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Immunodeficiency Virus (immunodeficiency + virus)
Kinds of Immunodeficiency Virus Terms modified by Immunodeficiency Virus Selected AbstractsOrbital sarcoma in HIV positive patient: A diagnostic dilemmaDIAGNOSTIC CYTOPATHOLOGY, Issue 1 2010D.N.B., Nalini Gupta M.D. Abstract Diagnosis of a high-grade sarcoma on fine needle aspiration cytology (FNAC) may not pose any difficulty; however, further sub-typing is sometimes difficult. The clinical data, investigations, and finer points on cytomorphology may help for proper categorization of the tumor, however, we encountered a case of orbital sarcoma in an Human Immunodeficiency Virus (HIV) positive patient, in which further sub-typing was difficult even on histopathology and immunohistochemistry was helpful. The diagnostic difficulties on FNA cytology smears as well as histopathology are highlighted. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source] A preliminary investigation of dental disease in children with HIV infectionINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 1 2000M. Gelbier Objective. To establish the levels of dental caries and gingivitis in a group of HIV-positive children. Study group. The study group comprised 35 children with the Human Immunodeficiency Virus attending The Great Ormond Street Hospital For Children. Outcome measures. Outcome measures included the number of decayed, missing and filled teeth and surfaces in both the primary and permanent dentitions; plaque and gingivitis scores. Results. The children included 18 boys and 17 girls. They were aged from 6 months to 18 years, with 17 aged 5 years or less and 15 aged 6 years or older. Twenty-four of the 35 children had some caries experience. The mean dmft was 4·4 and for those with permanent teeth the mean DMFT was 0·7. Mean plaque and gingivitis scores were 16·7 and 5·1 for plaque and gingivitis adjacent to primary teeth and 8·0 and 5·7 for that related to permanent teeth. Conclusions. There is a significant treatment need for children with HIV. [source] Prediction of Cardiorespiratory Fitness in Older Men Infected with the Human Immunodeficiency Virus: Clinical Factors and Value of the Six-Minute Walk DistanceJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2009Krisann K. Oursler MD OBJECTIVES: To investigate factors related to cardiorespiratory fitness in older human immunodeficiency virus (HIV)-infected patients and to explore the utility of 6-minute walk distance (6-MWD) in measuring fitness. DESIGN: Cross-sectional study in clinic-based cohort. SETTING: Veterans Affairs Medical Center, Baltimore, Maryland. PARTICIPANTS: Forty-three HIV-infected men, median age 57 (range 50,82), without recent acquired immunodeficiency syndrome,related illness and receiving antiretroviral (ARV) therapy. MEASUREMENTS: Peak oxygen utilization (VO2peak) according to treadmill graded exercise testing, 6-MWD, grip strength, quadriceps maximum voluntary isometric contraction, cross-sectional area, muscle quality, and muscle adiposity. RESULTS: There was a moderate correlation between VO2peak (mean ± SD; 18.4 ± 5.6 mL/kg per minute) and 6-MWD (514 ± 91 m) (r=0.60, P<.001). VO2peak was lower in subjects with hypertension (16%, P<.01) and moderate anemia (hemoglobin 10,13 gm/dL; 15%, P=.09) than in subjects without these conditions. CD4 cell count (median 356 cells/mL, range 20,1,401) and HIV-1 viral load (84% nondetectable) were not related to VO2peak. Among muscle parameters, only grip strength was an independent predictor of VO2peak. Estimation of VO2peak using linear regression, including age, 6-MWD, grip strength, and hypertension as independent variables, explained 61% of the variance in VO2peak. CONCLUSION: Non-AIDS-related comorbidity predicts cardiorespiratory fitness in older HIV-infected men receiving ARV therapy. The 6-MWD is a valuable measure of fitness in this patient population, but a larger study with diverse subjects is needed. [source] Changing Trends in Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome in the Population Aged 50 and OlderJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2007Sindy M. Paul MD OBJECTIVES: To alert persons in the public and private healthcare professions to the increasing trends in higher proportions of persons aged 50 and older who are newly diagnosed with human immunodeficiency virus (HIV) and who are living with HIV and acquired immunodeficiency syndrome (AIDS). DESIGN: Data from the period 1992 through 2004 from the HIV/AIDS Reporting System (HARS) were analyzed. SETTING: New Jersey is the eleventh-most-populous state, with the highest density of persons per square mile. It also has the fifth-highest number of AIDS cases. PARTICIPANTS: All persons residing in New Jersey and reported to HARS with HIV infection or who are considered to have AIDS. MEASUREMENTS: Trends in persons aged 50 and older were compared with those in the population younger than 50 during 1992 through 2004 for the numbers of persons living with HIV/AIDS and the number of persons newly diagnosed with HIV infection. RESULTS: The proportion of all persons aged 50 and older living with HIV/AIDS in 2004 was significantly greater than the comparable proportion of persons in 1992. Proportionally, more persons were newly diagnosed with HIV who were aged 50 and older according to sex and for each of the three major race or ethnicity groups (white non-Hispanic, black non-Hispanic, and Hispanic) than were persons younger than 50. Each of these increases was statistically significant. CONCLUSION: HIV/AIDS social marketing campaigns should include images and issues related to older persons in educational and prevention efforts. New methods that reach older populations should be considered. Physicians and other healthcare providers should be made aware of their role in prevention and education about HIV. Testing of older populations with risk factors should be encouraged. [source] When intimate partner violence against women and HIV collide:Challenges for healthcare assessment and interventionJOURNAL OF FORENSIC NURSING, Issue 2 2010FAAN, Kimberly Adams Tufts DNP, WHNP-BC Abstract