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

Respiratory failure secondary to Pneumocystis carinii pneumonia (PCP) is associated with high mortality in AIDS patients. In a search for prognostic indicators, we reviewed hospital charts of 13 AIDS patients admitted to our intensive care service from 1982 to 1989. Mortality rate was higher from 1982 to 1987 (4/5 patients) than later (3/8 patients). There was no significant difference between survivors and non survivors of this acute episode with regard to sex. HIV risk factors, time elapsed since AIDS diagnosis, vital signs (blood pressure, heart rate, respiratory rate), hemoglobin, white blood cell count, platelets, total and T4 lymphocytes, electrolytes, lactate dehydrogenase, P24 antigen Apache II and SAPS scores and corticosteroid treatment. Higher mortality was associated with more advanced age and an oxygen alveolar-arterial gradient greater than 65 mm Hg with an inspired fraction of oxygen of 0.21. We conclude that only the alveolo-arterial gradient could represent a prognostic indicator of practical interest. It is our belief that improvement since 1988 can be explained by earlier diagnosis and prompt treatment before development of severe lung alterations.
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PMID:[Survival of HIV-positive patients hospitalized in intensive care for respiratory insufficiency and pneumocystis carinii pneumonia]. 227 Apr 46

After reviewing the immunological anomalies provoked by the human immuno-deficiency virus (HIV) as well as their implications in pulmonary pathology, the authors enumerate the diagnostic and therapeutic methods currently available in the treatment of patients suffering from AIDS and pulmonary diseases. The clinical features as well as the chest radiograph--an essential first line tool--may lead to atypical features. Respiratory function tests and scintigraphy to Gallium may be a useful additional diagnostic technique but for a full pulmonary investigation a bronchoalveolar lavage is required and/or transbronchial biopsy. Open lung biopsy is rarely required, and then only as a last resort. The treatment of pneumocystis remains centred on Trimethoprim sulfamethoxazole and Pentamidine, with a similar efficacy (80% care) but both have side-effects which are less frequent but more severe with Pentamidine. Administration of Pentamidine by aerosol, Eflornithine and Trimetrexate are under study. The level of lactic dehydrogenase (LDH) seems to be a prognostic factor. The value of prophylaxis is discussed. If the treatment of tuberculosis, an infection which is seen more and more frequently, still rests on classical triple therapy, the treatment of atypical mycobacterial infections is even more deceptive than in non-immuno-suppressed hosts. The same is true with pneumonia due to cytomegalovirus. The treatment of lymphoid interstitial pneumonia which is probably a direct result of HIV infection, remains controversial. On the other hand, pulmonary Kaposi's sarcoma is associated with an elevated mortality, and all treatment (interferon and chemotherapy) is disappointing.
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PMID:[Pulmonary manifestations of acquired immunodeficiency syndrome]. 306 2

We determined the enzyme activities of glucose-6-phosphate isomerase, alanine aminotransferase, aspartate aminotransferase, and lactate dehydrogenase in serum from 23 normal controls, 27 anti-HIV seropositive individuals confirmed by Western blot, and 53 patients with acquired immunodeficiency syndrome (AIDS). There is a significant difference for all four enzyme activities among controls, HIV seropositive individuals, and patients with AIDS, the enzyme activities showing a progressive increase as the disease progresses. Evidently these enzyme measurements may be adjunctive biochemical markers for progression of AIDS.
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PMID:Enzyme abnormalities of patients with acquired immunodeficiency syndrome. 319 6

An increase in serum lactate dehydrogenase (LDH) activity is commonly taken to support the presumptive diagnosis of Pneumocystis carinii pneumonia (PCP), although the LDH level may also be increased in other lung infections and in a variety of extrapulmonary disorders. To assess its diagnostic value in patients with fever, lung infiltrates, and a high prevalence of HIV infection, we compared LDH levels in 42 hospitalized patients with PCP, 71 with disseminated tuberculosis (TB), 40 with pulmonary TB, and 37 with bacterial pneumonia. Peak LDH level was higher (p < 0.05) in patients with PCP (547 +/- 157 U/L) and disseminated TB (569 +/- 338 U/L) than in patients with pulmonary TB (258 +/- 66 U/L) or bacterial pneumonia (331 +/- 139 U/L). However, substantial overlap between groups limited its diagnostic value for individual patients. Expressing LDH as its ratio to simultaneous serum aminotransferases (AST or ALT) did not enhance its discriminatory value. Most patients in each group had abnormalities in other serum enzymes (AST, ALT, alkaline phosphatase, gamma-glutamyltransferase), making an isolated elevation of LDH level uncommon (21% of PCP cases). Serum LDH has a high sensitivity for PCP (100% in this series) but must be interpreted with caution given its lack of specificity.
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PMID:Serum lactate dehydrogenase (LDH) in Pneumocystis carinii pneumonia, tuberculosis, and bacterial pneumonia. 763 77

