ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo determine circulating viral load in HIV-2-infected individuals.MethodsViral load was determined in 40 HIV-2-infected adults using standardized quantitative cell and qualitative plasma viraemia assays. We also tested for proviral HIV-2 DNA using single and nested polymerase chain reaction (PCR) in fresh lymphocytes from 27 subjects. The results were compared, on the basis of the CD4+ lymphocyte count, with our published data for HIV-1 infection.ResultsHIV-2 was isolated from peripheral blood mononuclear cells (PBMC) from 19 individuals and plasma from four patients. The rate of cell and plasma viraemia positivity correlated with the CD4+ cell count and HIV-2 virus load increased as the CD4+ cell count fell. The cellular HIV-2 load in the patients with a CD4+ count<200 $$ 106/l was similar to reported values for HIV-1, but the HIV-2 isolation rate from the plasma of these individuals was significantly lower than for HIV-1. When the CD4+ count was between 200 and 500 $$ 106/l, the rate of HIV-2 isolation from plasma and the cellular virus load were both significantly lower than for HIV-1. When the CD4+ count was > 500 $$ 106/I, HIV-1 and HIV-2 were undetectable in plasma and HIV-1 was isolated from PBMC in significantly more cases than HIV-2. By single PCR, amplification were positive in 14 out of 27 subjects and there was a correlation between positivity and CD4+ cell count. By nested PCR, only four of the 27 subjects, all with a high CD4+ count, remained negative.ConclusionsDifferences in viral load between individuals infected with HIV-2 and those infected with HIV-1 could partly account for reported differences in the pathogenicity of the two viruses.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectivesHIV-1 infection of humans leads to states of immunosuppression. Therefore, we sought to determine precise levels of HIV-1 infection of cells in vivo, as these data may assist in the understanding of the pathogenetic processes involved in HIV infection.Design and methodsWe have developed an in situ polymerase chain reaction (IS-PCR), which allows amplification of various genetic elements within intact cells. Initial studies using this technique have demonstrated higher levels of HIV-1 provirus in unfractionated peripheral blood mononuclear cells (PBMC) of infected individuals than have been demonstrated in many previous studies using standard PCR techniques. This study describes a combined protocol in which an immunomagnetic bead separation technique is used with IS-PCR to specifically determine cellular reservoirs for HIV-1 and levels of infected cell types in the peripheral blood.ResultsCD4-positive lymphocytes infected with HIV-1 ranged from 0.2 to 69% in the 42 HIV-1-infected patients evaluated. The percentages of HIV-1-infected CD4-positive lymphocytes increased significantly with advancing stages of disease. These procedures also demonstrated that, with the exception of small percentages of infected peripheral blood monocytes, the CD4-positive lymphocyte is clearly the major cellular reservoir for HIV-1 in the peripheral blood.ConclusionsThese data suggest that, in certain infected individuals, high levels of CD4-positive lymphocytes may harbor the HIV-1 provirus. Thus, the levels of infected lymphocytes are consistent with possible direct effects of HIV-1 on lymphocyte depletionin vivo.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo study a possible correlate of protection in mother-to-infant transmission of HIV infection. In particular, to determine whether lack of HIV-specific T-helper (TH) function as indicated by HIV and non-HIV antigen-stimulated interleukin (IL)-2 production of mother and/or newborn peripheral blood leukocytes (PBL) is associated with mother-to-infant transmission of HIV.MethodsPBL from 21 HIV-seropositive pregnant women and 23 cord blood leukocytes (CBL) from their offspring were studied for in vitro TH function by IL-2 production in response to HIV and non-HIV antigens. Polymerase chain reaction (PCR) and viral culture assays were performed to determine HIV infection of the infants.ResultsPBL from 10 out of 21 (48%) mothers and from eight out of 23 (35%) CBL samples responded to two or more out of five synthetic gp160 envelope (env) peptides. Three of the 23 (13%) offspring were shown to be HIV-infected by PCR and/or viral culture on follow-up. All three infected infants were from a subset whose CBL did not exhibit env-specific TH immunity.ConclusionOur results demonstrate that fetal T cells can be primed to HIV env determinants in utero, suggest that HIV-specific TH immunity may be protective in newborns, and provide a possible means for identifying newborns who are at risk for HIV infection.