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

12 cases of peripheral facial nerve palsy in African patients attending the Centre National Hospitalier Universitaire de Bangui, Central African Republic, with HIV infections are described with clinical and serological findings. All sera were tested with ELISA and confirmed with Western blot for both HIV-1 and HIV-2 (ELAVIA 1, ELAVIA 2, LAV BLOT I, LAV BLOT II, Diagnostics Pasteur). All 12 were HIV-1 positive and HIV-2 negative. Clinically, 1 patient met the clinical definition of AIDS, 3 had AIDS-related complex, and 8 had been previously health. In 11 cases, facial nerve palsy was the 1st presenting syndrome of HIV infection. ONset was acute in all, and associated with flu-like symptoms in 7. The palsy resembled Bell's palsy in 9, but was associated with unilateral vesicular eruptions suggestive of Ramsay-Hunt syndrome, or varicella-zoster, in 2 cases. In 1 19-year old woman complete facial paralysis with peri-oral numbness and paresthesia of the cheek developed in 1 hour. All recovered in 2 weeks to 3 months. The T4 lymphocyte counts averaged 764 in the healthy patients and 373 in the ARC and AIDS patients, compared to 1949 in controls. T4/T8 ratios averaged 0.66 and 0.45 in these groups compared to 1.32 in controls. 4 other cases of facial palsy in persons testing negative for HIV are also described. Speculative explanations for the pathophysiology of these palsies were offered: local infection of the facial nerve or ganglion by HIV, inflammatory demyelinating neuropathy, or secondary infection, due to immunosuppression, by agents such as Herpes zoster.
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PMID:Peripheral facial nerve palsy related to HIV infection: relationship with the immunological status and the HIV staging in Central Africa. 168 26

A 33-year-old woman, seropositive for human immunodeficiency virus type 1 (HIV-1), presented with progressive weakness and numbness of the lower extremities, gait difficulties, and urinary frequency. Physical examination revealed bilateral lower extremity weakness, a left-sided Babinski reflex, and a thoracic sensory level to pinprick at T8. Serum rapid plasma reagin was 1:64, and fluorescent treponemal antibody-absorption (FTA-ABS) was 4+. Examination of the cerebrospinal fluid showed a mononuclear pleocytosis and reactive FTA-ABS. The myelopathy responded promptly to high-dose intravenous aqueous penicillin. Syphilis needs to be considered in the differential diagnosis of any patient who develops a myelopathy in association with HIV-1 infection. Because of the diverse nature in which syphilis may affect the spinal cord, treatment with intravenous aqueous penicillin, 12 to 24 million units daily, for a minimum of 10 days, should be considered in any HIV-1-seropositive patient with a progressive, unexplained myelopathy and positive serologic studies for syphilis.
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PMID:Spinal cord syphilis associated with human immunodeficiency virus infection: a treatable myelopathy. 173 97

The vast majority of patients with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) have symptoms or signs involving the feet and lower extremities. Patients presenting to podiatrists with foot complaints may, in fact, have neurologic complications of HIV originating in any level of the neuraxis, and multiple levels may be involved. These include multiple classes of peripheral neuropathy and myopathy, inflammatory radiculopathy, myelopathy, and central nervous system lesions caused by direct HIV infection or opportunistic infections. Common complaints such as pain, numbness, burning, tingling, weakness, cramps, unsteady gait, and others should be systematically evaluated with both podiatric and neurologic etiologies in mind for early diagnosis and intervention.
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PMID:Neurologic conditions affecting the lower extremities in HIV infection. 764 14

We examined the relationship of somatic complaints to coping behaviors and mood states among 50 HIV-positive patients without AIDS. Although no patients fulfilled the DSM-III-R criteria for mood disorders including major depression, scores for depressive symptoms were significantly higher in the HIV-positive patients than in healthy persons. Although depressive symptoms in HIV patients may not be strong enough to warrant a psychiatric diagnosis of mood disorders, these patients may be prone to depressive symptoms. The HIV patients indicated a tendency toward somatic complaints more frequently than their healthy counterparts. The scores for depressive symptoms were significantly and positively correlated with scores for avoidance coping responses. The presence or absence of six complaints (i.e., general fatigue, abdominal distress, chest pain or discomfort, and numbness or chills) could be discriminated based on the score of avoidance coping responses. The results of this study suggest that avoidance coping responses associated with depressive symptoms accompany several somatic complaints in HIV patients without AIDS.
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PMID:Liaison psychiatry and HIV infection (I): Avoidance coping responses associated with depressive symptoms accompanying somatic complaints. 907 52

