A randomized trial of noninvasive positive end expiratory pressure in patients with acquired immune deficiency syndrome and hypoxemic respiratory failure.

BACKGROUND: Acquired immunodeficiency syndrome (AIDS) is a pandemic disease commonly associated with respiratory infections, hypoxemia, and death. Noninvasive PEEP has been shown to improve hypoxemia. In this study, we evaluated the physiologic effects of different levels of noninvasive PEEP in hypoxemic AIDS patients. METHODS: Thirty AIDS patients with acute hypoxemic respiratory failure received a randomized sequence of noninvasive PEEP (5, 10, or 15 cm H(2)O) for 20 min. PEEP was provided through a facial mask with pressure-support ventilation (PSV) of 5 cm H(2)O and an F(IO(2)) of 1. Patients were allowed to breathe spontaneously for a 20-min washout period in between each PEEP trial. Arterial blood gases and clinical variables were recorded after each PEEP treatment. RESULTS: The results indicate that oxygenation improves linearly with increasing levels of PEEP. However, oxygenation levels were similar regardless of the first PEEP level administered (5, 10, or 15 cm H(2)O), and only the subgroup that received an initial treatment of the lowest level of PEEP (ie, 5 cm H(2)O) showed further improvements in oxygenation when higher PEEP levels were subsequently applied. The P(aCO(2)) also increased in response to PEEP elevation, especially with the highest level of PEEP (ie, 15 cm H(2)O). PSV of 5 cm H(2)O use was associated with significant and consistent improvements in the subjective sensations of dyspnea and respiratory rate reported by patients treated with any level of PEEP (from 0 to 15 cm H(2)O). CONCLUSIONS: AIDS patients with hypoxemic respiratory failure improve oxygenation in response to a progressive sequential elevation of PEEP (up to 15 cm H(2)O). However, corresponding elevations in P(aCO(2)) limit the recommended level of PEEP to 10 cm H(2)O. At a level of 5 cm H(2)O, PSV promotes an improvement in the subjective sensation of dyspnea regardless of the PEEP level employed.

Genotypical diversity of HIV clades and central nervous system impairment / Diversidade genotípica dos subtipos de HIV e comprometimento do sistema nervoso central

The central nervous system (CNS) and the immune system are considered major target organs for HIV infection. The neurological manifestations directly related to HIV are acute viral meningitis, chronic meningitis, HIV associated dementia, vacuolar myelopathy and involvement of the peripheral nervous system. Changes in diagnosis and clinical management have changed the aspect of HIV infection so that it is no longer a fatal disease, and has become a chronic disease requiring sustained medical management. After HAART the incidence of most opportunistic infections, including those affecting the CNS, has dropped markedly. Some studies suggest that neurological involvement of infected patient occur with different frequency, depending on HIV subtype involved in the infection. Subtype C may have reduced neuroinvasive capacity, possibly due to its different primary conformation of HIV transactivating regulatory protein (Tat), involved in monocyte chemotaxis. This review focus on physiopathologic aspects of HIV infection in CNS and its correlation with HIV clades.

O sistema nervoso central (SNC) e o sistema imunológico são considerados os principais órgãos alvo na infecção pelo HIV. As manifestações neurológicas diretamente relacionadas ao HIV são meningites virais aguda e crônica, demência associada ao HIV, mielopatia vacuolar e envolvimento do sistema nervoso periférico. Mudanças no diagnóstico e sobrevida têm mudado o aspecto da infecção pelo HIV, não mais considerada uma doença fatal e sim crônica. Após HAART, a incidência da maioria das doenças oportunistas, incluindo aquelas que afetam o SNC, reduziu-se significativamente. Alguns estudos sugerem que o envolvimento de pacientes infectados ocorre com frequência diferente, dependendo do subtipo de HIV. O subtipo C apresenta uma capacidade reduzida de neuroinvasão, possivelmente devido a conformação primária da sua proteína reguladora da transativação (Tat), que perde sua capacidade quimiotáxica. Esta revisão aborda aspectos fisiopatológicos da infecção do HIV no SNC e subtipos de HIV.

