RESUMEN
OBJECTIVE: It is unclear whether co-infection with hepatitis C virus (HCV) can influence HIV related morbidity or mortality, either by accelerating HIV-related disease progression, or by contributing to end stage liver disease. The aim of this study was to examine the effect of HCV infection on the severity and progression of HIV disease in a cohort of Edinburgh intravenous drug users (IDUs). METHODS: In 240 (47%) out of 508 patients in the Edinburgh IDU cohort both HIV seroconversion dates and anti-HCV serology were available. Demographic variables and HIV-related progression between anti-HCV positive and anti-HCV negative groups were compared. Parameters assessed included clinical endpoints (time of development of significant symptoms attributable to HIV (CDC stage IV), time of development of AIDS, and time of death) and immunological endpoints (time of CD4+ counts dropping below 200/mm3, 100/mm3 and 50/mm3). RESULTS: Two hundred and two out of 240 patients (84%) had positive anti-HCV serology. There was no significant difference in the frequency of clinical and immunological endpoints between the anti-HCV positive and negative groups. Progression analysis from HIV seroconversion to HIV related clinical endpoints indicated that anti-HCV serology was not a significant factor influencing the rate of HIV progression (relative risks (RR) for anti-HCV positive group: seroconversion to CDC IV, 1.01; seroconversion to AIDS, 1.05; seroconversion to death, 0.90). Likewise, HCV serostatus did not significantly affect progression to immunological endpoints (RR for anti-HCV positive group: seroconversion to CD4+ < 200/mm3, 1.04; seroconversion to CD4+ < 100/mm3, 1.13; seroconversion to CD4+ < 50/mm3, 0.97. Overall mortality from end stage liver failure was 4% in HCV-seropositive patients without AIDS. This suggests that HCV has had a clinically (though not statistically) significant impact on overall survival in this cohort. CONCLUSIONS: This study demonstrates that HCV co-infection does not influence the rate of progression to either clinical or immunological endpoints in our population of HIV-infected drug users. Further data are required to assess the effect of HIV on thge progression of HCV-related liver disease.
Asunto(s)
Infecciones por VIH/complicaciones , Hepatitis C Crónica/complicaciones , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Progresión de la Enfermedad , Femenino , Seropositividad para VIH , Humanos , Masculino , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de TiempoRESUMEN
Three patients with fish tank granuloma of the hand and forearm are reported. Each patient was treated with antimicrobial regimes which have rarely or never been previously used in this condition. Two patients responded well to treatment, one who received ciprofloxacin plus clarithromycin and another who was given clarithromycin plus ethambutol. The third patient received six different antimicrobial regimes before responding to a combination of rifabutin and ciprofloxacin. Our experience suggests that there now exist a number of effective alternatives to antimicrobials which have been traditionally used in the treatment of cutaneous Mycobacterium marinum infection.
