Severe acute respiratory syndrome, a pathological immune response to the new coronavirus--implications for understanding of pathogenesis, therapy, design of vaccines, and epidemiology.

Findings coming from autopsies and serum of SARS patients suggest an important immune-inflammatory implication in the evolution to respiratory distress. Conditions such as HIV infection or treatment with immunosuppressors (in cancer or autoimmune diseases) are not among the bad prognosis factors for development of distress. To date, there have been no reported case fatalities in children, probably due to their more immature immune system.

The unmasking of Pneumocystis jiroveci pneumonia during reversal of immunosuppression: case reports and literature review.

Background: Pneumocystis jiroveci pneumonia (PCP) is an important opportunistic infection among immunosuppressed patients, especially in those infected with human immunodeficiency virus (HIV). The clinical presentation of PCP in immunosuppressed patients have been well-reported in the literature. However, the clinical importance of PCP manifesting in the setting of an immunorestitution disease (IRD), defined as an acute symptomatic or paradoxical deterioration of a (presumably) preexisting infection, which is temporally related to the recovery of the immune system and is due to immunopathological damage associated with the reversal of immunosuppressive processes, has received relatively little attention until recently.

Lessons from the syphilis outbreak in homosexual men in east London.

Objectives: To describe the epidemiology, presentation, and diagnosis of early syphilis in 103 homosexual men in east London.

Methods: A retrospective study using data from KC60 returns, the Health Protection Agency (HPA) enhanced surveillance forms and case notes.

Results: 40 cases of primary (PS), 40 of secondary (SS) and 23 of early latent syphilis were identified, 33% co-infected with HIV.

Assessment of FIV-C infection of cats as a function of treatment with the protease inhibitor, TL-3.

Background: The protease inhibitor, TL-3, demonstrated broad efficacy in vitro against FIV, HIV and SIV (simian immunodeficiency virus), and exhibited very strong protective effects on early neurologic alterations in the CNS of FIV-PPR infected cats. In this study, we analyzed TL-3 efficacy using a highly pathogenic FIV-C isolate, which causes a severe acute phase immunodeficiency syndrome, with high early mortality rates.

Results: Twenty cats were infected with uncloned FIV-C and half were treated with TL-3 while the other half were left untreated.

Syphilitic hepatitis in HIV-infected patients: a report of 7 cases and review of the literature.

Background: A recent resurgence of primary and secondary syphilis has been observed in certain population groups, particularly among persons infected with human immunodeficiency virus (HIV). Liver involvement is an infrequently recognized complication of early syphilis, with no previous reports among HIV-infected patients.

Methods: We describe 7 cases of syphilitic hepatitis in HIV-positive individuals and review the literature.

Antiretroviral treatment. HIV infection in adults: better-defined first-line treatment.

(1) There is still no cure for HIV infection. The short-term treatment aims are to drive viral load below the current detection limit and to increase the CD4+ T cell count, in order to reduce morbidity and prolong survival. (2) Early initiation of treatment has both advantages and disadvantages.

Neurosyphilis.

Treponema pallidum, the bacterium that causes syphilis, invades the central nervous system early in the course of disease but causes persistent infection in only a subset of infected persons. Individuals with persistent infection or asymptomatic meningitis are at risk for developing symptomatic neurosyphilis if they are not treated with a drug regimen that achieves sufficient drug levels in cerebrospinal fluid to kill the organism. In this article, recent studies that address the risk, diagnosis, and management of neurosyphilis are discussed within the context of a brief review.

Hyperlactatemia in human immunodeficiency virus-uninfected infants who are exposed to antiretrovirals.

Objective: Exposure to nucleoside analogues in fetal or early life has been associated with rare clinically significant mitochondrial toxic effects, mainly neurologic symptoms. Lactate (LA) measurements have been used to monitor nucleoside-related mitochondrial toxicity. Our aim was to determine the prevalence, clinical evolution, and risk factors for hyperlactatemia in our cohort of human immunodeficiency virus (HIV)-uninfected children who were exposed to antiretrovirals.

