Cardiac dysfunction associated with the acquired immunodeficiency syndrome (AIDS)

Five patients with acquired immune deficiency syndrome (AIDS) developed clinical evidence of mild to severe cardiac dysfunction confirmed by nuclear angiography and echocardiography. In 4 patients who were studied postmortem there was no evidence of myocarditis, valvular, or ischemic heart disease. Cardiac involvement in patients with AIDS may include pericardial and myocardial involvement by opportunistic pathogens or Kaposi's sarcoma, subclinical myocardial dysfunction, or an as-yet unexplained cardiomyopathy.     

Surfactant therapy improves pulmonary function in infants with Pneumocystis carinii pneumonia and acquired immunodeficiency syndrome

Pneumocystis carinii pneumonia (PCP) is an important cause of acute respiratory failure in HIV-infected children. PCP may initiate acute respiratory distress syndrome (ARDS) by adversely affecting surfactant physiology. We report improved pulmonary function following administration of bovine lipid extract surfactant to two infants with AIDS-related PCP/ARDS. Pediatr. Pulmonol. 1997; 24:370–373. © 1997 Wiley-Liss, Inc.     

Cardiac involvement in acquired immunodeficiency syndrome—a review to push action

As more effective therapies have produced longer survival times for human immunodeficiency virus (HIV)-infected patients, new complications of late-stage HIV infection including HIV-related heart disease have emerged. Almost any agent that can cause disseminated infection in patients with acquired immunodeficiency syndrome (AIDS) may involve myocardium, but clinical evidence of cardiac disease is usually overshadowed by manifestations in other organs, primarily the brain and lungs. Cardiac abnormalities are found at autopsy in two-thirds of patients with AIDS, and more than 150 reports of cardiac complications have been published. Cardiac involvement in HIV disease includes pericardial effusion, myocarditis, dilated cardiomyopathy, and/or endocardial involvement at any stage of the disease. This review deals with all the cardiac manifestations of AIDS and serves to highlight two problems and one indication. First of all, there are very few clinical studies. Current knowledge is based almost exclusively on echocardiography and autopsy studies. Observational or clinical trials would be useful. Second, there exists very poor information on the impact of treatment; and epidemiologic and clinicopathologic studies are mandatory for obtaining detailed data concerning the mechanisms of myocardial damage in AIDS. Finally, because cardiac complications are often clinically inapparent or subtle in the initial stages, periodic screening of HIV-positive patients by electrocardiogram and echocardiogram is probably indicated. in addition, AIDS may also provide the opportunity to gain insights into the pathogenesis of little understood cardiac diseases such as lymphocytic myocarditis and dilated cardiomyopathy.     

艾滋病并肺部机会性感染2例临床分析

目的增强对艾滋病引发肺部机会性感染的诊断意识,减少误诊、漏诊发生。方法报告我院诊断的2例艾滋病患者,并复习相关文献。结果艾滋病容易引发肺部机会性感染,其中以卡氏肺囊虫肺炎和真菌感染最常见。结论艾滋病并肺部机会性感染发病率逐年增多,应当受到重视。     

Prognostic factors in acquired immunodeficiency syndrome

To identify prognostic factors in acquired immunodeficiency syndrome (AIDS), the authors studied an inception cohort of 45 patients in a non-endemic area (Group I). The probability of survival was 67% six months after the diagnosis of AIDS and 32% at 12 months. As shown by multivariate Cox regression analysis, survivals were shorter (p<0.01) in patients 35 years old or older and in those who had anemia when AIDS was diagnosed. In patients with neither of these poor prognostic factors, the 12-month survival was 64%; in patients with one factor, it was 22%; and in patients with both factors, 0%. The prognostic significance of these two factors was validated in a second inception cohort of 50 patients (Group II): in patients with zero, one, and two poor prognostic factors, the 12-month survivals were 80%, 58%, and 26%, respectively. Other poor prognostic factors in Group I included disseminatedMycobacterium avium-intracellulare and the development of new opportunistic infections or neoplasms. The authors conclude that clinically important prognostic factors can be identified in AIDS patients. These findings should be considered in planning therapeutic trials and in counseling patients. Received from the Divisions of General Internal Medicine, Infectious Disease, and Geographic Medicine, Department of Medicine and the Clinical Analysis Project, University Hospitals of Cleveland; the Division of Infectious Disease, Department of Medicine, Cleveland Metropolitan General Hospital; the Department of Infectious Disease, Cleveland Clinic Foundation; and Case Western Reserve University School of Medicine. Dr. Wenger is now with the Centers for Disease Control, Atlanta, Georgia. Supported in part by Grant Al-25314 from the NIAID.     

