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

The sequelae of human immunodeficiency virus (HIV) disease include a host of devastating conditions involving the lower extremity. These include rheumatologic dysfunction, Kaposi's sarcoma, peripheral neuropathies, and skin ulcers. Pain, weakness, and loss of range of motion caused by these conditions can lead to changes in gait pattern, loss of mobility and function, and limited quality of life. The role of the rehabilitation specialist in the care and treatment of HIV disease as it affects the lower extremity, and the treatment strategies, precautions, and suggestions will be discussed.
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PMID:Rehabilitation management of the lower extremity in HIV disease. 764 17

Tuberculosis (TB) remains endemic in many parts of the world. In developing countries, TB of the spine remains a major, expensive health problem. Tanzania has therefore since the 1970s reinforced its district and regional TB control efforts. The Ministry of Health has nonetheless reported a recent increase in the incidence of TB in the country. The authors have also noted an increase over the past several years in the number of pediatric patients with TB in the spine. They report retrospectively on 22 consecutive patients aged 3-13 years with TB of the spine who were managed at the Pediatric Surgical Unit of Muhimbili Medical Center in Dar es Salaam, Tanzania, over the period 1988-93. 12 subjects are male and 10 are female. The majority presented with back pain and/or deformity and weakness in the legs associated with difficulty in walking. The diagnosis was based upon radiological as well as hematological findings. Two patients had associated lung lesions and gave AFB-positive sputum. 63.5% were thoracolumbar T11-L2. All patients received chemotherapy, with two also undergoing simple drainage of paravertebral abscesses, and two debridement and bone grafting. There was no formal immobilization except that the children had to sleep on hard beds. All gave a history of BCG vaccination scars. Mantoux or Heaf test was performed on 16 of the 22, 11 of whom were positive. One patient resulted with paraplegia, one with marked paraparesis, and in 17 of 22 the kyphosis/gibbus increased. The authors conclude that laxity in the TB control programs and the widespread extent of HIV could be contributory factors in what appears to be an increase in TB infection in recent years.
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PMID:Tuberculosis of the spine in children at Muhimbili Medical Centre, Dar es Salaam. 778 56

A certain number of HIV-infected patients (about 17% in our series) manifest symptoms of cortisol resistance--weakness, weight loss, hypertension, chronic fatigue and intense mucocutaneous melanosis--symptoms which are also typical of Addison's disease. The diagnosis of cortisol resistance is determined through the increased plasma and urinary cortisol values and limited increases in ACTH values. Compared with patients with primary glucocorticoid resistance, AIDS patients have no symptoms of mineral-corticoid or androgen excess, only of glucocorticoid deficiency at target tissues. Mononuclear leukocytes from these patients show receptor changes which consist of an increased receptor number and decreased receptor affinity for glucocorticoids. They also show defective glucocorticoid-induced inhibition of [3H]thymidine incorporation. Glucocorticoid-resistant AIDS patients have a characteristic persistent increase in interferon-alpha production. The inverse correlation between plasma values of interferon-alpha and the receptor affinity for glucocorticoids clearly suggests that interferon production is regulated by the glucocorticoid receptor: the smaller the glucocorticoid effect on lymphocyte cells is, the greater interferon production is. Owing to the antiviral effect of interferon-alpha, it is possible that glucocorticoid-resistant AIDS patients have greater defences against viral infection than other AIDS patients. As interferon-alpha is melanogenetic, its increased production may also explain the intense skin pigmentation found in patients with the glucocorticoid-resistance syndrome.
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PMID:The syndrome of acquired glucocorticoid resistance in HIV infection. 781 Dec 21

