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

Histoplasmosis is particularly common in Missouri, and many important clinical observations about the disease were made in this state in the 1950s and 1960s. When the AIDS epidemic spread to Missouri in the mid-1980s, histoplasmosis became recognized as a common and important opportunistic infection among Missourians with AIDS. Clinicians must maintain a high level of suspicion for histoplasmosis in any HIV-infected patient who presents with unexplained fever, particularly if the patient has evidence of hepatosplenomegaly, generalized lymphadenopathy, pancytopenia, abnormal liver function tests, or bilateral pulmonary infiltrates. The diagnosis of histoplasmosis can be established rapidly by observation of organisms on peripheral blood smear or bone marrow biopsy specimens or by Histoplasma Polysaccharide Antigen testing. The diagnosis can be confirmed by blood cultures in most cases. Histoplasmosis in AIDS is invariably fatal if not treated. Treatment consists of two phases: initial induction therapy and subsequent lifelong maintenance therapy. Amphotericin B and itraconazole are extremely effective for induction and maintenance therapy; fluconazole appears to be effective maintenance therapy. Strategies for the prevention of histoplasmosis in high risk patients are being evaluated currently.
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PMID:Histoplasmosis in Missouri: historical review and current clinical concepts. 812 70

A twenty nine year old male homosexual presented with malaise, weight loss, fever and profuse sweating. An ill defined abdominal mass was found during physical examination in the right lower quadrant and chest X rays disclosed a pleural effusion. HIV antibodies and hepatitis B surface antigen were positive and immunological parameters were altered. Light and electron microscopic examination of operative biopsies of the abdominal mass revealed the presence of Histoplasma capsulatum. Treatment with Amphotericin B was started with a favorable response and the patient was discharged. He was readmitted with a septic shock and died. Necropsy showed pulmonary histoplasmosis. This is the first case of disseminated histoplasmosis in a patient with AIDS described in Chile.
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PMID:[Disseminated histoplasmosis in a patient with acquired immunodeficiency syndrome]. 823 68

Eighty-six patients with laboratory evidence of human immunodeficiency virus infection presented to Chiang Mai University Hospital in Chiang Mai, Thailand, between 1 June 1990 and 30 June 1992 with systemic infection caused by the dimorphic fungus Penicillium marneffei. Thirty isolates of P. marneffei from clinical specimens from these patients were tested for their in vitro susceptibilities to amphotericin B, 5-fluorocytosine, miconazole, ketoconazole, itraconazole, and fluconazole. P. marneffei was highly susceptible to miconazole, itraconazole, ketoconazole, and 5-fluorocytosine. Amphotericin B showed intermediate antifungal activity, while fluconazole was the least active; some strains of the fungus were resistant to fluconazole. The clinical and microbiological responses correlated with the overall patterns of in vitro susceptibility to the azoles, whereas results with amphotericin B were more difficult to assess. Antibiotic failures of initial therapy occurred in 8 of 35 (22.8%) patients treated with amphotericin B, 3 of 12 (25%) patients treated with itraconazole, and 7 of 11 (63.6%) patients treated with fluconazole. Itraconazole or ketoconazole should be considered to be the drug of first choice in the treatment of mild to moderately severe P. marneffei infection. Parenteral therapy with amphotericin B may be required for seriously ill patients. Since at least 12 patients who responded to initial therapy relapsed within 6 months regardless of initial antifungal therapy, maintenance oral therapy with itraconazole or ketoconazole may be necessary.
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PMID:Response to antifungal therapy by human immunodeficiency virus-infected patients with disseminated Penicillium marneffei infections and in vitro susceptibilities of isolates from clinical specimens. 828 25

