Early brain atrophy in HIV infection: a radiological-stereological study.

Patients with the acquired immunodeficiency syndrome (AIDS) frequently develop neurological abnormalities, and atrophy has been reported in neuropathological studies of brains from patients with AIDS. Our aim was to see whether increased ventricular volume, indicating central cerebral atrophy develops at an early stage of HIV-infection, before patients are severely immunodeficient. We also wished to follow ventricular size over time and to investigate whether enlargement would be more marked in patients, who became clinically demented. We studied 32 HIV-seropositive men who had several CT studies. At the time of the first CT the patients were divided into two groups, an immunocompetent group (IC) with CD4 cell count >400 and an immunodeficient group (ID) with CD4 cell count <400. These were compared with a control group of 44 seronegative men. Subsequent CT studies were used to measure changes in ventricular size with time. Ventricular volume was estimated with an unbiased stereological method previously applied to CT. Mean (geometric) ventricular volume was 15 ml (6-54 ml) in the controls, 23 ml (10-72 ml) in the IC group and 27 ml (8-80 ml) in the ID group. The increase in size in both patient groups was statistically significant compared with controls: P=0.005 (IC) and 9 x 10(-5)(ID). Regression analysis of the follow-up CT studies showed a significant increase in volume in the HIV group (r=0.74, P=0.002), but not in the AIDS group (r=0.41, P<0.1).

Pneumocystis carinii in bronchoalveolar lavage and induced sputum: detection with a nested polymerase chain reaction.

To evaluate polymerase chain reaction (PCR) for detection of Pneumocystis carinii, 117 bronchoalveolar lavage (BAL) specimens, from HIV-infected patients undergoing a diagnostic bronchoscopy, were processed and a nested PCR, followed by Southern blot and hybridization with a P32-labelled probe was performed. The sensitivity and specificity were 85 and 100% 934/40 and 77/77) respectively. A non-radioactive labelling system BluGENE was evaluated on all specimens, and found to be as effective as P32-labelling. To increase the speed and convenience of detection, a dot blot system was tested, but sensitivity dropped markedly with this system. A further 33 patients had both induced sputum and bronchoalveolar lavage performed and the induced sputum was analysed using PCR and routine microbiological methods. The PCR sensitivity on induced sputum was equal to that of routine methods. At present the evaluated PCR cannot replace routine microbiological methods for detection of Pneumocystis carinii, on either BAL fluid or induced sputum.

The seroprevalence of hepatitis B and C in hospitalized Danish patients.

Health care workers are at risk of acquiring blood-borne infections. To assess the risk of exposure to hepatitis B or C in the case of occupational blood exposure, we determined the seroprevalence of these infections in 466 patients admitted to a Copenhagen university hospital. Serological markers for hepatitis B or C were detected in 56 patients (12.0%). The seroprevalence of HBsAg and anti-HCV was 0.9% and 1.5% respectively. HCV RNA, indicating ongoing hepatitis C, was found in five of seven anti-HCV-positive patients by polymerase chain reaction. The serological findings had not previously been diagnosed in 4 of 10 potentially infectious patients and only 6 of 10 patients belonged to high-risk groups. In conclusion, health care workers should be aware of the potential the occupational risk of hepatitis B and C even in a low-prevalence country like Denmark. Management of health care workers after blood exposure should include serological testing for both hepatitis B and C. Strict adherence to universal precautions is recommended and vaccination against hepatitis B should be encouraged.

Tumour necrosis factor and eicosanoid production from monocytes exposed to HIV in vitro.

We investigated the hypothesis that exposure of monocytes to human immunodeficiency virus (HIV) augments production of proinflammatory mediators. The production of tumour necrosis factor alpha (TNF-alpha) and the eicosanoids PGE2 and LTB4 from human monocytes was evaluated after exposure to two strains of HIV (SSI-002 or HIV-1IIIB). After 16 h incubation with low doses of SSI-002, lipopolysaccharide-stimulated TNF-alpha production was enhanced 70-85% while PGE2 production was decreased. Heat-inactivated virus failed to alter the production of these mediators. Higher viral doses tended to decrease TNF-alpha and PGE2 production concomitantly, but this might be due to toxicity. HIV-1IIIB had no effect on either TNF-alpha or PGE2 production. Calcium ionophore-stimulated LTB4 production was doubled by HIV-1IIIB, but significantly decreased by SSI-002. Three or seven days after exposure to both HIV strains, increased PGE2 production was found. In conclusion, HIV only modestly altered the production of mediators from monocytes. The effects were strain-specific. In most experiments a second stimulus was required to demonstrate differences.

[Cerebral toxoplasmosis primarily diagnosed as a tumor]. / Cerebral toksoplasmose primaert diagnosticeret som tumor.

Three cases of cerebral toxoplasmosis as the presenting manifestation of AIDS are reported. The initial diagnoses were brain tumors because of the cerebral mass lesions which resembled glioblastoma. In the light of the increasing occurrence of AIDS, attention is drawn to cerebral toxoplasmosis as a differential diagnosis from glioblastoma multiforme.