Marijuana use and cognitive function in HIV-infected people.

The effect of marijuana use on cognitive function is controversial. Although marijuana use is common in HIV-infected individuals for recreational and medicinal purposes, there have been no studies of the impact of marijuana on cognitive function in these subjects. Marijuana also has known immunologic effects, which increases the relevance in HIV-infected patients.

The natural history of HIV-1 and HIV-2 infections in adults in Africa: a literature review.

About 30 million people in Africa are estimated to be living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), yet data about the natural history of infection on the continent are sparse. We reviewed the literature on the natural history of HIV-1 and HIV-2 infections among African adults. Only one study, conducted in rural Uganda, has reported on survival from the time of HIV-1 seroconversion: the median was 9.

Loss of viral control in early HIV-1 infection is temporally associated with sequential escape from CD8+ T cell responses and decrease in HIV-1-specific CD4+ and CD8+ T cell frequencies.

The outcome of human immunodeficiency virus type 1 (HIV-1) infection is related to the set-point plasma virus load (pVL) that emerges after primary HIV-1 infection (PHI). This set-point pVL generally remains stable but eventually increases with progression to disease. However, the events leading to loss of viremic control are poorly understood.

Antiretroviral therapy in drug-naive patients infected with human immunodeficiency virus.

A vast amount of knowledge has accumulated since the discovery of the immunodeficiency diseases caused by human immunodeficiency virus-1 (HIV-1) in the early 1980s. An expert panel of HIV researchers and clinicians produced the first set of treatment guidelines in 1997. Since then, these guidelines have been updated based on available clinical information and supplemented by expert opinion when scientific data were incomplete.

Factors associated with tuberculin skin test reactivity among HIV-infected people in Bangkok.

INH preventive therapy (IPT) has been shown in several randomized controlled trials to reduce the risk of developing active TB in tuberculin skin test (TST) or purified protein derivative (PPD) positive HIV infected individuals. Detection of latent tuberculosis by TST and determination of factors associated with the PPD positivity in HIV-infected persons are important for the targeting of chemoprophylaxis. Six hundred asymptomatic and early symptomatic HIV-infected subjects attending the AIDS Clinic of the Chulalongkorn University Hospital, Bangkok, Thailand were enrolled in two randomized clinical trials of chemoprophylaxis against TB from December 1994 to December 1996.

HIV and pulmonary tuberculosis: the impact goes beyond those infected with HIV.

Background: HIV infection increases the risk of tuberculosis. The HIV epidemic is also likely to have an indirect effect on the incidence of tuberculosis because of the increased number of infectious individuals in the population. This should be apparent as an increase in tuberculosis among HIV-negative individuals, but this has not previously been demonstrated directly.

Older age and plasma viral load in HIV-1 infection.

Background: The purpose of the study was to examine the relationship between age and plasma viral load in HIV-1-infected individuals.

Design: The experimental method was to recruit older (> 50 years of age) and younger (18-39 years of age) HIV-1-infected individuals. The plasma viral load was measured using the Roche Molecular Systems UltraSensitive Roche HIV-1 Monitor test reflexively with the standard Amplicor HIV Monitor test to quantify viral load in the range of 50-750,000 copies of HIV-1 RNA/ml plasma.

Respiratory syncytial virus: the virus, the disease and the immune response.

RSV is the primary cause of hospitalisation in the first year of life for children in most parts of the world, and nearly 100% of children in the USA are infected with the virus by 2 to 3 years of age. The agent is an enveloped RNA virus with a non-segmented single-stranded negative-sense genome. The viral genome encodes 8 structural and 2 non-structural proteins.

The sociodemographic profile, risk categories and prevalence of HIV infection among people attending a London same-day testing clinic, 2000-2001.

The objectives were to determine the sociodemographic profile, risk category, and prevalence of HIV infection amongst people attending a confidential clinic providing counselling, medical advice and results of HIV antibody testing on the same day of consultation. Data were collected on all 1749 individuals attending the same-day HIV testing clinic at the Royal Free Hospital, London and proceeding to HIV testing between June 2000 and May 2001. One thousand, one hundred and forty-eight men and 601 women (mean age 33.