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo determine the features and the prevalence of intestinal-dysfunction in HIV-infected children and to investigate its relationship to diarrhoea, growth failure, immune dysfunction and enteric pathogens.DesignCase controlled, cross-sectional multicentre study.SettingChildren enrolled in tertiary care Italian centres for paediatric HIV infection from June 1990 to June 1992. Intestinal function tests and investigation for enteric viruses were performed in Naples.PatientsForty-seven children with symptomatic HIV infection, six of whom had diarrhoea. Fifty non-infected children with diarrhoea and 48 healthy children were enrolled as controls for enteric viruses positivity and intestinal tests.MethodsIntestinal function was investigated by measuring fat, protein and carbohydrate absorption using the steatocrit method, and determining the faecal concentration α-1-antitrypsin and the d-xylose absorption, respectively. Microbiological studies included investigation for classical and opportunistic pathogens and for enteric viruses by electron microscopy in the stools of HIV-infected children. The presence of viruses in the stools of HIV-negative children was also investigated.ResultsA high prevalence of intestinal-dysfunction was detected in HIV-infected children; faecal fat loss was detected in 14 out of 47 (30%), carbohydrate malabsorption in 15 out of 47 (32%) and protein loss in eight out of 47 (1 7%) HIV-infected children. Mean values of xylose blood level and of steatocrit were significantly different from those of healthy controls. Four children with diarrhoea were positive for Cryptosporidium. The prevalence of enteric viruses was significantly increased in HIV-infected children (57%) compared with healthy controls (17%). Intestinal-dysfunction was not associated with diarrhoea, poor growth, enteric agents or degree of immune dysfunction.ConclusionsIntestinal-dysfunction, consisting of fat, carbohydrate and protein malabsorption, is a common feature of paediatric HIV infection. Although not clinically evident, it may contribute to further worsening of the disease.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo identify risk factors associated with a first episode of Clostridium difficile-associated diarrhoea (CDAD) in patients with HIV infection.DesignA case-control study.SettingUniversity teaching hospital HIV inpatient unit.Patients and methodsNineteen HIV-infected patients with CDAD, defined as diarrhoea with positive stool culture for Clostridium difficile (CD) and positive stool cytotoxin B assay, were compared with 38 randomly selected controls (HIV-infected patients hospitalized on the ward on the day the matched case was diagnosed). CD isolates were phenotyped by electrophoretic protein patterns.ResultsThe incidence of CDAD among HIV-infected patients was 4.1/100 of patient-admissions. On univariate analysis, cases were more likely to have used clindamycin [11 out of 19 compared with four out of 38; odds ratio (OR) 19; 95% confidence interval (Cl), 2–160; P= 0.0007], and pyrimethamine (14 out of 19 compared with 13 out of 38; OR, 4.8; 95% Cl, 1.4–16, P=0.02) in the month before diagnosis, and to have had cerebral toxoplasmosis (12 out of 19 compared with 13 out of 38; OR, 2.8; 95% Cl, 0.9–8.6; P= 0.09). There was also a significant increase of the risk of CDAD as duration of hospitalization in the ward increased (X2for trend, P= 0.007). Multivariate models associated two risk factors with CDAD: clindamycin use (OR, 42; 95% Cl, 2–813; P=0.01), and prolonged hospital ization in the ward (OR, 3.6 per week in the ward; 95% Cl, 1–13, P= 0.048). Of 18 available CD isolates, 15 (83%) had identical electrophoretic protein pattern.ConclusionsClindamycin use and prolonged hospital ization in the ward were the main risk factors associated with CDAD in this study. These observations, together with the occurrence of one major phenotype of CD, suggest nosocomial transmission of CD in the ward.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveCryptosporidium is a well recognized cause of AIDS-related sclerosing cholangitis for which no efficaceous therapy exists at present. We evaluated the efficiency of the combination of paromomycin and letrazuril in the treatment of this condition.Case reportWe report a case of cryptosporidial cholangitis in a patient with AIDS who responded to treatment with intravenous paromomycin followed by oral letrazuril as maintenance therapy.ConclusionThe combination of paromomycin and letrazuril should be considered in the treatment of AIDS-related sclerosing cholangitis.