Zhi-liang Hu, Hong-xia Wei, Wen-hu Yao and Yong-feng Yang
A 35-year-old man (body weight = 63 kg) with AIDS complaining fever and headache after having commenced anti-retroviral therapy (ART) for a week was admitted to our hospital. Five lumbar punctures performed during 38 days could not confirm a cryptococcal meningitis (CM) based on staining or culture methods for cerebrospinal fluid (CSF). The disease quickly progressed with serious hearing/vision impairment and frequent onset of seizure and coma after being treated with corticosteroids for five days, and then CM was confirmed. Subsequent lumbar puncture showed elevated intracranial pressure as high as 870 mm H2O, even though treated with standard antifungal regimens for CM. His disease was finally controlled by a new triple therapy with amphotericin B (0.7 mg•kg-1•day-1, intravenously), flucytosine (100 mg/kg perday, orally in four divided doses), and voriconazole (200 mg every 12 hours) and ART containing lamivudine (300 mg/day), stavuding (30 mg, twice a day) and efavirenz (300 mg, orally every night). Although it is rare, negative CSF stain or culture for cryptococci in AIDS patients with CM can persist for a long time. Corticosteroids should be used cautiously when an effective anti-fungal therapy is not administered. Triple therapy with amphotericin B, flucytosine and voriconazole may be selectively applied in severe CM. Voriconazole can be co-administered with efavirenz with modified dosing
It has always been a priority for all nations to reduce new HIV infections by implementing a comprehensive HIV prevention programme at a sufficient scale. Recently, the ‘HIV counselling & testing’ (HCT) campaign is gaining public attention, where HIV patients are identified through screening and immediately sent under a course of antiretroviral treatment (ART), neglecting the time extent they have been infected. In this article, we study a nonlinear mathematical model for the transmission dynamics of HIV/AIDS system receiving drug treatment along with effective awareness programs through media. Here, we consider two different circumstances: when treatment is only effective and when both treatment and awareness are included. The model is analyzed qualitatively using the stability theory of differential equations. The global stabilities of the equilibria under certain conditions are determined in terms of the model reproduction number. The effects of changes in some key epidemiological parameters are investigated. Projections are made to predict the long term dynamics of the disease. The epidemiological implications of such projections on public health planning and management are discussed. These studies show that the aware populations were less vulnerable to HIV infection than the unaware population.
Epidemiological studies have shown that infection with the human immunodeficiency virus (HIV) is an influential risk factor for infection with Mycobacterium tuberculosis (MTb), the rapid progression of the initial infection to active tuberculosis (TB), and the reactivation of latent TB infection. MTb infection is also one of the most common opportunistic infections in people with HIV, including AIDS patients receiving anti-retroviral therapy. Given the prevalence of HIV infection, the incidence of TB infection, which had begun to decline, is facing a severe situation. HIV associated with TB exerts an immense burden on the public health-care system, especially in countries with high incidences of HIV infection. Therefore, the global policies for the prevention and control of TB should be revised. Moreover, an increased investment in TB control has to be guaranteed. The purpose of this review is to summarize the recent progress in the prevention, treatment, and control of HIV and TB co-infection.
Supharat Jariyakosol, Pear Pongsachareonnont and Supapan Sitthanon
Background: Progressive outer retinal necrosis (PORN) is a necrotizing chorioretinopathy caused by herpes simplex virus, varicella-zoster virus, or cytomegalovirus.
Objective: To describe the clinical morphology of PORN presenting with asymmetrical isolated bilateral retrobulbar optic neuropathy.
Method: The medical records of a 45-year-old human immunodeficiency virus infected patient presenting with bilateral visual loss at King Chulalongkorn Memorial Hospital were reviewed with respect for the privacy of patient.
Result: Gradual visual loss progressed to no light perception in the right eye and 20/200 in the left eye within 1 month. The patient was initially diagnosed with retrobulbar optic neuritis in both eyes. The investigations included MRI, vitreous tapping, lumbar puncture, and serological testing. MRI elicited enhancement around both optic nerves, which suggested optic neuritis. Thereafter, multifocal areas of retinal necrosis developed with rapid progression and additional cutaneous zoster lesions were established. These findings led to a diagnosis of PORN. The patient was promptly treated with intravenous ganciclovir, anti-retroviral therapy, and vitrectomy with endophotocoagulation and silicone injection. Unfortunately, his visual prognosis in the left eye was still poor
Conclusion: PORN was uncommonly present with bilateral isolated optic neuropathy before retinal lesions developed. Retrobulbar optic neuropathy from herpetic infection in immunocompromised patients should be considered despite a normal fundus at initial presentation. Early diagnosis and prompt intervention may preserve vision. This case demonstrates the importance of careful physical examination and follow up of retinal lesions.
Oksana Koļesova, Jeļena Eglīte, Aleksandrs Koļesovs, Angelika Krūmiņa, Ilze Ekšteina, Monta Madelāne and Ludmila Vīksna
., Mocroft, A., Soriano, V., Rockstroh, J., Dore, G., Puoti, M., Tedaldi, E., Clotet, B., Kupfer, B., Lundgren, J. D., Klein, M. B., for the INSIGHT SMART Study Group. (2011). Hyaluronic acid levels predict increased risk of non-AIDS death in hepatitis-coinfected persons interrupting antiretroviral therapy in the SMART Study. Antivir. Ther. 16 (5), 667–675.
Qurishi, N., Kreuzberg, C., Lüchters, G., Effenberger, W., Kupfer, B., Sauerbruch, T., Rockstroh, J. K., Spengler, U. (2003). Effect of anti-retroviraltherapy on liver-related mortality in patients with HIV
Slobodan Stojanović, Snežana Brkić, Marina Jovanović and Nada Vučković
The authors present a case of a man with urticaria pigmentosa and acquired immunodeficiency syndrome - AIDS. The patient was diagnosed as HIV (human immunodeficiency virus) - positive in the year 2000, at the Infectious Diseases Clinic, Clinical Center of Vojvodina in Novi Sad. Urticaria pigmentosa was detected (nine years later) during a dermatological examination at the Dermatovenerology Department of the Outpatient Clinic, Clinical Center of Vojvodina. Urticaria pigmentosa is the most common manifestation of cutaneous mastocytosis. The patient was taking long term antiviral therapy for several years. Approximately 2 years after the onset of urticaria pigmentosa, this patient developed septicemia and ascites along with hepatosplenomegaly, liver damage, chronic cholecystitis, leukopenia, thrombocytopenia and relative eosinophilia. The patient had increased total serum IgE levels and tested positive for 5-hydroxyindoleacetic acid in a 24-hour urine test from the very beginning of urticaria pigmnentosa and during the course of his illness. Immunohistochemical results of dermal biopsy of the affected area confirmed the diagnosis of urticaria pigmentosa. Histology findings confirmed presence of typical dermal mast cell infiltrates with distinct oval and spindle granules that were CD117+ and CD1a-. Systemic mastocytosis was excluded by liver and bone marrow biopsies. To our knowledge, we present the third case of associated mastocytosis and acquired immunodeficiency syndrome published in world literature so far, in order to indicate the possible interaction between HIV infection and mast cells.
Marzena Rola-Łuszczak, Agnieszka Grabowska, Bogusław Szewczyk and Jacek Kuźmak
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