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

The Illinois Supreme Court upheld a statute which required HIV testing of individuals convicted of prostitution. The statute was neither an unreasonable search and seizure nor a denial of equal protection. The court found that controlling the spread of disease was within the state's police powers, and that the state's interest in AIDS prevention outweighed the convicts' interest in the requirement of individualized suspicion before a search. The court also noted that blood samples were minimally intrusive, and that the results would be confidential. The court recognized that states have broad regulatory and administrative powers in the public health fields, while convicts have a lesser expectation of privacy. In response to the convicted prostitutes' arguments about the ineffectiveness of mandatory testing, the court emphasized that it was concerned only with the constitutionality of the statute; not with whether this statute was the best way for the state to achieve its goal.
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PMID:People v. Adams. 1204 Dec 57

We present 2 patients with HIV/AIDS and suspected HIV-associated nephropathy who presented with end-stage renal disease and new-onset seizures. These cases highlight the relationship between metabolic disorders and new-onset seizures in HIV-infected persons. Causes of new-onset seizures in this setting include opportunistic infections, HIV-associated dementia (AIDS dementia complex), and various metabolic disorders. A sizable proportion of patients had no identifiable cause of seizures despite extensive workup. In these instances, seizures can be attributed to subclinical effects--direct and indirect--of HIV on the brain. Seizures tended to be recurrent, sometimes despite anticonvulsant therapy. In a subset of patients, seizures were the initial presenting sign of HIV infection.
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PMID:New-onset seizures as an initial presentation of end-stage renal failure in patients with HIV/AIDS. 1213 82

Stroke is an uncommon complication in pediatric patients with acquired immunodeficiency syndrome (AIDS). However, with the increasing life span of this patient population, more cases of stroke are being reported. We report the case of a 13-year-old girl with a known history of AIDS who presented with new-onset seizures and right hemiparesis. Serial imaging studies revealed progressive occlusion of the left middle cerebral artery and both anterior cerebral arteries with development of collateral circulation. The workup for other etiologies of stroke was negative. This nonatherosclerotic occlusive disease is most likely secondary to vasculopathy caused by the human immunodeficiency virus (HIV). HIV infection should be included in the differential diagnosis of children who present with seizures, mental status change or focal neurological deficits. Treatment options are limited. The different prognoses associated with the etiologies of stroke in this patient population mandate a careful and thorough evaluation.
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PMID:Stroke and pediatric human immunodeficiency virus infection. Case report and review of the literature. 1218 61

Fifteen HIV-infected patients who presented with new onset seizures (NOS) as the sole neurological manifestation, in whom no cause for the seizure was identifiable, were studied. The patients were mainly female with an average age of 31.3 years. They had generalised new onset seizures with a latency of 1.6 months between the discovery of the HIV positivity and the onset of the seizure. The neurological examinations were normal with no dementia. The electroencephalographic examinations were either normal or there was a generalised epileptic disturbance (GED). The patients have AIDS defining CD4+ T lymphocyte cell counts. There was a high prevalence of pulmonary tuberculosis (PTB) or multiple non-neurological illnesses in our study group. They have normal cerebrospinal fluid (CSF) analysis except for the presence of the HIV virus. All the patients have normal computerised tomogram (CT)/magnetic resonance imaging (MRI) scans of the brain. All the patients studied have abnormal right or left temporal lobe perfusion defects on the SPECT scan studies of the brain. The findings suggest that the new onset seizures in the HIV-infected patients are associated with direct HIV infection. The SPECT scan findings suggest that the HIV virus induce a focal metabolic abnormality or encephalopathy. The new onset seizure is then the manifestation of this abnormality.
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PMID:New onset seizures in HIV-infected patients without intracranial mass lesions or meningitis--a clinical, radiological and SPECT scan study. 1222 Jun 89

