Human immunodeficiency virus/acquired immunodeficiency syndrome in pregnant women.

A pregnant woman experiences selective immunosuppression as a physiologic response to the presence of a genetically heterologous fetus. Case reports early in the acquired immunodeficiency syndrome (AIDS) epidemic suggested that adverse human immunodeficiency virus (HIV)-related clinical outcomes might be causally associated with pregnancy. A review of relevant published data indicates that: (1) Adverse clinical outcomes of pregnancy are common among HIV-infected pregnant women, but no studies to date have fully disentangled the many confounding factors. (2) HIV-related complications are common in pregnancy only among immunosuppressed (< 300 CD4+ cells/mm3) women. (3) The distinct effect of pregnancy on the expression of HIV infection cannot be evaluated in the absence of appropriately controlled observations. (4) Cofactors for perinatal transmission are poorly understood. (5) Research into the motives for reproductive decisions and behaviors is of critical importance for improving our health education and outreach efforts for high-risk women. (6) Adequate clinical treatment and prophylactic health care services must be made easily accessible and available to women at high risk of HIV disease. (7) Treatment with available antiviral and anti-Pneumocystis drugs is advisable for HIV-infected pregnant women with fewer than 300 to 350 CD4+ cells/mm3, though data to definitively guide therapeutic decision making are not available. (8) Large multicenter studies are needed to recruit patients and to retain them in sufficient numbers, allowing for better evaluation of the many variables determining clinical outcomes for HIV-infected mothers and their infants. The natural history of HIV in pregnant women must be studied to facilitate clinical decision making, and to design and implement interventions, including prevention (behavior change, vaccines) and treatment (chemotherapy, immunotherapy).     

Physiopathology and treatment of acquired immunodeficiency syndrome

The last pandemia of the century, that of the Acquired Immunodeficiency Syndrome (AIDS) caused by the Human Immunodeficiency Virus (HIV), continues to advance with gigantic steps at about 18,000 new infections per day worldwide. In the last four years, breakthroughs have been achieved and new medications have been introduced, which have impacted the progression of HIV and its disease, decreasing associated morbidity and mortality. During the course of infection, HIV replicates actively producing as much as 10(10) genetically different virions (quasi-species), which relates to immune escape, higher pathogenicity and drug resistance. Persistent viral replication causes T CD4+ cell destruction and immunodeficiency through several mechanisms. Currently, there are 14 approved anti-retrovirals that when used as triple regimens have been able to decrease opportunistic infections, hospitalization and mortality rates. Unfortunately, these regimens still have many limitations, do not cure and can only suppress the virus effectively in 50% of the treated patients. Besides, when they are inadequately used there is associated resistance development. On the other hand, indications for treatment initiation are changing continuously and heading towards a conservative approach. In the case of salvage regimens, there are only general guidelines that have not been evaluated in clinical studies. Resistance assays have great limitations and their use is very specific. All these factors have made antiretroviral treatment a very complicated issue that should be prescribed and followed by an expert.     

Selenium deficiency and cardiomyopathy in acquired immunodeficiency syndrome

Selenium deficiency is common in patients with human immunodeficiency virus infection and may contribute to the development of cardiomyopathy. A 5-year-old boy with congenital human immunodeficiency virus infection developed cardiomyopathy. Evaluation for reversible causes of cardiomyopathy was notable for the diagnosis of selenium deficiency. Cardiac function improved on selenium supplementation. The role of selenium in cardiac dysfunction and the need for nutritional evaluation and supplementation of malnourished patients with acquired immunodeficiency syndrome is discussed.     

Selenium deficiency in the acquired immunodeficiency syndrome

Severe protein-calorie malnutrition is common in patients with AIDS (acquired immunodeficiency syndrome). These nutritional deficits are likely to further impair immune responses and other organ functions vital for recovery from serious infectious diseases. Since selenium deficiency is known to be associated with oral candidiasis and abnormal phagocytic function in animals and depressed helper T-cell numbers in man, we evaluated both selenium status and other nutritional parameters in 12 patients with AIDS compared to 27 healthy controls. Selenium was measured by a spectrofluorometric method. The mean (+/- SD) plasma selenium level in AIDS was 0.043 +/- 0.01 microgram/ml vs 0.095 +/- 0.016 microgram/ml in controls (p less than 0.001). Whole blood selenium and red blood cell selenium levels were also significantly reduced in AIDS (p less than 0.005). The mean weight loss in AIDS patients was 35.5 +/- 21.2 pounds. Serum albumin was significantly (p less than 0.01) lower in AIDS patients compared to controls. A good correlation between serum albumin and plasma selenium was noted (r = 0.77; p less than 0.001). We conclude that selenium deficiency is a common component of the malnutrition seen in AIDS patients. Therefore, aggressive nutritional support, including attention to selenium status, should be considered an integral part of the therapy of AIDS patients.     

Cardiac toxoplasmosis in pathology of acquired immunodeficiency syndrome

Four cases of myocarditis from toxoplasma gondii were observed at autopsy among 18 consecutive cases of acquired immunodeficiency syndrome (AIDS). All cases showed spotty inflammatory myocardial infiltration, consisting mainly of T lymphocytes and, to a lesser extent, of B lymphocytes, histiocytes, mastocytes and eosinophilic granulocytes, with presence of toxoplasma gondii in the cytoplasm of a few myocardial cells. The incidence of toxoplasmic myocarditis in heart involvement in AIDS was 22% in our cases, manifold higher than in preceding reports from the literature. This suggests that cardiac toxoplasmosis is far from rare in patients with AIDS.     

