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PubMedDate not supplied

Relationship between human immunodeficiency virus-1 RNA identification in placenta and perinatal transmission.

OBJECTIVES: The objectives of this study were to identify human immunodeficiency virus (HIV)-associated nucleic acids in placenta with 35S RNA in situ hybridization and to correlate the presence of virus with perinatal HIV transmission. STUDY DESIGN: Blood from nine mother-infant pairs was collected for CD4+ lymphocyte count and p24 antigen analysis. Placental specimens were obtained for in situ hybridization, viral culture, and hematoxylin-eosin histologic analysis. Neonatal infection was diagnosed by p24 antigen analysis, polymerase chain reaction, and viral culture. Pediatric follow-up was obtained by personal communication and review of chart records. RESULTS: Three of 10 placentas from nine HIV-positive pregnant women (one set of twins) were found to contain evidence of HIV infection by RNA in situ hybridization. Maternal age, gravidity, parity, previous number of terminations, duration HIV-seropositive, maternal CD4+ at delivery, and neonatal cord CD4+ count were similar in those whose placentas contained virus versus those in whom virus was not identified. The incidence of histologic changes was similar in the HIV-positive and negative placentas from seropositive subjects and was similar to the incidence of histologic changes in placentas from known seronegative subjects. Placental culture failed to demonstrate the presence of virus in vitro. Of the three placentas that had positive in situ hybridization, two infants became HIV-positive. CONCLUSIONS: 35S RNA in situ hybridization identified the presence of nucleic acids in syncytiotrophoblasts from formalin-fixed, paraffin-embedded placentas. This technique is a useful tool to screen placentas at birth for HIV-RNA to judge the likelihood of perinatal HIV transmission.

Adult↗
PubMed1996

Causes of fever in patients infected with human immunodeficiency virus who were admitted to Boston City Hospital.

We prospectively studied causes of fever in patients with human immunodeficiency virus (HIV) infection that required admission to a municipal hospital. A total of 168 HIV-infected persons were admitted for 220 episodes of fever: 72% were male, 80% were nonwhite, 65% reported prior injection drug use, and 74% had a baseline CD4 lymphocyte count of < 200/mm3. Bacterial infections, principally pneumonia, accounted for > 60% of the episodes; Streptococcus pneumoniae and Staphylococcus aureus were most commonly isolated. Pneumocystis carinii pneumonia (PCP) and disseminated infection with Mycobacterium avium complex (MAC) comprised 53% of the remaining sources of fever. In comparison with episodes of fever due to nonbacterial causes, those associated with common bacterial infections were significantly more likely to involve patients with a history of injection drug use (P = .02), higher admission leukocyte count (P < .004), shorter duration of fever (P = .003), shorter hospital stays (P = .0001), and a CD4 count of > 100/mm3 (P = .002). We conclude that bacterial infection, especially pneumonia, is a common cause of fever in HIV-infected patients admitted to our hospital. Patients with bacterial infections are more likely to report a history of injection drug use and have CD4 counts of > 100/mm3, shorter duration of fever, decreased length of hospitalization, and lower mortality than patients with fever due to PCP, disseminated MAC infection, or other causes.

AIDS-Related Opportunistic Infections↗
PubMed1996

[Pneumocystis carinii pneumonia in AIDS: retrospective analysis of 80 documented cases (1985-1993)].