Intimate Partner Violence (IPV) and Human Immunodeficiency Virus (HIV) both constitute major public health issues that impact the overall health of women. IPV, including sexual assault, remains a persistent public health concern that has proven to be both difficult and significantly dangerous to prevent and treat. Based on data from UNAIDS more than 14.5 million women were living with HIV by the end of 2005. IPV and HIV are often interrelated. Exposure to IPV has been associated with an increased risk for contracting HIV and women who are living with HIV may be more likely to become victims of IPV. Implications: comprehensive care and services have to be offered in the context of where women seek health care. Screening and effective intervention for IPV are essential components of HIV-related services including prevention programming, voluntary counseling and testing, and treatment. Including IPV-related services into the context of HIV-related services delivers the message that violence is not a taboo topic in the health-care setting. [source] Risk factors for oral hairy leukoplakia in HIV-infected adults of BrazilJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 6 2006Mariela Dutra Gontijo Moura Background:, Oral hairy leukoplakia (OHL) may be an indicator of the progression of Human Immunodeficiency Virus (HIV)-induced immuno-depression, and the evaluation of risk factors leading to OHL is important in the management of these HIV-infected patients. However, there are few studies that analyze risk factors leading to OHL in the Brazilian population. The aim of this case,control study is to present data about prevalence rates and risk factors leading to OHL in a sample of HIV-infected adults in Brazil. Methods:, This case,control study included 111 HIV-infected patients treated at a clinic for sexually transmitted diseases and HIV. In the initial examinations with dentists, variables were collected from all patients. Diagnosis of OHL was performed in accordance with the International Classification System and cytological features. The Fisher and the chi-squared tests were used for statistical analysis. The proportional prevalence and odds ratio were estimated. Results:, Outcome presented a positive, statistically significant association among the presence of OHL and viral load of 3000 copies/,l or greater (P = 0.0001; odds ratio (OR) = 5.8), presence of oral candidiasis (P = 0.0000; OR = 11.1), previous use of fluconazole (P = 0.0000; OR = 24.6), and use of systemic acyclovir (P = 0.032; OR = 4.3). Antiretroviral medication presented a negative, statistically significant association with the presence of OHL (P = 0.002; OR = 8.4). Conclusions:, Prevalence of OHL was 28.8%. Viral load, oral candidiasis, previous use of fluconazole, and systemic acyclovir were determined to be risk factors for OHL. Antiretroviral medication proved to be protective against the development of OHL. [source] Perianal Bowen Disease in a Child with Human Immunodeficiency VirusPEDIATRIC DERMATOLOGY, Issue 2 2010Kathleen A. Carroll M.D. A majority of these cancers have been reported in adult patients; few reports are available regarding anogenital HPV-associated carcinomas developing in children. We report a case of perianal Bowen disease in an HIV-positive child. An 8-year-old HIV-positive boy with a history of perianal verrucous lesions presented to a clinic in Lesotho because his caregiver noted his lesions were changing in color, texture, and extent. Histologic sections revealed squamous cell carcinoma in situ. Several cases of anogenital condyloma in HIV-positive children have been reported, but very few cases of HPV-associated cancer. Children with vertically transmitted HIV may be uniquely susceptible to persistent infection with strains of HPV acquired perinatally. While the introduction of highly active antiretroviral therapy has resulted in immune restoration, decreased opportunistic infection, and increased life expectancy for children and adults with HIV, it has not affected the incidence of HPV-related cancers in these patients. The increased life expectancy of children with HIV may actually put them at risk for developing an HPV-related anogenital cancer. [source] Gene therapy for HIV/AIDS: the potential for a new therapeutic regimenTHE JOURNAL OF GENE MEDICINE, Issue 8 2003Greg Fanning Abstract Human Immunodeficiency Virus (HIV) is the etiologic agent of Acquired Immunodeficiency Syndrome (AIDS). HIV/AIDS is a disease that, compared with the not so distant past, is now better held in check by current antiretroviral drugs. However, it remains a disease not solved. Highly active antiretroviral therapy (HAART) generally uses two non-nucleoside and one nucleoside reverse transcriptase (RT) inhibitor or two non-nucleoside RT and one protease inhibitor. HAART is far more effective than the mono- or duo-therapy of the past, which used compounds like the nucleoside reverse transcriptase inhibitor AZT or two nucleoside reverse transcriptase inhibitors. However, even with the relatively potent drug cocktails that comprise HAART, there are the issues of (i) HIV escape mutants, (ii) an apparent need to take the drugs in an ongoing manner, and (iii) the drugs' side effects that are often severe. This review speaks to the potential addition to these potent regimens of another regimen, namely the genetic modification of target hematopoietic cells. Such a new treatment paradigm is conceptually attractive as it may yield the constant intracellular expression of an anti-HIV gene that acts to inhibit HIV replication and pathogenicity. A body of preclinical work exists showing the inhibition of HIV replication and decreased HIV pathogenicity by anti-HIV genetic agents. This preclinical work used hematopoietic cell lines and primary cells as the target tissue. More recently, several clinical trials have sought to test this concept in vivo. Copyright © 2003 John Wiley & Sons, Ltd. [source] Research Priorities for Human Immunodeficiency Virus and Sexually Transmitted Infections Surveillance, Screening, and Intervention in Emergency Departments: Consensus-based RecommendationsACADEMIC EMERGENCY