A patient admitted to your unit this morning presents a dauntingly complex clinical picture. Maria DeJesus, 34 years old, has HIV infection, which progressed to AIDS last year with an episode of Pneumocystis carinii pneumonia. She's also experienced recurrent vaginal and esophageal candidiasis and cryptococcal meningitis, and her more recent history includes peripheral neuropathy, causing pain and numbness, as well as cognitive and motor function problems. Her admission was prompted by diarrhea that has persisted despite outpatient treatment. To provide the best care for patients like Ms. DeJesus, you need to understand HIV infection and the diseases associated with it. Yet that's a challenging task, given that the possible manifestations of advanced infection are so many and varied. Though your approach to care is holistic, you may find it helpful to consider the numerous facets of the patient's illness individually. In the following pages, we'll examine how HIV enters the body, infects immune cells, and eventually cripples the immune system. We'll look at some of the more common opportunistic infections preying on people with HIV. And we'll explore the less well-charted territory of complications attributed to HIV infection of the central and peripheral nervous systems.
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PMID:Understanding the devastation of AIDS. 924 79

Painful sensory neuropathy (PSN) is the most common neurological disorder associated with HIV infection and affects up to 30% of HIV-positive individuals. PSN may develop as a consequence of HIV infection or from the toxic effect of the antiretrovirals. Although several tools have been developed to screen for PSN, their validity and reliability has yet to be established among HIV-positive patients. The Subjective Peripheral Neuropathy Screen (SPNS) is a brief self-report tool that is currently being administered in the AIDS Clinical Trials Group. The objective of this study was to establish the psychometric properties of the SPNS screening tool for the correct identification of PSN in HIV-positive individuals. Specifically the goals were to determine the reliability, the validity, and the diagnostic efficiency of the SPNS in the detection of PSN. Data were abstracted on subjects enrolled in an ongoing natural history cohort. The SPNS was administered to a convenience sample of 39 HIV-positive individuals with PSN and 44 HIV-positive controls. Results showed the SPNS to be internally consistent (Cronbach's alpha = .86). SPNS score differences assessed by t-test were significantly different for individual symptoms of parasthesias, numbness, and pain of the lower extremities, and for severity measures (the Clinical Severity Grade, and the Average Severity Score) between the HIV-positive groups (p < .05). Using Spearman's rank, significant correlations were demonstrated between the neurological exam and the Clinical Severity Grade and the Average Severity Score, the neurological exam and vibratory quantitative sensory testing (QST) only, and the severity measures and vibratory QST only. Sensitivity and specificity analysis demonstrated that numbness of the lower extremities was the symptom with the highest efficiency for correctly classifying PSN. Thus, internal consistency, construct validity, and criterion related validity were confirmed with the SPNS for the correct classification of PSN in HIV-positive individuals.
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PMID:The reliability and validity of the subjective peripheral neuropathy screen. 965 64

We reported a case of acquired immune deficiency syndrome (AIDS) with acute lumbosacral polyradiculopathy (ALSP), resulting from the opportunistic infection of cytomegalovirus (CMV). A 22-year-old Thai woman noticed weakness of the both legs, and two weeks later, she became unable to walk and had the difficulty of voiding. Neurological examination revealed flaccid paraplegia, sensory disturbance of the both legs, areflexia of the patella and ankle, and urinary retention. She could not move the legs on either side except for ankle flexion or extension, and the passive elevation of the leg brought about severe sacral pain. Radiological examinations, including lumbar MRI, failed to reveal abnormal findings. The needle EMG showed an acute denervation of the lower leg muscles, and the lumbar puncture yielded a colorless fluid containing 2,097/cu mm WBC (polynuclear 88%), 412 mg/dl protein and 45 mg/dl glucose. The serum HIV-1 antibody was positive with a marked loss of CD4 lymphocytes (31/cu mm). In CSF, the DNA of CMV was detected in the polymerase chain reaction (PCR) method. In addition, large round cells with intranuclear or cytoplasmic inclusions showing immunopositivity for the CMV antibody were present. Ganciclovir (daily dose: 400 mg, every 12 h) was administered for two weeks, but the painful numbness gradually extended to the trunk. For AIDS patients, ALSP caused by the CMV infection is a rare neurological complication, and this is the first case report in Japan. Progressive flaccid paraplegia with sensory disturbance, radicular pain, or bladder dysfunction are characteristic symptoms, and CSF pleocytosis with elevated protein or hypoglycorrhachia provides a diagnostic clue for clinicians. In addition, the CMV-DNA amplification in the PCR method or immunohistochemical approach from CSF is a useful procedure.
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PMID:[A case of acquired immune deficiency syndrome presenting acute lumbosacral polyradiculopathy due to opportunistic infection of cytomegalovirus]. 986 11