Eighty initial episodes of HIV-associated Pneumocystis carinii pneumonia (PCP) diagnosed at Bordeaux hospital between 1985 and 1993 are reported (57 were men and 23 women). PCP revealed HIV infection in 29 patients (36%). Others cases were patients with poor medical follow up (10%), with a CD4+ lymphocyte count above 200/mm3 at last follow-up (9%), non compliant with PCP prophylaxis (9%), or using aerolized pentamidine (AP+) (20%). The main clinical symptoms were fever (90%), dyspnea (68%), non productive (63%) and productive (17%) cough. Radiographic infiltrates were purely interstitial (59%), acinar and interstitial (25%), purely acinar (5%) and absent (11%). Thirty-eight percent of AP+ had upper lobe preferential involvement and 13% a pleural effusion. In all cases, Pneumocystis carinii was detected in bronchoalveolar lavage. Extrapulmonary localizations of pneumocystosis were noticed (eye, liver, spleen, ascitis) in two AP+. Mean CD4+ count was 54/mm3 in patients not having received aerolized pentamidine (AP-) and 22/mm3 in AP+. P24 antigenemia was positive in 53% (AP-) and 88% (AP+). PaO2 LDH and albuminemia were similar in both groups. Antimicrobial therapy (Cotrimoxazole in 91% of the cases) was combined with corticosteroids in 45% and mechanic ventilation in 19%. After 30 days of follow-up, 17 deaths were observed (21%) and 14 attributed to PCP: mortality was worse in AP+ (31%) than in AP- (19%). The main conclusions of our study are the followings: HIV related PCP is still in 1995 frequent and severe; atypical features should not rule out diagnosis; preventive measures are neither sufficient nor efficient. PCP remains in 1995 a priority in HIV related public health and therapeutical research.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

[A study of initial antiretroviral therapy effectiveness, survival and safety in HIV+ patients].

OBJECTIVE: To study initial antiretroviral therapies indicated for HIV-infected patients during the 2001-2003 period regarding effectiveness, survival and safety. METHOD: A descriptive, retrospective study of clinical and drug-related variables of naïve HIV-infected patients through pharmacotherapeutic history. RESULTS: Mean CD4+ lymphocytes counts were 209.6 cells/mm3. Pneumonia by Pneumocystis carinii was the most commonly found condition at antiretroviral treatment onset. Most commonly used therapies included those based on a non-nucleoside reverse transcriptase inhibitor (NNRTI) combined with two nucleoside reverse transcriptase inhibitors (NRTIs). The longest mean survival was achieved by using combinations of three nucleoside reverse transcriptase inhibitors. The primary reason for initial antiretroviral therapy discontinuation were adverse effects, with stavudine exhibiting the poorest tolerability. CONCLUSIONS: Therapies based on non-nucleoside reverse transcriptase inhibitors and protease inhibitors (PIs) have shown similar effectiveness to increase CD4+ cell counts. Regarding viral load decreases, protease inhibitors were most effective. Therapies using three nucleoside reverse transcriptase inhibitors resulted in peak survival.

Adult↗
PubMed1993

Oral lesions in children born to HIV-1 positive women.

A cohort of 69 children born to HIV-1 positive women was studied to evaluate types, prevalences and relationships to clinical stages of HIV-1-related oral lesions. In addition, relationships among C. albicans biotypes, clinical features of oral candidiasis and HIV-1 disease were investigated. C. albicans biotypes did not correlate with clinical features of oral lesions, disease stages and CD4+ lymphocyte count. Of 8 patients with recurrent oral candidiasis, 4 changed clinical features and 5 changed biotype. Our study pointed out the high frequency (28.9%) of oral lesions, especially caused by fungi and the importance of the examination of the oral cavity in children born to HIV-1 positive women.

AIDS-Related Opportunistic Infections↗
PubMed2006

Additive deleterious effects of methamphetamine dependence and immunosuppression on neuropsychological functioning in HIV infection.

Methamphetamine (MA) dependence and HIV infection are independently associated with cerebral dysfunction, especially within frontal-basal ganglia circuits. Recent evidence indicates that MA dependence has an additive effect on neuropsychological (NP) deficits associated with HIV infection. This study extends prior findings by examining the combined effects of MA dependence (MA+) and immunosuppression (i.e., CD4 lymphocyte count <200) on NP functioning in 284 HIV+ individuals. Prevalence of NP impairment was examined in four demographically comparable groups: (1) MA+/CD4 < 200; (2) MA+/CD4 > or = 200; (3) MA-/CD4 < 200; and (4) MA-/CD4 > or = 200. Results revealed that both MA dependence and immunosuppression were significant predictors of NP impairment. More importantly, additive effects were evident whereby the MA+/CD4 < 200 group exhibited the highest rate of NP impairment. Findings indicate that MA dependence conveys an additive deleterious impact on NP status in immunosuppressed persons with HIV infection, perhaps reflecting the combined effects of neuropathophysiological mechanisms in fronto-striatal circuits.

