Establishment and evaluation of a CT-based radiomic model for AIDS-associated pulmonary cryptococcosis.

BACKGROUND: Establish a CT-based diagnostic radiomic model for AIDS complicated with pulmonary cryptococcosis and evaluate the diagnostic efficacy of this model. METHODS: This retrospective study enrolled 98 AIDS patients with pulmonary cryptococcosis and 103 AIDS patients with other infections or neoplastic lesions, comprising a total of 699 lesions. Patients were randomly divided into a training group and test group at a ratio of 2.75:1. Features from all lesions, cavity lesions and solid nodule lesions were extracted, and two kinds of radiomic models (6 types) were established. ROC curves were drawn, and the sensitivity and specificity were calculated to compare the SVM model and LR model, radiologists' empirical diagnoses and the combination of these empirical diagnoses with the radiomic model. RESULTS: The AUCs of senior radiologist for all lesions and cavity lesions were lower than those of the SVM and LR models. The diagnostic efficacy of primary radiologist was lower than that of both of the other model types. The diagnostic efficacy of the LR model was relatively stable, with the highest diagnostic efficiency of the 3 model/radiologist groups. The AUCs of intermediate radiologist in combination with the LR radiomic model for all lesions, nodular lesions and cavity lesions were 0.88, 0.84, and 0.9, respectively, which were the highest among all models and radiologists. CONCLUSIONS: The CT-based radiomic LR model of AIDS-associated pulmonary cryptococcosis exhibits good diagnostic performance, which was similar to that of senior radiologists and higher than that of the primary radiologist. With the help of a radiomic model, radiologists can achieve improved diagnostic accuracy compared to that when only an empirical diagnosis is used.

Selected nanotechnologies and nanostructures for drug delivery, nanomedicine and cure.

The development of nanoparticle-based drugs has provided many opportunities to diagnose, treat and cure challenging diseases. Through the manipulation of size, morphology, surface modification, surface characteristics, and materials used, a variety of nanostructures can be developed into smart systems, encasing therapeutic and imaging agents with stealth properties. These nanostructures can deliver drugs to specific tissues or sites and provide controlled release therapy. This targeted and sustained drug delivery decreases the drug-related toxicity and increases the patient's compliance with less frequent dosing. Nanotechnology employing nanostructures as a tool has provided advances in the diagnostic testing of diseases and cure. This technology has proven beneficial in the treatment of cancer, AIDS, and many other diseases. This review article highlights the recent advances in nanostructures and nanotechnology for drug delivery, nanomedicine and cures.

[Lipodystrophy and echographic hepatic steatosis in HIV-positive patients under highly active antiretroviral therapy (HAART) in Yaounde (Cameroon)]. / Lipodystrophie et stéatose hépatique échographique chez les patients VIH positifs sous multithérapie antirétrovirale (ARV) à Yaoundé (Cameroun).

The association between sonographic liver steatosis and clinical lipodystrophy in AIDS patients treated by highly active antiretroviral therapy (HAART) has been studied. We conducted a cross-sectional study reviewing medical files of 117 AIDS patients followed up in Yaounde, Cameroon (6.3 F/1 M, mean age = 40 ± 9.4 years), and treated the patients with HAART protocol comprising stavudine or zidovudine for at least six months. All participants underwent abdominal ultrasonography and anthropometric assessment including body mass index (BMI). Data analysis included determining the association between sonographic liver steatosis, clinical lipodystrophy, and other clinical and biological data using the ¢(2) test, and the calculation of odd ratio. Fifty-one patients presented clinical lipodystrophy. The sonographic prevalence of hepatomegaly and splenomegaly was 70.1% and 25.6%, respectively. The overall prevalence of sonographic steatosis was 28.2%; specifically 37.3% among lipodystrophic patients and 21.1% among nonlipodystrophic patients (P = 0.03). According to the type of lipodystrophy, the prevalence was 40.6% among lipohypertrophic patients, 38.5% among lipodystrophic patients, and 16.7% among lipoatrophic patients. Clinical lipohypertrophy was statistically associated with a higher prevalence of sonographic steatosis (odd ratio = 2.5; 95% CI: [1.01-6.39], and P = 0.04). HAART protocol including stavudine was associated with lipodystrophy. The prevalence of sonographic liver steatosis is high among AIDS patients under HAART and is associated with lipohypertrophy.

