Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: 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)

A follow-up study was done in Bissau on 113 HIV-2 seropositive patients and 97 HIV-2 seronegative patients 3-15 months after hospitalization. Follow-up totalled 63.5 person years for seropositive patients and 62 for seronegative patients. The mortality during the follow-up period was 43.3% among the seropositive patients (rate 72/100 person years; p.y.) and 25.8% among the seronegative patients (40/100 p. y.). Among 25 HIV-2 associated AIDS cases the mortality was 80% (rate 117/100 p. y.). The median survival time for the AIDS patients was 8 months. Among 48 HIV-2 seropositive patients who lacked signs or symptoms included in the WHO case definition for AIDS at the time of hospitalization 6 patients (12.5%) developed AIDS related symptoms (ARS) during altogether 31.5 person years of follow-up (rate 19/100 p. y.). Tuberculin anergy was demonstrated in 83.3% (15/18) of HIV-2 seropositive patients with AIDS or ARS, in 14.3% (6/42) of seropositive patients without HIV-related symptoms and in 6.9% (5/72) of seronegative patients. A low CD4 T-lymphocyte count in combination with a low CD4/CD8 T-cell ratio was found significantly more often in HIV-2 seropositive patients with AIDS or ARS (62.5%, 10/16) than in HIV-2 seropositive patients without HIV associated symptoms (6.9%, 2/29) or in seronegative patients (2.7%, 1/37). Thus the mortality among recently hospitalized HIV-2 seropositive patients was high and a high proportion of seropositive patients with HIV-related symptoms had evidence of immunodeficiency.
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PMID:Clinical and immunological follow-up of previously hospitalized HIV-2 seropositive patients in Bissau, Guinea-Bissau. 128 6

Individuals who are infected with human immunodeficiency virus (HIV) are at high risk of developing tuberculosis, probably due to the reactivation of latent infection associated with HIV-induced immunosuppression. Tuberculin skin test is the best diagnostic means to assess a previous tuberculous infection, but this test may be falsely negative in HIV seropositive subjects. To assess the validity of a non-reactive tuberculin skin test in asymptomatic HIV seropositive subject, we performed Mantoux test 5 TU, chest x-ray, HIV serologic tests on 141 asymptomatic prisoners. Determination of lymphocyte subsets in HIV seropositive carriers had already been performed. Chest x-ray film showed no pleuro-pulmonary lesion in any subject. We found 101 HIV seronegative subjects (89 men and 12 women; 30 +/- 6 yrs with 18-39 range; 34 Mantoux reactive and 67 non-reactive) and 40 HIV seropositive individuals (30 men and 10 women; 29 +/- 6 yrs with 21-39 range; 7 Mantoux reactive and 33 non-reactive). By subdividing HIV seropositive subjects in two groups (reactive and non-reactive to tuberculin test) a significant decrease of CD 4 lymphocytes and CD 4/CD 8 ratio was found in HIV seropositive/Mantoux non-reactive group, without changes in total lymphocytes and CD 8 subset. We conclude that: 1) a non-reactive tuberculin skin test cannot be confidently explained in asymptomatic HIV seropositive subjects with a T helper lymphocyte count decrease; 2) T helper cells are important to keep alive delayed hypersensitivity reaction.
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PMID:[Mantoux intradermal reaction and lymphocyte populations in asymptomatic HIV-seropositive subjects]. 198 96

Tuberculin skin testing is a notoriously poor marker of tuberculosis infection in patients who are serologically positive for the human immunodeficiency virus. A decision analysis was performed to determine if and when isoniazid should be prescribed to prevent tuberculosis in these patients. The decision was analyzed for an intravenous drug abuser who may have been anergic, while tuberculin test status, race, and gender were varied. The assumptions and parameter estimates selected for this investigation represent a highly conservative vantage point opposing the use of isoniazid as a preventive therapy. Nevertheless, results showed a benefit from the use of isoniazid as a preventive therapy for all groups, even without tuberculin testing, except tuberculin-negative black women. This benefit of isoniazid therapy increased patient life expectancy as much as 285 days. Further, the decisions continue to favor prescribing isoniazid even when the suspected incidence of tuberculosis infection falls as low as 3% to 8%. Tuberculin testing appears important primarily for black women, since those who have negative tuberculin skin tests may not be candidates for isoniazid therapy.
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PMID:Isoniazid as preventive therapy in HIV-infected intravenous drug abusers. A decision analysis. 203 71

