ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The &bgr;-chemokines, macrophage inflammatory protein (MIP)-1&agr;, MIP-1&bgr;, monocyte chemotactic protein (MCP)-1 and regulated-on-activation normal T cell, expressed and secreted (RANTES) are not only chemotactic for mononuclear cells but may be important in suppression of HIV-1 replication through competitive binding to the chemokine receptor, CCR5, which is critical to viral entry. In this study, bronchoalveolar cells (BACs) and autologous peripheral blood mononuclear cells (PBMCs) were obtained from HIV-1–infected participants who did not manifest clinical signs of lung disease with peripheral CD4 T-cell count >200/mm3(n= 7, group with high CD4 count), or CD4 T-cell count <200/mm3(n= 12, group with low CD4 count), and from healthy study subjects (n= 5). The capacity to express &bgr;-chemokines and CCR5 was assessed. Induction of MIP-1&agr; by lipopolysaccharide (LPS) in BAC of HIV-1–infected study subjects from the low CD4 group was less than BAC from healthy study subjects (p< .001), and also was less than in BACs from the group with a high CD4 group (p< .001). Moreover, the intracellular expression of MIP-1&agr; in LPS-induced monocytes of HIV-1–infected patients was significantly less than that from healthy study subjects (p< .01). In addition, spontaneous expression of mRNAs for CCR5 and MIP-1&agr; in BAC was significantly lower in HIV-1–infected patients compared with in healthy study subjects (p< .03 andp< .02, respectively). In contrast to the findings with MIP-1&agr;, LPS stimulated MCP-1 in BAC from the group of HIV-1–infected patients with high CD4 count was significantly higher than healthy study subjects (p< .001). These dysregulations in the ability to express &bgr;-chemokines by BAC may be important in the progression of HIV-1 infection in the lung.

ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Although anemia is common during HIV infection, it is unclear whether potent antiretroviral therapy would improve or worsen anemia. We conducted a study to examine the impact of highly active antiretroviral therapy (HAART) on anemia in a cohort of HIV-positive injection drug users (IDUs) in Baltimore, Maryland. At baseline, the overall prevalence of anemia was 40%. During mean follow-up of one year, among 102 subjects who received HAART, there was a mean increase in hemoglobin of 3.6 ± 1.7 g/L (p= .04) and a mean decrease in log10plasma HIV load of 0.78 ± 0.17 copies/ml (p<.0001). Among 103 control subjects who were not receiving antiretroviral medications, there was a mean decrease in hemoglobin of 4.2 ± 1.1 g/L (p<.0003) and mean increase in log10plasma HIV load of 0.25 ± 0.06 copies/ml (p<.0002). Multivariate analysis using mixed linear models showed that HAART was associated with an increase of hemoglobin of 0.223 g/L per month (p<.0001) after adjusting for body mass index, opportunistic infections, and gender. HAART was associated with an improvement in anemia, and potential mechanisms that may be involved include a reduction in opportunistic infections and the anemia of chronic disease and an improvement in nutritional status.

ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The Viral Activation Transfusion Study (VATS) was a randomized trial that compared leukocyte-reduced transfusions with unfiltered red blood cell transfusions in HIV and cytomegalovirus (CMV) antibody–positive patients with anemia who were undergoing their first blood transfusion. The relations of the baseline qualitative and quantitative polymerase chain reaction (PCR) measures of plasma CMV viremia, HIV RNA, CD4+cell counts, and quality of life in these study subjects were examined. The 511 study subjects had a median CD4+cell count equal to 15 cells/mm3, and 110 (21.5%) had CMV viremia by qualitative assay. In multivariate models, frequency of positive qualitative CMV increased with decreasing CD4+cell counts (p= .04 trend), higher HIV RNA (p< .001), and a history of CMV disease (p< .001). Quantitative CMV PCR were performed on the 110 qualitative assay–positive study subjects. Median CMV viral load was 1780 copies/ml. In multivariate regression models, lower CD4+cell count (p= .03), and a history of CMV disease (p< .001) correlated with the level of CMV load. HIV RNA load and CMV load were not correlated. A lower Karnofsky score was associated with both the presence and quantity of CMV DNA.

ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo assess changes in clinical presentation and outcome of HIV-associated tuberculosis (TB) before and after widespread implementation of highly active antiretroviral therapy (HAART).MethodsWe reviewed clinical charts of HIV-infected patients with culture-confirmed pulmonary TB in two referral clinical centers in Rome, Italy. The 67 patients diagnosed in 1995 to 1996 were compared with 51 patients diagnosed in 1997 to 1998. To analyze factors associated with survival we used a Cox model including antiretroviral therapy as a time-dependent covariate.ResultsPatients diagnosed in 1997 to 1998 were more likely to have TB as the first AIDS-defining illness (78% versus 58%,p< .05), to have HIV diagnosed <2 months before TB (33% vs. 7%,p< .005) and to have typical chest radiograph pattern (45% vs. 25%,p< .05), and had a higher CD4+count (median 105 vs. 43,p< .005). Survival at 1 year was 80% for patients diagnosed in 1997 to 1998 vs. 65% for those diagnosed in 1995 to 1996 (pby log-rank = .02). After adjusting at multivariate analysis, time period of diagnosis was not confirmed as associated with survival (hazard ratio, 1.05; 95% confidence interval, 0.39–2.81). Age, CD4+cell count <25/mm3, and AIDS-defining illnesses before TB diagnosis were all associated with an higher risk of death, whereas a decreased risk of death was observed in patients starting a triple combination antiretroviral therapy after TB diagnosis (hazard ratio, 0.14; 95% confidence interval, 0.03–0.57).ConclusionsCases of HIV-associated TB occurring in patients with advanced immunosuppression and presenting with atypical radiologic appearance tend to be relatively less common in the HAART era. HAART is a major factor in prolonging survival in these patients.

ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

A Phase II clinical trial was designed to evaluate the efficacy and tolerability of twice-daily abacavir, amprenavir, and zidovudine (ZDV)/lamivudine (3TC) in HIV-1–infected study subjects naive to protease inhibitors and 3TC. Plasma and cerebrospinal fluid (CSF) HIV-1 RNA levels and T-cell subsets were measured. In all, 27 newly diagnosed and 12 chronically HIV-1–infected study subjects are included in the analysis. Week 48 plasma HIV-1 RNA levels were <500 copies/ml in 100% of study subjects, and <50 copies/ml in 80% of chronically infected and 100% of newly infected study subjects. The mean change in CD4 was+150 cells/&mgr;l (newly infected,p< .001), and+155 cells/&mgr;l (chronically infected,p< .001). At Week 48, evidence of cellular activation persisted in both cohorts. A twice-daily regimen of amprenavir, abacavir, and ZDV/3TC affords potent viral suppression and significant increases in total CD4+cells in HIV-1–infected study subjects. Patient intolerance may limit the efficacy of this combination.

ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectivesTo evaluate the diagnostic accuracy of the test for antibodies to hepatitis C virus by enzyme-linked immunosorbent assay (anti-HCV ELISA-2) in patients with and without HIV-1 infection.DesignCohort study.MethodsIn all, 369 patients were tested and grouped by available serologic tests. HCV RNA was quantified in these 369 patients using an Amplicor HCV (and/or HIV-1) Monitor, v1.0 test. Among 110 patients who were anti-HCV negative by ELISA-2, 39 were HIV/HBV coinfected and 71 had HIV alone. One hundred twelve patients were HIV/HCV coinfected and 147 patients had HCV infection alone.ResultsSix of 110 (5.5%) ELISA-2 anti-HCV–negative, HIV-infected patients had circulating serum HCV RNA. Their median CD4 count was 36 cells/mm3, which was significantly lower than that observed in the HIV/HBV group (median CD4 = 109,p< .001) or the HIV/HCV cohort (CD4 = 235;p< .0001). The positive predictive value of the ELISA-2 test for diagnosing ongoing HCV infection in HIV-infected patients was 91%, which is significantly better than that determined for the HCV group, 76% (p= .002) presumably because HCV is less likely to resolve in the HIV patients. Mean alanine aminotransferase (ALT) levels were similar in the HIV/HCV (133 IU/L) and HCV (130 IU/L) cohorts. Median HCV RNA levels were higher in the HIV/HCV group (6.53 log10copies/ml) compared with the patients with HCV infection (5.62 log10copies/ml;p< .00001). There was no significant correlation between HCV RNA levels and ALT values, CD4 counts, or HIV RNA concentrations.ConclusionsThe predictive value of the anti-HCV ELISA-2 test is better in HIV-coinfected patients than in patients infected only with HCV. False negative results, usually associated with acute infection or with low CD4 counts, are uncommon. These patients may be diagnosed with the ELISA-3 assay or by reverse transcriptase polymerase chain reaction (RT-PCR). Compared with patients with only HCV infection, HIV/HCV patients display similar ALT profiles, but a higher proportion of detectable serum HCV RNA.

ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The assessment of potential “breakthrough infections” in HIV vaccine trials requires knowledge of viral load in unvaccinated persons. Therefore, HIV-1 RNA was quantitated in plasma from Thai adults with subtype E infections. RNA was detectable (≥500 copies/ml) in 93% of 255 specimens, with a mean (standard deviation) value of 4.09 (0.88) log copies/ml. The concentration of RNA was directly related to the presence of AIDS-defining illnesses, inversely related to CD4 count, and independent of gender after adjustment for CD4 count.

ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1525-4135    

出版商:OVID    

年代:2001

数据来源: OVID