Adult↗
PubMed2001

Modeling changes in CD4-positive T-lymphocyte counts after the start of highly active antiretroviral therapy and the relation with risk of opportunistic infections: the Aquitaine Cohort, 1996-1997.

After initiation of a treatment for human immunodeficiency virus type 1 infection containing a protease inhibitor, immune restoration associated with increases in CD4-positive (CD4+) T lymphocyte count may be delayed. In a sample of patients who had been prescribed protease inhibitors for the first time, the authors tested to see whether there was a minimal duration of CD4+ cell count increase before the increase had an impact on the occurrence of opportunistic infections. The evolution (difference between time t and baseline) of CD4+ cell count was modeled using a mixed effects linear model. Changes in CD4+ count estimated by this model were then included as time-dependent covariates in a proportional hazards model. Finally, the authors tested for the existence of a CD4+ change x time interaction. The authors used a sample of 553 French patients first prescribed protease inhibitors in 1996 and followed for a median of 16 months. During the first 120 days, there was no association between CD4+ change and the rate of opportunistic infections. After 120 days, each 50-cell/mm3 increase in CD4+ count was associated with a 60% (95% confidence interval: 45, 72) reduction in the incidence of opportunistic infections. These results, based on modeling of CD4+ cell response, at least indirectly reinforce the concept of a delayed but possible immune recovery with the use of protease inhibitors. The findings support the potential for interruption of certain types of prophylaxis against opportunistic infections under reasonable conditions of duration of antiretroviral therapy and sustained CD4+ cell response.

AIDS-Related Opportunistic Infections↗
PubMed1999

[Primary gastrointestinal lymphoma in patients infected with HIV: study of 15 cases in a series of 76 patients with non-Hodgkin's lymphoma and HIV infection].

BACKGROUND: To analyze the main clinical and biological data and the response to therapy in 15 patients with primary gastrointestinal lymphoma (PGIL) from a series of 76 patients with HIV related non-Hodgkin's lymphoma (NHL) diagnosed in a single institution in a 13 years period. PATIENTS AND METHODS: The main clinical, biological and evolutive data were recorded. Pathologic diagnosis of PGIL was made according to the REAL classification. Clinical stage was determined by the Ann Arbor system modified by Rohatiner et al. Response to therapy as well as overall survival (OS) were studied. Results were compared with non-PGIL HIV-related NHL patients. RESULTS: Mean age of the series was 38 years. Thirteen patients were male, and 8 intravenous drug abusers. Then had bad performance status (ECOG 2-4) and 11 B symptoms. All patients had a high grade malignant PGIL and the localization was gastric in 10 cases. The most frequent symptoms were abdominal pain (11 cases), gastrointestinal bleeding (4) and dysphagia (3). Ten patients had advanced stages (IIE2-IV). The median CD4 cell count was lower in PGIL patients (92 x 10(6)/l vs 148 x 10(6)/l; p < 0.05). Thirteen patients received intensive chemotherapy with CHOP regimen (in 5 surgical procedures were previously made). Complete response (CR) was obtained in 4 patients (31%) and 1 of them relapsed. Median OS was 10 months vs 16 months non-PGIL HIV-related lymphoma patients (p < 0.05). CONCLUSIONS: PGIL in HIV patients often presented advanced stages and high grade of malignancy. The most common localization is the stomach, and these patients usually have bad performance status and a low CD4 lymphocyte count. Response to therapy is poor. In our series OS was worse in PGIL patients than in the rest of HIV-related NHL, possibly due to the high degree of immunosuppression in the formers.

Adult↗
PubMed2005

Cryptosporidiosis and microsporidiosis in ugandan children with persistent diarrhea with and without concurrent infection with the human immunodeficiency virus.

