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

We report two cases of human immunodeficiency virus (HIV) seropositivity and pulmonary hypertension seen at our institution and present a comprehensive literature review and available histopathologic findings of the association between HIV seropositivity and pulmonary hypertension. Studies and reviews pertaining to HIV seropositivity and pulmonary hypertension were identified through a MEDLINE search and reference citations. All studies and series found in the MEDLINE search were reviewed and are discussed in this article. Where data were available, comparisons and analyses were made between groups of reported cases of HIV seropositivity and pulmonary hypertension with regard to the following parameters: sex distribution, mode of acquiring HIV infection, presence or absence of the acquired immunodeficiency syndrome, CD4 cell counts, PO2 or oxygen saturation by pulse oximetry, concurrent lower respiratory tract infection, and histopathologic features. We conclude that there is strong evidence for pulmonary hypertension associated with HIV infection that is histologically indistinguishable from primary pulmonary hypertension. Consequently, HIV-seropositive patients with unexplained dyspnea should be evaluated for primary pulmonary hypertension. Prospective studies in HIV-positive patients are indicated.
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PMID:Primary pulmonary hypertension and the human immunodeficiency virus. Report of two cases and a review of the literature. 748 62

This article provides a clinically-oriented overview of palliative care for patients with AIDS. Indicators of decreased survival time are divided into categories of infections/illnesses, clinical signs and symptoms, immunological and serological markers, and psychosocial factors. Primary symptoms in AIDS are discussed according to etiology and treatment. However, treatments of opportunistic infections per se are not directly addressed in this article. Problems discussed include pain, confusion, depression and anxiety, fatigue, fever, dyspnea, nausea and vomiting, diarrhea, wasting, and dehydration. The article also briefly addresses clinical and ethical questions and challenges presented by AIDS to hospice or palliative care providers, and the various stages of HIV infection.
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PMID:Palliative care for patients with acquired immunodeficiency syndrome. 749 35

Lung 99mTc DTPA transfer/permeability has been widely used to assess the integrity of the lung alveolar-capillary interface. The use in HIV positive patients to provide a rapid assessment of causes of breathlessness or fever is discussed in this overview. There is I believe a clear role for this technique in this group of patients. It is more sensitive than Gallium-67 scanning in defining lung disease and is capable of distinguishing between alveolitic processes and bacterial infections of Kaposi sarcomatous infiltration. The 99mTc DTPA transfer/permeability can also define the absence of lung involvement in those patients with a fever to allow more suitable investigation to proceed. The 99mTc DTPA transfer/permeability measurement is a rapid, easy method of evaluating patients with HIV disease. Depending on the clinicians philosophy it can be used as a basis to initiate treatment or at the very least point to the next necessary investigation.
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PMID:99mTc DTPA transfer/permeability in patients with HIV disease. 755 46

A thirty-six year old male was admitted to the hospital because of fever and dyspnea. On the eighth day the patient turned out to be HIV positive. Although aggressive therapy was performed, the patient died of HIV related disease such as Pneumocystis carinii pneumonitis and CMV infection which led to multiple organ failure seventeen days after admission. We reported a case of AIDS patient who was hard to diagnose from an initial symptom of interstitial pneumonitis.
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PMID:[A case of AIDS patient who was hard to diagnose from an initial symptom of interstitial pneumonitis]. 759 92

Kaposi's sarcoma (KS) is common in individuals infected with the human immunodeficiency virus (HIV-1). Although KS is frequently indolent, it can also be aggressive and life-threatening, especially in patients with pulmonary involvement (PKS), who have poor survival rates when untreated. In an effort to develop treatment regimens for PKS that would prolong life or reduce clinical symptoms, we used combination chemotherapy to treat 18 patients who had AIDS and PKS; 13 (72%) of them had a history of previous opportunistic infections. Doxorubicin, bleomycin, vinblastine, vincristine, actinomycin D, and dacarbazine were used in 3-week cycles with concomitant zidovudine, zalcitabine (dideoxycytidine), or didanocine (dideoxyinosine). Antiviral therapy was continued with chemotherapy. A partial or complete response to chemotherapy was obtained in 15 of the 18 patients (83%), as characterized by clearing of infiltrates on chest films and resolution of dyspnea and cough. Only 2 patients had opportunistic infections during treatment. Median survival was 9 months; patients who received dose reductions in less than three cycles of chemotherapy survived more than 1 year. Most deaths were related to unresponsive PKS. These results indicate that patients with symptomatic PKS can be safely and effectively treated with combination chemotherapy while receiving myelosuppressive drugs such as zidovudine. Such patients receive substantial relief from dyspnea and cough. Survival for treated patients exceeds survival for untreated historical controls.
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PMID:Chemotherapy for patients with pulmonary Kaposi's sarcoma: benefit of filgrastim (G-CSF) in supporting dose administration. 769 75

There are two aspects to considerations of the value of peritoneal dialysis (PD) in the treatment of renal insufficiency with associated pathology. The first involves the effects of the treatment on the symptoms or evolution of the pathology. Examples include the improvement of dyspnea due to cardiac insufficiency (CI) and of cirrhotic ascites (CA). However, there is also an undefined risk of reactivation lupus. The second facet is the increased risk of peritoneal infection, particularly for patients who are HIV + or who are immunosuppressed due to lupus or myeloma. In certain types of case (lupus with intractable vascular thrombosis, intolerance of ultrafiltration in cases of CI, AC or generalised amyloidosis) PD has particular advantages. Nevertheless, there has been no appropriate prospective study to demonstrate or otherwise the advantages in terms of survival. The use of PD remains therefore a matter of choice for individual patients and experienced health care team.
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PMID:[Peritoneal dialysis in cases of associated pathology]. 770 Apr 12

