Clinical predictors for the aetiology of peripheral lymphadenopathy in HIV-infected adults.

OBJECTIVES: The aim of the study was to determine the aetiology and clinical predictors of peripheral lymphadenopathy in HIV-infected individuals during the antiretroviral (ARV) era in a nontuberculosis endemic setting. METHODS: A multicentred, retrospective cohort study of peripheral lymph node biopsies in HIV-positive adults was carried out. A total of 107 charts were identified and reviewed for clinical features, lymphadenopathy size, and ARV use and duration. Biopsy results were categorized, and multivariate logistic regression determined independent predictors of lymphadenopathy aetiology. RESULTS: Evaluation of 107 peripheral lymph node biopsies revealed that 42.9% of peripheral lymphadenopathy was attributable to malignancy, 49.5% to reactive changes, and 7.5% to infections, with only 2.8% of all cases secondary to tuberculosis. Fevers, weight loss, ARV use, and lower viral loads are significantly associated with nonreactive lymphadenopathy. CONCLUSIONS: Lymphadenopathy is likely to be reactive or malignant in nontuberculosis endemic regions. Readily available clinical features can aid clinicians in predicting the underlying aetiology, those at risk for malignancy, and who to biopsy.

Surgical practice in a maximum security prison - unique and perplexing problems.

The practice of general surgery in a prison population differs considerably from that in a general surgical practice. We audited surgical consultations at the Mangaung Correctional Centre from December 2003 to April 2009. We found a high incidence of foreign object ingestion and anal pathology. Understanding the medical and social aspects of prison life facilitates the treatment of inmates with surgical problems.

The changing face of HIV/AIDS in treated patients.

The spectrum of complications emerging in successfully treated HIV-infected patients has dramatically changed since the advent of HAART. Typical AIDS-defining illnesses have been substituted by new comorbid conditions that threaten even those patients who maintain virologic suppression. Proper management of cardiovascular risk, and early diagnosis of AIDS-related and, particularly, non-AIDS-related malignancies (including papilomavirus-related neoplasms) must be introduced into the routine of care. Hot areas of investigation include HIV-associated neurocognitive disorders, hepatitis B and C coinfection, non-alcoholic fatty liver disease, progressive multifocal leukoencephalopathy and tuberculosis. Bone and kidney long-term toxicities and lipoatrophy remain as issues of paramount importance. The identification and early treatment of immune reconstitution disease is also of major interest, specially in those patients starting their antiretroviral treatment with severe CD4 cell depletion. The present review focuses on these twelve areas of increasing interest for physicians currently facing successfully treated HIV+ patients.

[Prevalence of neurological complications in Japanese patients with AIDS after the introduction of HAART].

We investigated trends in neurological complications of infection with human immunodeficiency virus (HIV) in Japan after the introduction of highly active antiretroviral therapy (HAART). Two questionnaire surveys were performed in hospitals treating acquired immunodeficiency syndrome (AIDS) to compare two periods: immediately after the introduction of HAART (1999-2001); and a few years later (2002-3). Neurological complications accompanied 15.9% in 1999-2001 and 9.8% in 2002-3. Neurological complications developed without HAART in about 80% of cases. Neurological complications developed as the first AIDS-defining disease for 8.3% of AIDS patients in 1999-2001 and for 5.4% in 2002-3. Prevalences of HIV encephalopathy and myelopathy decreased markedly over the study period, as reported in other developed nations. However, prevalences of cytomegalovirus encephalitis, PML and primary brain lymphoma did not decrease. PML and primary brain lymphoma occurred in patients who received HAART and whose CD4 counts were relatively high during the study period. This is probably related to the extended survival of HIV-infected individuals after the introduction of HAART as a worldwide therapy, and the reactivation of viremia or latent infection persisting within the central nervous system.

