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Biomedical subjects

G Angarano

Publications and source records attributed to G Angarano.

At least 73 records · Page 4Linked to original sources
PubMed1997

Chlamydia pneumoniae respiratory infections among patients infected with the human immunodeficiency virus.

Thirteen cases of Chlamydia pneumoniae infection in patients seropositive for the human immunodeficiency virus (HIV) are described. The occurrence, the clinical spectrum, and the significance of the infection during HIV disease are compared with data reported in the literature. Chlamydia pneumoniae infection was established by a serologic micro-immunofluorescence test using standard diagnostic criteria. In four cases the results of serological tests were confirmed by direct immunofluorescence on respiratory specimens. Five patients developed focal pneumonia but recovered completely after specific antibiotic treatment. Three patients developed severe and diffuse interstitial pulmonary involvement, two of whom died of acute respiratory failure. Five patients developed upper respiratory tract infection. Using 39 pair-matched HIV-seropositive subjects as controls, the cases of infection were found to be significantly associated with a previously diagnosed pulmonary disease. Upon retrospective analysis of 319 consecutive cases of pneumonia among HIV-infected patients, Chlamydia pneumoniae was the sole agent detected in eight (2.5%) cases, and Chlamydia pneumoniae together with other infectious agents was detected in seven (2.2%) cases. Chlamydia pneumoniae is a possible cause of severe respiratory infection in Italian HIV-infected immunocompromised patients, and its presence must be suspected when patients do not respond to therapy with beta-lactam agents or to anti-Pneumocystis carinii treatment.

AIDS-Related Opportunistic Infections↗
PubMed1997

Italian multicentre study of didanosine compassionate use in advanced HIV infection. Italian BMS-906 Study Group.

The aim of the present study, a multicentre trial of didanosine (ddI) compassionate use, was to identify factors associated with a better outcome in patients given ddI monotherapy. Enrolled were 1047 HIV-positive patients intolerant of and/or unresponsive to zidovudine (ZDV) therapy, with CD4+ cell counts of < 200/microliter or AIDS. Didanosine was given at a dose of 250 mg b.i.d. (patients > or = 60 kg) or 167 mg b.i.d. (patients < 60 kg). Clinical examinations and laboratory tests were performed every two months. Endpoints included death, the occurrence of a new AIDS-defining disease, or permanent discontinuation of ddI for a severe adverse event. At entry, the median CD41 cell count was 47/microliter and the median duration of prior ZDV treatment 19 months; 446 patients (43%) were classified as having AIDS. Severe toxicity occurred in 143 subjects (14%); the frequency of pancreatitis was very low (0.2%). The benefit in terms of CD4+ cell counts was greater for patients whose counts exceeded 100/microliter at entry and remained at this level until month 12 in those patients still receiving treatment. Death and/or new AIDS-defining events were observed in 374 cases (36%) over a median follow-up of eight months. AIDS dementia was observed in 11 patients (1%). Multivariate analysis of survival without disease progression showed that the factors associated with a worse outcome include the severity of immunodepression, a diagnosis of AIDS at entry, and a history of both intolerance of and clinical resistance to ZDV. Surprisingly, the patients who had received previous prolonged treatment with ZDV had a better outcome. In conclusion, severely immunodepressed patients previously administered long-term monotherapy may receive a short-term benefit from being switched to another antiretroviral drug.

AIDS Dementia Complex↗
PubMed1997

Familial clustering of HBV pre-C and pre-S mutants.

BACKGROUND/AIMS: Little is known about the persistence and risk of infection with hepatitis B viruses (HBV) containing mutations in the pre-C and pre-S region. The aim of this study was to study the long-term persistence and the risk of intrafamilial spreading of these variants. METHODS: Serological markers were analyzed immunologically and pre-C and pre-S sequences of HBV DNA in sera from several members of five families by DNA amplification and direct sequencing. RESULTS: In most HBV-DNA positive individuals of each family, either the dominant HBV population or a subpopulation had a stop codon in the pre-C region which prevented expression of e-antigen. The pre-S region of the dominant virus populations of 8/15 HBV-DNA positive sera showed different deletions or a pre-S2 translation initiation codon mutation in addition to various point mutations. Selection for pre-C and pre-S mutant viruses from a predominant "wildtype" virus population was observed in three individuals during the natural course of infection. Persistence of a pre-C/pre-S double mutant virus as a stable strain for 6 years was found in one patient. CONCLUSIONS: These data indicate extensive intrafamilial clustering of HBV variants with mutations in the pre-C and pre-S regions due to patient-specific selection mechanisms and long-term persistence of some mutants as stable strains. The type of viruses found suggests that occasionally virus subpopulations are selectively transmitted or become a dominant virus population after selection.