Cryptosporidium spp. and Enterocytozoon bieneusi are enteric pathogens that have emerged as significant causes of persistent diarrhea (PD) in immunologically compromised individuals particularly in association with HIV/AIDS. We conducted a cross-sectional study on the clinical epidemiology of E. bieneusi and Cryptosporidium in children with PD, with and without HIV/AIDS, attending Uganda's Mulago National Referral Hospital. Two hundred forty-three children aged < 60 months, admitted between November 2002 and May 2003 with PD (> 14 days), were analyzed for HIV status and CD4 lymphocyte counts, and stools were screened for the presence of E. bieneusi and Cryptosporidium by microscopy and positive samples genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. Eighty (32.9%) of the children were excreting E. bieneusi, and 76 (31.3%) were excreting Cryptosporidium. Ninety-one of the 243 children had HIV, of who 70 (76.9%) had E. bieneusi, versus 10 (6.6%) of the 152 without (odds ratio = 47.33; 95% CI = 19.88 to 115.97), while 67 (73.6%) had Cryptosporidium, versus 9 (5.9%) without (odds ratio = 44.36; 95% CI = 18.39 to 110.40). Children with counts < 25% CD4 cells were more likely to have either E. bieneusi (odds ratio = 7.42; 95% CI = 3.77 to 14.69) or Cryptosporidium (odds ratio = 6.45; 95% CI = 3.28 to 12.76) than those with higher CD4 percentages. However, only HIV status was independently associated with either Cryptosporidium or E. bieneusi. Among the 243 children with PD, 67 (27.8%) were infected with both enteric pathogens, with HIV being the only independent predictor of coinfection. Finally, some 81% of HIV-infected children with PD excreted one or both organisms, compared with only 10% of children with PD testing negative for HIV. Seventy-four percent of isolates were C. hominis, the anthroponotic species, 17% were C. parvum, the zoonotic species, and 8% were a mixture of the two or others.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Disseminated nontuberculous mycobacterial infections in AIDS patients].

Disseminated nontuberculous mycobacteriosis is a frequent and late complication of HIV infection. All the 13 patients described here had CD4-lymphocyte counts < 20/mm3. The causative agent was mainly M. avium complex. But we also found, for the first time, a double infection with M. avium complex and M. "genavense" and one patient with growth of M. shimoidei in the blood culture. Clinical signs are nonspecific (fever, reduced performance, anemia). Positive cultures of blood or tissue biopsies are diagnostic. The therapeutic approach is the combination of new macrolides with other antimycobacterial agents. Prognosis is poor, mainly due to advanced immunodeficiency, but two of our patients survived more than one year after diagnosis. Prophylactic treatment should be considered in patients with CD4-counts less than 50/mm3.

AIDS-Related Opportunistic Infections↗
PubMed2003

Discordant effects of interleukin-2 on viral and immune parameters in human immunodeficiency virus-1-infected monocyte-derived mature dendritic cells.

Use of interleukin-2 (IL-2) in the immunotherapy of human immunodeficiency virus (HIV) has frequently resulted in the restoration of CD4 lymphocyte counts but not of virus-specific responses. We reasoned that the absence of reconstituted functional immune parameters could be related to the inability of IL-2 to correct HIV-induced dysfunctions in antigen-presenting cells. In this study, we used in vitro-differentiated monocyte-derived macrophages (MDMs) and mature dendritic cells (MDDCs), acutely infected with primary HIV-1 isolates, to analyse the effects of IL-2 on virus replication, co-receptor expression, and cytokine or chemokine release. Stimulation of MDMs with IL-2 had no measurable effect on HIV-1 replication, on cytokine secretion, or on CD4 and CXCR4 gene expression. Moreover, although a significant down-regulation of CCR5 mRNA expression could be repeatedly detected in MDMs, this IL-2-mediated effect was not of substantial magnitude to affect virus replication. On the other hand, IL-2 stimulation of MDDCs dramatically increased HIV-1 replication and this effect was highly evident on low-replicating, CXCR4-dependent isolates. Nevertheless, the HIV-enhancing activity of IL-2 in MDDCs was not accompanied by any measurable change in cytokine or chemokine release, in virus receptor and co-receptor mRNA accumulation, or in the surface expression of a battery of receptors implicated in virus entry, cell activation or costimulatory function. Taken together, these findings point to a role for IL-2 in inducing virus purging from dendritic cell reservoirs but indicate no relevant potential of the cytokine in restoring defective elements of innate immunity in HIV infection.