Magnetic Resonance Features of Acquired Immune Deficiency Syndrome Involving Central Nervous System Diseases by Intelligent Fuzzy C-Means Clustering (FCM) Algorithm.

This study was aimed to explore the application of fuzzy C-means (FCM) algorithm in MR images of acquired immune deficiency syndrome (AIDS) patients. Sixty AIDS patients with central nervous disease were selected as the research object. A method of brain MR image segmentation based on FCM clustering optimization was proposed, and FCM was optimized based on the neighborhood pixel correlation of gray difference. The correlation was introduced into the objective function to obtain more accurate pixel membership and segmentation features of the image. The segmented image can retain the original image information. The proposed algorithm can clearly distinguish gray matter from white matter in images. The average time of image segmentation was 0.142 s, the longest time of level set algorithm was 2.887 s, and the running time of multithreshold algorithm was 1.708 s. FCM algorithm had the shortest running time, and the average time was significantly better than other algorithms (P < 0.05). FCM image segmentation efficiency was above 90%, and patients can clearly display the location of lesions after MRI imaging examination. In summary, FCM algorithm can effectively combine the spatial neighborhood information of the brain image, segment the BRAIN MR image, analyze the characteristics of AIDS patients from different directions, and provide effective treatment for patients.

PET/CT scanning with a high HIV/AIDS prevalence.

Positron emission tomography (PET) with [F-18]-fluoro-deoxy-glucose (FDG) has a well established and growing role in the management of most lymphomas. The interpretation of FDG PET scans in HIV positive patients is however challenging. This is largely due to scan changes giving a higher likelihood of false positive studies from both the direct effects of HIV and its treatment, and related to secondary HIV-related pathology. There is currently a need for further clinical research to evaluate to contribution of FDG PET in the management of HIV positive patients with lymphoma. In this paper existing studies related to FDG PET scanning in HIV positive patients will be reviewed, and potential pitfalls will be identified. These pitfalls can be avoided to some extent by the interpreter having a good clinical knowledge of the individual patients' condition, and an awareness of known scintigraphic patterns that can occur in these patients. PET remains a sensitive tool for the localisation of pathology, however when the exact nature of lesions has a direct bearing on patient management lesions need to be biopsied where possible. FDG PET can be particularly useful for the characterisation of brain lesions suspected to be related to primary central nervous system lymphoma.

Disseminated intraosseous Kaposi's sarcoma: A rare manifestation of HIV/AIDS.

Kaposi Sarcoma (KS), a mucocutaneous cancer that most frequently occurs in the context of Acquired Immunodeficiency Syndrome (AIDS) secondary to Human Immunodeficiency Virus (HIV), is a relatively benign condition, acting more as a marker of immunodeficiency than directly causing harm itself. However, it has been known to spread both locally and in a metastatic fashion, with reports of KS affecting almost all organ systems. One of the most rarely reported areas of involvement is the musculoskeletal system, with secondary osseous spread representing an even smaller subset of these. We report a case of biopsy proven disseminated intraosseous KS involving the entire imaged skeleton that occurred with HIV/AIDS, despite maximal treatment and normal imaging 8 months prior.

FDG-PET imaging in HIV-infected subjects: relation with therapy and immunovirological variables.

