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Biomedical subjects

J C Borleffs

Publications and source records attributed to J C Borleffs.

At least 55 records · Page 3Linked to original sources
PubMed1993

Use of an immunoglobulin M containing preparation for treatment of two hypogammaglobulinemic patients with persistent Campylobacter jejuni infection.

This report describes two hypogammaglobulinemic patients with persistent Campylobacter jejuni infections in spite of IgG substitution and antibiotic therapy. Since serum bactericidal activity (SBA) depends on IgM, these patients were each treated with six doses of an IgM-containing immunoglobulin preparation (Pentaglobin) at three-week intervals. During IgG therapy SBA was not seen in either patient. However, one hour following administration of the IgM preparation, SBA increased to 90%. Just before the next dose SBA was still at the 30-70% level. Both patients tolerated the therapy very well and there were no culture-confirmed relapses of Campylobacter jejuni infection. The IgM preparation may therefore be a useful alternative to conventional IgG in the treatment of hypogammaglobulinemic patients with persistent Campylobacter jejuni infection.

Adult↗
PubMed1993

In vitro and in vivo measurement of cell-mediated immunity in patients with HIV-1 infection.

We studied the usefulness of the in vitro lymphoproliferation assay and the in vivo skin test in HIV-1-infected patients by using Clostridium tetani and tuberculin as testing antigens. Moreover, the relationship between data obtained from both assays was studied. In 56 HIV-infected patients not receiving antiretroviral therapy CD4+ cell counting was performed. In addition, in vitro (lymphocyte proliferation assay) and in vivo (delayed type hypersensitivity skin test) measuring of the immune status was done using C. tetani and tuberculin as testing antigens. When using C. tetani a significant correlation between the results of both tests and the CD4+ cell count was found. In contrast to earlier reports from African countries, in vivo skin testing using tuberculin did not yield clinically significant information on the degree of immunodeficiency. We explain our findings by the fact that health care policy in The Netherlands encompasses vaccination with C. tetani, which enables the application of C. tetani as testing antigen for measuring immune function both in vitro and in vivo.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Polyarteritis nodosa in a patient with AIDS.

A 33-year-old male homosexual with the acquired immunodeficiency syndrome (AIDS) presented with pain, blue colouring and ulceration of fingers and toes. Angiography of the superior mesenteric artery and renal arteries showed vessel wall irregularities and aneurysms, characteristic of polyarteritis nodosa (PAN). We describe this patient because of the possible association between systemic vasculitis and AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1992

A controlled trial of aerosolized pentamidine or trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection. The Dutch AIDS Treatment Group.

BACKGROUND: Primary prophylaxis against Pneumocystis carinii pneumonia (PCP) is recommended for patients with human immunodeficiency virus (HIV) infection if their CD4 cell counts are below 200 per cubic millimeter (0.2 x 10(9) per liter). Either aerosolized pentamidine or trimethoprim-sulfamethoxazole (co-trimoxazole) is commonly prescribed for prophylaxis, but the relative efficacy and toxicity of these agents are unknown. METHODS: We conducted a multicenter trial involving 215 HIV-infected patients with no history of PCP but with CD4 cell counts below 200 per cubic millimeter. The patients were randomly assigned to one of three regimens: aerosolized pentamidine once a month, 480 mg of trimethoprim-sulfamethoxazole once a day (80 mg of trimethoprim and 400 mg of sulfamethoxazole), or 960 mg of trimethoprim-sulfamethoxazole once a day (160 mg and 800 mg, respectively). The cumulative incidence of PCP was estimated by Kaplan-Meier survival analysis. RESULTS: After a mean follow-up of 264 days, 6 of the 71 patients in the pentamidine group had a confirmed first episode of PCP (11 percent), whereas none of the 142 patients in the two trimethoprim-sulfamethoxazole groups had PCP (P = 0.002). However, adverse events that required discontinuation of the medication were much more frequent in the trimethoprim-sulfamethoxazole groups (17 and 18 patients) than in the pentamidine group (2 patients). The adverse reactions occurred significantly sooner in the group given 960 mg of trimethoprim-sulfamethoxazole than in the group given 480 mg (mean time, 16 vs. 57 days; P = 0.02). CONCLUSIONS: For patients with HIV infection, trimethoprim-sulfamethoxazole taken once a day is more effective as primary prophylaxis against PCP than aerosolized pentamidine administered once a month, although adverse drug reactions are more frequent with trimethoprim-sulfamethoxazole.

