Effects of Human Immunodeficiency Virus and Immune Status on Magnetic Resonance Imaging of the Brain in Hemophilic Subjects: Results From the Hemophilia Growth and Development Study

PEDIATRICS ◽  
1993 ◽  
Vol 91 (4) ◽  
pp. 742-746
Author(s):  
Wendy G. Mitchell ◽  
Marvin D. Nelson ◽  
Charles F. Contant ◽  
James F. Bale ◽  
Don A. Wilson ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Muscle Atrophy ◽  
Cerebral Atrophy ◽  
Hiv Positive ◽  
Neurologic Examination ◽  
Cd4 Counts ◽  
Immunodeficiency Virus ◽  
Diffuse Atrophy ◽  
The Brain ◽  
Hiv Negative

To determine the effects of hemophilia and human immunodeficiency virus (HIV) infection on the nervous system, the authors examined the relationship of brain magnetic resonance imaging (MRI) findings to immunologic function and neurologic examination findings. Baseline examinations included physical and neurologic examination, immunologic and virologic testing, and MRI of the brain. On neurologic examination, muscle atrophy was considered to be related to hemophilia if adjacent joints had arthropathy due to bleeding. Muscle atrophy was considered non-hemophilia-related if unrelated to arthropathy or if muscle atrophy was diffuse. Subjects were boys aged 6 to 19 years, enrolled in a multicenter study of the effects of hemophilia and HIV infection on growth and development, all with congenital coagulopathies requiring factor infusions. Three hundred ten subjects had complete data including neurologic examination, T-cell subsets, HIV antibodies, and MRI. Subjects with HIV infection whose CD4+ counts were <200/µL were compared with subjects with HIV infection and CD4+ counts ≥200/µL and with HIV-negative subjects, all of whom had CD4+ counts >200/µL. MRI studies were normal in 230. Abnormal MRI studies were more frequent in HIV-positive subjects with CD4+ counts <200 (29.4% abnormal compared with 17% in HIV-positive subjects with CD4+ counts ≥200 and 15.3% in HIV-negative subjects). Diffuse atrophy accounted for most of the excess abnormalities in HIV-positive subjects with CD4+ counts <200 (77.3% of abnormal scans). Diffuse atrophy on MRI was associated with decreased muscle bulk on neurologic examination, but not with abnormal tendon reflexes. Four of six subjects with non-hemophilia-related diffuse muscle atrophy had cerebral atrophy on MRI. All 6 were HIV-positive and had CD4+ counts <200. Congenital abnormalities (primarily arachnoid cysts) were present in 12 subjects, not related to HIV or CD4+ status. Acquired focal abnormalities including both old hemorrhagic lesions (12 subjects) and nonhemorrhagic lesions (66 subjects) were equally frequent in HIV-positive and HIV-negative groups and did not differ by CD4+ count. Multifocal white-matter lesions, hyperintense on T2-weighted images, seen in both HIV-positive and HIV-negative subjects, are of uncertain significance. Of the multiple MRI abnormalities found, only diffuse cerebral atrophy appears to be associated with HIV infection, and only in subjects with compromised immunologic function.

Abstract WP426: Subarachnoid Hemorrhage in patients infected with Human Immunodeficiency Virus

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Haralabos Zacharatos ◽  
Malik M Adil ◽  
Ameer E Hassan ◽  
Sarwat I Gilani ◽  
Adnan I Qureshi
Keyword(s):  
Human Immunodeficiency Virus ◽  
Subarachnoid Hemorrhage ◽  
Blood Transfusion ◽  
Hospital Mortality ◽  
Hiv Infection ◽  
The United States ◽  
Hiv Positive ◽  
Published Data ◽  
Immunodeficiency Virus ◽  
Hiv Negative