MEDICINE, Issue 11 2009Jason S. Haukoos MD Abstract This article describes the results of the human immunodeficiency virus (HIV) and sexually transmitted infections (STI) prevention in the emergency department (ED) component of the 2009 Academic Emergency Medicine Consensus Conference entitled "Public Health in the ED: Surveillance, Screening, and Intervention." The objectives were to use experts to define knowledge gaps and priority research questions related to the performance of HIV and STI surveillance, screening, and intervention in the ED. A four-step nominal group technique was applied using national and international experts in HIV and STI prevention. Using electronic mail, an in-person meeting, and a Web-based survey, specific knowledge gaps and research questions were identified and prioritized. Through two rounds of nomination and refinement, followed by two rounds of election, consensus was achieved for 11 knowledge gaps and 14 research questions related to HIV and STI prevention in EDs. The overarching themes of the research priority questions were related to effectiveness, sustainability, and integration. While the knowledge gaps appear disparate from one another, they are related to the research priority questions identified. Using a consensus approach, we developed a set of priorities for future research related to HIV and STI prevention in the ED. These priorities have the potential to improve future clinical and health services research and extramural funding in this important public health sector. [source] Effectiveness of Increasing Emergency Department Patients' Self-perceived Risk for Being Human Immunodeficiency Virus (HIV) Infected Through Audio Computer Self-interview,based Feedback About Reported HIV Risk BehaviorsACADEMIC EMERGENCY MEDICINE, Issue 11 2009Roland C. Merchant MD Abstract Objectives:, Prior research has demonstrated that emergency department (ED) patient acceptance of human immunodeficiency virus (HIV) screening is partially dependent on patients' self-perceived risk of infection. The primary objective of this study was to determine the effectiveness of audio computer-assisted self-interview (ACASI)-based feedback. The intervention aimed to increase patient's self-perceived risk of being HIV infected by providing immediate feedback on their risk behaviors. Methods:, This 1-year, randomized, controlled trial at a U.S. ED enrolled a random sample of 18- to 64-year-old subcritically ill or injured adult patients who were not known to be HIV infected. All participants completed an anonymous, ACASI-based questionnaire about their HIV risk behaviors related to injection drug use and sex, as well as their self-perceived risk for being HIV infected. Participants were randomly assigned to one of two study groups: an intervention group in which participants received immediate ACASI-based feedback in response to each of their reported risk behaviors or a no-intervention group without feedback. Participants were asked to indicate their level of HIV risk on a five-point scale before and after they answered the questions. Change in level of self-perceived HIV risk was calculated and compared by study group using Pearson's chi-square test. An HIV risk behavior score that summarized reported HIV risk behavior was devised. Because HIV risk behaviors differ by sex, scores were calculated separately for each sex. Linear regression models that adjusted for study group and same subject covariance were employed to determine if higher HIV risk behavior scores were associated with an increase in self-perceived HIV risk. Results:, Of the 566 trial participants, the median age was 29 years (interquartile range [IQR] = 22,43 years), 62.2% were females, and 66.9% had been tested previously for HIV. After answering the reported HIV risk behavior questions, 12.6% of participants had an increase, 79.9% had no change, and 7.5% had a decrease in self-perceived HIV risk. Of the 46.6% of participants who initially indicated that they were not at risk for HIV, 11.4% had an increase in self-perceived HIV risk after answering the reported HIV risk behavior questions. Change in self-perceived HIV risk did not differ by study group (p = 0.77). There were no differences in reported HIV risk scores between the intervention and no-intervention groups for females (p = 0.78) or males (p = 0.86). In the linear regression models, a greater increase in self-perceived HIV risk was associated with higher reported HIV risk behavior scores for females (, = 0.59, 95% confidence interval [CI] = 0.15, 1.04) but not for males (, = 1.00, 95% CI = ,0.13 to 2.14). Conclusions:, Some ED patients can be moved, although modestly, to recognize their risk for being HIV infected by asking about their HIV risk behaviors. However, ACASI-based feedback messages about HIV risk behaviors do not increase subjects' self-perceived HIV risk. Female ED patients appear to increase their self-perceived HIV risk more than males when queried about their HIV risk behaviors. [source] Nomenclature and Definitions for Emergency Department Human Immunodeficiency Virus (HIV) Testing: Report from the 2007 Conference of the National Emergency Department HIV Testing ConsortiumACADEMIC EMERGENCY MEDICINE, Issue 2 2009Michael S. Lyons MD Abstract Early diagnosis of persons infected with human immunodeficiency virus (HIV) through diagnostic testing and screening is a critical priority for individual and public health. Emergency departments (EDs) have an important role in this effort. As EDs gain experience in HIV testing, it is increasingly apparent that implementing testing is conceptually and operationally complex. A wide variety of HIV testing practice and research models have emerged, each reflecting adaptations to site-specific factors and the needs of local populations. The diversity and complexity inherent in nascent ED HIV testing practice and research are associated with the risk that findings will not be described according to a common lexicon. This article presents a comprehensive set of terms and definitions that can be used to describe ED-based HIV testing programs, developed by consensus opinion from the inaugural