Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study assessed the safety of inactivated Mycobacterium vaccae as a candidate vaccine to prevent disseminated mycobacterial disease in children with HIV infection. 35 children ages 1-8 with CD4 counts > or =300/mm3 in New Hampshire, Boston and Chicago were randomised in a 2:1 schedule to receive a 3-dose series of intradermal M. vaccae vaccine (MV) or hepatitis B vaccine (HBV) at 2-month intervals. Immunisation was safe and well tolerated; 2-day median vaccine site in duration was 5 mm in MV recipients and 0 mm in HBV recipients (p < 0.001). There were no significantly different changes in viral load or CD4 count between the two vaccine groups. No PPD skin test conversions occurred after immunisation. MV is safe and well tolerated and deserves further evaluation as a vaccine to prevent mycobacterial disease in HIV-infected children.
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PMID:Randomised trial of intradermal Mycobacterium vaccae or intradermal hepatitis B immunisation in children with HIV infection. 1041 6

The prevalence of mycobacterial infections was determined in a sample of 155 individuals infected with human immunodeficiency virus (HIV) who were treated in the Social Security Institute (SSI) of Cali, Colombia. A tuberculin test (2 TU PPD RT23) was used, and the presence of mycobacteria was checked through direct microscopy and culturing blood, urine, feces, and gastric aspirate. When clinically indicated, samples of cerebrospinal fluid, bone marrow, and sputum were also examined and cultivated. The absence of reactivity to tuberculin was significantly more frequent in the patients than in the controls (91.3%, compared to 57.4%; chi 2 = 33, P = 0). The prevalence of tuberculosis was 6.5%, in comparison with 0.04% among a group of HIV-negative ISS members (exact binomial 95% confidence interval: 0.0313% to 0.1154%). Nontuberculous mycobacteria (NTM), present in 43 patients, were significantly more frequent than Mycobacterium tuberculosis (27.7%, versus 6.5%; chi 2 = 24.78, P = 0.000,001), but they caused illness only in some cases. The most common species were those of the M. avium-intracellulare complex. M. avium-intracellulare and M. fortuitum had a total prevalence of 7.1% and were the most-prevalent NTM that caused disease in these patients (4.5%); they were also responsible for three cases of disseminated infection. Clinical disease caused by M. tuberculosis or NTM and complete tuberculin anergy were associated with stage-IV HIV infection and with CD4 lymphocyte counts < or = 400/microL. However, the lack of immunocellular response, shown by limited tuberculin reactivity, was found beginning with the asymptomatic HIV carrier stage. The progressive deterioration of the immune system of HIV-positive patients is the determining factor in the high morbidity and mortality with mycobacteria infections and requires prompt chemoprophylaxis or treatment.
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PMID:[Mycobacterial infections in HIV-infected patients in Cali, Colombia]. 1057 75

It is presented the clinical case of a man 60 years old, heterosexual, suffering from chronic bronchopathy from old date, inveterate smoker, with previous diskotomy, herniotomy, who presents a symptomatology characterized from recurrent fever, productive cough, dyspnea, asthenia and headache for 6 month. He was admitted to hospital for fever and for a sensory slightly obnubilated. A series of investigations for typhus fever, cytomegalovirus, all with negative results were performed. He resulted negative also to the test to PPD as well as to markers of B and C hepatitis and the test for HIV. The study of the principal cancer markers also gave negative results, while the blood smears displayed leukopenia with monocytosis. The magnetic nuclear resonance of the brain showed the presence of multiple lesions of the brain and along the meninges: the examination of the liquor underlines the presence of the Cryptococcus neoformans, making to set the diagnostic of cryptococcal meningitis. The immunological study showed low values of CD4 in presence of normal values of CD8 and of a normal natural killer function. The exitus happened at 64th day. The interest of the case consists in the fact that in the medical Italian literature, unlike the international one, are not described cases of cryptococcal meningitis in patients not infected by HIV.
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PMID:[A rare case of cryptococcal meningitis unrelated to AIDS]. 1070 79