Psychosocial aspects of acquired immunodeficiency syndrome]

Psychosocial aspects which arise with regard to people directly or indirectly involved with AIDS: patients, relatives and professional staff, are studied. The results show that the population assisted in the Ribeir?o Preto region is predominantly young, male and drug-addicted. The patients with "positive" results show reactions similar to those described by Kluber-Ross (1977) for terminal patients. The behavior observed in relatives forms a continuum which varies from the negation of the illness to the overprotection of the patient. For the professionals, perplexity is the most common reaction when they face a population which is different from that with which they are used to dealing. Finally, the data acquired indicate that the psychologist can help the professionals to deal with the reactions of the patients by integrating them into their organic and emotional aspects.     

Mycobacterium avium-intracellulare infection in the acquired immunodeficiency syndrome

Disseminated infection with Mycobacterium avium and M. intracellulare (MAI) is increasingly recognized as a significant contributor to both increased illness and death in patients with acquired immunodeficiency syndrome. Early reports of treatment of MAI were disappointing but recent studies have shown that combination antimycobacterial therapy may provide symptomatic relief and an improvement in mycobacteraemia.     

艾滋病功能性治愈研究新进展

抗反转录病毒治疗（antiretroviral therapy, ART）虽然能有效抑制HIV 1型（HIV-1）,但不能根治AIDS。AIDS功能性治愈须为停止ART后患者体内HIV-1 RNA长期低于检测下限, CD4+ T淋巴细胞数量和机体免疫功能保持正常,这一直是全球研究热点和难点。近年来,AIDS功能性治愈研究在HIV-1储存库激活和清除、免疫治疗、干细胞移植、基因编辑等方面取得了长足进步,本文就此进行综述,为进一步研究提供理论指导。     

Prevention and treatment of human immunodeficiency virus/acquired immunodeficiency syndrome in resource-limited settings

Strategies for confronting the epidemic of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) have included a range of different approaches that focus on prevention and treatment. However, debate persists over what levels of emphasis are appropriate for the different components of the global response. This paper presents an overview of this debate and briefly summarizes the evidence on a range of interventions designed to prevent the spread of HIV infection, paying particular attention to voluntary counselling and testing, treatment for sexually transmitted infections and prevention of mother-to-child transmission. We also review the experience with antiretroviral therapy to date in terms of response rates and survival rates, adherence, drug resistance, behavioural change and epidemiological impact. Although various studies have identified strategies with proven effectiveness in reducing the risks of HIV infection and AIDS mortality, considerable uncertainties remain. Successful integration of treatment and prevention of HIV/AIDS will require a balanced approach and rigorous monitoring of the impact of programmes in terms of both individual and population outcomes.     

Reduced cardiac selenium content in the acquired immunodeficiency syndrome

Selenium deficiency has been implicated in the pathogenesis of a dilated congestive cardiomyopathy in areas of China (Keshan disease) and in several patients on long-term total parenteral nutrition. Recently a clinically and pathologically similar cardiomyopathy has been described in AIDS. Since blood selenium levels are low in AIDS, we assayed cardiac selenium status by a spectrofluorometric method in eight AIDS patients at autopsy compared to nine age-matched, non-AIDS autopsy controls with histologically normal hearts. We found (mean +/- SD) a cardiac selenium level of 0.327 +/- 0.082 microgram/g dry weight in AIDS vs 0.534 +/- 0.184 microgram/g dry weight in controls (p less than 0.01; Student's t test). There were no significant differences between the groups for heart weight, serum CPK, or other laboratory parameters. No specific chest x-ray or electrocardiographic abnormalities were present. Histologically, all AIDS hearts were abnormal; mostly with mild degrees of muscle hypertrophy or fibrosis. Foci of myocytolysis and myocyte necrosis and fibrous replacement of myocytes and monocytic infiltration were present in two AIDS cases. We conclude that heart tissue in AIDS demonstrates a significant selenium deficit. These data provide a potential link between selenium deficiency and cardiomyopathy in AIDS.     

Cytomegalovirus colitis in patients with acquired immunodeficiency syndrome.

The spectrum of presentation of complications in patients with human immunodeficiency virus (HIV) disease is changing, in line with their improved survival. Infection of the colon with cytomegalovirus (CMV) is now more commonly encountered in clinical practice. We have reviewed the medical records of eleven patients with clinical and pathological evidence of CMV colitis. The clinical presentation, endoscopic and histological findings, and simultaneous infection of other organs with CMV are discussed. Diarrhoea in association with abdominal pain is the most frequent symptom complex in these patients and should raise the clinical index of suspicion for CMV colitis.     

The prevalent cohort study and the acquired immunodeficiency syndrome

The acquired immunodeficiency syndrome (AIDS) is caused by a retrovirus, the human immunodeficiency virus (HIV). A rapid and convenient method to identify additional cofactors or risk modifiers and markers of disease progression is to study a cohort prevalent with HIV antibody. However, because the time of viral infection is usually unknown in the cohort, there are several potential sources of bias. Three sources of bias in a prevalent cohort study are identified assuming a proportional hazards model: onset confounding, differential length-biased sampling, and frailty selection. A number of problems in the interpretation of results on markers from a prevalent cohort also are considered. It is concluded that risk estimates derived from a prevalent cohort are not directly comparable to risk estimates derived from an incident cohort.     

New Jersey's Medicaid waiver for acquired immunodeficiency syndrome

This article contains data from a study of New Jersey's home and community-based Medicaid waiver program for persons with symptomatic human immunodeficiency virus illness. Major findings include lower hospital costs and utilization for waiver participants compared with general Medicaid acquired immunodeficiency syndrome admissions in New Jersey. Average program expenditures were $2,400 per person per month. Based on study findings, it is evident that the waiver program is an important means of providing financial benefits and access to services and that comprehensive case management is a critical factor in assuring program quality.