Between June 1986 and October 1992, disseminated toxoplasmosis was diagnosed in 16 AIDS patients. 13 cases were diagnosed at autopsy where multiple organ involvement was documented in all 13. Three patients were diagnosed intra vitam. All 3 survived with appropriate treatment. Clinical features indicative of disseminated toxoplasmosis were: fever of unknown origin between 39 degrees and 40 degrees C in 16 cases, clinical signs suggestive of sepsis or septic shock in 15, with progression to multiorgan failure in 10, disseminated intravascular coagulopathy in 6, confusion, disorientation or apathy in 13 and lack of a systemic pneumocystis carinii prophylaxis in all 16. Typical laboratory markers were: CD4 cell counts below 100 x 10(6)/l in 16 cases, elevation of serum lactic dehydrogenase in 16 and creatine phosphokinase (in 4/6), normal or only slightly elevated C-reactive protein (in 9/11), positive Toxoplasma gondii IgG antibodies in 15/16 and negative IgM antibodies in all 16. Lesions indicative of cerebral toxoplasmosis were visualized on cranial computerized tomography in only 3/10 evaluated patients. In patients with advanced HIV infection presenting with a systemic illness, including the clinical and laboratory features described above, systemic Toxoplasma gondii infection must be included in the differential diagnosis. In these patients, specific and if warranted, invasive diagnostic procedures followed by early vigorous therapeutic intervention should be considered.
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PMID:Disseminated toxoplasmosis in AIDS patients--report of 16 cases. 778 18

A 51-year-old man, known to have chronic-aggressive hepatitis B, HIV infection and exertional dyspnoea, was hospitalized because of acute physical deterioration, cough with whitish exudate and dyspnoea at rest. Despite a CD4/CD8 ratio of 0.16 no prophylactic measures against Pneumocystis carinii had been taken. On examination the lungs were unremarkable, but the liver was enlarged and there were petechiae over all parts of the body. Laboratory tests showed impaired liver functions and a rise in lactate dehydrogenase activity (538 U/l). Chest radiogram demonstrated small to very small infiltrates in the lung. As Pneumocystis carinii pneumonia was suspected but bronchoscopy was too risky, he was at first treated with trimethoprim/sulphamethoxazole (four times 320/1600 mg/24 h intravenously). When this failed, he received pentamidine (4 mg/kg, after 4 days 2 mg/kg intravenously), and finally cefotiam (twice 2 g daily), tobramycin (three times 40 mg daily) and corticoids (100 mg). Despite this treatment he died after 10 days from respiratory failure. Autopsy revealed interstitial pneumonia throughout the lung as well as focal mucor infiltrations in the wall of middle-calibre lung veins. Mucor is a ubiquitous, facultatively pathogenic mold fungus.
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PMID:[Pulmonary mucormycosis in an HIV-infected patient]. 783 42

A 24-year-old male patient seropositive for the human immunodeficiency virus with Burkitt's Leukemia was treated successfully with aggressive systemic chemotherapy and central nervous system prophylaxis. He presented with a leukocyte count of 68,900/microliter with 33% L3 lymphoblasts, massive hepatosplenomegaly, generalized lymphadenopathy, a lactic dehydrogenase level of 9105 IU/l, creatinine level of 5.8 mg/dl, and a uric acid level of 43.5 mg/dl. Hemodialysis, intrathecal methotrexate, hydrocortisone and cytosine arabinoside, and fractionated doses of cyclophosphamide followed by vincristine and doxorubicin were promptly instituted. He received eight subsequent courses of chemotherapy consisting of either methotrexate with leucovorin rescue and high dose, continuous infusion cytosine arabinoside or cyclophosphamide, vincristine, and methotrexate with leucovorin. There was marked hematologic toxicity resulting from this treatment. However, the patient was alive and in complete remission more than 6 years from diagnosis. This paper demonstrated that it is possible to successfully treat a patient who is HIV-1 antibody positive with poor prognosis Burkitt's Leukemia. Further studies need to be undertaken to define the least toxic, most effective therapy for this disease.
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PMID:Successful treatment of a patient with seropositive human immunodeficiency virus with high risk Burkitt's leukemia. 805 47

