PubMed Health⌕ Search

Biomedical subjects

Marc Lipman

Publications and source records attributed to Marc Lipman.

9 recordsLinked to original sources
PubMed2006

Pneumocystis pneumonia revisited: delayed diagnosis in an HIV infected individual with high blood and low lung CD4 T cell counts.

The peripheral blood CD4 count is a useful marker of immunological status in HIV infection. However, it makes up only 1% of total body CD4 cells [Parslow T. Lymphocytes and lymphoid tissue. In: Stites D, Terr A, Parslow D, editors. Basic and clinical immunology. Appleton and Lange; 1994. p. 22-40.] has a wide intra- and inter-individual variability [Turner BJ, Hecht FM, Ismail RB. CD4+ T-lymphocyte measures in the treatment of individuals infected with human immunodeficiency virus type 1. A review for clinical practitioners. Arch Intern Med 1994;154:1561-73.] and CD4 cell pathology is just one of the immune defects caused by HIV [Fauci S. Multifactorial nature of human immunodeficiency virus disease. Science 1993;262:1011-8.]. Thus a given value should always be interpreted within a specific clinical context. We describe an individual with Pneumocystis pneumonia (PCP) who was reviewed by HIV medical services several times before the correct diagnosis was made. On each occasion the possibility of PCP was discounted as he had a well-preserved blood CD4 count. Subsequent examination of his pulmonary T-lymphocyte subsets revealed marked CD4 lymphopenia.

AIDS-Related Opportunistic Infections↗
PubMed2006

Immune reconstitution inflammatory syndrome in HIV.

PURPOSE OF REVIEW: The purpose of this review is to describe the epidemiology, clinical features, putative immune mechanisms and management of immune reconstitution inflammatory syndrome (IRIS) using data published in the last 2 years. RECENT FINDINGS: Ever more conditions are reported as IRIS events. These most frequently occur with mycobacterial (tuberculosis or Mycobacterium avium complex infection) or cryptococcal disease (each in approximately 30% of cases). Definitions have been proposed for its clinical diagnosis. These suffer from a lack of prospective studies to support their predictive value. The immunopathogenesis of IRIS appears to be related to the interaction between HAART-induced changes in host immune response and the presence of (usually microbial) antigen. Increasing evidence exists that this might be an anatomically compartmentalized phenomenon, such that immune responses may be localized to specific tissue sites such as the brain. This has implications for the use of simple blood tests, such as CD4 count or change in viral load, when assessing risk of IRIS. Treatment options include immune modulation, though supportive care is typically all that is required, unless symptoms are prolonged, significant or life-threatening. SUMMARY: IRIS is common and will become more so as HAART is rolled out worldwide. Clear clinical definitions are required to avoid its over-diagnosis due to misclassification of other conditions.

AIDS-Related Opportunistic Infections↗
PubMed2002

Raised viral load in patients with viral suppression on highly active antiretroviral therapy: transient increase or treatment failure?

OBJECTIVE: To assess the occurrence of viral load greater than 50 copies/ml in patients on highly active antiretroviral therapy (HAART) having achieved less than 50 copies/ml and the chance of whether a viral load greater than 50 copies/ml would lead to a sustained and increasing viral load. DESIGN: A cohort of 553 patients on HAART with viral loads of less than 50 copies/ml were followed. RESULTS: Over a median of 56 weeks 35% of patients experienced a transient increase and 8% virological failure (two consecutive viral loads of > 400 copies/ml). Transient increases and virological failure were more common in those with greater drug experience, and those with initial raised viral load values of more than 400 copies/ml were more likely to have a sustained increase and become virological failures. CONCLUSION: Transient increases in viral load are common, mainly in the 50-400 copies/ml range, and the majority of subsequent viral load estimations show a return to less than 50 copies/ml. A single raised viral load should lead to adherence support and intensified monitoring. Subsequent treatment decisions can then be based on evidence of true virological rebound and failure.

Antiretroviral Therapy, Highly Active↗
PubMed2002

The changing pattern of bronchoscopy in an HIV-infected population.

STUDY OBJECTIVE: s: Little information exists on the impact of antiretroviral therapies (ARTs) on HIV-related bronchoscopic activity. This study was performed to identify any changes to our pattern of use of bronchoscopy over the last decade, and how this might relate to the introduction of more effective ARTs to our center in 1996. DESIGN: Retrospective data analysis. SETTING: Academic medical center. PATIENTS: HIV-positive patients attending the clinic. METHODS: Basic demographic details and bronchoscopy status were collected and compared for all patients with HIV attending our center between 1989 and 1998. Poisson regression analysis was performed to more formally identify the risk factors for bronchoscopy. Individual case notes and bronchoscopic findings were also examined for all patients undergoing bronchoscopy in 1990, 1995, and 1998. RESULTS: From 1996 to 1998, bronchoscopic rates fell dramatically by 60% (p < 0.0001) despite a linear increase in patients receiving follow-up. Prior use of protease inhibitor (PI)/nonnucleoside reverse transcriptase inhibitor (NNRTI) combinations was significantly associated with a decreased risk of bronchoscopy even after adjusting for CD4 counts. Indications for bronchoscopy and diagnostic yield remained relatively stable in 1990, 1995, and 1998, although rates of pulmonary infection (Pneumocystis carinii pneumonia, bacteria, and virus) requiring bronchoscopy among our HIV population fell significantly from 1990 to 1998. CONCLUSION: Improvements in HIV health care are having a dramatic impact on the rates of certain pulmonary infections requiring bronchoscopy. Of these, the introduction of more effective ARTs to our service in 1996 seems most closely related to the temporal decline in bronchoscopy. PI/NNRTI combinations may have additional protective effects to their recognized action on CD4 counts.

AIDS-Related Opportunistic Infections↗