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

Involvement of the central nervous system (CNS) is common in patients with advanced disease due to human immunodeficiency virus (HIV). Symptoms range from lethargy and apathy to coma, incoordination and ataxia to hemiparesis, loss of memory to severe dementia, and focal to major motor seizures. Involvement may be closely associated with HIV infection per se, as in the AIDS dementia complex, but is frequently caused by opportunistic pathogens such as Toxoplasma gondii and Cryptococcus neoformans or malignancies such as primary lymphoma of the CNS. The clinical presentations of attendant and direct CNS involvement are remarkably non-specific and overlapping, yet a correct diagnosis is critical to successful intervention. Toxoplasmic encephalitis is one of the most common and most treatable causes of AIDS-associated pathology of the CNS. A great deal has been learned in the last 10 years about its unique presentation in the HIV-infected patient with advanced disease. Drs. Benjamin J. Luft of the State University of New York at Stony Brook and Jack S. Remington of the Stanford University School of Medicine and Palo Alto Medical Foundation's Research Institute have studied T. gondii for many years and are two of the leading experts in the field. This commentary comprises an update of their initial review (J Infect Dis 1988;157:1-6) and a presentation of the current approaches to diagnosing and managing toxoplasmic encephalitis in HIV-infected patients.
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PMID:Toxoplasmic encephalitis in AIDS. 152 Jul 57

This study presents the main clinical findings on 200 AIDS patients at Kilimanjaro Christian Medical Centre in the northern zone of Tanzania, with detailed neurological findings on 135 out of 200 cases and 53 controls. Results show that 21 out of 200 (10.5%) had an obvious focal neurological disorder, including cranial nerve palsies, hemiparesis and paraparesis. Ninety-seven out of 135 (72%) had less obviously detectable neurological disorders, versus 36% of controls (P less than 0.005). Most frequent were AIDS dementia complex (54%), retinopathy (23%), areflexia (21%), pyramidal tract signs (19%) and tremor and incoordination (19%). Frontal lobe release signs (FLRS) were found in 103 out of 135 (76%) patients, versus 36% of controls (P less than 0.005). Advanced and terminal AIDS cases were more likely to have neurological disorders than early AIDS patients. A further study on 87 non-AIDS patients with acute unexplained neurological disorders showed 10 out of 87 to be HIV seropositive. Three case studies are presented. This study suggests that neurological disorders are among the main clinical features of AIDS and HIV disease in Africa.
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PMID:Neurological disorders in AIDS and HIV disease in the northern zone of Tanzania. 250 33

There is an urgent need for new vaccines. The biotechnological revolution has created new hope. However, developments are hampered by inadequate basic knowledge about the immunology of infections, and lack of coordination between public and commercial research and development work on vaccines. Recombinant vaccines are an important step forward when combined with new adjuvants, but the authorization of these adjuvants for use in humans has been slow. Recombinant live vectors for vaccine antigens circumvent this problem, but imply some risk in HIV-infected people. Nucleic acid vaccines are met with strong emotional resistance, because of many unanswered questions as to their safety. Mucosal vaccines make quality control simpler, open up for a safer use of live recombinant vectors and simplify delivery of the vaccine. New vaccines marketed in the last decade are surprisingly "old-fashioned". Traditional ways of making vaccines have still not been abandoned.
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PMID:[New vaccines. What can we expect in the coming years?]. 757 May 34

A number of important neurological diseases, including HIV-1 encephalitis, Alzheimer's disease, and brain trauma, are associated with increased cerebral expression of the multifunctional cytokine transforming growth factor-beta 1 (TGF-beta 1). To determine whether overexpression of TGF-beta 1 within the central nervous system (CNS) can contribute to the development of neuropathological alterations, a bioactive form of TGF-beta 1 was expressed in astrocytes of transgenic mice. Transgenic mice with high levels of cerebral TGF-beta 1 expression developed a severe communicating hydrocephalus, seizures, motor incoordination, and early runting. While unmanipulated heterozygous transgenic mice from a low expressor line showed no such alterations, increasing TGF-beta 1 expression in this line by injury-induced astroglial activation or generation of homozygous offspring did result in the abnormal phenotype. Notably, astroglial overexpression of TGF-beta 1 consistently induced a strong upmodulation of the extracellular matrix proteins laminin and fibronectin in the CNS, particularly in the vicinity of TGF-beta 1-expressing perivascular astrocytes, but was not associated with obvious CNS infiltration by hematogenous cells. While low levels of extracellular matrix protein expression may assist in CNS wound repair and regeneration, excessive extracellular matrix deposition could result in the development of hydrocephalus. As an effective inducer of extracellular matrix components, TGF-beta 1 may also contribute to the development of other neuropathological alterations, eg, the formation of amyloid plaques in Alzheimer's disease.
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PMID:Increased central nervous system production of extracellular matrix components and development of hydrocephalus in transgenic mice overexpressing transforming growth factor-beta 1. 760 85

HIV/AIDS in Pakistan is slowly gaining recognition as a public health issue of great importance. However, the responses to the disease have been marred by lack of coordination and commitment. We examine, in this paper, the situation in the Sindh province of Pakistan, which is recognized as having the sole fully functioning AIDS prevention and control programme in the country. In discussing the results of the Sindh programme's activities we highlight progress made as well as gaps in data and surveillance. We also recommend strategies for implementation at the provincial and national levels. In addition this example of a sub-national government programme provides a case study for similar programmes in the region.
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PMID:Sub-national response in HIV/AIDS: a case study in AIDS prevention and control from Sindh province, Pakistan. 1082 47