The reference treatment in visceral leishmaniasis is administration of antimonial compounds (Pentostam, Glucantime). Primary and secondary failures have been reported and may involve several mechanisms resulting in alterations in the T-cell-dependent response, particularly in HIV-positive patients. Alternative agents proposed for use as single-drug therapy or in combination with other drugs include Lomidine, which carries a high risk of toxicity, allopurinol, cytokines (IL-2 and interferon gamma), and amphotericin B. Amphotericin B, in addition to effects on the metabolism of sterols in the wall of the protozoan, induces macrophage activation. This article illustrates the difficulty of treatment of visceral leishmaniasis by reporting the case of an immunocompetent 36-year-old patient whose bone marrow cultures remained positive after successive treatment, over 48 months, with two courses of Glucantime (60 mg/kg/day for 15 days), one course of allopurinol (10 mg/kg/4 weeks), two courses of Glucantime in combination with interferon gamma, splenectomy, and one course of Pentostam (20 mg/kg/4 weeks). Bone marrow cultures became negative after administration of amphotericin B (1 mg/kg every 48 hours for 8 weeks). Cytokine studies disclosed defective production of IL-2, IL-1 beta, and IFN gamma. Amphotericin B seems to be a valuable alternative when conventional treatment fails. The liposomal form is especially promising.
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PMID:[Visceral leishmaniasis resistant to conventional treatments: value of amphotericin B]. 830 24

HIV destroys the immune system, causing group of clinical signs which are referred to as AIDS. Some of these signs are cutaneous in nature. An acute rash on the trunk is associated with HIV seroconversion. It usually disappears in 8 days but can last for several hours or 30 days. Infectious manifestations of HIV infection are common. Candidiasis represents 90% of mycoses. It usually manifests on the tongue but can also occur on oral or genital mucosa. Antifungal medication usually treats it effectively. Yeastlike fungi cause seborrheic dermatitis, which is characterized by profuse inflammatory lesions resembling psoriasis. Topical and general antifungal medication do not effectively treat it. Dermacorticoids are more likely to be successful. Dermaphyte infections also occur HIV-infected persons. Organisms responsible for cutaneous profound mycoses, which tend to be rare but fatal, include Cryptococcus neoformans, Histoplasma capsulatum, sporotrichoses, scopulariopsis, and Pneumocystis carinii. Amphotericin B is the treatment of choice for manifestation of the first 2 organisms. Cutaneous viral infections in HIV-infected persons are caused by herpes simplex virus, herpes zoster, cytomegalovirus, Epstein Barr virus, Pox virus, and human papilloma virus. A patient who has had chronic cutaneous or mucosal herpes simplex infection for more than 1 month should be suspected of having HIV infection. Actclovir can treat herpes simplex infection, herpes zoster infection, and Epstein Barr virus (to make lesions disappear). Cytomegalovirus lesions are not specific. Cytomegalovirus infection is generally fatal. Cutaneous bacteria infections include banal infections (e.g., acne and folliculitis), syphilitic chancre lesions, and granulomatous tuberculosis. Protozoans and arthropods also cause cutaneous conditions in HIV-infected patients. Cutaneous neoplasms include Kaposi's sarcoma and other tumors (e.g., lymphomas). Other dermatoses are rare but may include psoriasis and toxidermia.
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PMID:[Cutaneous manifestations of AIDS]. 835 23

We retrospectively analyzed clinical outcome of meningeal and extrameningeal cryptococcosis in HIV-negative patients treated with amphotericin B (43 patients) or fluconazole (40 patients). Amphotericin B and fluconazole were prescribed equally to patients with neoplastic diseases and no risk factor, but organ transplant recipients and patients with other diseases were mostly given fluconazole and amphotericin B, respectively. Patients with more severe infections (i.e., meningitis, neurological disorders, or higher levels of antigen in cerebrospinal fluid) were more frequently treated with amphotericin B. A cure rate of > 70% was achieved regardless of the initial treatment and the severity of the infection. A Cox regression analysis showed that age of > 60 years, neoplastic disease, abnormal mental status, disseminated infection at the time of diagnosis, and therapeutic failure were independent predictors of death. Although fluconazole appears to be as effective as amphotericin B, only a prospective multicenter study will determine the best treatment regimen for patients with cryptococcal meningitis who do not have AIDS.
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PMID:Comparison of the efficacy of amphotericin B and fluconazole in the treatment of cryptococcosis in human immunodeficiency virus-negative patients: retrospective analysis of 83 cases. French Cryptococcosis Study Group. 872 44

