1/312. meningioma in four patients with human immunodeficiency virus infection.We describe four patients infected with the human immunodeficiency virus (HIV) who had development of meningiomas. In contrast to those in the general population who have meningiomas, all our patients were young men; the mean age was 40 years (range, 32 to 50). Their risk behavior for HIV was homosexuality (three patients) and intravenous drug use (one patient). The CD4 cell count in each of the three homosexual men was less than 50/microL and was 280/microL in the drug user. Imaging studies showed enhancing lesions in three of the patients. Although each of these meningiomas could have occurred in otherwise normal young to middle-aged men, we speculate that the meningiomas may have grown in these HIV-infected hosts because of either loss of immune function or dysregulation of cytokines.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/312. Molecular tracking of an Human Immunodeficiency Virus nef specific cytotoxic T-cell clone shows persistence of clone-specific T-cell receptor dna but not mRNA following early combination antiretroviral therapy.The mechanisms that lead to maintenance of an active effector cytotoxic T-cell (CTL) response in Human Immunodeficiency Virus type-1 (hiv-1) infection are not well understood. We have investigated the role of antigen in maintenance of an hiv-1 specific CTL response by studying a patient (313-7) whose antigenic stimulus was reduced using antiretroviral drug therapy started within 90 days of hiv-1 infection. This patient made a primary monospecific CTL response to an HLA-C*0802 restricted epitope in nef (KAAVDLSHFL) prior to treatment. Within 7 days of starting treatment the nef specific CTL precursor frequency (CTLp) had decreased from 60/10(6) to 4/10(6) peripheral blood mononuclear cells (PBMC), coincident with a decline in viremia from 18 470 to 615 copies/ml. Both plasma viremia and nef specific CTLp remained at low levels for 180 days. The nef-specific CTL clone T-cell receptor (TCR) mRNA transcripts also decreased after treatment, but clone specific TCR dna persisted. It appears that removal of antigen alters the state of HIV specific CTL from an activated effector population (detected in the CTLp assay and by measurement of clone specific rna) to a non-activated quiescent population (detected by measurement of clone-specific dna). This latter population may represent persisting HIV specific memory CTL.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
3/312. Insertion of two amino acids combined with changes in reverse transcriptase containing tyrosine-215 of hiv-1 resistant to multiple nucleoside analogs.OBJECTIVE: To identify genotypic drug resistance patterns of hiv-1 in patients who were extensively pretreated with anti-HIV drugs and not responding to their current antiretroviral combination therapy. methods: Drug susceptibility of the viruses was tested by a phenotypic recombinant virus assay. Genotypic analysis of HIV resistance was performed by sequencing of the amino-terminal part of the corresponding reverse transcriptase (RT) gene (amino acids 1-280) for serum-derived and recombinant viruses. RESULTS: Among viruses from 92 patients studied, three (3%) viruses contained a T215Y amino-acid change as well as a previously unseen combination of an amino-acid change at codon 67 (N-->E/S) and a two amino-acid insertion between codons 68 and 69 of the RT gene of hiv-1. Phenotypic resistance analysis showed high levels of resistance to zidovudine, lamivudine and stavudine (in all patients) and moderate levels of resistance to didanosine and zalcitabine (in two patients), whereas neither serum-derived nor recombinant viruses contained previously known amino-acid changes conferring resistance to didanosine, zalcitabine, lamivudine and stavudine. However, all recombinant viruses contained an insertion of two amino acids between codons 68 and 69 of RT as well as an amino-acid change at codon 67, as was seen in the serum-derived viruses. CONCLUSIONS: Antiretroviral therapy including zidovudine may yield replicating viruses with a two amino-acid insertion in RT in combination with amino-acid changes at codons 67 and 215, which are highly resistant to lamivudine and stavudine on top of zidovudine and have unpredictable susceptibility to didanosine and zalcitabine despite lack of previously reported corresponding resistance-associated amino-acid changes. It is currently unknown what regimens can induce the emergence of this type of multidrug-resistant viruses. This will only be elucidated when resistance assays are capable of detecting these mutants.- - - - - - - - - - ranking = 1.5keywords = drug (Clic here for more details about this article) |
4/312. methadone withdrawal when starting an antiretroviral regimen including nevirapine.Antiretrovirals from three drug classes, nucleoside analogs, nonnucleoside analogs, and protease inhibitors, can be combined to achieve viral suppression. The nonnucleoside analog nevirapine is an inducer of cytochrome P450 3A4 liver metabolism and has interactions with protease inhibitors and oral contraceptives. methadone has two roles in human immunodeficiency viral infection: pain management and treatment of opioid abuse. A drug-drug interaction may result in decreased methadone blood levels when administered with nevirapine. A patient experienced methadone withdrawal symptoms when combining these agents.- - - - - - - - - - ranking = 1.5keywords = drug (Clic here for more details about this article) |
5/312. Isolated renal aspergillus abscess in an AIDS patient with a normal CD4 cell count on highly active antiretroviral therapy.Isolated renal aspergillus abscess is a very rare complication of HIV infection. It usually occurs in patients with severe immune deficiency. The case of a 29-year-old HIV-infected homosexual male, a nonintravenous drug abuser, who developed a right renal aspergillus abscess despite normalization of the CD4 cell count after highly active antiretroviral treatment is described. When antimicrobial treatment failed (amphotericin b followed by itraconazole), he was cured by right nephrectomy and remains in good health 3 months later with no recurrence. In cases of aspergillus renal abscess in HIV-infected patients, surgery is the treatment of choice, especially in the current era of highly active antiretroviral therapy.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
