The prevalence of hairy leukoplakia in HIV seropositive and HIV seronegative immunocompromised patients.

The prevalence of hairy leukoplakia was determined among 176 symptomatic HIV seropositive patients seen at the outpatient department of the Institute of Tropical Medicine in Antwerp, Belgium. Moreover, systematic tongue biopsies were performed during postmortem examination of 21 patients with AIDS, 100 HIV seronegative immunocompromised patients with haematologic or other malignancies and 100 HIV seronegative non-immunocompromised patients who died at the University Hospital Antwerp. Hairy leukoplakia was observed in 52 (29.5%) of the outpatients, but only in one (5%) of the AIDS patients in the postmortem study (P = 0.03). An explanation for this difference may be that significantly more AIDS patients who died had received either acyclovir or ganciclovir during the 3 months prior to the postmortem examination than the HIV seropositive outpatients during the 3 months prior to examination. Hairy leukoplakia occurred more often in Caucasian homosexual men with HIV infection (38%) than among heterosexual Africans with HIV infection (17%) (P = 0.06). Hairy leukoplakia was observed in none of the HIV seronegative patients.     

A comparison of patients with seropositive and seronegative rheumatoid arthritis

Summary It has recently been suggested that a subpopulation of patients with rheumatoid arthritis, diagnosed on clinical, radiologic and pragmatic grounds, but with negative rheumatoid factor tests, represents a clinical entity quite distinct from that of seropositve rheumatoid arthritis. We have studied 60 sequentially presenting patients, 30 of whom were selected because they were seronegative, and 30 selected because they were seropositive in regard to IGM rheumatoid factor. The only major differences detected between the two groups on blind assessment were a greater tendency to deformity, a greater degree of erosion and the presence of subcutaneous nodules in the seropositive group. Seronegative and seropositive rheumatoid arthritis appear to have very similar clinical features, but differing degrees of severity.     

Nocardiosis in HIV seropositive clinically suspected pulmonary tuberculosis patients

To determine the frequency of nocardiosis in HIV-positive individuals clinically suspected of having tuberculosis (TB), 140 sputum samples were collected and processed by Gram stain, modified Ziehl-Neelsen staining and by culture on Lowenstein Jensen medium. Four (2.85%) patients were positive for nocardia by microscopy and five (3.6%) had positive culture for Nocardia asterioides. In areas where HIV-associated TB is common, some patients diagnosed as smear-negative pulmonary TB will actually have nocardiosis. Clinicians should be aware of this entity in HIV/immunocompromised patients with respiratory infections who fail to respond to antituberculous treatment.     

Increased mortality and tuberculosis treatment failure rate among human immunodeficiency virus (HIV) seropositive compared with HIV seronegative patients with pulmonary tuberculosis treated with "standard" chemotherapy in Kinshasa, Zaire

To evaluate their treatment outcomes 170 human immunodeficiency virus (HIV) seropositive and 597 HIV seronegative patients with active pulmonary tuberculosis (TB) treated for 1 yr with "standard" chemotherapy, including streptomycin, isoniazid, and, in most cases, thiacetazone, were traced at completion of therapy. All 582 survivors were invited for reevaluation, and 385 patients, of whom 82 (21.3%) were HIV seropositive, were evaluated. Of those, 325 consenting patients, of whom 67 (20.6%) were HIV seropositive, were followed for 12 months. One year after TB had been diagnosed 47 (31.3%) of the 150 HIV seropositive and 22 (4.4%) of the 501 HIV seronegative patients traced had died (p = 10(-6]. During the subsequent year the mortality of 67 HIV seropositive patients (26.3/100 patient-years) was higher than that of the 303 HIV seronegative patients (2.2/100 patients-years, p = 10(-6]. HIV seropositive patients had a higher overall TB therapy failure rate 24 months after the diagnosis of TB than did HIV seronegative patients (21.1/100 patient-years versus 8.1/100 patient-years, p = 0.002), mainly because their relapse rate of pulmonary TB (18.1/100 patient-years) was higher than that of HIV seronegative patients (6.0/100 patient-years, p = 0.03). Given their higher relapse rate after 1 yr of "standard" chemotherapy, the public health impact of routine maintenance therapy in HIV seropositive patients with pulmonary TB who complete such therapy should be assessed in comparison to the introduction of rifampicin-based short-course antituberculosis chemotherapy in developing countries.     