PURPOSE: To characterise tissue sites of immune activation and HIV replication we performed FDG-PET in ART-treated and ART-naive HIV-infected individuals. Specific aims were to establish whether HIV-infected patients can be differentiated on the basis of the detection of specific locations of viral replication, even in the presence of an apparently optimal immunovirological response to ART, and whether these FDG-PET findings can be related to immunovirological variables and AIDS history status. PATIENTS AND METHODS: Patients were divided into five groups as follows: subgroup A1 (full responders, n = 8): current ART treatment, CD4+ T lymphocytes >500/mL, viral load <50 copies/mL; subgroup A2 (full responders, n = 5): same criteria as A-1, but with a previous history of AIDS; subgroup A3 (immunological non responders, n = 5): current ART treatment, viral load <50 copies/mL, low CD4+ T lymphocytes (<200/mL); group B (virological non responders, n = 2): current ART treatment, CD4+ T lymphocytes around 500/mL, viral load >50,000 copies/mL; group C (ART-naïve, n = 5): no current or previous ART treatment, increased viral load. RESULTS: PET images revealed different patterns of FDG uptake. All ART-treated patients with either suppressed (<50 copies/mL; Group A) or high viremia (group B) showed a normal pattern of FDG uptake. On the contrary, the ART-naïve subjects with high viraemia (group C) displayed multiple foci of increased glucose metabolism in the lymph nodes. In the ART-naïve subjects, FDG uptake, apparently related to viraemia level, was observed in the upper torso mainly in the axillary nodes bilaterally in patients with viraemia below 100,000 copies/mL; in those with viraemia higher than 100,000 copies/mL, FDG uptake was also observed in the inguinal lymph nodes. CONCLUSIONS: The emergence, in our study, of a correlation between the percentage of CD8+/CD38+/RO+ T cells (well established markers of progression to AIDS independently of CD4+ T lymphocytes) and positive FDG-PET in ART-naive patients is a novel finding that seems to confer prognostic value on FDG uptake. FDG uptake is strongly associated with response to ART independently of a previous AIDS diagnosis. Notably, no differences were observed between ART-treated subjects classed as immunological responders and those classed as non responders. Data herewith indicate that FDG uptake and immunological variables are unrelated when ART is being administered. This is evidence of the complementarity of immunological and FDG measures. FDG uptake is a sensitive marker of disease state and its relation with CD8+/CD38+/CD45RO+ T cells indicates that it can be considered a marker of disease status. The lack of a correlation between FDG uptake and immunological variables in patients under ART warrants further investigation.

A comparative study on retinal thickness of the macular region among AIDS patients with normal ocular fundus, HIV-related microvascular retinopathy patients, and cytomegalovirus retinitis patients.

The present study aims to measure the retinal thickness of the macular region of AIDS patients with normal ocular fundus, HIV-related microvascular retinopathy patients and cytomegalovirus retinitis (CMVR) patients by optical coherence tomography, and generalize the characteristics of retinal thickness of these 3 groups of patients.In this retrospective case series, the study object comprised of 111 AIDS patients who received diagnosis and treatment in the Ophthalmology Department of Beijing Youan Hospital. There are 33 patients in the AIDS normal ocular fundus group, 47 patients in the HIV-related microvascular retinopathy group, and 31 patients in the CMVR group. The retinal thickness of the macular region of these above patients was measured. The main indicators were retinal thickness of 9 macular partitions, best corrected visual acuity, CD4+ T lymphocyte count, and the start of highly active antiretroviral therapy.In the CMVR group, except for the nasal-outer and temporal-outer sectors, the thickness of the affected eye of the rest of the regions was greater than that of healthy eye (P < .05). Furthermore, there was a difference in thickness of the superior-outer and inferior-outer sectors between the AIDS normal ocular fundus group and HIV-related microvascular retinopathy group. The difference in thickness of the superior-inner sector between patients in the AIDS normal ocular fundus group and CMVR group was not statistically significant, while the difference in thickness of the rest of the regions was statistically significant. The difference in thickness of various regions between patients in the HIV-related microvascular retinopathy group and CMVR group was statistically significant.The retinal thickness of patients in the CMVR group generally increased, the retinal thickness of superior-outer and inferior-outer sections of patients in the HIV-related microvascular retinopathy group increased, when compared to the AIDS normal ocular fundus group. These optical coherence tomography (OCT) examination results present its own characteristics in different eye diseases in AIDS patients, and different stages of eye disease.

Abdominal ultrasonography in HIV/AIDS patients in southwestern Nigeria.