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

Because of the abnormalities of host defenses caused by the human immunodeficiency virus (HIV), persons with HIV infection are vulnerable to tuberculosis. Inferential data from several parts of the country indicate increases in tuberculosis case rates, probably occurring in patients with HIV infection. In a person infected with both HIV and Mycobacterium tuberculosis, attack rates of tuberculosis seem to be very high. In general, the disease tends to occur earlier in the course of HIV infection than other opportunistic processes that serve to define the acquired immunodeficiency syndrome (AIDS), presumably because M tuberculosis is more pathogenic than Pneumocystis carinii or Mycobacterium avium complex, for example. The clinical features of tuberculosis in this patient population seem to vary depending on the stage of the HIV infection. Late in the process, tuberculosis usually has atypical features with chest films showing diffuse infiltration, no cavities, and intrathoracic adenopathy. Tuberculin skin tests commonly are negative. At earlier stages of HIV infection, the clinical findings are similar to those in HIV-seronegative persons. Response to treatment is generally good; however, it is recommended that the standard duration be at least 9 months, using isoniazid and rifampin usually supplemented by pyrazinamide in the first 2 months. The use of isoniazid for preventive therapy is recommended for all HIV-seropositive persons who have tuberculin skin test reactions greater than or equal to 5 minutes. Those implementing infection-control measures for HIV-infected patients who have pulmonary findings should take tuberculosis into account until the disease is excluded. Medical personnel providing care for patients with tuberculosis should use universal blood and body substance precautions because of the possibility of undetected HIV infection in patients with tuberculosis.
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PMID:Tuberculosis and human immunodeficiency virus infection. 266 35

Tuberculin skin testing is a reliable tool for the detection of tuberculous infection and the eventual prevention of tuberculous disease. False-negative tests may occur in individuals with a compromised immune system, including those with human immunodeficiency virus (HIV) infection, persons taking immunosuppressive drugs (eg. corticosteroids), the severely malnourished, and the elderly. Nevertheless, it still is useful in detecting infection in those persons who are in close contact with patients with tuberculous disease, including family members, hospital personnel, and those from high risk areas. Once a skin test is found to be reactive, further diagnostic studies should be done to rule out tuberculous disease. Once ruled out, preventive therapy with isoniazid should be instituted. Suitable candidates for prophylaxis include all individuals with reactive tuberculin skin tests who are (1) household contacts of patients with tuberculous disease, (2) recent tuberculin test convertors, (3) individuals with prior tuberculosis (TB) who did not receive adequate chemotherapy, (4) all individuals under the age of 35, and (5) individuals in special clinical circumstances who are over the age of 35. Newer, shorter course regimens are currently being studied. TB cannot be eliminated until the importance of preventive therapy is recognized by all.
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PMID:Tuberculosis skin testing and preventive therapy. 268 1

