Biomedical subjects
Publications and source records attributed to P Vanhems.
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This study examined the relationship between the severity of acute human immunodeficiency virus type 1 (HIV-1) illness and disease progression and death. The population included 218 patients with acute HIV-1 illness and 41 asymptomatic patients who underwent HIV-1 seroconversion; the patients were followed up prospectively. We analyzed progression to Centers for Disease Control and Prevention clinical categories B and C (AIDS-defining conditions) and death according to an additive clinical score (CS) based on six predictive clinical features at the time of acute HIV-1 infection. Compared with patients with a CS of 0 (asymptomatic patients), those with a CS of 3-4 and 5-6 had faster progression to category B disease (adjusted hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.01-1.92; and HR, 1.80; 95% CI, 1.34-2.40; respectively); those with a CS of 5-6 had faster progression to category C disease (HR, 1.37; 95% CI, 1.01-1.89) and death (HR, 2.05; 95% CI, 1.27-3.32). Thus, the number of symptoms and signs at the time of acute HIV-1 illness affects disease progression and survival, even in symptomatic patients who have undergone seroconversion.
Has there been a change in the duration of periods of hospitalization during the first two years after diagnosis of AIDS between patients diagnosed before 1988, compared with patients diagnosed since 1988? A cohort of 212 AIDS patients was studied. They were diagnosed before December 31, 1990 and were hospitalized between January 1, 1981 and March 31, 1993 in the University Hospital of Geneva, Switzerland. Overall, the duration of hospitalization did not seem to differ according to the year of AIDS diagnosis, though the more recently diagnosed patients were hospitalized with a more advanced level of immunosuppression. However, the pattern of hospitalization was slightly different. The periods of hospitalization for subjects diagnosed before 1988 were relatively longer soon after the AIDS diagnosis and at a late stage in the course of the disease, whereas for the more recent patients the lengths of hospital stays were more uniform during the whole course of the disease.
The purpose of this study was to describe the frequency and duration of clinical features at the time of acute human immunodeficiency virus type 1 (HIV-1) disease in 218 patients with documented symptomatic primary HIV-1 infection. The mean duration of acute HIV-1 disease was 25.1 days (median, 20.0 days) and did not differ by gender, age, and risk factor. The frequency and mean duration of clinical features occurring in >50% of patients were as follows: fever, 77.1% and 16.9 days; lethargy, 65.6% and 23.7 days; cutaneous rash, 56.4% and 15 days; myalgia, 54.6% and 17.7 days; and headache, 50.9% and 25.8 days. Only 15.6% of patients presented with a typical mononucleosis-like illness (MLI) defined as fever, pharyngitis or sore throat, and cervical adenopathy, and 10% had no features of an MLI. A meningitis-like syndrome occurred in 20 patients (9.2%). Acute HIV-1 disease is more diverse than previously reported, and the absence of fever or other MLI features does not rule out acute HIV-1 disease.
Primary infection by type 1 human immunodeficiency virus (HIV) is symptomatic in about 70% of cases. The acute illness is a mononucleosis-like syndrome with characteristics such as mucosal ulcerations. The duration and severity of the symptoms appear to be related to the prognosis. After reviewing the most frequent signs and symptoms of primary HIV infection, we report different prognostic studies which examined the association between the acute illness and the progression of HIV disease.
In the last few years, survival of patients infected with human immunodeficiency virus (HIV) has been improved because of a decreased incidence of some opportunistic complications attributable to prophylactic treatments and antiretroviral drugs. The impact of these agents should also be reflected in the quality of life (QoL) of patients. We have reviewed this topic with an emphasis on different types of measurements such as Q-TWIST, MOS and the Spitzer score which seem to be most appropriate for this patient population. We do not think that a special type of assessment should be designed for HIV-infected persons. It would be less time-consuming to improve already existing validated scores focusing on HIV infection. QoL in intravenous drug users with HIV should be evaluated more often.