BACKGROUND: Though the major target of the HIV-virus is the immune system, the frequency of abdominal disorders in HIV/AIDS patients has been reported to be second only to pulmonary disease. These abdominal manifestations may be on the increase as the use of antiretroviral therapy has increased life expectancy and improved quality of life. Ultrasonography is an easy to perform, non invasive, inexpensive and safe imaging technique that is invaluable in Africa where AIDS is most prevalent and where sophisticated diagnostic tools are not readily available. PURPOSE: To describe the findings and evaluate the clinical utility of abdominal ultrasonography in HIV/AIDS patients in Ibadan, Nigeria METHODS: A Prospective evaluation of the abdominal ultrasonography of 391 HIV-positive patients as well as 391 age and sex-matched HIV-negative patients were carried out at the University College Hospital, Ibadan. RESULTS: Of the 391 cases studied, 260 (66.5%) were females; the mean age was 38.02 years, (range 15-66 years). The disease was most prevalent in the 4th decade with an incidence of 40.4%. Compared with the HIV-negative individuals, the HIV+ group of patients had a significantly higher proportion of splenomegaly (13.5% vs. 7.7%; p < 0.01), lymphadenopathy (2.0% vs. 1.3%; p < 0.70), and renal abnormalities (8.4% vs. 3.8%; p < 0.02). There were no differences in hepatic and pancreatic abnormalities between the HIV+ and HIV- groups. There were significantly fewer gallstones in the HIV+ group (1.4% vs. 5.1%; p < 0.01). CONCLUSION: AIDS is a multi-systemic disease and its demographic and clinical pattern remains the same globally. Ultrasonography is optimally suited for its clinical management especially in Africa. Its accuracy and sensitivity may be much improved with clinico-pathologic correlation which may not be readily available in developing countries; further studies may provide this much needed diagnostic algorithms.

[Unusual venous thrombosis revealing a human immunodeficiency virus infection and a protein S deficiency. Two cases and literature review]. / Thromboses veineuses inhabituelles révélatrices d'une infection par le virus de l'immunodéficience humaine et d'un déficit en protéine S. A propos de deux cas et revue de la littérature.

The authors report two cases of unusual venous thrombosis associated with protein S deficiency in patients with the acquired immunodeficiency syndrome. The first case was a superior mesenteric vein thrombosis caused by HIV-1 infection associated with protein S deficiency in a 53-year-old patient. The second case was a cerebral venous thrombosis in a 34-year-old patient with HIV-1 and HIV-2 infections associated with protein S deficiency. None of the two patients were receiving antiretroviral therapy at the time of diagnosis. The evolution of thrombosis was favorable in both patients with heparin therapy and antivitamin K (AVK).

Temporal/compartmental changes in viral RNA and neuronal injury in a primate model of NeuroAIDS.

Despite the advent of highly active anti-retroviral therapy HIV-associated neurocognitive disorders (HAND) continue to be a significant problem. Furthermore, the precise pathogenesis of this neurodegeneration is still unclear. The objective of this study was to examine the relationship between infection by the simian immunodeficiency virus (SIV) and neuronal injury in the rhesus macaque using in vivo and postmortem sampling techniques. The effect of SIV infection in 23 adult rhesus macaques was investigated using an accelerated NeuroAIDS model. Disease progression was modulated either with combination anti-retroviral therapy (cART, 4 animals) or minocycline (7 animals). Twelve animals remained untreated. Viral loads were monitored in the blood and cerebral spinal fluid, as were levels of activated monocytes in the blood. Neuronal injury was monitored in vivo using magnetic resonance spectroscopy. Viral RNA was quantified in brain tissue of each animal postmortem using reverse transcription polymerase chain reaction (RT-PCR), and neuronal injury was assessed by immunohistochemistry. Without treatment, viral RNA in plasma, cerebral spinal fluid, and brain tissue appears to reach a plateau. Neuronal injury was highly correlated both to plasma viral levels and a subset of infected/activated monocytes (CD14+CD16+), which are known to traffic the virus into the brain. Treatment with either cART or minocycline decreased brain viral levels and partially reversed alterations in in vivo and immunohistochemical markers for neuronal injury. These findings suggest there is significant turnover of replicating virus within the brain and the severity of neuronal injury is directly related to the brain viral load.

Multiple Extradural Spinal Meningiomas in a Patient with Acquired Immunodeficiency Syndrome: Case Report and Literature Review.

