Increased homocysteine plasma level is associated with shortened prothrombin time in HIV-infected patients

Objective: To find factors associated with increased homocysteine plasma level in HIV-infected patients.

Methods: Cross-sectional study, carried out as a supplementary task to the standard care of HIV-infected patients. The possible association of increased homocysteine plasma level with blood analyses results was assessed with a multiple linear regression analysis, using the automatic linear modeling available in SPSS version 22.

Results: A total of 145 patients were included. Creatinine was higher than normal in 7 patients (5%), prothrombin time was shortened in 36 patients (25%), and a monoclonal gammopathy was detected in 2 patients (1%). In the regression analysis, an association was found between high homocysteine plasma level and the following variables: low prothrombin time (β coefficient ?0.286, confidence interval ?1.1854 to ?0.754, p < 0.001), high creatinine (coefficient 9.926, confidence interval 6.351–15.246, p < 0.001), low folic acid (coefficient ?0.331, confidence interval ?0–483 to ?0.187, p < 0.001), and low vitamin B₁₂ (coefficient ?0.007, confidence interval ?0.01 to ?0.001, p = 0.005).

Conclusion: An association was found between increased homocysteine plasma level and shortened prothrombin time.     

Oral lesions in children with perinatally acquired human immunodeficiency virus infection

Fifteen vertically HIV-infected children aged between 2 and 12 years were followed up for 1 year, weekly to monthly, to study the incidence of oral lesions. At the time of first examination, oral candidiasis (OC) was observed in nine children. Seven children presented with the erythematous type only and two with pseudomembranous oral candidiasis. Four cases of cheilitis were seen in association with the erythematous forms of oral candidiasis. One erythematous candidiasis progressed to pseudomembranous form. A second case of erythematous OC, after multiple recurrences in the form of erythematous OC, recurred as pseudomembranous OC. Another case of erythematous OC and one of pseudomembranous OC presented after multiple recurrences as a persistent, adherent pseudomembranous OC. An orofacial herpes-zoster infection, a hairy leukoplakia and a necrotic lingual ulcer were observed as second lesions and in association with oral candidiasis in three children. Erythematous oral candidiasis was the most frequent oral HIV-related lesion, was observed in different stages of HIV-infection, and in some cases progressed to pseudomembranous candidiasis. A different, selectively resistant, Candida clone was isolated in three cases of recurrent candidiasis.     

Pityrosporum ovale and seborrhoeic dermatitis in HIV-seropositive and HIV-seronegative men. Quantitative cultures and serological studies

Background Previous studies of quantitative determinations of Pityrosporum ovale in HIV-seropositive patients with and without seborrhoeic dermatitis are contradictory. Objective To investigate the number of P. ovale among HIV-seronegalive and HIV-seropositive men using contact plates containing cow's milk as the main lipid source and to analyse sera with ELISA for IgG antibodies to a P. ovale protein extract. Results There was no difference in the number of P. ovale between healthy controls and HIV-positive patients with and without seborrhoeic dermatitis. HIV-seropositive patients had significantly lower IgG antibody litres to a P. ovale protein extract compared with healthy individuals.     

Ocular findings in HIV-1 positive and HIV-1 negative participants in a rural population-based cohort in Uganda

Purpose: To report the ocular findings in HIV-1 seropositive individuals and HIV-negative controls in a population-based cohort in rural Uganda. Methods: Participants were examined by an ophthalmologist, who was unaware of their HIV-status. Results: 238 participants were examined, 43 were HIV-1 prevalent cases (infected prior to 1990); 62 were HIV-1 incident cases and 133 were HIV-negative controls. Eleven of the HIV-positive participants had AIDS, and a further 8 had a CD4 count of less than 200 cells/mm³ Bilateral low vision was recorded in 9 participants and cataracts were the main cause of bilateral low vision. The mean intra-ocular pressure (IOP) was 12.6 mm Hg, and no association was found between IOP and CD4 lymphocyte count. Although significantly more HIV positives had some sign of intraocular inflammation compared to the negatives (p = 0.02) there was no significant linear trend in the HIV positives with decreasing CD4 count. Overall, 11 (26%) prevalent, 6 (10%) incident cases and 8 (6%) HIV-negatives controls had some evidence of intraocular inflammation, however, only one person had reduced visual acuity attributable to these lesions. Punctate epithelial erosions and keratic precipitates in the anterior chamber were seen significantly more frequently in HIV-positives compared to the HIV-negative controls. Cotton wool spots were not seen. Conclusions: A substantial proportion of HIV-infected persons had ocular findings which may have been attributable to their infection, however in only one case did this result in reduced visual acuity. Although the ocular complications of AIDS seem to comprise a large extra element in the work load of tertiary care hospitals dealing with eye problems, on a population basis such cases are infrequent. This revised version was published online in July 2006 with corrections to the Cover Date.     