Atypical mycobacterial infection among HIV seronegative patients in Pondicherry

BACKGROUND: The role of non-tuberculous mycobacteria (NTM) as aetiological agents in the causation of lung infections has seldom been systematically studied from India. METHODS: Prospective study of Species identification from mycobacterial isolates. RESULTS: A total of 22 isolates of mycobacteria were isolated from 635 samples of suspected tuberculosis in a two months period, of which 17 were Mycobacterium tuberculosis, three Mycobacterium kansasii and one each of Mycobacterium fortuitum and Mycobacterium gordonae. CONCLUSIONS: This study highlights the importance of NTM as potential pathogens from both pulmonary and extrapulmonary sites in the Southern state of Pondicherry. Further studies on a larger scale are needed to delineate clearly the association of NTM and various infections, especially in immunocompromised patients.     

Long-term immunogenicity of a plasma-derived hepatitis B vaccine in HIV seropositive and HIV seronegative hemophiliacs

Short-term studies indicate that hepatitis B vaccines are safe and satisfactorily immunogenic in hemophiliacs. The duration of immunity in these immunocompromised patients, however, is not known. To determine this, we studied 78 hemophiliacs prospectively 2, 3, and 4 years after the initial vaccination with a plasma-derived vaccine given as three monthly injections followed by a fourth booster injection at month 14. The duration of immunity clearly depended on whether the patients were infected with the human immunodeficiency virus (HIV). In HIV seronegative hemophiliacs (n = 67), there was a progressive decline in titers of antibody to the hepatitis B surface antigen (anti-HBs), but antibody was still detectable 4 years later in all of them. From the curves of decline of antibody titers, it appears that there is no need to revaccinate patients for at least 5 to 6 years. The HIV seropositive hemophiliacs (n = 11) not only started from much lower anti-HBs titers, but 5 of 11 lost anti-HBs. None of the 45 patients treated with concentrates during the postvaccination period developed serologic signs of hepatitis B, even though 6 of them had come into contact with live or inactivated hepatitis B virus as shown by the occurrence of spontaneous anamnestic antibody responses. This vaccine and schedule of vaccination afford a prolonged duration of immunity in HIV seronegative hemophiliacs, but HIV seropositive hemophiliacs have a risk of losing immunity early.     

Serial evaluation of serum neopterin in HIV seronegative patients treated for tuberculosis.

OBJECTIVE: To delineate the course of serum neopterin (s-neo) concentrations in patients with pulmonary tuberculosis who are on anti-tuberculosis therapy. DESIGN: S-neo concentrations were measured by high performance liquid chromatography (HPLC) in 39 patients treated for pulmonary tuberculosis at pretreatment, at one month and at end of treatment. It was also measured in 11 relapse cases and their matched controls at the above time points and at the time of relapse. The results were correlated with bacteriological and radiological findings. RESULTS: All patients had elevated levels of s-neo at pretreatment which had declined at 1 month and were near normal at the end of treatment. The decline was more significant in patients with moderate lesions, suggesting that immune activation is maximum in this group of patients. The mean decrease was 37% at one month and 66% at the end of treatment. The corresponding decreases were 11% and 56% in patients with limited lesions and 11% and 45% in those with extensive lesions. It continued to fall after completion of therapy in patients who did not relapse, whereas an increase after completion of therapy was associated with bacteriologically proven relapse. CONCLUSIONS: The measurement of s-neo concentration could be of help in evaluating response to therapy. This study provides a rational basis for the association between s-neo concentration and relapse.     