BACKGROUND: Purely extradural spinal meningiomas are uncommon. Due to their typical location in the neural foramen, they are often mistaken for schwannomas, neurofibromas, and epidural metastases. In addition, comorbid conditions such as immunodeficiency may obscure the diagnosis. We present a case of extradural spinal meningiomas in a patient with human immunodeficiency virus (HIV). This is the first reported case of multiple extradural spinal meningiomas in 2 separate regions of the spine. CASE DESCRIPTION: A 40-year-old male with a past medical history of HIV and hepatitis B infection presented with a 2-month history of progressive back pain radiating to the left flank and thigh. Magnetic resonance imaging of the thoracic and lumbar spine with intravenous gadolinium contrast revealed 2 extramedullary masses in the left neural foramina of T6 and L1. The patient underwent laminectomy, which revealed that the 2 lesions were entirely extradural. Both lesions were resected, and the histological diagnosis for both lesions was meningioma, World Health Organization grade I. CONCLUSIONS: Our experience with this 40-year-old male with AIDS who presented with radicular symptoms due to multiple purely extradural meningiomas underscores the importance of considering meningioma as a possible diagnosis in patients with tumors of the neural foramina. In addition, a wide differential diagnosis should be made for patients with spinal lesions and history of HIV, including illnesses that are related to immunodeficiency and those that are not.

Pulmonary radiological characteristics in patients with HIV infection at the time of highly active antiretroviral therapy (HAART).

OBJECTIVE: To report on radiological and epidemiological characteristics of pulmonary disease in patients with HIV infection in times of highly active antiretroviral therapy (HAART). METHODS: Clinical data of 130 HIV infected adults with acute pulmonary symptoms were compared with findings in chest radiography (n = 130) and computed tomography (CT, n = 42). Presence and distribution of consolidation, interstitial changes, pleural effusion, and adenopathy were evaluated. Results were compared to findings from sputum, bronchoalveolar lavage, transbronchial biopsy, or empirical therapy results. RESULTS: 48% of patients presented pathologic findings. Overall sensitivity for the detection of pulmonary involvement was 0.87 (chest radiography) vs. 0.97 (CT). Disease specific sensitivity was 0.33 compared to 0.70. Bacterial pneumonia (BP, n = 26, 20%) was the most frequent diagnosis, followed by pneumocystis jiroveci pneumonia (PJP, n = 17, 13%), mycobacterium avium complex (MAC, 6%), Kaposi's sarcoma and lymphoma (KS and NHL, each 4%), fungal pneumonia (2%), and tuberculosis (TBC, 1%). Focal pulmonary infiltration was predominantly present in BP (50%, n = 13). Reticular (35%; n = 6) and micronodular (35%; n = 6) infiltration were predominantly found in PJP. CONCLUSIONS: Despite HAART, lung involvement is still common. Only contrast-enhanced computed tomography shows an acceptable disease-specific sensitivity. In unclear cases, CT should be performed.

Assessment of coronary artery calcium by chest CT compared with EKG-gated cardiac CT in the multicenter AIDS cohort study.

RATIONALE: Individuals with HIV are at increased risk for coronary artery disease (CAD). Early detection of subclinical CAD by assessment of coronary artery calcium (CAC) may help risk stratify and prevent CAD events in these individuals. However, the current standard to quantify CAC i.e. Agatston scoring requires EKG-gated cardiac CT imaging. OBJECTIVE: To determine if the assessment of CAC using non-EKG-gated chest CT and the Weston scoring system is a useful surrogate for Agatston scores in HIV-infected and HIV-uninfected individuals. METHODS AND MEASUREMENTS: CAC was assessed by both the Weston and Agatston score in 108 men enrolled in the Multicenter AIDS Cohort Study. RESULTS: Participants were 55.2 (IQR 50.4; 59.9) years old and 62 (57.4%) were seropositive for HIV. Inter-observer agreement (rs = 0.94, κ = 90.0%, p<0.001, n = 21) and intra-observer agreement (rs = 0.95, κ = 95.2%, p<0.001, n = 97) for category of Weston score were excellent. Weston scores were associated with similar CAD risk factors as Agatston scores (age, race, HDL cholesterol level, all p<0.05) in our cohort. There was excellent correlation (rs = 0.92, p<0.001) and agreement (κw = 0.77, p<0.001) between Weston and Agatston scores. CONCLUSIONS: This study is the first to examine calcium scoring using chest CT in HIV-infected individuals and to independently validate the Weston score as a surrogate for the Agatston score. In clinical or research settings where EKG-gated cardiac CT is not feasible for the assessment of coronary calcium, Weston scoring by using chest CT should be considered.