Risk Factors for tuberculosis among human immunodeficiency virus-infected persons. A case-control study in Belo Horizonte, Minas Gerais, Brazil (1985-1996)

The objective of this study was to identify tuberculosis risk factors and possible surrogate markers among human immunodeficiency virus (HIV)-infected persons. A retrospective case-control study was carried out at the HIV outpatient clinic of the Universidade Federal de Minas Gerais in Belo Horizonte. We reviewed the demographic, social-economical and medical data of 477 HIV-infected individuals evaluated from 1985 to 1996. The variables were submitted to an univariate and stratified analysis. Aids related complex (ARC), past history of pneumonia, past history of hospitalization, CD4 count and no antiretroviral use were identified as possible effect modifiers and confounding variables, and were submitted to logistic regression analysis by the stepwise method. ARC had an odds ratio (OR) of 3.5 (CI 95 per cent - 1.2-10.8) for tuberculosis development. Past history of pneumonia (OR 1.7 - CI 95 0.6-5.2) and the CD4 count (OR 0.4 - CI 0.2-1.2) had no statistical significance. These results show that ARC is an important clinical surrogate for tuberculosis in HIV-infected patients. Despite the need of confirmation in future studies, these results suggest that the ideal moment for tuberculosis chemoprophylaxis could be previous to the introduction of antiretroviral treatment or even just after the diagnosis of HIV infection.

Predominance of HIV-1 among patients with AIDS and AIDS-related complex in Ghana.

We determined the prevalence of HIV among AIDS and AIDS-Related Complex (ARC) patients seen within one year in two hospitals in southern Ghana. Subjects were screened by an ELISA procedure for anti-HIV antibodies. Specific identification of the HIV type was done with a particle agglutination (PA) kit. All PA-determined dual specimens were then confirmed by Western blotting and Pepti-Lav 1/2 monoepitope kit. Virus isolation was attempted from symptomatic patients by co-culturing patient peripheral blood monocyte cells (PBMCs) and CD4+ cell lines. PBMCs and HIV isolates were characterised by PCR. By ELISA, 43.5% of the subjects (253) had anti-HIV antibodies. Of these, 61 (24%) were HIV-1 positive and 42 (18.6%) were dually reactive by PA. However, only 19% were confirmed as true dually-infected cases by western blotting and Pepti-Lav through all 42 samples were HIV-1 positive on the two tests. No subject was infected with HIV-2 alone. Three viruses were isolated. By PCR two of them had both HIV-1 and HIV-2 proviral sequences while the third virus was HIV-1 only. HIV-1 prevalence now predominates over HIV-2 implying a switch in the HIV infection pattern in Ghana. Furthermore mixed infections exist. The predominance of HIV-1 infection in Ghana may indicate a similar trend in other parts of West Africa.

PIP: Recent studies have suggested that HIV-2 infection is becoming less prevalent in Ghana, while the prevalence of HIV-1 is increasing. To confirm such a modification in the HIV infection profile in Ghana, a 1-year serologic and molecular study was conducted among 253 patients from 2 hospitals in southern Ghana (Accra and Dzodze in the Volta region) with confirmed or suspected AIDS. All 253 serum specimens were screened with enzyme-linked immunosorbent assay (ELISA) and particle agglutination (PA); the 42 dually reactive specimens were subsequently confirmed by Western blot and Pepti-Lav tests. By ELISA, 110 samples (43.5%) were positive for anti-HIV antibodies; this rate was 39.2% in Accra and 81.0% in the Volta region. Of these, 61 (24.1%) were HIV-1 positive and 42 (18.6%) were dually reactive by PA. No case of HIV-2 alone was detected. Most dually reactive cases were a cross-reaction between genetically similar regions of the 2 HIV types. Only 19% of the 42 PA-diagnosed dually reactive specimens were confirmed by Western blot and Pepti-Lav as true cases of HIV-2 only infection, and all these specimens were strongly positive for anti-HIV-1 antibodies. 3 viruses were isolated. By polymerase chain reaction, 2 had both HIV-1 and HIV-2 proviral sequences, while the third was HIV-1 only. This study's findings provide support for the hypothesis that most individuals with antibodies to both HIV-1 and HIV-2 are probably infected with HIV-1 alone. Intensified population surveillance aimed at isolating more HIV strains in West Africa could reveal the true extent of HIV genomic variation and facilitate the design of more specific diagnostic kits.