Clinically relevant movement disorders are identified in 3% of patients with HIV infection seen at tertiary referral centres. In the same setting, prospective follow-up shows that 50% of patients with AIDS develop tremor, parkinsonism or other extrapyramidal features. Hemiballism-hemichorea and tremor are the most common hyperkinesias seen in patients who are HIV positive, but other movement disorders diagnosed in these patients include dystonia, chorea, myoclonus, tics, paroxysmal dyskinesias and parkinsonism. Patients with movement disorders usually present with other clinical features such as peripheral neuropathy, seizures, myelopathy and dementia. In the vast majority of patients, hyperkinesias result from lesions caused by opportunistic infections, particularly toxoplasmosis, which damage the basal ganglia connections. On the other hand, parkinsonism and tremor can result from dopaminergic dysfunction resulting from HIV itself or the use of antidopaminergic drugs. The management of patients who are HIV positive who present with movement disorders involves recognition and treatment of opportunistic infections, symptomatic treatment of the movement disorder and the use of highly active antiretroviral therapy (HAART). The most effective treatment of cerebral toxoplasmosis in patients with HIV infection is the combination of sulfadiazine and pyrimethamine. Symptomatic treatment of the movement disorder is often disappointing: hemiballism improves with antipsychotics, but tremor, parkinsonism and other phenomena usually fail to respond to available therapies. Preliminary data suggest that HAART may be helpful in the symptomatic control as well as prevention of movement disorders in patients who are HIV positive.
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PMID:HIV-related movement disorders: epidemiology, pathogenesis and management. 1226 60

Despite efforts of the Gambian government, which established a ministry in 1981 that would tackle gender issues, improve women's health, and promote empowerment, women are underrepresented in government and business, and 84% are illiterate. Child mortality is among the highest in Africa; 134 children per 1000 die before their fifth birthday. In the mid-1980s austerity measures adopted by the World Bank and IMF left the ministry without funds. Rice and vegetable production, the main source of income for women, fell in the 1990s. In 1994, paddy production dropped 23% from the previous year; this was due to a lack of technical and financial assistance. The collapse of tourism with Capt. Yahya Jammeh's seizure of power has put prostitutes catering to tourists out of work, but women who have lost jobs in the hotel industry may be pushed into local prostitution to survive. The impact of this on the HIV/AIDS epidemic is unclear. Although Gambia is one of the world's most aid-dependent countries (more than a quarter of the GNP before the coup), corruption and mismanagement in the nongovernmental sector is widespread. The director of the Women in Development Programme, a $15m World Bank project, was forced to resign over allegations of fraud. The political process sidelines women; only village chiefs, who are traditionally men, are allowed to vote when new heads are elected.
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PMID:Tourism's collapse puts Gambian women at risk. 1228 43

Case records of HIV infected patients were analyzed for identifying neurological manifestations. Eight patients (7 males) were identified to have probable HIV encephalopathy (in a period of 24 months) as per the CDC revised classification system. Their ages ranged from one year to ten years. The neurological manifestations noted included-developmental delay (2 cases), seizures (6 cases), acute onset alteration of sensorium (4 cases), aphasia (2 cases), loss of vision (2 cases), focal neurological deficits (6 cases), brisk deep tendon reflexes (7 cases), extensor plantar responses (5 cases) and signs of cerebellar dysfunction (2 cases). Other clinical features included growth failure, microcephaly, fever, lymphadenopathy, hepatomegaly, splenomegaly, pneumonia, otorrhea and oral candidiasis. Cerebrospinal fluid studies were normal. The neuroimaging features included cerebral atrophy and ventricular dilatation, cerebral infarction, basal ganglia calcification and cerebellar atrophy. Childhood HIV infection may have a variety of neurological abnormalities. HIV infection should be suspected in children presenting with unexplained neurological manifestations and growth failure.
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PMID:Neurological manifestations of HIV infection. 1265 56

