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PubMed1998

Oral manifestations of human immunodeficiency virus-infected patients in Taiwan.

To understand the characteristic clinical features of human immunodeficiency virus (HIV)-related oral lesions and determine the prevalence of various oral lesions in HIV-infected patients in Taiwan, we conducted a cross-sectional study of 207 HIV-infected patients at the Taipei Municipal Institute for Venereal Disease Control. Overall, 108 (52.2%) patients had at least one oral lesion. The most common oral manifestation of HIV infection among these 207 patients was oral hairy leukoplakia (OHL, 29.5%), followed by candidiasis (12.1%), xerostomia (10.6%), aphthous ulcers (8.7%), and linear gingival erythema (5.8%). Less frequently encountered oral lesions included leukoplakia (1.9%), papilloma (1.4%), necrotizing ulcerative periodontitis (1.0%), Kaposi's sarcoma (1.0%), herpes simplex (0.5%), Burkitt's lymphoma (0.5%), and parotid gland enlargement (0.5%). Thirty-one (15%) patients had multiple oral lesions. Patients with oral candidiasis or multiple oral lesions had significantly lower mean CD4 lymphocyte counts and CD4/CD8 lymphocyte ratios than those without any oral lesions (p < 0.05). Chi-square analysis revealed that patients with CD4 lymphocyte counts below 200 cells/mm3 were more prone to have OHL (p < 0.002), oral candidiasis (p < 0.001) and multiple oral lesions (p < 0.001). Those with CD4/CD8 lymphocyte ratios below 0.4 were more likely to have OHL (p < 0.02), oral candidiasis (p < 0.01) and multiple oral lesions (p < 0.02) than those with higher counts. In conclusion, the occurrence of oral lesions, especially OHL and oral candidiasis, is fairly common in Taiwanese HIV-infected patients.

Adolescent↗

PubMed2001

The use of and response to second-line protease inhibitor regimens: results from the EuroSIDA study.

OBJECTIVE: To describe the use of second line protease-inhibitor (PI) regimens across Europe and to determine factors associated with virological and immunological response. DESIGN: Analysis of data from 984 patients with a median follow-up of 21 months enrolled in EuroSIDA. Patients started their second PI-containing regimen at least 16 weeks after starting the first PI-containing regimen and with viral load > 1000 copies/ml. METHODS: Virological response was defined as a viral load < 500 copies/ml and immunological response as an increase of 50 x 10(6)/l or more in CD4 lymphocyte count. RESULTS: The median CD4 cell count at starting the second PI was 171 x 10(6) cells/l; viral load was 4.45 log copies/ml. As a second PI regimen, 45% were using a dual PI, while of those on one PI, indinavir (42%) and nelfinavir (34%) were most common. In multivariate Cox models, a higher viral load at starting the second PI [relative hazard (RH), 0.67 per 1 log higher; 95% confidence interval (CI), 0.58-0.77; P < 0.0001) and a lower CD4 cell count (RH, 1.15 per 50% higher; 95% CI, 1.06-1.26; P = 0.0014) were associated with a reduced probability of virological response. Those who had achieved viral suppression on the first PI-regimen were more likely to respond to the second (RH, 1.65; 95% CI, 1.30-2.10; P < 0.0001) as were those who added one or two new nucleosides to their second PI. CONCLUSIONS: Patients who initiate a second PI regimen at lower viral load, higher CD4 cell count or who added new nucleosides tended to be more likely to achieve a viral load < 500 copies/ml. The roles of cross-resistance and adherence in response to second-line regimens needs further investigation.

Adolescent↗

PubMed1997

Pharmacokinetics of antimycobacterial drugs in patients with tuberculosis, AIDS, and diarrhea.

