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

A randomized, placebo-controlled trial was designed to evaluate safety and immunogenicity of an anti-cytokine vaccine in high risk HIV-positive patients. This strategy was aimed to modulate the impaired cytokine regulation in AIDS. Twelve asymptomatic patients on antiretroviral therapy for at least 1 year and with CD4 cell counts between 100-300/mm3 were randomized to receive adjuvanted formol-inactivated interferon alpha-2a (IFN alpha) and continue the current antiretroviral treatment, whatever it was, or to receive the adjuvant alone and the current antiretroviral treatment. All patients received 4 i.m. injections monthly, followed by booster injections every 3 months. Clinical status, immunology and virology were monitored. Immune response to vaccination was evaluated in term of antibody detection (ELISA) and serum anti-IFN alpha neutralizing capacity. Only local discomfort and transient fever were reported. All vaccines except one showed increased levels of anti-IFN alpha Abs and developed serum IFN alpha neutralizing capacity. Viral load did not increase in vaccinees while it remained unchanged or even increased in placebo-treated patients. None of them showed HIV-related symptoms and all had their CD4 cell counts stabilized over 18 months, whereas 2 placebo-treated patients developed full-blow AIDS. In conclusion, anti-IFN alpha vaccine was safe and immunogenic. Stable clinical and immunological status over 18 months was observed in vaccinees coupled to increased serum IFN alpha neutralizing capacity.
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PMID:Anti-alpha interferon immunization: safety and immunogenicity in asymptomatic HIV positive patients at high risk of disease progression. 758 Aug 31

Researchers have found that a significant number of medical students harbor attitudes that have a negative impact on their willingness to care for persons who are HIV positive or have AIDS. To assess current HIV and AIDS knowledge and attitudes, the authors administered a 25-item survey tailored for medical professionals to 63 preclinical medical students. Respondents' mean score on the knowledge scale was 6.25 (SD 1.63) out of a possible score of 10. Factor analysis suggested three major groupings of medical students with regard to attitudes. The largest group had generally positive attitudes about patients with HIV and AIDS; two subgroups, however, would tend to refer such patients to another physician. One subgroup reported feeling more uncomfortable with homosexual behavior and with HIV-seropositive patients than they did with patients with other infectious diseases. This group also expressed discomfort with physically touching HIV-seropositive clients. The other group expressed discomfort with taking a patient's sexual history. Effective educational interventions must take these findings into account.
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PMID:A survey of knowledge and attitudes about HIV and AIDS among medical students. 767 81

Genital herpes infections are a major source of morbidity. These infections are responsible for significant health problems, including direct physical discomfort associated with outbreaks, potential complications such as neonatal transmission, and the often devastating psychological effects of a chronic illness. In addition, herpes infections have been identified as a significant co-factor in the transmission of human immunodeficiency virus infection. Accurate and rapid diagnosis and treatment are important steps necessary to minimize these effects.
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PMID:Management of genital herpes infection. 784 18

We describe five cases of gastrointestinal leishmaniasis in patients with human immunodeficiency virus infection and review 10 additional cases reported in the literature. All of the patients had CD4+ cell counts of < 200/mm3, and AIDS had been previously diagnosed for 12 patients. Fever and splenomegaly were present in 46% of cases. Thirteen patients had digestive symptoms; these symptoms included diarrhea (6), dysphagia and/or odynophagia (6), abdominal pain (2), epigastric pain (2), gastrointestinal hemorrhage (1), and rectal discomfort (1). The regions of the digestive tract most frequently affected by Leishmania organisms were the duodenal mucosa (90%) and the gastric mucosa (75%). Endoscopy showed normal-appearing mucosa in 45% of cases. In 10 cases the diagnosis of visceral leishmaniasis was first made by biopsy of the gastrointestinal mucosa. In most cases treatment with antimonial agents was not effective.
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PMID:Gastrointestinal leishmaniasis in human immunodeficiency virus-infected patients: report of five cases and review. 757 44

Jim's story illustrates many issues. The importance of the GP in any chronic condition is highlighted. In Jim's case he was never actually sick. All his visits were for monitoring, counselling, preventive medicine and co-ordinating other health care workers. There is a fine line between performing these vital functions and 'over-medicalising' a well person. All areas of Jim's life were touched by his diagnosis--work, recreation, relationships and sex--all had to be included in his overall management. I had to face my own difficulties in dealing with the potential tragedy of Jim's situation and maintain a personal detachment. An obvious friendship had developed between us and I too dreaded every blood count and new symptom in case it was a sign of deterioration. My discomfort was made worse by my inexperience with HIV and I had to struggle to keep ahead of Jim with regard to information about new medication and research findings. Jim experienced the usual grief reactions and emotional responses that anyone with bad news must work through. In his situation his lack of support from family or lover left him particularly vulnerable. His dealing with the diagnosis was made that much harder as he saw his partner and friends dying from the same condition. In summary, Jim was a well man who was given a result that changed his life. The principles of his management were the same for every other medical condition in that mind and body, work and play are all important for good care.
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PMID:HIV in general practice. 784 51