meeting of the National ED HIV Testing Consortium. These definitions are designed to facilitate discussion, increase comparability of future reports, and potentially accelerate wider implementation of ED HIV testing. [source] Application of the Lewis Acid,Lewis Base Bifunctional Asymmetric Catalysts to Pharmaceutical Syntheses: Stereoselective Chiral Building Block Syntheses of Human Immunodeficiency Virus (HIV) Protease Inhibitor and ,3 -Adrenergic Receptor Agonist.CHEMINFORM, Issue 44 2003Hiroyuki Nogami Abstract For Abstract see ChemInform Abstract in Full Text. [source] T-cell subset counting and the fight against AIDS: Reflections over a 20-year struggleCYTOMETRY, Issue 2 2002Francis Mandy Abstract The story of T-lymphocyte subset immunophenotyping technology is reviewed on the occasion of the 20th anniversary of CD4 T-cell enumeration. Over time, immunophenotyping has evolved into precise, reliable, but complicated and expensive technology requiring fresh blood samples. The gating technologies that were universally adapted for clinical flow cytometry for the past decade relied on rapidly deteriorating morphological scatter characteristics of leukocytes. This special issue dedicated to CD4 T-cell enumeration features most of the available new options that will have a significant impact on how this technology will be implemented within the first decade of the 21st century. In a series of original publications, including the new NIH guideline for T-cell subset enumeration, contemporary gating protocols that use immunologically logical parameters are presented as part of the more reliable and affordable immunophenotyping alternative. Some of the improvements addressed here include the costs of the assays and the capacity to monitor interlaboratory and intralaboratory performances. It is clear that an effective attack on the human immunodeficiency virus (HIV) epidemic has to embrace resource-poor regions. Reducing the cost of the assay while improving reliability and durability is a move in the right direction. Cytometry (Clin. Cytometry) 50:39,45, 2002. © 2002 Wiley-Liss, Inc. [source] Impact of the international program for quality assessment and standardization for immunological measures relevant to HIV/AIDS: QASICYTOMETRY, Issue 2 2002Francis Mandy Abstract Measurements of CD4 T-cell levels are essential for the assessment of human immunodeficiency virus (HIV) disease course, clinical staging, epidemiological studies, and decisions regarding prophylactic therapies against opportunistic infection. Until now, only in the industrialized countries was T-cell subset monitoring considered a practical option to assess disease progression. The Quality Assessment and Standardization for Immunological Measures Relevant to HIV/AIDS (QASI) program was established in 1997 to meet performance assessment for immunophenotyping laboratories in countries where such service is not available. The QASI program is provided at no cost to any laboratory in a resource-poor setting that wishes to participate. This report describes the beneficial impact of participation in the QASI program. Carefully selected commercial stabilized whole blood preparations were sent regularly to participating laboratories. Participants reported the T-cell subset values they obtained by flow cytometry. Once the aggregate mean values for the T-cell subsets were established for the shipment, a comprehensive and confidential report was sent to each laboratory. The results from five consecutive shipments were analyzed. The coefficient of variation decreased from 7.2% to 4.7% and from 14.2% to 8.8% for percent and absolute CD4 T-cell counts, respectively. With the implementation of the QASI program using commercial stabilized whole blood specimens, it is possible to reduce interlaboratory error. This study illustrates that a quality assessment program can improve the overall performance of laboratories. Reducing interlaboratory variation can enhance significantly the effectiveness of multicenter HIV vaccine or drug trial evaluation. Cytometry (Clin. Cytometry) 50:111,116, 2002. © 2002 Wiley-Liss, Inc. [source] Human immunodeficiency virus gag and pol-specific CD8 T cells in perinatal HIV infectionCYTOMETRY, Issue 5 2001Thomas W. McCloskey Abstract Background: Binding of fluorochrome-conjugated MHC class I tetramers is a powerful means to detect antigen-specific CD8 T lymphocytes. In human immunodeficiency virus (HIV) infection, cellular immune response is essential in curtailing HIV disease progression but gaps persist in our understanding of HIV-specific cells during the disease course. In this study, we evaluated tetramer binding HIV-specific CD8 T cells in HIV-infected children. Methods: Fluorescently labeled tetramers for HIV gag and pol were utilized to quantify antigen-specific cells by flow cytometry using a whole blood labeling method in a cohort of 19 HLA-A2+ HIV- infected children (age range 1 month to 17 years). Results: Fourteen children had detectable gag (median 0.4%) and pol (median 0.1%) binding CD8 T cells, three children had gag binding cells only, and two had neither. Numbers of gag and pol binding cells correlated with each other and each correlated independently with total CD8 T cells and total CD4 T cells. Conclusions: HIV gag and pol-specific CD8 T cells are maintained during the chronic phase of HIV infection in children and CD4 lymphocytes appear to be important for sustaining their levels. Cytometry (Comm. Clin. Cytometry) 46:265,270, 2001. © 2001 Wiley-Liss, Inc. [source] Cosmetic Use of Poly- l -Lactic Acid: A Retrospective Study of 130 PatientsDERMATOLOGIC SURGERY, Issue 2 2010MELANIE D. PALM MD BACKGROUND Poly- l -lactic acid (PLLA) is an effective treatment for patients seeking to correct volume loss due to aging. Although the Food and Drug Administration has approved PLLA for use in people with the human immunodeficiency virus (HIV), it is well-suited for patients seeking cosmetic treatment. OBJECTIVE To evaluate the efficacy and incidence of adverse events of HIV-negative patients treated with PLLA for volume restoration. MATERIALS AND METHODS This is a retrospective, single-center