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

Peripheral neuropathy is common in human immunodeficiency virus type-1 (HIV-1) infection. Peripheral neuropathies complicate all stages of the HIV-1 disease and cause considerable morbidity and disability in HIV-1 infected individuals and acquired immunodeficiency syndrome (AIDS) patients. Whereas symptomatic neuropathies occur in approximately 10% to 15% of HIV-1-infected patients overall, pathologic evidence of peripheral nerve involvement is present in virtually all end-stage AIDS patients. There are 6 major clinical types of HIV-associated neuropathies that are regularly seen in large HIV-1 clinics. Distal sensory polyneuropathy (DSP) is the most common among the HIV-1-associated neuropathies. DSP generally occurs in later stages of HIV-1 infection and it follows an indolent and protracted clinical course. The dominant clinical features in DSP include distal pain, paresthesia and numbness in a typical length-dependent fashion with proximal to distal gradient. Whereas toxic neuropathies--secondary to certain antiretroviral agents--are clinically similar to DSP, their temporal relation to neurotoxic medication helps distinguish them from other HIV-1-associated neuropathies. DSP and toxic neuropathy may coexist in a single patient. Acute and chronic inflammatory demyelinating polyradiculoneuropathies (AIDP and CIDP) produce global limb weakness. AIDP may occur at seroconversion and it can therefore be the initial manifestation of HIV-1 infection. CIDP generally occurs in the mid to late stages of HIV-1 infection. Progressive polyradiculopathy (PP) occurs in patients with advanced immunodeficiency and is generally caused by the opportunist cytomegalovirus (CMV) infection. Mononeuropathy multiplex (MM) in early stages of HIV-1 infection is immune mediated, whereas in advanced AIDS it is caused by the CMV infection. Finally, subclinical autonomic nervous system involvement is common in all stages of HIV-1 infection. Because HIV-1-associated neuropathies are diverse in their etiology and pathogenesis, a precise clinical diagnosis is required to formulate a rational therapeutic intervention.
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PMID:Epidemiology and clinical features of HIV-1 associated neuropathies. 1129 7

AIDS-associated vacuolar myelopathy (VM) is a common neurologic complication of AIDS. Pathologically, VM is characterized by vacuolization in the lateral and posterior columns of the thoracic spinal cord and has a striking similarity with the myelopathy of vitamin B12 deficiency. In autopsy series, 20% to 55% of patients with AIDS have evidence of spinal cord disease consistent with VM. The myelopathy usually manifests late in the course of HIV infection, with slowly progressive weakness of the lower extremities, gait disorder, sensory abnormalities in the legs, impotence in men, and urinary frequency and urgency. Its course is invariably progressive and leads to severe paralysis of the lower limbs, with loss of the ability to walk and of sphincter control. The differential diagnosis is extensive and includes metabolic, infective, and neoplastic spinal cord diseases. The diagnosis is based on the clinical observation and the exclusion of other causes of myelopathy via serologic, radiographic, and cerebrospinal fluid studies. The pathogenesis of VM is unknown. Attempts to detect HIV in the spinal cord have not yielded significant results, and there is no evidence of a relationship between the presence of HIV and the development of myelopathy. A metabolic disorder of the vitamin B12-dependent transmethylation pathway, induced by HIV or cytokine activation, is considered the possible cause of VM associated with AIDS. There is no known treatment for AIDS myelopathy and there is no evidence that antiretroviral drugs can improve the symptoms or slow the progression of VM. The symptomatic treatment includes antispasticity agents, management of sphincter dysfunction, and physical therapy. Experimental treatments are being tested in clinical trials.
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PMID:AIDS-associated vacuolar myelopathy. 1136 93

Histoplasmosis is one of the most common opportunistic infections in HIV-infected patients who reside in endemic areas, and "imported infections" also occur elsewhere. A recent decline in the incidence of histoplasmosis appears to correlate with advances in antiretroviral therapy. Histoplasmosis occurs due to either dissemination of newly acquired infection or reactivation of latent foci of infection. Major risk factors include a CD4 count < or = 150/microL, positive complement fixation serology for the Histoplasma capsulatum mycelial antigen, and a history of exposure to chicken coops; in addition, suboptimal antiretroviral therapy seems likely to be a risk factor. Although there are a variety of clinical manifestations, most patients present with a several-week history of fever, chills, weakness, and weight loss. Diagnosis is based on positive cultures of blood, bone marrow, or other sites; detection of antigen in serum or urine; or characteristic histopathologic findings in biopsy specimens. Induction therapy consists of amphotericin B for acutely ill patients or itraconazole for patients with mild to moderately severe disease. Subsequent lifelong maintenance therapy with itraconazole is recommended. In patients with CD4 counts of < or = 150/microL, itraconazole is effective primary prophylaxis.
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PMID:Histoplasmosis in AIDS: advances in management. 1136 22

