461/867. Peripheral T-cell lymphoma or Hodgkin's disease in a HIV seropositive patient: a histopathological study. Malignant lymphomas occurring in patients with AIDS are usually derived from the B-cell lineage while T-cell malignant lymphomas are very rare in these patients. We report a HIV seropositive 29-year-old homosexual man in whom cervical lymph node biopsy showed an atypical lymphoproliferative process. On morphological and paraffin section immunohistochemical grounds the possibility of Hodgkin's disease (HD) mixed cellularity was initially suggested, but frozen section immunohistochemical studies revealed that the cellular infiltrate exhibited an aberrant pan T immunophenotype and consequently the diagnosis of peripheral T-malignant lymphomas (T-ML) was made. However, genotypic studies would be required to definitely confirm this diagnosis, in such cases. In our case, varying numbers of small and medium-sized cells were positive for both Leu 3/CD4 and Leu 2/CD8 whereas some large cells reacted only with Leu 3/CD4 antibody. Some medium-sized, large and giant cells showed cytoplasmic positivity for Leu M1/CD15. Furthermore, the positivity of many large and giant cells with the activation markers BerH2/CD30, Ki-1/CD30, Tac/CD25 and HLA-DR suggested an activation state for these cells. Our findings emphasize the usefulness of frozen section immunohistochemical methods in order to investigate the spectrum of lymphoid malignancies occurring in HIV seropositive patients, and confirm results of previous studies which stressed the diagnostic difficulties that may appear in distinguishing HD from peripheral T-ML. ( info) |
462/867. Long-term persistence of false positive antibody reactivity in HIV western blot testing of sera from a healthy blood donor. HIV-Western blot (WB) testing of sequential sera from a blood donor revealed identical bands in the p24 and p55 positions. Additional testing using indirect immunofluorescence antibody technique, radioimmunoprecipitation assay and an HIV p24 antigen immunoassay were negative. During a 5-year follow-up period the blood donor has remained apparently healthy and no signs of disease have developed. We conclude that sera from this blood donor show a false positive HIV WB reactivity. The nature of this reactivity remains obscure but has practical implications for the routine HIV screening of blood donors. ( info) |
463/867. Transmission of HIV to heterosexual partners of infected men and women. Future heterosexual spread of HIV will in part depend on the efficiency of transmission from men to women and from women to men. We studied seventy-eight female sexual partners of men infected with HIV and 18 male sexual partners of infected women. Participants were interviewed concerning sexual practices, use of contraception and other risk factors for HIV infection. Fifteen out of 78 (19.2%) female partners and one out of eighteen (5.5%) male partners were seropositive for HIV antibody. All couples had practised vaginal intercourse. Seropositive female partners did not differ significantly from seronegative partners with regard to length of relationship, number of acts of vaginal intercourse, other sexual practices, stage of clinical disease in the index case, or numbers of other sexual partners in the last five years. In two women, seroconversion was documented after one act of unprotected sexual intercourse. The majority of infected female partners (eight out of 15) had sexual relationships with men who were asymptomatic and did not practice anal intercourse. biological factors such as variability in infectivity of the index case and susceptibility of the contact, as well as behavioural variables may be important in determining transmission. ( info) |
464/867. Neurological disorders in AIDS and HIV disease in the northern zone of tanzania. This study presents the main clinical findings on 200 AIDS patients at Kilimanjaro Christian Medical Centre in the northern zone of tanzania, with detailed neurological findings on 135 out of 200 cases and 53 controls. Results show that 21 out of 200 (10.5%) had an obvious focal neurological disorder, including cranial nerve palsies, hemiparesis and paraparesis. Ninety-seven out of 135 (72%) had less obviously detectable neurological disorders, versus 36% of controls (P less than 0.005). Most frequent were aids dementia complex (54%), retinopathy (23%), areflexia (21%), pyramidal tract signs (19%) and tremor and incoordination (19%). frontal lobe release signs (FLRS) were found in 103 out of 135 (76%) patients, versus 36% of controls (P less than 0.005). Advanced and terminal AIDS cases were more likely to have neurological disorders than early AIDS patients. A further study on 87 non-AIDS patients with acute unexplained neurological disorders showed 10 out of 87 to be HIV seropositive. Three case studies are presented. This study suggests that neurological disorders are among the main clinical features of AIDS and HIV disease in africa. ( info) |