CD4 Antigens↗
PubMed1999

Studies of body composition and fat distribution in HIV-infected and control subjects.

OBJECTIVE: Recent studies have documented alterations in body fat distribution that have been associated with protease inhibitor therapy. We compared body composition, including measurements of fat distribution, in 96 HIV-infected subjects studied since January 1996 (current HIV), subjects seen prior to January 1996 (previous HIV), and healthy controls. DESIGN: Retrospective cross-sectional studies of subjects matched by gender, race, age, and height. METHODS: Body weight, height, body cell mass by whole-body counting of 40K plus fat, fat-free mass, and body fat distribution by anthropometry were measured. RESULTS: Current HIV men weighed more (p = .025) and had more body cell mass than previous HIV men, but less than controls (p < .001). In women, the between group differences in fat were greater than the differences in body cell mass. Current and previous HIV study subjects had lower indices of subcutaneous and higher indices of visceral fat than controls. In current HIV subjects, body fat distribution was significantly associated with log plasma HIV RNA content but not with antiretroviral or protease inhibitor usage, nor with CD4+ lymphocyte counts. In 7 of 9 current HIV subjects studied, 24-hour urinary free cortisol excretion was abnormally high. CONCLUSIONS: Alterations in body fat distribution are a characteristic feature in HIV infection. The occurrence of increased visceral fat content and decreased subcutaneous fat content preceded the era of combination antiretroviral therapy. The alteration in fat distribution may be affected by plasma HIV RNA content rather than antiretroviral or protease-inhibitor therapy. The body composition alterations might be associated with endogenous hypercortisolism.

Adult↗
PubMed2006

A behavioral and cognitive profile of clinically stable HIV-infected children.

OBJECTIVE: The purpose of this research was to characterize behavioral and cognitive profiles of clinically and immunologically stable antiretroviral-experienced HIV-infected children. METHODS: Two hundred seventy-four previously treated HIV-infected children aged 2 to 17 years were assessed for behavioral, developmental, and cognitive functioning. Correlations between neuropsychological measures, age, and CD4 lymphocyte count were investigated. RESULTS: The most common behavioral problems, as measured by the Conners' Parent Rating Scale, were psychosomatic (28%), learning (25%), hyperactivity (20%), impulsive-hyperactive (19%), conduct (16%), and anxiety (8%) problems. Mean Wechsler Intelligence Scale for Children-III scores were less than established population norms; the mean verbal IQ was 85, the mean performance IQ was 90, and the mean full-scale score was 86. Hyperactivity was more frequent in children with a Wechsler Intelligence Scale for Children-III performance IQ of <90. Anxiety problems were more likely in children > or =9 years of age. Children with CD4 counts of <660 cells per mm3 were more likely to be identified as having a conduct disorder. No association was noted between behavioral problems and neuroimaging. CONCLUSIONS: Clinically and immunologically stable HIV-infected children had more frequent behavioral problems and lower developmental and cognitive scores than established childhood norms.

Adolescent↗
PubMed2004

Highly active antiretroviral therapies among HIV-1-infected children in Abidjan, Côte d'Ivoire.

OBJECTIVE: To describe the effect of highly active antiretroviral therapy (HAART) in HIV-1-infected African children. STUDY DESIGN: Observational ANRS 1244 cohort of 159 children with HIV between October 2000 and September 2002; 78 children (49%) receiving HAART were followed for a mean duration of 21 months. METHODS: Weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ), CD4 lymphocyte count and HIV-1 RNA viral load were measured before initiating HAART and every 6 months during treatment. Probability of survival and incidences of pneumonia and acute diarrhoea were calculated. RESULTS: Values before and after 620 days of HAART, respectively, were -2.02 and -1.39 for mean WAZ, (P < 0.01); -2.03 and -1.83 for mean HAZ (P = 0.51); 0.07 and 0.025/child-month (P = 0.002) for incidence of pneumonia; and 0.12 and 0.048/child-month for incidence of acute diarrhoea (P < 0.001) (incidence changes statistically significant only in children < 6.5 years). Overall, the probability of survival under HAART was 72.8% at 24 months for children with < 5% CD4 cells versus 97.8% in children with >/= 5% (P < 0.01). At HAART initiation, median viral load and CD4 cell percentage were 5.41 log10 copies/ml and 7.7%, respectively. After 756 days of HAART, on average, 50% of patients had undetectable viral load and 10% had 2.4-3.0 log10 copies/ml. The median CD4 percentage was 22.5%. CONCLUSION: In resource-limited setting, it is possible to use HAART to treat African children. This treatment appears as effective as in developed countries.