The increased burden of tuberculous lymphadenitis in central Africa: lymph node biopsies in Lusaka, Zambia, 1981 and and 1990.

In order to assess the effect of the HIV epidemic on lymph node biopsies in Central Africa, HIV-1 serology was tested on a cohort of patients undergoing node biopsy in Lusaka in 1990, and the histology of all lymph nodes biopsied in Lusaka in 1981 and 1990 was reviewed. One hundred and eighteen lymph nodes were biopsied in 1981 and 351 in 1990. Cases of tuberculous lymphadenitis increased from 52 (31 children and 21 adults) in 1981 to 186 (22 children, 160 adults, four patients unknown age) in 1990. Sixty-eight of 77 adults (88%) with tuberculous lymphadenitis in 1990 tested HIV-positive. Cases of histology suspicious of primary HIV lymphadenopathy and nodal Kaposi's disease also increased. Cases of malignant lymphadenopathy and overall number of surgical biopsies remained equivalent for 1981 and 1990. The study concludes that the HIV epidemic has led to a large increase in diagnostic lymph node biopsies in Lusaka, mostly through an increase in HIV-related adult tuberculous lymphadenitis.

Importance of human immunodeficiency virus-associated lymphadenopathy and tuberculous lymphadenitis in patients undergoing lymph node biopsy in Zambia.

The relative importance of human immunodeficiency virus (HIV)-associated lymphadenopathy amongst patients presenting for lymph node biopsy in Central Africa is unknown. HIV-1 serology and histology of patients undergoing superficial lymph node biopsy during 1989-1990 in Lusaka, Zambia, were examined in a prospective cohort study of HIV serology and by retrospective review of laboratory records. Of 727 lymph nodes biopsied in Lusaka in 1989-1990, 380 (52 per cent) showed tuberculous lymphadenitis, 160 (22 per cent) histology suggestive of primary HIV lymphadenopathy and 66 (9 per cent) nodal Kaposi's disease. HIV serology was tested in 280 adults and was positive in 91 per cent (255 patients), including 89 per cent (153 of 171) of those with tuberculous lymphadenitis, 98 per cent (63 of 64) of those with histology suspicious of primary HIV lymphadenopathy and all (24 of 24) with nodal Kaposi's disease. Other HIV-associated lymphadenopathy included nodal lymphomas and lymphoepithelial cysts. HIV serology was tested in 22 children and was positive in eight, including four of 14 with tuberculous lymphadenitis. It is concluded that HIV-associated lymphadenopathy, especially tuberculous lymphadenitis, is very common amongst patients presenting for lymph node biopsy in Central Africa.

PIP: Data from a prospective cohort study conducted during 1989-1990 of HIV serology and from a retrospective review of laboratory records of 727 patients presenting for superficial lymph node biopsy at the University Teaching Hospital in Lusaka, Zambia, were analyzed to determine the relative significance of HIV-associated lymphadenopathy among patients undergoing lymph node biopsy. 380 (52%) of the 727 biopsy patients had tuberculous lymphadenitis (secondary HIV lymphadenopathy). Another 160 (22%) had presumed primary HIV lymphadenopathy. The remaining 66 (9%) had nodal Kaposi's disease. 280 adults were tested for HIV antibodies. 91% tested positive for HIV. The HIV rate was 89% for patients with tuberculous lymphadenitis, 98% for suspected primary HIV lymphadenopathy cases, and 100% for those with nodal Kaposi's disease. As for the 22 children 0-16 years old, 8 were HIV positive. 50% of HIV-positive children who underwent lymph node biopsy had tuberculous lymphadenitis. Three had suspected primary HIV lymphadenopathy and 1 had nodal Kaposi's disease. These findings show that HIV-associated lymphadenopathy, particularly tuberculous lymphadenitis, is very prevalent in patients undergoing lymph node biopsy. They stress the importance of investigating further HIV-positive patients with suspicious asymmetrical nodes in central Africa. Simple, appropriate methods (e.g., wide-needle aspiration) are needed for the diagnosis of tuberculous lymphadenitis in this region, with its dearth of facilities for surgery and histopathology.