Background: There is limited data regarding the unique attributes of ischemic stroke among patients infected with human immunodeficiency virus (HIV). There is no published data regarding the occurrence and outcomes of subarachnoid hemorrhage (SAH) among HIV infected persons. Methods: The largest all-payer Nationwide Inpatient Sample (NIS 2002-2010) data was used to identify and analyze all patients presenting with the primary diagnosis of SAH in the United States. Among this cohort, we identified the patients who were not HIV positive and those who were HIV positive. Patient demographics, medical co-morbidities, in-hospital complications, in-hospital procedures, and discharge disposition were compared between the two groups. The association between HIV infection and outcomes was evaluated in multivariate analysis after adjusting for potential confounders. Results: Of the 351,491 patients admitted with SAH, 1367 (0.39%) were infected with HIV. HIV infected patients were younger, mean age [±SD] of 45 ±14.2 years versus those who were not 58±19 years, (p<0.0001). The rate of blood transfusion [27,286 (7.8%) versus 245.6 (18%), p=0.0003], mechanical ventilation [51,199 (14.6%) versus 316.1(23.1%), p=0.008], and sepsis [14,644 (4.2%) versus 236.1 (17.3%), p<0.0001] was significantly higher among HIV infected patients. After adjusting for age, gender, hypertension, coagulopathy, atrial fibrillation, renal failure, and dyslipidemia, HIV negative patients had a significantly higher rate of discharge to home (odds ratio [OR] 1.9, 95% CI: 1.4-2.6, p<0.0001) and lower in-patient mortality (OR 0.4, 95% CI: 0.3-0.5, p<0.001). Further adjustment for blood transfusion and sepsis reduced the odds of discharge to home for the HIV negative patients, from 1.9 to 1.7 but did not affect in-hospital mortality. Conclusion: The in-hospital mortality in HIV infected patients with SAH is higher despite these patients being younger than non-HIV infected patients. We believe that this study provides a nationwide perspective which may have some important implications for early recognition and diagnosis of HIV-infection in SAH patients.

scholarly journals Neurocysticercosis and HIV Infection: what can we learn from the published literature?

2019 ◽  
Vol 77 (5) ◽  
pp. 357-365 ◽  
Author(s):  
Omar Herrera Vazquez ◽  
Matthew L. Romo ◽  
Agnès Fleury
Keyword(s):  
Hiv Infection ◽  
Immune Status ◽  
Taenia Solium ◽  
Response To Treatment ◽  
Hiv Positive ◽  
Historical Series ◽  
Immunodeficiency Virus ◽  
The Central Nervous System ◽  
Published Research ◽  
Hiv Negative

ABSTRACT Infections caused by the human immunodeficiency virus (HIV) and by the larvae of Taenia solium (i.e., cysticercosis) are still widespread in many developing countries. Both pathologies modify host immune status and it is possible that HIV infection may modulate the frequency and pathogeny of cysticercosis of the central nervous system (i.e., neurocysticercosis [NCC]). Objective: To describe published cases of NCC among HIV-positive patients and to evaluate whether the characteristics of NCC, including frequency, symptoms, radiological appearance, and response to treatment differed between HIV-positive and HIV-negative patients. Methods: Forty cases of NCC/HIV co-infected patients were identified in the literature. Clinical and radiological characteristics, as well as response to treatment, were compared with non-matching historical series of NCC patients without HIV infection. Results: Most of these patients had seizures and multiple vesicular parasites located in parenchyma. Clinical and radiological characteristics were similar between HIV-positive and HIV-negative patients with NCC, as well as between immunocompromised and non-immunocompromised HIV-positive patients. Conclusion: Our review did not reveal clear interactions between HIV and NCC. This may be partially due to the small number of cases and reliance on published research. A systematic, multi-institutional effort aiming to report all the cases of this dual pathology is needed to confirm this finding and to clarify the possible relationship between both pathogens.

scholarly journals Levels of Macrophage Inflammatory Protein 1α (MIP-1α) and MIP-1β in Intervillous Blood Plasma Samples from Women with Placental Malaria and Human Immunodeficiency Virus Infection

2003 ◽  
Vol 10 (4) ◽  
pp. 631-636 ◽  
Author(s):  
Sujittra Chaisavaneeyakorn ◽  
Julie M. Moore ◽  
Lisa Mirel ◽  
Caroline Othoro ◽  
Juliana Otieno ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Blood Plasma ◽  
Plasma Levels ◽  
Placental Malaria ◽  
Hiv Positive ◽  
Inflammatory Protein ◽  
Immunodeficiency Virus ◽  
Macrophage Inflammatory Protein ◽  
Hiv Negative