AIDS-Related Opportunistic Infections↗
PubMed1992

[Quality of life of persons with HIV infection in an academic hospital].

OBJECTIVE: Comparison of the quality of life of asymptomatic (n = 24) and symptomatic (n = 20) HIV-infected patients and description of the changes in quality of life during the symptomatic stage. DESIGN: Prospective study. SETTING: University Hospital Utrecht. METHOD: Every four months questionnaires on quality of life were completed by 44 of 55 consecutive HIV-infected patients. RESULTS: Physically, asymptomatic HIV-infected patients were better off than symptomatic HIV-infected patients; psychologically, however, both groups of patients showed similar responses. During the symptomatic stage the patients' physical functioning diminished further, but feelings of anxiety or depression showed no marked change; self-evaluations of health conditions became slightly more negative with time.

Academic Medical Centers↗
PubMed1992

Transplantation tolerance in heart transplant recipients as demonstrated by unresponsiveness in cell-mediated lympholysis.

Transplantation tolerance or adaptation to an allograft is associated with unresponsiveness to donor-specific transplantation antigens measured in in vitro cell-mediated lympholysis (CML). We here demonstrate in a longitudinal follow-up that CML nonreactivity develops in seven of ten patients following heart transplantation. The first manifestation of this nonreactivity manifested between 3 and 27 months after transplantation. CML nonreactivity correlated with time after transplantation and the percentage of activated lymphocytes in peripheral blood. CML nonreactivity was also associated with good graft function, i.e., in condition of nonresponsiveness patients did not manifest acute rejection. The only exception was seen in one patient in whom the immunosuppressive therapy was strongly reduced. A more detailed evaluation of this patient indicated that the underlying mechanism for CML nonreactivity is clonal anergy or active suppression of the alloreactive cells.

Cytotoxicity, Immunologic↗
PubMed1992

Bacteriuria in men infected with HIV-1 is related to their immune status (CD4+ cell count).

OBJECTIVE: Reports from the United States that urinary tract infections (UTI) are more common in homosexual than in heterosexual men have not been confirmed in Europe. The occurrence of several UTI in men infected with HIV-1 has been recorded in The Netherlands. We therefore analysed the relationship between the presence of bacteriuria and the immune status (CD4+ cell count) in these HIV-1-infected patients. DESIGN: Urinary cultures were obtained prospectively for 2 years, during the first visit and every 6 months thereafter, when signs and symptoms of UTI occurred and when patients had fever of unknown origin. CD4+ cell counts were measured at the same time. SETTING: The study was performed at the University Hospital, Utrecht, The Netherlands. PATIENTS, PARTICIPANTS: One hundred and thirty HIV-1-infected men attended our hospital. Data from 98 were analysed. Eighty-nine (91%) of these men were either homo- or bisexual. MAIN OUTCOME MEASURES: Positive urinary culture. RESULTS: Group 1 (CD4+ cell count less than 200 x 10(6)/l) consisted of 47 patients; 30% had at least one period of bacteriuria, with 21 episodes. Group 2 (CD4+ cell count 200-500 x 10(6)/l) consisted of 27 patients; 11% had at least one period of bacteriuria, with five episodes. We did not find bacteriuria in the 24 patients in group 3 (CD4+ cell count greater than 500 x 10(6)/l). The rate of bacteriuria per patient-month, 4 (group 1) versus 2 (group 2), differed significantly (P less than 0.001). A significant relationship between CD4+ cell count and bacteriuria was found (P = 0.00003); no relationship, however, was found with anal intercourse, hospitalization, Karnofsky score, follow-up, or age. CONCLUSION: We conclude that men infected with HIV and presenting with a CD4+ cell count less than 200 x 10(6)/l are at increased risk for bacteriuria.

Adult↗
PubMed1991

[Zidovudine treatment and need of blood transfusion in patients with AIDS].

