Immune thrombocytopenia and response to splenectomy in chronic liver disease

Six patients had chronic liver diseases of diverse origin, persistent unexplained thrombocytopenia, and no palpable splenic enlargement. Platelet-associated IgG levels were increased in all cases. Two patients underwent splenectomy; the spleens weighed 375 and 230 g. Each patient had prompt, complete, and sustained platelet count normalization. Two other patients treated briefly with prednisone had no response. These observations indicate that a minimally enlarged spleen may be responsible for thrombocytopenia in chronic liver disease and suggest that immune mechanisms may contribute to thrombocytopenia in this setting.     

Patterns of antibody response in individuals infected with the human immunodeficiency virus

Immunofluorescence and immunoblot assays were conducted on 488 sera from patients with AIDS and clinically healthy individuals at risk for infection by the human immunodeficiency virus. Of these, 360 contained antiviral antibodies, and nearly all reacted with the envelope precursor glycoprotein gp160. Sera from 103 individuals for whom a complete clinical history was available were evaluated in detail. Most sera recognized both the gp160 and the p55 gag precursor protein. Because these two antigens are found primarily in infected cells, the results suggest that this association makes them more immunogenic. A high prevalence of antibodies to the polymerase gene products (p65 and p31) and to a viral protein p48, which is not yet fully defined, was also noted. Many sera, particularly those from patients with Kaposi's sarcoma or Pneumocystis carinii pneumonia, lacked antibodies to both p25 and gp41. These antibody patterns could help predict the prognosis for virus-infected individuals.     

Clinical analysis of 4 Chinese hemophiliacs with human immunodeficiency virus infection

Human immunodeficiency virus (HIV-is) now considered the causative agent of acquired immunodeficiency syndrome(AIDS). A high risk of AIDS has been reported among patients with hemophilia who received lyophilized commercial factor VIII and IX concentrates of American origin. In a prevalence survey conducted from September to December 1985, HIV antibodies were found in all the 4 patients with hemophilia treated with the batch number W87307, 955 I.U. of American commercial factor VIII concentrate supplied by Armour pharmaceutical Company U.S.A. One of the seropositive patients developed AIDS-related complex (ARC) and died of cerebral hemorrhage. The other three sero-positive patients had abnormalities in cell mediated immunity; among them two developed left lumbosacral radiculopathy and hemorrhagic herpes zoster and one remains well so far.     

Pancreatitis in children infected with human immunodeficiency virus

The incidence of pancreatitis in HIV-infected children is not well known. Medical records of 42 children with HIV infection followed at Children's Hospital during a 6-year period were reviewed. Pancreatitis (elevated serum lipase levels) developed in 10 children (23.8%). Three children acquired HIV infection from vertical transmission and seven from contaminated blood products (hemophiliacs). Nine were severely immunosuppressed (CD4+ of < 100 cells/mm3). Lipase values were more often elevated than amylase values. The clinical course was protracted and severe in two children, one had four recurrences, and seven had only a single episode of pancreatitis lasting a few weeks. Opportunistic infections were present in four children and seven were receiving medications previously implicated as cause of pancreatitis. Discontinuation of dideoxynosine (ddI) in one child led to rapid resolution of pancreatitis, but continuation of medications in the other children did not alter the course. The etiology of pancreatitis may be multifactorial. Severe and prolonged clinical course is associated with advanced HIV infection. Determination of serum lipase is more useful than serum amylase for identifying those with pancreatitis.     

Listeriosis in patients infected with human immunodeficiency virus

Although resistance to Listeria monocytogenes infection requires intact T cell-mediated immunity, only 20 patients with human immunodeficiency virus (HIV) infection and listeriosis (including one patient described herein) have been reported to date. Listeriosis developed before AIDS in five cases. Syndromes included meningitis in nine cases, bacteremia in nine, brain abscess in one, and endocarditis in one. Eighteen patients were treated with ampicillin, penicillin, or amoxicillin with or without aminoglycosides. Clinical and microbiologic responses were obtained in one patient with bacteremia treated with vancomycin and in one patient with meningitis treated with trimethoprim-sulfamethoxazole. Three of the nine patients with meningitis died, as did the patient with brain abscess. All nine patients with bacteremia and the patient with endocarditis survived. No case of relapse was documented. L. monocytogenes, although uncommon, should be considered in the differential diagnosis of febrile illness, meningitis, and brain abscess in patients with HIV infection.     