ABSTRACT Macrophage inflammatory protein-1α (MIP-1α) and MIP-1β play an important role in modulating immune responses. To understand their importance in immunity to placental malaria (PM) and in human immunodeficiency virus (HIV)-PM coinfection, we investigated levels of these chemokines in the placental intervillous blood plasma (IVB plasma) and cord blood plasma of HIV-negative PM-negative, HIV-negative PM-positive, HIV-positive PM-negative, and HIV-positive PM-positive women. Compared to HIV-negative PM-negative women, the MIP-1β concentration in IVB plasma was significantly elevated in HIV-negative PM-positive women and HIV-positive PM-positive women, but it was unaltered in HIV-positive PM-negative women. Also, PM-infected women, irrespective of their HIV status, had significantly higher levels of MIP-1β than HIV-positive PM-negative women. The MIP-1α level was not altered in association with either infection. The IVB plasma levels of MIP-1α and MIP-1β positively correlated with the cord blood plasma levels of these chemokines. As with IVB plasma, only cord plasma from PM-infected mothers had significantly elevated levels of MIP-1β compared to PM-negative mothers, irrespective of their HIV infection status. MIP-1β and MIP-1α levels in PM-positive women were positively associated with parasite density and malaria pigment levels. Regardless of HIV serostatus, the IVB MIP-1β level was significantly lower in women with PM-associated anemia. In summary, an elevated level of MIP-1β was associated with PM. HIV infection did not significantly alter these two chemokine levels in IVB plasma.

Emotional deficit: an adaptative and evolutive process in HIV infection

1995 ◽  
Vol 10 (7) ◽  
pp. 345-351 ◽  
Author(s):  
C Bungener ◽  
JJ Lefrère ◽  
D Widlöcher ◽  
R Jouvent
Keyword(s):  
Hiv Infection ◽  
Well Being ◽  
Structured Interview ◽  
Emotional Disturbances ◽  
Hiv Positive ◽  
Homosexual Men ◽  
Immunodeficiency Virus ◽  
Advanced Stages ◽  
Hiv Negative ◽  
Asymptomatic Hiv

SummaryThe objective of the present study was to evaluate emotional disturbances and psychopathological symptoms in early stages of human immunodeficiency virus (HIV) infection. Seventy-one homosexual subjects, positive to HIV and two groups of HIV-negative subjects (32 homosexuals and 26 heterosexuals) were evaluated in a semi-structured interview by two trained raters. The results showed the presence of emotional perturbations already in asymptomatic HIV-positive individuals even in the absence of caracterized depression and/or anxiety. This emotional deficit seemed to be more important in more advanced stages of the disease. Depressive and anxious symptoms appeared to be slightly but significantly present in both groups of homosexual men. This emotional deficit could be the reflect of an adaptative process to the threatening consequences of HIV-infection. Emotional perturbations, even mild should not be neglected, because their reduction contributes to the psychological well being of HIV-positive subjects.

scholarly journals Incidental Findings on Coronary Computed Tomography Angiography in Human Immunodeficiency Virus (HIV)-Positive and HIV-Negative Persons

2018 ◽  
Vol 5 (5) ◽  
Author(s):  
Sara Reinschmidt ◽  
Teja Turk ◽  
Philip E Tarr ◽  
Roger Kouyos ◽  
Christoph Hauser ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Computed Tomography Angiography ◽  
Incidental Findings ◽  
Coronary Computed Tomography Angiography ◽  
Hiv Positive ◽  
Factors Associated ◽  
Immunodeficiency Virus ◽  
Hiv Negative