study of 130 HIV-negative patients treated with PLLA from 2003 to 2008. Patient satisfaction and incidence of adverse reactions were evaluated. RESULTS The most common reaction to PLLA treatment was the formation of nodules (8.5%). Almost all of the nodules were palpable; only one was visible. Treatment areas with the highest incidence of post-treatment nodules were the hands (12.5%) and cheeks (7.2%). Overall, patients were satisfied, with 55% having good to excellent correction; 75% of patients with five or more treatments rated their correction as good to excellent. Sixty-eight percent of all patients would repeat the procedure again. CONCLUSION PLLA is a safe, biodegradable volumizer used to reverse the signs of aging by gradually correcting volume loss. Patients should be aware of possible adverse reactions during the course of treatment. Nodule formation is low, with most patients having good to excellent correction. Drs. Butterwick and Goldman are consultants for Sanofi-Aventis. [source] Full Scope of Effect of Facial Lipoatrophy: A Framework of Disease UnderstandingDERMATOLOGIC SURGERY, Issue 8 2006BENJAMIN ASCHER MD BACKGROUND Facial lipoatrophy has been observed to occur in a variety of patient populations, with inherited or acquired disease, or even in aging patients as a natural progression of tissue change over time. There is currently no framework from which physicians of all medical specialties can communally discuss the manifestations, diagnoses, and management of facial lipoatrophy. OBJECTIVE The aim of this assembly was to derive a definition of facial lipoatrophy capable of being applied to all patient populations and develop an accompanying grading system. RESULTS The final consensus of the Facial Lipoatrophy Panel encompasses both aging and disease states: "Loss of facial fat due to aging, trauma or disease, manifested by flattening or indentation of normally convex contours." The proposed grading scale includes five gradations (Grades 1,5; 5 being the most severe), and the face is assessed according to three criteria: contour, bony prominence, and visibility of musculature. CONCLUSION Categorizing the presentation of facial lipoatrophy is subjective and qualitative, and will need to be validated with objective measures. Furthermore, during the assembly, several topics were exposed that warrant further research, including the physiology of volume loss, age and lipoatrophy, and human immunodeficiency virus and lipoatrophy. [source] Therapy of HIV infectionDERMATOLOGIC THERAPY, Issue 6 2004Yuchi C. Chang ABSTRACT:, HIV is a devastating disease caused by the human immunodeficiency virus. Symptoms of illness can manifest in every organ system, including the skin. Although there is no definitive cure, the creation of antiretroviral drugs and aggressive treatment regimens have dramatically altered disease morbidity and mortality. However, the precise drug selection is often difficult and intimidating given the sheer abundance of drug therapies available. In this article, the HIV disease course is reviewed and different classes of antiretroviral medications are presented with emphasis on initial drug regimens, potential adverse effects, particularly those of dermatologic nature, possible drug interactions, patient compliance, and the emergence of drug resistance. [source] A review of antiviral therapies in the treatment of cytomegalovirusDERMATOLOGIC THERAPY, Issue 3 2000Adrienne M. Hinkle ABSTRACT: Cytomegalovirus (CMV) is a member of the herpesvirus family that is very prevalent world wide based on serologic testing. In immunocompromised persons CMV produces high rates of morbidity and mortality. Congenital CMV is the leading infectious cause of fetal abnormalities in the United States. Infection of human immunodeficiency virus (HIV) seropositive persons or transplant patients with CMV can produce retinitis, encephalitis, pneumonitis, hepatitis, gastrointestinal ulcerations, and cutaneous lesions. Three intravenous therapies are available for CMV infections: ganciclovir; foscarnet and cidofovir. Most recently a fourth antiviral agent was approved for intravitreal injection. This drug, fomivirsen, is the first antisense oligonucleotide available for therapeutic use. A number of other antiviral drugs and vaccines are currently under study. [source] The role of weight for age and disease stage in poor psychomotor outcome of HIV-infected children in Kilifi, KenyaDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 12 2009AMINA ABUBAKAR PHD Aim, We aimed to investigate the contribution of disease stage and weight for age to the variability in psychomotor outcome observed among children with human immunodeficiency virus (HIV) infection. Method, This cross-sectional study involved 48 Kenyan children (20 females, 28 males) aged 6 to 35 months (mean 19.9mo SD 8.9) exposed prenatally to HIV. Two subgroups of HIV-exposed children were seen: those who were HIV-infected and those who were uninfected. The reference population was composed of 319 children (159 females, 160 males) aged 6,35 months, (mean age = 19 months, SD=8.43) randomly selected from the community. Disease stage varied from stage 1 to stage 3, reflecting progression from primary HIV infection to advanced HIV infection and acquired immune deficiency syndrome. A locally developed and validated measure, the Kilifi Developmental Inventory, was used to assess psychomotor development. Result, Using age-corrected psychomotor scores, a significant main effect of HIV status was observed (F(2,38.01)=7.89, p<0.001). Children in the HIV-infected group had lower mean psychomotor scores than the HIV-exposed children and the reference group. In the HIV-infected group, disease stage was a negative predictor and weight for age a positive predictor of psychomotor outcome. Interpretation, Weight for age and disease stage provide viable, easily measurable benchmarks to specify when frequent developmental monitoring and psychomotor rehabilitation are required. Nutritional intervention and other measures aimed at slowing disease progression may delay the onset and severity of psychomotor impairment in the paediatric HIV