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

In the 1990s, HIV has replaced syphilis as the "great masquerader." Virtually every level of the neuraxis may be affected in a patient with HIV infection. The superimposition of multiple levels of neuropathology further complicate the bedside neurologic diagnosis of an AIDS patient. This article has reviewed the variety of forms of peripheral neuropathy that may be associated with HIV infection and its treatment. Distal symmetrical polyneuropathy may be produced in patients with HIV infection by neurotoxic drugs (e.g., vincristine, INH, ddC, or ddI) or by vitamin B12 deficiency or may develop in the later stages of HIV infection without identifiable cause. GBS and CIDP occur with increased frequency in early HIV infection owing to presumed autoimmunity, and these IDPs respond to plasmapheresis or prednisone, similar to HIV-seronegative patients. A limited distribution of mononeuropathy simplex or multiplex occurs in patients with CD4 counts greater than 200; the neuropathy will usually spontaneously improve in these patients. Widespread mononeuropathy multiplex may occur in patients with AIDS and CD4 counts less than 50 and is then usually caused by CMV infections; those neuropathies are usually progressive unless antiviral treatment is given. Progressive polyradiculopathy usually occurs in patients with AIDS and low CD4 counts. If the cerebrospinal fluid has a polymorphonuclear pleocytosis, CMV infection is almost always present, and progression is expected unless ganciclovir therapy is promptly started. Finally, mild autonomic neuropathy is commonly present in HIV-infected patients. Protocols for the evaluation and therapy of cranial and peripheral neuropathies are presented (Figs. 6 and 7). It is unfortunate but likely that increasing numbers of "neuro-AIDS" patients will be encountered, not only in urban medical centers but also in general community practice. The pace at which research in the field of HIV research has proceeded is unprecedented. It is, therefore, important that neurologists stay at the forefront of investigation and clinical care of these complex disorders.
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PMID:Peripheral neuropathies associated with human immunodeficiency virus infection. 132 49

Whether tuberculosis patients received short-course chemotherapy with treatment of isoniazid (INH) and rifampicin (RIF), combined or not with pyrazinamide (PZA) and ethambutol (EMB) or streptomycin (SM), or long term chemotherapy with INH, SM and thiacetazone (Tb1), the rate of sputum culture conversion was similar in HIV-positive and HIV-negative patients. To prevent relapses it was recommended to treat patients for a minimum of 9 months and for at least 6 months after culture conversion, or even to administer INH for life after the end of treatment. However, no difference was observed in the percentage of relapses between HIV-positive and HIV-negative patients. Side-effects were observed in approximately 20% of HIV-positive patients treated with INH + RIF + PZA + EMB (or SM) or with INH + SM + Tb1, Tb1 being responsible for epidermal necrolysis, in some cases fatal. The mean survival of HIV-patients with tuberculosis was from 10 to 18 months after the diagnosis of tuberculosis. Other opportunistic infections could have been the main cause of death. Acquired drug resistance is not a common complication of tuberculosis treatment in HIV-positive patients, but several epidemics of nosocomial transmission of multiple drug-resistant tuberculosis have recently been observed in the USA. Sparfloxacin, a new fluoroquinolone with a long half-life and low MIC (0.25-0.50 mg/l) against Mycobacterium tuberculosis, is a promising drug against tuberculosis.
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PMID:Treatment of tuberculosis in HIV infection. 826 Jun 70

In the past 5 yr, an increased incidence of tuberculosis has been noted in the United States. Simultaneously, the population infected with human immunodeficiency virus-type I (HIV-I) and the number of cases of acquired immunodeficiency syndrome (AIDS) have increased. Selected areas of the United States have also reported increases in the frequency of drug-resistant isolates of Mycobacterium tuberculosis. Because our institution serves a population in which tuberculosis, AIDS, and drug resistant isolates of M. tuberculosis are frequently encountered, we sought to better define interrelationships among these factors by retrospectively reviewing the demographic, clinical, bacteriologic, and radiologic data for all adult patients in whom M. tuberculosis was isolated from a culture of respiratory-tract secretions during a 1-year period (June 1, 1988 to May 31, 1989). Two hundred forty-six patients were thus identified; 66.5% were U.S. born blacks, and 62.6% were 17 to 40 yr of age. Risk factors for HIV infection were present in 106 patients. The overall resistance rate (one or more drugs) = 30.9%, with primary resistance = 22.6% (35 of 155) and secondary resistance = 49.2% (29 of 59). In addition, 12 resistant isolates were found in 32 patients whose prior treatment status was indeterminate. Of the resistant isolates, 56.6% (43 of 76) were multiply resistant. Isoniazid resistance was noted in 90.7% (69 of 76) and rifampin resistance was noted in 50% (38 of 76) of the resistant isolates. No significant differences in the overall frequency of resistance were noted in patients at risk for HIV infection compared with those without these risks.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Drug-resistant tuberculosis in an urban population including patients at risk for human immunodeficiency virus infection. 843 Sep 76

