RESUMEN
BACKGROUND: The incidence of melanoma in the United States is increasing. Data on this disease in African-Americans is sparse. METHODS: Chart review of patients diagnozed with melanoma from 1975 to 1997 at Charity Hospital New Orleans (CHNO). Age, gender, anatomic distribution, histology, presenting stage, survival, and race were evaluated. RESULTS: Forty-four of 198 patients were African-American, of whom the majority developed cutaneous melanoma on the acral surface of the foot. African-American males were four times more likely to present with a cutaneous lesion than were African-American females. The median survival time for African-American with cutaneous lesions was 45 months, compared to 135 months for caucasians who were 3.6 times more likely to present with early disease (P < 0.05). TNM stage at presentation, and ulceration were significant, independent factors associated with a worse outcome in African-Americans. CONCLUSION: Overall survival time for African-Americans with cutaneous melanoma is significantly shorter than for caucasians with this disease. This trend may be attributable to the fact that African-Americans present with advanced disease. An increased level of awareness among both patients and health-care providers is necessary to identify African-Americans with melanoma at earlier stages of disease and to improve survival.
Asunto(s)
Negro o Afroamericano/estadística & datos numéricos , Melanoma/epidemiología , Neoplasias Cutáneas/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Melanoma/mortalidad , Melanoma/patología , Persona de Mediana Edad , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/patología , Tasa de Supervivencia , Población BlancaRESUMEN
Genetic variation of SIV env during the course of infection provides a large population pool that is continually shaped by selective forces in vivo and may influence the development of clinical disease. SAIDS-associated lymphoma (SAL) in the SIV-infected macaque is typically a clonal or oligoclonal mass of B cell origin, extranodal in anatomic distribution, in which SIV is restricted largely to infiltrating macrophages. To explore the degree of genetic variation in SIV env represented in SAL, a 480-bp DNA fragment containing the V1 region was PCR amplified from seven cases of SAL and from a nonneoplastic lymph node of an SIV-infected macaque. The nucleotide sequence of the V1 region was determined from at least 10 clones from multiple independent amplification reactions of each tissue. Overall, the degree of V1 variability within lymphomas was found not to be restricted but to resemble the heterogeneity reported in SIV-infected lymphoid and other tissues. V1 variation in the nonneoplastic lymph node was unexpectedly limited, perhaps related to the unusual disease condition associated with SAIDS in that animal. Unlike observations from SIV-infected tissues of animals without neoplastic disease, no increase was detected in the number of O- or N-linked glycosylation sites in the V1 regions isolated from lymphomas as compared with the original inoculum. These findings suggest that, within the microenvironment of the lymphoma, the immune evasion conferred by increased glycosylation may offer little selective advantage.
Asunto(s)
Genes env , Linfoma/virología , Síndrome de Inmunodeficiencia Adquirida del Simio/virología , Virus de la Inmunodeficiencia de los Simios/genética , Algoritmos , Animales , Variación Genética , Macaca fascicularis , Macaca mulatta , Datos de Secuencia Molecular , Alineación de Secuencia , Análisis de Secuencia de Proteína , Síndrome de Inmunodeficiencia Adquirida del Simio/patologíaRESUMEN
Conditions associated with abnormal B-cell proliferation have an increased incidence in the HIV-infected population. A longitudinal study conducted at the Tulane Regional Primate Research Center has followed more than 1,000 rhesus macaques infected with simian-immunodeficiency virus (SIV) since 1984. While spontaneous B-cell malignancy in SIV-negative macaques has not been reported, 42 cases of SIV-associated-lymphoma (SAL) have been documented in this cohort. Recently we identified a single case of B-cell leukemia, first suggested by clinical abnormalities and confirmed and further characterized by molecular analysis. The case is important because it models the occurrence of B-cell leukemia in the human AIDS patient and because it extends our understanding of the B-cell lymphoproliferative diseases associated with AIDS.
