[HIV infection]. / HIV-Infektion.

The skin can be an indicator of decreased immunocompetence. Dermatological markers include new and extensive seborrheic eczema, psoriasis without a family history, widespread herpes zoster in young adults, oral hairy leucoplakia and mollusca in adults. In these cases an HIV test should be offered. During the last 15 years the clinical picture of HIV has changed dramatically. Almost every year new drugs with better efficacy, lower pill burden and less side effects have been approved. Life expectancy is close to normal in western countries. In spite of better treatment options, prevention is the key to stop the worldwide epidemic. Awareness campaigns have to account for the synergies between HIV and other sexually transmitted diseases. This poses a great challenge for dermatovenereology.

Treatment of condylomata acuminata with pegylated interferon alfa-2b in HIV-infected patients.

BACKGROUND: Interferon in a variety of topical, interlesional, and parenteral preparations has been used for condylomata acuminata (CA) in HIV negative patients. - STUDY GOALS: This open trial was initiated to determine the safety and efficacy of a new formulation of interferon, pegylated interferon-alpha2b (PEG-IFN, PegIntron in the treatment of recalcitrant CA in patients with HIV infection. - STUDY DESIGN: 22 HIV-1 infected patients in virologic steady state with clinically demonstrable anogenital CA were enrolled in this study (treatment group, n=12; control group, n=10). Patients in the treatment group received 80 microg PEG-IFN s.c. once a week for 24 weeks. Follow-up period was 6 month. The effects were assessed by a clinical scoring system (complete response; major response; minor response; stable disease; progression of disease). - RESULTS: 2 patients did not finish the study because of side effects. PEG-IFN was well accepted and completed by ten patients. Four patients revealed complete response, four patients had major response and two had minor response after PEG-IFN. In the control group, all patients showed progression of CA during the 24 weeks of this study (p < 0.001). 7/10 patients of the treatment group and 8/10 patients of the control received HAART. - While the differences of CD4 cell counts between treatment group and control group were not significant (increase of the mean CD4 cell count in the treatment group was 31.5 (75.33 without patient 1 with leucopenia under ribavirine), in the control group 69.75 CD4 cells), the HIV RNA decline in the PEG-IFN group was impressive (0.74 log subset10). Biological side effects of PEG-IFN treatment included flu-like symptoms, fatigue, local reaction, leucopenia, and increase of AST. This result makes an educated guess that PEG-IFN enhances the benefit of HAART. - CONCLUSION: PEG-IFN is an effective and safe therapy option in HIV infected individuals with CA with concomitant positive effects on the suppression of HIV-1 replication and CD4 cell count. It might be considered as an alternative in patients that have failed to standard therapies of CA and - at the same time -could improve the benefit of HAART to a great extent. This last hypothesis needs further research.

Prevalence of antibodies to HTLV-III in AIDS risk groups in West Germany.

The prevalence of antibodies to human T-lymphotropic virus III was determined in acquired immunodeficiency syndrome (AIDS) risk groups by an enzyme linked immunosorbent assay and confirmatory tests in four different areas in West Germany. Twenty-four of 28 homosexual AIDS patients (86%), 24 of 33 homosexual patients with lymphadenopathy syndrome or AIDS related complex (73%), and 44 of 113 asymptomatic homosexuals at risk for AIDS (39%) were seropositive. In three groups of hemophiliacs, 8 of 35 in 1983 (23%), 25 of 65 in early 1984 (39%), and 19 of 23 in late 1984 (83%) showed positive results. Two sera from 36 polytransfused patients were also positive, whereas 36 selected blood donors, and 32 healthy laboratory and clinical personnel were all negative. Also no human T-lymphotropic virus III antibodies were detected in sera of 187 prostitutes in the Munich area.

Immunopathology of AIDS (acquired immune deficiency syndrome) observations in 75 patients with pre-AIDS and AIDS.