Arterial aneurysms in HIV patients: molecular mimicry versus direct infection?

There is growing literature on the subject of aneurysmal degeneration of arteries in patients who are infected with HIV. A patient recently seen at our medical center with an aneurysm of the carotid artery stimulated our interest in reviewing the mechanisms by which HIV may initiate or predispose to these pathologies. There are at least three major possibilities: (1) immunodeficiency allows bacteria that are known to cause mycotic aneurysms to proliferate without immune restraint; (2) one or more of the HIV envelope proteins sufficiently resemble one or more artery-specific-antigenic proteins (ASAPs) that may trigger an autoimmune response (molecular mimicry); and (3) the HIV virus itself infects arterial-resident cells that maintain the integrity of the load-bearing matrix. The computational searches reported here suggest that the ASAP, matrix cell adhesion molecule-1 (Mat-CAM-1), has a high degree of similarity to known ligands for HIV envelope proteins gp41 and gp120. No similarities of Mat-CAM-1 to the HIV envelope glycoproteins were detected. Accordingly, among the possibilities for explaining the HIV/aneurysm connection, direct infection of aortic fibroblasts by the HIV virus is more likely to be the pathogenetic mechanism than the process of molecular mimicry.

[Radiological features of AIDS complicated by pulmonary tuberculosis and the association with CD4+ T lymphocytes].

OBJECTIVE: To explore the imaging features in cases with AIDS complicated by pulmonary tuberculosis and the association with CD(4)(+) T lymphocytes. METHODS: A retrospective analysis was carried out of the manifestations of chest X-rays in patients with late stage AIDS complicate by pulmonary tuberculosis (n = 26 cases) and patients with pulmonary tuberculosis only (n = 60 cases). The results of measurements of CD(4)(+) T lymphocytes were compared. RESULTS: (1) The chest X-ray features in patients with AIDS complicated by pulmonary tuberculosis showed more patchy and blurring shadows (53.8% vs 8.3%; P < 0.01), more military changes (23.1% vs 5.0%; P < 0.05), more enlarged intrathoracic lymph nodes (34.6% vs 8.3%; P < 0.01) as well as more extra-pulmonary tuberculous processes (23.1% vs 3.3%; P < 0.05) as compared to patients with pulmonary tuberculosis alone. Fewer upper lung or apical lesions (23.1% vs 76.7%; P < 0.01), as well as less consolidation (11.5% vs 71.7%; P < 0.01) and cavity formation (7.7% vs 30.0%; P < 0.05) were found in AIDS patients. No significant difference was found in the occurrence of hydrothorax (11.5% vs 20.0%; P > 0.05). (2) The relative numbers of CD(4)(+) T lymphocytes in patients with AIDS complicated by pulmonary tuberculosis and in patients with pulmonary tuberculosis alone were (5.0 +/- 6.4)% and (65.3 +/- 1.5)% respectively. Atypical manifestations of tuberculosis were found in 15 out of the 26 cases of AIDS patients showing a CD(4)(+) T lymphocytic count < 50/microl, in 3 of the 4 cases with the count between 50/microl - 100/microl, while in cases with CD(4)(+)T lymphocytic count between 100/microl -200/microl (n = 4) and > 200/microl (n = 2), numbers of atypical tuberculosis were 2 and 0 respectively. CONCLUSIONS: The chest X-ray changes of tuberculosis in cases with late stage AIDS were mostly of the atypical pattern, and were related to a significant decrease in CD(4)(+)T lymphocyte count.

Chronic rhinosinusitis in HIV-infected patients: radiological and clinical evaluation.

