摘要:

ObjectiveTo assess the presence of covert HIV-1 infection.SettingHigh-risk seronegative homosexual men from the Pittsburgh portion of the Multicenter AIDS Cohort Study were examined for the presence of HIV-1 infection.Patients, participantsTen men (group 1) were examined prospectively for the presence of HIV-1 in their freshly-obtained peripheral blood mononuclear cells (PBMC). Furthermore, cryopreserved PBMC from 26 men (group 2) at their first visit (1984–1985) were examined retrospectively for the presence of HIV-1.Main outcome measuresPBMC samples from groups 1 and 2 were examined for HIV-1 by polymerase chain reaction (PCR) using gag, env and strong-stop (long terminal repeat) specific primers. In addition, fresh PBMC samples from group 1 were examined for HIV-1 by virus culture.ResultsNone of the 10 PBMC samples from group 1 were positive for virus culture and PCR. Only one of the 26 men from group 2 was positive for gag and strong-stop DNA sequences. This PCR-positive, seronegative subject was found to be negative for HIV-1 by PCR at follow-up visits up to 48 months later. None of 15 seronegative, low-risk homosexual men and 12 seronegative heterosexual men were found to be PCR-positive for HIV-1. However, six HIV-1-seropositive men were positive by PCR for gag, env, and strong-stop HIV-1 DNA sequences.ConclusionsThese results suggest a low prevalence of covert HIV-1 infection in high-risk seronegative homosexual men in our geographic area.

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveThe purpose of this study was to determine any correlation between the expression of CD4 antigen on the surface of monocytes, and the frequency with which these cells are infected with HIV.DesignCD4 surface expression on monocytes is significantly less than that expressed on CD4+ lymphocytes. Nevertheless, all monocytes express the HIV CD4 receptor and infected individuals have a significant decrease in the number of monocytes that express a higher density of CD4 surface fluorescence.MethodsThree-color flow cytometric analysis was used to characterize monocyte-enriched peripheral blood mononuclear cells (PBMC) in terms of surface expression of CD4, CD14 (macrophage antigen), and class II major histocompatibility antigen (HLA-DR). HLA-DR+ monocytes from HIV-positive individuals were sorted into two subpopulations based on either ‘bright’ or ‘dim’ CD4 surface expression. A polymerase chain reaction (PCR) assay was used to detect the presence of proviral HIV sequences within the DNA from 105cells from each sorted population.ResultsPost-sort analysis revealed that the dim CD4+ monocyte subset expressed dim HLA-DR surface antigen, while the bright CD4+ monocyte subset contained both bright and dim HLA-DR+ cells. PCR results showed that four out of eight dim CD4+ monocyte subsets contained proviral HIV DNA, compared with one out of eight bright CD4+ monocyte subsets.ConclusionsOur data suggest that PBMC that express dim CD4 surface antigen are more likely to contain monocytotrophic HIV variants than monocytes that express a higher surface density of CD4 antigen.

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveThe purpose of this study was to assay reactivity of antibody-positive sera to different parts of the HIV-1 and HIV-2 proteinase (PR) proteins.DesignSince the majority of HIV-1-antibody-positive sera react to the proteinase, but the antigenic determinants on the protein have not been identified, we attempted to identify these determinants.InterventionsWe synthesized 18 peptides representing the PR of HIV-1 and HIV-2 in order to map serum reactivity to the PR protein.ResultsBoth HIV-1-and HIV-2-antibody-positive sera recognized four distinct antigenic regions in the HIV-1 and HIV-2 PR.ConclusionsCorrelation between our results and the crystallographic structure of the protein revealed that the antigenic regions are positioned at the surface of the HIV-1 PR. Although the structure of HIV-2 PR has not yet been characterized, our results indicate that the folding of the HIV-1 and HIV-2 PR may be very similar.

