Human Immunodeficiency Virus–Positive Patient Presenting With Acute Renal Failure and Hypercalcemia Diagnosed With Sarcoidosis

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S87-S87
Author(s):  
Amir Dehghani ◽  
Elham Yousefi ◽  
Mohamed Alshal ◽  
Qiang Xie ◽  
Alejandro Zuretti
Keyword(s):  
Renal Failure ◽  
T Lymphocytes ◽  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Renal Involvement ◽  
Pulmonary Involvement ◽  
Cd4 Count ◽  
Positive Patient ◽  
Hiv Positive ◽  
Bilateral Hilar Lymphadenopathy

Abstract Objectives A 42-year-old African American man with a history of HIV infection on highly active antiretroviral therapy (HARRT) presented with excessive thirst, polydipsia, polyuria, weight loss, and abnormal kidney function tests. Physical examination was normal. Methods The patient workup results were as follows: calcium 13.8 mg/dL (8.4-10.3 mg/dL), ACE 88 U/L (8-52 U/L), PTH 7.34 pg/mL (14-72 pg/mL), 1,25 (OH)2 vitamin D 125 pg/mL (19.9-79.3 pg/mL), BUN 38 mg/dL (6-20 mg/dL), Cr 2.42 mg/dL (0.4-1.2 mg/dL), glucose 87 mg/dL (70-99 mg/dL), CD4 count 303/μL (544-1,894/μL). Chest CT scan showed diffuse pulmonary nodules with mediastinal and bilateral hilar lymphadenopathy. A transbronchial biopsy was performed. Results Biopsy revealed noncaseating granuloma and Schaumann bodies. AFB and GMS stains were negative for micro-organisms. These findings were compatible with sarcoidosis. The patient received prednisone and showed significant improvement in his renal function (creatinine: 1.23 mg/dL) and calcium level (9.12 mg/dL). Conclusion CD4+ T lymphocytes have a crucial role in the formation of sarcoid granulomas. However, HIV infection is characterized by a profound loss of the CD4+ T-lymphocytes. Therefore, sarcoidosis in HIV-positive patients is rare. The development of sarcoidosis usually occurs when a significant increase in CD4+ T-cell count induced by HAART has taken place. Pulmonary involvement and symptoms are responsible for the majority of the morbidity and mortality in sarcoidosis. Renal involvement is significantly less common than respiratory symptoms. This patient was one out of two HI- positive cases of sarcoidosis among 200 patients who were diagnosed with sarcoidosis in our three major affiliated hospitals from 2000 to 2019. This case is unique and rare both in terms of unusual presentation of renal failure and hypercalcemia and also the co-occurrence of sarcoidosis in an HIV-positive patient while the CD4 count is lower than the normal limit.

Clinical observation of a prurigo nodularis in a HIV-positive patient

2021 ◽  
Author(s):  
Е.Н. Ефанова ◽  
Ю.Э. Русак ◽  
Е.А. Васильева
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Clinical Manifestations ◽  
Antiretroviral Drugs ◽  
Positive Patient ◽  
Hiv Positive ◽  
Prurigo Nodularis ◽  
Immunodeficiency Virus ◽  
Mucous Membranes