Clinicopathological features of hepatocellular carcinoma--comparison of hepatitis B seropositive and seronegative patients

Clinicopathological features were studied in 113 non-alcoholic patients with histology-proven hepatocellular carcinoma, of whom 35 were positive for hepatis B virus surface antigen (HBsAg), 23 were negative for all seromarkers for hepatitis B virus, and 55 were negative for HBsAg, but positive for anti-HBs and/or anti-core antibody (anti-HBc) with low titers. It was found that the age of the patient at the time of diagnosis was significantly lower in HBsAg cases than in the other two groups. Serum alpha-fetoprotein levels were often normal or below 100 ng/ml in the seronegative cases, and its measurement less frequently served as a diagnostic clue. Otherwise, clinically there was no difference between the three groups except for more frequent liver disease within the second degree of kinship in the HBsAg patients. Histopathological study of the livers showed that there were more expanding type hepatocellular carcinomas in the seronegative cases as compared with the HBsAg positive cases. There was no autoimmune chronic liver disease in these patients. These observations and data seem to indicate that there are certain differences between HBsAg positive and seronegative hepatocellular carcinomas. Since most patients had progressive liver disease, it is likely that many of these seronegative cases had chronic non-A, non-B viral disease, which is very common in Japan. It may be inferred further that non-A, non-B hepatitis virus is less carcinogenic as compared with hepatitis B virus.     

Diagnostic value of anti-annexin A5 antibodies in seropositive versus seronegative antiphospholipid syndrome patients

Background: Current laboratory criteria for antiphospholipid syndrome (APS) classification recommend testing positive for antiphospholipid (aPL) antibodies. However, there appears to be a subset of patients with classical APS manifestations who test negative. Aim of the work: To analyze the potential clinical usefulness of testing for anti-annexin A5 antibodies in patients with APS and to study the effectiveness of testing for non-criteria aPLs in an attempt to increase the diagnostic yield, particularly in seronegative APS. Patients and methods: 60 APS patients were divided into two groups; 30 seropositive (SP-APS) (group I) and 30 age and sex matched seronegative (sN-APS) testing negative for aPL antibodies. Serum assay for detection of isotypes of anti-annexin A5 antibodies (IgG and IgM) were conducted. Results: The mean age of the patients was 32.9 ± 5.8 years, female:male 57:3 and disease duration in SP-APS versus sN-APS (10.17 ± 4.9 years versus 9.6 ± 5.5 years) respectively. Secondary APS was present in 16(53.3%) patients in group I compared to 3(10%) in group II (p < 0.0001). The mean anti-AnxA5 IgG level was 10.7 ± 5.6 U/ml and IgM was 11.2 ± 7.1 U/ml and were comparable between the 2 groups. The obstetric and thrombotic morbidity had no significant differences between SP and sN-APS. The IgG and IgM levels significantly correlated with the pregnancy morbidity, venous and arterial thrombosis events and showed reasonable sensitivities in their prediction (IgG:71.2%,72.8% and 75.8%; IgM: 68%,67.8% and 71.4% respectively) and specificities (IgG:75.9%,77.8% and 81.5%; IgM: 70.9%,73.1% and 73.7% respectively). Conclusion: anti-annexinA5 antibodies are promising for detecting obstetric and thrombotic morbidity in both SP- and sN-APS patients.     

Evaluation of staining techniques, antigen detection and nested PCR for the diagnosis of cryptosporidiosis in HIV seropositive and seronegative patients

The study was designed to determine the efficacy of modified Ziehl-Neelsen (ZN), safranine methylene blue (SM) staining, antigen detection ELISA and a nested PCR assay (specific for Cryptosporidium parvum) for detection of Cryptosporidium in HIV seropositive and seronegative patients with diarrhoea. Cryptosporidium was detected in 10 (4.9%), 9 (4.4%), 39 (18.9%) and 27 (13.1%) of 206 HIV seropositive and 7 (4.6%), 6 (3.9%), 21 (13.7%) and 17 (11.1%) of 153 HIV seronegative patients by ZN staining, SM staining, antigen detection ELISA and PCR, respectively. None of the 50 apparently healthy control subjects was found to be infected with Cryptosporidium by any of the techniques. Based on the criteria of 'true positive' samples positive by at least any two techniques out of ZN staining, antigen detection and PCR, sensitivity of ZN and SM staining techniques was 37% and 33.3% in HIV seropositive and 41.2% and 35.3% in seronegative patients, respectively. Sensitivity of antigen detection ELISA was 92.6% and 94.1% in HIV seropositive and seronegative patients, respectively, while sensitivity of PCR was 100% each in HIV seropositive and seronegative patients. Specificity of all three techniques, i.e. ZN, SM staining and PCR was 100% in both HIV seropositive and seronegative patients while specificity of antigen detection was 92.2% and 96.3% in HIV seropositive and seronegative patients, respectively. The staining techniques were found less sensitive as compared to antigen detection and PCR for detection of Cryptosporidium in HIV seropositive patients with CD4 count >200cells/microl.     

