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

To confirm the presence of cardiac dysfunction in a group of patients seropositive for the human immunodeficiency virus with either dyspnea on exertion or a reduced anaerobic threshold, 9 patients with no history of opportunistic infection underwent exercise right-sided heart catheterization. When compared with 13 control patients previously exercised in the same manner, the patients showed elevated exercise pulmonary capillary wedge pressure (14.6 +/- 3.3 mm of mercury versus 9.9 +/- 3.3 mm of mercury; P less than .005) and right atrial pressure (10.1 +/- 2.1 mm of mercury versus 4.7 +/- 3.2 mm of mercury; P less than .001) at a similar exercise oxygen consumption and cardiac index. Of the 9 patients, 8 had at least 1 catheterization value outside the 95% confidence limits for the control group and 4 patients had multiple abnormalities. Values for blood CD4 lymphocytes were 0.2 x 10(9) per liter or more for 7 of the 9. One patient underwent endomyocardial biopsy with findings consistent with a cardiomyopathy. We conclude that cardiac disease may occur at any immunologic stage of human immunodeficiency virus infection. These observations suggest an effect of this disease on the heart.
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PMID:Cardiac dysfunction in patients seropositive for the human immunodeficiency virus. 177 74

The discovery of decreased plasma cysteine and cystine levels and elevated plasma glutamate levels in HIV-infected patients has led to intense investigations into the role of cysteine in T cell-mediated immune responses. A large body of evidence indicates that certain aspects of the T cell response require the action of active oxygen derivatives while other aspects of the response require the action of antioxidants such as cysteine and glutathione (GSH). The prooxidant and antioxidant states may be required sequentially at different times during T cell activation. The extremely weak cystine transport activity of T cells together with oxidizing metabolites from inflammatory microenvironments appear to be important factors that support the prooxidant state. The relatively high cystine transport activity of the antigen-presenting macrophages, in contrast, provides these cells with a "cysteine pumping" function that allows the antigen binding T cells in their vicinity to shift to the antioxidant state. The difference between the membrane transport activities for cysteine of T cells and macrophages thus appears to be the key element of a mechanism that facilitates both, the prooxidant state of T cells and their regulated shift to the antioxidant state. When T cells do not receive sufficient amounts of cysteine, the intracellular GSH levels and rates of DNA synthesis activity decrease, and the cells may suffer from various manifestations of oxidative damage.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Requirement for prooxidant and antioxidant states in T cell mediated immune responses.--Relevance for the pathogenetic mechanisms of AIDS? 179 89

Arterial oxygen saturation (SaO2) was monitored continuously during and immediately after sputum induction in 41 HIV positive patients with respiratory symptoms and in 20 symptomless medical and nursing staff, who acted as control subjects. Arterial oxygen desaturation (defined as SaO2 less than or equal to 92%) occurred during sputum induction and persisted for up to 20 minutes after the end of the procedure in 11 of the 20 patients with Pneumocystis carinii pneumonia and in nine of the 21 patients with other respiratory diagnoses. None of the control subjects showed oxygen desaturation. Neither the severity of chest radiographic abnormalities, the alveolar-arterial oxygen gradient (both measured before sputum induction), nor baseline SaO2 prospectively identified the patients who developed oxygen desaturation. Two patients, one with pneumocystis pneumonia, developed dyspnoea and had a fall in arterial oxygen saturation to 84% within 10 minutes of starting sputum induction. The procedure was abandoned in both patients and in two further patients, who developed severe nausea and reaching but no oxygen desaturation. Sputum induction in HIV positive patients with respiratory symptoms may induce a fall in SaO2 that persists after this procedure. This may be important if other procedures are performed soon after sputum induction.
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PMID:Arterial desaturation in HIV positive patients undergoing sputum induction. 185 86

