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

To confirm the presence of cardiac dysfunction in a group of patients seropositive for the human immunodeficiency virus with either dyspnea on exertion or a reduced anaerobic threshold, 9 patients with no history of opportunistic infection underwent exercise right-sided heart catheterization. When compared with 13 control patients previously exercised in the same manner, the patients showed elevated exercise pulmonary capillary wedge pressure (14.6 +/- 3.3 mm of mercury versus 9.9 +/- 3.3 mm of mercury; P less than .005) and right atrial pressure (10.1 +/- 2.1 mm of mercury versus 4.7 +/- 3.2 mm of mercury; P less than .001) at a similar exercise oxygen consumption and cardiac index. Of the 9 patients, 8 had at least 1 catheterization value outside the 95% confidence limits for the control group and 4 patients had multiple abnormalities. Values for blood CD4 lymphocytes were 0.2 x 10(9) per liter or more for 7 of the 9. One patient underwent endomyocardial biopsy with findings consistent with a cardiomyopathy. We conclude that cardiac disease may occur at any immunologic stage of human immunodeficiency virus infection. These observations suggest an effect of this disease on the heart.
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PMID:Cardiac dysfunction in patients seropositive for the human immunodeficiency virus. 177 74

A 50-year-old man, who developed bronchial asthma at the age of 43 and was treated continuously with corticosteroids from the beginning of the first treatment, was admitted with exacerbation of exertional dyspnea. In spite of various treatments for bronchial asthma, such as theophylline, beta-stimulants, anti-allergic drugs and steroid-inhalation, asthmatic symptoms did not improve and he continued to receive intravenous administration of steroids. Five months after admission, he suddenly developed severe respiratory failure and died after five days. Autopsy revealed Pneumocystis carinii pneumonia and marked atrophy of adrenal glands. No evidence of malignancy or hematologic disease was seen. Serum HIV antibody was negative. Secondary immunodeficiency induced by long-term corticosteroid administration of over 7 years was considered to be the cause of Pneumocystis carinii pneumonia. It seems that no case of Pneumocystis carinii pneumonia with bronchial asthma alone has ever been reported in medical literature.
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PMID:[A case of Pneumocystis carinii pneumonia with bronchial asthma following long-term corticosteroid therapy]. 192 Sep 86

A 41-year-old homosexual man complained about weight loss of 14 kg over a period of 6 months. He developed exertional dyspnea and fever up to 39.6 degrees C. The ESR was elevated and the fraction of immature neutrophils increased. Penicillin was administered with no effect, chest X-ray showed basal pulmonary infiltrates, P. carinii was found in bronchioalveolar fluid. HIV-serology was positive. Sulfamethoxazole/trimethoprim (1600/320 mg daily) and 100 mg of prednisolone/die led to reduction of fever. Prevention of P. carinii pneumonia relapse is currently underway with bi-weekly inhalation of pentamidine-isethionate aerosol.
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PMID:[Weight loss, fever, dyspnea]. 230 43

Primary pulmonary hypertension (PPH) is at present little understood. It is characterized by extensive remodeling of the pulmonary vasculature, with consequent deleterious hypertrophic changes in the right ventricle. Median survival is 2.6 years, although this varies with the severity of right heart failure. Although PPH can occur at any age and in either sex, it primarily affects young to middle-aged women. A genetic predisposition appears to be a component of this disease, triggered by presentation of a stimulus (e.g., drugs or HIV infection). Symptomatic presentation includes exertional dyspnea, chest pain, and syncope. At present, therapy consists principally of anticoagulation, calcium antagonists, nitric oxide inhalation, or continuous intravenous prostacyclin.
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PMID:Pathology and pathophysiology of primary pulmonary hypertension. 784 55

In a retrospective study, the perioperative findings and complications of AIDS patients and asymptomatic HIV-positive patients were compared to those of HIV-negative patients. Characteristic operations in HIV-positive patients were those of extremities in general surgery, and dilatation and curettage in gynecology. There were significant differences among three groups concerning preoperative hemoglobin, GOT, electrolyte concentrations and heart rate. As the preoperative findings, hepatitis and dyspnea on exertion were remarkable in the HIV-positive patients. During anesthesia tachycardia was more frequent in the HIV-positive patients. Postoperatively high fever, anemia and tachycardia were significantly more frequent in the HIV-positive patients. The postoperative leucocyte count was less in the AIDS-patients than in other two groups. As a whole there are some peculiarities about the estimation of the risk and the planning of anesthesia in the HIV-positive patients.
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PMID:[Perioperative complications in HIV-positive patients]. 818 23