During November 1990 and June 1992 a total of 102 patients with myelopathy who attended four hospitals in the city of Salvador, Bahia, Brazil, were studied. The human T-cell lymphotropic virus types I and II (HTLV-I/II) was obtained by means of enzyme-linked immonosorbent assay (ELISA) and Western blot tests. There were 36 patients who had HTLV-I/II associated myelopathy (HAM) of whom 26 were women (72%). The age range was 8 to 82 years, and the average age of those with HTLV-I myelopathy was 45.8 years. Previous history of blood transfusion was established in 6 patients. Only 3 patients had a history of promiscuity, defined as more than 5 partners in a year. The most frequent clinical symptoms included progressive weakness in the lower extremities (29/36), followed by lumbar pain (18/36), and urinary urgency (15/36). The progression of myelopathy was slow and gradual in 25 cases and more rapid in 11 cases, reaching severe muscular force in about 2 years. Except for 2 patients all others reported asymmetry in the muscular force of the lower extremities. On examination all of them had a spastic paraparesis, variable degrees of lower motor neuron syndrome, and deep and superficial sensitive syndrome. Clinical and magnetic resonance findings revealed that the inflammatory lesions of HAM involved not only the spinal cord but also the brain and the peripheral nervous system. Magnetic resonance examination of the thoracic column of 19 patients demonstrated encephalitic disorder in 11 patients. The cerebrospinal fluid (LCR) indicated cellular augmentation in 24 patients with the range of cells from 1 to 40 per cubic millimeter and with the predomination of lymphocytes. Electrophoresis of proteins of LCR showed the increase of albumin in 8 patients and the increase of gamma globulin in 29 patients. HIV antibodies were detected in 2 patients.
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PMID:[HTLV-1 associated myelopathies in the city of Salvador, Bahia]. 789 4

Patients infected with the human immunodeficiency virus type 1 (HIV-1) frequently develop central and peripheral nervous system complications, some of which may reflect the effect of the virus itself. In order to elucidate the pathogenic mechanisms of HIV in neurological disease in a small animal model, we generated transgenic mice expressing the entire HIV genome under control of the promoter for the human neurofilament NF-L gene. The transgene was predominantly expressed in anterior thalamic and spinal motor neurons. Animals developed a neurological syndrome characterized by hypoactivity and weakness and by axonal degeneration in peripheral nerves. These results provide evidence for a role of HIV in affecting both the central and peripheral nervous systems. This animal model may also facilitate the development of therapeutic agents against the human disease.
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PMID:Expression of human immunodeficiency virus type 1 in the nervous system of transgenic mice leads to neurological disease. 793 91

Approximately 25,000 HIV-positive persons had been reported in Sub-Saharan Africa during 1989, which amounts to 16% of the global total of reported HIV cases. 25-50% of all hospital beds were occupied by AIDS patients in Central Africa in 1989. A Health Belief Model has been developed to bring about the necessary behavioral change to avoid AIDS. The model can be divided into three major categories: 1) individual perceptions, 2) modifying factors, and 3) the probability of action. Factors in the spread of HIV include sex, age, geography, interpersonal relationships and sex preferences (homo- and bisexuality), socioeconomic factors, peer pressure, awareness and knowledge about AIDS, and education/prevention. The largest proportion of AIDS cases is in the 20-29 age group. In the Sub-Saharan region 20-30% of all sexually active individuals in the age group of 20-40 years are infected with HIV. In South Africa most AIDS cases are found in the 20-40 year age range. From a geographical point of view, the spread of AIDS is heaviest in central, eastern, and southern Africa. The interrelationship between socioeconomic factors and susceptibility to HIV infection has been proven. Low economic status coupled with helplessness, psychological weakness, social isolation, and low income promote HIV infection. Peer pressure and experimentation among youngsters with high risk behavior are also contributing factors. AIDS awareness and education programs are the only means of prevention of the spreading of AIDS in the absence of drugs against AIDS. School-based education programs could exert an influence on the knowledge level of students and induce behavioral change. AIDS is also a disease of the poor, and 26 out of 35 of the poorest countries in the world are in Africa. Safe sex practices would also diminish the risk of contracting HIV.
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PMID:[Adaptation of the Health Belief Model for the prevention of HIV infection]. 798 60

The authors' primary purpose was to identify home healthcare needs of adults (N = 244) living with HIV disease/AIDS. The study followed a retrospective chart review of a stratified random sample of cases discharged during 1991 from a certified home health agency (CHHA) in New York City. Frequently observed signs and symptoms included dyspnea, weakness, fatigue/lethargy, pain, ataxia, cough, skin lesions, and memory deficit. Additional problems identified included inadequate nutrition, issues related to compliance with prescribed medications, inadequate in-home support systems, inadequate facilities/utilities in the home, financial concerns and lifestyles that included drug/alcohol abuse and tobacco use. The results suggest that the health care needs of people living with HIV disease/AIDS in the home care setting are multifaceted and extend beyond the clinical manifestations of HIV disease.
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PMID:Home healthcare needs of adults living with HIV disease/AIDS in New York City. 803 11