Peptides representing a sequence of 23 amino acid residues at the N terminus of human immunodeficiency virus type 1 (HIV-1) envelope glycoprotein gp41 bind and subsequently induce fusion of large unilamellar vesicles (LUV), an activity presumably related to gp41 function in viral infection. These in vitro effects can be modulated by several factors that are known to affect HIV-1 infectivity and gp41-mediated virus-cell fusion. Peptide-induced membrane fusion but not peptide binding can be inhibited by two factors known to block gp41 activity: a polar amino acid substitution V --> E in position 2 and the presence of the N-terminal hexapeptide of gp41 in addition to the parent sequence. Whereas inclusion of the alternative gp120 receptor galactosylceramide in membranes has virtually no effect, membrane cholesterol stimulates fusion activity. In view of its putative physiological relevance, we have used the fusion activity of the peptides as a tool to evaluate the inhibitory effect of antivirals that might target this sequence. We describe three dissimilar effects: Amphotericin B inhibits in a cholesterol-independent way peptide-induced fusion but not binding, human serum albumin inhibits binding and consequently fusion, and dextran sulfate (M(r) 5000) does not affect either binding or fusion.
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PMID:Membrane fusion induced by the HIV type 1 fusion peptide: modulation by factors affecting glycoprotein 41 activity and potential anti-HIV compounds. 931 Feb 87

With the increased use of antibiotics and immunosuppressive agents, oropharyngeal candidiasis is becoming more common. This infection is also associated with such advances in medical management as chemotherapy and organ transplantation and with human immunodeficiency virus infection. Various topical and systemic agents are available to treat patients with candidiasis, but optimal management can be elusive. Treatment of uncomplicated oropharyngeal candidiasis in the immunocompetent patient involves selecting a particular formulation of a topical medication based on oral conditions, length of contact time, and taste, texture, and cost of the medication. Treatment of severe oropharyngeal candidiasis, particularly in patients with a compromised immune system, is often more difficult, and relapses are common. Reports of resistance to systemic agents, particularly in patients needing recurrent therapy, are increasing. Amphotericin B, long used as an intravenous agent, is now available as an oral suspension that may offer therapeutic benefits comparable to those of systemic therapy without the toxicity associated with systemic absorption.
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PMID:Oropharyngeal candidiasis: a review of its clinical spectrum and current therapies. 952 3

Aspergillosis is an infrequent but commonly fatal infection among HIV-infected individuals. We review 342 cases of pulmonary Aspergillus infection that have been reported among HIV-infected patients, with a focus on invasive disease. Invasive pulmonary aspergillosis usually occurs among patients with <50 CD4 cells/mm3. Major predisposing conditions include neutropenia and steroid treatment. Fever, cough, and dyspnea are each present in >60% of the cases. BAL is often suggestive, but biopsy specimens are necessary for definite diagnosis. Amphotericin B is the mainstay of treatment and mortality is > 80%. Avoiding neutropenia and judicious use of steroids may be helpful in prevention. Aggressive diagnostic approach, early initiation of treatment, adequate dosing of antifungals, and close follow-up may improve the currently dismal prognosis.
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PMID:Pulmonary aspergillosis and invasive disease in AIDS: review of 342 cases. 967 77

Two imported cases of Penicillium marneffei infection in Belgium are reported. Both patients are Thai women co-infected with HIV. P. marneffei infection should be suspected in immunocompromised patients originating or travelling from South-East Asia with unexplained fever (> 38 degrees C), weight loss, a generalised lymphadenopathy, hepatomegaly, splenomegaly, skin lesions, cough and anaemia. Diagnosis is made by culture and/or histopathological examination. Mild to moderate infections are treated with itraconazole 400 mg/day as first choice. Amphotericin B parenteral therapy may be required for seriously ill patients. Maintenance therapy with itraconazole 200 mg/day is necessary to prevent relapses.
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PMID:Two imported cases of Penicillium marneffei infection in Belgium. 979 45


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