A 25-year old HIV-1-positive hemophiliac was admitted with fever, cough, exertional dyspnea and pleuritic chest pain. Chest x-ray showed diffuse bilateral infiltrates with a left sided nodular consolidation. Pneumocystis-carinii-pneumonia was suspected and diagnosed by broncho-alveolar lavage. With therapy the diffuse infiltrates improved, but the nodule and the symptoms failed to resolve. A fine-needle aspiration of the nodule revealed concurrent cryptococcosis. Treatment with fluconazole resulted in complete resolution of symptoms. Details of the case are presented and clinical implications are discussed.
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PMID:[Double infection of the lung with Pneumocystis carinii and Cryptococcus neoformans in an AIDS patient]. 830 25

A 37-year old patient, HIV-1-infected, consulted for progressive weakness and dyspnea on exertion, increasing over three months. Complete blood count showed pancytopenia, while the bone marrow revealed severe hypoplasia. Other investigations, including serology for CMV, vitamin levels, Coombs test, gastroscopy and colonoscopy were non contributing. A diagnosis of zidovudine-induced medullary aplasia was made; the clinical course was favourable after this drug was replaced by triple therapy. The authors discuss the differential diagnosis of cytopenias in the patient infected by HIV and they suggest a diagnostic approach.
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PMID:[Clinical case of the month. Apropos of pancytopenia in a seropositive patient]. 992 66

Primary pulmonary hypertension (PPH) is a pulmonary vascular disease characterized by an elevation in mean pulmonary artery pressure and pulmonary vascular resistance. Recently, PPH gained national attention because of its association with appetite suppressants. PPH may also be associated with pregnancy, hypothyroidism, autoimmune disorders, human immunodeficiency virus infection, and the use of drugs such as oral contraceptives and cocaine. Patients with PPH may report dyspnea on exertion and fatigue. Early diagnosis is crucial. New therapeutic regimens have dramatically reduced mortality rates and improved quality of life by halting the progression of pulmonary vascular remodeling and averting right-sided heart failure. These therapies include high-dose calcium channel antagonists, anticoagulants, and continuous intravenous prostacyclin. Lung or heart-lung transplantation remains a viable therapeutic option for patients who are treated late in the disease process, who are not responsive to medical management, or who remain symptomatic and continue to deteriorate.
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PMID:Diagnosing and treating primary pulmonary hypertension. 1050 69

In recent years, much more thought has been given to the pathogenic role of HIV and to the clinical manifestations of HIV-related pulmonary hypertension (HRPH), which currently represents one of the most severe events during HIV disease. HRPH occurs in early and late stages of HIV infection and does not seem to be related to the degree of immune deficiency. Many of the symptoms in HRPH result from right ventricular dysfunction: the first clinical manifestation is effort intolerance and exertional dyspnea that will progress to the point of breathlessness at rest. The diagnosis of HRPH can be made only after all etiologies for pulmonary hypertension have been excluded. Echocardiography has been proven to be an extremely useful tool for diagnosing HRPH, and Doppler echocardiography can be used to estimate systolic pulmonary artery pressure and to monitor the effects of therapy. Assessment of hemodynamic measures by catheterization remains, however, the best test for evaluating response to therapy. Cardiac catheterization is mandatory to characterize the disease and exclude an underlying cardiac shunt as etiology. Vasodilators have been extensively used in the treatment of pulmonary hypertension, since vasoconstriction is a determinant characteristic of this disease. However, HRPH remains a progressive disease for which treatment is often unsatisfactory and there is no cure. As new, more efficient antiretroviral treatment are introduced, clinicians should expect to encounter an increasing number of cases of pulmonary hypertension in HIV+ patients in the future.
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PMID:Clinical manifestation of HIV-related pulmonary hypertension. 1176 89

Acute histoplasmosis is usually a benign, self-limited infection in endemic areas. Since protection against Histoplasma capsulatum infection requires specific, cell-mediated immunity, histoplasmosis is well documented in patients with acquired T cell deficiencies e.g. due to HIV infection. We report here for the first time a case of pleural effusion due to H. capsulatum infection in a patient with idiopathic CD4 lymphocytopenia (ICL). A 25-year-old woman presented with chest pain, dyspnea on exertion and a moderate weight loss. Chest X-ray showed a large left pleural effusion, and thoracentesis yielded an exudate. Histologic examination of pleural biopsies identified H. capsulatum. Laboratory tests revealed lymphocytopenia with low CD4+ T cell counts (<100/microl) and a decreased CD4/CD8 ratio. Serology, including HIV, was repeatedly negative. The diagnosis of pleural effusion due to H. capsulatum infection in a patient with idiophatic ICL was established. There was no evidence of any other opportunistic infection. Treatment with itraconazole was initiated and pleural effusion resolved within 2 weeks of treatment. Moreover, the patient was found to have idiopathic thrombocytopenic purpura, as confirmed by the detection of autoantibodies against thrombocytes. In a 1-year follow-up, the patient remained asymptomatic without relapse or any new infection. Treatment with itraconazole was given for 12 months. Because of persistent CD4+ T cell counts below 100/microl, prophylactic antibiotic treatment is continued.
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PMID:Pleural effusion due to Histoplasma capsulatum and idiopathic CD4 lymphocytopenia. 1258 5


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