Each year, tuberculosis (TB) affects 10 million people and kills 3 million people all in the 15-53 year age group--the group which supports society economically and socially. It comprises the largest percentage of avoidable adult deaths (29%) in developing countries. The TB incidence is rising worldwide which, evidence indicates, is probably due to the HIV epidemic. Between mid-1988 to mid-1989, prevalence of HIV seropositivity among TB patients in Harare rose from 33% to 47%. Among the 20-40 year old male TB patients, 63.7% were HIV positive. Some evidence in Zimbabwe and elsewhere shows that TB responds well to standard treatment in most HIV positive patients. The most important public health measure against TB is to treat it with effective antibiotic regimens (95% relapse-free cure rates), but many TB treatments fail due to poor patient compliance. In fact, operational surveys of TB programs show that poor compliance is very common. Various forms of treatment include short course chemotherapy (6 months) and intermittent therapy (e.g., 2 doses each week). Various TB antibiotics are isoniazid, rifampicin, INH, pyrazinamide, thiacetazone, streptomycin, and ethambutol. Some new possible antibiotics are emerging such as ansamycin and ciprofloxacin used to treat atypical mycobacteria. The Harare City Health Department in Zimbabwe has evidenced a 5-fold increase in the risk of a drug reaction in HIV infected TB patients. Thiacetazone and streptomycin were involved in 85% of these reactions. Antituberculosis treatment is costly in sub- Saharan Africa. Drug costs make up only 30% of the medical costs of outpatient treatment and only 5% for 1-2 months hospitalization. Nondrug costs include patient travel costs, time lost from work, and compromised job security and income. Thus developing countries should adopt the already known to be effective 6-month regimen for TB treatment.
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PMID:Therapeutic review: tuberculosis. 180 99

Approximately 25 percent of individuals exposed to Mycobacterium tuberculosis become infected. Of those, about 10 percent will develop clinically active tuberculosis at some time in their lives. The tuberculin skin test should be used to screen all patients, especially those at greatest risk of contracting the disease, such as the young and the old, and those with weakened immune systems from poor nutrition, alcohol and drug abuse, chronic illness and human immunodeficiency virus infection. Depending on the characteristics of the local population and individual medical risk factors, a reaction (induration) between 5 and 15 mm (or more) generally represents infection. Isoniazid therapy in persons with positive skin tests will decrease the risk of disease by 60 to 80 percent. Family physicians will play a critical role in efforts to eliminate tuberculosis from the United States by the year 2010.
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PMID:Return of tuberculosis: screening and preventive therapy. 199 Jul 30

485 HIV-positive patients have been treated at our institution in Bonn during 1985 to 1989. Mycobacterial infections occurred in twelve (2.5%) HIV-positive patients. Of 166 AIDS-manifestations according to CDC, eleven (6.6%) were mycobacterial infections. There occurred one case of miliary tuberculosis, six cases of extrapulmonary, one of disseminated tuberculosis and four cases of atypical mycobacteriosis. Mycobacteriosis other than tuberculosis (MOTT) were caused three times by Mycobacterium kansasii and once by Mycobacterium scrofulaceum. Tuberculosis was seen less often in haemophiliacs. Disseminated tuberculosis and atypical mycobacteriosis developed in late stages of HIV-infection with underlying severe immunodeficiency. The lung was the main target organ of tuberculosis. MOTT most often affected the gastrointestinal tract additionally. Noninvasive materials, first of all sputum and gastric acid, were reliably diagnostic but available with delay in particular cases. In those cases histologic studies proved helpful. Application of five-fold regimen (INH, RMP, EMB, PZA and SM) always succeeded in negative cultures in a mean of 15 days in all cases of tuberculosis. Two cases of atypical mycobacteriosis with Mycobacterium kansasii were treated with a five-fold regimen (one case with ciprofloxacin additionally) and culture-negative after six resp. 28 weeks of therapy.
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PMID:[Tuberculosis and atypical mycobacterioses in HIV infection. Results from the Bonn Center 1985 to 1989]. 211 68