HIV-related weight loss can be broken into four categories: 1) episodic weight loss accompanying acute infections or malignancies; 2) intermittent anorexia; 3) the late, accelerated weight loss phase associated with a 10 -20 percent loss of body weight; and 4) the terminal phase of HIV disease in which weight loss has resulted in cachexia and weakness. Several studies using megestrol acetate to treat advanced breast cancer, HIV-associated cachexia, and AIDS wasting, have demonstrated its association with weight gain. These led to the establishment of two multicenter, randomized, double- blind trials. In the first study patients received either 800 mg/day of Megace (a liquid suspension of megestrol acetate) or placebo; and in the second they received one of three daily doses of Megace (100 mg, 400 mg, or 800 mg) or placebo. Most patients were in the fourth phase of weight loss. Over 50 percent of the enrollees dropped out of the first study. Increased calorie consumption, fat mass and overall weight was observed in the remaining 65 enrollees in the treatment group. The second study, enrolling 271 patients, showed a dose-dependent, step-wise relationship between megestrol acetate administration and weight gain. Overall, megestrol acetate was well tolerated. Patients receiving treatment experienced greater caloric and protein intake, weight gain and subjective sense of well-being. Therefore, a starting dose of 400 mg/day is recommended, to be adjusted after four weeks of therapy. Drug treatment in the earlier stages of weight loss should be considered.
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PMID:Recent results with Megace. 1136 97

Many studies have shown that brain infections occur early in HIV infection, usually within weeks of seroconversion. Asymptomatic seropositive persons frequently show HIV in the brain and spinal fluid. The most common presenting symptoms are memory loss, walking difficulties, mental slowing, and depressive symptoms. In patients with localized abnormalities, such as weakness, another opportunistic infection should be suspected. Most patients with HIV dementia have clear psychomotor slowing, greater than normal reflexes, and signs indicating widespread brain dysfunction. As the dementia progresses, patients develop language and attention problems, apathy, severe psychomotor slowing, and lack of insight. Delirium is a frequent side effect of the medicines used to treat dementia. Diagnosis is fairly simple, with MRI being used to rule out CMV, progressive multifocal leukoencephalopathy, and herpes. AZT and antiretrovirals offer protective effects to delay the onset and progression of AIDS dementia. The AIDS Clinical Trials Group has completed a study showing that nimodipine, a calcium-channel blocker, can lessen damage to the brain, and is safe and generally well tolerated. Combination therapies, such as antiretrovirals with cytokine blockers, will probably emerge as the treatment of choice for dementia.
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PMID:Diagnosing and treating HIV dementia. 1136 57

Ritonavir (Norvir), a protease inhibitors, was approved for HIV treatment by the Food and Drug Administration (FDA). Studies have shown that ritonavir helps people live longer and delays the progression of the illness. One study showed that the death rate for the treated group was half that of the group taking a placebo. Ritonavir should be taken with meals. Many people cannot tolerant the side effects, including nausea, vomiting, weakness, diarrhea, elevated liver enzymes, and numbing around the mouth. Ritonavir affects the way other drugs are absorbed by the body, and its use should be closely monitored for toxic reactions.
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PMID:Ritonavir (Norvir). 1136 97

HIV can infect brain tissue and can lead to a dementia-related complication called progressive multifocal leukoencephalopathy (PML). PML is a progressive expansion of brain lesions caused by the JC virus, and may involve multiple lesions. A characteristic finding is the degeneration of the white matter of the brain. A London study found that AZT reduced the risk of PML. The disease has been difficult to study; two-thirds of all Americans harbor the JC virus, but very few develop PML. Symptoms include disturbances in movement and coordination, muscular weakness on one side, visual disturbances, aphasia, apraxia, and dementia. Mechanisms of the disease are described. Diagnosis is made via brain biopsy, cerebrospinal fluid analysis, blood or radiologic studies, or during an autopsy. Studies are underway to determine effective treatments. The current outlook for people with PML is improving, largely due to the aggressive antiretroviral treatments now being prescribed.
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PMID:Progressive multifocal leukoencephalopathy. 1136 95

The accommodations that employers should consider offering employees with HIV and AIDS are outlined. These include general accommodations such as wheelchair access, flexible schedules, and specific accommodations for weight loss, vision problems, fatigue, weakness, breathing difficulties, and concentration and memory problems. Employers should consider that every accommodation potentially sets a precedent and that accommodations should address the employee's disability rather than other people's discomfort. It is also noted that accommodations must be documented.
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PMID:Accommodating workers with AIDS. 1136 66

Wasting is a severe, dangerous medical condition, and it can occur quickly, even in overweight patients. In wasting, the digestive process is disrupted, and patients lose their ability to absorb necessary nutrients from food. HIV interferes with metabolism, causing the body to burn muscle mass before it burns fat. Additionally, other physical problems can make eating difficult or painful, and the nausea associated with HIV therapies compounds the problem. Several nutritional supplements are recommended for people with weakness, fatigue, or poor appetite. Some are standard supplements intended to boost caloric intake easily, others are modified fat supplements or special formula supplements designed for special purposes.
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PMID:Managing weight loss with nutritional supplements. 1136 27

Adefovir (Preveon) is a new compound for treating HIV infection and presents no risk for developing cross resistance. Adefovir, at 125 mg/day, has created a 0.5 log decrease in viral load in 50 percent of patients tested. At 250 mg/day, the decreases are similar. Increases in CD4+ cells are also recorded. Adverse reactions from adefovir include nausea, diarrhea, weakness, headache, and pain; slight elevations in liver enzymes were also recorded in some subjects. At the 12th week of the study, patients also experienced drops in carnitine levels by 42 percent at 125 mg/day, and 62 percent at 250 mg/day. Overall, adefovir is determined to be better tolerated at 125 mg/day with no greater benefits derived at higher doses.
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PMID:New drug, new hope. 1136 29


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