Sarcoma de Kaposi asociado a VIH: uso de doxorrubina liposomal terapia antirretroviral de alta eficacia / Kaposi syndrome associated to HIV use of liposomal doxorrubicin high efficacy entirretroviral therapy

No existen criterios definidos para el tratamiento del sarcoma de Kaposi asociado a infección por VIH en la era de terapia antirretroviral de alta eficacia. Hay evidencias de regresión de lesiones cutáneas solamente con terapia antirretroviral sin quimioterapia; es muy poco probable que lesiones viscerales y mucosas respondan sin administración simultánea de quimioterapia. Estudio prospectivo en pacientes Kaposi de “bajo riesgo” y “alto riesgo”, tratando de definir el momento oportuno de quimioterapia simultáneamente con administración de terapia antirretroviral. 66 pacientes 28 (42 por ciento) T0I0S0, 6 (9 por ciento) T0I0S1, 8 (12 por ciento) T0I1S1, 5 (8 por ciento) T1I1S0 y 19 (29 por ciento) T1I1S1. Todos los pacientes T1, T0I1S1 y un tercio de T0I0S1 fueron tratados con quimioterapia (4 a 8 ciclos con doxorrubicina liposomal) ninguno de los pacientes T0I0S0 recibió quimioterapia. Total de 34 respuestas clínicas, 6 (18 por ciento) completas (3 T1I1S1, 2 T1I1S0, y 1 T0I0S1), 23 (68 por ciento) parciales (16 T1I1S1, 3 T1I1S0, 3 T0I1S1 y 1 T0I0S1) y 5 (14 por ciento) estabilizaron enfermedad (T0I1S1). Pacientes con tumor extenso (T1) requieren quimioterapia desde el diagnóstico, y administración de antirretrovirales. Pacientes con tumores localizados, con nivel células CD4 ≤200/μL (II), síntomas sistémicos requieren quimioterapia aproximadamente 2 a 3 meses después del inicio terapia antirretrovitral, ninguno de los pacientes con tumores localizados, sin síntomas sistémicos, y nivel células CD4 > 200/μL (I0) van a requerir quimioterapia, al menos durante un promedio de 20 meses.

At present there are no defined criteria for treating Kaposi´s sarcoma associated with HIV in the era of highly active antiretroviral therapy. Evidence of regression of cutaneous lesions with only retroviral high efficacy therapy without need of chemotherapy; nevertheless, it is very unlikely that visceral or mucous lesions respond to retroviral without simultaneous initiation chemotherapy. Prospective study in “low risk” and “high risk” Kaposi patients, trying to define the adequate moment for initiating the chemotherapy simultaneously with retroviral. 66 male Kaposi patients, 28(42 percent) T0I0S0, 6 (9 percent) T0I0S1, 8 (12 percent) T0I1S1, 5 (8 percent) T1I1S0 y 19 (29 percent) T1I1S1. All T1, T0I1S1 and a third of T0I0S1 patients were treated with chemotherapy (4 to 8 cycles with liposomal doxorubicin) but none of the T0I0S0 patients. 34 clinical responses, 6 (18) complete (3 T1I1S1, 2 T1I1S0, and 1 T0I1S1), 23 (68 percent) partial (16 T1I1S1, 3 T1I1S0, 3 T0I1S1, and 1 T0I0S1) and 5 (14 percent) stable disease (T0I1S1). All patients with extensive tumors require chemotherapy administration since the moment of diagnosis, together with retroviral high efficacy agents. Patients with localized tumors, CD4 cell levels ≤ 200/μL), and systemic symptoms will require chemotherapy in approximately 2 to 3 months period after initiation of retroviral, while none of patients with localized tumors, without systemic symptoms, and CD4 cell levels > 200/μL will require chemotherapy, at least in a mean 20 months follow-up period.