HIV seropositivity among adult tuberculosis patients in Delhi

We report HIV seropositivity among tuberculosis patients from our hospital between 1994-99. Of the 500 patients with various forms of tuberculosis, two were found to be seropositive (0.4%). This report contrasts with the HIV seropositivity reports from other parts of India where increasing HIV seropositivity has been reported. As the HIV infection is making rapid in-roads in India, it is suggested that continuous HIV sero-surveillance should be done in patients with tuberculosis.     

Seroprevalence of HIV infection among tuberculosis patients in Agra, India--a hospital-based study

In this study which was carried over a period of 4 years, from 2001 to 2004, 600 adult patients with active TB disease attending the OPD of TBDTC, Agra, were screened for HIV-1/2 antibodies. Of these, 26 were found to be HIV-positive. Seroprevalence of HIV infection among adult TB patients in Agra is 4.3% (26/600). The HIV infection was found to be more in females, i.e. 7.95% (7/88) than in males, 3.71% (19/512). HIV-positivity of 5% was observed in the age groups, 15-24 and 25-34 years, i.e. 3/60 and 13/260, respectively. Among HIV-positive TB patients, 4.2% (22/524) were of pulmonary and 5.3% (4/76) were of extra-pulmonary type. A total of 3.04% (6/197) of HIV-positive TB patients were PPD positive and 4.96% (20/403) were PPD negative and bacillary positivity was 4.4% (15/340) and bacillary negativity was 4.2% (11/260). A total of 3.5% (18/515) of TB patients had a history of positive contact, i.e. spouse or one of the family members was HIV-infected. The difference in signs and symptoms among the HIV positive and HIV negative TB patients was found to be statistically significant.     

Synovial fluid acid phosphatase in seropositive and seronegative arthritides

Synovial fluid acid phosphatase was investigated in 82 arthritic patients with hydropsy in a knee joint. 39 of the patients were seropositive and 43 seronegative. 36 of the seropositive group had erosive rheumatoid arthritis. The mean synovial fluid acid phosphatase in the seropositive group, 11.6 U/l (SD +/- 8.4), was significantly higher (p less than 0.001) than in the seronegative group, 6.5 U/l (SD +/- 4.8).     

Differing X-ray patterns in seronegative and seropositive rheumatoid arthritis

Clinical Rheumatology - Anti-citrullinated protein antibody (ACPA) and rheumatoid factor (RF) status are important predictors for rheumatoid arthritis (RA) erosivity. Qualitative differences on...     

Group intervention with HIV seropositive patients and their partners

Persons with HIV infection and AIDS may have complex psychosocial needs. Many find it difficult to share fears and feelings so are unlikely to join traditional support groups, although they lack crucial social support. As they frequently report a need for more information it was proposed to use an 'information' group as an opportunity to provide not only information but also social support. Fourteen homosexual men with HIV infection or their partners, who lacked social support were recruited to a closed 'information' group. Sessions comprised an informative talk by an invited speaker, and a discussion. The group was evaluated after 12 sessions and again 16 months later. The group was positively evaluated by a majority of members. It appeared beneficial that the group was closed, and that there was a mixture of people. It proved important that the sessions were structured with an informative topic to stimulate conversation. Follow up indicated that long term coping skills had been fostered. In the short term, however, the group did not reduce the need for individual counselling. It is suggested that group intervention is better seen as an adjunct to individual counselling rather than as an alternative.