To test the hypothesis that antituberculous drug disposition is altered in patients with AIDS, we studied the steady-state pharmacokinetics of isoniazid (300 mg/d), rifampin (600 mg/d), and pyrazinamide (1,500 mg/d) in 29 adults (14 patients infected with human immunodeficiency virus [HIV] and 15 non-HIV-infected patients) with tuberculosis in Nairobi, Kenya. Intestinal integrity was assessed with xylose. Neither HIV infection nor diarrhea accounted for the interpatient variability in the area-under-the-plasma concentration vs. time curve (AUC), the maximum concentration, or the terminal half-life (t1/2) of isoniazid, rifampin, and pyrazinamide. No significant association between HIV infection or diarrhea and pharmacokinetics was seen for any of the compounds. In addition, neither the AUC nor the t1/2 of any of these drugs reflected interpatient differences in CD4 lymphocyte counts. Xylose absorption was uniformly low. We did not demonstrate that HIV infection, diarrhea, or CD4 lymphocyte counts contributed significantly to the variability in pharmacokinetics of isoniazid, rifampin, and pyrazinamide in TB patients in Nairobi.

AIDS-Related Opportunistic Infections↗

PubMed1999

Delayed-type hypersensitivity, in vitro T-cell responsiveness and risk of active coccidioidomycosis among HIV-infected patients living in the coccidioidal endemic area.

The prognostic importance of specific and general tests of immune function were examined among a cohort of 170 subjects infected with human immunodeficiency virus type-1 (HIV), living in an area endemic for the fungal infection coccidioidomycosis. Using the proportional hazards model and multivariate analysis, lack of expression of coccidioidal delayed-type hypersensitivity (DTH) was found to be dependent on anergy in response to the non-coccidioidal antigens mumps, Trichophyton and Candida (relative hazard 4.2, 95% CI 1.8-9.8, P=0.001). Among subjects with CD4 lymphocyte counts >/=250 microl-1 on entry into the study, the in vitro lymphocyte transformation (LT) response to the coccidioidal antigen toluene spherule lysate was 4967+/-1652 (mean counts per minute (c.p.m.)+/-SEM) in subjects with coccidioidal DTH compared with 136+/-222 in those with negative DTH (P<0.001). However, amongst those whose CD4 count was <250 microl-1, LT responses were low and there was no significant difference based on coccidioidal DTH (P=0.965). Using the proportional hazards model and multivariate analysis, only a CD4 count <250 microl-1 was prognostically associated with the development of either active coccidioidomycosis or AIDS. These data indicate that immunodeficiency, particularly a CD4 lymphocyte count <250 microl-1, is the most important factor in the lack of expression of specific immunity to coccidioidomycosis and in the development of active coccidioidomycosis among HIV-infected individuals living in the coccidioidal endemic area.

Arizona↗

PubMed1998

Colour vision in AIDS patients without HIV retinopathy.

Patients suffering from AIDS develop ocular complications, the most frequent being HIV retinopathy. It is however not clear, if functional visual impairments can be observed as early indicators of ocular complications, before clinical diagnosis of HIV retinopathy is made at fundus examination. To address this issue, we measured colour vision in a group of 49 AIDS subjects with normal clinical fundi using the 'two equation method'. This method, combining red-green Rayleigh and the blue-green Moreland metameric matches, enables more complete and quantitative assessments of colour vision than those based on pigmentary tests. Data were collected on our computer controlled colorimeter and compared to those of normal subjects. While most AIDS subjects without HIV retinopathy demonstrated normal colour vision, a significant portion of them had wider matches than normal subjects (11% for the Rayleigh equation and 16% for the Moreland equation). Furthermore, matching ranges of the Moreland equation were significantly correlated with CD4 lymphocyte counts. Patients with low CD4 values tended to produce larger matching ranges than the patients with high CD4 values. A within subject study on 17 patients confirmed this trend and showed that the patients who increased/decreased their CD4 blood counts generally improved/impaired their colour discrimination in the Moreland match. No such correlation was found between the matching ranges of the Rayleigh equation and the CD4 counts. These results show that colour discrimination is slightly reduced in some AIDS subjects, although there are no detectable ocular complications. They also suggest two different types of colour vision impairments in AIDS patients without retinopathy: one reversible process affecting colour discrimination in the blue-green range; and another irreversible process affecting colour discrimination in the red-green range.