Asunto(s)
Leucemia de Células B/veterinaria , Macaca mulatta/virología , Síndrome de Inmunodeficiencia Adquirida del Simio/complicaciones , Virus de la Inmunodeficiencia de los Simios/patogenicidad , Animales , Células Clonales/patología , ADN Viral/análisis , Femenino , Reordenamiento Génico de Cadena Pesada de Linfocito B , Infecciones por Herpesviridae/complicaciones , Infecciones por Herpesviridae/veterinaria , Leucemia de Células B/etiología , Estudios Longitudinales , Lymphocryptovirus/aislamiento & purificación , Linfoma de Células B/etiología , Linfoma de Células B/veterinaria , Infección por Mycobacterium avium-intracellulare/complicaciones , Reacción en Cadena de la Polimerasa , Infecciones Tumorales por Virus/complicaciones , Infecciones Tumorales por Virus/veterinariaRESUMEN
SAIDS-associated lymphoma (SAL) represents a monoclonal expansion of B-cell origin in which simian immunodeficiency virus (SIV) infection is not detected. However, tumor cells are frequently infected with rhesus lymphocryptovirus (RhLCV), a rhesus homologue of Epstein-Barr virus (EBV). In previous studies, the incidence of RhLCV infection in SAL was determined to be 89% as measured by polymerase chain reaction (PCR) and/or in situ hybridization. The main objective of the present study was to ascertain whether the level of RhLCV infection in the SIV-infected macaque is influenced as a function of SAIDS progression, and/or whether increased levels of RhLCV infection may correlate with the development of SAL. To this end, RhLCV infection was evaluated in three independent groups: (1) in lymphomas from SIV-infected rhesus macaques, (2) in peripheral blood mononuclear cells (PBMC) from a cohort of 69 randomly selected healthy animals, and (3) in PBMC collected from 22 SIV-infected animals at various times during progression to SAIDS or SAL. The relative levels of RhLCV infection were evaluated by PCR/Southern blot analysis, visual comparison to a standard dilution series, and assignment of relative signal intensity to a uniform classification scheme. The data show that SIV-infected monkeys have a generally higher RhLCV load in PBMC than do healthy animals, but that the virus load varies widely among animals during disease progression. Increased RhLCV load does not occur uniformly during the progression of SAIDS, although evidence indicates an increased RhLCV viral load in the development of SAL.
Asunto(s)
Infecciones por Herpesviridae/complicaciones , Lymphocryptovirus , Linfoma de Células B/virología , Síndrome de Inmunodeficiencia Adquirida del Simio/complicaciones , Infecciones Tumorales por Virus/complicaciones , Animales , Southern Blotting , Progresión de la Enfermedad , Infecciones por Herpesviridae/virología , Macaca mulatta , Reacción en Cadena de la Polimerasa , Distribución Aleatoria , Síndrome de Inmunodeficiencia Adquirida del Simio/virología , Infecciones Tumorales por Virus/virología , Carga ViralRESUMEN
PURPOSE: Drug therapies for patients with human immunodeficiency virus (HIV) infection are associated with adverse events that can potentially limit their effectiveness. We sought to quantify the incidence of these events in clinical practice and determine whether there were demographic and clinical differences in adverse event rates for these drugs. PATIENT AND METHODS: We calculated specific and overall adverse event rates from use of zidovudine, didanosine, zalcitabine, cotrimoxazole, and dapsone in an observational urban cohort of 1,450 HIV-infected patients with a CD4+ count of 500 cells/mm3 or less. We compared adverse event rates by gender, race, age, injecting drug use, and CD4+ count. RESULTS: Overall adverse event rates in order of incidence were dapsone, 16.2 per 100 person-years (PY); didanosine, 24.1 per 100 PY; zidovudine, 26.3 per 100 PY; cotrimoxazole, 26.3 per 100 PY; and zalcitabine, 37.0 per 100 PY. Rates increased significantly with decline in CD4+ count from > 200 to < 100 cells/mm3 for all drugs but dapsone. In addition, women were more likely than men to have an adverse event for didanosine (relative risk [RR] = 2.7, P = 0.03) and from cotrimoxazole (RR 1.5; P = 0.05). Whites were at greater risk than blacks for adverse events from cotrimoxazole (RR = 1.6, P = 0.03). Only 22 of 357 total events (6%) required hospitalization, and there were no deaths. CONCLUSIONS: Adverse events from antiretroviral drugs and Pneumocystis carinii pneumonia prophylaxis that interrupt therapy are relatively common, although serious events requiring hospitalization are rare. Adverse event rates increase progressively with decline in CD4+ count. The gender and race of the patient modify the risk of adverse events for some drugs.