Sequential changes in the morphology of immunocompetent and other organs, in the accompanying immunocytological and immunovirological measurements are described in 75 patients with lymphadenopathy syndrome and with AIDS. The data presented demonstrate a stepwise development of the disease from a hyperimmunization syndrome to T-cell immune deficiency. Excessive antigenic stimulation by a large number of infectious organisms or by transfusion of blood and blood products account for antigenic overloading and hyperimmunization. Among such infectious organisms are certain viruses which per se interfere with cells of the immune system as for instance Epstein-Barr virus, cytomegalovirus, and HTLV3. Developing immunological incompetence will favor the persistence of these and other infectious organisms enhancing the damage of the immune reactivity and finally allow lethal infections or malignant tumors to occur.

Dermatological diseases and signs of HIV infection.

Therapy of HIV infection has undergone significant changes since the introduction of highly-active antiretroviral therapy (HAART). Mortality and the appearance of opportunistic infections have significantly been reduced. Diseases of the skin and adjacent mucous membranes often provide the first signs for HIV infection. The spectrum of dermatologic findings related to HIV includes a variety of cutaneous and mucocutaneous disorders. The most frequent diagnoses are oral candidiasis, mollusca contagiosa, oral hairy leuokoplakia, herpes zoster and herpes simplex, seborrheic dermatitis, and Kaposi's sarcoma. Incompatibility reactions to drugs are observed on a strikingly frequent basis in HIV infection. Such severe incompatibility reactions are much more frequent in HIV patients than in the normal population. Inducers often include sulfonamides, cotrimoxazole, tuberculostatics as well as nucleoside-type reverse transcriptase inhibitors.

[Preventive pentamidine inhalation of Pneumocystis carinii pneumonia in patients with immune deficiency. Preliminary evaluation of a multicenter study]. / Pentamidin-Inhalationsprophylaxe der Pneumocystis-carinii-Pneumonie bei Patienten mit Immunschwäche. Zwischenauswertung einer multizentrischen Studie.

In the first evaluation of an uncontrolled multicenter study on inhalative pentamidine prophylaxis (300 mg pentamidine-isethionate monthly) of pneumocystis carinii pneumonia in immunocompromised patients, 48 patients (all 48 patients HIV1-infected, 36 without preceding pneumocystis carinii pneumonia (primary prophylaxis), twelve after pneumocystis carinii pneumonia (secondary prophylaxis); age 20 to 68 years (median 38); 45 male, two female, one unknown; 22 patients AIDS) were observed for 0 to 8.5 months (mean 4 +/- 2 months, intended observation time twelve months). No proven pneumocystis carinii pneumonia was found in the observed patients. One patient was treated with cotrimoxazole because of a suggested pneumocystis carinii pneumonia-relapse, which could not be proven. Out of seven (14.6%) patients, whose therapy was discontinued, three patients died, three refused further therapy, one patient had a relapse of a cerebral toxoplasmosis. Six patients (12.5%) reported adverse reactions (cough, metallic or bitter taste, slight nausea). New opportunistic infections appeared in four patients (8.3%).

[Therapeutic possibilities in HIV infection and AIDS]. / Therapeutische Möglichkeiten bei HIV-Infektion und AIDS.

Improvement regarding the diagnostics and therapy of secondary manifestations in HIV infection has had a positive influence on the quality of life as well as life-expectancy of AIDS patients. Early treatment with high doses, critical evaluation, and prophylactic therapy are of outstanding importance. Since recently, effective modes of antiretroviral therapy have been available. A number of cutaneous manifestations are valuable markers of incipient immunodeterioration, and thus can serve as indicative criteria regarding antiretroviral therapy. Whereas current possibilities of immunorestoration have been unsatisfactory as far, we expect more of the development of defined lymphokines and growth factors with defined and controllable effects.

[Skin changes in drug-dependent patients]. / Hautveränderungen bei Drogenabhängigen.

In parenteral drug abuse, cutaneous manifestations are very common. A variety of skin lesions are indicators of a possible drug addiction: obliteration of peripheral veins and hyperpigmentation of the overlying skin, punched-out scars due to subcutaneous injection, persistent edema following thrombophlebitis, and excoriations due to heroin pruritus. Infectious and non-infectious complications may be accompanied by typical skin alterations, such as ecthyma in sepsis caused by Pseudomonas aeruginosa, multiple ulcers due to embolic infarct, or hypersensitivity reactions mediated by an immunological process. A variety of serious complications may develop at the injection sites: abscesses, gangrene, necrosis, or necrotizing fasciitis. These examples show that the dermatologist is in many ways involved in the care for addicted patients. In addition, these patients frequently suffer from sexually transmitted diseases or blood-borne infections; HIV-infection is rapidly spreading in this group. We now face new problems of differential diagnosis, especially since constitutional symptoms of HIV-infection may mimic symptoms of drug abuse and vice versa. Moreover, immunological alterations similar to those in HIV patients may even occur in drug addicts who are not infected with the virus.