population in Africa. [source] Neurodevelopmental outcomes in children with HIV infection under 3 years of ageDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 8 2006C J Foster BA MBBS MRCPCH Following the introduction of combination antiretroviral therapy, children vertically infected with the human immunodeficiency virus (HIV-1) living in the developed world are surviving into adult life. This paper reviews the neurodevelopmental outcomes of 62 consecutively-presenting children with HIV-1 infection diagnosed before 3 years of age (32 males, 30 females; median age at presentation 6mo). Neurological and developmental data are presented with immunological and virological responses to antiretroviral therapy. Fourteen children (22%) had abnormal neurological signs and 25 (40%) demonstrated significant developmental delay on standardized developmental assessments. Children presenting with more severe HIV-1 disease and immune compromise had significantly more abnormal neurological signs and developmental delays than children presenting with milder HIV-1 symptomatology. Immune function, control of HIV-1 viral replication, and growth parameters improved with antiretroviral therapy (median age at last follow-up 7y 3mo); however, abnormal neurological signs and significant gross motor difficulties persisted. [source] Intrastriatal administration of human immunodeficiency virus-1 glycoprotein 120 reduces glial cell-line derived neurotrophic factor levels and causes apoptosis in the substantia nigraDEVELOPMENTAL NEUROBIOLOGY, Issue 12 2006Rachel L. Nosheny Abstract Uninfected neurons of the substantia nigra (SN) degenerate in human immunodeficiency virus (HIV)-positive patients through an unknown etiology. The HIV envelope glycoprotein 120 (gp120) causes apoptotic neuronal cell death in the rodent striatum, but its primary neurotoxic mechanism is still under investigation. Previous studies have shown that gp120 causes neurotoxicity in the rat striatum by reducing brain-derived neurotrophic factor (BDNF). Because glial cell line-derived neurotrophic factor (GDNF) and BDNF are neurotrophic factors crucial for the survival of dopaminergic neurons of the SN, we investigated whether gp120 reduces GDNF and BDNF levels concomitantly to induce apoptosis. Rats received a microinjection of gp120 or vehicle into the striatum and were sacrificed at various time intervals. GDNF but not BDNF immunoreactivity was decreased in the SN by 4 days in gp120-treated rats. In these animals, a significant increase in the number of caspase-3- positive neurons, both tyrosine hydroxylase (TH)-positive and -negative, was observed. Analysis of TH immunoreactivity revealed fewer TH-positive neurons and fibers in a medial and lateral portion of cell group A9 of the SN, an area that projects to the striatum, suggesting that gp120 induces retrograde degeneration of nigrostriatal neurons. We propose that dysfunction of the nigrostriatal dopaminergic system associated with HIV may be caused by a reduction of neurotrophic factor expression by gp120. © 2006 Wiley Periodicals, Inc. J Neurobiol, 2006 [source] Comparative cytological study of lymph node tuberculosis in HIV-infected individuals and in patients with diabetes in a developing countryDIAGNOSTIC CYTOPATHOLOGY, Issue 2 2002C.B. Sridhar B.Sc., M.B.B.S., M.D. Abstract Tuberculosis (TB) is a common infection affecting patients with human immunodeficiency virus (HIV) and diabetes mellitus (DM). With the increasing incidence of HIV infection and DM in a developing country like India, TB is definitely on the rise. In a given population, one expects to see these three diseases in varying combinations, such as HIV and TB, DM and TB, HIV and DM with TB. In such combinations TB may lack the characteristic clinical and histological picture due to the associated depressed cell-mediated immunity seen in both diseases and TB may have an unusual clinical presentation and cytology picture. In this retrospective study of 36 months, from January 1997 to December 1999, 109 cases diagnosed cytologically as tuberculous lymphadenitis and tested for HIV infection and investigated as well for DM were selected. Forty-six (42%) were nondiabetic HIV patients, 13 (12%) were non-HIV DM patients, and 50 (46%) had TB without HIV infection or DM. The coexistence of both HIV and DM was not noted. The cytomorphological characteristics supplemented by culture studies of each of these three groups were compared in detail and based on these four cytological patterns, Pattern 1, Pattern 2, Pattern 3, and Pattern 4 emerged and were characterized. This study highlights the usefulness of cytomorphology of the lymph nodes to characterize the cytopathological profile of TB in both HIV and DM, which have many clinical and immunological similarities, and indirectly postulate the extent of immune suppression and evolve effective strategies in the management of coexisting diseases. Such a comparative study has not been carried out in the past. Diagn. Cytopathol. 2002;26:75,80; DOI 10.1002/dc.10059 © 2002 Wiley-Liss, Inc. [source] Alcohol use and non-adherence to antiretroviral therapy in HIV-infected patients in West AfricaADDICTION, Issue 8 2010Antoine Jaquet ABSTRACT Aim To investigate the association between alcohol use and adherence to highly active antiretroviral treatment (HAART) among human immunodeficiency virus (HIV)-infected patients in subSaharan Africa. Design and setting Cross-sectional survey conducted in eight adult HIV treatment centres from Benin, Côte d'Ivoire and Mali. Participants and measurements During a 4-week period, health workers administered the Alcohol Use Disorders Identification Test to HAART-treated patients and assessed treatment adherence using the AIDS Clinical Trials Group follow-up questionnaire. Findings A total of 2920 patients were enrolled with a median age of 38 years [interquartile range (IQR) 32,45 years] and a median duration on HAART of 3 years (IQR 1,4 years). Overall, 91.8% of patients were identified as adherent to HAART. Non-adherence was associated with current drinking [odds ratio (OR) 1.4; 95% confidence interval (CI) 1.1,2.0], hazardous drinking (OR 4.7; 