Genotypical diversity of HIV clades and central nervous system impairment.

The central nervous system (CNS) and the immune system are considered major target organs for HIV infection. The neurological manifestations directly related to HIV are acute viral meningitis, chronic meningitis, HIV associated dementia, vacuolar myelopathy and involvement of the peripheral nervous system. Changes in diagnosis and clinical management have changed the aspect of HIV infection so that it is no longer a fatal disease, and has become a chronic disease requiring sustained medical management. After HAART the incidence of most opportunistic infections, including those affecting the CNS, has dropped markedly. Some studies suggest that neurological involvement of infected patient occur with different frequency, depending on HIV subtype involved in the infection. Subtype C may have reduced neuroinvasive capacity, possibly due to its different primary conformation of HIV transactivating regulatory protein (Tat), involved in monocyte chemotaxis. This review focus on physiopathologic aspects of HIV infection in CNS and its correlation with HIV clades.

Tuberculous meningitis in HIV-infected patients in Brazil: clinical and laboratory characteristics and factors associated with mortality.

BACKGROUND: Tuberculous meningitis (TBM) is a growing problem in HIV-infected patients in developing countries, where there is scarce data about this co-infection. Our objectives were to analyze the main features and outcomes of HIV-infected patients with TBM. METHODS: This was a retrospective study of HIV-infected Brazilian patients admitted consecutively for TBM. All patients had Mycobacterium tuberculosis isolated from the cerebrospinal fluid (CSF). Presenting clinical and laboratory features were studied. Multivariate analysis was used to identify variables associated with death during hospitalization and at 9 months after diagnosis. Survival was estimated using the Kaplan-Meier method. RESULTS: We included 108 cases (median age 36 years, 72% male). Only 15% had fever, headache, and meningeal signs simultaneously. Forty-eight percent had extrameningeal tuberculosis. The median CD4+ cell count was 65 cells/microl. Among 90 cases, 7% had primary resistance to isoniazid and 9% presented multidrug-resistant strains. The overall mortality during hospitalization was 29% and at 9 months was 41%. Tachycardia and prior highly active antiretroviral therapy (HAART) were associated with 9-month mortality. The 9-month survival rate was 22% (95% confidence interval 12-43%). CONCLUSIONS: Clinical and laboratory manifestations were unspecific. Disseminated tuberculosis and severe immunosuppression were common. Mortality was high and the 9-month survival rate was low. Tachycardia and prior HAART were associated with death within 9 months of diagnosis.

Two specific strains of Histoplasma capsulatum causing mucocutaneous manifestations of histoplasmosis: preliminary analysis of a frequent manifestation of histoplasmosis in southern Brazil.

OBJECTIVES: Skin lesions, uncommon in US cases (<10%), occur in 38-85% of cases reported from Latin America. Although these differences may reflect reporting bias, delayed diagnosis, or differences in host immune response among different ethnic groups, they also could result from genetic differences changing the pathobiology of the organism. It is possible that genetic differences among strains of H. capsulatum may influence the pathogenesis and clinical manifestations of histoplasmosis. METHODS: We examined the clinical features of patients with mucocutaneous manifestations of histoplasmosis and performed genetic analysis based on nucleotide sequence variations in the internal transcribed spacer regions of rRNA genes of H. capsulatum isolates of patients. Two pairs of PCR primers were designed to develop and amplify the ITS regions of H. capsulatum, 5'-TACCCGGCCACCCTTGTCTA-3' and 5'-AGCGGGTGGCAAAGCCC-3'. These primers were based on the ITS sequence of Ajellomyces capsulatus, the ascomycetous teleomorph form of H. capsulatum, deposited in the GenBank (accession number U18363). Eight patients attending a tertiary-care hospital in southern Brazil were enrolled into the study. All case patients had skin cultures growing H. capsulatum at the mycology laboratory. RESULTS: Six of eight (75%) patients were HIV-positive and presented involvement of multiples organs by H. capsulatum. Two HIV-negative patients did not present evidence of involvement of other organs besides mucosa and skin. ITS sequencing of a DNA H. capsulatum fragment of 485-bp from isolates of 8 patients revealed two distinct strains. The 2 distinct fragments (Hc1, Hc2) differed from each other at 7 positions in the ITS regions. They were identical to strains of H. capsulatum isolated in patients from Colombia and Argentina, but different from strains isolated in US. Hc1 and Hc2 were isolated in 5 patients and 3 patients, respectively, with mucocutaneous manifestations of histoplasmosis. Both Hc1 and Hc2 strains were isolated in HIV-infected and non-HIV-infected patients. CONCLUSIONS: Mucocutaneous manifestations of histoplasmosis, which are frequently seen in Brazilian patients were caused by 2 specific strains in our institution. Those strains have been isolated in patients with these particular clinical features of histoplasmosis in Latin America. Our study suggests that unique pathogenic characteristics among the Latin American species of H. capsulatum might explain its increased dermatotropism.