Influence of HLA-B57 on clinical presentation and viral control during acute HIV-1 infection.

Background: HLA-B57, as well as cytotoxic T-lymphocyte (CTL) responses restricted by this allele, have been strongly associated with long-term non-progressive chronic HIV-1 infection. However, their impact on viral replication during acute HIV-1 infection is not known.

Methods: Clinical and immunological parameters during acute and early HIV-1 infection in individuals expressing HLA-B57 were assessed.

Effect of maternal HIV and malaria infection on pregnancy and perinatal outcome in Zimbabwe.

Objective: To investigate the effect of isolated or concomitant infection with malaria and HIV on pregnancy and neonatal outcome.

Methods: Data were collected on pregnant women admitted during the rainy seasons in the obstetric division of a district referral hospital in northern Zimbabwe in 2000 and 2001. The effects of malaria and HIV infection were determined by multivariate analysis.

Mortality and progression to AIDS after starting highly active antiretroviral therapy.

Objectives: To examine survival and progression to AIDS among HIV-infected patients after starting highly active antiretroviral therapy (HAART).

Methods: The study population consisted of 3724 patients from the ATHENA observational cohort who initiated HAART. We considered progression to either an AIDS-defining disease or death, distinguishing HIV-related and non-related (including therapy-related) deaths.

Symptomatic primary HIV infection or risk experiences? Circumstances surrounding HIV testing and diagnosis among recent seroconverters.

Our objective was to understand the circumstances surrounding HIV testing among recent HIV seroconverters (n=80) compared to HIV-negative controls (n=106) in Ontario, Canada using self-reported interview data. Diagnosis of symptomatic primary HIV infection (SPHI) was defined as diagnosis by the participant's physician. Testing in response to symptoms was reported by 42% of seroconverters vs 12% of controls.

Infrequent diagnosis of primary human immunodeficiency virus infection: missed opportunities in acute care settings.

Although primary human immunodeficiency virus infection (PHI) is usually symptomatic and early management is likely important, the diagnosis is infrequently made. We examined a prospectively enrolled cohort of individuals diagnosed as having PHI in the southeastern United States to determine problems associated with the diagnosis of PHI. The following information was collected on each individual: site of initial presentation, number of visits to health care settings before diagnosis, diagnosing physician, alternative diagnoses, presumptive therapies, and time to diagnosis of PHI.

An in-house HIV DNA PCR assay for early diagnosis of HIV infection in children in Thailand.

Eighty-five venous blood specimens were collected at 4, 6 or 9 months of age from asymptomatic human immunodeficiency virus (HIV)-exposed infants and from symptomatic HIV-infected infants on admission to the hospital. The specimens were tested by in-house HIV deoxyribonucleic acid (DNA) nested polymerase chain reaction (PCR) and the commercial Amplicor HIV-1 DNA test. In order to determine the accuracy of the tests, the results were compared with the HIV infection status of the children.

Hyperlactataemia during antiretroviral therapy: incidences, clinical data and treatment.

Lactic acidosis is a serious complication of antiretroviral therapy. Symptomatic hyperlactataemia is a milder form of this syndrome, but its incidence is unclear. In this prospective ongoing observational study of a large cohort of HIV-infected adults, hyperlactataemia was diagnosed in 64 patients.

Epidemiology of the ocular complications of HIV infection in Chiang Mai.

Objective: To identify the magnitude of ocular complications in HIV infection in Chiang Mai, and determine the signs or symptoms that indicate the risk factors for developing ocular complications in HIV-positive patients

Method: A prospective study was carried out in newly diagnosed HIV-positive patients seen in the Ocular Infectious Disease Clinic of Maharaj Nakorn Chiang Mai Hospital from March 1, 2000 through February 28, 2001. A complete ophthalmic examination was performed on each patient together with a systemic evaluation of present illness and current medications.

Results: Three-hundred and ninety-five HIV-positive patients were seen for ophthalmic evaluation.