Вирус иммунодефицита человека (ВИЧ) имеет глобальные масштабы распространения и представляет собой одну из самых серьезных социальных и медицинских проблем. Эпидемическая ситуация с ВИЧ-инфекцией в мире и Российской Федерации остается напряженной. У ВИЧ-положительных больных нередко отмечаются особенности поражения кожных покровов и слизистых оболочек. Кожные процессы у ВИЧ-позитивных пациентов протекают, как правило, атипично, имеют торпидное течение, могут возникать в несвойственных для них возрастных группах и нередко резистентны к стандартному лечению. Поражения кожных покровов и слизистых оболочек у ВИЧ-инфицированных можно условно разделить на несколько групп: аллергические реакции, инфекционные, паранеопластические процессы и дерматозы с неизвестным патогенезом. В современной литературе недостаточно освещен вопрос о группе «дерматозов с неясным патогенезом» на фоне ВИЧ-инфекции, в частности о пруриго. В описанном клиническом случае представлена ВИЧ-позитивная пациентка с редким проявлением узловатого пруриго. Освещены история вопроса, этиология, клинические проявления, методы лечения. Представленный случай иллюстрирует манифестацию пруриго на фоне системных причин (ВИЧ-инфекции) и начала высокоактивной антиретровирусной терапии без предшествующего атопического анамнеза. Вразрез с данными литературы, количество CD4+ у пациентки с почесухой составляло более 200 клеток/мкл, хотя, как известно, почесуха относится к дерматозам с низким числом клеток CD4+. Остается неясной роль иммунодефицитного состояния в патогенезе пруриго. Возможно, в данном случае развитие дерматоза спровоцировано прямым вирусным эффектом или токсическим влиянием антиретровирусных препаратов. Интересным является факт быстрого положительного ответа кожного процесса на традиционную терапию. Ключевые слова: узловатая почесуха, пруриго, ВИЧ-инфекция, иммунодефицит, клиническая картина, особенности течения, клиническое наблюдение. The human immunodeficiency virus (HIV) is a globally spreading virus that represents one of the most serious social and health problems. The epidemic situation of HIV (human immunodeficiency virus) infection in the world and, in particular, in the Russian Federation remains tense. In HIV-positive patients, specific lesions of the skin and mucous membranes are often noted. Skin processes in HIV-positive patients are usually atypical, have a torpid course, may occur in unusual age groups and are extremely difficult to respond to standard treatment. Lesions of the skin and mucous membranes in HIV-infected can be divided into several groups: allergic reactions, infectious, paraneoplastic processes and dermatoses with unknown pathogenesis. In the modern literature, the issue of the group of «dermatoses with an unclear pathogenesis» against the background of HIV infection, in particular about prurigo, is insufficiently illuminated. In the described clinical case, an HIV-positive patient with a rare manifestation of nodular prurigo is presented. The history of the issue, etiology, clinical manifestations, and treatment methods are covered. The presented case illustrates the manifestation of prurigo against the background of systemic causes (HIV infection) and initiation of highly active antiretroviral therapy without a previous atopic history. Contrary to the literature data, the CD4+ count in a patient with prurigo was more than 200 cells/μL, although pruritus is known to be a dermatoses with a low CD4+ cell count. The role of the immunodeficiency state in the pathogenesis of prurigo remains unclear. Perhaps, in this case, the development of dermatosis is provoked by a direct viral effect or the toxic effect of antiretroviral drugs. An interesting fact is the rapid positive response of the skin process to traditional therapy.

scholarly journals Hematological Profile of HIV-Infected Patients on First-Line Highly Active Antiretroviral Therapy and Its Correlation With CD4 Count

2021 ◽  
Author(s):  
John Jospeh Diamond Princy ◽  
Kshetrimayum Birendra Singh ◽  
Ningthoujam Biplab ◽  
Ningthoukhongjam Reema ◽  
Rajesh Boini ◽  
...  
Keyword(s):  
Platelet Count ◽  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Cd4 Count ◽  
Total Leukocyte Count ◽  
Hiv Patients ◽  
Positive Correlation ◽  
Highly Active ◽  
The Mean

Abstract Introduction Human immunodeficiency virus (HIV) infection is a state of profound immunodeficiency. Disorders of hematopoietic system are a common but often overlooked complication of HIV infection. This can manifest at any stage of the disease but more commonly in the advanced stage with low CD4 count. Anemia is the most common hematological abnormality in HIV patients and prevalence ranges from 1.3 to 95%. As HIV disease progresses, the prevalence and severity of anemia also increase. Hence, this study was undertaken to assess the hematological parameters of HIV-infected patients on highly active antiretroviral therapy (HAART) at different treatment durations with the hope to improve the HAART outcome in HIV patients and its correlation with CD4 count. Methods This prospective longitudinal study enrolled 134 HIV-infected patients admitted to or attending the OPD in the Department of Medicine or Antiretroviral Therapy (ART) Center (Center of Excellence), Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, from 2018 to 2020. Complete hemogram, CD4 count, and other related-blood investigations were studied. Results The mean age of the study population was 39.9 ± 11.04 years. Of the 134 patients, 75 (56%) were males and 59 (44%) were females. Twelve (9%) patients had a history of injecting drug use (IDU). TLE (tenofovir, lamivudine, efavirenz) regimen was started on 112 (83.6%) patients and the majority of them (69/134 [51.5%]) had a CD4 count of 200 to 499 cells/mm3, which increased significantly 6 months after HAART to 99 to 1,149 cells/mm3, with a mean of 445 ± 217 cells/mm3. There were significant improvements in hemoglobin (Hb) levels, total leukocyte count (TLC), absolute neutrophil count (ANC), and absolute lymphocyte count (ALC) after HAART indicating a positive correlation with CD4 count (p < 0.05). Thrombocytopenia was observed higher after HAART when compared to baseline. There was a positive correlation between platelet count and CD4 count. However, the mean corpuscular volume (MCV) and erythrocyte sedimentation rate (ESR) had a negative correlation with CD4 count. Conclusion The study inferred a strong positive correlation between CD4 and Hb levels, TLC, ANC, ALC, and platelet count after HAART with improvement in these values as CD4 count increases. Specific treatment intervention based on the changes in the immunohematological profile trends can help prevent most of the adverse effects on HIV patients in our community.

