Rates and types of psychiatric disorders in perinatally human immunodeficiency virus-infected youth and seroreverters

Background: The purpose of this study was to examine 1) the prevalence of psychiatric and substance use disorders in perinatally HIV‐infected (HIV+) adolescents and 2) the association between HIV infection and these mental health outcomes by comparing HIV+ youths to HIV exposed but uninfected youths (HIV‐) from similar communities. Methods: Data for this paper come from the baseline interview of a longitudinal study of mental health outcomes in 9‐16 year old perinatally HIV‐exposed youths (61% HIV+) and their caregivers. Three hundred forty youths and their primary adult caregivers were recruited from four medical centers and participated in separate individual interviews. Youth psychiatric disorder was assessed using the caregiver and youth versions of The Diagnostic Interview Schedule for Children (DISC‐IV). Results: According to caregiver or youth report, a high percentage of HIV+ and HIV‐ youths met criteria for a non‐substance use psychiatric disorder, with significantly higher rates among the HIV+ youths (61% vs. 49%, OR = 1.59; CI = 1.03,2.47; p < .05). The most prevalent diagnoses in both groups were anxiety disorders (46% for total sample) which included social phobia, separation anxiety, agoraphobia, generalized anxiety disorder, panic disorder, obsessive‐ compulsive disorder, and specific phobias. One quarter of the sample met criteria for a behavioral disorder (ADHD, conduct disorders, and oppositional defiant disorders), with ADHD being most prevalent. HIV+ youths had significantly higher rates of ADHD (OR = 2.45; CI = 1.20, 4.99, p < .05). Only 7% of youths met criteria for a mood disorder and 4% for a substance abuse disorder. Several caregiver variables (caregiver type and HIV status) were also associated with both child HIV status and mental health outcomes. Conclusions: Our data suggest that HIV+ youths are at high risk for mental health disorders. Further longitudinal research is necessary to understand the etiology, as well as potential protective factors, in order to inform efficacy‐based interventions.     

Prevalence and Correlates of Ischemic ECG Findings among Adults With and Without HIV in Tanzania

Introduction:HIV confers increased risk of myocardial infarction (MI), but there has been little study of ischemic electrocardiogram (ECG) findings among people with HIV in sub-Saharan Africa.Objectives:To compare the prevalence of ischemic ECG findings among Tanzanians with and without HIV and to identify correlates of ischemic ECG changes among Tanzanians with HIV.Methods:Consecutive adults presenting for routine HIV care at a Tanzanian clinic were enrolled. Age- and sex-matched HIV-uninfected controls were enrolled from a nearby general clinic. All participants completed a standardized health questionnaire and underwent 12-lead resting ECG testing, which was adjudicated by independent physicians. Prior MI was defined as pathologic Q-waves in contiguous leads, and myocardial ischemia was defined as ST-segment depression or T-wave inversion in contiguous leads. Pearson’s chi-squared test was used to compare the prevalence of ECG findings among those with and without HIV and multivariate logistic regression was performed to identify correlates of prior MI among all participants.Results:Of 497 participants with HIV and 497 without HIV, 272 (27.8%) were males and mean (sd) age was 45.2(12.0) years. ECG findings suggestive of prior MI (11.1% vs 2.4%, OR 4.97, 95% CI: 2.71–9.89, p < 0.001), and myocardial ischemia (18.7% vs 12.1% OR 1.67, 95% CI: 1.18–2.39, p = 0.004) were significantly more common among participants with HIV. On multivariate analysis, ECG findings suggestive of prior MI among all participants were associated with HIV infection (OR 4.73, 95% CI: 2.51–9.63, p = 0.030) and self-reported family history of MI or stroke (OR 1.96, 95% CI: 1.08–3.46, p = 0.023).Conclusions:There may be a large burden of ischemic heart disease among adults with HIV in Tanzania, and ECG findings suggestive of coronary artery disease are significantly more common among Tanzanians with HIV than those without HIV.     

