertain cause. The swelling completely regressed under 60Co gamma radiation. Subsequently subfebrile temperatures were noted, together with nausea and back pain. Hepatomegaly with signs of biliary stasis occurred, LDH levels rose to 808 U/l, and pleural effusion and pericarditis with pericardial effusion occurred. Histological examination of inguinal lymph nodes revealed HIV-associated Burkitt's lymphoma in stage IVb. A full but short remission set in during a six-drug COP-BLAM treatment regimen. The patient died six months after the diagnosis had been made of rapidly spreading recurrence.
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PMID:[Burkitt's lymphoma in HIV infection]. 240 85

Tuberculosis (TB) remains endemic in many parts of the world. In developing countries, TB of the spine remains a major, expensive health problem. Tanzania has therefore since the 1970s reinforced its district and regional TB control efforts. The Ministry of Health has nonetheless reported a recent increase in the incidence of TB in the country. The authors have also noted an increase over the past several years in the number of pediatric patients with TB in the spine. They report retrospectively on 22 consecutive patients aged 3-13 years with TB of the spine who were managed at the Pediatric Surgical Unit of Muhimbili Medical Center in Dar es Salaam, Tanzania, over the period 1988-93. 12 subjects are male and 10 are female. The majority presented with back pain and/or deformity and weakness in the legs associated with difficulty in walking. The diagnosis was based upon radiological as well as hematological findings. Two patients had associated lung lesions and gave AFB-positive sputum. 63.5% were thoracolumbar T11-L2. All patients received chemotherapy, with two also undergoing simple drainage of paravertebral abscesses, and two debridement and bone grafting. There was no formal immobilization except that the children had to sleep on hard beds. All gave a history of BCG vaccination scars. Mantoux or Heaf test was performed on 16 of the 22, 11 of whom were positive. One patient resulted with paraplegia, one with marked paraparesis, and in 17 of 22 the kyphosis/gibbus increased. The authors conclude that laxity in the TB control programs and the widespread extent of HIV could be contributory factors in what appears to be an increase in TB infection in recent years.
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PMID:Tuberculosis of the spine in children at Muhimbili Medical Centre, Dar es Salaam. 778 56

WHO estimates 250 million new cases worldwide of sexually transmitted diseases (STDs) each year. STDs of growing concern are chlamydial infections responsible for pelvic inflammatory disease (PID) in women and pneumonia and ophthalmia in newborns, and incurable viral infections, including Herpes simplex virus, human papilloma virus (HPV), hepatitis B virus, and HIV infection. HPV types 16 and 18 are associated with cervical intraepithelial neoplasia, one of the most serious complication of STDs. PID is another serious STD complication because it tends to recur and causes chronic abdominal pain, eventually resulting in hysterectomy, infertility, ectopic pregnancy, or chronic backache. STDs adversely affect pregnancy, often leading to ectopic pregnancy, stillbirth, prematurity, congenital and perinatal infections, and puerperal maternal infections. Genital ulcer diseases, e.g., chancroid, facilitate HIV transmission. HIV infection boosts the virulence of STD pathogens, e.g., Herpes simplex virus. Many people with STDs are asymptomatic and the clinical profile of STDs is always in flux, thus resulting in less than optimal case detection. Obstacles of STD treatment include antibiotic resistance of betalactamase-producing Neisseria gonorrhoea strains and the immunocompromising effect of HIV infections. Tourists are responsible for introducing HIV infection into many countries. Some countries (e.g., Saudi Arabia) require a negative HIV test before foreigners can work in those countries. Health resources are not keeping up with the spread of STDs and HIV. Governments should embark on health education campaigns to stem the spread of HIV. They should also integrate AIDS prevention with the control of other STDs.
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PMID:Sexually transmitted diseases in the age of AIDS. 847 83

There is an increasing population of immunocompromised patients with HIV, IV drug abuse, organ transplantation, and long-term steroid treatment developing spinal infections. Delayed diagnosis because of blunted host immune response and lack of outward signs and symptoms places the treating physician at a disadvantage in the treatment of this type of disease, which presents at a later stage of development. Immunocompromised patients are infected by a different group of pathogens than their healthier cohorts (e.g., Pseudomonas, gram-negative bacteria and fungal infections) because their host defenses are diminished. Osteomyelitis with or with out pyomyositis and epidural abscess may occur. The overriding symptom is back pain. Radiculopathy, myelopathy, and sensory loss may accompany local pain and tenderness. Plain film radiography, CT scan, MR image, and bone scan is invaluable in the diagnosis of these infections. The cornerstone of treatment is identification of the responsible pathogen, appropriate medical therapy, immobilization of the affected segment of the spine, and physical therapy to combat physical deconditioning. Psoas abscesses may require surgical debridement if they cannot be adequately drained by CT-guided percutaneous catheterization. Epidural abscesses with neurologic compromise require surgical drainage. Impingement of the spinal cord or cauda equina by collapsed osteomyelitic vertebral bodies requires surgical debridement by anterior vertebrectomy, with an autologous tricortical iliac crest strut and immobilization of the spine using external bracing or posterior instrumentation as dictated by the disease.
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PMID:Spinal infections in the immunocompromised host. 853 51

Case of a 33-year-old female with AIDS who presented with fevers, chills, lower back pain and a large right hilar mass. Biopsy of the right paratracheal nodes revealed poorly differentiated non-small cell carcinoma with extensive necrosis. In patients infected with HIV the incidence of primary lung carcinoma is unknown. Despite these uncertainties, primary lung carcinoma must be considered in the differential diagnosis of young HIV-infected individuals presenting with intrathoracic radiographic abnormalities.
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PMID:Poorly differentiated non-small cell carcinoma of the lung in acquired immunodeficiency syndrome. 857 21