Echocardiographic detection of kaposi's sarcoma causing cardiac tamponade in a patient with acquired immunodeficiency syndrome

Pericardial effusions are common in patients with acquired immunodeficiency syndrome (AIDS). The differential diagnosis is diverse, and in most cases the etiology cannot be established. A cardiac tamponade was diagnosed in a 32-year-old male with AIDS and systemic Kaposi's sarcoma. Transthoracic echocardiography revealed a large pericardial effusion with right atrial collapse and a mobile multilobular mass at the apex protruding into pericardial space. Autopsy showed that this mass was Kaposi's sarcoma confined to the epicardial fat. This is the first case of cardiac Kaposi's sarcoma detected premortem by echocardiography.     

Multicenter trial of octreotide in patients with refractory acquired immunodeficiency syndrome-associated diarrhea

Diarrhea is a significant problem in patients with acquired immunodeficiency syndrome (AIDS). The aim of this study was to determine octreotide effectiveness in refractory AIDS-associated diarrhea. In a 3-week protocol, 129 patients with a stool weight of >500 g/day despite standard antidiarrheal therapy were randomized to receive octreotide or placebo (3:2 ratio). Octreotide dose was increased 100 μg weekly to a maximum of 300 μg three times a day based on weekly 72-hour stool collections. Subsequently, patients received open-label octreotide at doses of up to 500 μg three times a day. A 30% decrease in stool weight defined response. After 3 weeks, 48% of octreotide- and 39% of placebo-treated patients had responded (P = 0.43). At 300 μg three times a day, 50% of octreotide- and 30.1% of placebo-treated patients responded (P = 0.12). At a baseline stool weight of 1000–2000 g/day, 57% of octreotide- and 25% of placebo-treated patients responded (P = 0.06). Response rates based on CD4 counts, diarrhea duration, body weight, human immunodeficiency virus risk factor, and presence or absence of pathogens showed no benefit of octreotide. Adverse events were more frequent in the octreotide-treated group. In the doses studied, octreotide was not more effective than placebo in patients with refractory AIDS-associated diarrhea. This lack of effectiveness may be attributable to inadequate sample size, doses, and duration of study treatment.     

Human immunodeficiency virus infection in Haemophiliacs in Taiwan: the importance of CD4 lymphocyte count in the progression to acquired immunodeficiency syndrome

From July 1984 to December 1996, we tested and studied 303 haeophilic patients for the infection of the human immunodeficiency virus (HIV). Among the 261 Haemophilia A patients 44 were HIV positive (16.9%), while none of the Haemophilia B patients was HIV positive. The mean age of the 44 HIV-seropositive patients in 1984 was 20.6 years (2–37 years). Seven who had known seroconversion dates and 29 whose first seropositive dates were known seroconverted before 1986. Acquired immunodeficiency syndrome (AIDS) has developed in 16 patients, nine of whom presented with Pneumocystis carinii pneumonia, three with tuberculosis infection, and 13 had died. The Kaplan–Meier estimate of the progression rate to AIDS after the date of first seropositive test is about 30% at the 10th year. The median survival time after development of AIDS obtained from the Kaplan–Meier estimate of the survival curve was 11.7 months. Statistical analysis for the covariate effects on the risk of developing AIDS by the Cox proportional hazards model revealed that there was a statistically significant negative association of the risk for progression to AIDS with the logarithm of initial CD4 cell counts ( P  = 0.027) and the rate of decline of CD4 cell counts ( P  = 0.040), but not with age ( P  = 0.650). In conclusion, the clinical characteristics of AIDS Haemophiliacs in Taiwan were not different from that observed in western countries. Low initial CD4 cell count and sharp decline in CD4 cell counts, but not age, increased the risk of progression to AIDS.     

