[Cytomegalovirus retinitis after highly active antiretroviral therapy: a case report]. / Retinitis por citomegalovirus tras terapia antirretroviral altamente activa: a propósito de un caso.

CASE REPORT: An HIV infected patient with cytomegalovirus retinitis with a CD4 lymphocyte count of 498 cells/mm3 after a good response to highly active antiretroviral therapy is described. COMMENT: Some aspects of the immune system after highly active antiretroviral therapy remain unknown. CD4 T lymphocyte count might not be a good marker to identify some patients at risk of developing cytomegalovirus retinitis after this therapy.

Retinitis por citomegalovirus tras terapia antirretroviral altamente activa: a propósito de un caso / Cytomegalovirus retinitis after highly active antiretroviral therapy: a case report

Caso clínico: Se describe a un paciente HIV positivo que desarrolló retinitis por citomegalovirus con un recuento de linfocitos CD4 de 498 células/mm3 tras una buena respuesta a la terapia antirretroviral altamente activa. Discusión: Algunos aspectos del funcionamiento del sistema inmune tras la terapia antirretroviral altamente activa permanecen desconocidos. El recuento de linfocitos CD4 podría no ser un buen marcador para detectar algunos pacientes con riesgo de sufrir retinitis por citomegalovirus tras este tratamiento (AU)

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Value of limited necropsy in HIV-positive patients.

We performed limited autopsy with histological examination of tissue cores obtained percutaneously using the Tru-Cut needle and the Jamshidi trocar in 150 adult HIV-positive patients. Data were compared retrospectively with the antemortem clinical diagnosis. Eighty-one percent of the patients were male, and 78% were intravenous drug users. Specimens were obtained from the brain, liver, lung, bone marrow, and kidney of most patients. The main findings included liver cirrhosis in 22 cases (associated with HCV infection in 81%), Pneumocystis carinii pneumonia in 21, Cytomegalovirus (CMV) infection in 19, Mycobacterium avium-intracellulaire (MAI) infection in 17, bacterial pneumonia in 14, tuberculosis in 12, and lymphoma in 13 cases. Forty-six (30.6%) patients had at least one clinical diagnosis that was confirmed by autopsy, i.e., there was 40.6% agreement between pre- and postmortem findings. Forty-six (30.6%) patients had at least one clinical diagnosis that was not confirmed at autopsy, whereas 41 (27.3%) had at least one AIDS-related or unrelated disease that was not suspected clinically. The results obtained by limited autopsy are principally comparable to those achieved by full necropsy, with the advantages of decreasing the contagious risk, saving cost and time, including a rapid final diagnosis, and easily obtaining the consent for postmortem examination so that necropsy studies may be performed on a larger number of patients, thus contributing to a better understanding of the spectrum of HIV infection in our environment.

[Tuberculin test in HIV infection]. / Prueba de la tuberculina en infección por HIV.

BACKGROUND: Intravenous infected-HIV drug abusers (IDAP/HIV+) are known to have a higher risk of tuberculosis (TB) than others. The effectiveness of tuberculin testing (Mantoux) in the detection of the TB infection in HIV(+) patients is probably lower than HIV(-) individuals. The aim of this paper is to assess tuberculin testing in the active search of cases of TB infection in IDAP individuals and their differences between HIV(+) and HIV(-) ones. METHODS: We studied 332 patients with intravenous drug use belonging to a therapeutic community and to in-patients. Tuberculin testing was performed on all of them. They were examinated if had been previously vaccinated with BCG and we carried out the counting of linfocites CD4 in HIV(+) ones. In the cases of negative tuberculin skin test a second test was administered after 7 days. The patients were grouped in HIV(+) and HIV(-) and the variables were statistically assessed by the chi 2 and a logistic regression model. RESULTS: Tuberculin testing resulted positive in 16.9% IDAP/HIV(+) in comparison with 39.9% of IDAP/HIV(-). The induration size was significantly smaller in HIV(+) than HIV(-) individuals. In both cases, we found that in BCG vaccinated patients positive tuberculin testing was significantly lower than negative tuberculin. The booster effect was detected in 8.9% of HIV(+), whereas in HIV(-) not BCG vaccinated it was of 21.4% and in HIV(-) BCG vaccinated it increased to 30.9%. When the level of the linfocites CD4 exceeds 500/mm3 in HIV(+) the percentage of Mantoux test (+) equals HIV(-) individuals. CONCLUSIONS: A decrease in sensitivity of tuberculin testing in the diagnosis of TB infection in IDAP/HIV(+) was detected. A high percentage of booster effect in IDAP was also demonstrated. We recommend the performance of tuberculin testing at the beginning of HIV infection.