Gastric adenocarcinoma associated with human immunodeficiency virus (HIV) infection

Gastric adenocarcinoma developed in a 33-year-old homosexual man with human immunodeficiency virus (HIV) infection. This type of cancer is very rare in a man of his young age and in the absence of other factors. The tumor was aggressive and led to rapid death. Whereas Kaposi's sarcoma and lymphomas have been associated with HIV, there are only a few documented cases of adenocarcinoma associated with a suppressed immune system. The association between HIV infection and the virulence of this tumor appears to be strong.     

Systemic complications of human immunodeficiency virus infection.

HIV infection causes a wide spectrum of complications affecting all organ systems. These complications may be primary to the direct infection of a specific organ system by HIV or secondary to the immunodeficiency associated with HIV infection. These complications may be specific to certain stages of HIV infection. Selected common complications of HIV infection include pulmonary, neurologic, GI, dermatologic, oral, ocular, endocrine, and hematologic complications.     

Neurosurgical aspects of human immunodeficiency virus infection.

The spectrum of neurologic disease that complicates human immunodeficiency virus (HIV) is extremely broad. This article deals with those HIV-related diseases that may occur with a frequency of more than 1% and are of potential neurosurgical importance: those that result from a direct involvement of the nervous system by HIV and those that result either directly or indirectly from the concomitant immunosuppression. Infectious complications are the most common but not the sole cause of neurologic disability in the latter category. Other causes of neurologic disease seen in association with HIV infection include neoplasms, metabolic-nutritional disorders, and vascular complications.     

Renal aspects of therapy for human immunodeficiency virus and associated opportunistic infections

Patients with human immunodeficiency virus infection and the acquired immunodeficiency syndrome are often treated with a variety of potentially nephrotoxic drugs. This review summarizes the renal, fluid, and electrolyte complications of drugs used to treat human immunodeficiency virus and associated opportunistic infections. The pharmacokinetics of the drugs are also briefly reviewed, and dosing guidelines for the use of these drugs in patients who have renal insufficiency or who are receiving dialysis are provided.     

Mycobacterial infection in patients infected with the human immunodeficiency virus.

Of 207 homosexual or bisexual patients with the acquired immune deficiency syndrome (AIDS), 24 with the AIDS related complex, and 39 with asymptomatic HIV infection, 32 patients were found to have mycobacterial infection. Mycobacterium tuberculosis was found in 13 patients with AIDS and in two with the AIDS related complex. M avium-intracellulare was found in 15 patients with AIDS and was disseminated in 12. One patient was infected with M kansasii and one with M ulcerans. Invasive procedures were frequently required to obtain positive bacteriological results. Subclinical carriage of M avium-intracellulare and other mycobacteria thought to be nonpathogenic was common in patients seronegative for the human immunodeficiency virus and at all stages of human immunodeficiency virus infection. All but one isolate of M tuberculosis were fully sensitive to standard antimycobacterial antibiotics. Response to treatment was usually rapid. M avium-intracellulare isolates were all resistant to first line agents in vitro, and antibiotics such as ansamycin and amikacin were required to obtain a clinical response.     

Prevalence of infection with human immunodeficiency virus in elective surgery patients.

An anonymous survey of elective surgery patients was performed to assess prevalence of antibody to human immunodeficiency virus (HIV) in a large urban hospital. Of 4087 patients evaluated, 18 (0.4%) were found to be infected with HIV as confirmed by a positive Western blot antibody test. Assessment of risk factors demonstrated that patients with a history of a blood transfusion did not differ in demographics or rate of infection from the population as a whole. Of the 18 HIV infected patients, 13 gave an admission history of one or more risk factors, including 10 with a history of a prior positive test. Only five, or 0.12% of the patients, provided no history of a risk factor or a history of transfusion only. The authors conclude that the prevalence of HIV infection among elective surgery patients is low, and that there would not be any substantial benefit from screening such patients for antibody against HIV.     

