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

Among the many infectious complications of infection with human immunodeficiency virus (HIV), tuberculosis is now recognized as one of the most important. Coexisting HIV infection is believed responsible for the soaring incidence of tuberculosis in Africa, and for the increase in the number of reported cases in the United States. As HIV-induced immunosuppression worsens, tuberculosis may supervene by reactivation of remotely acquired infection or failure to defend against newly acquired Mycobacterium tuberculosis. Both mechanisms undoubtedly occur in Africa where the rate of exposure is high; the former prevails in the United States. The risk of tuberculous infection progressing to tuberculous disease is about six times higher in HIV seropositive than seronegative persons. Although not incontrovertibly established, tuberculosis probably also has a deleterious effect on coexisting HIV infection, either by accelerating the rate of destruction of CD4+ lymphocytes and/or promoting the release of new virions from HIV-infected macrophages. Tuberculosis, whether HIV-linked or not, can be controlled by the traditional means of case-finding and treatment, vaccination with BCG, and chemoprophylaxis. HIV infection can be controlled by eliminating high-risk behavior, and using uncontaminated blood and other medical supplies. An extensive campaign is needed to prevent further spread of these dual scourges that are overwhelming already meager health resources in many parts of the world.
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PMID:Tuberculosis and human immunodeficiency virus infection during the 1990's. 185 39

A retrospective study of tuberculosis was undertaken among 125 patients infected with human immunodeficiency virus (HIV) who attended our regional infectious disease unit between 1986 and 1989. Nine TB-positive patients (five English, three Africans, one Indian) were identified. In three patients who presented with pyrexia of unknown origin and no objective evidence of any organ involvement, the diagnosis of TB was established from examination of sputum induced by nebulized hypertonic saline. Four other patients had extrapulmonary disease while another two had only pulmonary manifestations of TB. Chest radiographs from five patients were normal, while the other four showed cavities with consolidation, pleural effusion, miliary opacities and hilar enlargement, respectively. All but two mycobacterial isolates were fully sensitive to standard first-line chemotherapeutic drugs. Response to treatment was rapid and only complicated in one patient. There were no relapses following treatment without maintenance therapy after a mean follow-up of 22.2 months (range 9-48). Three patients died, of causes unrelated to TB. Tuberculosis may occur at any stage of HIV disease and is an important cause of fever in HIV-infected British patients, even when chest radiographs are normal and previous BCG vaccination has been performed.
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PMID:Tuberculosis in patients infected with the human immunodeficiency virus. 194 41

Estimates show that 5 million people worldwide are infected with human immunodeficiency virus (HIV). Recent estimates are that 8-10 million new tuberculosis (TB) cases occur each year in the world. 2-3 million die. In developing countries, TB is one of the most common opportunistic infections in people who are seropositive for HIV-1. About 90% of the TB is pulmonary. Of those without pulmonary tuberculosis, 85% had lymphadenopathy, bone and joint disease, or pleural effusion. In adults and children over 15 who had pulmonary TB, 78% had positive sputum smears for acid-fast bacilli. 66% had cavitation on chest radiography. Many people with TB and HIV infection have typical clinical and radiologic features. However, African clinicians have seen a change. This makes TB harder to diagnose. In Bangui, Central African Republic, 30% of pulmonary TB patients were HIV seropositive. Studies from Zaire and Zambia also had patients with suspected TB and extrapulmonary TB with higher HIV seropositivity rates than those with sputum-positive TB. Haitians show a similar disease pattern to that of Africa. 70% of people with tuberculosis and the acquired immunodeficiency syndrome (AIDS) had extrapulmonary disease compared with 20% of the HIV-negative people with TB. Chemotherapy of TB in Africans who also have HIV infection is not certain. Clinical impressions suggest that the disease responds well to the usual therapy. However, a Central African study found that mortality 12 months after the start of the usual drug therapy was 32.5% in HIV-seropositives compared with 1.5% in HIV-seronegatives. Several countries in Africa use short-course drug therapy for smear-positive pulmonary TB. They use the usual regime for smear-negative and extrapulmonary TB. Since AIDS, there are more skin allergic reactions to the usual drug therapy. There are more severe reactions now. Thiacetazone is the drug which probably causes this reaction. BCG immunization is used to control TB in Africa. World Health Organization guidelines are to withhold BCG from HIV- seropositive people with symptoms. What about infants born to HIV- seropositive mothers?
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PMID:Tuberculosis and human immunodeficiency virus infection in developing countries. 197 Jan 1

Infectious diseases are the main cause of mortality and morbidity in developing countries. The Expanded Program on Immunization, initiated by WHO in 1974, now reaches 60 million a year at a cost of less than 2 US$/immunized child, and saved 2.2 million lives annually. The currently available vaccines, however, have significant shortcomings. Measles vaccine is given too late to prevent the large number of deaths occurring in the 1st year of life. Attentuated polio vaccine has to be given 3 times and inherits the risk of vaccine palsy and reversion to virulence. Tetanus vaccine given to children does not prevent neonatal tetanus, the main cause of tetanus mortality. BCG does not control the spread of tuberculosis. Vaccines given parenterally involve some risk of HIV spread, and some potentially useful vaccines are too expensive for developing countries. By only modest investments, modern gene technology could provide improved and new vaccines which would potentially save 20 million lives/year. Particularly promising is the recent development of multivaccine vectors. However, poor prospects for profit in developing countries and patent swapping by commercial producers severely hamper development in the vaccine field. (author's)
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PMID:[Vaccines and developing countries]. 204 82