The pandemic dimension of HIV disease is a reality. The cases of acquired immunodeficiency syndrome (Aids) and of new infections with HIV continue to increase. Available antiretroviral therapy cannot halt the progress of the disease. However, because of early diagnosis and treatment, life expectancy has increased. Oral diseases in these patients have the potential to cause severe pain, discomfort, alter form and function and disseminate systemically. Comprehensive dental management may be complicated by complex medical problems. Nevertheless, as the epidemic grows, a higher number of infected individuals will need dental care. A comprehensive dental management concept of the HIV-seropositive individual still needs scientific investigation. There are several unresolved psychosocial issues concerning the willingness of dentists to treat HIV-infected patients. The possible transmission of the virus from a dentist to his patients in a dental office in Florida generated public and professional hysteria. Lack of knowledge about the disease contributed to this situation. This literature review presents the state-of-the-art information available on medical and dental aspects of HIV disease and trends for the future in dental research, education and patient care.
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PMID:HIV disease: medical and dental aspects and trends for the future. A literature review. 802 8

Acceptance of health status as an outcome in clinical trials of new treatments for HIV disease has been hampered by the lack of valid and clinically relevant means of summarizing differences across multiple dimensions. We formed a summary Perceived Health Index from health status measures adapted from RAND Medical Outcomes Study scale and contained in the HIV-PARSE survey instrument, which had been administered to a large number of participants in clinical trials for advanced HIV disease. The psychometric properties of the included health status scales were assessed using multitrait scaling and test-retest stability. Weights for the index were derived from regressions of Current Health Perceptions on the domain-specific health status scales. The effect of participant characteristics on weights was tested. Finally, the reliability and known-clinical groups validity of the index was assessed. Data were obtained from 1,862 clinical trial participants who provided a total of 7,352 observations. The mean CD4 count was 131. The internal consistency reliability of the multi-item scales ranged from 0.86 to 0.90, and items demonstrated excellent discrimination across scales. The domain-specific scales explained 59% of the variation in the Current Health Perceptions scale (P < 0.00001). The resulting Perceived Health Index was equal to 0.20 Physical Functioning + 0.15 Pain + 0.41 Energy/Fatigue + 0.10 Emotional Well-being + 0.05 Social Functioning + 0.09 Role Functioning. The strong positive bivariate relationship between the Cognitive Function/Distress scale and the Current Health Perceptions scale was subsumed by the combination of the other domain-specific scales in multiple regressions, so it does not appear independently in the index. The proportional weights used in the index were insensitive to variations in demographics. The reliability of the index was conservatively estimated to be 0.94. Patients with index scores in the lowest quartile had a 2- to 11-fold higher probability than those in the highest quartile of reporting various specific clinical events, and the index correlated significantly more highly with the number of such events than did the current health perceptions scale. The modified MOS health status scales included in the HIV-PARSE are reliable and valid in patients with advanced HIV disease. The Perceived Health Index provides a reliable and valid means of summarizing self-reported current health, correlates strongly with clinical indicators, and should be useful as a outcome measure in patients enrolling into clinical trials of therapies for advanced HIV disease. Regression based weights are a useful means of summarizing multidimensional measures.
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PMID:A Perceived Health Index for use in persons with advanced HIV disease: derivation, reliability, and validity. 802 6

Thoracoscopic lung biopsy provided diagnostic histologic material with minimal patient discomfort in an HIV-positive man with diffuse pulmonary Kaposi's sarcoma. This minimally invasive procedure will have an increasing role in providing a histologic diagnosis in patients with diffuse lung disease.
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PMID:Thoracoscopic biopsy in the diagnosis of pulmonary Kaposi's sarcoma. 811 Nov 10

Nutritional support of patients with HIV or acquired immune deficiency syndrome (AIDS) has many similarities to other disease states in that the same nutritional products and techniques are used. Some patients with HIV, and many with AIDS without secondary infection, experience a metabolic milieu similar to patients with cancer cachexia. In providing dietary counselling to the HIV patient, we encounter many of the obstacles that must be overcome to improve nutrition in cancer: anorexia, gastrointestinal discomfort, lethargy, and poor nutrient utilization, which limit the ability for nutritional repletion. When a secondary infection is superimposed on HIV, patients resemble more highly catabolic trauma patients or patients in the intensive care unit (ICU), where, despite aggressive efforts to feed, there is usually a net nitrogen wasting leading to the more rapid development of cachexia. However, even in this setting, feeding will limit substantially net catabolism when compared to total starvation. Because the nutritional needs of HIV patients vary greatly, individual strategies have to be designed as the patient moves through the stages of disease. Patients are generally able to consume adequate nutrition either as regular food or dietary supplements during the latency period of viral replication. Once secondary infections become prevalent, artificial diets administered by tube or by vein may be required during the period of active secondary infections, with dietary supplements often helpful during more quiescent periods. Patients with HIV are among the most challenging for clinicians providing nutritional support. Knowledge from treatment of patients with other diseases may be useful, but more data must be gathered on the unique aspects of aetiology and treatment of the anorexia, malabsorption, and ultimate wasting associated with AIDS.
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PMID:Nutrition support and the human immunodeficiency virus (HIV). 811 86

Kaposi's sarcoma is a common tumour in HIV-infected patients, frequently involving the oropharynx. Conventional treatment with radiotherapy is efficacious, but causes considerable discomfort. This paper illustrates a new technique of local injection of vinblastine into oral lesions, which combines satisfactory palliation with high patient acceptability.
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PMID:Intralesional vinblastine in the treatment of oral Kaposi's sarcoma. 833 68


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