To determine the risk of active tuberculosis associated with human immunodeficiency virus (HIV) infection, we prospectively studied 520 intravenous drug users enrolled in a methadone-maintenance program. Tuberculin skin testing and testing for HIV antibody were performed in all subjects. Forty-nine of 217 HIV-seropositive subjects (23 percent) and 62 of 303 HIV-seronegative subjects (20 percent) had a positive response to skin testing with purified protein derivative (PPD) tuberculin before entry into the study. The rates of conversion from a negative to a positive PPD test were similar for seropositive subjects (15 of 131; 11 percent) and seronegative subjects (26 of 202; 13 percent) who were retested during the follow-up period (mean, 22 months). Active tuberculosis developed in eight of the HIV-seropositive subjects (4 percent) and none of the seronegative subjects during the study period (P less than 0.002). Seven of the eight cases of tuberculosis occurred in HIV-seropositive subjects with a prior positive PPD test (7.9 cases per 100 person-years, as compared with 0.3 case per 100 person-years among seropositive subjects without a prior positive PPD test; rate ratio, 24.0; P less than 0.0001). We conclude that, although the prevalence and incidence of tuberculous infection were similar for both HIV-seropositive and HIV-seronegative intravenous drug users, the risk of active tuberculosis was elevated only for seropositive subjects. These data also suggest that in HIV-infected persons tuberculosis most often results from the reactivation of latent tuberculous infection; our results lend support to recommendations for the aggressive use of chemoprophylaxis against tuberculosis in patients with HIV infection and a positive PPD test.
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PMID:A prospective study of the risk of tuberculosis among intravenous drug users with human immunodeficiency virus infection. 279 92

We tested 403 clients at an inner-city methadone clinic to determine the rate of positive tuberculin test reactions and to determine how this rate was influenced by race, gender, and infection with the human immunodeficiency virus (HIV). In addition to skin testing, an experimental urine test for antibody to HIV was offered; 73% of the clients provided urine specimens. Positive urine test results were confirmed by serum antibody testing. Of the subjects who returned for follow-up, 33.9% had indurations > or = 10 mm; 49.7% of these subjects were Black, 30% were Hispanic, and 18% were White. Antibodies to HIV were present in 12.5% of urine specimens. Tuberculin reactions of > or = 5 mm were observed for 32.7% of HIV-positive subjects and 48.4% of HIV-negative subjects. Screening of urine for antibodies to HIV proved to be simple, specific, and well accepted by the subjects. Providing prophylaxis for tuberculosis should be a high priority in populations with rates of tuberculin reactions and HIV infection that are comparable to those for clients of our methadone clinic.
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PMID:Tuberculin reactions among attendees at a methadone clinic: relation to infection with the human immunodeficiency virus. 788 40

Human immunodeficiency virus causes an immunological 'state of anergy'. This state is due to a defective function of antigen-presenting cells, a depletion of CD4+ helper cells, a reduction in the production of soluble factors required for signal transduction, and a decrease in cytotoxic cell activation. The human immunodeficiency virus epidemic has resulted in a global resurgence of tuberculosis. Tuberculin skin testing is negative in 58% of the patients with acquired immunodeficiency syndrome who develop tuberculosis. The mechanism leading to a state of anergy and the mechanism leading to dissemination of dormant tuberculosis appear to be identical.
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PMID:Anergy, AIDS and tuberculosis. 874 82

Discrepancies have been reported between results obtained with tuberculin skin tests (TSTs) performed with use of different reagents. We compared TST results and determined the sensitivities of the two commercially available TSTs in 51 human immunodeficiency virus-negative persons with culture-confirmed active tuberculosis. Simultaneous TSTs were done with use of the Mantoux method and 5-tuberculin unit purified protein derivative (PPD) tuberculin preparations from single lots of Aplisol and Tubersol. Aplisol skin test reactions ranged from 5 mm to 26 mm (median, 16.0 mm), and Tubersol reactions ranged from 7 mm to 23 mm (median, 15.0 mm). The mean difference in paired reaction sizes for the two reagents was 0.58 mm and was not statistically different from zero (P value, 0.26). The difference in reaction sizes was < or =2 mm in 55% and > or =5 mm in 18% of patients. With a cutoff of either 5 mm or 10 mm to define a positive reaction, all results were concordant, with sensitivity of 100% and 96%, respectively. We found indistinguishable reaction size distributions and median TST results for the two commercially available PPD TST reagents, Aplisol and Tubersol, in a population with recent culture-proven tuberculosis.
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PMID:Comparison of sensitivities to two commercially available tuberculin skin test reagents in persons with recent tuberculosis. 970 3


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