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveWe compared the efficacies of low-dose trimethoprim—sulphamethoxazole (TMP-SMX; one tablet: IMP, 160 mg, SMX, 800 mg, twice daily, twice a week) and aerosolized pentamidine (300 mg every 4 weeks) as secondary prophylaxis againstPneumocystis cariniipneumonia (PCP) in patients with HIV infection.DesignA retrospective controlled study.SettingThe study was performed at St Vincent's Hospital, Sydney, Australia, which is a tertiary referral university hospital.Patients, participantsOver a 4-year period, following primary episodes of PCP, 60 patients received TMP—SMX and 73 aerosolized pentamidine. Thirty-eight patients who received no secondary prophylaxis served as historical controls.Main outcome measuresThe rate of and time to PCP relapse was recorded for patients receiving low-dose TMP-SMX, aerosolized pentamidine, or no prophylaxis.ResultsOnly one (1.7%) patient in the TMP—SMX-treated group relapsed, compared with 31 (42.5%) of those in the aerosolized pentamidine group and 21 (55.1%) of those in the control group (P<0.0001). Median PCP-free survival times were > 1153 days in the TMP—SMX group, 496 days in the pentamidine group, and 265 days in the control group (P< 0.0001 between all groups). The rate of or time to relapse was not influenced by CD4+ lymphocyte count at the start of prophylaxis, primary therapy of PCP, history of allergy to TMP—SMX, or zidovudine therapy during the period of secondary prophylaxis in any patient group. Both therapies were well tolerated, with three (5%) of those receiving TMP-SMX and four (5%) of those receiving pentamidine discontinuing therapy as a result of side-effects.ConclusionsLow-dose TMP-SMX appears to be more effective compared with aerosolized pentamidine as secondary prophylaxis against PCP in HIV-infected patients. Zidovudine was well tolerated by both groups, but did not influence the rate of or time to relapse.

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveBoth AIDS and cervical neoplasia (CN) can result from sexual transmission of HIV infection and may affect similar groups of women. Available data on the association between AIDS and CN have practical implications for gynecological care. We review these data to provide an estimate of the magnitude of the association between CN and HIV infection.DesignTwenty-one studies were reviewed, including reports and abstracts published from January 1986 to July 1990. Of these, five included a comparison group and had sufficient data for inclusion in the analysis.ResultsAll five controlled studies reported a significant association between HIV infection and CN. One included women with both intraepithelial and invasive lesions; the other four considered women with intraepithelial lesions only. The summary odds ratio indicated that the odds of HIV-infected women having CN are 4.9 (95% confidence interval, 3.0–8.2) times that of HIV-negative women.ConclusionsResearch is needed to clarify etiological relationships and the role of human papillomavirus in the causal pathway of the observed association. Meanwhile, available data are sufficient to encourage regular Papanicolaou's smear screening of HIV-infected women, and HIV testing and counseling of women with CN considered at risk for HIV infection.

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveReports from the United States that urinary tract infections (UTI) are more common in homosexual than in heterosexual men have not been confirmed in Europe. The occurrence of several UTI in men infected with HIV-1 has been recorded in The Netherlands. We therefore analysed the relationship between the presence of bacteriuria and the immune status (CD4+ cell count) in these HIV-1-infected patients.DesignUrinary cultures were obtained prospectively for 2 years, during the first visit and every 6 months thereafter, when signs and symptoms of UTI occurred and when patients had fever of unknown origin. CD4+ cell counts were measured at the same time.SettingThe study was performed at the University Hospital, Utrecht, The Netherlands.Patients, participantsOne hundred and thirty HIV-1-infected men attended our hospital. Data from 98 were analysed. Eighty-nine (91%) of these men were either homo-or bisexual.Main outcome measuresPositive urinary culture.ResultsGroup 1 (CD4+ cell count <200 × 106/I) consisted of 47 patients; 30% had at least one period of bacteriuria, with 21 episodes. Group 2 (CD4+ cell count 200–500 × 106/l) consisted of 27 patients; 11% had at least one period of bacteriuria, with five episodes. We did not find bacteriuria in the 24 patients in group 3 (CD4+ cell count >500 × 106/l). The rate of bacteriuria per patient-month, 4 (group 1) versus 2 (group 2), differed significantly (P< 0.001). A significant relationship between CD4+ cell count and bacteriuria was found (P= 0.00003); no relationship, however, was found with anal intercourse, hospitalization, Karnofsky score, follow-up, or age.ConclusionWe conclude that men infected with HIV and presenting with a CD4 + cell count <200 × 106/l are at increased risk for bacteriuria.

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveWe conducted a comparison of itraconazole versus amphotericin B plus flucytosine in the initial treatment of cryptococcal meningitis in patients with AIDS and established the efficacy of itraconazole as maintenance treatment.DesignThe trial was a prospective, randomized, and non-blinded study.Setting: The study was performed at an academic centre for AIDS, Amsterdam, The Netherlands.Patients, participantsTwenty-eight HIV-1-seropositive men with a presumptive diagnosis of cryptococcal meningitis, randomized between 5 February 1987 and 1 January 1990, were included for analysis.InterventionsOral itraconazole (200 mg twice daily), versus amphotericin B (0.3 mg/kg daily) intravenously plus oral flucytosine (150 mg/kg daily) was administered for 6 weeks followed by maintenance therapy with oral itraconazole (200 mg daily) to all patients.Main outcome measuresOutcome measures were a complete or partial response, recrudescence and relapse.ResultsA complete response was observed in five out of the 12 patients who completed 6 weeks of initial treatment with itraconazole versus all 10 patients who completed treatment with amphotericin B plus flucytosine (P= 0.009). A partial response was observed in seven out of the 14 patients assigned to itraconazole. During maintenance therapy, recrudescence (n = 6) or relapse (n = 1) occurred in seven out of the 12 patients initially assigned to itraconazole, whereas two relapses occurred among nine patients initially treated with amphotericin B plus flucytosine (P= 0.22); recurrence of clinical symptoms was significantly related to a positive cerebrospinal fluid culture at 6 weeks (P= 0.003).ConclusionItraconazole is less effective compared with amphotericin B plus flucytosine in achieving a complete response in initial therapy in AIDS patients with cryptococcal meningitis.

