Assessment of lipid profile in patients with human immunodeficiency virus (HIV/AIDS) without antiretroviral therapy

ObjectiveTo assess lipid profile in patients with HIV positive infection and to correlate the variation in lipid profile with the CD4⁺ and CD8⁺ cell count and establish the relationship between the variables.MethodsNinety-one participants were enrolled for the present study of which forty seven patients were HIV positive patients and forty four were controls. The study was carried out at College of Medicine & JNM Hospital, Kalyani. Ten mL of blood samples were collected from the participants. The CD4 and CD8 lymphocyte count was estimated by Fluoresence Activated Cell Sorter (FACS) count system (Becton Dickinson). Lipid profiles were analyzed enzymatically using kit obtained from Randox Laboratories Limited, Crumlin, UK.ResultsThe changes in total cholesterol (TC), HDL-C, TC/HDL-C and age were not significant when compared between cases and controls. Significantly higher levels of triglycerides, low-density lipoprotein-cholesterol (LDL-C), LDL/HDL-C, TG/HDL-C and CD4/CD8 ratio were observed along with decline in CD-4 cells/μL, CD-8 cells/μL (P=0.0001). Furthermore there was a strong correlation between CD-4 cells/μL and TG, LDL-C. Also triglycerides and LDL-C level increased proportional to the increase in CD-4 cells/μL.ConclusionsIt can be concluded that the changes in lipid profile can be a good index of disease progression in HIV infection.     

Impact of antiretroviral therapy and changes in virus load on human immunodeficiency virus (HIV)-specific T cell responses in primary HIV infection

Human immunodeficiency virus (HIV)-specific CD4(+) and CD8(+) T cell responses were evaluated prospectively in a large cohort of subjects with HIV primary infection via long-term follow-up examining different virological profiles related to different treatment interventions. No correlation was observed between baseline virus load and HIV-specific CD4(+) and CD8(+) T cell responses. Highly active antiretroviral therapy (HAART)-induced suppression of viremia was associated with an increase in CD4(+) T cell proliferative responses. The HIV-specific proliferative response also increased, at least in the first 18 months, in subjects with detectable viremia, either treated or untreated. The magnitude of the HIV-specific CD8(+) T cell response decreased with suppression of viremia. In subjects with detectable viremia, the breadth and magnitude of the HIV-specific CD8(+) T cell responses increased progressively. Finally, whether HAART was initiated before or after seroconversion had little effect on HIV-specific CD4(+) and CD8(+) T cell responses.     

Platelet antibodies in serum of patients with human immunodeficiency virus (HIV) infection

Between 10 and 15% of human immunodeficiency virus (HIV) seropositive individuals develop an immune thrombocytopenic purpura; however, the mechanism involved in platelet destruction is not yet established. In the present work, we have analyzed 208 sera from HIV seropositive individuals, including 85 thrombocytopenic patients, for the presence of autoantibodies against platelet proteins by using the Western blot technique. Our results indicate that: (1) antibodies against platelet proteins were found in 8 of 123 (6.5%) nonthrombocytopenic patients, as compared with 17 of 85 (20%) of thrombocytopenic patients (p less than 0.03); (2) these antibodies appeared to be more frequently found in advanced stages of disease (p less than 0.02); (3) the reactivity of positive sera with antigenic determinants implicated several distinct platelet proteins; (4) antigens thus recognized are unrelated to the major membrane glycoproteins IIb and IIIa, as well as absent in vero cells and trypsin-sensitive cells. Such results underscore the difficulties in establishing the mechanisms involved in platelet destruction during HIV infection.     

Rheumatologic manifestations of infection with human immunodeficiency virus (HIV)

PURPOSE: To review the various rheumatologic manifestations of human immunodeficiency virus (HIV) infection and to discuss their potential pathogenic mechanisms. DATA IDENTIFICATION: A literature search using MEDLINE (1981 to 88) and Index Medicus (1981 to 88) and review of references from all identified articles. STUDY SELECTION: All studies and case reports addressing arthritis, myopathies, vasculitis, the sicca syndrome, systemic lupus erythematosus, and autoimmune phenomena in HIV-infected patients are cited. RESULTS OF DATA SYNTHESIS: The Reiter syndrome and other reactive arthritides are the commonest arthritides seen in HIV-infected patients. Psoriatic arthritis and septic arthritis with opportunistic agents, as well as an articular pain that is severe, acute, and intermittent, may also occur with HIV infection. An arthritis that may be specific for the acquired immunodeficiency syndrome (AIDS) has been described. Myopathies, especially of a polymyositic type, vasculitis, and the sicca syndrome are also part of the spectrum of rheumatologic presentation of HIV infection. Several autoimmune phenomena, such as antinuclear and anticardiolipin antibodies, as well as lupus anticoagulant, have been reported in HIV-infected patients. CONCLUSIONS: The Reiter syndrome, reactive arthritis, polymyositis, and the sicca syndrome may herald the onset of clinically evident HIV infection. These diseases and others may also occur in patients with full-blown AIDS. Furthermore, HIV infection may mimic systemic lupus erythematosus.     

Cost effectiveness of low-dose zidovudine therapy for asymptomatic patients with human immunodeficiency virus (HIV) infection.