HIV-associated tuberculosis (TB) poses an immediate and serious threat to public health, especially in the developing world. Moreover, atypical clinical presentation and unfavorable outcome have been observed in HIV-infected patients with TB. The authors report their findings from an investigation of the impact of HIV infection upon the clinical presentation, response to treatment, and outcome of pulmonary TB. The symptoms, radiographic pattern, sputum direct smear, drug susceptibility, treatment outcome, and adverse reactions of 88 HIV-infected patients seen during January-October 1993 at the Central Chest Hospital, Nonthaburi, Thailand, with newly-diagnosed, culture-proven, untreated pulmonary TB were compared with those of age- and gender-matched HIV-seronegative patients. There were 82 men and six women in each group of mean age 35.6 years, with the majority being aged 16-40. Heterosexual contact was the most common risk factor for HIV infection, with homosexuality implicated in only 1% of all cases of infection. No difference was observed between the two groups in the frequency of pyrexia, dyspnoea, cough, or hemoptysis, although cavitary lesions and upper zone infiltrates were observed significantly less often in the HIV-infected group. Direct smear positivity was comparable in the two groups. Resistance rates to anti-TB drugs were not different except for Streptomycin which was higher among the HIV-infected patients. Cutaneous hypersensitivity reactions and drug-induced hepatitis occurred more often in the HIV-seropositive group, but the difference was not statistically significant. Default was much higher among the HIV-infected, although the culture conversion rate was satisfactory among those who completed treatment. Twelve HIV-infected patients died during the course of treatment, four due to TB. The authors that their findings lead physicians to suspect TB among HIV-seropositive patients and provide them with the appropriate and timely short-course chemotherapy.
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PMID:Clinical aspects and treatment outcome in HIV-associated pulmonary tuberculosis: an experience from a Thai referral centre. 774 73

We present a patient with a very large pericardial effusion due to disseminated Mycobacterium avium complex (MAC) infection with associated bacteraemia and gastroenteritis. He was HIV antibody-positive with a CD4+ lymphocyte count of 10 x 10(6)/l. He complained of fevers, diarrhoea and dyspnoea and an echocardiogram showed a pericardial effusion. Chest X-ray showed progressive enlargement of the cardiac silhouette over a 3-month period. The effusion was drained surgically and antimycobacterial therapy (clarithromycin, clofazamine, rifampicin, ciprofloxacin, amikacin) was initiated. The patient had complete resolution of his pericardial effusion both clinically and radiologically. Three other AIDS patients with pericardial effusions caused by MAC are described in the medical literature, two died of cardiac dysfunction shortly after diagnosis. There is a case described of MAC-related pericardial effusion in a HIV-negative immunocompetent patient which resolved antimycobacterial therapy. MAC should be included in the differential diagnosis of pericardial effusions in AIDS patients. A combination of medical therapy and surgical intervention may give rise to considerable clinical benefit especially if initiated early.
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PMID:Mycobacterium avium: a potentially treatable cause of pericardial effusions. 775 68

Between July and November 1992, in Senegal, health workers took sputum samples from 27 HIV-positive patients (19 men and 8 women) aged 20-66 at the infectious disease service of Fann University Hospital Center in Dakar so researchers could determine the prevalence of Pneumocystis carinii pneumonia among HIV-positive patients and specify the characteristics of P. carinii pneumonia among HIV-positive patients in Dakar. The simple, effective, and low-cost technique used was coloration of the sputum with Toluidine O. 70.3% had HIV-1 infection, 26% had HIV-2 infection, and 3.7% had both HIV-1 and HIV-2 infection. 55.5% had CD4 counts under 200/cu. mm. 40.7% had higher CD4 counts. The CD4 count could not be measured in one patient. Six (22.2%) tested positive for P. carinii. Four of the patients with P. carinii pneumonia were HIV-1 positive. The other two were HIV-2 positive. 83.3% had fever and were becoming thinner. 33.3% had a cough. 16.6% had difficulty breathing. One patient with P. carinii infection was asymptomatic. Two pneumocystis patients had diffuse interstitial infiltration and perihilar infiltration. Another patient also had pulmonary tuberculosis. The CD4 count for 80% of HIV-infected patients who tested positive for P. carinii pneumonia was less than 200/cu. mm.
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PMID:[Preliminary study of pneumocystis carinii pneumonia diagnosed by induced expectoration in HIV positive patients in Dakar]. 775 66

A 51-year-old man, known to have chronic-aggressive hepatitis B, HIV infection and exertional dyspnoea, was hospitalized because of acute physical deterioration, cough with whitish exudate and dyspnoea at rest. Despite a CD4/CD8 ratio of 0.16 no prophylactic measures against Pneumocystis carinii had been taken. On examination the lungs were unremarkable, but the liver was enlarged and there were petechiae over all parts of the body. Laboratory tests showed impaired liver functions and a rise in lactate dehydrogenase activity (538 U/l). Chest radiogram demonstrated small to very small infiltrates in the lung. As Pneumocystis carinii pneumonia was suspected but bronchoscopy was too risky, he was at first treated with trimethoprim/sulphamethoxazole (four times 320/1600 mg/24 h intravenously). When this failed, he received pentamidine (4 mg/kg, after 4 days 2 mg/kg intravenously), and finally cefotiam (twice 2 g daily), tobramycin (three times 40 mg daily) and corticoids (100 mg). Despite this treatment he died after 10 days from respiratory failure. Autopsy revealed interstitial pneumonia throughout the lung as well as focal mucor infiltrations in the wall of middle-calibre lung veins. Mucor is a ubiquitous, facultatively pathogenic mold fungus.
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PMID:[Pulmonary mucormycosis in an HIV-infected patient]. 783 42


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