Treatment of cryptococcosis with liposomal amphotericin B (AmBisome) in 23 patients with AIDS.

OBJECTIVE: To determine the safety and efficacy of liposomal amphotericin B (AmBisome) in the primary treatment of AIDS-associated cryptococcosis. DESIGN: A Phase II, multicentre, European, non-comparative, open study to assess the use of AmBisome in 23 patients (26 enrolments) with cryptococcosis. Dose requirements, mycological response and toxicity were documented. SETTING: Hospital-based HIV units. PATIENTS: Twenty-three HIV-1-seropositive patients. RESULTS: Drug toxicity, assessed in 25 enrolments, was well-tolerated with little renal, hepatic or haematological toxicity. Eighteen out of 23 (78%) enrolments responded clinically. Nineteen enrolments had cryptococcal meningitis: sterilization of spinal fluid was achieved in 12 out of the 18 (67%) who were mycologically evaluable. Fourteen out of the 19 (74%) responded clinically. CONCLUSION: AmBisome is well-tolerated and may be an effective formulation in the treatment of cryptococcosis.

Active replication of hepatitis B virus (HBV) in HIV type 1 and in HIV type 2 infected patients.

To evaluate the effect of concurrent infection by HIV on HBV infection or immunity, we have studied a group of 66 HIV1+ symptomatic Caucasian patients and another of 38 African HIV2+ asymptomatic individuals, concerning their HBV status: serological markers of infection and presence of HBV-DNA in serum, the last taken as sign of hepatitis B virus active replication, were monitored. HIV+ groups were compared with seronegative controls, adequately matched for age, sex and ethnological background. HBV DNA was found in 7.6% of HIV1+ Caucasian patients and 3.2% of seronegative controls; in African HIV2+ individuals 2.6% were also HBV DNA+, a percentage close to that found in HIV2 seronegative controls (2.9%). No correlation was found between HIV infection and HBV active replication. Immunodepression that follows HIV infection over time may be compatible with a degree of T cell function capable of avoiding reinfection with or reactivation of HBV, even in symptomatic stages of acquired immunodeficiency syndrome. Our findings are relevant to the choice of preventive strategies in populations at risk for HIV and HBV infection.

[Cerebral toxoplasmosis in AIDS patients, CT and MRI images and differential diagnostic problems]. / Toxoplasmose do SNC em doentes com SIDA, aspectos TC e RM e problemas de diagnostico diferencial.

Cranial computed-tomographies (CT) and magnetic resonance imaging (MRI) of 14 patients with AIDS and central nervous system toxoplasmosis (CNST) were reviewed. In spite of the low specificity of CT and MRI findings in CNS mass lesions of AIDS patients, there are some features which have been observed as more typical of CNST, namely: 94.9% of the lesions were round shaped and 94.5% had ring or nodular enhancement; 81.3% of the cases presented multiple lesions; 60.2% of the lesions were localized at the cerebral cortical or corticomedullary junction (100% of the cases showed at least 1 lesion in this localization); 34.6% of the lesions had less than 1cm in diameter.; on nonenhanced CT, 91.3% of the lesions were hypodense.; On T2-weighted MR images, 53.4% of the lesions had at least one hypointense zone on T2-weighted images. The existence of target-shaped lesions with hypointense centre on T2-weighted MR images (29.3% the observed lesions) is also suggestive of CNST, which, to our belief, had not been previously reported and will need confirmation with larger series. The visualization of iso/hyperdense lesions on nonenhanced CT or irregular shape lesions is uncommon in CNST. The finding of a solitary lesion, on CT or MR, it is not, by itself, a good criterion of differential diagnosis.

[Broncho-splenic fistula caused by hydatidosis]. / Fistula bronco-esplénica devida a hidatidose.

To our knowledge, this is the first case report of a broncho-splenic fistula of hydatid origin. We discuss the clinical, radiological and therapeutic aspects of this rare complication of hydatid disease.

[Verrucous herpes zoster in AIDS patients]. / Herpes zoster verrucoso em doentes com SIDA.

The authors describe a case of disseminated Herpes-Zoster (VZV) in an HIV 1 positive patient with AIDS. Hyperkeratotic characteristics, acyclovir resistance and sensitivity to foscarnet of cutaneous lesions are the most important features of this example. From the casuistics of the department, the authors describe two similar cases and review the medical literature with emphasis on etiopathogenic, diagnostic and therapeutic factors of lesions caused by DNA Virus in immunocompromised hosts.

[Immunologic profile of HIV-2 seropositive African individuals (follow-up)]. / Perfil imunológico de indivíduos africanos HIV-2 seropositivos (follow-up).

In the geographic distribution of HIV-2, it is known that this infection is most prevalent in West Africa. Since 1986 we have studied seropositive and seronegative clusters, in Guinea-Bissau with follow-ups in 1988, 1989, 1990 and 1991. Analysis of the results show the high incidence of this infection. 8.51% of the 4,372 people of the general population studied were seropositive, showing the high predominance of HIV-2 infection. Only 4 cases were exclusively reactive to HIV-1 and a slow evolution of HIV-1 infections. In the seroconversions of HIV-2 infections the antibodies appeared first to the core components and secondly to the surface glycoproteins. Some of the laboratory parameters affected in the evolution of the infection include a gradual increase in immunoglobulins and a decrease in CD4 lymphocytes and in the CD4/CD8 ratio. A comparison of these variations in HIV-2 infected people, with or without cross-reactivity to HIV-1, reveals that they are much more evident in exclusively HIV-2 positive people. This fact can indicate that the variants responsible for the cross-reactions are less pathogenic and phylogenetically less developed.