Lymph node biopsy in patients with human immunodeficiency virus infections

Twenty-one male homosexuals were followed up by repeated lymph node biopsy for a mean (+/- SEM) follow-up of 99 +/- 18 weeks. Four histologic patterns were seen on biopsy: explosive follicular hyperplasia (EFH), follicular involution (FI), a mixed pattern of EFH with FI in the same node, and lymphocyte depletion. Patients with FI and lymphocyte depletion had mean survival times that were significantly less than those for the subjects with EFH. The percentage of lymph node follicles with suppressor cell clusters (T8) in EFH lymph nodes was significantly higher (43% vs 8%) than in nodes from patients without risk for human immunodeficiency virus infection. Helper/suppressor T-cell ratios in control nodes were 1.6; in EFH nodes, 0.97; and in FI nodes, 0.88. A remarkable 33% of patients in this lymphadenopathy group ultimately developed large-cell (B-cell) lymphoma, suggesting that the follicular stimulation noted histologically played a role in the development of this neoplasm. These data show that there is a progressive destruction of lymph node follicles that correlates with the progression of the disease and that lymph node histologic features may provide important prognostic information.     

Digestive implications of human immunodeficiency virus infection

AIDS, still present with severe prognosis at the beginning of the 3rd Millennium, may present gastrointestinal and hepatic involvement. Even they have not a fatal prognosis, in order to improve the quality of life of AIDS patients we need a broad knowledge of and to treat the gastrointestinal and hepatic manifestation of the disease.     

Surgical intervention in children with human immunodeficiency virus infection

Twenty-one children with human immunodeficiency virus (HIV) infection required surgical intervention during the course of their disease. There were 11 females and 10 males (age range, 3 months to 6 years). The children underwent 54 operative procedures after diagnosis of their disease. These included placement of central venous catheter (23 patients), open lung biopsy (11), incision and drainage of perirectal abscess (4), incision and drainage of soft tissue abscess (5), myringotomy (2), diverting colostomy (3), Nissen fundoplication (1), and other (5). All 21 patients had clinical AIDS by the Centers for Disease Control CDC classification. To date, there have been 12 deaths in the 21 patients (57%) due to progressive deterioration with the patient's disease. Most procedures were adjuncts for diagnostic and therapeutic intervention in a population of children with a uniformly fatal disease. The knowledge of various high risk groups for AIDS must heighten the surgeon's awareness to the growing and significant pediatric segment of the HIV population, the complications of their disease, and the surgeon's limited role in treating these problems.     

Musculoskeletal manifestations of human immunodeficiency virus infection

Musculoskeletal manifestations of the human immunodeficiency virus (HIV) are common and are sometimes the initial presentation of the disease. Knowledge of the conditions affecting muscle, bone, and joints in HIV-infected patients is essential for successful management. Myopathies may be caused by pyogenic infection (eg, pyomyositis), idiopathic inflammation (eg, polymyositis), or drug effect (eg, AZT myopathy). Characteristic skeletal infections, such as tuberculosis and bacillary angiomatosis, require a high index of suspicion for accurate diagnosis. Neoplastic processes, such as non-Hodgkin's lymphoma and Kaposi's sarcoma, occur more frequently as the immune system deteriorates. Inflammatory and reactive arthropathies are more prevalent in HIV-positive than HIV-negative individuals and include Reiter's syndrome, psoriatic arthritis, HIV-associated arthritis, painful articular syndrome, acute symmetric polyarthritis, and hypertrophic osteoarthropathy. Patients with atypical musculoskeletal complaints and a suspected history of exposure should be tested for HIV.     

Surgical complications of human immunodeficiency virus infection

To assess the role of the general surgeon in the care of patients with acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC) the hospital records of all patients with AIDS or ARC who underwent a major operation at the General Surgical Service of Crawford W. Long Memorial Hospital were reviewed. Of 79 patients with AIDS or ARC diagnosed since 1982, 14 required major abdominal surgery. Operations performed were for gastrointestinal (GI) complications of opportunistic infections and neoplasms (four), diagnosis of major retroperitoneal lymphadenopathy (four), and treatment of AIDS-related immune thrombocytopenia (six). GI complications consisted of two cases of cytomegalovirus perforation of ileum and colon, one case of bleeding ileocolonic lymphoma, and one case of cryptosporidium cholecystitis. Laparotomy for diagnosis of retroperitoneal lymphadenopathy was performed in four patients and provided diagnostic material in three of them. Six patients underwent splenectomy for AIDS-related immune thrombocytopenia. Four of these patients had previously been treated with prednisone without impressive results. All patients had marked improvement of their platelet counts and clinical bleeding after splenectomy. Postoperative complications were common and consisted of wound infection, disseminated intravascular coagulation, GI bleeding, pneumocystis pneumonia, small-bowel obstruction, and cytomegalovirus pneumonia. One patient died after laparotomy for perforated ulcers of the ileum and colon.     