95% CI 2.6,8.6) and was associated inversely with a history of counselling on adherence (OR 0.7; 95% CI 0.5,0.9). Conclusions Alcohol consumption and hazardous drinking is associated with non-adherence to HAART among HIV-infected patients from West Africa. Adult HIV care programmes should integrate programmes to reduce hazardous and harmful drinking. [source] Modeling the effect of high dead-space syringes on the human immunodeficiency virus (HIV) epidemic among injecting drug usersADDICTION, Issue 8 2010Georgiy V. Bobashev ABSTRACT Aims To illustrate the impact of different proportions of injecting drug users (IDUs) sharing high dead-space syringes (HDSS) or low dead-space syringes (LDSS) on the probability of human immunodeficiency virus (HIV) transmission; and thus the impact on injection-related HIV prevalence and incidence. Design A stochastic mathematical model was used to evaluate the impact of HDSS use in high- and low-risk IDU populations. Model parameters were obtained from peer-reviewed publications. Analytical solutions of a simplified deterministic model were obtained to explain the effect of HDSS on HIV endemic states. Findings Simulation analysis shows that the HIV epidemic could be sustained even when a small percentage of sharing (10%) involved HDSS. The effect is much stronger in high-risk compared with low-risk populations. Steady state HIV prevalence increases with the proportion of HDSS, and for high- and low-risk populations reaches around 80% and 20%, respectively. For low-risk populations, the use of LDSS could result in the virtual elimination of HIV. These results are dependent upon an evidence-supported assumption of a significant difference in HIV transmission risk associated with HDSS versus LDSS. Conclusions Our models suggest that injection-related HIV epidemics may not occur when most (e.g. 95% or more) IDUs use LDSS. While these results are based on indirect risk measures and a number of simplifying assumptions, the effect of blood retained in high dead-space syringes on HIV prevalence seems to be very strong, even using relatively conservative assumptions. The findings have potential implications for needle exchange programs and the types of syringes produced and distributed world-wide. [source] Drug-related behaviors independently associated with syphilis infection among female sex workers in two Mexico,US border citiesADDICTION, Issue 8 2010Oralia Loza ABSTRACT Aims To identify correlates of active syphilis infection among female sex workers (FSWs) in Tijuana and Ciudad Juarez. Design Cross-sectional analyses of baseline interview data. Correlates of active syphilis (antibody titers >1 : 8) were identified by logistic regression. Setting Tijuana and Ciudad Juarez, two Mexican cities on the US border that are situated on major drug trafficking routes and where prostitution is quasi-legal. Participants A total of 914 FSWs aged ,18 years without known human immunodeficiency virus (HIV) infection who had had recent unprotected sex with clients. Measurements Baseline interviews and testing for syphilis antibody using Treponema pallidum particle agglutination (TPPA) and rapid plasma reagin (RPR) tests. Findings Median age and duration in sex work were 32 and 4 years, respectively. Overall, 18.0% had ever injected drugs, 14.2% often or always used illegal drugs before or during sex in the past month, 31.4% had clients in the last 6 months who injected drugs, and 68.6% reported having clients from the United States. Prevalence of HIV and active syphilis were 5.9% and 10.3%, respectively. Factors independently associated with active syphilis included injecting drugs (AOR: 2.39; 95% CI: 1.40, 4.08), using illegal drugs before or during sex (AOR: 2.06; 95% CI: 1.16, 3.65) and having any US clients (AOR: 2.85; 95% CI: 1.43, 5.70). Conclusions Among female sex workers in Tijuana and Ciudad Juarez, drug-using behaviors were associated more closely with active syphilis than were sexual behaviors, suggesting the possibility of parenteral transmission of T. pallidum. Syphilis eradication programs should consider distributing sterile syringes to drug injectors and assisting FSWs with safer-sex negotiation in the context of drug use. [source] Health outcomes associated with methamphetamine use among young people: a systematic reviewADDICTION, Issue 6 2010Brandon D. L. Marshall ABSTRACT Objectives Methamphetamine (MA) use among young people is of significant social, economic and public health concern to affected communities and policy makers. While responses have focused upon various perceived severe harms of MA use, effective public health interventions require a strong scientific evidence base. Methods We conducted a systematic review to identify scientific studies investigating health outcomes associated with MA use among young people aged 10,24 years. The International Classification of Diseases (ICD-10) was used to categorize outcomes and determine the level of evidence for each series of harms. Results We identified 47 eligible studies for review. Consistent associations were observed between MA use and several mental health outcomes, including depression, suicidal ideation and psychosis. Suicide and overdose appear to be significant sources of morbidity and mortality among young MA users. Evidence for a strong association between MA use and increased risk of human immunodeficiency virus (HIV) and other sexually transmitted infections is equivocal. Finally, we identified only weak evidence of an association between MA use and dental diseases among young people. Conclusions Available evidence indicates a consistent relationship between MA use and mental health outcomes (e.g. depression, psychosis) and an increased risk of mortality due to suicide and overdose. We found insufficient evidence of an association between MA use and other previously cited harms, including infectious diseases and dental outcomes. As such, future research of higher methodological quality is required to further investigate possible associations. Current interventions should focus attention upon MA-related health outcomes for which sound scientific evidence is available. [source] Response