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo investigate the efficacy of fluconazole prophylaxis against systemic fungal infections in HIV-positive patients.DesignOpen label treatment compared with historical controls.SettingPatients were seen at the Parkland Memorial Hospital HIV Clinic, Dallas, Texas, USA between 1 March 1990 and 28 February 1991.Patients, participantsThree hundred and thirty-seven historical controls were followed for 157 patient-years, and 329 fluconazole-treated patients for 145 patient-years.InterventionsFluconazole (100 mg daily) was administered to all patients with CD4 lymphocyte counts < 68 × 106/l seen at our HIV clinic after 1 March 1990.Main outcome measuresLysis-centrifugation blood cultures were recorded monthly for all patients during both study periods.ResultsTwenty infections (16 cryptococcosis, four histoplasmosis) occurred in 337 historical reference control patients (product-limit 1-year incidence, 7.5 × 2.0/year). Four infections (one cryptococcosis, three histoplasmosis) occurred in the treated patient group (product-limit 1-year incidence, 1.8 × 0.9/year).ConclusionsFluconazole warrants further evaluation for prophylaxis against systemic fungal infections in HIV-positive patients.

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveWe compared the level ofEnterocytozoon bieneusiinfection at different sites within the small intestine among patients with AIDS.DesignThe level ofE. bieneusiinfection of each patient biopsy was determined and compared using semi-thin plastic section light microscopy and transmission electron microscopy (TEM).Patients, participantsNine subjects with chronic diarrhea who had endoscopic biopsies of either proximal (bulb) or distal (fourth portion) duodenum plus proximal jejunum (just past ligament of Treitz), either simultaneously or within a few months of each other were studied. All patients had TEM-confirmed diagnoses ofE. bieneusiintestinal microsporidiosis.ResultsThe intensity of infection was always greater in biopsies taken from the patients' jejunum compared with those taken from the duodenal bulb. In one patient, the duodenal bulb biopsy was negative while the jejunal biopsy, taken at the same time, was positive. The distal duodenum was usually, but not always, equal to the jejunum in terms of parasite burden. Esophageal, gastric, and colorectal biopsies from these and other patients were negative forE. bieneusi.ConclusionsFor the diagnosis ofE. bieneusito evaluate chronic diarrhea in AIDS patients, upper intestinal endoscopy biopsies should be taken at the most distal site possible.

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveThe objective of this study was to evaluate the effect of isoprinosine on HIV-antigen expression in HIV-positive patients without AIDS.DesignSerum samples from anti-HIV-positive patients without AIDS participating in a double-blind, placebo-controlled trial of isoprinosine in the treatment of HIV infection were analysed for the presence of HIV antigen.SettingData and samples were collected from the 21 medical centres who participated in the Scandinavian multicentre placebo-controlled isoprinosine study.Patients, participantsSamples were available from 19 of 21 participating centres. Of 866 patients who enrolled, baseline serum samples were available for 642 (74%; 308 isoprinosine-and 334 placebo-treated patients).InterventionsTreatment was 1 g isoprinosine administered orally three times a day or matching placebo for 24 weeks.Main outcome measuresComparison of HIV-antigen levels before and during treatment in both the isoprinosine-treated group and the placebo-treated group of patients.ResultsDuring the study, AIDS developed in 19 patients; 17 of whom were receiving placebo treatment and two isoprinosine. The proportion of HIV-antigen-positive patients developing AIDS during treatment was signifcantly different from the proportion of HIV-antigen-negative patients in whom AIDS developed (6 versus 2%;P= 0.02). No significant changes in HIV-antigen levels were observed between the isoprinosine-and the placebo-treated group of HIV-antigen-positive patients. Median HIV-antigen levels did not change significantly in either the isoprinosine-or the placebo-treated group.ConclusionOur results suggest that isoprinosine does not have antiviral activity against HIVin vivo.

ISSN:0269-9370    

出版商:OVID    

年代:1992

数据来源: OVID