Regression of AIDS-related Kaposi's sarcoma following ritonavir therapy.

This paper describes a case report of an HIV-infected patient with mucocutaneous Kaposi's sarcoma (KS) with oral involvement, which presented complete clinical resolution of lesions on antiretroviral treatment with ritonavir, an HIV-1 protease inhibitor. Although it has still not been demonstrated that ritonavir has a specific antiviral action against HHV-8, a gamma herpesvirus probably involved in KS aetiopathogenesis, it has been proven that it reduces the HIV load significantly. This affects certain growth factors of KS, such as Tat protein and cytokines, and favours recovery of immune function, which correlates with protection against AIDS-defining conditions.

[The oxidative metabolic activity of the polymorphonuclear neutrophilic leukocytes in patients infected with the human immunodeficiency virus]. / Actividad metabólica oxidativa de los leucocitos polimorfonucleares neutrófilos en pacientes infectados por el virus de la inmunodeficiencia humana.

BACKGROUND: Contradictory results on oxidative burst activity in HIV infection have been reported in the literature. PATIENTS AND METHODS: Neutrophil oxidative metabolism was evaluated in 160 HIV-infected patients, by measuring the intracellular production of rhodamine. RESULTS: Neutrophil oxidative metabolism was decreased. This impairment was related to viral load, CD4+ lymphocyte counts, neutrophil counts and therapy. CONCLUSIONS: In HIV-infected patients, neutrophil oxidative metabolic activity decreases with disease progression. This may contribute to secondary opportunistic infections.

Quantitative and functional neutrophil deficiencies.

Neutrophil is a cell involved in the maintenance of homeostasis of the organism. It plays an important role in the elimination and control of certain pathogenic microorganisms. Deficiency in function and quantity of neutrophils, either due to congenital or secondary etiological extrinsic factors, lead to recurrent infectious processes of variable severity. The most frequent oral complications in these patients are ulcers, periodontal disease and candidiasis. Due to their high susceptibility to infections and the risk implied in undergoing surgical procedures, actions leading to a higher degree of prophylaxis must be carried out on these patients (oral hygiene habits, fluoridation, dietary advise, etc.). The use of granulocyte colony-stimulating factors (G-CSF) allows, in some cases, the fullfillment of some, until recently considered controversial dental procedures. Its administration demands an adequate selection of patients and a close collaboration between physician and dental practitioner. Despite G-CSF effectiveness, dental treatment in severe neutropenic patients must be carried out in a hospital and, in some cases, regardless of adequate care, the progress of periodontal disease cannot be avoided.

Remission of HIV-associated myelopathy after highly active antiretroviral therapy.

HIV-associated myelopathy is the leading cause of spinal cord disease in HIV-infected patients. Typically, it affects individuals with low CD4 T cell counts, presenting with slowly progressive spastic paraparesis associated with dorsal column sensory loss as well as urinary disturbances. Other aetiologies must be first ruled out before establishing the diagnosis. We report here the case of a 37-year-old woman with advanced HIV disease, who developed HIV-associated myelopathy. The patient showed a gradual improvement after beginning with highly active antiretroviral therapy and, finally, she achieved a complete functional recovery. In addition, neuroimaging and neurophysiological tests normalized.

[Paronychia in patients infected with HIV treated with indinavir]. / Paroniquia en pacientes infectados por el VIH tratados con indinavir.

A retrospective study of cases of paronychia associated with anti-retroviral therapy diagnosed in two general hospitals is here reported. Lesions appeared from 3 and 48 months after institution of therapy. At diagnosis, 84.6% of patients were on indinavir therapy. CD4 values ranged from 120 and 1,332 cells/mm3 and viral load was lower than 200 copies/ml in 92.3 of cases. Conservative therapy was applied in 7 patients and surgery in 6. In all patients indinavir therapy was discontinued, and cure was achieved 16 weeks later. The "retinoid" effect of indinavir is discussed as likely pathogenic explanation for this complications. We advocate for topic therapy and change of anti-retroviral therapy, reserving surgery for patients not responding to therapy. Pain and functional limitation caused by this non uncommon complication (1.6% of our patients treated with anti-retroviral agents) makes its knowledge necessary and an active search by clinicians in patients receiving indinavir therapy.