Linfoma primario de intestino delgado relacionado al SIDA: informe de un caso / Primary lymphoma of the bowel related to AIDS: a case report

El linforma no Hodgkin es una neoplasia relacionada con el SIDA, cuya incidencia se incrementa a mayor duración de la infección por el VIH. Se presenta el caso de un hombre de 21 años de edad con diagnóstico de linfoma no Hodgkin inmunoblástico de células grandes, primario del yeyuno

Evaluation of commercially available assays for antibodies to HIV-1 in serum obtained from South African patients infected with HIV-1 subtypes B, C, and D.

Between 1984 and 1990, virus was routinely isolated and serum collected from patients diagnosed at hospitals in the Western Cape as suffering from AIDS or AIDS-related conditions (ARC). From these, 17 virus strains were selected at random for sequencing and molecular characterisation of the env gene. The strains were previously characterised as belonging to HIV-1 subtypes B, C and D. The purpose of the present study was to evaluate retrospectively the serological diagnosis of HIV-1 in these 17 South African patients. Thirteen anti-HIV screening assays, including 7 rapid/simple test devices (RTDs), 4 enzyme-linked immunosorbent assays (EIAs) and 2 Western immunoblot assays were evaluated. Using commercial EIAs, 16 serum samples were HIV antibody-positive and these results were confirmed by Western immunoblot analysis. Serum from one terminal AIDS patient was found negative with all the serological tests. Some RTDs gave false negative antibody reactions on specimens from patients infected with subtype D strains. To investigate the false negative antibody reactions, the polymerase chain reaction (PCR) was used to amplify, clone and sequence proviral DNA from the immunodominant gp41 region from 7 of the HIV-1 strains. Two patients, both subtype D strains (D214 and D482) with false negative results in the RTDs, showed a significant amino acid substitution, i.e., substitution of a histidine residue for leucine at env position 607. It was concluded that although there were false negative RTD reactions on patients with HIV-1 subtype D strains, the commercial EIAs tested are sensitive and are able to detect patients infected with HIV-1 subtypes B, C and D that are present in South Africa.

Differential reactivities of antibodies to HIV and HTLV-I in sera of suspected AIDS and ARC patients.

Sera collection from 255 clinically diagnosed AIDS and ARC patients were analyzed for antibodies to HIV and HTLV-I by Western blot and particle agglutination methods respectively. Antibodies to HIV were detected in 37.3% of the sera collected as compared to 5.5% for HTLV-I. Most (95%) of the HIV positive sera had dual reactivity to both HIV-I and HIV-2. Antibodies to HTLV-1 were more frequently detected in HIV positive sera (11.58%) than in HIV negative sera (1.88%). Conversely, antibodies to HIV were detected twice as frequently in HTLV-1 positive sera (78.6%) than in HTLV-1 negative sera (34.85%).

[Mucocutaneous pathology in HIV infection]. / Patologia cutâneo-mucosa na infecção pelo VIH.

Several infectious, neoplastic or inflammatory skin diseases, may be early manifestations of HIV infection. We reviewed the clinical data of 226 HIV seropositive male patients with cutaneous disease, from a total of 337 inpatients at the Infectious Diseases Unit--Department of Medicine 1--Curry Cabral Hospital, from 1985 to 1991. Some considerations are made about the most common dermatological disorders: oral candidiasis, seborrheic dermatitis, Kaposi's sarcoma, herpes simplex infection, drug-related skin disorders, herpes zoster and dermatophytosis. The high prevalence of cutaneous manifestations in HIV infection, the uncommon clinical findings and their occasional therapeutic problems, makes an early diagnosis essential.

Late manifestations of HIV in Asia and the Pacific.