Rapidly progressive periodontal disease associated with human immunodeficiency virus

Severe periodontal inflammation with generalized dental plaque accumulation, spontaneous and severe gingival bleeding, fungal infection, and interdental papillae necrosis are presented in a patient infected with human immunodeficiency virus (HIV). Bite-wing radiographs revealed a generalized horizontal alveolar bone loss of 7-8 millimetres in both arches. Erythematous patches were noted on the gingival mucosa in both jaws. DNA testing was performed to indentify the periodontopathogens. The patient had no signs or symptoms of acquired immunodeficiency syndrome. This case-report presents the massive periodontal destruction that occurred in a patient infected with HIV. Therefore, it is highly recommended that patients infected with HIV should be regularly monitored to aid in early detection and to provide proper management of periodontal inflammatory conditions to minimize its destruction.     

Parotid disease and human immunodeficiency virus infection in Zambia.

Among the salivary glands the parotid is unusual in that it contains lymphoid tissue within its capsule. The focus of infection with human immunodeficiency virus (HIV) is the lymphatic system and this results in a specific HIV-related pathology in the parotid. This 2-year surgical audit of parotid disease in HIV-infected patients in Lusaka shows patients presenting with parotid lymphadenopathy, bilateral diffuse parotid enlargement and parotid lymphoepithelial cysts. Clinical presentation and management are discussed.     

Glomerular disease and human immunodeficiency virus infection in Brazil.

Clinically overt glomerular disease was detected in 6 (1.1%) of 543 patients with HIV infection followed at a Brazilian National Referral Center for AIDS. In 4 cases, glomerulosclerosis was present (focal and segmental in 3, diffuse and global in 1) and rapid progression to terminal renal failure was observed 1-10 months after clinical presentation. The other 2 patients died with normal renal function, and autopsy studies suggested the diagnosis of minimal change disease. Clinically overt glomerular disease was significantly more common among Black patients, whether all the cases with glomerulopathy (p < 0.001) or just the cases with glomerular sclerosis were considered (p = 0.011). Autopsy study of renal fragments from patients without clinical evidence of glomerular disease was additionally performed and revealed the presence of focal and segmental glomerulosclerosis in 3 cases (7.5%). We concluded that a glomerulopathy with clinicopathological features which match the definition of HIV nephropathy can be found among Brazilian patients with HIV infection. Accordingly to what has been described in American series, Brazilian Black patients seem to be at increased risk of the development of that nephropathy.     

Outcome of dialysis in children with human immunodeficiency virus infection

Human immunodeficiency virus (HIV) infection accounts for an unknown percentage of children with end-stage kidney disease (ESKD). Our objective was to compare the outcome of renal replacement therapy (RRT) in subjects with ESKD due to HIV and other diagnoses and to examine the prevalence of ESKD due to HIV. We analyzed Kt/V, morbidity, mortality, echocardiography, nutritional, and transplant status in 12 dialysis patients with HIV and 32 without HIV followed at our center between February 2002 and February 2007. Body mass index (BMI) was lower and Kt/V higher in HIV than in non-HIV patients. Shortening fraction was significantly lower in HIV patients. There were six deaths in the HIV group and one in the non-HIV group over the study period. Hemodialysis (HD) is the prevalent mode of RRT in HIV in urban settings, and its adequacy as measured by Kt/V was higher in HIV patients than in non-HIV patients. Decreased BMI and cardiovascular disease may be associated with increased mortality in children with HIV on RRT.     

Pseudoaneurysm of the thoracic aorta in patients with human immunodeficiency virus infection.

Arterial pseudoaneurysm has been reported as a possible complication of immunodeficiency virus infection. We report two cases of HIV-positive patients with a pseudoaneurysm at the level of the descending thoracic aorta. The first patient refused surgery and has been followed up to 14 months, whereas the second patient underwent successful surgical repair. The importance of magnetic resonance imaging in the diagnosis of thoracic aorta pseudoaneurysm is also discussed.