Abstract Background Incidental findings on coronary computed tomography angiography (CCTA) have a great impact on the benefits and costs of testing for cardiovascular disease. The number of incidental findings might be increased in human immunodeficiency virus (HIV)-positive individuals compared with the general population. Data are limited regarding the association between incidental findings and HIV infection. Methods We assessed the prevalence and factors associated with incidental findings among HIV-positive and HIV-negative participants ≥45 years undergoing CCTA. Logistic regression was performed to evaluate the factors associated with incidental findings in the HIV-positive and HIV-negative groups. For the analysis of the HIV effect, a propensity score-matched dataset of HIV-positive/HIV-negative participants was used. Results We included 553 participants, 341 with and 212 without HIV infection. Incidental findings were observed in 291 of 553 (53%) patients. In 42 of 553 (7.6%) participants, an incidental finding resulted in additional workup. A malignancy was diagnosed in 2 persons. In the HIV-positive group, age (1.31 per 5 years, 1.10–1.56) and smoking (2.29, 1.43–3.70) were associated with incidental findings; in the HIV-negative group, age (1.26, 1.01–1.59) and a CAC score &gt;0 (2.08, 1.09–4.02) were associated with incidental findings. Human immunodeficiency virus seropositivity did not affect the risk of incidental findings. Conclusions Incidental findings were highly prevalent among HIV-positive and HIV-negative persons. Human immunodeficiency virus infection was not associated with an increased risk of incidental findings.

scholarly journals Characteristics of Primary Thrombotic Microangiopathy in Patients with and without Human Immunodeficiency Virus: Thirteen Year Experience at the University of Maryland

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4203-4203
Author(s):  
Victoria Giffi ◽  
Mya S. Thein ◽  
Ann Zimrin
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Thrombotic Microangiopathy ◽  
Laboratory Data ◽  
Hiv Positive ◽  
Sample Collection ◽  
University Of Maryland ◽  
Immunodeficiency Virus ◽  
The University ◽  
Hiv Negative

Abstract Background: Thrombotic microangiopathy (TMA) is a syndrome characterized by thrombocytopenia and microangiopathic hemolytic anemia. TMAs can be primary or secondary to variety of clinical conditions: pregnancy, malignancy, autoimmune diseases and medications. Human immunodeficiency virus (HIV) infection is associated with thrombotic thrombocytopenic purpura (TTP), although the pathophysiology and clinical presentation has not been well-defined. Methods: In an urban center with a 3% prevalence of HIV infection, we retrospectively reviewed the charts of patients who underwent therapeutic plasma exchange (TPE) for TTP from January 2000 to December 2013 after IRB approval. The aim of our study is to describe and analyze the clinical differences seen in primary TMA with or without HIV infection. Differences of laboratory data between the 2 groups were assessed using the t -test. Results: Of 188 patients requiring TPE over 13 years at our urban tertiary medical center, 31 (17%) were HIV-positive and 154 (83%) were HIV negative. HIV-positive patients had median age of 43 years (range, 26-65), 30 (96%) black, 23 (74%) female, 23 (74%) with primary TMA. HIV-negative patients had a median age of 46 years (range, 16-82) 92 (59%) black and 104 (66%) female, 54 (35%) with primary TMA. Fifteen of 31 HIV-positive patients (48%) presented with comorbid infections caused by bacterial, viral, fungal and opportunistic organisms, whereas only 29 of the 157 (18%) HIV-negative patients presented with concomitant infection. The following comparisons were made between HIV-positive (n=23) and negative (n=54) patients with primary TMA. Laboratory data revealed that hemoglobin was lower (mean Hb: 7.0 vs 8.1 g/dL, P=0.03) and renal failure was more severe (mean creatinine 2.3 vs 1.6, P=0.04) in HIV-positive patients compared with HIV-negative. There was no statistically difference between 2 groups in LDH and platelet counts. ADAMTS13 level was available in 6/23 HIV positive and 18/54 HIV-negative primary TMA patients. The level <10% was seen in 11 HIV-negative patients. ADAMTS13 level of HIV-positive patients ranged from 14 to 74 (Sample collection was delayed in 3/6 patients). All HIV-positive cases showed immunosuppression, with a mean CD4 count of 124 cells/ µL, ranging from 2 to 444 cells/ µL. Regarding treatment, HIV-negative patients required an average of 23% more TPE sessions (18 vs. 15) than HIV-positive patients. Steroids, intravenous immune gamma-globulin and rituximab were used in both groups. Mortality and complications were similar in both groups. Discussion: The frequency of 1 in 5 patients with TMA also having HIV at the University of Maryland is one of the highest frequencies reported in the literature outside of South Africa. Our study suggests that HIV-positive patients might have a thrombotic microangiopathy triggered by an infection more commonly than patients without HIV. The absence of ADAMTS13 deficiency was notable in our HIV-positive patients. However, delayed sample collection in 3/6 patients might limit the significance of this data. The etiology of TMA in HIV infection remains unclear. Prior studies have suggested that a HIV-specific mechanism such as B cell dysregulation as a result of T cell depletion; cytokine production and HIV infection of endothelial cells play a role. The limited number of patients seen individual centers precludes controlled clinical trials to study the efficacy of treatment for this serious disease. Future prospective collaborative research studies are needed to expand our knowledge of TMA in HIV-positive populations. Disclosures No relevant conflicts of interest to declare.