PIP: Late-stage HIV infection is characterized by profound immunodeficiency with a progressive and irreversible decline in the CD4 count, functional impairment of cellular and humoral immunity, and evidence of increased viral replication, with the appearance of p24 antigenemia and increasing levels of beta(2)-microglobulin and neopterin. These changes are associated with increased susceptibility to many infections, the emergence of malignancies, and neurological complications due to the direct infection of neural tissue with HIV. In Australia, opportunistic infections and malignancies account for 75% and 18% of AIDS diagnoses, respectively. Opportunistic infections and neurological involvement usually occur late in the illness and may be associated with disturbances of function of each part of the neuraxis. The detailed clinical nature of the involvement has been described in several recent reviews and is probably not different in the Asia-Pacific region. The most common opportunistic infections in Australia are Pneumocystis carinii pneumonia (PCP), esophageal candidiasis, toxoplasmosis, CMV infection, atypical mycobacteriosis, and cryptococcal meningitis. There are few data from Asian countries, but it seems that the most common opportunistic infections are tuberculosis, PCP, systemic Penicillium marneffei infection, and cryptococcal meningitis. There is little information from Asia on neurological conditions. Tuberculosis is probably the most significant threat to public health in Asia and the Pacific. Its management and prevention require ongoing planning and resources. To that end, a collaborative effort is called for to help resource-poor countries. Mycobacterial, fungal, viral, and protozoal infections are discussed, along with consideration of neurological complications, malignant disease, and late manifestations of HIV infection in children.^ieng

Comparison of four commercial enzyme-linked immunosorbent and one agglutination assays for the detection of HIV antibodies in sera from Zimbabwe.

Sera from 871 AIDS and AIDS related complex patients were used to evaluate four ELISA and one agglutination assays. Commercial tests compared were Abbot, Wellcoyzyme, Biotest, Du Pont and Serodia. Wellcozyme and Serodia had the highest sensitivity (96.8 pc and 98.8 pc respectively) but the lowest specificity (53.3 pc and 46.5 pc respectively). Du Pont was the least sensitive test (89.1pc). Biotest and Abbot were comparable--Biotest had a higher sensitivity (93.2pc as compared with 90.6pc) but Abbot had a higher specificity (94.1 pc as compared with 89.1 pc). Thus, Abbott and Biotest both had a satisfactory high sensitivity and specificity and could thereby be recommended for use in screening of HIV-1 antibodies in south east Africa.

[Azidothymidine in the treatment of patients with human immunodeficiency virus infection and persistent generalized adenopathies]. / La azidotimidina en el tratamiento de los pacientes con infección por el virus de la inmunodeficiencia humana y adenopatías generalizadas persistentes.

The effectiveness and security of azidothymidine (AZT) in the treatment of patients with infection by the human immunodeficiency virus (HIV) and persistent generalized adenopathies (PGA), were assessed. Thirty six patients with HIV infection and PGA participate in the study. Eighteen were treated with AZT and the other 18 were included in the control group, since they did not accept the treatment. Both groups were homogeneous with respect to their clinical, immunological and virological characteristics. A common study protocol was used and the clinical, immunological and virological effectiveness was assessed. Lymphocyte subpopulations were quantified by flow cytometry, viral antigens were determined by sandwich-type ELISA and antibodies against viral proteins (anti-gp120, anti-gp160, anti-gp41, anti-gp24 and anti-p18) were detected by Western blot. Naranjo and Busto's algorithm was used for the causality of adverse effects. We did not observe any significant differences regarding the presence of infection and the evolution of AIDS in both groups. A positive response to thrombocytopenia was observed, more evident in patients under low doses of AZT. The small initial transitory improvement of the immunological parameters was not statistically significant. The viral antigen was not modified by the treatment. With respect to the behaviour of the several antibodies studied, no differences were observed. The initial doses of AZT had to be modified in 44% of patients due to their hematological toxicity, more frequent in the first stages of the treatment. In two patients, the treatment had to be finally discontinued due to severe neutropenia. 25% of patients showed mild to moderate gastrointestinal manifestations.(ABSTRACT TRUNCATED AT 250 WORDS)

The epidemiology of acquired immunodeficiency syndrome and associated tumours in Europe.