The human immunodeficiency virus type 1 (HIV-1) Tat protein is a key pathogenic factor in a variety of acquired immune deficiency syndrome (AIDS)-associated disorders. A number of studies have documented the neurotoxic property of Tat protein, and Tat has therefore been proposed to contribute to AIDS-associated neurological diseases. Nevertheless, the bulk of these studies are performed in in vitro neuronal cultures without taking into account the intricate cell-cell interaction in the brain, or by injection of recombinant Tat protein into the brain, which may cause secondary stress or damage to the brain. To gain a better understanding of the roles of Tat protein in HIV-1 neuropathogenesis, we attempted to establish a transgenic mouse model in which Tat expression was regulated by both the astrocyte-specific glial fibrillary acidic protein promoter and a doxycycline (Dox)-inducible promoter. In the present study, we characterized the phenotypic and neuropathogenic features of these mice. Both in vitro and in vivo assays confirmed that Tat expression occurred exclusively in astrocytes and was Dox-dependent. Tat expression in the brain caused failure to thrive, hunched gesture, tremor, ataxia, and slow cognitive and motor movement, seizures, and premature death. Neuropathologies of these mice were characterized by breakdown of cerebellum and cortex, brain edema, astrocytosis, degeneration of neuronal dendrites, neuronal apoptosis, and increased infiltration of activated monocytes and T lymphocytes. These results together demonstrate that Tat expression in the absence of HIV-1 infection is sufficient to cause neuropathologies similar to most of those noted in the brain of AIDS patients, and provide the first evidence in the context of a whole organism to support a critical role of Tat protein in HIV-1 neuropathogenesis. More importantly, our data suggest that the Dox inducible, brain-targeted Tat transgenic mice offer an in vivo model for delineating the molecular mechanisms of Tat neurotoxicity and for developing therapeutic strategies for treating HIV-associated neurological disorders.
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PMID:Neuropathologies in transgenic mice expressing human immunodeficiency virus type 1 Tat protein under the regulation of the astrocyte-specific glial fibrillary acidic protein promoter and doxycycline. 1270 54

Understanding the reaction mechanism of co-catalytic metallopeptidases provides a starting point for the design and synthesis of new molecules that can be screened as potential pharmaceuticals. Many of the enzymes that contain co-catalytic metallo-active sites play important roles in cellular processes such as tissue repair, protein maturation, hormone level regulation, cell-cycle control and protein degradation. Therefore, these enzymes play central roles in several disease states including cancer, HIV, stroke, diabetes, bacterial infections, neurological processes, schizophrenia, seizure disorders, and amyotrophic lateral sclerosis. The mechanism of AAP, an aminopeptidase from Aeromonas proteolytica, is one of the best-characterized examples of a metallopeptidase containing a co-catalytic metallo-active site, although this enzyme is not a specific pharmaceutical target at this time. As a large majority of co-catalytic metallopeptidases contain active sites that are nearly identical to the one observed in AAP, the major steps of their catalytic mechanisms are likely to be very similar. With this in mind, it is possible to propose a general catalytic mechanism for the hydrolysis of amino acid substrates.
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PMID:Co-catalytic metallopeptidases as pharmaceutical targets. 1271 52

Seizure disorders may complicate HIV disease, either as a direct result of HIV or as a manifestation of a secondary opportunistic infection. Unless a reversible cause of seizure activity can be discerned, current treatment guidelines recommend the use of anticonvulsant drugs in these patients. The concurrent use of antiretrovirals and anticonvulsants is a poorly studied area. Controlled clinical trials examining drug-drug and drug-disease interactions in this area are scant, leaving clinicians a therapeutic dilemma in terms of drug selection. Most studies have been retrospective in nature. Generalized seizures appear to be most common and occur most frequently in patients with more severe disease as indicated by lower mean CD4(+) cell counts. In short follow-up periods, seizures appear to recur relatively frequently. Treatment of seizures in this population is hindered by a lack of clear data and numerous reports of drug-drug and drug-disease interactions. In order to best provide evidence-based care, controlled clinical trials are needed to discern which anticonvulsants are best suited for use in this population. Trials should also examine appropriate dose adjustments that may be warranted when anticonvulsants and antiretrovirals agents are used concurrently. Unless an identifiable and reversible cause of seizures is identified in this patient population seizures should be treated with standard therapy and close follow-up and monitoring. Newer anticonvulsants (i.e., gabapentin, tiagabine) with fewer drug interactions may be better alternatives when compared to older anticonvulsant agents. Clinicians might avoid valproic acid given some conflicting reports regarding potential for increasing viral replication.
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PMID:Concurrent use of antiretrovirals and anticonvulsants in human immunodeficiency virus (HIV) seropositive patients. 1276 23


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