Leprosy reversal reaction as immune reconstitution inflammatory syndrome in patients with AIDS.

We report 2 instances in which reactional borderline leprosy manifested itself as an immune reconstitution phenomenon in patients with acquired immunodeficiency syndrome. We discuss the clinical, laboratory-based, histopathologic, and immunohistochemical characteristics of both patients. Furthermore, we review similar reports from the literature.

Disseminated histoplasmosis in acquired immunodeficiency syndrome patients in Uberaba, MG, Brazil.

Histoplasmosis occurs in approximately 5% of acquired immunodeficiency syndrome (AIDS) patients in endemic areas and often evolves to a disseminated picture if diagnosis is delayed and/or CD4 count falls below 150 cells x mm(3) without high active antiretroviral therapy (HAART). This report presents clinical features of patients with histoplasmosis admitted from 1992 to 2005. Of the 57 individuals, 45 (79%) were male, aged 20-40 years; 30 (52.6%) presented histoplasmosis together with HIV diagnosis and 35 (61.4%) referred illness course up to 4 weeks. Fever, hepatomegaly and/or splenomegaly, dyspnea and skin lesions were noticed in 50 (87.7%), 38 (66.7%), 30 (52.6%) and 25 (43.9%) patients respectively. High levels of lactic acid dehydrogenase, X-ray lung interstitial pattern, pancytopenia and CD4 count <100 cells x mm(3) were observed in 48 (84.2%), 35 (66%), 34 (59.6%) and 33 (94%) patients respectively. Mycological diagnosis was performed by one or more methods in all patients. Thirty nine (68.4%) received amphotericin B and/or itraconazole. A cure rate was observed in 76.9% and nine (23.1%) died early during therapy. Otherwise death occurred in 18 (31.6%) before diagnosis was completed. Despite free HAART disposal in public Brazilian health services, histoplasmosis still occurs as the first AIDS baseline condition in patients without antiretroviral therapy, many of whom are not receiving any medical care for HIV infection.

Tuberculosis y SIDA en el niño / HIV associated tuberculosis in children

La reemergencia de la tuberculosis a nivel mundial se vincula a diferentes factores dentro de los cuales está la infección VIH, esto también se ve reflejado en la población pediátrica, planteando dificultades en el diagnóstico y tratamiento oportuno, lo que obliga a tratar a nuestros niños por un equipo multidisciplinario.

Pneumocystis jiroveci thyroiditis: report of 15 cases in the literature.