Acquired Immunodeficiency Syndrome↗

PubMed1995

[Tumor necrosis factor-alpha in human immunodeficiency virus infection].

BACKGROUND: The aim of the present was to determine the levels of the tumor necrosis factor (TNF)-alpha in patients with HIV infection to study the relationship with the concentration of triglycerides (TG), CD4 lymphocyte count and clinical diagnosis. METHODS: Seventy-eight HIV-infected patients (58 males, 20 females); mean age 32 years presenting different clinical situations were studied. TNF, TG, CD4 lymphocyte count, and clinical diagnosis at the time of the study were analyzed. RESULTS: The mean TNF values in the sample was 25.5 x 10(-3) pg/l with a confidence interval of 95% (Cl 95%), 16.6 x 10(-3) pg/l to 34.4 x 10(-3) pg/l with a trend to being higher in the group with less than 200 x 10(6) CD4/l (Cl 95%: 18.6 x 10(-3) pg/l-44.3 x 10(-3) pg/l). Mean TG values in the sample were 2.02 milligrams (Cl 95%: 1.72 milligrams-2.31 milligrams) being significantly higher in the group with less than 200 x 10(6) CD4/l (X = 2.35 +/- 1.32 milligrams; p < 0.005). TNF concentrations were found to be significantly higher in the group with acute infection (Cl 95%: 27 x 10(-3) pg/l-69 x 10(-3) pg/l) with respect to the group without infection at the time of the study (Cl 95% 7 x 10(-3) pg/l-19 x 10(-3) pg/l). The correlation coefficient between TNF and TG was r = 0.34 (p = 0.01). CONCLUSIONS: Both the tumor necrosis factor and triglycerides are high in patients with HIV infection and CD4 lower than 200 x 10(6)/l. The correlation between tumor necrosis factor and triglyceride concentrations is positive and significant. The increase in the former is more important when there is concomitant infection and could be considered as a marker of opportunistic infection.

AIDS-Related Opportunistic Infections↗

PubMed1998

Herpes zoster and lymphopenia associated with sodium stibogluconate therapy for cutaneous leishmaniasis.

A review of 84 patients with cutaneous leishmaniasis treated with sodium stibogluconate (Pentostam) at our institution revealed that three had developed herpes zoster during or shortly after receiving therapy. Because zoster has been associated with depressed cellular immunity, we prospectively followed serial lymphocyte subpopulations in eight patients with cutaneous leishmaniasis who received Pentostam. By day 7 of therapy, the white blood cell count had fallen by a median of 1.15/mm3, the total lymphocyte count by a median of 804/mm3, and the CD4+ lymphocyte count by a median of 306/mm3 (67% of baseline; confidence interval, 52%-78%). An in vitro cell-viability assay demonstrated that Pentostam is not toxic to human mononuclear cells. The administration of Pentostam for the treatment of cutaneous leishmaniasis results in lymphopenia that may be related to the subsequent occurrence of herpes zoster.

Adult↗

PubMed1991

Immune activation markers and AIDS prognosis.

Four assays for serum levels of cellular products of immune activation were examined as prognostic markers for AIDS in a prospective study of asymptomatic HIV-seropositive homosexual men. Baseline serum values of beta 2-microglobulin (beta 2M), neopterin, soluble CD8 (sCD8), and soluble interleukin-2 receptor (sIL-2R) for 185 men were examined univariately and multivariately as predictors of AIDS during 36 months of follow-up. Thirty-three cases of AIDS (18%) were diagnosed during the follow-up period. All four assays correlated highly with each other (r = 0.48-0.63), and all four were good univariate predictors of AIDS and comparable to CD4 lymphocyte count. beta 2M, neopterin, and sCD8 predicted AIDS independently of both CD4 count and HIV p24 antigen or p24 antibody in multivariate analysis. Within the range of CD4 count 200-499 x 10(6) cells/l, an immune activation marker used in combination with an assay for p24 antigen identifies those at 3-6% risk of AIDS over 36 months (low risk on both assays) and those at 63-86% risk (high risk on both assays). These results can be used to guide physicians and patients making decisions about treating asymptomatic HIV infection with zidovudine in individuals with CD4 lymphocyte count of 200-499 x 10(6) cells/l.