[Preliminary results of Re-PUVA therapy in cutaneous T-cell lymphomas]. / Vorläufige Ergebnisse der Re-PUVA-Therapie bei kutanen T-Zell-Lymphomen.

Eight patients with T-cell-lymphoma of the skin (6 mycosis fungoides, 2 parapsoriasis variegata) were treated with Tigason in combination with PUVA-therapy. The daily dose of Tigason was 50-100 mg. There was complete regression of skin lesions in three patients, partial regression in three patients, and an improvement in two patients.

[Psoriasis in HTLV-III-induced immunologic defect--status of cellular immunity and immunohistologic findings]. / Psoriasis bei HTLV-III-bedingtem Immundefekt--zellulärer Immunstatus und immunhistologische Befunde.

Four patients suffering from immune deficiency related to HTLV III developed psoriasis vulgaris. All patients showed lymphadenopathy and cutaneous hypergy or anergy. In three of them, the count of peripheral helper cells was critically decreased (less than 400/microliter), and they showed oral candidosis. One patient suffered from disseminated Kaposi's sarcoma and developed pneumocystis carinii pneumonia. The psoriasis was extensive, exsudative, and almost refractory to therapeutical approaches. The bulk of dermal infiltrating mononuclear cells were T lymphocytes, mostly the T 8 positive phenotype. The majority of these cells were HLA-DR positive, so were many epidermal cells. OKT6 positive epidermal Langerhans' cells were not diminished. Thus we observed the development of psoriasis in spite of severe disturbances of cellular immunity. We suppose that immune mechanisms mediated by T cells--after having got out of control--might play some role in the pathogenesis of the disease.

[Aseptic skin necrosis after subcutaneous injection of alpha interferon]. / Aseptische Hautnekrose nach subkutaner Injektion von Interferon-alpha.

Aseptic necrosis of the skin developed in two patients with HIV-associated disseminated Kaposi's sarcoma after subcutaneous injection of recombinant interferon-alpha. Both patients were given it at a daily dosage of 20 x 10(6) IU/m2 body surface area. One of the patients, after full remission had been achieved, received a reduced dosage of 3 x 10(6) IU/m2, twice weekly. The clinical picture and course of the changes were similar to those of embolia cutis medicamentosa (Nicolau's syndrome), which can occur after injection of various drugs, intended to be intramuscular but by mistake given intra-arterially.

[Marked regression of melanoma metastases under combined chemotherapy]. / Deutlicher Rückgang von Melanom-Metastasen unter kombinierter Chemotherapie.

We report a 60-year-old patient suffering from malignant melanoma and multiple cutaneous, lung, and intraabdominal metastases. After 6 series of combination chemotherapy ( BNCU , Hydroxyurea, Dacarbacin ), the metastases showed a remarkable regression. At present, the patient is in a nearly complete remission.

[Sporadic, endemic and AIDS-related Kaposi's sarcoma. Different clinical course variants of the tumor demonstrated by 3 typical cases]. / Sporadisches, endemisches und bei Immundefekt auftretendes Kaposi-Sarkom. Unterschiedliche Verlaufsformen des Tumors, dargestellt an drei exemplarischen Fallberichten.

We report on three patients suffering from Kaposi's sarcoma (KS) of the classical, endemic, and AIDS-related variant. We point out the uniformity of this tumor in terms of histomorphology. We found the characteristic findings of angiomatous structures and dense spindle cell formations. All variants of the tumor show histochemical and immunohistological evidence for a histogenesis probably from endothelial cells of venous capillaries. On the basis of our cases and the literature, we discuss to what extent cellular immunity may determine both the tumor biology and therapeutical considerations.