The use of two measures of health-related quality of life in HIV-infected individuals: a cross-sectional comparison

Two measures of health-related quality of life in 65 HIV-infected individuals were compared in a cross-sectional design. The Quality of Well-Being Scale (QWB) results in a single score ranging from death to perfect health. The MOS-HIV Health Survey (MOS-HIV, 34-item version) gives scores in 11 dimensions. The QWB score distinguished subjects with AIDS from those who were asymptomatic (p=0.027). For the seven multi-item scales of the MOS-HIV, Cronbach's alpha ranged from 0.85–0.95, indicating good internal consistency reliability. Clinical HIV-infection status was significantly associated with the dimensions of Overall Health (p=0.002), Role Function (p=0.022), Social Function (p=0.037), Energy/Fatigue (p=0.027) and Health Distress (p=0.025). All eleven dimensions of the MOS-HIV were significantly correlated with the QWB score (Spearman's coefficient = 0.405–0.670; for all, p<0.01) and the QWB score could be predicted from the MOS-HIV dimension scores using multiple regression. The QWB and the MOS-HIV may be useful in assessing health-related quality of life in patients infected with HIV.Funding support for this study provided by the Center for Pharmaceutical Economics of the University of Arizona.     

Oral hairy leukoplakia in an HIV-seronegative heart transplant patient

While oral hairy leukoplakia has been observed predominantly in patients with HIV-infection at various stages, recent reports have shown that HL may also occur in patients immunosuppressed for other reasons. This report describes oral hairy leukoplakia in a heart transplant recipient with negative HIV serology. The histopathologic diagnosis of HL was confirmed by immunohistochemical detection of EBV-VCA in the surface epithelium of the lesion and by negative staining electron microscopy.     

Treatment of symptomatic amebic colitis in human immunodeficiency virus-infected persons

While most Entamoeba histolytica appearing in male homosexuals infected with human immunodeficiency virus (HIV) is considered non-invasive in Western countries, and treatment of amebiasis in these persons has received very little attention, in Japan some male homosexual amebiasis patients infected with HIV complain of symptoms attributable to E. histolytica infection. We investigated whether symptomatic E histolytica amebic colitis in HIV-infected persons requires higher doses or longer duration of antiamebic drug therapy than in non HIV-infected patients. Four symptomatic amebic colitis patients infected with HIV-1, three of them severely immunocompromised, with CD4 cell counts <200/mm³, were treated with oral metronidazole: 1500 mg a day for 10 days in 2 patients, 1000 mg a day for 10 days in 1 patient, and 1000 mg a day for 6 days and then 750 mg for 4 days in 1 patient, and good therapeutic results with no side effects were obtained. This indicates that symptomatic amebic colitis in HIV-infected persons can be successfully treated with metronidazole at the same dose and duration of treatment used in non-HIV-infected persons.     

Community-acquired bacterial pneumonia in adult HIV-infected patients

Introduction: Despite active antiretroviral therapy (ART), community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected patients and incurs high health costs.

Areas covered: This article reviews the most recent publications on bacterial CAP in the HIV-infected population, focusing on epidemiology, prognostic factors, microbial etiology, therapy, and prevention. The data discussed here were mainly obtained from a non-systematic review using Medline, and references from relevant articles.

Expert commentary: HIV-infected patients are more susceptible to bacterial CAP. Although ART improves their immune response and has reduced CAP incidence, these patients continue to present increased risk of pneumonia in part because they show altered immunity and because immune activation persists. The risk of CAP in HIV-infected patients and the probability of polymicrobial or atypical infections are inversely associated with the CD4 cell count. Mortality in HIV-infected patients with CAP ranges from 6% to 15% but in well-controlled HIV-infected patients on ART the mortality is low and similar to that seen in HIV-negative individuals. Vaccination and smoking cessation are the two most important preventive strategies for bacterial CAP in well-controlled HIV-infected patients on ART.     

The Role of the Family System in HIV Risk Reduction: Youths With Hemophilia and HIV Infection and Their Parents

Objective. To examine the relationship between family communicationand HIV risk reduction behaviors among a multisite sample of125 male youths (ages 12—25) with hemophilia and HIV-infection,as well as their parents. Methods: Participants completed self-report surveys assessingcommunication and attitudes regarding HIV risk reduction interventions;adolescents also provided data about their sexual behaviors. Results: Adolescents with parents who discuss sexual issueswere more likely to report HIV status disclosure to sexual partners.Most parents were supportive of HIV risk reduction interventionsfor their adolescents, but the youths themselves tended to endorseonly interventions that offered opportunities for recreationalactivities and socialization with peers. Conclusions: Findings are discussed in terms of interventionimplications and the need for family systems-based programs.     