An antisense phosphorothioate oligodeoxynucleotide 27-mer complementary to the rev gene mRNA of the human immunodeficiency virus (HIV-1) was administered to rats through intravenous injections and subcutaneous infusions in order to investigate the disposition of this compound. In addition, nonlethal toxic responses of the rat were evaluated. A biphasic plasma clearance with t1/2 alpha of 20-25 min and t1/2 beta of 27-41 hr was observed. Single doses ranging from 35 to 3257 micrograms were examined, and the plasma concentration and area under the plasma concentration-time curve (AUC) were found to be directly proportional to the dose. Continuous subcutaneous infusion of 50 mg over 28 days was also examined. The oligonucleotide is completely eliminated in the urine over 3 days. Electrophoretic analysis demonstrated that the excreted compound has the same mobility and UV-absorbance profile as the administered compound. Measurement of accumulation and distribution into tissues revealed unique tissue-specific rates and extent of oligonucleotide movement into and out of tissues. Results of the chronic infusion study suggest that uptake into tissue is not saturated, even after 28 days of infusion. Analysis of blood plasma from oligonucleotide-treated animals shows a possible transient elevation in levels of lactate dehydrogenase (LDH), alanine aminotransferase (ALT), and aspartate aminotransferase (AST), but not alkaline phosphatase (AP), gamma-glutamyltransferase (GT), and bilirubin. The data collectively support the potential utility of phosphorothioate oligonucleotides as therapeutic agents in vivo.
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PMID:Pharmacokinetics of an antisense phosphorothioate oligodeoxynucleotide against rev from human immunodeficiency virus type 1 in the adult male rat following single injections and continuous infusion. 806 15

A 41-year-old man infected with HIV-1 developed fever up to 39.8 degrees C together with nonproductive cough and dyspnoea. Lactate dehydrogenase concentration rose from a level of 998 U/l to 6307 U/l. As pneumocystis carinii pneumonia was at first suspected he was treated with co-trimoxazole (1600 mg sulfamethoxazole and 320 mg trimethoprim, four times daily). But the symptoms did not abate. Bone-marrow puncture revealed numerous macrophages containing ovoid inclusions typical of Histoplasma capsulatum varietas capsulatum. The diagnosis of disseminated histoplasmosis was confirmed by culture and serologically by an increase in Histoplasma polysaccharide antigen. On treatment with amphotericin B (at first 10 mg, then 50 mg daily for 4 weeks) the symptoms regressed within a few days. After the concentrations of lactate dehydrogenase and Histoplasma antigen had become normal again, maintenance treatment was changed to itraconazole (200 mg twice daily), after a total amphotericin B dose of 1150 mg. The patient has remained free of recurrence.
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PMID:[Disseminated histoplasmosis in AIDS]. 818 12

Considering that in the HIV infection there is a precocious deterioration of humoral immunity with rapid turn-over of cellular B clones, we have evaluated the conduct of serum lactate-dehydrogenase activity (LD, EC 1.1.1.27) and its isoenzymes in 21 children born from HIV-positive mother respect to a control group (30 subjects). Furthermore we have checked the existence of a probable correlation between those and other clinical and immunologic parameters (total lymphocytes, CD4/CD8, immunoglobulins, classification according to the Atlanta CDC). In seropositive children we saw, respect to those evolved towards P3 stage, a significantly raising of LD4 (also vs. control group) for likely pulmonary parenchyma's damage, LD3 for B immature lymphocytes' increase and a reduction of LD1 (also vs. control group) for mature clones' decrement. Furthermore in seropositive subjects there was the existence of a direct correlation between LD1 and CD4/CD8 values. As such, the evaluation of LD isoenzymes can establish an useful element in the clinical monitoring of seropositive children.
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PMID:[Lactate dehydrogenase isoenzymes in HIV-positive children]. 826 59


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