Cluster Analysis↗
PubMed1997

Giardiasis in HIV: a possible role in patients with severe immune deficiency.

We report the epidemiological, clinical and therapeutic characteristics of giardiasis in a population of HIV-infected patients with diarrhoic syndrome. During the period between 1988 and 1995, 720 HIV-patients with diarrhoic syndrome were evaluated. Fecal specimens were submitted to parasitological examination according to the Ritchie formalin-ethil acetate centrifugal sedimentation method and stained with iodine. Samples also underwent modified Ziehl-Neelsen staining and standard bacteriologic testing. Cystis of G. intestinalis were identified in stool sample of 25 patients. Two patients were classified as in stage A2 and 23 in C3. Mean CD4 values of patients with giardiasis (26.9 cells/mmc) were compared with those of 65 patients from whom, during the study, was isolated Cryptosporidium parvum (63.12, cells/mmc): the difference resulted highly significant (p < 0.001). Among the patients with full-blown AIDS, giardiasis occurred following a single previous AIDS-defining event in 13 inividuals, in seven and in five subjects giardiasis was the 3rd and, respectively, the 4th relevant AIDS-defining condition. Death occurred within the following 2 months in nine patients and within 6, 12 and 24 months in seven, six and two patients, respectively; at present only three AIDS patients are still alive. In general, G. intestinalis in HIV+, is not considered a major cause of enteritis; nevertheless, in our experience enteritis due to G intestinalis is a frequent event among AIDS patients, especially in the most advanced stage of disease, irrespectively of the risk factor. The increase in mean survival of AIDS patients will probably lead to a progressive emergence of this pathogen which could determine a severe diarroic syndrome with hydro-electrolytic impairments.

AIDS-Related Opportunistic Infections↗
PubMed1997

Augmented serum neutralizing activity against primary human immunodeficiency virus type 1 (HIV-1) isolates in two groups of HIV-1-infected long-term nonprogressors.

Neutralizing activity against primary human immunodeficiency virus type 1 (HIV-1) isolates from 17 persons who were long-term disease nonprogressors (LTNPs) and 13 persons who were fast progressors (FPs) was compared. Sera from LTNPs showed higher neutralizing activity both in titer and in host spectrum than did sera from FPs. However, LTNP sera had limited neutralizing activity against HIV-1 subtypes from different geographic areas. Sera collected 6 years earlier from both groups had limited neutralizing activity, indicating that early responses are not predictive for disease progression. LTNPs had very low virus loads, as reflected by only one positive isolation, which was an MT-2-negative phenotype. Virus was isolated from all FPs, and the isolates showed a phenotype switch from MT-2 negative to MT-2 positive. Development of high-titer, broadly cross-reactive neutralizing antibodies is associated with control of virus replication and low virus load in HIV-1-infected LTNPs.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Markers of response to zidovudine monotherapy among treated HIV seroconverters. Italian Seroconversion Study.