Class-specific antibody response to pneumococcal capsular polysaccharides in men infected with human immunodeficiency virus type 1

We characterized the effect of infection with human immunodeficiency virus type 1 (HIV) on levels of total immunoglobulins and pneumococcal vaccine-specific immunoglobulins in 28 heterosexual and 25 homosexual men seronegative for HIV; 27 asymptomatic, seropositive homosexual men; and 21 patients with AIDS. Total serum IgG levels were increased in both HIV-seropositive groups compared with the HIV-seronegative men (P less than .001). Total IgM levels, however, were elevated only in the asymptomatic, HIV-seropositive men (P less than .08); total IgA levels were elevated only in the patients with AIDS (P less than .05). Vaccine-specific serum IgG, IgM, and IgA significantly increased over baseline three and six weeks after immunization in all groups (P less than .05). Responses to vaccine among the HIV-seronegative groups were similar but were greater for all antibody classes than were responses among the HIV-seropositive groups (P less than .05).     

Immune thrombocytopenia and HIV-1 infection. Response to splenectomy

We present a case of thrombocytopenic purpura associated to acquired immunodeficiency; this disease is very infrequently associated to AIDS; the clinical characteristics are similar to the classical Idiopathic Thrombocytopenic Purpura, including the response to splenectomy. We discuss the therapeutic approach of this condition and review the literature, adding this new case of a patient with AIDS, Walter and Reed's stage II, who responded to splenectomy.     

Significance of blood analysis in hemophiliacs co-infected with human immunodeficiency virus and hepatitis viruses

AIM： To study the effect of hepatitis virus infection on cirrhosis and liver function markers in HIV-infected hemophiliacs.
METHODS： We have analyzed the immunological, liver function and cirrhosis markers in a cohort of hemophiliacs co-infected with human immunodeficiency virus （HIV） and hepatitis viruses.
RESULTS： There was no difference in immunological markers among co-infected patients and patients infected with HIV only and those co-infected with one or more hepatitis virus. Although liver function and cirrhosis markers remained within a normal range, there was a worsening trend in all patients co-infected with hepatitis virus C （HCV）, which was further exacerbated in the presence of additional infection with hepatitis virus B （HBV）.
CONCLUSION： Co-infection with HIV, HBV and HCV leads to worsening of hyaluronic acid and liver function markers. Increases in serum hyaluronic acid may be suggestive of a predisposition to liver diseases.     

Platelet kinetics in human immunodeficiency virus induced thrombocytopenia

A platelet kinetic study was performed in 34 patients (33 homosexuals and/or drug addicts) with (in most of them) severe and isolated thrombocytopenia and human immunodeficiency virus positive serological tests. The reported data indicate that the thrombocytopenia is due to an extracorpuscular hyperdestruction. The sequestration of the labeled platelets is exclusively splenic in most of the cases. Splenectomy was successful in the ten cases in which it was done; however, corticoids showed no or low effect, and Ig-G infusion had only a temporary efficacy.     

Effect of human immunodeficiency virus infection on hepatitis C virus infection in hemophiliacs

Chronic liver disease due to hepatitis C virus (HCV) infection is a major problem in hemophiliacs. Recent reports suggested that hemophiliacs coinfected with hepatitis C virus and human immunodeficiency virus (HIV) have an increased incidence of liver failure but the mechanism of accelerated liver injury is not clear. We tested plasma from 100 hemophiliacs for anti-HCV by second generation ELISA, anti-HIV by EIA, and HCV RNA and HIV RNA by branched DNA and polymerase chain reaction assays to determine if hemophiliacs coinfected with HCV and HIV have higher HCV RNA levels and more active liver disease. Seventy-nine (79%) patients were anti-HCV positive, of whom 85% were HCV RNA positive. None of the anti-HCV-negative patients had detectable HCV RNA in plasma. Forty-two (42%) patients were anti-HIV positive, of whom 47% had detectable HIV RNA. All the anti-HIV-positive patients were also anti-HCV positive. The prevalence of both anti-HCV and anti-HIV increased significantly with age. There was no difference in HCV RNA levels between anti-HIV-positive and anti-HIV-negative patients (mean: 21±4 vs 18±5 Meq/ml), although HCV RNA levels were significantly higher in anti-HIV-positive patients with CD4 counts<200/mm³ (P=0.008). There was an inverse correlation between HCV RNA levels and CD4 counts but no correlation was found between HCV RNA and serum aminotransferase levels. We found a high prevalence of HCV and HIV coinfection in our hemophiliacs. Hepatitis C virus replication appears to be increased in patients with severe immunodeficiency secondary to progressive HIV infection. However, there was no correlation between HCV RNA and serum ALT level, suggesting that HCV is not directly cytopathic.     