The treatment of AIDS patients with zidovudine extends their survival time. However, hematological side effects frequently require a reduction of the dosage and the administration of blood transfusions. We reviewed the history of zidovudine treatment and blood transfusions for 27 patients with AIDS treated in the University Hospital Utrecht between July 1st, 1987 and July 1st, 1990. The initial dosage of zidovudine was 1000-1200 mg daily orally. Two months after the initiation of the therapy, 48% of the patients required a reduction of the zidovudine dosage. This percentage had increased to 85% after 12 months since the start of the therapy. During this period, 26% of the patients received blood transfusions. The zidovudine dosage was on the average of 480 mg per day after reduction. One year after the start of the therapy, 81% of the patients were still alive, and after 1 1/2 years this percentage was 68. In our study the proportion of patients undergoing a reduction of the zidovudine dosage was high in comparison with data reported in the literature. However, the need for blood transfusions was clearly lower. The survival percentages after 1 and 1 1/2 years were about the same as reported in other studies. Therefore, we conclude that an early reduction of the zidovudine dosage and resulting low total dosage were effective and resulted in a decreased need for blood transfusions.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Fatal disseminated hemorrhagic toxoplasmic encephalitis as the initial manifestation of AIDS.

A 28-year-old woman presented with progressive coma after being asymptomatic for 1 year after the demonstration of seropositivity for human immunodeficiency virus and high serum immunoglobulin G toxoplasma titers. Computed tomographic scanning showed multiple rounded cerebral hemorrhages and massive cerebral edema. Postmortem examination disclosed Toxoplasma gondii cysts scattered throughout the brain. An overwhelming fatal toxoplasmosis associated with multiple cerebral hemorrhages may be the first presentation of the acquired immunodeficiency syndrome. We raise the possibility that frequent neuroradiological monitoring may be indicated in asymptomatic human immunodeficiency virus-infected patients with high immunoglobulin G toxoplasma titers.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Histoplasma capsulatum infection, a manifestation of AIDS unusual for The Netherlands].

The history of 29-year-old male from Surinam with antibodies to HIV-1 and long-lasting fever, lymphadenopathy, pain in the right upper abdomen and a granulomatous hepatitis is described. The patient suffered from disseminated histoplasmosis, a fungal disease rare in The Netherlands, which is the indicator disease for the diagnosis of AIDS (CDC-IVCI). It is stressed that in seropositive patients coming from endemic areas, including Surinam, the possibility of this disease should be considered.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Hospital cost for patients with HIV infection in a university hospital in The Netherlands.

Precise data on the utilization of health care facilities by HIV infected patients are generally not available. Nor are there data on the related cost, effectiveness and efficiency of the treatment provided. This is due mainly to the lack of a suitable method for recording demographic, medical and financial data on individual patients in hospitals. For this reason we have been developing a system of data collection, which provides a detailed cost record of each patient. The application of this system for 52 patients with HIV infection treated in a university hospital over a two-year period showed that for a patient with AIDS the mean cost of inpatient and outpatient hospital services was $19,507 per person-year. For patients with HIV infections other than AIDS the mean costs ranged from $1,769 for CDC III patients to $2,064 for CDC II patients (expressed in 1987 US dollars). Continued operation of the registration system will make it possible to analyze the causal background of costs as well as the cost-effectiveness of the treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1990

HIV-1 infection and virus production in follicular dendritic cells in lymph nodes. A case report, with analysis of isolated follicular dendritic cells.

Follicular dendritic cells (FDC) from axillary lymphoid tissue of a patient with acquired immune deficiency syndrome (AIDS) were analyzed for the presence of gag and env proteins and env mRNA of human immunodeficiency virus type-1 (HIV-1), both in a purified FDC suspension and on frozen sections. Isolated cells with morphologic and immunocytochemical features of FDC expressed HIV-1 core (gag) proteins p15, p17, p24, and envelope (env) protein gp41; in addition HIV-1 env mRNA was detected in some of these cells. This corresponded with intense expression of HIV-1 proteins by FDC in germinal centers in situ, and the presence of HIV-1 mRNA-positive cells in germinal follicles. These findings led us to conclude that FDC are infected and able to produce HIV-1. Such infection may contribute significantly to the destruction of the FDC network during the lymphadenopathy phase after HIV-1 infection.

Acquired Immunodeficiency Syndrome↗