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

Renal failure is a known complication of HIV infection. The most common form is HIV-associated nephropathy, or HIVAN. It is characterized by high-grade proteinuria with rapid progression to end-stage renal disease. The kidneys of affected patients appear enlarged on ultrasonography. Histopathologically, there is focal segmental glomerulosclerosis with glomerular collapse. Before the era of HAART, patients with HIVAN had limited survival, although in some cases this was prolonged if dialysis was instituted. Over the past few years, isolated case reports have shown that patients with HIVAN will recover renal function following initiation of HAART. We report 3 patients believed to have HIVAN who exhibited marked improvement in renal function after treatment with a regimen comprising 2 nucleoside reverse transcriptase inhibitors and a protease inhibitor.
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PMID:Resolution of renal failure after initiation of HAART: 3 cases and a discussion of the literature. 1196 39

Podocytes are well-differentiated postmitotic cells whose function is largely based on their complex cytoskeletal architecture. In diseases with proteinuria, podocytes undergo morphologic changes. Podocytes react to an injurious stimulus by a reorganization of their foot process architecture that is independent of the primary injury and the cause of the proteinuria. Collapsing glomerulopathies, including the idiopathic and secondary forms due to HIV infection, have been previously considered a part of the focal sclerosing glomerulosclerosis (FSGS) spectrum. However, in contrast to FSGS, both forms of collapsing glomerulopathy are characterized by segmental and global collapse of the glomerular basement membrane (GBM) and by characteristic ultrastructural alterations in podocytes. These alterations include loss of the actin-based cytoskeleton, a dysregulated/dedifferentiated phenotype, cellular hypertrophy, and cell proliferation. These observations raise the following questions: 1) What mechanism causes glomerular collapse and do podocytes have a role? We recently proposed that in collapsing glomerulopathies the composition of the GBM is altered and contains more immature forms of collagen IV. These observations suggest that dedifferentiated/dysregulated podocytes may participate in remodeling the GBM composition, producing fetal collagen isoforms. 2) What is the pathomechanism underlying podocyte dysregulation? Although it is still unclear which etiologic factors are responsible for the idiopathic forms of collapsing glomerulopathy, in situ hybridization studies in a transgenic mouse model of HIV-associated collapsing glomerulopathy and on renal biopsies of patients with HIV-associated collapsing glomerulopathy demonstrated the presence of the HIV-1 RNA in podocytes and tubular epithelial cells. These findings suggest a direct link between viral gene expression and the dysregulation of the podocyte phenotype. 3) Another open question is how podocytes become infected in HIV-associated collapsing glomerulopathy. HIV-1 typically uses CD4 and a co-receptor such as CCR5 or CXCR4 to enter cells. So far, there is no demonstration of the expression of these receptors in podocytes. These negative findings, however, do not exclude the possibility that in the kidney another, CD4 independent, co-receptor may be used for viral cell entry. Finally, is it important to mention that collapsing glomerulopathies have a high prevalence in black patients, suggesting a link between racial background and the virus-related podocyte injury.
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PMID:Modulation of podocyte phenotype in collapsing glomerulopathies. 1201 94

This review focuses on the role of the extended macrophage/monocyte family in the central nervous system during HIV or SIV infection. The accumulated data, buttressed by recent experimental results, suggest that these cells play a central, pathogenic role in retroviral-associated CNS disease. While the immune system is able to combat the underlying retroviral infection, the accumulation and widespread activation of macrophages, microglia, and perivascular cells in the CNS are held in check. However, with the collapse of the immune system and the disappearance of the CD4(+) T cell population, productive infection reemerges, especially in CNS macrophages. These cells, as well as noninfected macrophages, are stimulated to high levels of activation. When members of this cell group become highly activated, they elaborate a wide spectrum of deleterious substances into the neural parenchyma. In the final phases of HIV or SIV infection, this chronic, widespread, and dramatic level of macrophage/monocyte/microglial activation constitutes a self-sustaining state of macrophage dysregulation, which results in pathological alterations and the emergence of various neurological problems.
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PMID:Central nervous system damage, monocytes and macrophages, and neurological disorders in AIDS. 1205 20

The authors begin by examining the intrapsychic implications that HIV/AIDS presents after knowledge of infection. Using examples drawn from two cases, they explore how knowledge of infection precipitates an insidious traumatizing process that comprises a number of key defensive strategies and dynamic processes. Particular kinds of defensive splitting, projective dynamics, and key identifications, as well as the collapse of the symbolic function, are isolated as being central to understanding the traumatizing process. With this in mind, the role and aim of the insight-oriented therapist is considered. The authors argue that much of the therapeutic work in this area revolves around a central organizing fantasy about the limitations of "good enough" objects in helping them with their diagnosis and its implications. This is linked to a number of technical dilemmas that the therapist will inevitability have to face if he or she chooses to work analytically. Particular technical problems explored include: 1. the management of frame deviations, 2. the therapist's role/s, 3. the use of interpretation, and 4. countertransference experience and enactment.
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PMID:Working with HIV/AIDS sufferers: "when good enough is not enough". 1212 94

There are a growing number of reports of bone problems (avascular necrosis and osteonecrosis) among people with HIV. These problems are caused by a lack of blood supply in the bone, which leads to the deterioration and death of bone tissue. Generally, bones try to repair themselves. But bones that support a lot of weight, like the hip, can weaken when this condition occurs. This may cause the bone to fracture or collapse. This condition can also lead to severe pain and inflammation or overgrowth of bone in and around the joints (osteoarthritis). While still relatively uncommon, people should be aware of reports of avascular necrosis that have led to hip fracture or dislocation. Symptoms of pain associated with avascular necrosis also commonly affect the shoulder and/or knee. Avascular necrosis is different from osteoporosis, a general term for a progressive loss in bone density that results in skeletal (bones that make up the framework of the body) weakness.
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PMID:Bone problems. 1217 Oct 7

