Human immunodeficiency virus (HIV) antigenemia (p24) in the acquired immunodeficiency syndrome (AIDS) and the effect of treatment with zidovudine (AZT)

Infection with human immunodeficiency virus (HIV) may cause viral antigenemia, detected primarily as p24 viral core protein. Among 16 patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex studied serially, 12 had or developed antigenemia ranging from 16 to 3006 pg/mL in plasma. The level could be categorized as high (greater than 100 pg/mL) or low (15 to 65 pg/mL). Three patients with anti-p24 antibody had no antigenemia. Zidovudine (AZT), 200 or 250 mg every 4 hours, reduced antigenemia by about 90%; other regimens were less effective. Leukocyte cultures were positive for HIV from patients with antigenemia, and in one third of samples in the absence of antigenemia. High levels of antigenemia correlated with symptoms, CD4 cell count, and prognosis. Drug toxicity requiring a lower dose was followed by increased antigenemia, recurrent symptoms, and decreased CD4 cells, suggesting lymphocyte toxicity. Monitoring antigenemia can be useful in evaluating patients with HIV infection and in evaluating the effect of antiviral chemotherapy.     

Acquired T cell specific deficiency other than acquired immunodeficiency syndrome (AIDS).

Evidence of an acquired T cell-specific deficiency distinct from acquired immunodeficiency syndrome (AIDS) in a 63-yr-old Japanese female is provided. Recently, this patients suffered from primary invasive pulmonary aspergillosis. Skin tests to purified protein derivative of tuberculin (PPD) and Aspergillus antigens were negative. Upon admission to our hospital, her lymphocytes were exclusively unresponsive to T cell mitogens (concanavalin A, phytohemagglutinin, and OKT 3). The level of cells defined by monoclonal antibodies (CD1, CD2, CD3, CD4, WT31, and CD5) was less than 3%. In contrast, no decrease in the number of red blood cells, platelets, neutrophils or B cells was apparent. Five years ago, the patient had a normal white blood cell and lymphocyte count. However, over the following 4 yr, she developed lymphopenia. With medication, her pulmonary disease recovered, while lymphopenia still continued. The levels of immunoglobulins, complements and enzyme activities (adenosine deaminase and purine nucleoside phosphorylase) were normal. Moreover, several tests for HIV (ELISA and Western bolt) were negative suggesting that the T cell-specific deficiency was not a congenital immunodeficiency or AIDS but rather a new type of acquired immunodeficiency.     

An update on the acquired immunodeficiency syndrome (AIDS)

The pandemic, acquired immunodeficiency syndrome (AIDS) has been described in 40 nations throughout the world. This paper describes the wide spectrum of gastrointestinal tract manifestations seen in this syndrome, with particular attention to the epidemiology, etiology, and measurement of these problems. Discussion of candidiasis, herpes simplex, “hairy” leukoplakia, Kaposi's sarcoma, cytomegalovirus, anal warts and carcinoma, chlamydial proctitis (LGV), coccidiosis, and mycobacterial diarrhea, as well as “gay bowel syndrome,” demonstrates the complex management problems associated with this condition.     

Bone marrow findings in acquired immunodeficiency syndrome (AIDS)

Bone marrow aspirates and biopsies from 35 AIDS/AIDS-related complex patients, consisting primarily of intravenous drug abusers, were studied. The most common findings included hypercellularity (86%), plasmacytosis (63%), reticular fibrosis (50%), and lymphocytosis (37%) occasionally admixed with histiocytes. Granulocytic hyperplasia was present in 27 patients (77%). Erythrocytic hypoplasia was observed in 15 patients (43%). Megaloblastic changes of intermediate form were seen in two cases and serous fat atrophy was noted in another three patients. One M. tuberculosis granuloma, a foreign body granuloma and two granulomas of undetermined etiology were seen, each in separate patients. A previously unreported focal vascular proliferation was seen in one case. The majority of cases showed increased stainable iron. Some of our findings are at variance with previous reports. This may reflect differences in patient population, geographic distribution, risk factors and epidemiologic mode in our cases.     

Focal esophageal candidiasis in acquired immunodeficiency syndrome (AIDS)

When candidiasis involves the esophagus, it usually does so as an extensive and diffuse infection. In our experience, however, esophageal candidiasis in patients with the acquired immunodeficiency syndrome (AIDS) is clinically distinct from the same infection in patients with other immunodeficiency states. Of 25 patients with AIDS and esophageal candidiasis studied radiographically, 4 patients with localized involvement of the esophagus are presented. The clinical and radiologic manifestations of focal esophageal candidiasis in these patients are reviewed and compared to previously described cases of esophageal candidiasis.     

Gastropathy and ketoconazole malabsorption in the acquired immunodeficiency syndrome (AIDS)

STUDY OBJECTIVE: To correlate oral ketoconazole absorption with gastric acid secretion in patients with the acquired immunodeficiency syndrome (AIDS). DESIGN: Prospective measurement of maximal acid output and oral ketoconazole absorption with and without 0.1-N hydrochloric acid. SETTING: Hospital in-patients in university medical center. PATIENTS: Ten consecutive male patients with AIDS. INTERVENTION: Maximal acid output was determined after pentagastrin stimulation in all patients. Serum ketoconazole levels were measured the day after ingestion of a 200-mg ketoconazole tablet in the fasted state. On the final day, ketoconazole was ingested with 200 mL of 0.1-N hydrochloric acid. MEASUREMENTS AND MAIN RESULTS: Maximal acid output was below 15 mEq/h in 7 of 10 patients. In all 7, the area under the serum ketoconazole concentration-time curve was below normal (1.4 +/- 0.9 mg/h.L; mean +/- SE), and absorption was normalized by hydrochloric acid (9.9 +/- mg/h.L). Two of three patients with maximal acid outputs above 15 mEq/h had normal ketoconazole absorption (15.1 +/- 6.7 mg/h.L). CONCLUSIONS: The bioavailability of oral ketoconazole is reduced in patients with AIDS, largely as a result of gastric hypochlorhydria. Ketoconazole tablets should therefore be given with acid in these patients.     

Cardiac complications in acquired immunodeficiency syndrome (AIDS): a review

Acquired immunodeficiency syndrome (AIDS) has become an increasingly important health problem worldwide. This review focuses on its cardiac complications. The key elements in the clinical syndrome are the opportunistic infections and the cancer that occur as a by-product of the immunodeficiency process. However, as early diagnosis, aggressive therapy and better supportive care become increasingly available, with consequently longer survival rates, cardiac lesions other than those due to opportunistic infections or malignancy should be seen. Cardiac complications are described in terms of the pathologic lesions, the clinical manifestations that ensue as a result of the pathologic lesions and the cardiac abnormalities that can occur from administration of the various therapeutic agents in the syndrome.     

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.