Role of Cerebrospinal Fluid Shunting for Human Immunodeficiency Virus-positive Patients with Tuberculous Meningitis and Hydrocephalus

Neurosurgery ◽  
2000 ◽  
Vol 47 (3) ◽  
pp. 644-650
Author(s):  
Syed Sameer Nadvi ◽  
Narendra Nathoo ◽  
Ken Annamalai ◽  
James R. van Dellen ◽  
Ahmed I. Bhigjee
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cerebrospinal Fluid ◽  
Tuberculous Meningitis ◽  
Hiv Positive ◽  
Negative Group ◽  
Cd4 Counts ◽  
Positive Group ◽  
Immunodeficiency Virus ◽  
Cerebrospinal Fluid Shunting ◽  
Hiv Negative

ABSTRACT OBJECTIVE Tuberculous meningitis (TBM) and its complications continue to have devastating neurological consequences for patients. Budgetary constraints, especially in developing countries, have made it necessary to select patients for shunting who are likely to experience good recoveries. To date, the value of cerebrospinal fluid shunting for human immunodeficiency virus (HIV)-positive patients with TBM has not been clearly established. METHODS Thirty patients with TBM and hydrocephalus were prospectively evaluated. Coincidentally, one-half of the patients were HIV-positive. All patients underwent uniform treatment, including ventriculoperitoneal shunt placement and antituberculosis treatment. CD4 counts were measured for all patients. Outcomes were assessed at 1 month. RESULTS No complications related to shunt insertion were noted. The HIV-positive group fared poorly (death, 66.7%; poor outcome, 64.7%), compared with the HIV-negative group (death, 26.7%; poor outcome, 30.8%). Despite cerebrospinal fluid shunting, no patient in the HIV-positive group experienced a good recovery (Glasgow Outcome Scale score of 5). This is in contrast to the six patients (40%) in the HIV-negative group who, with the same treatment, experienced good recoveries (Glasgow Outcome Scale scores of 5) at discharge (P &lt; 0.14). No patient (either HIV-positive or HIV-negative) who presented in TBM Grade 4 survived, whereas no HIV-positive patient who presented in TBM Grade 3 survived. A significant relationship was noted between CD4 counts and patient outcomes (P &lt; 0.031). CONCLUSION In the absence of obvious clinical benefit, HIV-positive patients with TBM should undergo a trial of ventricular or lumbar cerebrospinal fluid drainage, and only those who exhibit significant neurological improvement should proceed to shunt surgery.

scholarly journals Strong Impact of Smoking on Multimorbidity and Cardiovascular Risk Among Human Immunodeficiency Virus-Infected Individuals in Comparison With the General Population

2015 ◽  
Vol 2 (3) ◽  
Author(s):  
Barbara Hasse ◽  
Philip E. Tarr ◽  
Pedro Marques-Vidal ◽  
Gerard Waeber ◽  
Martin Preisig ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cardiovascular Risk ◽  
General Population ◽  
Hiv Infection ◽  
Poisson Regression ◽  
Hiv Positive ◽  
Strong Impact ◽  
Hiv Status ◽  
Immunodeficiency Virus ◽  
Hiv Negative