to first-line antiretroviral treatment among human immunodeficiency virus-infected patients with and without a history of injecting drug use in IndonesiaADDICTION, Issue 6 2010Rudi Wisaksana ABSTRACT Background There is a common belief that injecting drug use (IDU) is associated with lower uptake, retention and success of antiretroviral treatment (ART) in human immunodeficiency virus (HIV)-infected patients. We examined this in an Indonesian setting, where IDU is the main risk factor for HIV infection. Methods Patient characteristics and response to ART were recorded for all patients diagnosed with HIV infection in the referral hospital for West Java (40 million people). Kaplan,Meier estimates and Cox's regression were used to compare mortality, loss to follow-up and virological failure between patients with and without a history of IDU. Result A total of 773 adult HIV patients (81.9% IDUs) presented between January 1996 and April 2008. IDUs had a median CD4 cell count of 33 [interquartile ratio (IQR), 12,111] cells/mm3 compared to 84 (IQR, 28,224) cells/mm3 in non-IDUs. Among patients with a history of IDU, 87.7% were coinfected with hepatitis C (HCV). Mortality was associated strongly with CD4 count; after 6 months of ART, 18.3, 20.3, 7.1 and 0.7% of patients with CD4 cell counts <25, 25,99, 100,199, respectively, ,200/mm3 had died (P < 0.0001). Mortality [adjusted for CD4; hazard ratio (HR) = 0.65; 95% confidence interval (CI) 0.35,1.23], loss to follow-up (HR = 0.85, 95% CI 0.51,1.41) and virological failure (HR = 0.47, 95% CI 0.19,1.13) were not significantly different in IDUs and non-IDUs. Conclusion Intravenous drug users (IDUs) in Indonesia with HIV/acquired immune deficiency syndrome tend to have more advanced disease but respond similarly to non-IDUs to antiretroviral therapy. [source] Flashblood: blood sharing among female injecting drug users in TanzaniaADDICTION, Issue 6 2010Sheryl A. McCurdy ABSTRACT Aims This study examined the association between the blood-sharing practice of ,flashblood' use and demographic factors, human immunodeficiency virus (HIV) status and variables associated with risky sex and drug behaviors among female injecting drug users. Flashblood is a syringe-full of blood passed from someone who has just injected heroin to someone else who injects it in lieu of heroin. Design A cross-sectional study. Setting Dar es Salaam, Tanzania. Participants One hundred and sixty-nine female injecting drug users (IDUs) were recruited using purposive sampling for hard-to-reach populations. Measurements The association between flashblood use, demographic and personal characteristics and risky sex and drug use variables was analyzed by t -test and ,2 test. The association between flashblood use and residential neighborhood was mapped. Findings Flashblood users were more likely to: be married (P = 0.05), have lived in the current housing situation for a shorter time (P < 0.000), have been forced as a child to have sex by a family member (P = 0.007), inject heroin more in the last 30 days (P = 0.005), smoke marijuana at an earlier age (P = 0.04), use contaminated rinse-water (P < 0.03), pool money for drugs (P < 0.03) and share drugs (P = 0.000). Non-flashblood users were more likely to live with their parents (P = 0.003). Neighborhood flashblood use was highest near downtown and in the next two adjoining suburbs and lowest in the most distant suburbs. Conclusions These data indicate that more vulnerable women who are heavy users and living in shorter-term housing are injecting flashblood. The practice of flashblood appears to be spreading from the inner city to the suburbs. [source] Evidence for the effectiveness of sterile injecting equipment provision in preventing hepatitis C and human immunodeficiency virus transmission among injecting drug users: a review of reviewsADDICTION, Issue 5 2010Norah Palmateer ABSTRACT Aims To review the evidence on the effectiveness of harm reduction interventions involving the provision of sterile injecting equipment in the prevention of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) transmission among injecting drug users (IDUs). The interventions assessed were needle and syringe programmes (NSP), alternative modes of needle/syringe provision (pharmacies, vending machines and outreach) and the provision of injecting equipment other than needles/syringes. Methods Systematic searches of the English language literature to March 2007 were undertaken to identify systematic, narrative or meta-analytical reviews (also known as a review of reviews) of the impact of interventions on HCV transmission, HIV transmission or injecting risk behaviour (IRB). Critical appraisal criteria classified the reviews as either high quality (,core') or supplementary: a framework based on the quality of reviews, the reviewers' conclusions and the designs/findings of the primary studies was used to derive evidence statements. Results Three core and two supplementary reviews of injecting equipment interventions were identified. According to the proposed framework, this study found (a) insufficient evidence to conclude that any of the interventions are effective in preventing HCV transmission; (b) tentative evidence to support the effectiveness of NSP in preventing HIV transmission; (c) sufficient evidence to support the effectiveness of NSP (and tentative evidence of an additional impact of pharmacy NSP) in reducing self-reported IRB; and (d) little to no evidence on vending machines, outreach or providing other injecting equipment in relation to any of the outcomes. Conclusions The evidence is weaker than given credit for in the literature. The lack of evidence for effectiveness of NSP vis-à-vis biological outcomes (HCV and HIV incidence/prevalence) reflects the limitations of studies that have been undertaken to investigate these associations. Particularly for HCV, low levels of IRB may be insufficient to reduce high levels of transmission. New studies are required to identify the intervention coverage necessary to achieve sustained changes in blood-borne virus transmission. [source] | ||||||||||||||||||||||||||||||||||||||||||||||