Collapsing glomerulopathy is a pattern of renal injury that has emerged along with the epidemic of HIV infection. The disease process is now increasingly recognized in non-HIV patients. In HIV and non-HIV patients the disease shares many clinical and pathologic features, and, we presume, pathogenetic factors. The disease entity is characterized by very heavy proteinuria frequently combined with rapidly progressive renal failure, poor outcome, glomerular collapse with hyperplasia and other degenerative changes of the visceral epithelial cells, and prominent tubulointerstitial injury with frequent microcystic changes. HIV-associated nephropathy has a higher prevalence in blacks, high frequency of intra-endothelial tubuloreticular inclusions, and prominent microcystic tubular changes. These differences, however, are not sufficient to predict the patient's HIV status from the biopsy findings alone. Collapsing glomerulopathy can also develop in association with lymphoproliferative disorders, systemic lupus erythematosus-like and other autoimmune diseases, other immune deficiency syndromes and viral infections, and in the context of immunosuppressive therapy.
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PMID:Collapsing glomerulopathy--a new pattern of renal injury. 1218 Jun 32

The existence of tropical medical emergencies is a recurrent issue that joins the debate over the definition of tropical medicine. Is it medicine practiced in warmer climates, medicine practiced with poor diagnostic and therapeutic facilities or medicine involving only tropical diseases? Presentation of a few case reports provides a better response to this question than a long speech. The first case involves a 57-year-old man presenting a complicated attack of Plasmodium falciparum malaria and severe respiratory distress. The second case involves a pregnant AIDS patient presenting multifocal miliary tuberculosis associated with renal abscess and bacteremia. The third case involves a 34-year-old soldier hospitalized for right hilar pneumonia in whom work-up demonstrated co-infection by HIV 1 and 2, thick drop tests revealed uncomplicated Plasmodium falciparum malaria, and cytobacterial examination of sputum samples identified Salmonella enteritidis and acid-alcohol resistant germs. The fourth case involves a 60-year man hospitalized for febrile collapse in whom work-up revealed amebic pericarditis. These four case reports illustrate the main features of tropical medical emergencies: adult patients (frequently young), associated deficiencies or immunocompromise (HIV infection/AIDS), severe or complicated tropical disease, severe advanced stage disease because of inability to pay for care, multiple pathology, poor diagnostic/therapeutic facilities, and high mortality.
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PMID:[Does emergency tropical medicine exist? The physician's point of view]. 1224 20

In order to best understand the impact of AIDS on a national level, it may be more important to understand its impact on the magnitude and severity of poverty than on national economic growth. It may also be true that the primary economic impact of AIDS is the concentrated breakdown of vulnerable structures such as the family, community, or even nations. The larger the structure, the more likely it can withstand collapse by distributing the impact, but vulnerability to collapse must be understood to avoid the catastrophe of breakdown. Rwanda may present the first example of the latter. Its AIDS prevalence was among the highest in the world, and the prevalence rate among members of the military was even higher. If studies consider the impact of HIV infection in terms of direct and indirect costs only, more dollars would be saved by preventing one case in the US than in most other countries. If, on the other hand, a hunger index is used (for each case of HIV how many people will go hungry and how many formerly hungry people will become malnourished), the greatest prevention benefit would probably occur in Uganda. In order to understand how economic factors fuel the epidemic and determine its impact, more socioeconomic data must be collected. When making the economic choices that maximize benefits to AIDS victims, the difficulty occurs in defining benefit. Most developing countries cannot provide the resources to prolong life and avert disability. However, there are ways to alleviate the impact of AIDS which all countries can afford: reducing pain, removing the barriers of discrimination, providing support groups, and helping people with the activities of daily life. In order to design the appropriate comprehensive care approaches in different settings, more data must be collected on how HIV-infected individuals perceive the impact of the disease on their lives.
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PMID:Adding the human dimension to economic analysis: why DALYs don't tell the whole story. 1228 11

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

Much has been learned about the causes of HIV infection and AIDS and the factors which influence HIV transmission among humans. Despite this rapid accumulation of data, however, Africa continues to have an enormous AIDS epidemic. During the 1994 International AIDS Conference, sub-Saharan Africa was declared an endemic zone for HIV/AIDS. Almost 90% of the HIV-infected individuals in the region live in East and Central Africa. There is growing concern about the high prevalence of HIV infection among reproductive-aged women. Sentinel surveillance of pregnant women shows a rapid increase in HIV seroprevalence from the age of 15 years and a peak in HIV seroprevalence among women aged 20-24 years. Such prevalence has been influenced by changing value systems, socioeconomic marginalization, increased sexual liberalization, the collapse of traditional systems which taught young people how to manage their sexuality, and the biological vulnerability of young girls. HIV prevalence varies widely among urban areas. Studies, however, indicate that people in the region know what causes AIDS and that they are reasonably knowledgeable about the modes of HIV transmission. Some traditional practices are associated with a risk of HIV transmission, but it is fervently believed that failure to perform certain practices and rites angers the spirits and brings a curse upon the family and clan members. The strength of African societies lies in their general cohesiveness as well as their supportive nature during both difficult and prosperous times. This way of life, however, presents problems when addressing the prevention of HIV infection. New and innovative ways need to be developed to address AIDS prevention.
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PMID:Community based HIV / AIDS programmes. 1229 Aug 49


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