465/867. Non-pigmented oral kaposi's sarcoma (AIDS). Report of two cases. In 90% of cases of AIDS-associated Kaposi's sarcoma (KS), the lesion is observed in the oral cavity. Oral KS usually reveals distinct clinical features characterized by a brown-bluish or otherwise pigmented appearance. The histological features are identical to classical KS. The occurrence of a non-pigmented oral KS in 2 male homosexual patients has prompted the present case reports. Clinicians should be aware that not all cases of AIDS-associated oral KS appear as brown or purplish tumors but may present without any discoloration. ( info) |
466/867. Nonsecretory multiple myeloma in a 26-year-old man with acquired immunodeficiency syndrome, presenting with multiple extramedullary plasmacytomas and osteolytic bone disease. High grade B-cell lymphoma and leukemia have been well described in patients with the acquired immunodeficiency syndrome (AIDS). Malignant transformation of more differentiated lymphoid cells has not been well described in these patients. We report a 26-year-old man with AIDS-associated multiple myeloma, who had a highly unusual presentation and clinical course. A review of the literature indicates that monoclonal gammopathy in patients seropositive for the human immunodeficiency virus (HIV) is common. multiple myeloma and extramedullary plasmacytomas, diseases that are extraordinarily rare in young persons, are now being reported in patients with AIDS and should be added to the list of neoplastic diseases now associated with HIV infection. ( info) |
467/867. Rapidly progressive non-A, non-B hepatitis in patients with human immunodeficiency virus infection. No information is available on the role of non-A, non-B hepatitis in the various hepatic abnormalities described in patients with the acquired immune deficiency syndrome. Of 97 patients referred with suspected non-A, non-B hepatitis, 3 were found to have antibody to the human immunodeficiency virus. These latter 3 patients all developed symptomatic cirrhosis within 3 yr of onset of hepatitis. Such a rapid progression of liver disease was rare in patients with non-A, non-B hepatitis who did not have simultaneous human immunodeficiency infection. These findings suggest that human immunodeficiency virus infection may potentiate the liver injury of chronic non-A, non-B hepatitis. ( info) |
468/867. First documented case of human immunodeficiency virus type 2 infection in an asymptomatic Swiss subject. Few cases of human immunodeficiency virus type 2 (hiv-2) infection have been reported in individuals other than of West African origin. The first well documented case of hiv-2 infection observed in a Swiss subject is presented here. The 50-year-old woman had a sexual relationship with a Senegalese man, who was later shown to be HIV seropositive. Initially, the subject's serum was tested using a routine screening assay for the detection of hiv-1 antibodies. This assay elicited a borderline positive result. A confirmatory competitive EIA and a Western blot test for anti-hiv-1 antibodies showed a positive reaction with gag and pol proteins of hiv-1, but not with env proteins. Thus, hiv-2 infection was suspected and subsequently confirmed by three different methods, including Western blot analysis and an hiv-1/hiv-2 differentiation test. This case emphasizes the need for screening with combined hiv-1/hiv-2 tests. ( info) |
469/867. Clinical analysis of four Chinese hemophiliacs with human immunodeficiency virus infection. Human immunodeficiency virus (HIV) is now considered as the causative agent of acquired immunodeficiency syndrome (AIDS). A high risk of AIDS has been reported among patients with hemophilia who received lyophilized commercial factor viii and IX concentrates of American origin. At a prevalent survey from September to December 1985, hiv antibodies were found in all four patients with hemophilia treated with the batch number W87307, 955 I.U. of American commercial factor viii concentrate supplied by Armour Pharmaceutical Company, USA. One of the sero-positive patients developed aids-related complex (ARC) and died of cerebral hemorrhage. The other three sero-positive patients had abnormalities in cell-mediated immunity. Of them two developed left lumbosacral radiculopathy and hemorrhagic herpes zoster and one remained well so far. ( info) |
470/867. Management of the oral surgery patient addicted to heroin. A review of the clinical characteristics of heroin addiction and parameters surrounding outpatient and inpatient care of patients afflicted with heroin dependency is presented. A case report demonstrating the difficulties encountered when one elects to treat the heroin addict is included. ( info) |