摘要:

ObjectiveAlterations in glucose and lipid metabolism, lactic acidemia, bone disorders, and abnormal body fat distribution have been recognized recently as frequent complications associated with HIV-1 infection and potent antiretroviral therapy, but limited data are available regarding the appropriate management of these disorders. These recommendations were developed to guide physicians actively involved in HIV care in the management of metabolic complications that occur primarily within the context of potent antiretroviral therapy.ParticipantsA 12-member panel representing international expertise in HIV-1 patient care, antiretroviral therapy, and endocrine and metabolic disorders was selected in the spring of 2000 by the International AIDS Society–USA, a not-for-profit physician education organization. Panel members met in closed meetings beginning in May 2000. All work was funded by the International AIDS Society–USA; the panel members are not compensated for their participation.EvidenceThe panel reviewed published results of clinical, epidemiologic, and basic science studies and data and abstracts presented at research conferences, primarily from 1997 to 2002. The panel also considered studies of the pathophysiology and treatment of similar metabolic abnormalities in noninfected persons. Emphasis was placed on results from prospective, randomized, controlled clinical trials when available.ProcessFor each metabolic complication, 1 or more member(s) reviewed and presented all available evidence to the panel, and then wrote a summary of the evidence and preliminary recommendations. Final recommendations were determined by full group consensus. The summaries were combined into a single working document and all panel members edited and approved all subsequent drafts.ConclusionsCarefully controlled studies to determine the incidence, etiology, risk factors, and most appropriate treatments for metabolic complications in HIV-1 infection are urgently needed. In the absence of these data, and to prevent acute illness and mitigate long-term risks, the panel recommends routine assessment and monitoring of glucose and lipid levels and assessment and monitoring of lactic acidemia and bone abnormalities if clinical signs or symptoms are detected. With the exception of body fat distribution abnormalities, specific treatments for these complications are also recommended. Successful long-term antiretroviral therapy will require diligent monitoring and preemptive treatment of metabolic complications to optimize the risk-benefit ratio of antiretroviral therapies.

ISSN:1525-4135    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Buccal and digestive tract opportunistic infections occur frequently in patients infected by HIV. In this study, we measured lysozyme (Lz), lactoferrin (Lf), total IgA (T-IgA), and secretory IgA (S-IgA) levels to investigate nonspecific secretory immunity in HIV-infected patients with oral candidiasis. Serum, saliva, and stool samples were analyzed by time-resolved immunofluorometric assay for Lz and Lf levels and by enzyme-linked immunosorbent assay for T-IgA and S-IgA levels. Mean salivary Lf and T-IgA levels (66.50 mg/L and 0.10 g/L, respectively) and mean fecal Lf, T-IgA, and S-IgA outputs (0.87, 54.0, and 43.6 mg/d, respectively) were significantly higher in HIV-infected patients with oropharyngeal candidiasis than in HIV-infected patients without oropharyngeal candidiasis and healthy subjects. There was a modification in the molecular form rate, with a high increase in S-IgA and monomeric IgA transudation from the plasmatic compartment into salivary and digestive fluids and an increase in salivary Lf local synthesis by polymorphonuclear neutrophils. HIV infection appears to be associated with dysregulation of some of the nonspecific immune factors at the mucosal surface. Despite high saliva concentrations and high intestinal output, innate immunity was not able to stop yeast expansion in HIV-infected patients.

ISSN:1525-4135    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

We analyzed the reverse transcriptase (RT) and protease sequences of HIV-1 isolates obtained over 7 years from two couples with known transmission histories. Phylogenetic trees constructed from the sequence data reflected the known transmission histories, despite the fact that the drug resistance mutations were most consistent with the drug treatment histories. However, the RT sequences from one couple diverged by 2.9% even before therapy was begun, and three (0.9%) of 339 unrelated individuals had viruses that shared a common ancestor with sequences from the recipient member of the couple but not with sequences from the transmitter. The divergence between the first two isolates from this couple is consistent with a pretransmission interval during which the transmitter developed a heterogeneous virus population. The closeness between the three controls and the recipient's first RT sequence may indicate slower evolution on the branches of the control sequences. Although the RT and protease genes contain phylogenetic information, they are suboptimal for reconstructing transmission history because the genetic distance between RT and protease isolates from unrelated individuals may occasionally approximate the distance between RT and protease isolates from related individuals.