Injection treatment of hemorrhoids in patients with acquired immunodeficiency syndrome

PURPOSE: Patients with acquired immunodeficiency syndrome are often in poor general physical condition. Diarrhea and bleeding hemorrhoids frequently contribute to the morbidity, and patients with such problems cause an increasing load on many outpatient clinics. METHODS: Twenty-two patients (17 males) with acquired immunodeficiency syndrome had injection treatment for bleeding second-degree to fourth-degree hemorrhoids according to standard outpatient clinic routines. Mean follow-up was 24 months. RESULTS: No complications were recorded. The treatment was successful in all patients, and no hemorrhoidectomy was necessary. Nineteen patients improved after their first injection, whereas 3 patients required two to six weeks repeated treatments to improve. Four subjects with the longer follow-up (4 years) showed an improvement lasting 12 to 18 months and then required one to two treatments per year to stop recurrent bleeding. CONCLUSIONS: Because of their poor general condition and poor wound healing, a conservative approach is preferable to avoid a formal hemorrhoidectomy in patients with acquired immunodeficiency syndrome. Sclerotherapy seems to be an attractive alternative.Presented at Current Trends in Colon and Rectal Surgery, Sorrento, Italy, September 23 to 26, 1998.     

以腹痛为主要表现的获得性免疫缺陷综合征临床分析

[目的]探讨以腹痛为主要表现的获得性免疫缺陷综合征(AIDS)的临床特征,以提高对该病的认识。[方法]对22例AIDS患者的临床资料进行回顾分析,并结合文献进行复习。[结果]全部患者均有腹痛(100%),其他主要症状为腹胀(77.3%)、腹泻(59.1%)、吞咽困难或吞咽疼痛(22.7%)、口腔炎或口腔真菌感染(18.2%)、纳差(72.7%)、乏力(68.2%)、不明原因发热(31.8%)、体质量减轻(40.9%)等,2例(9.0%)面部出现米糠样皮疹。胃镜下主要表现为胃黏膜充血水肿、糜烂,结肠黏膜主要表现为弥漫性或局限性充血水肿、糜烂或浅表溃疡等。[结论]AIDS以腹痛等消化系统症状为主要表现者比较多见,但临床表现无特异性,临床医务人员尤其是消化内科医师要不断提高对该病的认识,早诊早治,减少误诊。     

Hepatic portal venous gas due to cryptosporidiosis in a patient with acquired immunodeficiency syndrome

Although the presence of hepatic portal venous gas (HPVG) on computed tomography (CT) is typically an ominous finding, HPVG may sometimes be less catastrophic. The clinical significance of HPVG is variable, and it depends primarily on the underlying pathology. We report a case of a patient with acquired immunodeficiency syndrome (AIDS) who was found to have HPVG on CT as a presumed result of gastrointestinal cryptosporidiosis, an association that, to our knowledge, has not been reported. This case illustrates another cause of HPVG that should be considered in patients with AIDS.     

Pancreatic tuberculosis with acquired immunodeficiency syndrome: a case report and systematic review

Pancreatic tuberculosis (TB) is a relatively rare disease that can mimic carcinoma, lymphoma, cystic neoplasia, retroperitoneal tumors, pancreatitis or pseudocysts. Here, I report the case of a 31-year-old immigrant Burmese woman who exhibited epigastralgia, fever, weight loss and an epigastric mass. The patient was diagnosed with pancreatic TB and acquired immunodeficiency syndrome, and was treated with antituberculous drugs and percutaneous catheter drainage without a laparotomy. The clinical presentation, radiographic investigation and management of pancreatic TB are summarized in this paper to emphasize the importance of considering this rare disease in the differential diagnosis of pancreatic masses concomitant with human immunodeficiency virus infection. I also emphasize the need for both histopathological and microbiological diagnosis via fine-needle aspiration.     