Adolescent↗
PubMed1994

[Primary and secondary prevention of Pneumocystis carinii pneumonia with pentamidine aerosol. Effectiveness, side effects and incidence of extrapulmonary Pneumocystis carinii manifestations].

BACKGROUND: We report on a retrospective study in 544 HIV-positive patients, (42 women, 502 men, mean age 35 years) showing CD4 lymphocyte counts below 200 c/mcl or after their cure of Pneumocystis carinii pneumonia, who received 300 mg pentamidine aerosol as prophylaxis against Pneumocystis carinii pneumonia every four week. PATIENTS AND METHODS: 277 patients were asymptomatic, 120 in the AIDS related complex stage (ARC) and 147 in the full stage of AIDS. The mean follow-up was 14.4 months. RESULTS: A total of 25 cases of Pneumocystis carinii pneumonia was observed (3.83/year): in the primary prophylaxis group 18 (3.25%/year), in the secondary prophylaxis group seven (6.8%/year). By introducing the loading dose (one inhalation per day for five consecutive days for patients with CD4 cell counts below 150 c/mcl) we reduced the percentage of early manifestations within the first three months from 61% to 14%. No extrapulmonary Pneumocystis carinii manifestation was observed. CONCLUSION: This study supports the efficacy of pentamidine aerosol prophylaxis of primary and secondary Pneumocystis carinii pneumonia.

AIDS-Related Opportunistic Infections↗
PubMed1996

Lung cancer in patients with HIV-infection.

PURPOSE: To identify and review the clinical characteristics and natural history of lung cancer in HIV-seropositive patients. A secondary objective was to compare the clinical features of HIV-seropositive and HIV-indeterminate lung cancer cases at our institution. PATIENTS AND METHODS: Sixteen patients with HIV infection and lung cancer were diagnosed between January 1988 and March 1995 at our institution and the clinical records were reviewed. HIV-indeterminate lung cancer cases were identified by the Albany Medical Center Hospital (AMCH) Tumor Registry. A Medline database search of HIV infection/AIDS and lung cancer was undertaken through December 1994. The New York State Department of Health (NYSDOH), Bureau of Cancer Epidemiology provided information on the incidence of lung cancer among residents of New York State by county of residence. Case reports and series regarding the clinical features of HIV-seropositive patients with lung cancer were reviewed. A more focused comparison between HIV-seropositive and HIV-indeterminate male lung cancer cases between 35 and 54 years of age at our institution was performed. The following clinical variables were identified in our 16 patients and 109 cases extracted from available clinical reports: sex, age, year and county of residence at time of lung cancer diagnosis, cigarette smoking history, HIV risk behavior, CD4 count at time of lung cancer diagnosis, CDC classification of HIV disease, interval in months from time of HIV seropositivity to lung cancer diagnosis, pathology and stage of lung cancer, performance status, treatment, response, and survival. RESULTS: Lung cancer in HIV-seropositive patients is characterized by the following: a younger age at time of diagnosis when compared to HIV-indeterminate cases; the majority of cases occur in a background of extensive cigarette smoking; over 80% of patients present with advanced stage of lung cancer (stage III and IV); up to 50% of cases have asymptomatic to mildly symptomatic HIV infection with a median CD4 lymphocyte count of 233 per microliter; there is a predominance of adenocarcinoma histopathology; and shortened survival when compared to HIV-indeterminate cases. CONCLUSION: Current reports of lung carcinoma in HIV-seropositive patients suggest that the natural history of this disease is different than in HIV-indeterminate cases. Lung cancer must be considered in the differential diagnosis of a solitary mass lesion on chest X-ray in HIV-seropositive patients.

