Confronting AIDS Directions for Public Health, Health Care, and Research (1986) / Chapter Skim
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Appendix A. Clinical Manifestations of HIV Infection
Appendix A. Clinical Manifestations of HIV Infection
Pages 279-303
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Appendixes
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Protozoal Infections Pneumocystis carinii Pneumonia Pneumocystis carinii pneumonia (PCP) is the most common AIDSrelated opportunistic infection in U.S.
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It is also one of the most treatable AIDS-related opportunistic infections. Clinical features of CNS infection with Toxoplasma gondii include seizures, focal necrologic deficits, and encephalopathy.
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A diagnosis of T gondii infection of the CNS can be suspected when a patient with AIDS or in an AIDS risk group complains of seizures or focal necrologic deficits (Luft et al., 19841.
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. There have been no treatment trials for either thrush or Candida esophagitis in AIDS, so treatment recommendations must be based on clinical experience and the results of treatment trials in other immunocompromised populations.
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However, prospective trials are needed to establish the role of ketoconazole in the treatment of cryptococcal infection in patients with AIDS. Bacterial Infections Mycobacterium tuberculosis Tuberculosis is seen with increasing frequency in groups at risk for AIDS, typically preceding the actual diagnosis of AIDS by several months (Louie et al., 19851.
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Pulmonary colonization alone does not necessitate treatment, but close observation for potential disseminated infection is warranted. Salmonella Infections Several recent reports have disclosed 14 cases of bacteremic Salmonella infections in AIDS and ARC patients.
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There are neither studies of the natural history nor comparative treatment trials of these viral infections in AIDS or ARC. Acyclovir used topically, intravenously, and orally reduces viral shedding and enhances the healing of cutaneous lesions in other immunocompromised populations (Epstein, 19831.
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Although evidence is still lacking, the fear remains that the delta agent may spread more readily in both homosexual men and IV drug users, given established chronic cases of hepatitis B and cellular immune deficiency. Because infectious diseases are a common feature of at least two of the major AIDS risk groups independent of the AIDS epidemic, it may be extremely difficult to establish any direct connection between HIV
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~.. ~ I-~1A _;- ~+ Throughout the AIDS epidemic, Kaposi's sarcoma has played an important role as an easily monitored clinical marker of the underlying immune deficiency.
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have been suggested as possible cofactors leading to the increased incidence of Kaposi's sarcoma in this population, but there are currently no data to support these contentions. The clinical spectrum of Kaposi's sarcoma in AIDS is broad, possibly reflecting a variably severe underlying immune deficiency.
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No published series exists that evaluates treatment of patients with AIDS-associated primary central nervous system lymphoma, but these patients tend not to survive long. Moreover, treatment of primary central nervous system lymphoma even in immunocompetent patients has been largely unsuccessful.
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With the exception of Hodgkin's disease in homosexual men, there is as yet minimal direct evidence that these other cancers are caused by HIV-induced immune deficiency or that their mode of presentation or response to therapy is different from prior experience. Some of these cancers in particular anal squamous cell carcinomas, malignant melanoma, and testicular malignancies are known to have been relatively common in young men even before the beginning of the AIDS epidemic.
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Cerebrospinal fluid shows a mononuclear cell pleocytosis and protein elevation. This may represent HIV's initial invasion of the central nervous system.
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Despite the severity of clinical disease and the dramatic findings on imaging studies, histopathologic changes are remarkably subtle. There is a diffuse pallor of white matter, perivascular infiltrations of lymphocytes and macrophages, and, in more advanced cases, multinucleated cells.
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These specimens included spinal fluid isolates from 6 of 7 patients with chronic meningitis, the brains of 6 patients with dementias, the spinal cord of one patient with myelopathy, the spinal fluid from one patient who had an acute meningitis at the time of seroconversion, and a peripheral nerve of one patient with demyelinating neu ropathy. Further evidence for the direct replication of HIV in the brain comes from the demonstration of intrathecal antibody synthesis in patients.
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How much time elapses between involvement of the central nervous system and the development of the subacute encephalitis with dementia also remains unknown. Clearly, this has broad implications for the use of therapeutic immunomodulators, which could improve hematologic parameters and clear systemic infections but have little effect on an ongoing or latent infection within the central nervous system.
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of AIDS cases in children have Pneumocystis carinii pneumonia. Candida esophagitis occurs in 22 percent of cases, and disseminated cytomegalovirus infection is found in 24 percent.
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Bacterial infections seen include recurrent pneumonia, bacterial sepsis (especially with Streptococcus pneumonias and Haemophilus influenzoe) , and chronic draining otitis media.
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1986. The usefulness of induced sputum in the diagnosis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome.
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1985. Isolation of HTLV-III from cerebrospinal fluid and neural tissues of patients with neurologic syndromes related to the acquired immunodeficiency syndrome.
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1984. Pneumocystis carinii pneumonia: A comparison between patients with acquired immunodeficiency syndrome and patients with other immunodeficiencies.
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In press. Cellular localization of human immunodeficiency virus infection within the brains of acquired immunodeficiency syndrome (AIDS)
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Relation to generalized lymphadenopathy and the acquired immunodeficiency syndrome.
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