Abstract Background.  Although acquired immune deficiency syndrome-associated morbidity has diminished due to excellent viral control, multimorbidity may be increasing among human immunodeficiency virus (HIV)-infected persons compared with the general population. Methods.  We assessed the prevalence of comorbidities and multimorbidity in participants of the Swiss HIV Cohort Study (SHCS) compared with the population-based CoLaus study and the primary care-based FIRE (Family Medicine ICPC-Research using Electronic Medical Records) records. The incidence of the respective endpoints were assessed among SHCS and CoLaus participants. Poisson regression models were adjusted for age, sex, body mass index, and smoking. Results.  Overall, 74 291 participants contributed data to prevalence analyses (3230 HIV-infected; 71 061 controls). In CoLaus, FIRE, and SHCS, multimorbidity was present among 26%, 13%, and 27% of participants. Compared with nonsmoking individuals from CoLaus, the incidence of cardiovascular disease was elevated among smoking individuals but independent of HIV status (HIV-negative smoking: incidence rate ratio [IRR] = 1.7, 95% confidence interval [CI] = 1.2–2.5; HIV-positive smoking: IRR = 1.7, 95% CI = 1.1–2.6; HIV-positive nonsmoking: IRR = 0.79, 95% CI = 0.44–1.4). Compared with nonsmoking HIV-negative persons, multivariable Poisson regression ide.jpegied associations of HIV infection with hypertension (nonsmoking: IRR = 1.9, 95% CI = 1.5–2.4; smoking: IRR = 2.0, 95% CI = 1.6–2.4), kidney (nonsmoking: IRR = 2.7, 95% CI = 1.9–3.8; smoking: IRR = 2.6, 95% CI = 1.9–3.6), and liver disease (nonsmoking: IRR = 1.8, 95% CI = 1.4–2.4; smoking: IRR = 1.7, 95% CI = 1.4–2.2). No evidence was found for an association of HIV-infection or smoking with diabetes mellitus. Conclusions.  Multimorbidity is more prevalent and incident in HIV-positive compared with HIV-negative individuals. Smoking, but not HIV status, has a strong impact on cardiovascular risk and multimorbidity.

scholarly journals Shorter Granulocyte Telomeres Among Children and Adolescents With Perinatally Acquired Human Immunodeficiency Virus Infection and Chronic Lung Disease in Zimbabwe

2020 ◽  
Author(s):  
Abhinav Ajaykumar ◽  
Glenn C Wong ◽  
Louis-Marie Yindom ◽  
Grace McHugh ◽  
Ethel Dauya ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Hiv Positive ◽  
Newly Diagnosed ◽  
Cart Initiation ◽  
Immunodeficiency Virus ◽  
Perinatally Acquired ◽  
Hiv Negative

Abstract Background Chronic lung disease (CLD) has been reported among African children with perinatally acquired human immunodeficiency virus (HIV) infection (C-PHIV), despite combination antiretroviral therapy (cART). In adults, shorter telomere length (TL) has been reported in association with both CLD and HIV. As little is known in children, our objective was to compare TL in HIV-positive (cART-naive or -treated) and HIV-negative children with and without CLD. Methods Participants included Zimbabwean C-PHIV, aged 6–16, who were either newly diagnosed and cART-naive, or on cART for &gt;6 months, and HIV-negative controls of similar age and sex. Packed blood cell (granulocyte) TLs from 621 children were compared cross-sectionally between groups. For a subset of newly diagnosed C-PHIV, changes in TL following cART initiation were evaluated. Results C-PHIV had shorter granulocyte TL compared with uninfected peers, regardless of cART. Among 255 C-PHIV without CLD, TL was shorter in cART-naive participants. In multivariable analyses adjusted for age, sex, CLD, and HIV/cART status, shorter TL was independently associated with older age, being HIV positive, and having reduced forced vital capacity (FVC). Last, cART initiation increased TL. Conclusions In this cohort, C-PHIV and those with reduced FVC have shorter granulocyte TL, possibly the result of increased immune activation and cellular turnover due to longstanding HIV infection with delayed cART initiation.

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