Asunto(s)
Antibióticos Antituberculosos/uso terapéutico , Peces/microbiología , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Tuberculosis Cutánea/tratamiento farmacológico , Adulto , Anciano , Animales , Antibacterianos , Quimioterapia Combinada/administración & dosificación , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/transmisión , Tuberculosis Cutánea/transmisiónRESUMEN
Nineteen cases of cerebral toxoplasmosis (CTOX) are reported from a group of Edinburgh AIDS patients. All patients were severely immunodeficient at the time of presentation with CD4 count < 50 cells/mm3. Thirteen patients had suffered a previous AIDS-defining illness. In Edinburgh, CTOX has developed in 48% of patients who are seropositive for toxoplasma and have a CD4 count < 50 cells/mm3. It is estimated that at least half of the toxoplasma seropositive patients will develop CTOX if they survive for 21 months after reaching a time in their illness when the CD4 count = 50 cells/mm3. The incidence of CTOX in toxoplasma-seronegative patients with a CD4 count < 50 cells/mm3 is 1.3%. All patients showed improvement on treatment and there was no correlation between clinical or radiological features and patient survival. Those patients unable to tolerate first choice anti-toxoplasma therapy had a significantly shorter survival than the remainder but there was no single therapeutic regimen which conferred a survival advantage. Eighteen patients had died at the time of study and the median survival following diagnosis of cerebral toxoplasmosis was 10 months (range 3-38 months). Postmortem examination of the brain was available in 8, 4 of whom had concomitant cerebral lymphoma. The survival from AIDS or CD4 count = 50 cells/mm3 did not differ significantly between those with treated CTOX and a control group who had no toxoplasma infection, suggesting that treatment is reasonably effective. CTOX is a disease associated with severe HIV-related immunodeficiency and, in those with a CD4 count < 50 cells/mm3, occurs more than 35 times as frequently in toxoplasma-seropositive than toxoplasma-seronegative patients. Treatment is effective but the outcome of treated disease cannot be predicted from presenting clinical or radiological features. Concomitant space-occupying cerebral pathology is evident in 50% of post-mortem examinations.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Toxoplasmosis Cerebral/epidemiología , Adulto , Antibacterianos/uso terapéutico , Antiinfecciosos/uso terapéutico , Antifúngicos/uso terapéutico , Atovacuona , Autopsia , Azitromicina/uso terapéutico , Encéfalo/patología , Recuento de Linfocito CD4 , Clindamicina/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Incidencia , Linfoma Relacionado con SIDA/diagnóstico , Masculino , Persona de Mediana Edad , Naftoquinonas/uso terapéutico , Pirimetamina/uso terapéutico , Estudios Retrospectivos , Sulfadiazina/uso terapéutico , Toxoplasmosis Cerebral/diagnóstico , Toxoplasmosis Cerebral/tratamiento farmacológico , Toxoplasmosis Cerebral/mortalidad , Reino Unido/epidemiologíaRESUMEN
We retrospectively analysed 46 cases of disseminated infection with Mycobacterium avium complex (MAC) within a cohort of 702 HIV-infected patients in Edinburgh. Clinical features were compared with case-matched controls (AIDS cases without disseminated MAC), and survival and progression times were controlled for confounding variables that influence survival. Disseminated MAC was diagnosed antemortem in 18% of AIDS patients, and was the AIDS-defining diagnosis in 6% of all AIDS cases. Concomitant colonization of respiratory and gastrointestinal tracts was common (61% and 48%, respectively). In 58% of cases, CD4+ counts were < 10 cells/mm3 (median 6 cells/mm3). Weight loss, anaemia, leucopenia, and elevated liver transaminases and alkaline phosphatase were significantly more common among cases than controls. Therapy was given in 74%, and not tolerated in 32%. Following AIDS diagnosis, disseminated MAC incidence was 14% at one year, 25% at 2 years and 36% at 3 years. Median survival after disseminated MAC diagnosis was 6 months, with shorter survival in untreated cases. However, overall survival from AIDS diagnosis was not significantly different between patients who did or did not develop disseminated MAC. Disseminated MAC contributes significantly to AIDS morbidity, and its incidence increases with prolonged AIDS survival. Although survival following diagnosis is short, the development of disseminated MAC in AIDS probably does not affect overall survival. In cohorts with a low incidence, an alternative to prophylaxis might be surveillance and early diagnosis.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Infección por Mycobacterium avium-intracellulare/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/mortalidad , Adulto , Estudios de Casos y Controles , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Mycobacterium/clasificación , Infección por Mycobacterium avium-intracellulare/tratamiento farmacológico , Infección por Mycobacterium avium-intracellulare/mortalidad , Estudios Retrospectivos , Escocia/epidemiología , Tasa de SupervivenciaAsunto(s)