Acquired Immunodeficiency Syndrome↗

PubMed1993

Erratic zidovudine bioavailability in HIV seropositive patients.

The bioavailability of zidovudine was evaluated in 16 HIV seropositive patients using a prospective standardized study. Symptomatology, D-xylose absorption and immune status were also measured to determine indicators of poor bioavailability. Zidovudine was rapidly absorbed (Tmax: 0.82 +/- 0.39 h) with a large variation in peak serum concentrations (Cmax: 1.21 +/- 0.64 mg/L). The mean elimination half-lives after intravenous and oral administration were 1.5 +/- 0.4 h and 1.3 +/- 0.2 h, respectively. Mean zidovudine bioavailability was 64.0 +/- 21.3% and was not associated with D-xylose absorption values. Five h urine D-xylose excretion was abnormal in seven patients but only three (43%) had zidovudine bioavailabilities below the mean for the group. Conversely, only five of nine patients (56%) with normal D-xylose absorption tests had zidovudine absorption values below the mean. The presence of a mild alteration in bowel habits, defined as up to four unformed or semi-solid stools per day, showed a highly significant relationship to low bioavailability (P < 0.0001, Student's t-test). Lower CD4 lymphocyte counts were also associated with a low bioavailability (R-squared, 0.36, P = 0.0143). Patients with lower CD4 lymphocyte counts or with mild diarrhoea may be at risk for erratic zidovudine absorption.

Adult↗

PubMed1996

Clinical features of tuberculosis associated with HIV infection in Taiwan.

To understand the clinical characteristics and outcome of tuberculosis (TB) in patients with acquired immunodeficiency syndrome (AIDS) in Taiwan, we reviewed the medical records of 118 adult AIDS patients who were hospitalized at National Taiwan University Hospital between January 1988 and September 1995. Among them, 29 (24.6%) had TB. The mean age of the AIDS patients with TB was 37 years (range, 25-66 yr). Most patients were in the advanced stages of AIDS when human immunodeficiency virus (HIV) infection and/or TB were first diagnosed. The mean CD4+ lymphocyte count was 0.037 x 10(9)/L (range, 0-0.152 x 10(9)/L) at the time TB was diagnosed. There was no statistically significant difference in the mean CD4+ lymphocyte count between patients with isolated pulmonary TB and those with extrapulmonary involvement. Twenty-two patients (75.8%) had extrapulmonary TB with the most common site being the lymph nodes (72.7%). Clinical symptoms were nonspecific, and the chest physical examination was not helpful in the diagnosis. Acid-fast bacilli were detected in sputum smears from eight patients (36.4%). A primary tuberculosis pattern (hilar adenopathy, pleural effusion, middle or lower lobe infiltrates) in the chest radiographs was the most common radiologic finding (36.4%) in patients with pulmonary TB. The reactivation pattern (predominant upper-lobe infiltrates with or without cavitation) could only be found in cases of pulmonary TB without extrapulmonary involvement. Atypical patterns (diffuse interstitial infiltrates mimicking Pneumocystis carinii pneumonia or other patterns) and normal chest radiographs were noted in nearly one-third of the patients with pulmonary TB. A good response to antituberculosis drugs and a favorable outcome were demonstrated in the patients, except for two with drug-resistant Mycobacterium tuberculosis infection. Early identification of TB in HIV-infected patients requires clinical awareness of the unusual clinical presentations, especially among patients in the advanced stages of AIDS.

AIDS-Related Opportunistic Infections↗

PubMed2001

Enterobacter spp. infections complicating the course of HIV disease.