PIP: In 1986, a total of 4372 persons were included in an HIV-2 seroepidemiological study covering the whole of Guinea-Bissau. An 8.5% incidence of HIV-2 infection was revealed by the enzyme-linked immunosorbent assay (ELISA) confirmed by Western Blot and/or RIPA. Only 4 cases of HIV-1 seropositivity were found. Annual follow-up of 78 seropositive (e died of AIDS) and 320 seronegative individuals in 1988, 1989, 1990, and 1991 was initiated. In the present investigation, a total of 70 individuals were included: 19 were seropositive (6 with double reactivity) and 51 were seronegative. During this period there were 3 seroconversion cases among seronegative persons, and the appearance of double reactivity in 3 previously HIV-2 positive cases. The reexamination of sera before seroconversion indicated reactivity to the core proteins and in 3 cases to GP-160 or GP-140 surface glycoproteins. The average values of immunoglobulins increased, but the beta-2 microglobulin, and cytomegalovirus antibodies (CMV) did not differ in the sera of 1250 decreased patients compared with seronegative persons. In seropositives, a progressive diminution of the CD4 lymphocyte values and of the T4/T8 (CD4/CD8) ratio was observed which was much more evident in HIV-2 monoreactive patients than in double reactive patients. The interpretation of HIV-1 and HIV-2 double reactivity whether the result of a double infection or of an intermediate variant of the virus between HIV-1 and HIV-2 has not been reconciled with these results. These findings indicate that the variants responsible for double reactivity are less pathogenic, less adapted to the human host, and less developed phylogenetically.

Computer-assisted tomographic findings in a patient with African trypanosomiasis.

A 5-year-old boy was diagnosed to have trypanosomiasis and responded to treatment with diminazine. However, 22 months later symptoms recurred, with evidence of cerebral trypanosomiasis. Computer assisted tomography (CAT) scans were subsequently performed on three occasions. He was treated with melarsoprol and to date has made a full recovery. This paper reports on the evolution of the cerebral lesions shown up by the CAT scans.

Six new isolates of human immunodeficiency virus type 2 (HIV-2) and the molecular characterization of one (HIV-2CAM2).

We report the isolation of human immunodeficiency virus type 2 (HIV-2) from each of six West Africans with AIDS-related complex or AIDS. One isolate (HIV-2CAM2) was molecularly cloned and shown by restriction mapping to differ in seven out of 22 sites from the prototype HIV-2ROD. Nevertheless, by a number of serological criteria these isolates are all clearly HIV-2.

Human immunodeficiency virus type 2 infection associated with AIDS in West Africa.

We recently reported the isolation of a new retrovirus, termed human immunodeficiency virus type 2 (HIV-2), from two West African patients with the acquired immunodeficiency syndrome (AIDS). This virus is related to but distinct from the well-characterized AIDS retrovirus, human immunodeficiency virus type 1 (HIV-1). We report here evidence of infection with HIV-2 in 30 patients, almost all from West Africa. Seventeen of them had a clinical syndrome indistinguishable from AIDS (7 of these 17 died). Others had either the AIDS-related complex or no HIV-related symptoms. All patients had serum antibodies reacting with HIV-2 in an indirect immunofluorescence assay. All serum tested contained antibodies reacting with the envelope glycoprotein of the virus in an immunoprecipitation assay. Cross-reactivity of serum antibodies with HIV-1 was detected in a minority of patients and varied according to the assay used. Retroviral isolates were obtained from the blood lymphocytes of 11 patients and were all identified as HIV-2 by nucleic acid hybridization; none hybridized with an HIV-1 probe. These findings indicate that some cases of AIDS in West Africa may be caused by HIV-2, but the extent of the spread of this virus and its clinical correlates will require careful epidemiologic investigation.

Active replication of hepatitis B virus (HBV) in HIV type 1 and in HIV type 2 infected patients

A fim de avaliar as consequencias da infeccao por HIV no curso da infeccao por HBV, ou na imunidade anteriormente adquirida, estudamos um grupo de 66 doentes Caucasoides HIV1+ sintomaticos e outro de 38 individuos seropositivos para HIV2 e provenientes da Africa, quanto a marcadores serologicos de infeccao por HBV e quanto a presenca de DNA viral circulante, tomada como sinal de replicacao do virus da hepatite. Os grupos HIV+ foram comparados com controles seronegativos adequados tendo-se verificado que 7,6 por cento dos doentes HIV1+ eram tambem HBV-DNA+ (versus 3,2 por cento nos seronegativos) bem como 2,6 por cento dos HIV2+ (versus 2,9 por cento nos controles seronegativos), nao sendo as diferencas estatisticamente significativas em qualquer um dos casos e nao tendo sido encontrada correlacao entre infeccao por HIV e replicacao ativa de HBV...