The diagnostic and therapeutic implications of human immunodeficiency virus (HIV) infection and tuberculosis in South Africa, where tuberculosis remains a major health problem, are reviewed. Mycobacterium tuberculosis is a high-grade pathogen and is able to establish infection early in immunodeficiency. With HIV infection showing significant entry into the heterosexual population in the RSA, an increasing number of cases with both infections can be expected to occur. The radiological appearance in combined infection is variable, ranging from a formal cavitatory picture to the more common finding of diffuse pulmonary infiltration. Intrathoracic adenopathy is a more specific sign of tuberculosis in HIV infection, since it is not associated with persistent generalised lymphadenopathy and pulmonary opportunistic infections, such as Pneumocystis carinii pneumonia. Intercurrent pneumonic infections and other pulmonary manifestations of HIV disease render the interpretation of new infiltrates on chest radiography problematical. Tuberculin skin testing remains useful in HIV infection and should be performed in all HIV-infected patients. The value of tuberculosis serology still remains questionable. Standard antituberculosis drug regimens are effective, but maintenance treatment must be continued for life and should include isoniazid and rifampicin. BCG vaccination is recommended routinely at birth in infants with HIV infection and for asymptomatic HIV-infected individuals who have not previously been immunised.
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PMID:AIDS and tuberculosis. 223 87

Current experience with the safety and efficacy of vaccines in infected children and adults is reviewed to examine the basis for decisions about routine immunisations of children infected with the human immunodeficiency virus (HIV). No adverse reactions to inactivated vaccines have been noted, but complications with live vaccines have been recorded with both BCG and smallpox. Limited experience with live poliomyelitis and measles vaccines in HIV-infected children has not yet shown any severe complications from these vaccines. Theoretical concerns that immunisation might accelerate the course of HIV infection are not supported by available data. Serological response to most inactivated and live vaccines is reduced in HIV-infected persons, and is related to the degree of immunosuppression present. Preliminary evidence suggests that the severity of some vaccine-preventable diseases is increased in HIV-infected children. This review finds general support for recommendations on immunisation of HIV-infected children that have been developed by the World Health Organisation.
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PMID:Human immunodeficiency virus infection and routine childhood immunisation. 288 50

Some significant studies reported in the world literature which provide a scientific basis for immunization policy for those children known to be infected with human immunodeficiency virus (HIV) are reviewed. The review covers current experience with immunization of children infected with HIV along with relevant data on immunization of HIV-infected adults and in vitro studies with vaccine antigens and HIV-infected cells. Live vaccines have been contraindicated in children with immunodeficiency diseases because of the potential for disseminated infection with either the viral or bacterial vaccine strain. The assessment of a similar risk in HIV-infected children is complicated by the fact that it is not always known whether HIV-infected children actually are immunodeficient when immunized. Generally, inactivated vaccines are not considered to present a risk to immunodeficient children, but questions have been raised regarding the potential for any immunization to accelerate the course of HIV infection. Consequently, the safety of inactivated vaccines must be considered also. Local reactions and disseminated disease have been describe in HIV-infected individuals. The rate of dissemination of BCG cannot be determined from the available case reports, but they suggest the possibility of an increased risk for this otherwise unusual complication of BCG immunization. Limited data suggest that live measles vaccine doses not cause severe complications in children with HIV infection. Both reports from the US and Europe have failed to document adverse reactions to either live oral or inactivated polio vaccines. No side effects of DPT vaccine were noted in 2 published reports from Europe and the US. Available data on immunogenicity in children and adults show that both primary and secondary antibody responses to immunization are attenuted in the presence of HIV infection. This is particularly the case when immunodeficiency is present. It has been difficult to assess vaccine efficacy in HIV-infected children from industrialized nations due to the relatively low incidence of both vaccine-preventable disease and HIV infection. Only preliminary studies on vaccine efficacy are available from developing nations. This review offers some general support for the recommendations on immunizations of HIV-infected children that were developed by the World Health Organization and the Advisory Committee on Immunization Practices of the US Public Health service. For asymptomatic HIV-infected children, both groups recommend continued administration of standard vaccines. For symptomatic HIV-infected children, both groups recommend continued administration of inactivated vaccines but differ in their recommendations on live vaccines.
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PMID:HIV infection and routine childhood immunization: a review. 332 88

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

CTL responses are known to be important for the control of HIV and SIV infections. Such responses are targeted against various components of these viruses including regulatory proteins like Nef. The SIVmac251nef gene was cloned in Mycobacterium bovis BCG under the control of P(AN), a promoter from Mycobacterium paratuberculosis. Nef was expressed as a fused polypeptide with ORF2, an open reading frame adjacent to P(AN). Mice inoculated with rBCG(SIVmac251nef) exhibited proliferative and CD8+ cytotoxic T-cell (CTL) responses against several Nef synthetic peptides. A mapping of the epitopes recognized by CTLs revealed that the central region of Nef is mainly involved in responses. This region had already been demonstrated to induce CTLs in experimentally SIV-infected macaques as well as in HIV-infected individuals. These results demonstrate the feasibility of constructing BCG vaccine strains expressing nef for eliciting cytotoxic responses.
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PMID:Recombinant BCG strains expressing the SIVmac251nef gene induce proliferative and CTL responses against nef synthetic peptides in mice. 754 15

Incidence rates of leprosy seem to be falling in most countries around the world, despite the HIV epidemic. Among the reasons for the declining rates are changing socioeconomic conditions and high BCG vaccination coverage. The numbers of people disabled by leprosy, however, are more important than incidence rates of leprosy per se. The issue of the disabled will remain a public health problem for many decades to come.
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PMID:Leprosy. The beginning of an end to a public health problem? 755 1


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