Adult↗
PubMed1995

Prospects for preventing cryptococcosis in persons infected with human immunodeficiency virus.

Cryptococcosis is a major cause of illness and death among persons infected with human immunodeficiency virus (HIV). Its management must include both initial and maintenance treatment. Although most authorities favor an initial period of therapy with amphotericin B for acute cryptococcosis, the triazoles play a role in both the management of acute disease and subsequent maintenance therapy. AIDS surveillance data collected by the Centers for Disease Control and Prevention document the occurrence of cryptococcosis in more than 17,000 (6.2%) of adults with AIDS in the United States, although this figure is known to be an underestimate. The risk of cryptococcosis among HIV-infected persons is highest at CD4+ lymphocyte counts of < 100/microL. Although cryptococcosis is especially frequent among AIDS patients who are black, male, or injection drug users, the explanations for these patterns remain unclear. Whether geographic differences in rates of cryptococcosis result from variations in the environmental distribution of Cryptococcus neoformans as well as in the distribution of HIV infection is also unclear. Although exposure to pigeon feces is the best known of the putative exposure-related risk factors, proof is lacking that avian excreta are the primary environmental source of the organism in most cases of cryptococcosis. Prophylaxis with triazoles can prevent cryptococcosis and may be considered for adults and adolescents with CD4+ counts of < 50/microL. However, it is uncertain whether prophylaxis will affect survival, be cost-effective, or have an adverse impact on the susceptibility of a variety of fungi to antifungal drugs. Vaccines and monoclonal antibodies designed to prevent or modify cryptococcosis in HIV-infected persons are in the experimental stage.

Adult↗
PubMed1996

Determinants of nontraditional therapy use in patients with HIV infection. A prospective study.

BACKGROUND: The popularity and use of nontraditional therapies among patients with human immunodeficiency virus (HIV) infection has grown enormously. DESIGN: A prospective, longitudinal cohort study of 56 patients aged 23 through 68 years with HIV infection followed up at the HIV clinic at a university-affiliated Veterans Affairs Medical Center. OBJECTIVE: To assess the demographic and psychologic characteristics of patients who seek nontraditional remedies, and their impact on disease progression and mortality from HIV. METHODS: A standardized, self-administered questionnaire to assess the incidence and type of nontraditional therapies used by patients with HIV. Data on demographics, medical status, physical functioning (Karnofsky performance score), CD4 lymphocyte counts, depression (Beck Depression Inventory), coping (inventory of coping with illness scale), psychological and/or emotional stress (Profile of Mood States scores), and compliance with prescribed therapy were prospectively assessed on all patients at baseline and every 6 months. RESULTS: Thirty percent of patients reported using nontraditional therapies. Nontraditional therapy users were significantly older than patients who did not use such therapies (44 vs 38 years, P = .03); with 94% of patients who used nontraditional therapy being older than 35 years compared with 56% of conventional therapy users (P = .005). Alternative therapy use did not correlate with race, education, HIV-risk group affiliation, duration of HIV seropositivity, stage of HIV disease, CD4 cell count, or Karnofsky performance scores. Nontraditional therapy users reported greater community-based acquired immunodeficiency syndrome group support (P = .06), greater perceived social support (P = .08), and significantly higher recreational or "street drugs" use (P = .02). Depression, adaptive coping, and emotional stress were not different between nontraditional and conventional therapy users; however, nontraditional therapy users were significantly more assertive (P = .04). On follow-up, CD4 cell count, HIV disease progression, physical functioning, or mortality were similar between the two groups. CONCLUSIONS: Recourse to nontraditional therapy is common among patients with HIV. Because of the possibility of untoward effects and potential adverse drug interactions associated with nontraditional therapy, HIV care givers should be aware of its use in their patients and take a history of nontraditional therapy first. Patients who choose nontraditional remedies do so not because they are depressed or emotionally disturbed, but rather because they seek greater control of the outcome of their disease. However, no beneficial effect on disease progression, CD4 cell count, or mortality was observed in these patients when compared with patients receiving only conventional medical therapy.

Adaptation, Psychological↗