The AIDS Vaccine Advocacy Group issued a report on May 15 claiming that both the pharmaceutical industry and the United States government have made little progress towards the development of an HIV vaccine. President Clinton set a goal of 2007 for a vaccine, but the Advocacy Group states that a viable vaccine will not be available by then, due to a lack of coordination and leadership. While Federal funding has increased for vaccine research, the pharmaceutical industry has scaled back or eliminated many HIV vaccine research programs. The Advocacy Group has proposed that policy makers take a more direct role to encourage vaccine research, develop financial incentives for vaccine research, begin planning for global access to an HIV vaccine, and prevent discrimination against volunteers in vaccine clinical trials.
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PMID:Advocacy group sees little progress toward an HIV vaccine. 1136 44

Until recently, the only sustained AIDS activity in India has been alarmist media attention complemented by occasional messages calling for comfort and dignity. Public perception of the AIDS epidemic in India has been effectively shaped by mass media. Press reports have, however, bolstered awareness of the problem among literate elements of urban populations. In the absence of sustained guidance in the campaign against AIDS, responsibility has fallen to voluntary health activists who have become catalysts for community awareness and participation. This voluntary initiative, in effect, seems to be the only immediate avenue for constructive public action, and signals the gradual development of an AIDS network in India. Proceedings from a seminar in Ahmedabad are discussed, and include plans for an information and education program targeting sex workers, health and communication programs for 150 commercial blood donors and their agents, surveillance and awareness programs for safer blood and blood products, and dialogue with the business community and trade unions. Despite the lack of coordination among volunteers and activists, every major city in India now has an AIDS group. A controversial bill on AIDS has ben circulating through government ministries and committees since mid-1989, a national AIDS committee exists with the Secretary of Health as its director, and a 3-year medium-term national plan exists for the reduction of AIDS and HIV infection and morbidity. UNICEF programs target mothers and children for AIDS awareness, and blood testing facilities are expected to be expanded. The article considers the present chaos effectively productive in forcing the Indian population to face up to previously taboo issued of sexuality, sex education, and sexually transmitted disease.
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PMID:AIDS in India: constructive chaos? 1228 25

There is great concern over the prevalence of the acquired immunodeficiency syndrome (AIDS) in Sub-Saharan Africa (SSA), especially because of the existence of the HIV-1 and HIV-2 viruses. For example, in Senegal 9.8% of all prostitutes are infected with the HIV-2 virus as against 1.3% infected with the HIV-1 virus, and 0.7% infected by the 2 viruses. This situation has created many logistical problems for SSA as quoted from Dr. Ngaly's presentation at the International AIDS Conference in Montreal: 1) epidemiological problems; 2) socio-cultural problems; 3) illiteracy among most rural populations; 4) political factors; 5) ethical and legal problems; 6) the lack of new technologies; and 7) the inability to treat HIV positive patients. Added to these obstacles is the lack of coordination between national AIDS programs and the lack of institutional structures between African researchers and those in charge of the national AIDS programs. Lastly, in SSA there is the lack of an AIDS regional policy. In SSA, unlike North America and Europe where there are 4 high-risk groups for AIDS, everyone who is sexually active (with more than 1 partner) is at risk. However, epidemiological data concludes that genital ulcerations are co-factors of the HIV infection. Preventive strategies needed that are region specific for SSA include: 1) a more active role in mobilizing governments by the World Health Organization (WHO) requiring more coordination by clinicians, researchers and administrators of AIDS programs; 2) the need for national strategies aimed at 3 groups: the HIV-infected, the positive but asymptomatic, and the healthy population; and 3) the need to reach rural populations just as religious missionaries have done in the past. The discovery of an AIDS vaccine could solve many of these problems, but the ethical problem remains of how the vaccine could be tested in SSA without a regional policy.
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PMID:[Strategies and prevention of the increase of AIDS in Africa]. 1234 27

People with chronic and acute illnesses experience uncertainty about their prognoses, potential treatments, social relationships, and identity concerns. In a focus group study of people living with HIV or AIDS, we examined how social support may facilitate or interfere with the management of uncertainty about health, identity, and relationships. We found that support from others helps people with HIV or AIDS to manage uncertainty by (a) assisting with information seeking and avoiding, (b) providing instrumental support, (c) facilitating skill development, (d) giving acceptance or validation, (e) allowing ventilation, and (f) encouraging perspective shifts. Respondents also reported a variety of ways in which supportive others interfered with uncertainty management or in which seeking support imposed costs. Problems associated with social support and uncertainty management included a lack of coordination in uncertainty management assistance, the addition of relational uncertainty to illness uncertainty, and the burden of others' uncertainty management. Our study reveals strategies respondents used to manage costs and complications of receiving support, including developing an active or self-advocating orientation, reframing supportive interactions, withdrawing from nonproductive social situations, selectively allowing others to be support persons, and maintaining boundaries.
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PMID:Social support and the management of uncertainty for people living with HIV or AIDS. 1526 53

Disaffiliated cocaine users have a precarious contact with the health care system thus complicating prevention of HIV and hepatitis. The lack of confidence of cocaine users towards the health care system as well as society's way of taking charge of them, hinders both the development of a relationship based on change and for users to take action towards risk reduction. The lack of coordination between health care resources constitutes yet another obstacle. After reviewing the literature on social disaffiliation and the risks of viral infections in cocaine users, the authors make a critical analysis of preventive means concerning viral infections. Thus, the model based on harm reduction, low-access programs, information interventions, sensitization as well as motivational approaches, empowerment and health promotion are discussed.
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PMID:[Disaffiliated cocaine users: measures of prevention]. 1536 19


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