scholarly journals Difficulties in diagnosing amyotrophic lateral sclerosis in a HIV-Positive Patient

2018 ◽  
Vol 10 (4) ◽  
pp. 139-144 ◽  
Author(s):  
T. M. Alekseeva ◽  
N. V. Skripchenko ◽  
S. V. Lobzin ◽  
V. S. Demeshonok ◽  
E. A. Yurkina ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Differential Diagnosis ◽  
Hiv Infection ◽  
Positive Patient ◽  
Hiv Positive ◽  
Genetic Tests ◽  
Lateral Sclerosis

We described a case of amyotrophic lateral sclerosis (ALS) with comorbid HIV infection. The diagnosis was confirmed by genetic tests. The difficulty of the differential diagnosis between amyotrophic lateral sclerosis and HIV-associated ALS syndrome is discussed.

Human Immunodeficiency Virus–Associated Squamous Cell Cancer of the Anus: Epidemiology and Outcomes in the Highly Active Antiretroviral Therapy Era

2008 ◽  
Vol 26 (3) ◽  
pp. 474-479 ◽  
Author(s):  
Elizabeth Y. Chiao ◽  
Thomas P. Giordano ◽  
Peter Richardson ◽  
Hashem B. El-Serag
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Squamous Cell ◽  
Highly Active Antiretroviral Therapy ◽  
Cell Cancer ◽  
Cox Proportional Hazards ◽  
Administrative Databases ◽  
Hiv Positive ◽  
Highly Active ◽  
Hiv Negative

Purpose To evaluate and determine predictors of squamous cell carcinoma of the anus (SCCA) outcomes in the highly active antiretroviral therapy (HAART) era for HIV-positive and -negative individuals using large national Veterans Affairs (VA) Administration databases. Patients and Methods We used the VA administrative databases to perform a retrospective cohort study in 1,184 veterans diagnosed with SCCA between 1998 and 2004. We calculated HIV infection rates and used logistic regression to identify epidemiologic factors that were associated with HIV infection. Kaplan-Meier curves and Cox proportional hazards models were calculated to compare survival between HIV-positive and HIV-negative veterans. Results In our cohort, 175 patients (15%) were HIV positive. The median age of the HIV-negative and -positive patients was 63 and 49 years, respectively (P < .001). Individuals with HIV were eight times more likely to be male (P = .01) and three times more likely to be African American (P < .001). There were no differences between HIV-positive and HIV-negative individuals in the receipt of treatment. The 2-year observed survival rates were 77% and 75% among HIV-positive and HIV-negative individuals, respectively. In multivariate Cox analysis, significant predictors of survival were age, sex, metastasis at diagnosis, and comorbidity score. HIV infection did not affect survival. Conclusion A noteworthy proportion of individuals with SCCA in the VA system are HIV positive. HIV-associated SCCA seems mainly to be a disease among younger men. Survival of SCCA is equivalent between HIV-positive and HIV-negative individuals in the HAART era. Treatment should not be withheld or deintensified based on HIV status.

scholarly journals Progressive HIV infection in the presence of a raised CD4+ count: HIV/HTLV-1 co-infection

2013 ◽  
Vol 14 (2) ◽  
pp. 92-94 ◽  
Author(s):  
Ahmad Farid Haeri Mazanderani ◽  
Osman Ebrahim
Keyword(s):  
Immune Deficiency ◽  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Lymphoproliferative Disorders ◽  
Cd4 Count ◽  
Hiv Diagnosis ◽  
Highly Active ◽  
Human T Cell

There are a number of pathophysiological causes for a normal or raised CD4 count in the context of progressive HIV infection. These include various co-infections, previous splenectomy, and lymphoproliferative disorders. Such circumstances can both confound HIV diagnosis and delay initiation of chemoprophylaxis and highly active antiretroviral therapy (HAART). We describe the case of a patient co-infected with HIV and human T-cell lymphotropic virus type 1 (HTLV-1) who, prior to HAART initiation, was found to have progressive immune deficiency associated with a raised CD4 count.