The aim of the study was to evaluate indicators of response to zidovudine monotherapy in terms of progression to AIDS and death in a cohort of human immunodeficiency virus (HIV) seroconverters. From a larger observational epidemiological cohort of 1,024 HIV seroconverters we identified 315 persons on zidovudine monotherapy. In this treated cohort, age, sex, risk group, constitutional symptoms, CD4 cell count, and p24 antigen levels at initiation of treatment and 6 months later were examined separately for two outcomes, AIDS and death, using standard survival methods. The variables measured at the visit at which zidovudine monotherapy was initiated that predicted more rapid progression to AIDS were CD4 cell count (RH = 2.61); constitutional symptoms (RH = 2.56); p24 antigenaemia level (RH = 2. 17); and subsequent change in CD4 cell count (> 30% decline) contributed additional predictive information (RH = 2.70). Results were similar for mortality, and did not vary significantly by risk group. In a tested subset of patients, p24 antigenaemia was associated with high levels of plasma RNA viral load. The median number of HIV RNA copies was about 28,000 copies/ml among p24 antigen-positive individuals and about 7,700 copies/ml among participants who were persistently negative for p24 antigenaemia. CD4 cell count, symptoms and p24 antigenaemia at the start of therapy and CD4 cell decline after initiation of treatment are early indicators of disease progression in zidovudine-treated patients. The combined use of these indicators may help to better predict who will respond to zidovudine or to other antiretroviral therapies.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Lymphogranuloma venereum: a case report in an Italian traveller.

A 38-year-old man with a recent history of travel in India and unprotected sexual intercourse with Indian women, was admitted with painful enlarged lymphnodes predominantly in the right inguinal area. Diagnosis of lymphogranuloma venereum was made by means of a positive immunofluorescence test (Total Ig titer of 1:512) and a positive detection of chlamydial antigens by ELISA in a semen sample. He was successfully treated with ciprofloxacin. This observation emphasizes the relevance of infection due to C. trachomatis serotypes L1-L3 that may be acquired during travel in developing countries.

Adult↗
PubMed1997

The use of serum-free medium delays, but does not prevent, the cytotoxic effects of seminal plasma in lymphocyte cultures: implications for studies on HIV infection.

Evidence indicates that seminal plasma is cytotoxic when used in lymphocyte cultures. In fact, an amine oxidase which is normally present in Fetal Calf Serum (FCS) causes spermine oxidation and, finally, cytotoxic substances are released. This seminal quality might obviously hamper studies aiming to evaluate the role of semen in HIV sexual transmission, since lymphocytes are generally used as target or effector cells in virological or immunological studies on HIV. We evaluated the efficacy of FCS free-medium, heat inactivated seminal plasma and/or the washing-out of cultures after a three hour incubation period in preventing the cytotoxicity to lymphocytes. Results show that when cultures are carried out in the absence of FCS and/or after seminal plasma removal, cytotoxicity is not prevented, although delayed. This finding indicates that, along with still unrecognized additional factors, spermine oxidation is still an important factor for semen cytotoxicity, and this considerably hampers any immunological and virological study, requiring the use of lymphocytes, concerning seminal fluid.

Animals↗
PubMed1997

Serological markers predicting tuberculosis in human immunodeficiency virus-infected patients.

SETTING: Human immunodeficiency virus (HIV)-positive patients retrospectively identified at the Hospital of Bari, Italy, with diagnosis of tuberculosis (TB) (n = 30) or non-tuberculous pneumonia (n = 29). Serum samples drawn at the time of diagnosis and one year before. Anti-purified protein derivative (PPD) and anti-diacyltrehalose (DAT) serum antibodies quantified by ELISA assay. OBJECTIVE: Since TB patients with HIV infection may present with elevated serum antibodies against Mycobacterium tuberculosis, we hypothesized that TB-specific antibody markers might predict TB in these subjects. DESIGN: A retrospective study was designed to assess the presence of M. tuberculosis-specific antibodies in HIV-positive patients developing TB. RESULTS: Of 30 HIV-positive TB patients, 24 (80%) had anti-PPD or anti-DAT antibodies at the time of TB diagnosis, and 20 (67%) one year before. In a sub-population of 16 of the 30 HIV-positive subjects, positivity for anti-PPD or anti-DAT antibodies one year before TB diagnosis was higher (11/16, 69%) than for the PPD skin test (4/16, 25%, P < 0.01). Antibody tests were specific for TB since positivity rates were lower both in patients with non-tuberculous pneumonia (P < 0.01) and in those with M. avium infection (P < 0.05). CONCLUSION: Antibody markers may predict TB in HIV-positive subjects, including those with negative PPD skin test.

AIDS-Related Opportunistic Infections↗
PubMed1996

The role of HIV type 1 phenotype and genotype in long-term responders to zidovudine therapy.