The authors review the epidemiology, clinical manifestations, diagnosis and treatment of Pneumocystis jiroveci thyroiditis of 15 cases reported in the medical literature. Patients with acquired immunodeficiency disease syndrome were particularly at risk. P. jiroveci thyroiditis was diagnosed at autopsy as a part of disseminated infection in a substantial number of patients without clinical manifestations and laboratory evidence of thyroid dysfunction. Local signs and symptoms of infection were indistinguishable from other infectious thyroiditis and included neck enlargement with or without cervical pain, sometimes associated with dysphagia and dysphonia, and clinical and laboratory features of hypothyroidism. Antemortem diagnosis of fungal thyroiditis was made by direct microscopy and culture of a fine-needle aspirate in most cases. As most patients with P. jiroveci thyroiditis had disseminated Pneumocystis infection with a delay in diagnosis and treatment, the overall mortality was high. Pneumocystis jiroveci thyroiditis is rare but should be suspected in HIV-infected patients with CD4 count lower than 200 cells micro(-1) on prophylatic inhalatory pentamidine who present with neck enlargement with or without pain, and clinical and laboratory evidence of hypothyroidism.

Clinical correlates of tuberculosis co-infection in HIV-infected children hospitalized in Peru.

INTRODUCTION: In developing countries, tuberculosis (TB) is responsible for almost 250,000 deaths among children yearly. Active TB in children with human immunodeficiency virus (HIV) infection is difficult to diagnose and progresses rapidly to death. The aim of this preliminary study was to investigate the prevalence and clinical correlates of TB-related illness among HIV-infected children admitted to an infectious diseases ward in Peru, a country where TB is highly endemic. METHOD: Forty-seven HIV-infected children admitted for a suspected infectious process in a Peruvian hospital were investigated for evidence of clinical tuberculosis by auramine stain, culture, and polymerase chain reaction (PCR) of clinical specimens. RESULTS: Eight children (17%) had evidence of tuberculosis, including five with positive cultures and three with positive PCR tests only. Weight loss was the only feature associated with a positive test for tuberculosis. Radiological changes were very common in both TB-positive and TB-negative groups and these changes were not useful to identify TB-positive cases. CONCLUSIONS: Weight loss may be used to identify high-risk HIV positive children who require more aggressive evaluation for tuberculosis. Radiological changes were common in both TB-positive and TB-negative groups.

[Cerebral aneurysm related to pediatric AIDS. Case report]. / Aneurisma cerebral asociado al síndrome de inmunodeficiencia adquirida en la infancia: descripción de un caso.

INTRODUCTION: Aneurysms, described in pediatric AIDS, are related with bad prognosis with high mortality in 5 months. The twenty reports found in literature were considered late (mean age 9.97 years old) and associated with severe immunological involvement. The mean CD-4 count was 79.17 cells and mean viral load 222,662 copies/mL. Some authors consider this complication associated to the human immunodeficiency virus (HIV), to an opportunistic agent (citomegalovirus and Mycobacterium avium) or due to inflammatory mechanisms related with the immunological improvement. CASE REPORT: This paper present a 9 years old girl with severe AIDS (C-3) and with transient amaurosis related to transient ischemic attacks on ophthalmic artery during her immunological improvement on viral load and CD-4 counts. Necropsy showed aneurysm due to atypical micobateriosis. CONCLUSION: This report highlights the occurrence of this rare but severe HIV complication witch was associated with an opportunistic etiology during an immunological recovery, when inflammatory mediators could play a role.

Paracoccidioidomycosis in patients with human immunodeficiency virus: review of 12 cases observed in an endemic region in Brazil.

OBJECTIVE: To study the clinical characteristics of 12 patients with paracoccidioidomycosis (PCM) and human immunodeficiency virus (HIV) infection. METHODS: The clinical manifestations, diagnosis, treatment, and outcome of PCM in 12 patients infected with HIV attended at a University Hospital of Mato Grosso do Sul, Brazil, were evaluated. RESULTS: All patients were men, mean age 36.1 years old, and 11 had a diagnosis other than PCM as the aids-defining illness. Lymph nodes were the organs most often involved (10 patients, 83.3%), followed by lung involvement, usually with an interstitial pattern (seven patients, 58.3%), papule-nodular skin lesions with central ulceration in six (50%) and ulcerated lesions of oral mucous membrane in five (41.6%) patients. Pleural involvement occurred in one patient who presented large pleural effusion beside a pathologic rib fracture caused by P. brasiliensis. Seven patients showed involvement in more than one extrapulmonary organ. In eight (66.6%) cases the diagnosis was established by direct microscopy of clinical specimens. All patients used trimethoprim-sulfamethoxazole and seven patients were also treated with amphotericin B. Eight patients died with progressive PCM manifestations. CONCLUSION: Our review demonstrates that PCM, an endemic systemic mycosis in Brazil, when associated with AIDS, behaves clinically as an opportunistic disease.