Reported is a study of the human T-cell lymphotropic virus type 1 (HTLV-1) seroprevalence in Zimbabwe. HTLV-1, a retrovirus, is known to cause myelopathy and adult T-cell leukemia. Three widely separated collection sites were used. Three testing techniques, the enzyme-linked immunosorbent assay (ELISA) (Dupont), the particle agglutination test, and ELISA (Virgo) were employed in processing the sera samples. All positives were confirmed using Western blot analysis (Dupont). Of the 1082 specimens analyzed, only 4 were determined as being strongly positive for HTLV-1, having an optical density reading (OD) of 1.5-2.0 using ELISA techniques. 8 patients were determined to have leukemia, 23 were hemophiliacs, and 88 were HIV-seronegative "AIDS" patients. None of these patients were HTLV-1 positive. There were 32 neurologically diseased patients; 11 (34.4%) were found to be HIV-seropositive and 3 were HTLV-1 seropositive. 2 of the 11 HIV-positive patients also tested positive for HTLV-1. Clinical histories of the 3 HTLV-1 seropositive patients are described. Case 1 was a 53-year-old, HIV-positive man who demonstrated problems in walking and urinary incontinence. Upon examination, it was determined he had a spastic quadraparesis with loss of sphincter control. Case 2 was a 21-year-old woman who reported a 5 month history of neurological symptoms. She was HIV seropositive and showed a loss of feeling in the thorax area of her body. Sphincter muscle control was also lacking. She deteriorated rapidly and died. Case 3 was a 38-year-old woman who had deteriorating weakness in her legs until, after 3 years, she could no longer walk. She was HIV seropositive. All 3 cases had normal myelograms. This study demonstrates that the prevalence of HTLV-1 is very low in Zimbabwe. There appears to be a strong association between spinal cord disease and HTLV-1 seropositivity. Co-infections of HTLV-1 and HIV-1 were also proven. These cases generally resulted in a faster progression of the neurological disease than seen in patients solely infected with HIV-1 or HTLV-1. HTLV-1 should be considered in any patient who displays an unexplainable spinal cord disease.
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PMID:Human T cell lymphotropic virus type 1 in Zimbabwe. 803 62

The quest for an ideal vascular graft began in the early 1950s and continues at a steady pace. The perfect graft has yet to be designed. As a result, patients with vascular prostheses may suffer complications that range from minor to catastrophic. The emergency physician may be faced with the initial presentation of patients with these vascular graft complications. If he or she is not familiar with these possibilities, then the resulting morbidity and mortality could be devastating. Probably the most unnerving complication involving the failure of vascular prostheses is that of the aortoenteric fistula. Instantaneous decisions and interventions must be made when a patient presents in this state of pre-exsanguination. Massive GI bleeding is at one end of the spectrum with other less-severe GI complications involving aortoenteric erosions and small bowel obstructions due to graft migration at the other end of the spectrum. Infection of a vascular prosthesis is a complication much feared by vascular surgeons. A spectrum of presentation also exists here whereby a patient may present with an obvious draining wound or with subtle complaints of fever, weakness, and a minimally elevated white blood cell count. The function of the emergency physician is critical here but only if he or she is able to suggest the possibility of graft infection to the admitting physician. Fortunately, thrombosis of a vascular graft is an infrequent complication that may occur at any time postoperatively, although the frequency decreases with time. There are many different causes of graft occlusion of which the emergency physician should be aware. If the cause of the thrombosis is known, then the secondary vascular reconstruction can be optimized. The dialysis population has grown rapidly over the past two decades and as a result so have complications of renal dialysis grafts. Because the dialysis population now includes large numbers of older subjects as well as those with systemic diseases such as diabetes and HIV, recognition and prompt aggressive management of clinical complications is of paramount importance.
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PMID:Vascular prostheses. 806 92

Neuromuscular manifestations, including a variety of peripheral neuropathies and myopathies, can occur either as isolated clinical phenomena or concurrently with other clinical manifestations, and are common in acquired immunodeficiency syndrome (AIDS). A 33-year-old male patient had a four-year history of increasing proximal muscle weakness of the extremities. Elevated muscle enzymes, a muscle biopsy and interstitial lung disease all suggested a diagnosis of polymyositis with lung involvement. However, a transbronchial lung biopsy revealed Pneumocystis carinii pneumonia, and serology for HIV infection disclosed positive results. Zidovudine and cotrimoxazole were instituted and the patient improved. HIV-associated myopathy should be considered by practicing clinicians in cases presenting with myopathy, since the number of patients with HIV infection is increasing in Taiwan.
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PMID:Myopathy associated with human immunodeficiency virus infection: report of a case. 810 53


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