The HIV pandemic is one of the factors that have contributed to the the worldwide increase in tuberculosis cases especially in subsaharian Africa. The copathogenicity between M. tuberculosis and HIV is best illustrated by the high susceptibility of the HIV-infected persons for reactivation of a remote tuberculous infection or early progression of a newly acquired disease and by the negative impact of tuberculosis on natural history of HIV characterised by increased incidence of clinical progression and increased mortality rates. Clinical presentation is rather atypical and severe when immune suppression is advanced: no cavitation on the chest X-rays, visceral ganglionnar involvement with frequent fistulization, positive blood cultures. A standard 6 months antituberculous therapy has the same efficacy as in HIV uninfected patients excepted in severe cases especially if immunosuppression is advanced when 9 months treatment are recommended. Higher frequency of side effects to the antituberculous drugs and drug interactions between the rifamycin and several antiretrovirals due to the induction or inhibition of the CYP3A could interfere with the treatment of the tuberculosis. Paradoxical reaction to the antituberculous therapy after immuno-restoration is induced by the combined antiviral therapy has also been reported. Isoniazid prophylaxis is recommended in patients with a induration of more than 5 mm on PPD skin test and is associated with a 60% reduction of risk of development of tuberculosis.
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PMID:[Tuberculosis associated with the human immunodeficiency virus]. 1082 99

We reported a case of cervico-mediastinal tuberculous lymphadenitis followed by the development of pulmonary lesions and recurrent laryngeal nerve palsy. A 48-year-old man was admitted to our hospital due to fever, dry cough, and loss of body weight. He had no medical history of tuberculosis or other significant diseases. On admission, a right cervical tumor was palpable and chest X-ray films revealed widened superior mediastinum. Chest computed tomography showed multiple swollen mediastinal lymph nodes, including multiple low-density areas and contrast medium-enhanced septa and margins. Gallium-67 scintigraphy demonstrated abnormal uptake in the right cervix and mediastinum. A PPD skin test was strongly positive and ribosomal RNA of tubercle bacilli was detected in aspirated gastric juice. Although anti-tuberculous chemotherapy was initiated, fever and cough persisted, and hoarseness due to left recurrent laryngeal nerve palsy developed. One month later, chest X-ray films showed abnormal infiltration in the left upper lung field. The patient was sero-negative for HIV. To confirm the diagnosis, right supraclavicular lymph node biopsy was performed. Microscopic examination of the biopsy specimen revealed acid-fast bacilli and granuloma with central caseous necrosis surrounded by Langhans' giant cells and epithelioid cells. After 9 months of extended anti-tuberculous chemotherapy, the cervical and mediastinal masses receded and the abnormal chest X-ray shadows disappeared. Because the incidence of tuberculosis in Japan is gradually increasing among young people as well as the elderly, the differential diagnosis of this disease will become more necessary.
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PMID:[An adult case of cervico-mediastinal tuberculous lymphadenitis]. 1084 6

Based on the potentially important role of IL-10 and IL-12 in the pathogenesis of HIV infection, we have examined the effect of highly active antiretroviral therapy (HAART) on the production of these two cytokines, and whether addition of IL-12 or anti-IL-10 in vitro could improve the proliferative response in peripheral blood mononuclear cells (PBMC) from HIV-infected patients during such therapy. Our findings are: (i) After initiating HAART there were no significant changes in PHA- or MAC-PPD-stimulated IL-10 and IL-12 levels in PBMC supernatants in the patient group as a whole. (ii) However, while a decline in IL-10 synthesis was shown in patients with high baseline MAC-PPD- and PHA-stimulated IL-10 levels, IL-10 increased in patients with lower baseline levels. A similar pattern was seen for MAC-PPD-stimulated IL-12 levels. (iii) Exogenously added IL-12 and anti-IL-10 markedly and additively improved MAC-PPD-stimulated PBMC proliferation in vitro. Thus, a loss of cell-mediated immune response exists in HIV-infected patients also during apparently successful HAART and this can be significantly improved by addition of IL-12 and anti-IL-10, at least in vitro. These results suggest that further exploration of both IL-10 and IL-12 as targets for immunomodulating therapy in HIV-infected patients in addition to HAART might be important.
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PMID:Enhancement of lymphocyte proliferation induced by interleukin-12 and anti-interleukin-10 in HIV-infected patients during highly active antiretroviral therapy. 1111 48