Through a retrospective review of clinical and laboratory data of 2517 consecutive patients with HIV disease hospitalized since 1991, 13 patients were identified (0.52%), who suffered from a confirmed Enterobacter spp. infection (urinary tract disease in 7 cases, sepsis in 4 patients, and pneumonia in 2 cases). A severe immunodeficiency was recognized in all cases, as expressed by a mean CD4+ lymphocyte count <60 cells/microL, and frequently, a prior diagnosis of AIDS. Bloodstream infection proved linked to a lower mean CD4+ cell count, a more frequent occurrence of leukopenia-neutropenia, and nosocomial origin of the infecting pathogen. Hospital-acquired Enterobacter spp. disease was more frequent than community-acquired, and was significantly associated with leukopenia-neutropenia, and a diagnosis of AIDS. Antibiotic susceptibility assays showed a resistance rate to ampicillin and cephalothin involving >90% of tested strains, and a higher (but varied) sensitivity to other beta-lactams, aminoglycosides, fluoroquinolones, and cotrimoxazole. Adequate chemotherapy provided clinical and bacteriological success in all evaluated patients, in the absence of mortality or relapses. Only 34 episodes of HIV-associated Enterobacter spp. infection have been reported to date in 11 different literature studies. Our data point out that also Enterobacter spp. organisms may have an appreciable pathogenic potential in patients with HIV disease, especially in those with a low CD4+ lymphocyte count, leukopenia-neutropenia, who are hospitalized. Despite the unpredictable antibiotic susceptibility profile of these organisms, HIV-related Enterobacter spp. disease may be properly managed through rapid identification and timely and appropriate antimicrobial treatment.

Adult↗

PubMed1991

Management of HIV infection in adults.

The natural history of HIV infection continues to change with improved diagnostic and therapeutic modalities available to manage opportunistic infections and malignancies. Antiretroviral therapy with zidovudine and other investigational agents has improved the median survival of AIDS patients from 11 months in 1985 to 18-25 months at present. Most importantly, early intervention with zidovudine can delay onset of clinical illness in asymptomatic patients and progression to AIDS in symptomatic patients. A 500 mg/d dose has been found as effective as previously recommended doses of 1200-1500 mg/day. Lower doses decrease the incidence and severity of adverse effects and therapeutic benefit appears to be greatest in asymptomatic patients with CD4 lymphocyte counts less than 500/ul. Indications for zidovudine, therefore, have been expanded to include asymptomatic adults with CD4 lymphocyte counts less than 500/ul. Concerning early intervention with zidovudine, studies were not designed to measure survival or define the optimal timing of intervention based on immunologic status. In addition, long-term benefits are not clearly defined, particularly since the drug seems to lose clinical effectiveness after approximately two years, probably due to emergence of resistant HIV strains. Adverse effects continue to occur even at low doses including headaches, nausea, anemia and neutropenia, myopathy and possible hepatitis. Nevertheless, the overall clinical benefit seems to be greatest, albeit temporary, in asymptomatic patients. The optimal dosage appears to be 500-600 mg/d; however, this may not be sufficient for infection in the central nervous system.

Acquired Immunodeficiency Syndrome↗

PubMed1998

Clinical experience with adding delavirdine to combination therapy in patients in whom multiple antiretroviral treatment including protease inhibitors has failed.