The object of investigation is to illustrate the values of two noninvasive procedures: the induced sputum test and the exercise test in the diagnosis of Pneumocystis carinii pneumonia (PCP). Both of the procedures are described. Fifty HIV-positive men in whom interstitial pneumonia was suspected participated. PCP was diagnosed in 16 patients, in ten of these by the induced sputum test, the sensitivity of which is, therefore, 35-85% (95% confidence limits). The exercise test, an investigation for demonstration of exercise induced oxygen desaturation, was of good predictive value. Thus, seven out of nine patients with positive exercise test results had PCP as compared with two out of 19 with normal exercise test results, p = 0.0009. The sensitivity was thus 40-97%. In five out of the six patients with false negative results to the induced sputum test, the exercise test was performed and was positive in all of the case. The method is rapid and simple and merely requires access to an exercycle and a pulse-oxymeter preferably with a recorder. It is concluded that the exercise test and the induced sputum test are valuable investigations which supplement one another in cases of suspected PCP and which avoid the need for bronchoscopy in 53-80% of the patients.
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PMID:[Diagnosis of Pneumocystis carinii pneumonia in HIV-positive patients. The diagnostic value of induced sputum and exercise test]. 186 66

Physicians at a district general hospital in London, England admitted a 26 year old pregnant political refugee from Uganda complaining of shortness of breath, fever, and a productive cough for 1 week. She was at 10 weeks gestation and had not yet sought prenatal care. 6 years earlier she had a child and her pregnancy and delivery were normal. They diagnosed an interstitial pneumonia based on an X ray, arterial gases, and quick breathing and administered intravenous (IV) ampicillin and erythromycin for 3 days. Her condition deteriorated nevertheless, so they had her blood tested for HIV. She tested positive and suspected pneumocystosis (later confirmed) and began treatment with IV Septrin and hydrocortisone. She worsened, and by the 10th day of this treatment she was receiving 60% oxygen. They changed her treatment to IV pentamidine and oral rifampicin and isoniazid. By this time, her white blood cell count was 28.7x109/1 and hemoglobin concentration 8.2g/dl. Her condition would not allow her to undergo general anesthesia so an abortion requested by the patient was not performed. Additional treatment included continuous infusion of eflornithine, but she died despite it. This case poses 2 questions. Could she have lived if there had not been a delay in HIV diagnosis? Research shows that CD4 lymphocytes cell counts fall considerably during pregnancy in HIV positive women. So some advocate prophylaxis earlier in these women than other immunocompromised patients. Was it indeed her pregnancy that contributed to the severity of her illness and its inability to respond to treatment? Some researchers find pregnancy accelerates the progress of HIV infection, but researchers do not yet know if it also accelerates the progress of opportunistic infections. If so, terminating pregnancy may be considered.
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PMID:A maternal death caused by AIDS. Case report. 188 2

The value of continuous positive airway pressure (CPAP) ventilation via a tight fitting face mask was assessed in eight HIV-1 antibody-positive patients with Pneumocystis carinii pneumonia who were in hypoxaemic respiratory failure. All patients were conscious, able to protect their airway and not hypercapnic. Treatment was effective in seven patients. Prior to CPAP, mean (range) arterial oxygen tension was 6.7 (4.7-10.5) kPa in seven patients breathing oxygen via a face mask (FiO2 = 0.6), 6.1 kPa in one patient breathing room air and rose to 9.9 (6.8-12.8) kPa with CPAP (FiO2 = 0.6 and PEEP = 1.3 kPa in six patients and 2.6 kPa in one patient); the mean increase in PaO2 was 3.1 kPa (P less than 0.02). These seven patients experienced a rapid reduction in dyspnoea and their respiratory rate fell from a mean of 40 breaths min-1 to 32 breaths min-1 (P less than 0.001). One patient deteriorated rapidly on CPAP and died: no other complications were seen with this technique. CPAP was continued for a mean of 4.5 days and the seven responders all survived the episode of P. carinii pneumonia. We conclude that mask CPAP provides an effective means of improving oxygenation in severely hypoxaemic patients with P. carinii pneumonia.
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PMID:Continuous positive airway pressure ventilation for respiratory failure associated with Pneumocystis carinii pneumonia. 188 30