In this report the authors describe a patient in whom pneumococcal spondylitis was the presenting manifestation of HIV infection and discuss bone and joint infections during HIV infection. The case report involves a 43-year-old man from Mali who was admitted for fever and back pain that occurred during upper airway infection. Pneumococcal spondylitis was diagnosed based on MRI images showing an epidural effusion and on positive hemocultures for Streptococcus pneumoniae. Initial standard x-ray findings were normal but repeat imaging revealed the disco-vertebral lesions. HIV serology was positive but there was no evidence of immunodepression or decreased CD4 lymphocyte levels. Since the introduction of antibiotics bone and joint involvement in pneumococcal disease has become uncommon in developed countries. In patients with HIV infection pyogenic arthritis is rare but the risk of pneumococcal disease is greatly enhanced and arthritic lesions can occur. Only eleven cases of pneumococcal arthritis associated with HIV infection have been reported in the literature. However the incidence of these infections seems higher in Black Africa where they account for 50% of pyogenic arthritis. The authors emphasize the lack of correlation between the stage of HIV infection and the onset of pneumococcal osteoarthritic infections which could account for occurrence of the latter as presenting manifestations of retroviral seropositivity.
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PMID:[HIV infection manifesting as a pneumococcal spondylodiscitis]. 902 96

A study was undertaken to determine the role of typhoid in febrile illness. It was found that in 1992, Salmonella typhi, the causative agent of typhoid, played a 2.3% role in 25404 diagnostic specimens sent to Mulago Hospital, Kampala, the largest hospital in Uganda. The rates of isolation fell gradually from 2.3% in 1992 to 0.3% by 1995. Instead malaria was found to play a major role in febrile illnesses. Out of 355 patients attending a private clinic in Kampala, whose blood was examined for both malaria and typhoid, 97% were positive for malaria parasites compared to 0.84% with significant O and H Salmonella typhi antibody titres of > 1:80. Also malaria parasites were found in 60% (out of 105) of patients who had had persistent fevers and in whom doctors had also requested for HIV antibodies. Those who had HIV antibodies alone were six per cent and the ones with both were 28%, a finding which showed relatively low association of malaria and HIV. Where multiple tests were requested on one patient having general malaise or body joint pains and/or constant headaches, malaria was found to play a major role (73%) compared to syphilis (4.3%) and brucellosis (13.3%). Malaria parasites were seen in normal sizes and in somehow young or stunted forms. The latter were found more often in patients who had experienced one or a combination of the following: intermittent fevers, backache, headache, tiredness, joint and/or neck pains, and who had already received treatment for malaria.
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PMID:Selected laboratory tests in febrile patients in Kampala, Uganda. 964 Aug 25

Lentinan is a beta 1-->3 glucan isolated from Lentinus edodes (Shiitake mushroom) which has immune modulating properties. We have conducted two phase I/II placebo-controlled trials on a total of 98 patients. In one study at the San Francisco General Hospital (SFGH), ten patients each were administered 2, 5, or 10 mg of lentinan or placebo i.v. once a week for eight weeks. In the second study at the Community Research Initiative in New York (CRI), two groups of 20 patients each were administered 1 or 5 mg of lentinan i.v. twice a week for 12 weeks, and ten patients were administered placebo (vehicle containing mannitol plus dextran 40) i.v. twice a week. Entry criteria were an HIV positive test, CD4 levels of 200-500 cells, age 18-60 years, and without current opportunistic infections. This study confirms, in Caucasian subjects also, the good tolerability of lentinan observed in Japanese cancer patients. Side effects were mainly mild, especially when infusion was carried out over a 30-minute period. In the SFGH study, where administration was over a ten minute period, there were nine side effects severe enough to be reported to the FDA (one case each of anaphylactoid reaction, back pain, leg pain, depression, rigor, fever, chills, granulocytopenia and elevated liver enzymes) and there were four patients who discontinued therapy because of side effects. In the CRI study, where infusion was over a 30-minute period, there were no side effects reportable to the FDA and there were four dropouts due to side effects or personal preference. Most side effects resolved promptly after the discontinuation of medication, and all of them were relieved within 24 hours. Patients in the study have shown a trend toward increases in CD4 cells and in some patients neutrophil activity. Because of the small numbers, these values do not have statistical significance. Inasmuch as no side effects such as anemia, leukopenia, pancreatitis or neuropathy were seen, and in view of the positive effects of lentinan on certain surrogate markers (recognizing that these were small studies), we recommended a long-term clinical trial of lentinan in combination with didanosine (ddI) or zidovudine in HIV positive patients. Most patients in these trials did not have measurable p24 levels. In the CRI trials of ten patients with elevated p24 levels, eight on lentinan and two on placebo had decreased p24 levels. Of these decreases, those with lentinan and one with placebo were marked. These results were provocative and needed confirmation. Subsequent to this study, a trial of lentinan in combination with didanosine (ddI) showed a mean increase of 142 CD4 cells/mm3 over a twelve month period, in contrast to a decrease in CD4 cells in patients on ddI alone (Gordon et al. 1995).
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PMID:A placebo-controlled trial of the immune modulator, lentinan, in HIV-positive patients: a phase I/II trial. 1050 66


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