OBJECTIVE: To determine the effectiveness and safety of adding delavirdine mesylate to a treatment regimen that included indinavir and nucleoside analog reverse transcriptase inhibitors in patients in whom combination therapy had failed. DESIGN: Observational study. SETTING: Private practice. PATIENTS: HIV-1-positive patients with peripheral blood CD4+ lymphocyte counts < 300 x 10(6)/l in whom antiretroviral therapy had failed or whose condition was deteriorating. Of the 53 patients who were eligible for the study, 47 took part; for the majority of these patients indinavir combination therapy had been unsuccessful. the majority of the patients were male (98%), white (92%) and homo/bisexuals (96%). INTERVENTIONS: Delavirdine added to current therapy (usually zidovudine, indinavir and lamivudine); in approximately half of the patients zidovudine was replaced with stavudine. MAIN OUTCOME MEASURES: Plasma HIV-1 RNA levels; peripheral blood CD4+ and CD8+ lymphocyte counts. Safety of the therapy was assessed by monitoring side-effects. RESULTS: Mean baseline CD4+ lymphocyte count was 127 x 10(6)/l and mean baseline HIV-1 plasma RNA was 5 log10 copies/ml. Adding delavirdine to the therapeutic regimen produced a rapid and sustained decrease in the mean plasma HIV-1 RNA of 1.1 log10 copies/ml over 6 months; 18-21% of patients showed decreases of 2-3 log10 copies/ml. Viral burden in 33% of subjects declined below the assay's limit of detection (2.6 log10 copies/ml) after 6 months. CD4+ lymphocyte counts increased by 66-90% in each group between 1 and 9 months (mean increase approximately 60 x 10(6)/l after 6 months). Adding delavirdine to current therapy was well tolerated. Side-effects reported were: skin rash, 28%; nausea, 9%; kidney stones, 9%; diarrhea, 6%; flank pain, 2%; proteinuria, 2%. Three patients reported serious medical events all of which resolved and none of which were attributed to delavirdine. CONCLUSIONS: Adding delavirdine to the combination regimen of patients in whom protease inhibitor therapy had failed often resulted in a rapid and remarkable decrease in viral load, sustained improvement in CD4+ lymphocyte counts and viral load, and clinical improvement with minimal toxicity.

Adult↗

PubMed2004

Abdominal aortic surgery in patients with human immunodeficiency virus infection.

PURPOSE: Human immunodeficiency virus (HIV) infection is known to cause acquired immune deficiency syndrome, which has been associated with a wide array of cardiovascular pathologies. This report examined the clinical outcome of patients infected with HIV who underwent abdominal aortic reconstruction for aneurysm or occlusive disease. METHODS: Hospital and clinic records of all patients with HIV infection who underwent an abdominal aortic operation were reviewed during an 11-year period. Relevant risk factors and clinical variables were assessed for surgical outcome. RESULTS: Forty-eight HIV patients (mean age 54 +/- 13 years) were identified who underwent abdominal aortic bypass grafting during the study period. Indications for aortic operation included aneurysm (n = 20) and aortoiliac occlusive disease (n = 28). All patients underwent successful aortic reconstructions without intraoperative mortality. Postoperative complications and in-hospital mortality occurred in 16 patients (33%) and 7 patients (15%), respectively. The mean follow-up period was 41 months. Life-table survival rates in aneurysm and occlusive patients at 60 months were 43.2% +/- 5.3% and 46.3% +/- 7.4% (not significant), respectively. Multivariate analysis showed that low CD4 lymphocyte counts (< 200/microL, P <0.05) and hypoalbuminemia (<3.5 g/dL, P <0.05) were risk factors for postoperative complications. CONCLUSION: Perioperative morbidity and mortality rates are high in HIV patients undergoing an abdominal aortic operation. Low CD4 lymphocyte counts and hypoalbuminemia are associated with poor clinical outcomes in HIV patients undergoing abdominal aortic reconstruction.

Adult↗

PubMed2002

Correlates of plasma HIV-1 RNA viral load among HIV-1-seropositive women in Dar es Salaam, Tanzania.

This study was conducted to determine the predictors of plasma HIV-1 RNA viral load in HIV-1-positive pregnant women (N = 151) participating in a clinical trial in Tanzania. Viral load was measured at randomization, delivery, and approximately 7 months after delivery. The median viral load was 20,400 copies/mL at baseline, 20,216 copies/mL at delivery, and 19,100 copies/mL 7 months after delivery. The absolute CD4+ lymphocyte count had a strong negative correlation with HIV-1 RNA viral load at baseline (r = -.38), time of delivery (r = -.36), and 7 months after delivery (r = -.53). The association between CD4+ lymphocyte count and HIV-1 RNA viral load was modified by the per capita daily food expenditure in the household, although the difference in viral load became small as the food expenditure in the household increased and was marginally significant at the 75th percentile of the per capita food expenditure. The presence of malaria parasites at baseline was associated with an approximate 116% higher viral load at the three evaluation points (p =.007). Although the long-term effects of malaria on viral load are unknown, prevention of malaria among people living with HIV-1 should be given the highest priority.