6/312. stevens-johnson syndrome caused by indinavir.A case is presented of an HIV-infected man who developed stevens-johnson syndrome shortly after the initiation of treatment with indinavir. This is the first case ever reported of this adverse drug reaction occurring with an hiv protease inhibitor.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
7/312. typhoid fever and HIV infection: a rare disease association in industrialized countries.typhoid fever is still a global health problem, mainly in tropical and subtropical areas of the world and in developing countries, where relatively elevated morbidity and mortality rates still are present, mostly because of persisting poor hygienic conditions. In the majority of Mediterranean regions, including italy, the disease is constantly present, though with a low prevalence rate, as a result of an endemic persistence of salmonella typhi infection.1-4 On the other hand, in industrialized countries, most cases of S. typhi infection are related to foreign travel or prior residence in endemic countries.4-6 In the united states, 2445 cases of typhoid fever have been reported in the decade 1985 to 1994, and the annual number of cases remained relatively stable over time: over 70% of episodes were acquired in endemic countries (mostly mexico and india).6 The persisting morbidity of S. typhi also may be supported by the increasing resistance rate of this pathogen against a number of commonly used antimicrobial compounds. For instance, 6% of 331 evaluable S. typhi strains were resistant to ampicillin, chloramphenicol, and cotrimoxazole, and 22% of isolates were resistant to at least one of these three agents in a recent survey performed in the united states.6 The spread of antibiotic resistance among S. typhi isolates is emerging in many countries, and multidrug-resistant strains have been isolated, as well as isolates with poor susceptibility to fluoroquinolones,3-5,7-9 so that in vitro susceptibility should be determined for all cultured strains, and antimicrobial treatment should be adjusted accordingly. Nevertheless, fluoroquinolones (e.g., ciprofloxacin and pefloxacin) or third-generation cephalosporins, still represent the best choice for empirical treatment,2,4,6-8,10 and mortality remains rare in Western countries (less than 1% of episodes), although it is expected to be greater in developing areas of the world. The aim of this report is to describe two cases of typhoid fever that occurred in patients with human immunodeficiency virus (HIV) infection, a rarely reported disease association in industrialized countries.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
8/312. Cutaneous T-cell lymphoma and human immunodeficiency virus infection: 2 cases and a review of the literature.Cutaneous non-Hodgkin's lymphomas are rare in patients with hiv-1 infection and almost all of the cases reported are of T-cell lineage with histopathological features of mycosis fungoides or sezary syndrome. We studied 2 cases of mycosis fungoides in hiv-1-positive patients who were intravenous drug abusers and were in stage II and IV C2 (CDC'86), respectively. The first patient (stage II) had multiple, erythematous and infiltrated large plaques on the abdomen, back, arms and legs, whereas the second patient (stage IV) had smaller erythematous, slightly scaly and infiltrated pruritic plaques on the trunk and limbs. Their CD4 lymphocyte counts were 634 and 250 cells/mm3, respectively. Biopsies showed features consistent with mycosis fungoides, with an epidermotropic pattern. The immunohistochemical study revealed a T-cell lineage of this atypical infiltrate. Both patients partially responded to topical steroid ointment, showing moderate improvement. Further biopsies performed 6 months later confirmed the prior diagnosis of mycosis fungoides. No tumour stage was observed during a 2-year follow-up. We conclude that mycosis fungoides is rare in HIV-positive patients, but must be included in the differential diagnosis of erythematous plaques in these patients. In suspected, but non-diagnostic cases of mycosis fungoides in HIV-positive patients, only a close clinical and histopathological follow-up can confirm the diagnosis.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
9/312. Antiviral treatment for human immunodeficiency virus patients co-infected with hepatitis b virus: combined effect for both infections, an obtainable goal?A large percentage of human immunodeficiency virus (HIV) patients have serological evidence of a past or present hepatitis b virus infection (HBV). Long-term survival is increasing for HIV patients because of highly active antiretroviral therapy. Therefore, the chronic hepatitis B infection may become an important determinant of disease outcome in these co-infected patients. We describe two HIV/HBV co-infected patients who were treated with extended antiviral therapy, initially indicated for the HIV infection. lamivudine, a suppressor of viral replication in both infections, was one of these antiviral drugs. One patient showed a severe rebound of the HBV after withdrawal of lamivudine, the other patient developed a mutant hepatitis b virus after 18 months of treatment. This mutation was exclusively induced by lamivudine. These patients show that, with improved HIV-related survival, the HBV infection should be monitored carefully, thereby enabling the physician to interfere with therapy when necessary.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
10/312. Management of liver failure in a haemophilic patient co-infected with human immunodeficiency and hepatitis c viruses.We present a case of liver failure in a haemophilic patient coinfected with transfusion acquired human immunodeficiency (HIV) and hepatitis c (HCV) viruses. The case illustrates the interaction of multiple viruses with accelerated progression to end stage liver disease and ultimately death. We report the impact on the patient management of two liver biopsies, which diagnosed an initial drug induced hepatitis and subsequently an atypical HCV related hepatitis.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
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