A follow-up study of neuropsychological functioning in AIDS-patients Prognostic significance and effect of zidovudine therapy

Thirty-three patients with AIDS were subjected to neuropsychological and immunological testing with semi-annual examinations over a two year period. No patient had signs of opportunistic infections or neoplasms in the CNS. Patients who were neuropsychologic ally impaired at the time of AIDS diagnosis (n = 12) survived for a significantly shorter period than did the non-impaired subjects (n = 21), and neuropsychological function at first test had a significant predictive value concerning survival time. The poor prognosis associated with impaired neuropsychological status was seen also in patients treated with zidovudine (ZDV). Of the 21 patients who started ZDV treatment shortly after the first neuropsychological examination, 12 were retested. Follow-up data showed that this group of patients had a significant improvement in neuropsychological functioning during the first 6 months. However, a decrease in performance was observed at second follow-up. In the group not treated with ZDV (n = 7), two initially normal patients developed signs of HIV-encephalopathy, while none of the initially normal ZDV-treated patients did so. This might suggest a prophylactic effect of ZDV on development of neuropsychological dysfunction. Changes in neuropsychological test results were correlated with changes in serum concentration of neopterin irrespective of ZDV treatment, suggesting that monocyte/macrophage activation may be involved in the pathogenesis of HIV-encephalopathy.     

Efficacy and tolerability of multiple drug therapy in HIV-infected children

OBJECTIVES: To characterize the efficacy and tolerability of multiple drug therapy (MDT) among heavily pre-treated HIV-infected children. METHODS: An observational study of seven children treated with 4-7 antiretroviral agents. MDT regimens were chosen with regard to past antiretroviral exposure and genotypic resistance data. Five children received MDT once, one child twice and one child four times. All patients had AIDS and severe CD4+ depletion and failed >2 PI-based HAART regimens. RESULTS: Virologic response, defined as a > or =log10 decrease in plasma HIV-1 RNA at week 24, was achieved in 7/11 MDT. Successful MDT kept a sustained viral suppression (<50 copies/ml) at longest follow-up (72-96 weeks). Successful MDT obtained a great immune recovery: the median rise in absolute and percentage of CD4+ cells was 261 and 4 at week 24 and it reached 480 and 16 at 72-96 weeks. Adverse events were common but generally manageable. Mild/moderate gastrointestinal complaints and laboratory abnormalities were detected in 5/11 and 8/11 MDT. Grade 2 severity pancreatitis occurred in one case with chronic active hepatitis C. Pancreatitis resolved within 30 days of MDT interruption. CONCLUSIONS: MDT may be a therapeutic option in children who failed to respond to most standard HAART regimens.     

Prevalence and risk factors of mild chronic renal failure in HIV-infected patients: influence of female gender and antiretroviral therapy

Background

In people living with HIV, much is known about chronic kidney disease, defined as a glomerular filtration rate under 60 mL/min. However, there is scarce data about prevalence and risk factors for milder impairment (60–89 mL/min).

Impaired antibody response after immunization of HIV-infected individuals with the polysaccharide vaccine against Salmonella typhi (Typhim-Vi®)

Infections with Salmonella species, including Salmonella typhi, are more frequently observed in HIV-infected individuals than in healthy individuals. HIV-infected individuals were vaccinated with polysaccharide vaccine against Salmonella typhi (Typhim-Vi®) which is assumed to be a T-cell-independent antigen. We found that the antibody response in patients with <200×10⁶/l CD4⁺ T lymphocytes was significantly lower compared with patients with ≥200×10⁶/l CD4⁺ T lymphocytes and healthy controls. The antibody response after vaccination with the polysaccharide salmonella Vi-antigen was correlated with the number of CD4⁺ T lymphocytes and therefore Typhim-Vi can be considered to be a T-cell-independent type 2 antigen. The results of this study indicate that after vaccination the proportion of HIV-infected individuals with protective antibody concentrations against Salmonella typhi will be lower than in healthy controls.     

CT findings in different stages of HIV infection: a prospective study

Summary In the acquired immunodeficiency syndrome (AIDS), different patterns of CT findings have been described. In a prospective and unselected CT study we examined 200 patients in different stages of HIV-1 infection, 14% of whom had focal lesions, 37% atrophic changes and 49% normal findings. The differential diagnosis is discussed. Depending on the patient's complaints and clinical findings, even when the CT scan is normal there may be treatable complications that must be detected by other diagnostic techniques, such as lumbar puncture.