ISSN:1525-4135    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

In HIV-infected patients with intrathoracic lymphadenopathy, it is not known whether clinical and radiographic findings are useful in predicting a specific diagnosis. We determined the etiology and predictors of the etiology of computed tomography (CT)–diagnosed intrathoracic lymphadenopathy in HIV-infected patients evaluated from June 1993 through April 1999. Multivariate analyses were performed to determine clinical and radiographic predictors of the three most common diagnoses. Of 318 patients, 110 (35%) had lymphadenopathy on chest CT. Among these 110 patients, tuberculosis/nontuberculous mycobacterial disease (n= 31), bacterial pneumonia (n= 26), and lymphoma (n= 21) were the most common diagnoses. Multivariate analysis identified cough and necrosis of lymph nodes on chest CT as independent predictors of tuberculosis/nontuberculous mycobacterial disease. African-American race, symptoms for 1 to 7 days, dyspnea, and presence of airways disease on chest CT were independent predictors of bacterial pneumonia; symptoms for >7 days, absence of cough, and absence of pulmonary nodules on CT independently predicted lymphoma. Intrathoracic lymphadenopathy is a frequent chest CT finding in HIV-infected patients. Opportunistic infections and lymphoma are the most common causes, and specific clinical and radiographic features can suggest these particular diagnoses.

ISSN:1525-4135    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Combination of antiretroviral drugs has dramatically improved the prognosis of human HIV infection but is also associated with many adverse effects, the mitochondrial origin of which is discussed. In this study using extensive diagnostic procedures set up for inherited mitochondrial disorders, we analyzed HIV+patients under active antiretroviral therapy who complained of severe adverse symptoms unexplained by HIV. All these patients had been treated for at least 5 years. They all had significant mitochondrial damage as evidenced by the diverse combination of lactate accumulation in blood or cerebrospinal fluid, mitochondrial morphologic alterations in muscle, and biochemical defects in muscle and liver, which designated mitochondrial DNA (mtDNA) as the main target of the toxic mechanisms. Southern blot and/or polymerase chain reaction –based analyses disclosed multiple deletions of the muscle mtDNA and reduction of the muscle and/or liver mtDNA copy number in a majority of the patients. In opposition to muscle and liver, blood mononuclear cells were devoid of significant biochemical or genetic alterations. Whether the mitochondrial toxicity is directly responsible for the patients' adverse symptoms remains disputable, because the investigations were transversal. Its severity argues for its clinical relevance, however. The skewed tissue distribution of mitochondrial alterations indicates potential pitfalls in the needed future prospective studies.

ISSN:1525-4135    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo determine factors related to the timing and probability of nondisclosure of HIV status to perinatally HIV-infected children, and to explore factors associated with emotional distress in HIV-infected children.MethodsThis is a cross-sectional study of 51 HIV-infected children based on medical records, parent interviews, and child assessments.Results1) Probability of earlier age of disclosure is associated with higher child IQ (p= .04) and more family expressiveness (p= .01); 2) controlling for child age, disclosure status at time of study is associated with major life events, but not with medical status; and 3) factors associated with increased parent-rated anxiety in HIV-infected children in univariate analyses are: HIV disclosure (p= .04), other major life events (p= .001), higher medication dose frequency (p= .01), and child age (p= .01). Increased depression is associated only with more medication doses (p= .02).ConclusionThese data indicate that higher child IQ and greater family expressiveness increase the probability of earlier diagnostic disclosure to HIV-infected children. Factors associated with emotional distress highlight important areas of clinical attention. These data suggest that diagnostic disclosure may not necessarily minimize emotional distress, indicating the need for further evaluation of the appropriate timing and type of disclosure for pediatric HIV.

ISSN:1525-4135    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The rate of HIV disease progression is associated with the severity of the acute retroviral syndrome (ARS). We explored the clinical features of ARS by gender, age and route of infection among 378 individuals with documented ARS enrolled in 5 prospective cohort studies with similar enrollment criteria. No major differences were detected by gender or by age. Several symptoms were reported less frequently in the injecting drug users as compared with infection acquired through sexual contacts (either heterosexual or homosexual). This was observed in particular for fever (50% vs. 77%,p= .001), skin rash (21% vs. 51%,p= .001), pharyngitis (18% vs. 43%,p= .004), and myalgia (29% vs. 52%,p= .01). Genital ulcerations were present only in cases of sexual exposure to HIV. Injecting drug users had or reported symptoms associated with the ARS less frequently than persons acquiring HIV via sexual transmission.