Distal symmetrical peripheral neuropathy is a common adverse experience in persons with HIV infection. This condition, which presents as a pain, numbness. burning and/or dysaethesia initially in the feet, is often multi-factorial in its origin. Nucleoside analogue reverse transcriptase inhibitors represent an important contributor to peripheral neuropathy. Specifically, around 10% of patients receiving stavudine or zalcitabine and 1 to 2% of didanosine recipients may have to discontinue therapy with these agents due to neuropathy. Prompt withdrawal of these therapies enables gradual resolution of signs and symptoms in most patients, although a period of symptom intensification may occur shortly after withdrawal. Risk factors for developing peripheral neuropathy during nucleoside analogue therapy include low CD4+ cell count (<100 cells/mm3), a prior history of an AIDS defining illness or neoplasm, a history of peripheral neuropathy, use of other neurotoxic agents including high alcohol (ethanol) consumption and nutritional deficiencies such as low serum hydroxocobalamin levels. Thus, patients at increased risk of peripheral neuropathy should potentially avoid the use of the neurotoxic nucleoside analogues or be more carefully monitored during therapy. Management of this problem includes patient education. prompt withdrawal of the likely causative agent (giving consideration not to leave the patient on a sub-optimal therapy regimen) and simple analgesia. with augmentation with tricyclic antidepressants or anticonvulsant agents when pain is severe. New agents that may assist in managing this condition include levacecarnine (acetyl-L-carnitine) and nerve growth factors such as recombinant human nerve growth factor.
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PMID:Peripheral neuropathy with nucleoside antiretrovirals: risk factors, incidence and management. 988 91

The authors administered the Medical Outcomes Study (MOS 20) Short Form Health Survey to 369 persons with HIV disease. The MOS survey measures six domains of health: physical function, role function, social function, mental health, health perception, and pain. Additional data included sociodemographics, HIV risk group, time since HIV diagnosis, symptoms (dyspnea, diarrhea, fever, chills, sweats, weight loss, weakness, numbness, memory trouble, seizures), and CD4 lymphocyte count within 3 months of the MOS survey. Bivariate analyses revealed worse MOS scores associated with older age in five health domains: physical function (p less than .01), health perception (p <.10), role function (n.s.), social function (n.s.), and mental health (n.s.). Older subjects reported less pain. When controlling for CD4 count and for sociodemographic and clinical variables, older age was significantly (p less than .05) associated with worse MOS scores in physical function, social function, and health perception, nonsignificantly associated with worse MOS scores in role function and mental health, and nonsignificantly associated with less reporting of pain.
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PMID:The impact of age on the quality of life in persons with HIV infection. 1016 53

A 43-year-old HIV-positive male was referred to our pain clinic one month after his fourth attack of herpes zoster infection. He complained of intermittent intolerable sharp and lancinating pain accompanied by numbness over the inner aspect of the left upper extremity, left anterior chest wall and the back. Physical examination revealed allodynia over the left T1 and T2 dermatomes without any obvious skin lesion. The pain was treated with epidural block made possible by a retention epidural catheter placed via the T2-3 interspace. After the administration of 8 ml of 1% lidocaine in divided doses, the pain was completely relieved for 4 h without significant change of blood pressure or heart rate. A pump (Baxter API) for patient-controlled analgesia (PCA) filled with 0.08% bupivacaine was connected to the epidural catheter on the next day and programmed at a basal rate of 2 ml/h, PCA dose 2 ml, lockout interval 15 min, with an one-hour dose limit of 8 ml. He was instructed to report his condition by telephone every weekday. The pump was refilled with drug and the wound of catheter entry was checked and managed every 3 or 4 days. The epidural catheter was replaced every week. During treatment, the pain intensity was controlled in the range from 10 to 0-2 on the visual analogue scale. He was very satisfied with the treatment and reported only slight hypoesthesia over the left upper extremity in the early treatment period. Epidural PCA was discontinued after 28 days. He did not complain of pain thereafter but reported a slight numb sensation still over the lesion site for a period of time. In conclusion, postherpetic neuralgia in an HIV-infected man was successfully treated with ambulatory therapeutic modality of epidural PCA for 28 days.
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PMID:Patient-controlled epidural analgesia for postherpetic neuralgia in an HIV-infected patient as a therapeutic ambulatory modality. 1039 20


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