Asunto(s)
Antivirales/efectos adversos , Infecciones por VIH/tratamiento farmacológico , Adulto , Recuento de Linfocito CD4 , Dapsona/efectos adversos , Didanosina/efectos adversos , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/etnología , Infecciones por VIH/etiología , Humanos , Masculino , Neumonía por Pneumocystis/prevención & control , Factores de Riesgo , Combinación Trimetoprim y Sulfametoxazol/efectos adversos , Salud Urbana , Zalcitabina/efectos adversos , Zidovudina/efectos adversosRESUMEN
BACKGROUND: A syndrome of hepatomegaly with severe steatosis has been described in case reports and case series in HIV-infected patients receiving nucleoside analog antiretroviral therapy. We wished to quantitate the incidence of this syndrome in a well characterized, demographically heterogeneous cohort of HIV-infected patients followed longitudinally. METHODS: All patients enrolled into a comprehensive primary care HIV Clinic from July 1989 through July 1994 (N = 1836) were screened for evidence of steatosis and liver disease by assessment of hospital discharge diagnoses, pathology reports, out- and in-patient laboratory data, and clinic records. RESULTS: A total of 322 (18%) patients had evidence of a liver abnormality. In these patients, viral hepatitis and alcohol-induced liver disease were the most common diagnoses. Only two patients had hepatomegaly with moderate to severe steatosis and acidosis. Both cases occurred in white men with very advanced HIV disease who were receiving nucleoside analog antiretroviral therapy. The incidence of the syndrome was 1.3 per 1000 person-yr of follow-up in antiretroviral users in our cohort (95% confidence interval: 0.2, 4.5 per 1000 person-yr). CONCLUSION: The hepatic steatosis syndrome manifesting as a severe, potentially fatal complication of antiretroviral therapy in HIV disease is rare. Both men and women and patients in early and late stages of HIV infection appear to be susceptible. It is not currently known whether a milder form of this syndrome is occurring in a larger population.
Asunto(s)
Antivirales/efectos adversos , Hígado Graso/inducido químicamente , Infecciones por VIH/tratamiento farmacológico , Hepatomegalia/inducido químicamente , Acidosis Láctica/inducido químicamente , Acidosis Láctica/epidemiología , Adulto , Antivirales/uso terapéutico , Estudios de Cohortes , Hígado Graso/epidemiología , Hepatomegalia/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Factores de Riesgo , SíndromeRESUMEN
To determine how the patterns of inpatient hospital care for HIV-infected patients have evolved in recent years, we analyzed data obtained from a statewide hospital discharge database from Maryland for the years 1988, 1990, and 1992. For each of these years, we compared demography, diagnoses, lengths of stay, use of the intensive care unit, third-party payer, and hospital charges (inflation-adjusted to 1992 dollars). HIV-infected patients accounted for 0.42% of all Maryland's hospital admissions in 1988, 0.68% in 1990, and 1.1% in 1992, with progressively more women and African-Americans hospitalized. Average lengths of stay fell from 11.7 days (1988) to 10.7 days (1990) and 9.5 days (1992) (p < 0.0001). Average charges per admission fell from $11,634 (1988) to $9,938 (1990) and $8,618 (1992) (p < 0.0001). Medicare or Medicaid paid for 50.9% of hospital admissions in 1988, 56.8% in 1990, and 66.8% in 1992 (p < 0.001). In-hospital mortality rates (7.8% in 1988, 7.9% in 1990, and 7.7% in 1992; p = 0.783) were stable, as was severity of illness. P. carinii pneumonia (PCP) was the most common principal diagnosis, but it declined in prevalence from 13.6% in 1988 to 9.1% in 1992 (p < 0.0001). Principal diagnoses of other opportunistic infections remained stable (8.0% in 1988, 9.9% in 1990, 8.6% in 1992; p = 0.90), as did other nonopportunistic infections (32.8% in 1988, 27.2% in 1990, and 30.0% in 1992; p = 0.16). Non-PCP pneumonias increased from 7.6% (1988) to 10.2% (1992) (p < 0.0001). Substance abuse as a principal or secondary diagnosis increased from 30.9% (1988) to 34.3% (1992) (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)