Ein Fall von AIDS-assoziierter Histoplasmose in Deutschland

Summary In a thirty-year-old patient with AIDS the diagnosis of disseminated histoplasmosis was established via biopsy and culture. The patient had grown up in Argentina, where histoplasmosis is endemic. He had not been in an endemic region during the last two years anteceding the manifestation of systemic histoplasmosis. Accordingly, in patients with a progressive immunodeficiency syndrome, reactivation of a former (possibly inapparent) infection withHistoplasma capsulatum must be considered. Therapy with Amphotericin B lead to a remarkable improvement of clinical, laboratory and sonographic findings. Due to the fact that total eradication ofH. capsulatum from the infected host cannot be achieved with any known drug regimen, a life-long follow-up therapy was begun. The patient showed no signs of relapse after a follow-up of 7 months.

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Abkürzungsverzeichnis HIV human immunodeficiency virus - AIDS acquired immunodeficiency syndrome - BSG Blutkörperchensenkungsgeschwindigkeit - n.W. nach Westergren - LDH Laktatdehydrogenase - ASAT Aspartat-Aminotransferase - ALAT Alanin-Aminotransferase - AP alkalische Phosphatase - -GT Glutamyl-Transpeptidase     

Oral candidosis in HIV-infected patients. Prognostic value and correlation with immunological parameters

In a prospective study, 29 patients were observed over a period of 42 weeks for signs of oral candidosis (OC), immunological parameters and other typical AIDS-related events. Before the study started, no OC was observed in any of the patients. During the observation period, OC was diagnosed in 12 of the 29 patients (41%). 5 of these 12 patients (42%) developed full-blown AIDS during the 42 weeks. In contrast, a progression to AIDS was observed in only 1 of the 17 patients (5.9%) without OC. The laboratory findings for patients with and without OC showed statistically significant differences for neopterin (23.6 against 14.4 nmol l-1), CD4 counts (417 against 763/mm3) and CD4/CD8 ratios (0.45 against 0.85). Based on these results, it seems justifiable to consider prophylactic measures such as pentamidine inhalation and/or treatment with zidovudine in HIV-infected patients with immunodeficiency and occurrence of OC.     

Analysis of Bone Mineral Content in Horizontally HIV-Infected Children Naïve to Antiretroviral Treatment

AbstractLow bone mass is a frequent finding in HIV-infected individuals. Reduced bone mass has been found in vertically infected children who are receiving antiretroviral treatment. Little is known about bone mass in horizontally infected young patients who are naïve to antiretroviral therapy. We measured the bone mineral content (BMC) at the lumbar spine and in the whole skeleton by using dual-energy X-ray absorptiometry (DXA) in 16 HIV-infected children (age 9.3 ± 3.9 years) naïve to antiretroviral treatment, and in 119 healthy children (age 9.7 ± 3.3 years). Thirteen patients were also pair-matched by anthropometric measures, sex, and age with healthy children. Median spine BMC of HIV-infected children was 14.9 g (8.2–39.2 g), and whole body BMC was 1106.1 g (55.5–2344.1 g). Spine BMC of healthy children was 18.6 g (6.8–52.2 g), and whole body BMC was 1213.5 g (541.0–2722.0 g). Multivariate analysis showed a mean difference of spine BMC values of 0.004 g (P = 0.64) between the two groups. Similarly, the whole body BMC difference between the two groups (0.001 g) was not statistically significant (P = 0.55). Mean spine BMC measurements in the case-control evaluation were 21.1 g (9.7 g) (patients), and 22.3 g (6.9 g) (controls). Whole body BMC measurements of patients and controls were 1258.5 g (539.6 g) and 1311.1 g (479.2 g), respectively. In both cases the differences were not significant. The duration of HIV infection did not relate to BMC values. In conclusion, horizontally HIV-infected children naïve to antiretroviral therapy have bone mineral measurements comparable to those of healthy children.