Infecciones por VIH/diagnóstico , VIH-1 , Trastornos Relacionados con Sustancias/complicaciones , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Adolescente , Adulto , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/mortalidad , Seropositividad para VIH , Humanos , Masculino , Escocia , Análisis de SupervivenciaAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Vacunas Bacterianas , Infecciones por VIH/complicaciones , Meningitis Neumocócica/complicaciones , Streptococcus pneumoniae/inmunología , Abuso de Sustancias por Vía Intravenosa/complicaciones , Vacunación , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Infecciones Oportunistas Relacionadas con el SIDA/prevención & control , Adulto , Anticuerpos Antibacterianos/biosíntesis , Resultado Fatal , Humanos , Masculino , Meningitis Neumocócica/inmunología , Meningitis Neumocócica/prevención & control , Vacunas NeumococicasRESUMEN
Retrospective analysis of medical records of 557 HIV positive patients (including 113 with AIDS) revealed 17 patients with an antemortem clinical diagnosis of cytomegalovirus (CMV) disease. This group comprised 7 injection drug users (2 male and 5 female) and 10 homosexual men. Males were significantly older than females, and homosexual men were significantly older than drug users at the time of diagnosis of CMV. All 17 patients had evidence of retinitis, and 6 also had evidence of extraocular disease. CMV retinitis was the AIDS defining diagnosis in two patients, and the attack rate of CMV in all AIDS patients progressively increased with time, with a 3-year CMV-free survival of 57%. Fifteen patients with CMV disease had evidence of previous CMV infection (CMV IgG positive), with 7 also having a positive CMV IgM and 10 a positive viral culture. The mean CD4+ lymphocyte count at diagnosis of CMV was 17 cells/mm3, compared with 68 cells/mm3 at diagnosis of AIDS. Therapy was unsatisfactory, often being complicated by marrow suppression. Relapse occurred in 11 patients after initial improvement but despite this only 3 patients died with severe visual impairment. The mean survival after a diagnosis of CMV was 10.5 months. This study confirms that disease caused by CMV is usually a late manifestation of AIDS, and the increasing prevalence among patients with AIDS implies that, the longer the survival, the greater the risk of disease. Frequent fundoscopy in HIV positive patients is of paramount importance particularly in patients who have a CD4+ lymphocyte count of less than 100 cells/mm3.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Infecciones por Citomegalovirus/epidemiología , Infecciones Virales del Ojo/epidemiología , Retinitis/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Adulto , Anticuerpos Antivirales/sangre , Citomegalovirus/inmunología , Citomegalovirus/aislamiento & purificación , Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones por Citomegalovirus/microbiología , Infecciones Virales del Ojo/tratamiento farmacológico , Infecciones Virales del Ojo/microbiología , Femenino , Foscarnet/uso terapéutico , Ganciclovir/uso terapéutico , Humanos , Masculino , Retinitis/tratamiento farmacológico , Retinitis/microbiología , Estudios Retrospectivos , Escocia/epidemiología , Tasa de SupervivenciaRESUMEN
In a retrospective analysis of all known HIV-positive patients admitted to the City Hospital before November 1989, 208 patients accounted for 612 admissions, 72% being injection drug users (IDUs). One hundred and eighty admissions (29%) were for chest-related disorders, and this was the commonest reason for admission. Unlike other U.K. centres where more than 50% chest problems are due to Pneumocystis carinii pneumonia (PCP), only 27% of our chest admissions were for PCP. Fifty-four percent of chest admissions were for bacterial chest infections (BCIs), the commonest organism isolated being Haemophilus influenzae. Despite the fact that most (50/97) of these admissions were in patients with 'asymptomatic' HIV disease (CDC classification 2 and 3), 50% had radiological pneumonia, 43% were hypoxic, 28% were hypercapnic and the average duration of hospitalisation was 10 days. BCIs were more common in HIV-positive IDUs when compared with HIV-negative IDUs, other HIV-positive patients and the general age-matched population. Medical provision for IDU-related HIV disease should take into account the high rate of BCIs and of hospital admissions in patients who do not yet have CDC stage 4 disease.