Generalised tuberculosis in a patient with acquired immunodeficiency syndrome

We describe a heroin addict who presented with cellular immunodeficiency, generalised tuberculosis, and pneumonia caused by Pneumocystis carinii, and discuss the risk of these associations.     

艾滋病合并结核病的诊断与治疗

目的 探讨艾滋病合并结核病的临床特点和治疗方法 .方法 对1995～2000年期间在本院诊断的10例艾滋病合并结核病的患者进行分析.结果 (1)临床分型血行播散型肺结核合并结核性脑膜炎3例,淋巴结结核4例(其中肠系膜淋巴结结核1例、纵隔淋巴结结核+颈部淋巴结结核1例、颈部淋巴结结核2例),原发型肺结核3例,同时合并其它机会性感染如卡氏肺孢子虫肺炎(PCP)等.(2)免疫功能检测和结核菌素试验CD+4(2～87)×106/L,其中7例CD+4＜50×106/L,平均CD-4(33±13)×106/L.10例结核菌素(PPD)试验均阴性.(3)治疗5例联合抗结核+高效抗逆转录病毒治疗(HLAART),5例单用抗结核治疗,其中HAART组CD+4细胞上升明显,与单独抗结核治疗相比,差异有显著性(P＜0.05).结论 CD+4细胞下降可能是艾滋病并发结核病的主要原因.结核菌素试验对诊断无帮助.艾滋病合并结核病的患者,血行播散型肺结核多、肺外结核多、合并症多、临床表现复杂多样、治疗时间长.联合高效抗逆转录病毒治疗能缩短病程,改善艾滋病合并结核病的预后.     

The role of tumour necrosis factor-α in acquired immunodeficiency syndrome

Abstract. Tumour necrosis factor-α (TNF) is a primary mediator in the pathogenesis of infection, tissue injury and inflammation. It is synthesised by various activated, phagocytic and non-phagocytic cells, and a wide variety of infectious or inflammatory stimulae are capable of triggering TNF biosynthesis. Recent studies indicate that overproduction of TNF in septicaemia is a critical step in triggering septic shock and multiple organ damage. Intravenous administration of recombinant human TNF induced the same types of derangement in cardiovascular homatologic, inflammatory and metabolic homeostasis that are found with endotoxic or septic shock. Chronic TNF production causes a potentially lethal syndrome of cachexia, anaemia, and protein and lipid wasting. Several investigators have recently demonstrated elevated levels of serum TNF in patients with acquired immunodeficiency syndrome (AIDS), these levels being closely correlated with the severity of the disease. This review discusses the role of TNF in the pathophysiology of AIDS and of several disorders associated with the latter. In addition, it discusses the interactions between TNF and several agents used in AIDS therapy, and suggests the use of TNF-antagonists in combination as a therapeutic regimen for AIDS patients.     

Strong impact of highly active antiretroviral therapy on survival in patients with human immunodeficiency virus-associated Hodgkin's disease

Hodgkin's disease (HD) is the most common non-acquired immunodeficiency syndrome (AIDS)-defining malignancy in human immunodeficiency virus (HIV)-infected patients. We analysed the outcome of patients with HIV-associated HD (HIV-HD) with respect to the use and efficacy of highly active antiretroviral therapy (HAART) and other prognostic factors. To evaluate the effects of several variables on overall survival (OS), Kaplan-Meier statistics and extended Cox regression analysis were performed. Response to HAART was used as a time-dependent variable and was defined as an increase of >0.1 x 10(9) CD4 cells/l and/or at least one viral load <500 copies/ml during the first 2 years following diagnosis of HIV-HD. Fifty-seven patients with HIV-HD diagnosed between 1990 and 2002 were included in the study. In the Cox model, the only factors independently associated with OS were HAART response [relative hazard (RH) 0.19; 95% confidence interval (CI) 0.06-0.60], complete remission (RH 0.30, 95% CI 0.13-0.72), and age 相似文献   