[A quick test of latex agglutination for diagnosing streptococcal pharyngitis and predictive value of the clinical picture]. / Test rápido de aglutinación de látex para el diagnóstico de faringitis estreptocócica y valor predictivo del cuadro clínico.

One hundred and sixty patients with symptoms suggestive of pharyngitis were prospectively studied. The responsible agent in 24% of the cases was streptococcus B haemolyticus group A (EGA) with a clear predominance of female (64%) over male (36%) patients. The greatest number of infections by S. Pyogenes was observed in the age group between 5 and 9 years. No positive cases were found in children less than 3 years old. Utilizing the quick latex agglutination test and comparing the results to those obtained with conventional cultures, a diagnostic fiability of 91% was reached, with 94% specificity, 82% sensibility, 82% PPV, and 94% NPV. These results together with the simplicity and convenience of the technique confirm the usefulness of this diagnostic method. No clinical symptom can be significantly related to streptococcus B haemolyticus pharyngitis. The diagnosis based on the clinical picture has turned out inefficient.

Response to standard syphilis treatment in patients infected with the human immunodeficiency virus.

In a study designed to evaluate the efficacy of penicillin in HIV-infected patients with syphilis and to determine the clinical and laboratory responses after treatment, 13 patients with HIV infection and syphilis were assessed at enrollment and at the last follow-up examination (median time of 21 months). The Venereal Diseases Research Laboratory (VDRL) test, the Treponema pallidum hemaglutination test, and leukocyte counts in cerebrospinal fluid were evaluated both at enrollment and at the last follow-up visit, and the polymerase chain reaction for Treponema pallidum DNA and the rabbit infectivity test were performed on cerebrospinal fluid samples at the last follow-up visit. Primary syphilis was confirmed in four patients, latent syphilis in five, and neurosyphilis in four. After penicillin treatment, all patients were asymptomatic. The serum rapid plasma reagin test became negative in five patients, and titers declined in eight. The VDRL test, Treponema pallidum DNA, and the rabbit infectivity test were negative in all 13 patients. Except for one patient whose serological titer was slow to decline, all patients had good clinical and serological responses to penicillin. In certain settings, factors other than penicillin treatment failure should be considered in HIV-infected patients with suspected relapse of syphilis.

Enfermedad de Kikuchi-Fujimoto en una portadora del VIH / Kikuchi-Fujimoto disease in an HIV carrier

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Paroniquia en pacientes infectados por el VIH tratados con indinavir / Paronychia in HIV-positive patients treated with indinavir

Presentamos un estudio retrospectivo de los casos de paroniquia, asociados a terapia antirretrovírica, diagnosticados en dos hospitales generales. Las lesiones aparecieron entre 3 y 48 meses desde el inicio de la terapia. El 84,6 por ciento de los pacientes se encontraban en tratamiento con indinavir en el momento del diagnóstico. La cifra de CD4 varió entre 120 y 1.332 cél/mm3 y la carga vírica fue inferior a 200 cop/ml en el 92,3 por ciento de los casos. Se realizó terapia médica conservadora en 7 pacientes y en 6 cirugía; en todos los casos se suspendió la terapia con indinavir, con lo que tras 16 semanas se consiguió la curación.Se discute el probable efecto retinoide-like del indinavir como probable explicación patogénica de esta complicación. Se preconiza la realización de terapia tópica y la modificación del tratamiento antirretrovírico, reservando la terapia quirúrgica para los casos refractarios. El dolor y la limitación funcional que produce esta complicación, no infrecuente (1,6 por ciento de nuestros pacientes tratados con antirretrovíricos), hace necesario su conocimiento y búsqueda activa por parte de los clínicos en los pacientes que reciben tratamiento con indinavir (AU)