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STUDY OBJECTIVE: (1) To evaluate a clinical score predicting the early death from Pneumocystis carinii pneumonia (PCP) in HIV-infected patients and to compare it with lactate dehydrogenase (LDH) levels and Karnofsky's performance score. (2) To compare the association of this score and partial oxygen pressure (PaO2) at baseline (at ambiant air) with change in therapy. DESIGN: This clinical score was based on respiratory rate, degree of fever, cough, dyspnea, chest tightness, and chest radiographic findings. It was prospectively assessed in patients enrolled in two clinical trials for primary therapy of PCP. SETTING: A university hospital with a large AIDS population. PATIENTS: PCP scores (PCPSc) were assessed on treatment days (D) 0, D3, D7, D14, and D21 for 78 patients with mild to moderately severe PCP (PaO2 > 50 mm Hg at entry at room air). Regardless of the treatment received, these patients were stratified into two groups (survivors and nonsurvivors) within 45 days after the beginning of therapy. MEASUREMENTS AND RESULTS: The PCPSc was associated with 45 days survival at treatment D3 (p = 0.03) and D14 (p < 0.001). Its decrease was significant between D0 and D7 and between D7 and D14 for survivors only. The LDH levels during the treatment course did not correlate with outcome. The fall in LDH values was significant only for survivors between D7 and D14 of therapy. The PaO2 at hospital admission was associated with death at 45 days and was well correlated with the PCPSc on D0 by single and multiple linear regression (R = 0.60, p < 0.0001). The PCPsc on D0 was associated with the change of initial therapy due to failure or drug adverse effects whereas PaO2 on D0 was associated only with treatment failure. CONCLUSIONS: For HIV-infected patients with mild to moderately severe PCP, this clinical score is easy to assess and has a prognostic value for survivors. It could be helpful to predict both treatment failure and occurrence of severe adverse drug reactions. The PCPSc should be validated in a larger number of patients, including those with more severe forms of PCP.
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Zidovudine (azidothymidine, Retrovir) and ddI (di-deoxy-inosine, Videx) interfere with the multiplication of HIV by incorporation into nascent DNA chains and interruption of the further linking of nucleotides. Zidovudine lowers early mortality in patients with Aids and pneumocystis carinii pneumonia. However, much of the effectiveness of zidovudine is lost later on; the average prolongation of life in treated patients is estimated to be about 1 year. About two thirds of patients with Aids can be treated with zidovudine; in the others, the drug is ineffective or contraindicated. Frequent blood counts are necessary to monitor myelotoxicity, even at relatively low doses of 500 mg/day. In contrast, zidovudine is well tolerated by asymptomatic patients with 200 to 500 CD4 lymphocytes/mm3, in whom it diminishes the incidence of Aids from about 7 to 3% during the first year of treatment, with less than 2% severe anemia or leukopenia. For patients who do not tolerate zidovudine, ddI is an alternative. It is not myelotoxic but can cause neuritis and pancreatitis, especially at doses in excess of 10 mg/kg/day. Although its antiviral effect is excellent both in vitro and in vivo, there is still a lack of firm data on its clinical value, such as the decrease in opportunistic infections and increase in survival.
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The aim of this retrospective study was to assess the prevalence of hepatitis C virus antibodies and their follow-up in a series of 64 orthotopic liver transplantation patients. Indications for transplantation were cirrhosis in 28 cases, primary biliary cirrhosis in 6 cases, liver cancer in 11 cases, fulminant hepatitis in 2 cases, and alveolar echinococcosis in 17 cases. The prevalence of serum antibodies to hepatitis C virus was assessed by an ELISA test (Ortho-Diagnostic-Systems). Sera were tested before liver transplantation and every two months after. Twenty-nine patients seronegative before transplantation remained negative. Four patients seropositive before liver transplantation remained seropositive. Twenty-eight patients seropositive before transplantation, became seronegative after, and 3 patients seronegative before transplantation became seropositive after. The prevalence of seroconversion was 9.3 percent. The prevalence of seropositive patients after transplantation was 11 percent. The high number of seropositive patients before transplantation (50 percent) could be explained by false positive results. Seropositivity before transplantation appeared to be related to hypergammaglobulinemia (p less than 0.001). This hypothesis was confirmed a posteriori by a concomitant disappearance of both seropositivity and hypergammaglobulinemia after transplantation in 62 percent of patients.
The prognostic value of the CD4+ T cell count is not clearly established for HIV-1 infected patients with an advanced immunosuppression. The aim of this study was to assess the relationship between CD4+ T cell counts and survival in patients with less than 50 CD4+ T cells per mm3 (/mm3). We examined an historical cohort of 97 patients with 2 consecutive CD4+ T cells determinations < 50/mm3 within 3 months, followed at a university hospital of the University of Montreal. The proportion of men was 93% with 74% being homo/bisexual. The means of the 2 CD4+ T cell counts/mm3 were 25 and 25.1 respectively. Median survival after the first CD4+ T cell count < 50 CD4+ T cells/mm3 was 15.2 months. Using the proportional hazard model, the median survival of patients with 2 consecutive CD4+ T cell counts < or = 20/mm3 was 9.3 months compared to 19.2 for those with 20-50 CD4+ T cells/mm3 (P < 0.0001). It seems then, that the CD4+ T cell count is a helpful prognostic marker, even in very immunosuppressed patients. Its prognostic value is more accurate if the measurement is replaced within 1-3 months because of high variability at this level of immunosuppression.