获得性免疫缺陷综合征合并肺结核临床特征与T细胞亚群的相关性分析

目的 探讨获得性免疫缺陷综合征合并肺结核(AIDS/PTB)双重感染的类型,影像特征及临床表现为PTB菌阴及菌阳时,患者T细胞亚群计数的差异及意义.方法 回顾性分析93例AIDS/PTB双重感染患者的类型,影像特征及临床表现分别为PTB菌阴及菌阳时,检测其T细胞亚群水平并进行统计学比较.结果 ①CD4+细胞计数与结核病的发病率成反比,当CD4+＜50×106/L时,结核的发病率明显上升(67.74%,63/93).②影像特征不典型的PTB病例CD4+T细胞计数为(47.79±32.17)×106/L,影像特征典型的PTB病例CD4+T细胞计数为(95.3456±64.89)×106/L.二者之间CD4+T细胞计数差异有统计学意义(P＜0.01).③不同临床表现患者CD4+T细胞计数差异有统计学意义,PTB菌阴组患者明显高于PTB菌阳组患者(P＜0.02),CD8+T细胞计数比较差异无统计学意义(P＞0.05).结论 AIDS/PTB感染患者临床特征与其T细胞亚群计数相关.     

Thrombotic thrombocytopenic purpura in patients with human immunodeficiency virus infection: a report of three cases and review of the literature.

Three cases of thrombotic thrombocytopenic purpura (TTP) and coexistent human immunodeficiency virus (HIV) infection are presented with a review of 15 cases reported in the literature. Of the 18 total patients, one-half presented with no symptoms of HIV infection while nine patients presented with symptomatic HIV disease before or simultaneous to the diagnosis. The presenting symptoms were similar to those with classic TTP and included fever in 75% and 40% with neurologic symptoms. Laboratory parameters reflected the microangiopathic hemolytic anemia typically seen in patients with TTP. The median hematocrit was 19.4%, while the median platelet count was 16,000/mm3. As with classic TTP, patients with HIV-related TTP only had mild renal dysfunction (median creatinine of 1.2 mg/dl, range 0.8-4.8 mg/dl). Plasma exchange produced clinical remission in a majority of the patients. Importantly, approximately one-third of the patients died prior to the initiation of therapy. We conclude that TTP is a rare but treatable condition in patients with HIV infection. A TTP diagnosis should be considered in patients with HIV infection who present with severe anemia and thrombocytopenia. Plasma exchange should be considered as initial therapy. The role of both antiplatelet therapy and aspirin is unknown.     

获得性免疫缺陷综合征心脏损伤的临床分析

目的 :探讨获得性免疫缺陷综合征 (AIDS)的心脏损伤及相应的心电图改变。方法 :回顾性分析 1995～ 2 0 0 0年间收治的 2 5例 A IDS患者的临床资料 ,并结合文献复习。结果 :2 5例患者心电图表现分别为窦性心动过速、束支传导阻滞、Q- T间期延长及 ST- T改变 ;超声心动图提示心脏增大 ,射血分数降低 ,临床上多死于循环、呼吸衰竭。结论 :心脏损伤是人类免疫缺陷病毒感染的相关心肌病变 ,也是 AIDS致死的主要原因 ,尽早地对A IDS患者进行心电图及超声心动图监测 ,对治疗及改善预后有着重要的作用。     

Porphyria cutanea tarda associated with the acquired immune deficiency syndrome

Three male subjects with cutaneous symptoms and biochemical signs typical of porphyria cutanea tarda (PCT) developed acquired immune deficiency syndrome (AIDS). All three were in a classic high risk group for the latter disease and developed a typical progressive illness. Two patients succumbed to opportunistic infections; the third is alive but critically ill. The symptomatic prodrome of AIDS developed concurrently with or followed the onset of symptoms of PCT in all three individuals. PCT and AIDS are both uncommon disorders; their association in three patients is thus of inherent clinical interest. If this association is not coincidental, it raises the possibility that the occurrence of photosensitivity, skin lesions, and evidence of biochemical changes characteristic of PCT may, in certain patients at risk for AIDS, presage the subsequent full clinical expression of the latter disease.