By the end of September 1991, more than 60,000 cases of acquired immunodeficiency syndrome (AIDS) had been reported to the World Health Organization (WHO) by 31 countries in the WHO European region. Most of the cases (58,280/60,485-96%) were recorded in western Europe, chiefly in five countries: France (16,552 cases), Italy (10,584), Spain (10,101), Germany (6,968) and the United Kingdom (5,065). From the first reports in 1981 of European cases of AIDS until 1987, AIDS spread faster in the northern and central areas than elsewhere in the European region. Since then, the spread of the epidemic has been remarkably more rapid in southern Europe, while in eastern Europe AIDS is still in an early phase. More than 70% of the cases among homosexual or bisexual men were from the northern part of Europe, while the cases among intravenous drug users (IVDUs) were concentrated in the southern European countries, principally Italy and Spain. Over time, an increasing proportion of cases was recorded among IVDUs and in heterosexuals. More than 10,000 patients in Europe were diagnosed as having Kaposi's sarcoma (KS) (14% of all AIDS cases) or non-Hodgkin's lymphoma (NHL) (3%) as the presenting clinical manifestation of AIDS. The possibility of predicting the evolution of the epidemic in Europe depends heavily on the development of unbiased monitoring systems for HIV infection in the general population (i.e. anonymous unlinked testing).

Pulmonary function in human immunodeficiency virus infection. A prospective 18-month study of serial lung function in 474 patients.

To investigate the development of a reduced DLCO in patients with HIV-related disease, we studied 474 HIV-seropositive patients and performed serial lung function measurements over 18 months. The mean values of DLCO at presentation were lower in patients with more advanced HIV disease compared with asymptomatic HIV-seropositive patients (DLCO 88% of predicted). When compared with the DLCO in asymptomatic HIV-seropositive patients, the DLCO had reduced values in patients with persistent generalized lymphadenopathy (PGL) (82% of predicted, p less than 0.05), acquired deficiency syndrome-related complex (ARC) (73% predicted, p less than 0.001), nonpulmonary Kaposi's sarcoma (KS) (72% of predicted, p less than 0.001), nonpulmonary complications of AIDS excluding KS (73% of predicted, p less than 0.001), pulmonary KS (63% of predicted, p less than 0.001), pulmonary mycobacterial infection (68% of predicted, p less than 0.05), pyogenic infection (70%, p less than 0.05), acute Pneumocystis carinii pneumonia (PCP; 49%, p less than 0.001), and following recovery from PCP (71%, p less than 0.001). Serial lung function measurements over 18 months revealed no change in DLCO within any patient group, and in particular there was no tendency for a gradual decline. Clinical deterioration due to the development of PCP was associated with a reduction in DLCO. Conversely, in patients recovering from PCP, there was a partial improvement in DLCO over 3 months. Zidovudine (AZT) use did not affect DLCO within any diagnostic group or the recovery in DLCO following PCP. However, cigarette smoking was associated with further reductions in DLCO in all patient groups and with an impaired recovery of DLCO following acute PCP.(ABSTRACT TRUNCATED AT 250 WORDS)

Natural history of advanced HIV disease in patients treated with zidovudine. The Zidovudine Epidemiology Study Group.