The goal of modern therapy of tuberculosis is the rapid killing of all bacilli with potent and relatively atoxic antituberculous drugs. Currently available first-line drug regimens are highly effective, well tolerated and relatively easily administered. The addition of Pyrazinamide enables the minimum treatment period to be shortened to six months (two months Isoniazid, Rifampin, Pyrazinamide and four months Isoniazid, Rifampicin). This article reviews the available first-line drugs in treatment of tuberculosis, the rationale for the recommended chemotherapeutic regimens, the follow-up of treated patients and special issues related to the treatment of extrapulmonary tuberculosis and tuberculosis in HIV-infected patients.
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PMID:[Tuberculosis therapy 1990]. 219 Feb 95

The demographic, social and clinical presentation of 100 HIV positive patients hospitalized in Tikur Anbessa Hospital, Addis Ababa, Ethiopia, between 1986 and 1989 are described. The mean age is 38.2 years with a range of 16 to 58. Over 75% of the patients are under 40 years. They came from ten different regions of Ethiopia. Only 82% of the patients fulfil the provisional World Health Organization clinical case definition of AIDS (acquired immunodeficiency syndrome). Tuberculosis is the commonest infection, presenting in unusual and aggressive ways. However, response to chemotherapy is similar to that in HIV-negative patients. It is recommended that all patients with unusual and aggressive tuberculosis should be screened for HIV and Mantoux-positive HIV carriers should receive INH prophylaxis. Also, all non-Hodgkin's lymphoma cases should be tested for HIV. Kaposi's sarcoma was not seen (see Addendum). As HIV infection is spreading rapidly and diagnostic facilities are limited, physicians and other health workers must develop a high index of suspicion to test for HIV among high risk groups, such as prostitutes, individuals having contacts with prostitutes, single, divorced and unemployed women living in towns and truck drivers, when they present with significant weight loss, unexplained and prolonged fever and diarrhoea, lymphadenopathy and oral thrush. Also, facilities and expertise for diagnosing opportunistic infections should be available in hospitals to prolong the lives of patients with AIDS.
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PMID:The demographic, social and clinical presentations of one hundred Ethiopian patients with human immunodeficiency virus (HIV) infection. 236 37

TB is common in the setting of HIV-induced immunosuppression, especially among demographic groups with a high background prevalence of tuberculous infection. It is often the first (sentinel) infectious disease to appear, extrapulmonary and disseminated disease is common, the chest x-ray picture is frequently atypical, and the tuberculin skin test is often falsely negative. It therefore requires a high index of suspicion and an aggressive diagnostic approach to avoid missing HIV-related tuberculous disease, which is communicable from man to man by the aerosol route and which appears to be highly treatable with conventional anti-TB drugs. Identification and INH prophylaxis of tuberculous-infected, HIV-seropositive persons is likely to be very important in the prevention of tuberculous disease. MAI is also a very common pathogen that frequently produces extrapulmonary and disseminated disease among patients with AIDS. In contrast to TB, AIDS-related MAI disease occurs more uniformly among the AIDS risk groups, occurs late among the HIV-related infections, and is not effectively treated with current drug regimens.
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PMID:Mycobacterial disease: epidemiology, diagnosis, treatment, and prevention. 304 79

A 27-year old female HIV-positive patient developed septic tuberculosis, with mycobacterium tuberculosis typus humanus repeatedly found not only in sputum, bronchial secretion, blood and faeces but also in biopsy material from the liver. Although standard therapy with Pyrazinamid, Rifampicin and INH had to be replaced at times by Ethambutol or Streptomycin respectively, there was a surprisingly fast clinical and bacteriological improvement. Establishment of the diagnosis AIDS requires not only HIV-infection but also the occurrence of opportunistic infections. The latter include, according to the definition given by CDC, atypical mycobacteriosis, but not tuberculosis. Tuberculosis, however, is increasingly seen in HIV-infected patients. This observation allows us to question whether mycobacterium tuberculosis typus humanus should not be included in the list of opportunistic agents in AIDS. We conclude that in HIV infection the possibility of atypical and typical mycobacteriosis has to be taken into consideration. On the other hand, in tuberculosis patients at risk from AIDS the possibility of infection with HIV has to be considered. Tuberculin reactivity in HIV infected subjects is frequently missing and therefore can not be used for diagnosis. HIV-positive patients may require prophylactic treatment with INH, but BCG vaccination is strictly contraindicated. With early combination therapy continued for at least nine months, the prognosis may be good.
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PMID:[Septicemia due to tuberculosis in HIV infection]. 367 72


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