Cerebral toxoplasmosis in HIV-positive patients in Brazil: clinical features and predictors of treatment response in the HAART era.

A prospective study of 55 confirmed or presumptive cases of cerebral toxoplasmosis in HIV positive patients in Brazil was performed to describe clinical characteristics and to identify predictive factors for clinical response to the anti-Toxoplasma treatment. Cerebral toxoplasmosis led to the diagnosis of HIV infection in 19 (35%) patients, whereas it was the AIDS defining disease in 41 (75%) patients. Of these, 22 (54%) patients were previously know to be HIV-positive. At diagnosis of cerebral toxoplasmosis, only 4 (7%) patients were on highly active antiretroviral therapy (HAART), and 6 (11%) were receiving primary cerebral toxoplasmosis prophylaxis. The mean CD4+ cell count was 64.2 (+/- 69.1) cells per microliter. Forty-nine patients (78%) showed alterations consistent with toxoplasmosis on brain computed tomography. At 6 weeks of treatment, 23 (42%) patients had complete clinical response, 25 (46%) partial response, and 7 (13%) died. Alteration of consciousness, Karnofsky score less than 70, psychomotor slowing, hemoglobin less than 12 mg/dL, mental confusion, Glasgow Coma Scale less than 12 were the main predictors of partial clinical response. All patients were placed on HAART within the first 4 weeks of diagnosis of cerebral toxoplasmosis. One year after the diagnosis, all available patients were on HAART and toxoplasmosis prophylaxis, and only 2 patients had relapse of cerebral toxoplasmosis. In Brazilian patients with AIDS, cerebral toxoplasmosis mainly occurs as an AIDS-defining disease, and causes significant morbidity and mortality. Signs of neurologic deterioration predict an unfavorable response to the treatment. Early start of HAART seems to be related to better survival and less relapses.

Cytomegalovirus Glycoprotein B Genotypes and Central Nervous System Disease in AIDS Patients

To investigate any association between cytomegalovirus glycoprotein B (CMV gB) subtypes and central nervous system (CNS) disease in AIDS patients, proportions of different gB genotypes detected in AIDS patients with CNS disease were compared with the gB genotypes detected in AIDS patients with no neurological disorder. The patients were matched by CD4+ cell counts. CMV was detected by PCR in cerebrospinal fluid (CSF) samples obtained from AIDS patients with CNS disease and from urine and saliva samples obtained from AIDS patients without CNS disease. CMV strains obtained were digested by restriction enzymes HinffI and RsaI to classify the genotypes. The CMV gB genotype was determined in 26 CSF samples. Of these, 11/26 (42.3 por cento) typed as gB group 1, seven (26.9 por cento) as gB2, four (15.4 por cento) as gB3, and four (15.4 por cento) as gB4. The CMV gB genotype frequency distribution in the 42 AIDS patients without CNS disease showed that 18/42 (42.8 por cento) were classified as gB group 1, 10 (23.8 por cento) as gB2, seven (16.6 por cento) as gB3, and seven (16.6 por cento) as gB4. In the present study, no association was found between CMV gB genotypes and CMV-related central nervous system disease

Cytomegalovirus glycoprotein B genotypes and central nervous system disease in AIDS patients.