scholarly journals Diffuse infiltrative lymphocytosis syndrome presenting as renal failure in South African HIV-positive individuals: a single-centre case series

2018 ◽  
Vol 21 (1) ◽  
Author(s):  
Kate McMullen ◽  
Megan Borkum ◽  
Francois CJ Botha ◽  
Maureen Duffield ◽  
Nicola Wearne
Keyword(s):  
Renal Failure ◽  
South African ◽  
Renal Involvement ◽  
Clinical Manifestations ◽  
Case Series ◽  
Lymphocytic Infiltration ◽  
Hiv Positive ◽  
Single Centre ◽  
Immunodeficiency Virus ◽  
Sicca Symptoms

Diffuse infiltrative lymphocytosis syndrome (DILS) in human immunodeficiency virus (HIV) infection presented most commonly with parotidomegaly and sicca symptoms in the pre-antiretroviral era. However, numerous clinical manifestations are possible due to the multi-organ nature of the CD8+ lymphocytic infiltration. Renal involvement is infrequently described, but common characteristics of a renal syndrome associated with DILS have been identified. This case series describes four South African HIV-positive patients with DILS, in whom renal failure was the sole clinical manifestation. As DILS responds well to antiretroviral and corticosteroid therapy, this series highlights the importance of considering this syndrome as a cause of renal failure in an HIV-positive patient.

scholarly journals HIV infection and its psychiatric manifestations: A clinical overview

2017 ◽  
Vol 23 (4) ◽  
pp. 265-277 ◽  
Author(s):  
Mark Jonathan Knights ◽  
Alexandros Chatziagorakis ◽  
Surendra Kumar Buggineni
Keyword(s):  
Life Expectancy ◽  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Psychiatric Symptoms ◽  
Bipolar Affective Disorder ◽  
Adjustment Disorder ◽  
Hiv Positive ◽  
Highly Active ◽  
Psychiatric Conditions ◽  
Psychiatric Manifestations

SummaryHighly active antiretroviral therapy (HAART) has led to a reduction in HIV-related morbidity and mortality, and the life expectancy of HIV-positive individuals has improved significantly. It is therefore becoming more likely that clinicians will encounter patients with psychiatric manifestations of the disease. This review summarises the evidence on prevalence, manifestations and treatment of psychiatric conditions in HIV-positive adults. The most prevalent psychiatric illness in this population is depression (35.6%), followed by substance misuse, anxiety, psychosis, adjustment disorder and bipolar affective disorder. Neurocognitive impairment is also common, ranging in severity from asymptomatic (the most frequent) to dementia (the least frequent). Effective treatment of both HIV and psychiatric manifestations is essential to maximising life expectancy and quality of life.Learning Objectives• Comprehend the prevalence, manifestations and treatment of psychiatric conditions in HIV-positive individuals• Learn about the HIV-associated neurocognitive disorders• Develop an understanding of the relationship between HIV infection and psychiatric symptoms

scholarly journals Granulomatous nephritis: A rare presentation of juvenile-onset sarcoidosis

2021 ◽  
Author(s):  
Prashant Chotalia ◽  
Sapan Pandya ◽  
Puja Srivastava
Keyword(s):  
Renal Failure ◽  
Renal Involvement ◽  
Cervical Lymphadenopathy ◽  
Unknown Origin ◽  
Oral Prednisolone ◽  
Pulmonary Involvement ◽  
Juvenile Onset ◽  
Rare Presentation ◽  
Pyrexia Of Unknown Origin ◽  
Renal Functions

ABSTRACT Sarcoidosis is rare in children. Incidence and prevalence of sarcoidosis in India are not known. Renal involvement in childhood sarcoidosis is further rare with no clear data about prevalence. Here we report a case of a 13-year-old girl who presented with sarcoidosis with multi-system involvement including renal sarcoidosis. She initially presented with pyrexia of unknown origin and cervical lymphadenopathy – evaluation of which led to diagnosis of sarcoidosis. Later, after development of pulmonary involvement, she was treated with oral prednisolone and azathioprine. She again defaulted on medicines and later presented with renal failure and was diagnosed with a renal sarcoidosis. She was treated with oral prednisolone and mycophenolate mofetil with which she gradually improved with normal renal functions.

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