We performed a cross-sectional and partly retrospective virological evaluation of 31 long-term responders (LTRs) to zidovudine (ZDV) (persistent increase in the CD4+ cell counts without progression of HIV infection throughout a period of ZDV therapy > 3 years) and 17 well-matched controls who developed a marked immunological deterioration over a 24-month period of ZDV therapy. The biological phenotype of HIV-1 was assessed by testing the capacity of the isolates to replicate in the MT-2, HUT-78, C-8166, and U-937 T cell lines, and mutations at codons 215 and 41 of RT were checked in proviral DNA from uncultured PBMCs. Show/low non-syncytium-inducing (S/L-NSI) and rapid/high syncytium-inducing (R/H-SI) variants were detected in 25 (81%) and 2 (6%) LTRs, respectively. HIV-1 could not be isolated in the remaining four LTRs (13%). Conversely, 12 of 17 (71%) controls yielded R/H-SI variants. Conversion from the S/L-NSI to R/H to R/H-SI phenotype occurred in 5 controls but in none of the 18 LTRs tested. Mutant sequences in proviral DNA from control PBMCs were consistently detected (94%), while a wild-type sequence of the residues investigated was found in the majority of LTRs (77%). In our series, patients who received immunological and clinical benefits even after prolonged ZDV treatment had S/L-NSI viruses and a low risk to develop ZDV resistance. Conversely, subjects who demonstrated an immunological and clinical deterioration yielded R/H-SI variants or shifted from S/L-NSI to R/H-SI phenotypes and were at higher risk to develop mutations indicating ZDV resistance.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Choreoathetosis in acquired immune deficiency syndrome patients with cerebral toxoplasmosis.

The aim of our study was to evaluate both the incidence and the pathologic and clinical features of extrapyramidal disorders in a population of acquired immune deficiency syndrome (AIDS) patients with cerebral toxoplasmosis. Of 240 AIDS patients evaluated in the 1985-1994 period, 50 of them were diagnosed to have cerebral toxoplasmosis on the basis of the following criteria: occurrence of specific antibodies, computed tomography and/or magnetic resonance imaging (MRI), and regression of the symptoms after specific therapy. Three of 50 (6%) had hemichoreoathetosis. In the first case, the disorder began as a dyskinesia of the left hand that subsequently spread to the whole ipsilateral arm and assumed the features of choreic athetotic movements. The other two cases were characterized by left hemisomatic distal choreic movements. Therapy with pyrimethamine and sulfadiazine led to a complete recovery of the extrapyramidal signs in two cases and to improvement in the third. According to our observations, the onset of these movement disorders could not be related to the dimension of the lesion or to the edema, but to a specific localization in subthalamic nucleus, in subthalamic/pallidal, and pallidal/thalamic pathways. MRI seems the elective tool to perform a more accurate study of the anatomic areas involved in this pathway and to verify their integrity. Cerebral toxoplasmosis in AIDS can be considered as a new etiopathogenic cause of choreoathetosis.

AIDS Dementia Complex↗
PubMed1996

Polymerase chain reaction for non-invasive diagnosis of brain mass lesions caused by Mycobacterium tuberculosis: report of five cases in human immunodeficiency virus-positive subjects.

To investigate whether the polymerase chain reaction (PCR) on the IS6110 sequence of Mycobacterium tuberculosis could permit the early and non-invasive diagnosis of tuberculous brain lesions without meningeal involvement in acquired immunodeficiency virus patients, we examined retrospective cerebrospinal fluid (CSF) samples from five patients diagnosed as having cerebral lesions caused by M. tuberculosis. M. tuberculosis deoxyribonucleic acid was detected in CSF samples obtained from each of the patients studied, but in none of the controls. The PCR results coincided with M. tuberculosis isolation from CSF in two patients. In an additional two subjects, culture for M. tuberculosis on CSF was negative, and the diagnosis of central nervous system tuberculosis was achieved by response to specific therapy. In the last patient the PCR result on CSF was confirmed by isolation of M. tuberculosis from brain biopsy. Interestingly, in this patient the CSF did not yield M. tuberculosis isolation when cultured. The data show the value of PCR as a potentially useful approach for the early and rapid diagnosis of cerebral tuberculosis even without meningitis.

AIDS-Related Opportunistic Infections↗