To investigate any association between cytomegalovirus glycoprotein B (CMV gB) subtypes and central nervous system (CNS) disease in AIDS patients, proportions of different gB genotypes detected in AIDS patients with CNS disease were compared with the gB genotypes detected in AIDS patients with no neurological disorder. The patients were matched by CD4+ cell counts. CMV was detected by PCR in cerebrospinal fluid (CSF) samples obtained from AIDS patients with CNS disease and from urine and saliva samples obtained from AIDS patients without CNS disease. CMV strains obtained were digested by restriction enzymes HinffI and RsaI to classify the genotypes. The CMV gB genotype was determined in 26 CSF samples. Of these, 11/26 (42.3%) typed as gB group 1, seven (26.9%) as gB2, four (15.4%) as gB3, and four (15.4%) as gB4. The CMV gB genotype frequency distribution in the 42 AIDS patients without CNS disease showed that 18/42 (42.8%) were classified as gB group 1, 10 (23.8%) as gB2, seven (16.6%) as gB3, and seven (16.6%) as gB4. In the present study, no association was found between CMV gB genotypes and CMV-related central nervous system disease.

[Acquired immunodeficiency syndrome by vertical transmission: neurological disorders]. / Sindrome de inmunodeficiencia adquirida por transmision vertical: alteraciones neurologicas.

INTRODUCTION: Forty million people are currently infected by HIV; of these, 50% are women and children. Vertical transmission occurs in 90% of the cases reported in the literature and was also observed by the authors of the present study at Hospital de Clínicas de Porto Alegre, Brazil, in the follow up of 340 HIV positive children since 1985. Transmission can occur during pregnancy (intrauterine) or during labor and delivery (intrapartum). In addition, HIV has been identified in the breast milk of infected mothers, which represents a contraindication for breastfeeding in these cases. Laboratory diagnosis is carried out using the following tests: ELISA, Western blot, and indirect immunofluorescence. DEVELOPMENT: Neurological manifestations in children may be divided into primary neurological diseases and secondary complications. Primary neurological diseases include both static encephalopathy, of slow evolution, and progressive encephalopathy, which affects neuropsychomotor development. The follow up of 340 children with AIDS showed encephalopathy in 32.5% of cases and delayed neuropsychomotor development in 42.5%. Opportunistic infections occurred in 33.8% of cases (one infant presented meningoencephalitis caused by Trypanosoma cruzi). One child presented lymphomas, 2.6% had cerebrovascular accidents, and 5% had peripheral neuropathies. Currently, 54 children of those followed since birth have over 10 years of age, and of these, 31 (57%) present neurological symptoms 40% with encephalopathy and 30% with neurological complications; the remaining children present educational, behavioral, and developmental difficulties. CONCLUSIONS: Several factors have influenced the natural history of AIDS in childhood, such as early diagnosis, drug regimen used, social, economic, and nutritional conditions, as well as health practices aimed at this population.

Differences in histoplasmosis in patients with acquired immunodeficiency syndrome in the United States and Brazil.

Demographic and clinical parameters among patients with acquired immunodeficiency syndrome and histoplasmosis in Brazil and United States were compared. The Brazilian isolates were typed by restriction-fragment length polymorphism analysis and were DNA fingerprinted by random amplification of polymorphic DNA (RAPD)-polymerase chain reaction (PCR). Skin lesions occurred in 66% of Brazilian case patients, compared with 1%-7% of US case patients. Of 21 treated case patients, 4 (19%) died, a rate similar to that of the US case patients (5%-13%). By nuclear gene typing, the Brazilian isolates were equally divided between South American classes 5 and 6, and RAPD-PCR showed 18 distinct genetic fingerprints in 20 isolates. Skin lesions are more common in infection with class 5 or 6 organisms than with class 2 Histoplasma capsulatum. The role of genetic differences in the organism as a cause for the clinical differences requires investigation.

Manifestações otológicas da Aids / AIDS otologic manifestations

A maioria dos pacientes com Aids apresenta manifestações em região de cabeça e pescoço, que podem inclusive representar sinais iniciais da infecção pelo HIV. O presente artigo descreve as principais manifestações otológicas encontradas nessa população, com seu quadro clínico e propostas de abordagem diagnóstica e terapêutica