Adult↗

PubMed2005

The impact of anemia on energy and physical functioning in individuals with AIDS.

BACKGROUND: To our knowledge, the relationship between changes in hemoglobin level and energy and physical functioning in the anemic and "normal" ranges of hemoglobin among individuals with AIDS has not been well characterized. METHODS: In a multicenter, prospective, cohort study involving 19 clinics in the United States, 1406 individuals, 13 years and older, with AIDS were administered the Medical Outcomes Study HIV [human immunodeficiency virus] Health Survey (MOS-HIV) at baseline and at 3- to 6-month follow-up visits. Energy and physical functioning scores were the main outcomes. RESULTS: At baseline, a higher hemoglobin level was associated with a higher energy score and a higher physical functioning score (P < .001 for both), after adjusting for CD4 lymphocyte count, sex, age, education, and HIV risk factor. In longitudinal analyses, increases in hemoglobin were associated with increases in energy and physical functioning scores (P < .001 for both), after adjusting for CD4 lymphocyte count, sex, age, education, and HIV risk factor. Changes in the energy scales were, on average, 1.5 and 2.3 scale points per 1-g/dL change in hemoglobin level in the normal and anemic ranges, respectively. For the physical functioning scale, average changes were 2.7 and 2.6 scale points per 1-g/dL change in hemoglobin level in the normal and anemic ranges, respectively. CONCLUSIONS: Higher levels of hemoglobin are associated with better quality of life among individuals with AIDS. Changes in hemoglobin level within the conventional normal range of hemoglobin are also significantly associated with changes in quality of life.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Mathematical modelling of chemotherapy in HIV infection.

A mathematical model of CD4+ lymphocyte depletion in HIV infection is used to simulate and analyse the effect of AZT treatment. In most cases, permanent administration of AZT is observed to stop the CD4+ lymphocyte count decline and to stimulate their increase up to a new steady-state level, which depends on the intensity of AZT treatment, i.e. AZT dose. Temporary administration of AZT leads only to a temporary increase in CD4+ lymphocyte count. After the treatment is terminated, the count starts to decline again. However, the resulting prolongation of patient's survival exceeds the time interval of AZT administration. Interestingly, the survival prolongation is greater, if the treatment is started at five than at two years after the infection and there is no striking increase in survival time if a dose of AZT inhibiting 75% of HIV proliferation is used instead of a lower one inducing 25% inhibition only.

CD4 Lymphocyte Count↗

PubMed2000

A prospective study of positive tuberculin reactions in women with or at risk for HIV-1 infection. HER Study Group. HIV Epidemiology Research.

We prospectively studied 1310 women with or at risk for HIV-1 infection to assess subsequent tuberculin reactions in those with > or = 10 mm induration. Forty-seven HIV-positive and 57 negative women had tuberculin reactions > or = 10 mm induration; reversions to reactions < 10 mm occurred in 44% and 46% of those retested, respectively (P = NS). Among seropositives, reversions were associated with lower CD4+ lymphocyte count (P = 0.02). Of a total of 45 subsequent tuberculin tests in seropositive women, only two (4%) resulted in 5-9 mm induration, both at CD4+ counts < 500/mm3. Three (30%) of an additional 10 seropositive women with maximal reactions of 5-9 mm induration reported prior tuberculosis exposure, a significantly lower proportion than the 36/47 (77%) with reactions > or = 10 mm induration (P < 0.01), but not different than women with maximal reaction sizes < 5 mm (219/814, 27%). This study suggests that reversions of > or = 10 mm tuberculin reactions to 5-9 mm are rare. In HIV-positive persons, especially those with CD4+ lymphocyte counts > or = 500/mm3, reaction sizes of 5-9 mm often may not indicate Mycobacterium tuberculosis infection.

AIDS-Related Opportunistic Infections↗