OBJECTIVE: To describe the natural history of advanced HIV disease in patients treated with zidovudine. DESIGN: Longitudinal, observational study. SETTING: Twelve academic and community-based sites. PATIENTS, PARTICIPANTS: Eight hundred and sixty-three patients with AIDS or AIDS-related complex (ARC) with a CD4+ lymphocyte count less than 250 x 10(6)/l, who first received zidovudine between 15 April 1987 and 14 April 1988. MAIN OUTCOME MEASURES: Survival, progression to AIDS and first development of specific opportunistic illness. RESULTS: Median survival after initiation of zidovudine therapy ranged from greater than 900 days in patients with a baseline CD4+ lymphocyte count greater than or equal to 150 x 10(6)/l to 560 days in patients with a CD4+ lymphocyte count less than 50 x 10(6)/1. Other factors associated significantly with poorer survival were diagnosis of AIDS (versus ARC), baseline age greater than or equal to 40 years, hematocrit less than 35%, and diminished functional status. In patients with ARC at enrollment, median time of progression to AIDS ranged from 810 days in patients with a CD4+ lymphocyte count greater than or equal to 150 x 10(6)/l to 310 days in patients with a CD4+ lymphocyte count less than 50 x 10(6)/l. Rates of development of specific opportunistic infections or neoplasms and HIV encephalopathy were determined for different baseline CD4+ lymphocyte count ranges. Myelosuppression was significantly more common in patients with CD4+ lymphocyte counts greater than or equal to 100 x 10(6)/l. Sixty-five per cent of patients with a CD4+ lymphocyte count greater than or equal to 100 x 10(6)/l and 51% with a CD4+ lymphocyte count less than 100 x 10(6)/l continued to receive zidovudine 2 years after starting therapy. CONCLUSIONS: We describe the natural history of a cohort of patients treated with zidovudine for advanced HIV disease. These CD4+ lymphocyte count-stratified estimates of disease progression should provide prognostic information useful in the clinical management of advanced disease and the design of future studies.

Disseminated tuberculosis in the acquired immunodeficiency syndrome era.

To assess the influence of human immunodeficiency virus type 1 (HIV)-induced immunodeficiency on the clinical, radiographic, and pathologic features of disseminated tuberculosis (TB), we studied 79 patients presenting in 1984 through 1987 with miliary or focal disseminated disease due to Mycobacterium tuberculosis, as well as 4 additional non-HIV patients diagnosed after 1987. Clinically defined acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) was present in 51 (Group 1). A total of 20 had TB unrelated to HIV disease (Group 2). The remaining 12 were excluded because the role of HIV could not be determined. Clinical features were similar between groups aside from younger age; lower hemoglobin, total leukocyte, lymphocyte, and platelet counts; and more frequent tuberculin anergy (90 versus 40%) in AIDS/ARC patients (p less than or equal to 0.03). Chest radiographs showed a miliary pattern in about half of each group. Pleural effusion occurred only in AIDS/ARC patients (24%, p = 0.02), but intrathoracic lymphadenopathy was present in about a third of each group. Tissue biopsies (n = 70) usually revealed necrotizing granulomatous inflammation in each group, with a tendency to greater necrosis and more numerous acid-fast bacilli in Group 1. Granulomas were usually poorly formed in AIDS/ARC patients (59 versus 18%, p = 0.01). Autopsy of 9 AIDS/ARC patients with overwhelming miliary TB revealed a "nonreactive" histologic pattern with poorly organized or absent granulomas, extensive necrosis, and numerous bacilli. HIV-related disseminated TB causes a major constitutional illness with a high short-term mortality (25%).(ABSTRACT TRUNCATED AT 250 WORDS)

Major salivary gland lymphoepithelial lesions and the acquired immunodeficiency syndrome.

Presently, there is no consensus regarding the most appropriate diagnostic and therapeutic approach to patients with human immunodeficiency virus (HIV)-associated lymphoepithelial lesions of the major salivary glands. A retrospective review of 60 consecutive patients with lymphoepithelial lesions is presented. Thirty-eight cases were associated with HIV infection. Lesions associated with HIV infection were usually bilateral, multiple, cystic, and associated with lymphadenopathy. In contrast, in those cases without HIV infection, the lesions tended to be solitary and solid. In the HIV-infected group, treatment included surgery, radiotherapy, zidovudine (AZT), and/or cyst aspiration. All therapeutic regimens, other than aspiration alone, were found to be effective. Eighteen of the patients with HIV infection developed the acquired immunodeficiency syndrome (AIDS) during the study period. Surgical treatment is probably not necessary in the majority of HIV-associated cases. Depending upon individual circumstances, treatment with AZT or low-dose radiotherapy is recommended. A diagnostic and therapeutic algorithm is presented as a guide to the management of future cases.