Autoimmune neutropenia and thrombocytopenia associated with development of antibodies to human immunodeficiency virus

We report on two patients with acute human immunodeficiency virus (HIV) infection, who developed an infectious mononucleosis-like clinical episode with thrombocytopenia and granulocytopenia. In both cases we detected the presence of IgG antigranulocyte antibodies and in one case the presence of IgG, IgM and IgA antiplatelet antibodies. The mechanisms of these cytopenias are discussed. The association between such autoimmune cytopenias and acute HIV infection has not been previously reported. We suggest testing for HIV seroconversion in patients with a seronegative infectious mononucleosis-like syndrome belonging to groups with a high risk for HIV infection.     

Cardiac surgery in patients infected with human immunodeficiency virus

From January 1991 through December 1999, 5 consecutive patients who were infected with human immunodeficiency virus presented in need of cardiac surgery. All were men; the median age was 44 years. Two of them presented with mitral and aortic infectious valve endocarditis, 1 with tricuspid endocarditis, 1 with prosthetic valve endocarditis, and 1 with pericarditis and pericardial tamponade. Under cardiopulmonary bypass, the 4 patients with endocarditis underwent these procedures: mitral and aortic valve replacement (2), tricuspid valve replacement (1), and aortic valve replacement (reoperation) and concomitant repair of a mycotic ascending aortic aneurysm (1). In the patient who had pericardial effusion, subxifoid pericardiostomy and drainage were performed, and a pericardial window was created. There was no intraoperative mortality. The patient with pericardial effusion died 8 days after surgery; he was in septic shock and had multiple organ failure. Two deaths occurred at 2 and 63 months, due to hemoptysis and sudden death, respectively. The 2 patients who underwent double valve replacement are alive and in good condition after a median follow-up of 71 months. Cardiac surgery is indicated in selected patients infected by the human immunodeficiency virus. These patients are frequently drug abusers or homosexual. Valvular endocarditis is the most common finding. Hospital morbidity and mortality rates are higher than usual in this group of patients.     

Fertility parameters in men infected with human immunodeficiency virus

The effect of human immunodeficiency virus type 1 (HIV) infection on semen parameters that assess fertility was investigated in 50 semen specimens from 21 asymptomatic or minimally symptomatic HIV-seropositive men and 3 specimens from 3 men with AIDS. HIV was isolated from 15 (30%) of 50 specimens from asymptomatic or minimally symptomatic persons and from 1 of 3 specimens from patients with AIDS. The men with AIDS all had pyosemia and grossly abnormal sperm. In contrast, semen specimens from other seropositive men did not differ significantly from semen specimens from healthy seronegative semen donors. No abnormality in sperm count, morphology, numbers or types of leukocytes in semen, or other seminal parameters was associated with HIV shedding in semen. Zidovudine therapy did not affect sperm morphology or seminal characteristics. Thus, although patients with AIDS had abnormal semen, the laboratory parameters that assess fertility were not affected by shedding of HIV in semen or concomitant therapy with zidovudine.     

Immunization for persons infected with human immunodeficiency virus

Immunization is an important measure to protect HIV-infected children and adults against certain vaccine preventable diseases. However, the antibody response, which is associated with the level of CD4+ T cell count, is frequently impaired in this group of patients. Certain vaccines enhance virus replication and transiently increase HIV viral load. Theoretically, vaccination should be given before the immune status of the patients is suppressed. Inactivated vaccines are generally safe and are beneficial for HIV-infected patients. These vaccines should be administered at appropriate age recommended for immunocompetent individuals. Live vaccines should be used with caution since some of the vaccines may be harmful to patients with severe immunologic suppression. Recommendations for immunization in HIV-infected patients may differ from country to country, depending on the availability and affordability of each vaccine, and the prevalence of each preventable disease. Vaccine trial in HIV-infected patients is needed in order to establish the most appropriate vaccine recommendation for this group of patients.