Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Human immunodeficiency virus (HIV) infection is associated to different clinical and laboratory hemostatic alterations. The most important is thrombocytopenia, which very often leads to a picture indistinguishable from idiopathic thrombocytopenic purpura with poor clinical relevance but with possible important problems of differential diagnosis. Thrombotic thrombocytopenic purpura is sometimes associated to HIV infections, although only few reports there exist. Finally, the high incidence of lupus anticoagulant in some phases of HIV infection has not a clinical relevance, but is essentially a laboratory finding which is to be known because it can cause a prolonged partial thromboplastin time.
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PMID:Hemostatic alterations during human immunodeficiency virus infection: a review. 267 75

Thrombocytopenia (TC) is noted in three to nine percent of patients who are seropositive for human immunodeficiency virus (HIV). Causes of this may be immune, infectious, platelet destruction, or underproduction. Thrombocytopenia associated with HIV will be seen with increasing frequency. Corticosteroids and splenectomy are the usual therapeutic approaches. Intravenous gammaglobulin and antiviral agents may be indicated and useful in some patients.
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PMID:Thrombocytopenia: proposed mechanisms and treatment in human immunodeficiency virus infection. 267 49

We report on two patients with acute human immunodeficiency virus (HIV) infection, who developed an infectious mononucleosis-like clinical episode with thrombocytopenia and granulocytopenia. In both cases we detected the presence of IgG antigranulocyte antibodies and in one case the presence of IgG, IgM and IgA antiplatelet antibodies. The mechanisms of these cytopenias are discussed. The association between such autoimmune cytopenias and acute HIV infection has not been previously reported. We suggest testing for HIV seroconversion in patients with a seronegative infectious mononucleosis-like syndrome belonging to groups with a high risk for HIV infection.
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PMID:Autoimmune neutropenia and thrombocytopenia associated with development of antibodies to human immunodeficiency virus. 270 31

Idiopathic thrombocytopenia purpura (ITP) is a primary immune thrombocytopenia that is typically manifested in adults by acute bleeding, severe thrombocytopenia, and normal to increased megakaryocytes in the bone marrow. Labeling studies suggest that most patients with ITP have an IgG antibody directed against the platelet membrane resulting in sequestration in the spleen. Splenectomy and/or corticosteroids remain the mainstay of therapy, with permanent remissions induced in 75% of patients. Despite the use of cyclophosphamide, azathioprine, vincristine, high-dose gamma globulin, and other forms of therapy, less than 50% of refractory patients achieve long-term satisfactory platelet counts. In view of these facts, ten consecutive patients with immune thrombocytopenia, unrelated to human immunodeficiency virus (HIV), received plasma perfusion over a staphylococcal protein A column (PROSORBA column) to evaluate efficacy and toxicity. All patients had an initial platelet count less than 50,000 and had failed corticosteroids. Five patients had also failed splenectomy. Two patients were not splenectomized due to pediatric age, two due to severe coexisting medical conditions, and one due to refusal of operation. Multiple other forms of therapy had also failed in this cohort of patients. Patients received two to ten treatments with the protein A column. All patients are evaluable for response and toxicities. Of the ten patients, results were as follows: complete response in one (platelet count greater than 150,000); partial response in four (platelet count greater than 50,000 and less than 150,000); and no response in five. Duration of responses ranged from 1 to 6 or more months.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Immune thrombocytopenia purpura: a pilot study of staphylococcal protein A immunomodulation in refractory patients. 272 21

The pathogenesis of thrombocytopenia associated with human immunodeficiency virus (HIV) infection is not fully understood. Immune mechanisms provide a partial explanation but fail to account for a lack of compensatory megakaryocytosis, the rapid reversal after treatment with azidothymidine, and the ultrastructural aberrations seen in the megakaryocytes of patients with acquired immunodeficiency syndrome. Therefore, a direct effect of HIV on megakaryocytes was investigated. The bone marrow of HIV seropositive individuals was analyzed ultrastructurally, and the megakaryocytes of 10 thrombocytopenic patients were subjected to in situ hybridization with a HIV RNA probe. The structural aberrations in HIV megakaryocytes were distinct from those in HIV-negative immune thrombocytopenias, and the megakaryocytes of 10 of 10 patients examined by in situ hybridization unambiguously expressed viral RNA. Therefore, it is likely that direct infection of megakaryocytes with HIV-1 is one mechanism for the decrease in platelet production.
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PMID:Megakaryocytes of human immunodeficiency virus-infected individuals express viral RNA. 274 5

Tests for anticardiolipin antibodies (ACL) on sera from 100 male homosexuals and 60 male heterosexuals showed that 57% of the homosexuals, in contrast to none of the heterosexuals, were ACL positive. The ACL were predominantly of the immunoglobulin G isotype and, in a high proportion of cases tested (82%), were reactive with other phospholipids, especially those with a negative charge. ACL were not related to the clinical status of the homosexuals, being evenly distributed among 40 with acquired immunodeficiency syndrome (AIDS), 20 with AIDS-related complex (ARC), 20 with asymptomatic infection with human immunodeficiency virus (HIV) and/or lymphadenopathy syndrome, and 20 who were HIV-antibody negative. Nor were they associated with thrombocytopenia, thrombosis, neurologic disease, a biological false-positive test for syphilis (BFP), or antibodies to DNA. It is concluded that factors other than infection with HIV are responsible for ACL positivity in homosexual males and that the epitopes recognized by ACL in this group are distinct from those associated with thromboembolism or the BFP reaction or cross-reactive with DNA.
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PMID:Anticardiolipin antibodies in homosexual men: prevalence and lack of association with human immunodeficiency virus (HIV) infection. 276 31