Asunto(s)
Seropositividad para VIH/complicaciones , Enfermedades Pulmonares/epidemiología , Infecciones Oportunistas/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Femenino , Seropositividad para VIH/epidemiología , Seropositividad para VIH/microbiología , Humanos , Tiempo de Internación , Enfermedades Pulmonares/microbiología , Masculino , Infecciones Oportunistas/microbiología , Admisión del Paciente/estadística & datos numéricos , Neumonía por Pneumocystis/epidemiología , Neumonía por Pneumocystis/microbiología , Infecciones del Sistema Respiratorio/microbiología , Estudios Retrospectivos , Escocia/epidemiologíaRESUMEN
beta 2-microglobulin (beta 2M) levels were measured in 217 Edinburgh drug users to assess their usefulness as a marker for HIV-related disease. Eighty HIV-seronegative drug injectors had significantly higher levels than 100 HIV-seronegative blood-donor controls. Amongst 137 asymptomatic HIV-seropositive drug users, those who were defined as continued drug users had significantly higher beta 2M levels and percentages of CD3+ T lymphocytes with DR Class II expression than non-injecting drug users. beta 2M levels correlated with the percentage of activated DR+ CD3+ T lymphocytes. These findings indicate that changes in beta 2M levels may reflect differences in drug-injecting behaviour and are not influenced solely by HIV status or progression. These changes in beta 2M probably represent differing degrees of immunostimulation resulting from the antigenic challenges afforded by continued or frequent drug injection. It is important to establish normal ranges for beta 2M from HIV-seronegative controls who are matched with respect to risk group and behaviour. All these factors should be taken into account if beta 2M is to be used as a marker of HIV progression.
Asunto(s)
Seropositividad para VIH/sangre , Abuso de Sustancias por Vía Intravenosa/sangre , Microglobulina beta-2/metabolismo , Adulto , Biomarcadores , Femenino , Seropositividad para VIH/complicaciones , Seropositividad para VIH/psicología , Humanos , Activación de Linfocitos , Masculino , Asunción de Riesgos , Abuso de Sustancias por Vía Intravenosa/complicaciones , Abuso de Sustancias por Vía Intravenosa/psicología , Linfocitos T/inmunologíaRESUMEN
We are now witnessing the anticipated explosion of cases of AIDS resulting from the epidemic of HIV infection among Edinburgh drug users in the first half of the last decade. We expect the number of new cases of AIDS to continue to increase, although the rate at which they do so may be mitigated by intervention which slows the rate of progression to AIDS. There is evidence that current management of patients may postpone a diagnosis of AIDS until later in the natural history of HIV infection when immunity is very low as manifested by CD4+ lymphocyte counts. Health care planners need to provide resources for an increasing number of HIV-infected persons who have not yet fulfilled the definition of AIDS but who nevertheless require extensive resources both in the community and in hospital.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/epidemiología , Brotes de Enfermedades/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Síndrome de Inmunodeficiencia Adquirida/sangre , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Linfocitos T CD4-Positivos , Infecciones por VIH/epidemiología , Humanos , Recuento de Leucocitos , Escocia/epidemiología , Factores de Tiempo , Zidovudina/uso terapéuticoRESUMEN
Anti-cardiolipin antibodies of IgG class were found in 48% of intravenous drug users, 38% of homosexuals and 14% of heterosexuals (with no other risk factor) infected with HIV. Anti-cardiolipin antibodies were not increased in HIV-negative heterosexual partners of HIV-infected patients, but mildly elevated levels were detected in HIV-negative drug users, relative to healthy controls unselected for HIV status. Among HIV infected drug users, anti-cardiolipin antibodies were not associated with thrombocytopenia, Pneumocystis carinii pneumonia, disease progression or clinical stage. Anti-cardiolipin antibodies appear to be another non-specific marker of HIV infection which may be particularly common in male intravenous drug users infected with the virus.