Immune parameters were compared in four groups of Ugandan subjects: HIV-and HIV+ adult patients with active pulmonary TB (HIV- PTB n = 38; HIV+ PTB n = 28), patients with HIV infection only (n = 26) and PPD+ healthy controls (n = 25). Compared with healthy controls, CD4 and CD8 T cells from patients with HIV and/or PTB expressed more activation markers (HLA-DR, CD38); their CD8 T cells expressed more CD95 (pre-apoptosis) and less CD28 (co-stimulatory receptor). Peripheral blood mononuclear cells (PBMC) of patients with either HIV or PTB were impaired in interferon-gamma (IFN-gamma) production upon antigenic stimulation. PTB (with or without HIV) was characterized by monocytosis, granulocytosis, increased transforming growth factor-beta 1 production and PPD-induced apoptosis. In vivo CD4 T cell depletion, in vitro increased spontaneous CD4 T cell apoptosis and defects in IFN-gamma responses upon mitogenic stimulation were restricted to HIV+ subjects (with or without PTB). Overlapping and distinctive immune alterations, associated with PTB and HIV, might explain mutual unfavourable influences of both diseases.
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PMID:T cell activation, apoptosis and cytokine dysregulation in the (co)pathogenesis of HIV and pulmonary tuberculosis (TB). 1112 31

After growing controversy about the usefulness and effectiveness of anergy testing, the Centers for Disease Control and Prevention (CDC) may change its four-year-old recommendation that all HIV-positive people at risk for Tuberculosis (TB) be tested for anergy at the time of their TB skin test. Anergy, a condition in which immunosuppressed people cannot mount a reaction to a PPD (purified protein derivative) skin test, is common in HIV-positive patients. Although anergy testing has been common practice, an unpublished study from the Johns Hopkins University in Baltimore suggests that anergy testing is not an accurate diagnosis for infection. As a result, health officials are revising recommendations to underscore the controversy. Earlier this year, the CDC's Advisory Council for the Elimination of Tuberculosis (ACET) revised its guidelines on TB screening in high risk populations, stating that the scientific basis for anergy testing is tenuous and is generally not part of screening for TB infection. However, those at high risk for TB may be evaluated for anergy, taking into account that anergy practices are not well standardized. The Hopkins study found high rates of change in anergy status in both seropositive and seronegative groups although they found that anergy did tend to stabilize in HIV-positive patients with CD4 counts below 350.
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PMID:Anergy tests draw strong reaction from experts. 1136 46

The Centers for Disease Control and Prevention (CDC) has advised health care workers to evaluate HIV-positive people for delayed-type hypersensitivity (DTH) anergy at the time of PPD (purified protein derivative) testing. However, controversy remains among those that feel anergy testing is either unnecessary or inaccurate. A study conducted by researchers at the Johns Hopkins University in Baltimore, MD, demonstrated that anergy test results were not stable. If CD4 counts are above 500, it is highly unlikely that they will be anergic. Anergy testing may be just as unnecessary in patients with low CD4 counts. People with CD4 counts less than 200 are very likely to be anergic. The CDC recommends that if patients are anergic, those with a high risk of TB infection should be given prophylaxis. Researchers at Hopkins suggest that clinicians look closely at rates of prevalence and incidence within the patient's community. Given limited resources, and limited incidence and prevalence of TB, Hopkins representatives suggest providers concentrate efforts on PPD-positive patients.
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PMID:Some HIV clinics changing protocols on anergy. 1136 53

It was reported at the 1995 Second National Retrovirus Conference that AIDS has now surpassed unintentional injury as the leading cause of death for male Americans between the ages of 25 to 44, and for women, AIDS is fourth behind unintentional injury. A study of multidrug resistant tuberculosis that showed improved survival rates as long as appropriate therapy began within four weeks of diagnosis was also presented. The current recommendation is to consider the PPD skin test positive in persons with HIV if the bump that appears is over five millimeters in diameter. A new ganciclovir implant study demonstrated the implant's effectiveness in preventing CMV disease progression with low rates of complications, suggesting implants should probably replace intravenous ganciclovir as maintenance therapy. Another study demonstrated the effectiveness of cidofovir as a treatment for CMV infection, indicating that cidofovir was appropriate as a salvage therapy for those failing ganciclovir and foscarnet. In vitro studies involving Taxol and Kaposi's sarcoma (KS) show partial responses (55 percent), and some disease stabilization (40 percent). Four of five patients with pulmonary KS responded with clearance of tumor lesions. The first randomized trial involving Loviride with zidovudine has shown a sustained increase in CD4 cells with headache, nausea, and diarrhea as the most common side effects. Preliminary assessments reveal a reduction in viral load using the combination as opposed to monotherapy. Additional Loviride combination trials are being planned in Europe.
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PMID:Second National Retrovirus conference: a further report. 1136 59


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