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo identify risk factors in a nosocomial outbreak of multidrug-resistant Mycobacterium bovis (MDRMB) tuberculosis (TB) among HIV-infected patients.DesignWe evaluated the study period (from the first to the last MDRMB smear-positive patients hospitalized in the unit) using a case-control study with three control groups. Since MDRMB is extremely rare, we assumed that a single strain was responsible for all six cases.SettingA 19-bed infectious diseases unit in Paris, France.PatientsThe index case was an AIDS patient who was hospitalized in September 1989 because of MDRMB TB. The cases were five HIV-infected patients who developed MDRMB TB between January 1990 and October 1991. Controls were randomly selected from HIV-infected patients in our unit during the study period (case-control study 1, 15 patients), during the contact period (at least one MDRMB smear-positive patient hospitalized in the unit; case-control study 2, 20 patients), and patients matched according to the length of contact (case-control study 3, 24 patients).InterventionsAfter detecting the nosocomial outbreak, we took respiratory isolation precautions for all patients suspected of having active TB.Main outcome measuresRisk factors for MDRMB nosocomial transmission, and the occurrence of new cases of MDRMB infection in HIV-infected patients and health-care workers after the introduction of isolation precautions.ResultsThe most important predictor of nosocomial transmission of MDRMB to HIV-infected patients was the (mean$pM s.d.) length of contact in days [cases, 22$pM 15.8; study 1 controls, 11.2 $pM18.9 (P=0.07); study 2 controls, 14.6$pM 8.5 (P=0.043)]. Only one case of MDRMB TB resulted from exposure to MDRMB-smear-positive patient after the introduction of respiratory isolation measures. The incubation period in the single health-care worker who developed MDRMB TB was longer than in the cases.ConclusionIn a nosocomial outbreak of MDRMB TB, the contact time was the main risk factor of transmission to HIV-infected patients. Respiratory isolation measures appear to be effective.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectivesThe AIDS epidemic in sub-Saharan Africa affects whole communities, adding to the already high burden of morbidity. Reports of AIDS cases are usually from hospital attenders, often diagnosed using the World Health Organization (WHO) clinical case definition. Little is known about the extent of HIV-associated morbidity in the general population. The objectives of this study were to describe the prevalence of (1) markers of general morbidity and (2) the criteria of the WHO clinical case definition for AIDS and (3) to determine the association between these markers and HIV-1 serostatus in a rural Ugandan community.MethodsA survey was conducted among the adult population (aged ≥ 13 years) of 15 neighbouring villages in Masaka District, south-west Uganda. The survey included medical history, physical examination and testing for HIV-1 antibodies.ResultsThe HIV-1 seroprevalence among 41 75 out of 5278 (79%) eligible adults was 8.2%. Current health problems were reported by 57.6% of adults, with increased rates in HIV-1-positive subjects, women and older people. Five of the 10 most common complaints showed significant associations with HIV-1 status, as did reported genital ulcer and vaginal discharge. The crude HIV-1 attributable disease burden in the population was 1.2% for current illness, 4.3% for previous serious illness and 9.9% for illness leading to hospital admission. Overall, 11 (3.3%) of the HIV-1-positive and nine (0.2%) of the HIV-1-negative subjects had AIDS as defined by the clinical case definition. The positive and negative predictive values and specificity were 55.0, 92.0%, and 99.8%, respectively.ConclusionsAgainst a background of high general morbidity, we observed a relatively small population attribution of HIV-1-associated morbidity. The results indicate that the clinical AIDS case definition may provide a useful tool for population surveys.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo examine the role of acute infection as a cause of morbidity in patients with tuberculosis.DesignCross-sectional documentation of predefined acute morbid events. Setting: Infectious Diseases Hospital, Nairobi, Kenya.PatientsAdults (≥ 15 years), inpatients and outpatients with a diagnosis of tuberculosis presenting with one or more of a series of clinical features. A new event was defined as one occuring at least 1 week after the initial event.InterventionsPatients' treatment was modified depending on the results of laboratory investigations.Main outcome measuresThere were 642 events from 398 patients, 235 HIV-positive patients had 438 events and 163 HIV-negative patients had 204 events (P< 0.0001). Forty-two out of the 235 (18%) HIV-positive patients were bacteraemic compared with nine out of the 163 (6%) HIV-negative patients (P= 0.0003). The most common isolates from blood were Salmonella typhimurium and Streptococcus pneumoniae.ResultsFaecal specimens were obtained more commonly from HIV-positive patients (P< 0.001), and often contained bacterial pathogens.ConclusionsMany of the causes of morbidity in patients with tuberculosis and HIV are not due to tuberculosis or antituberculous therapy, and will not be identified without microbiological investigation.

ISSN:0269-9370    

出版商:OVID    

年代:1993

数据来源: OVID