UNLABELLED: The advent of protease inhibitors, which enhances the survival rate of HIV-infected individuals, leads patients to search for otorhinolaryngologists, as 40-70% of them may present some sort of otorhinolaryngological disorder. AIM: We aimed at comparing the CT scan findings and the nasosinusal complaints of HIV-infected and AIDS patients with clinical diagnosis of chronic rhinosinusitis. The literature on the subject is revised and discussed. STUDY DESIGN: Clinical prospective with transversal cohort. MATERIAL AND METHODS: Prospectively, 39 patients with chronic rhinosinusitis, in use of antiretroviral therapy, were included in the present study and divided into two groups: patients with diagnosis of AIDS (group I) and those infected by HIV (group II). Clinical and laboratorial assessments, with CD4+ cell count and CT evaluation, were performed and compared among groups I and II. RESULTS: Group I and II presented mean CD4+ cell count of 118 cells/10-9l and 377 cells/10-9l, respectively. Comparison of the tomographic findings by the Lund-Mackay staging system presented a score of 12 for group I and 5.63 (pd" 0.001) for group II. Fever and postnasal discharge were more prevalent in group I (pd" 0.001). CONCLUSIONS: In our Service, prevalence of chronic rhinosinusitis in HIV-infected patients was 12%. AIDS patients had a higher incidence of fever and postnasal discharge than those of group II. Moreover, extensive radiological findings were prevalent in patients with AIDS (group I) than in HIV-infected individuals (group II).

AIDS Presenting as Granulomatous Amebic Encephalitis: PET and MR Imaging correlation.

Granulomatous amebic encephalitis (GAE) is a rare and oftentimes fatal disease in immune compromised patients caused by free living amebae Acanthamoeba and Balamuthia. We report a patient in whom GAE secondary to Acanthamoeba was the initial presentation of acquired immunodeficiency syndrome in a 41-year-old male, and discuss the FDG positron emission tomography (PET) and magnetic resonance imaging findings that preceded the pathological diagnosis. The PET results provided complementary information when coupled with the MR brain findings. Improved understanding of the clinical and imaging findings of this deadly disease is the best hope for early diagnosis and treatment of this uncommon but deadly disease.

Fat distribution evaluated by computed tomography and metabolic abnormalities in patients undergoing antiretroviral therapy: preliminary results of the LIPOCO study.

BACKGROUND: Fat distribution abnormalities have been reported in patients treated with various antiretroviral drug regimens. The LIPOCO study is an ongoing observational study of unselected HIV-infected patients which aims to better characterize such disorders and their metabolic correlations. METHODS: Cross-sectional analysis of data collected at baseline in the first 154 male patients included. Investigators divided patients into four predetermined clinical categories of fat distribution: lipoatrophy, obesity, mixed condition and normal. Body composition (tetrapolar bioelectrical impedance analysis and skinfold thickness), fat distribution [computed tomography (CT) scan], plasma glucose and insulin concentrations both fasting and during an oral glucose tolerance test and endocrine and lipid profile were measured and compared between the four groups. RESULTS: Patients in the lipoatrophy group had significantly decreased abdominal and mid-thigh subcutaneous fat area values and elevated levels of plasma triglycerides. Patients in the obese and mixed groups had significantly increased intra-abdominal fat area values and elevated levels of plasma insulin and C-peptide. The CT scans identified some patients with isolated subcutaneous fat accumulation but no other alterations in fat distribution and no insulin resistance. Visceral adipose tissue measured by CT scan was positively correlated with fasting insulin and the sum of insulin levels (P < 0.0001). Fasting insulin as well as the sum of insulin levels were negatively correlated with the delta HIV-RNA (log(10)). In a multivariate logistic regression model, the use of stavudine significantly correlated with fat wasting in both nucleoside reverse transcriptase inhibitor and protease inhibitor groups: odds ratio (OR), 413 [95% confidence interval (CI), 5.2-999; P = 0.0068] and OR, 2.08 (95% CI, 0.92-7.0; P = 0.058) respectively, when compared with the use of zidovudine. Neither lamivudine or didanosine use, nor the use of protease inhibitors were significantly associated with fat distribution abnormalities or fat wasting. CONCLUSIONS: These preliminary results suggest that three major types of fat distribution abnormalities may occur in isolation or in association in HIV-infected patients undergoing active antiretroviral therapy: a fat depletion or 'lipoatrophy' syndrome which might be related to the use of stavudine; a mixed or fat redistribution syndrome related to an unusual side-product of effective virus control; and a subcutaneous adiposity syndrome reflecting increase in caloric intake.