Asunto(s)
Autoanticuerpos/sangre , Cardiolipinas/inmunología , Infecciones por VIH/inmunología , Autoanticuerpos/inmunología , Ensayo de Inmunoadsorción Enzimática , Femenino , Infecciones por VIH/complicaciones , Homosexualidad , Humanos , Hipergammaglobulinemia/complicaciones , Hipergammaglobulinemia/inmunología , Inmunoglobulina G/inmunología , Masculino , Factores de Riesgo , Factores Sexuales , Conducta Sexual , Abuso de Sustancias por Vía Intravenosa/complicaciones , Abuso de Sustancias por Vía Intravenosa/inmunologíaRESUMEN
During the last 15 years, at least 35 patients with severe falciparum malaria or babesiosis have recovered following treatment by exchange of up to 10 l of blood. In a patient treated in Manchester, a parasitaemia of 2.10 X 10(6) microliters (42 per cent) was virtually eliminated over eight hours by a 3.5 litre exchange blood transfusion. However, the equipment and amounts of compatible blood required for total exchange are rarely available in areas endemic for malaria and the risks of the procedure, including transfusion-related infections, are high. Partial exchange transfusion with one to two litres of blood carried out over two to seven hours, reduced Plasmodium falciparum parasitaemias of 0.33-1.48 X 10(6)/microliters (13-38 per cent) to 0.11-0.81 X 10(6) (4-17 per cent) in six Thai patients who were receiving intravenous quinine. The reduction in parasitaemia ranged from 0.13-0.67 X 10(6) microliters (9-12 per cent) within six hours. During the same period, parasitaemia in 13 patients with cerebral malaria treated with chemotherapy alone showed little reduction from initial levels of 0.20-1.74 X 10(6)/microliters (11-42 per cent). One of the patients who were treated with exchange transfusion died with intractable hypotension before the procedure could be completed and two others developed oliguric renal failure which was controlled by peritoneal dialysis. Partial exchange transfusion is a promising and practical alternative to total exchange where facilities are limited. It deserves further assessment in the rural tropics.
Asunto(s)
Recambio Total de Sangre , Malaria/terapia , Adolescente , Adulto , Animales , Niño , Femenino , Humanos , Malaria/sangre , Masculino , Persona de Mediana Edad , Plasmodium falciparum , Quinina/uso terapéuticoAsunto(s)
Infecciones por VIH/complicaciones , Leishmaniasis Visceral/complicaciones , Antiprotozoarios/uso terapéutico , Linfocitos T CD4-Positivos/microbiología , Linfocitos T CD4-Positivos/parasitología , Centers for Disease Control and Prevention, U.S. , Humanos , Leishmaniasis Visceral/clasificación , Recuento de Leucocitos , Estados UnidosRESUMEN
The hazards of ultraviolet radiation (UVR) include immunosuppression, activation of human immunodeficiency virus (HIV) type 1 expression, and photocarcinogenesis particularly in immunosuppressed individuals. Fifty-eight male homosexuals positive for HIV antibody and 61 controls not at risk for HIV infection answered a questionnaire on their attitudes and exposure to natural and artificial sources of UVR. Controls were matched for sex but were not from an at-risk group for HIV infection. Mean ages were similar for both groups. HIV seropositives had greater recreational UVR exposure than controls: 12/58 versus 4/61 had regular use of a sunbed (P less than 0.05), and experienced 11.6 weeks versus 9.5 weeks of prolonged natural UVR exposure (P = 0.056) over a four-year period. One reason for this difference may be the misconception present in two-thirds of the HIV seropositive group that a suntan would improve their health and the outcome of their HIV infection. Those with HIV infection must be made aware that there is a potential for further immunosuppression and viral activation from UVR and they should be advised to avoid undue recreational exposure.
Asunto(s)
Infecciones por VIH/inmunología , VIH/efectos de la radiación , Tolerancia Inmunológica/efectos de la radiación , Neoplasias Cutáneas/etiología , Rayos Ultravioleta/efectos adversos , VIH/fisiología , Infecciones por VIH/microbiología , Homosexualidad , Humanos , Masculino , Factores de Riesgo , Luz Solar/efectos adversos , Encuestas y Cuestionarios , Replicación Viral/efectos de la radiaciónRESUMEN
Thirty adult patients with typhoid or paratyphoid fever were treated with ciprofloxacin. All patients were cured with eradication of the causative organism. No major adverse reactions were seen. Ciprofloxacin is an effective agent for the treatment of enteric fever.