ISSN:1525-4135    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Sexual disturbances develop in some patients treated with highly active antiretroviral therapy (HAART). To evaluate sexual dysfunction and the influence that different antiretrovirals could have on those parameters, we conducted a prospective study in patients with stable clinical condition attending an HIV outpatient clinic. A total of 351 evaluations were performed in 189 HIV-infected men, who were interviewed about symptoms of sexual dysfunction. Sexual hormones as well as other clinical and laboratory parameters were also measured at the time of each evaluation. The mean CD4 count was 451.1 × 106cells/L, and viral load was undetectable in two thirds of the determinations. The prevalence of sexual dysfunction was 19.5% overall, but it was influenced by treatment, particularly (although not exclusively) by protease inhibitors (PIs) (27.1% vs. 3.8% for untreated patients). Sexual dysfunction was not related to hypophyseal or gonadal hormonal values. Although several parameters were associated with sexual dysfunction in the univariate analysis, only antiretroviral treatment was significantly predictive of this disorder in a logistic regression analysis. Sexual dysfunction is common in HIV-infected patients in stable clinical condition receiving HAART, and all antiretroviral drugs, particularly PIs, seem to be related to it. Sexual dysfunction in these patients is not related to hormonal causes.

ISSN:1525-4135    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Virologic factors may influence survival of HIV-1–infected infants. We compared survival of Ugandan infants with subtype A and subtype D HIV-1 infection. This study was performed in the context of the Ugandan clinical trial HIVNET 012, which compared the efficacy of single-dose nevirapine (NVP) and short-course zidovudine (AZT) for prevention of HIV-1 mother-to-child transmission. HIV-1 subtypes were determined by phylogenetic analysis of HIV-1 protease and reverse transcriptase sequences from 32 women in the NVP arm and 54 women in the AZT arm of HIVNET 012 whose infants were HIV-1 infected by 6 to 8 weeks of age. We found no association between HIV-1 subtype (A vs. D) and infant survival in this cohort. Further studies are needed to evaluate whether HIV-1 subtype influences clinical outcome in pediatric HIV-1 infection.

ISSN:1525-4135    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundTransmission of HIV-1 through breastfeeding is a major problem, although its timing is not well characterized.MethodsThe authors examined the timing and correlates of HIV-1 transmission through breastfeeding among 1078 HIV-infected pregnant women from Dar es Salaam, Tanzania enrolled in a trial to examine the effect of vitamin A and other vitamin supplements on mother-to-child transmission of HIV-1 and other health outcomes. Cumulative incidence was measured among children of women not randomized to vitamin A (n= 312), given the higher risk of infection observed among those in the vitamin A arm. For analyses of correlates, data from all children not infected by age 6 weeks were used (n= 659).ResultsMean duration of breastfeeding was 20.3 months (SD = 4.4 months; median = 20.5 months). Thirty-seven infections were observed during 4372 child-months of follow-up evaluation, or 10.2 cases per 100 child-years. Infection risk by age 4 months was 3.8% (95% confidence interval [CI], 1.6%–6.1%) and increased to 17.9% (95% CI, 11.2%–24.5%) by age 24 months. In a multivariate proportional hazards model, high maternal viral load (p= .0001), low CD4+cell count (p= .004), and high maternal erythrocyte sedimentation rate (ESR;p= .004) were significant predictors of transmission of HIV-1 through breastfeeding. Mothers who had breast lesions during pregnancy were 2.00 times more likely to transmit the virus during breastfeeding than mothers without these lesions (95% CI, 1.29–3.08;p= .002).ConclusionsThe rate of breastfeeding transmission of HIV-1 is high, and early weaning is likely to be associated with reduced transmission. Antiretroviral drugs given to HIV-infected mothers are likely to reduce the risk of breastfeeding transmission. In their absence, interventions that enhance immune reconstitution, such as micronutrient supplements, may be beneficial against transmission. Methods to prevent and treat nipple cracks and mastitis may also be important.

ISSN:1525-4135    

出版商:OVID    

年代:2002

数据来源: OVID