Immune thrombocytopenia is a well-recognized part of the clinical spectrum of infection with the human immunodeficiency virus. From November 1985 to February 1988, 15 patients who were human immunodeficiency virus-positive underwent splenectomy for refractory immune thrombocytopenia. Eight patients had thrombocytopenia only, and 7 others were pancytopenic prior to splenectomy. Three of the 15 patients fulfilled criteria for acquired immunodeficiency syndrome before splenectomy, and acquired immunodeficiency syndrome developed in 5 patients during the follow-up period. The median duration of thrombocytopenia prior to surgical therapy was 6 months. A bone marrow biopsy specimen showed hypercellularity with increased megakaryocytes. All patients had a therapeutic response to splenectomy. Long-term remission from thrombocytopenia/pancytopenia was achieved in 14 of the 15 patients during a follow-up period of 2 to 21 months. Splenectomy can be accomplished with an acceptable morbidity. Pneumonia developed postoperatively in 2 patients, but they did not manifest the characteristic picture of overwhelming postsplenectomy sepsis. They had received vaccinations against encapsulated organisms preoperatively. We conclude that splenectomy provides a durable and lasting response for HIV-related thrombocytopenia. Vaccination for Streptococcus pneumonia and Haemophilus influenzae should be given prior to splenectomy although its efficacy is not clear in this group.
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PMID:Splenectomy. The treatment of choice for human immunodeficiency virus-related immune thrombocytopenia? 278 77

We studied five patients with hemophilia A in the age range of 18 to 64 years who were infected with human immunodeficiency virus and who developed immune thrombocytopenia. The clinical course of immune thrombocytopenia in relation to human immunodeficiency virus infection and the patients' responses to splenectomy and immune variables were determined. All five patients developed antibody to human immunodeficiency virus 6 to 60 months (median, 24 months) before the onset of thrombocytopenia, and two patients became human immunodeficiency virus antigenemic (one patient at the onset of immune thrombocytopenia and the other 60 months after the onset of immune thrombocytopenia [24 months after splenectomy]). All five patients had a strong platelet-associated immunoglobulin G and three patients also had a weak platelet-associated immunoglobulin M on their platelets. In four of five patients danazol therapy failed, and three patients required moderate doses of prednisone. Because of the progression of immune thrombocytopenia, four of the five patients underwent splenectomy with preoperative high-dose intravenous immune globulin. All four had an excellent immediate response to splenectomy, with a rise in platelet count to more than 300 x 10(9)/L and sustained remission during postsplenectomy follow-up of 6 to 45 months. There was no significant drop in CD4 and CD8 counts after splenectomy, and all four patients remained clinically well.
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PMID:Immune thrombocytopenia in hemophiliacs infected with human immunodeficiency virus and their response to splenectomy. 278 46

Bone marrow examinations were performed on 20 patients with acquired immune deficiency syndrome (AIDS) and 39 with AIDS-related complex (ARC). Fever of unknown origin and thrombocytopenia were common in ARC, but anemia and leukopenia were most frequent in AIDS. Changes in stromal cells and perivascular cuffing of plasma cells were found significantly more often in patients with AIDS than in those with ARC. Malignancies were common in both groups. Human immunodeficiency virus (HIV) nucleic acids were detected with the use of a 3H-labeled cDNA probe with an in situ hybridization method in 11 bone marrow samples (three ARC and eight AIDS). Most commonly positive cells were mononucleated, resembling lymphocytes and histiocytes. Endothelial cells, interdigitating reticulum cells, nucleated red blood cells, and immature myeloid cells also had positive results in some instances. The number of HIV-positive cells was not related to the size of the bone biopsies or the clinical diagnoses. The authors postulate that changes in the peripheral blood and bone marrow of these patients may be related to latent persistent infection with HIV.
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PMID:Bone marrow examination in patients with AIDS and AIDS-related complex (ARC). Morphologic and in situ hybridization studies. 281 12

To establish the indications for splenectomy in patients with human immunodeficiency virus (HIV) infection we retrospectively analyzed 12 patients who underwent splenectomy. Patients with HIV infection who had immune thrombocytopenic purpura (ITP) were excluded as they had no splenomegaly and a definite indication for splenectomy exists in some of these patients. All 12 patients were anemic; 6 were thrombocytopenic and 6 leukopenic. All patients had splenomegaly and all were febrile. At surgery 3 patients were found to have Mycobacterium avium intracellulare (MAI) infection; 2 had splenic abscess due to Salmonella group D; 1 each had cytomegalovirus (CMV) splenitis and localized Kaposi's sarcoma (KS) of the spleen. No definite histopathologic diagnosis could be made in five patients, all of whom had evidence of extramedullary hematopoiesis. The degree of splenic enlargement did not correlate with the outcome. Both clinical and hematologic improvements were achieved in patients with splenic abscess and in patients who had splenomegaly, anemia, and thrombocytopenia. The presence of either of these findings constitutes an indication for splenectomy. Anemia and/or leukopenia without thrombocytopenia failed to improve; the presence of MAI and active CMV infection also resulted in failure. The presence of either of these conditions may be considered a contraindication to splenectomy.
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PMID:Splenectomy in patients with AIDS. 281 11


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