Disseminated tuberculosis in the acquired immunodeficiency syndrome era.

To assess the influence of human immunodeficiency virus type 1 (HIV)-induced immunodeficiency on the clinical, radiographic, and pathologic features of disseminated tuberculosis (TB), we studied 79 patients presenting in 1984 through 1987 with miliary or focal disseminated disease due to Mycobacterium tuberculosis, as well as 4 additional non-HIV patients diagnosed after 1987. Clinically defined acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) was present in 51 (Group 1). A total of 20 had TB unrelated to HIV disease (Group 2). The remaining 12 were excluded because the role of HIV could not be determined. Clinical features were similar between groups aside from younger age; lower hemoglobin, total leukocyte, lymphocyte, and platelet counts; and more frequent tuberculin anergy (90 versus 40%) in AIDS/ARC patients (p less than or equal to 0.03). Chest radiographs showed a miliary pattern in about half of each group. Pleural effusion occurred only in AIDS/ARC patients (24%, p = 0.02), but intrathoracic lymphadenopathy was present in about a third of each group. Tissue biopsies (n = 70) usually revealed necrotizing granulomatous inflammation in each group, with a tendency to greater necrosis and more numerous acid-fast bacilli in Group 1. Granulomas were usually poorly formed in AIDS/ARC patients (59 versus 18%, p = 0.01). Autopsy of 9 AIDS/ARC patients with overwhelming miliary TB revealed a "nonreactive" histologic pattern with poorly organized or absent granulomas, extensive necrosis, and numerous bacilli. HIV-related disseminated TB causes a major constitutional illness with a high short-term mortality (25%).(ABSTRACT TRUNCATED AT 250 WORDS)

Population characteristics of tuberculosis in an HIV/AIDS registry from an East Harlem Hospital.

The recent increase of tuberculosis nationally and in New York City has been attributed in part to the progression of the acquired immunodeficiency syndrome (AIDS)/human immunodeficiency syndrome (HIV) epidemic. The East Harlem/South Bronx/Bushwick sections of New York City have an especially high incidence of tuberculosis. An HIV/AIDS registry (1986-1990) consisting of 1,312 patients from a community hospital serving East Harlem was examined for population characteristics associated with documented tuberculosis in the registrants. Tuberculosis affected males more commonly than females and was observed in comparable frequency in patients with AIDS-related complex (ARC) (12.9%) and AIDS (15.0%). The proportion of cases in blacks (18.3%) was significantly greater than that in Hispanics (10.4%, chi 2 = 15.196, p = 0.0003) or whites (8.7%, chi 2 = 5.62, p = 0.0171). Among intravenous (IV) drug users, the proportion of tuberculosis cases was also significantly higher in blacks than in Hispanics. These data could be consistent with a difference in exposure to tuberculosis and/or the purported racial susceptibility of blacks to tuberculosis infection. A review of new tuberculosis cases in East Harlem also suggests that blacks are at a greater risk for developing tuberculosis than Hispanics.

Factors associated with AIDS and AIDS-like syndrome among homosexual and bisexual men in Minas Gerais, Brazil.

A case-control study to determine factors associated with AIDS and AIDS-like syndrome among homosexual/bisexual men was conducted in the State of Minas Gerais (Brazil). Eighty-three per cent (45 patients) of all AIDS/AIDS-like syndrome cases in homosexual/bisexual men reported in Minas Gerais between February, 1986 and June, 1987 were compared to 133 seronegative controls seen at the same clinic. Blood samples were tested by ELISA and confirmed by Western blot. Sex with men from the USA, sex with someone who developed AIDS, number of male partners (greater than or equal to 100 lifetime), age (greater than or equal to 30 years old) and ethnicity (white) were independently associated with AIDS/AIDS-like syndrome (Odds Ratios = 5.5, 4.3, 3.9, 3.5 and 2.7, respectively). Thirty-nine per cent of cases and 44% of controls reported bisexual activity during the previous two years. From these, a high proportion reported anal intercourse with women in the same period (53% of bisexual cases and 33% of bisexual controls). Bisexual men had more male partners than female partners in the previous two years (median male partners = 20 for cases and five for controls; median female partners = three for both cases and controls). This explains in part why the epidemic has increased more rapidly among men then among women in Minas Gerais, despite the large proportion of bisexuals with the disease.

PIP: A case control study to determine factors associated with AIDS and AIDS- like syndrome among homosexual/bisexual men was conducted in the state of Minas Gerais, Brazil. 83% (45 patients) of all AIDS/AIDS-like syndrome cases in this group of men reported in Minas Gerais between February 1986-June 1987 were compared to 133 seronegative controls seen at the same clinic. Blood samples were tested by ELISA and confirmed by western blot. Sex with men from the US, with someone who developed AIDS, number of male partners ( or = 100 lifetime), age ( or = 30 years old), and ethnicity (white) were independently associated with AIDS/AIDS-like syndrome (odds ratio=5.5, 4.3, 3.9, 3.5, and 2.7, respectively). 39% of cases and 44% of controls reported bisexual activity over the previous 2 years. From these, a high proportion reported anal intercourse with women in the same period (53% of bisexual cases and 33% of bisexual controls). Bisexual men had more male partners than female ones in the previous 2 years (median number=20 for cases and 5 for controls; median number of female partners=3 for both cases and controls). This explains in part why the epidemic has increased more rapidly among men than women in Minas Gerais, despite the large proportion of bisexuals with the disease.

Update on the virology of AIDS

This article looks at the history, development, progress and research of the Human Immunodeficiency Virus (HIV) which causes AIDS. The author reports of the ongoing research into a vaccine for HIV, he examines the viral life cycle and indicates the points at which the virus can be attacked, and classifies antiviral strategies

[Acquired immunodeficiency syndrome and generalized lymphadenopathy in persons seropositive for the HIV virus]. / Sindrom priobretennogo immunodefitsita i generalizovannaia limfoadenopatiia u lits, seropozitivnykh k virusu HIV.

Of 20 examined Africans who were seropositive to HIV in the Western Blot technique, the syndrome of acquired immunodeficiency was found in 2, generalized lymphoadenopathy in 17; in one patient infection was asymptomatic. A decrease in the T-helper/T-suppressor ratio was noted in all the examinees, in 88% of the patients the Ig level was elevated. Each case was described.

[HLA typing in patients with chronic adenopathies in a population at risk for AIDS]. / Typage HLA chez des patients porteurs d'adénopathies chroniques dans une population à risque de SIDA.

HLA-A B and DR typing were performed in 77 patients with AIDS related complex (ARC)--69 lymphadenopathy associated syndrome and 8 thrombocytopenic purpura LAV/HTLV III related--and 21 symptom free homosexual males. A significant increase in the frequency of HLA DR5 antigen was observed in patients with ARC mainly in purpura thrombocytopenic patients. We suggest that increase of HLA DR5 antigen support the view that DR5 antigen could be one of the factors necessary at the spreading out clinical symptoms.