The effects of oxygen deprivation, or anoxia, on human immunodeficiency virus (HIV-1) expression in chronically (ACH.2) and acutely (H9/HIV-1-IIIB) infected cell lines was investigated. Temporary cellular anoxia has previously been shown to activate transcription of endogenous type C leukemia virus sequences, resulting in a significant increase in retroviral RNA within the cell (1). Here we report a 15-fold increase in HIV-1-specific RNA in unstimulated ACH.2 T cells within 24 h of anoxia. This induction of RNA is accompanied by an accumulation of intracellular p24 gag protein as well as an increase in envelope protein. Anoxia induces a further increase in total HIV-1 RNA in ACH.2 cells prestimulated to produce virus by phorbol 12-myristate 13-acetate and in H9 T cells acutely infected with HIV-1-IIIB. The induction of RNA in ACH.2 cells appears to be reversible. Anoxic culture for 24 h followed by a 24-h re-oxygenation period results in a return to "resting state" levels of HIV-1 RNA. These data indicate that oxygen tension within the cellular environment modulates HIV-1 expression, providing a model system in which to study the reversible regulation of HIV-1 RNA and viral gene products within the cell.
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PMID:Anoxia induces human immunodeficiency virus expression in infected T cell lines. 190 63

In the first paper of this series a new structure with anti-HIV-1 activity was disclosed and analogues were synthesized to explore the structure-activity relationship of changes in the substituent (R) attached at the N-6 position of 9. This study describes the syntheses and anti-HIV-1 testing of analogues with variations of the five-membered urea ring of the 4,5,6,7-tetrahydro-5-methylimidazo[4,5,1-jk] [1,4]benzodiazepin-2(1H)-one (TIBO) structures. Although many different rings were synthesized to replace the cyclic urea of TIBO, most were found to be inactive in inhibiting the replication of the HIV-1 virus in MT-4 cells. The exceptions were replacement of the urea oxygen with sulfur or selenium to give the corresponding thio- or selenoureas. These were found to be more active than the oxygen counterparts. A small series of analogues was synthesized and tested which allowed direct comparison of urea and thiourea derivatives. Without exception, the latter were always more active than the former. The most active compound of this series (8d) was found to inhibit the HIV-1 virus with an IC50 of 0.012 microM which is comparable to that of AZT.
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PMID:Synthesis and anti-HIV-1 activity of 4,5,6,7-tetrahydro-5-methylimidazo[4,5,1-jk][1,4]benzodiazepin-2(1H)-on e (TIBO) derivatives. 2. 195 37

Severe pulmonary hypertension presenting as acute cor pulmonare was observed in a HIV positive heroin addict. The usual aetiological investigations were negative. The apparently primary pulmonary hypertension was resistant oxygen and vasodilator therapy and was fatal in 6 months. Anatomopathological examination revealed the presence of talc microemboli in the pulmonary arterioles, severe medial hypertrophy and fibrous subendothelial thickening. The presence of the talc suggests that the pulmonary hypertension in this case was due to obstruction of the pulmonary vascular bed by the obstructive arterial lesions, despite the context of HIV infection.
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PMID:[Pulmonary hypertension secondary to talc microemboli in a HIV seropositive heroin-addict woman]. 195 22

Lymphocytic interstitial pneumonia is at present a pathologic diagnosis. In the setting of a chronic interstitial pneumonia in a child with lymphocytosis, hyperglobulinemia, and lymphadenopathy or parotid enlargement, the diagnosis is often clinically presumed. At present the diagnosis can be established firmly only by lung biopsy. Models of pathogenesis include nonspecific stimulation of the immune system, HIV-specific stimulation, or synergy between EBV and HIV. Treatment includes oxygen and bronchodilators as needed. The role of zidovudine and of steroids in the management of LIP remains to be determined.
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PMID:Lymphocytic interstitial pneumonia. 198 20


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