PubMed · 12295529
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1993. Editorial.. https://pubmed.ncbi.nlm.nih.gov/12295529/
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Infection with HIV-1 is known to impair B cell function. To further elucidate the role of B cells during infection and tumorigenesis, we studied their numbers in cases of AIDS-related Kaposi's sarcoma (KS) during the HAART era. Patients with AIDS-related KS were identified from a database of 4,480 HIV-1 positive individuals and the incidence of KS and rate ratio was stratified according to nadir number of B cells, measured as the CD19 count. In an unadjusted model, we observed that lower B cell counts were associated with a statistically significant increased risk of KS development (p < 0.001). We also observed a trend toward increased counts during KS resolution. When adjusted for nadir CD4 count in a multi-variable model, higher B cell counts were protective against KS development (p = 0.015). These data highlight a potential role for B cells and therefore the humoral immune system in KS aetiopathogenesis.
The intimate relationship between the HIV-1 life-cycle and the activation state of cells supporting viral replication results in a dynamic interaction between coinfections and HIV-1 replication in dually infected people. The immunologic impact of recurrent coinfections has the potential to increase viral replication, viral genotypic heterogeneity and CD4 T lymphocyte loss, leading to accelerated decline in immune function, reduced survival and increased HIV-1 transmission risk. These effects may play a particularly significant role in the HIV-1 epidemic in sub-Saharan Africa. The mechanisms underlying these effects on virus-host dynamics are reviewed and data describing the impact of tuberculosis, malaria, schistosomiasis and genital ulceration on HIV-1 infection are presented.
Medical and scientific knowledge is not intrinsically different from other kinds of knowledge and has gone through the same processes in terms of its development. As a profession, medicine achieved its dominance in the 19th century and has subsequently consolidated its power base. A socio-historical perspective shows us that medicine has no more and no less fraud, heresy, schism, and relative knowledge than any other equivalent forms of knowledge. Orthodox medicine emerged from a number of healing systems in the 19th century by claiming the superiority and consequent authority of the biomedical model and its special relationship to laboratory science. This process has been seen by some to resemble the growth of religious orthodoxy and the emergence of alternative beliefs with the dissenting medical systems, based on different paradigms, becoming analogous to religious sects. An increasing body of opinion rejects the notion of "objective" knowledge and sees medical knowledge and practice as "socially constructed". An examination of HIV/AIDS measurement and 19th century craniology and contagion and anti-contagion theories indicates processes which are "contextual" rather than "objective". Heresy and schism are natural concomitants of socially constructed knowledge, functioning as providers of impetus and change and, as such, are to be welcomed as non-orthodox challenges.