We did a cost-effectiveness analysis of zidovudine therapy for asymptomatic patients with human immunodeficiency virus (HIV) infection. The incremental direct medical costs of zidovudine therapy were determined, and data on the effects of therapy were derived from the report of the Acquired Immunodeficiency Syndrome (AIDS) Clinical Trials Group Protocol 019. Zidovudine therapy has an annual incremental cost of $2653 per person. The cost per year of life saved ranges between $6553 and $70 526, depending on which epidemiologic model of potential long-term zidovudine effect is used (in sensitivity analyses, the cost per year of life saved ranges between $2649 and $250 546). Although expensive, zidovudine therapy has the potential to yield a substantial survival benefit to patients. The cost effectiveness of zidovudine therapy compares favorably with that of other common medical therapies.     

Endocrine manifestations of human immunodeficiency virus (HIV) infection

Endocrine manifestations of HIV infection include both pathological changes and disturbances in function. Mechanisms include direct infection of glands by HIV or opportunistic organisms, infiltration by neoplasms, side effects of drugs, and production of humoral factors that may alter metabolism. The adrenal gland is most often affected, but virtually every endocrine system may be involved. Dysfunction is often subtle, with symptoms overlapping those of the HIV infection itself. Endocrine manifestations may be found at any time in the course of the disease, from the asymptomatic HIV-positive stage through full-blown AIDS. Optimal management of these patients may include a careful search for, and appropriate treatment of, associated endocrine abnormalities.     

42例HIV感染/艾滋病患者的心脏表现

目的　总结 42例人免疫缺陷病毒 ( HIV)感染 /艾滋病患者的心脏表现。方法　对 42例 HIV感染 /艾滋病患者进行回顾性分析。结果　 42例 HIV感染 /艾滋病心脏表现有 :心律失常 5 0 .0 % ( 2 1/ 4 2 ) ,感染性心内膜炎 4.8% ( 2 / 4 2 ) ,心包积液 2 .4% ( 1/ 4 2 ) ,扩张型心肌病合并心功能不全 14 .3% ( 6 / 4 2 )。结论　心脏亦为 HIV感染 /艾滋病的受累器官之一。艾滋病患者可因自身突出的全身症状掩盖而使心脏病变隐匿 ,心电图、胸片、超声心动图有助早期诊断并指导治疗     

Rheumatologic manifestations of infection with the human immunodeficiency virus (HIV)

The aim of this study was to assess the type and frequency of rheumatologic manifestations among patients followed at an HIV clinic in a general hospital, and to evaluate the usefulness of a questionnaire in identifying the presence of these manifestations. Fifty-two consecutive patients with HIV infection completed a questionnaire regarding the presence of rheumatologic symptoms. All patients were interviewed and examined for the prevalence and spectrum of musculoskeletal manifestations. The questionnaire was found to be sensitive in identifying patients with rheumatologic manifestations which were detected on clinical examination. The latter were found in 34 patients (65.3%). Twenty-one patients (40.3%) had arthralgias, 8 (15.2%) had spondyloarthropathies (including Reiter's syndrome, psoriatic arthritis and undifferentiated spondyloarthropathy). Two patients (3.8%) had oligoarthritis and one case each had myositis, Sj?gren's syndrome and Beh?et's syndrome. Muscle pain was common, occurring in 35% of the patients, and it was related to the use of zidovudine therapy. In contrast to previous reports, most of the patients with arthritis had mild disease, responding promptly to non-steroidal anti-inflammatory drugs. This difference may be explained by the use of zidovudine therapy, stage of HIV infection, and lifestyle. A questionnaire may be helpful in identifying the prevalence of rheumatologic manifestations in HIV-infected subjects.     

Treatment of chronic hepatitis C virus infection in human immunodeficiency virus (HIV) infected patients

Treatment of chronic hepatitis C Virus (HCV) infection in human immunodeficiency virus (HIV) infected patients has become a topic of great importance, since the complications of chronic hepatitis are the first one cause of mortality among HIV patients. The aim of this study is to review the biological and epidemiological data in HIV-HCV coinfection, to establish treatment guidelines taking in consideration drugs' adverse effects and interactions, and to report the results of the main studies carried out. The treatment currently accepted includes pegylate interferon andribavirin, which have improved prior treatments, but the response rate depends on HCV genotype.     

Pneumocystis carinii infection among human immunodeficiency virus (HIV) infected Myanmar patients

A total of 60 HIV infected patients complaining of dry cough for at least two weeks and attending the Out-patient Department of the Specialist Hospital, Waibargi, were screened for Pneumocystis carinii. Induced sputum samples were examined with Giemsa and Gomori silver methenamine stains. P. carinii were detected in 18 patients (30%) with silver stain and 13 patients (21.7%) with Giemsa stain. The sensitivity and specificity of the Giemsa stain were 72.2% and 95.2%, respectively. The range of CD4 counts in P. carinii-positive patients was found to be 0-562/microl, and the mean CD4 count was 132.3/microl. Out of 18 P. carinii-positive cases, CD4 counts of 15 cases (83.3%) were <200/microl and those of 3 cases were >200/microl. Clinically, P. carinii-positive cases were associated with fever in 55.5%, with tightness of the chest in 38.9%, and with cyanosis and tightness of the chest in 11.1%. Co-infection with tuberculosis was found in 16.7%. Anti-pneumocystic prophylaxis is recommended for those patients with a CD4 count <200/microl. Giemsa staining could be used as an alternative diagnostic method for detecting P. carinii. This study documented the existing prevalence of P. carinii among HIV-infected Myanmar patients.