Mycobacterial disease in patients with human immunodeficiency virus infection

Article Abstract:

Patients infected with the human immunodeficiency virus (HIV, the virus that causes AIDS) are often found to be infected with mycobacterial disease. Mycobacterial infection (MI), which includes mycobacterium tuberculosis (M.tuberculosis), has responded well to treatment; however, patients infected with mycobacterium avium complex (MAC) have not been successfully treated. Because of the difference in the efficacy of the therapies for mycobacterium tuberculosis and MAC, researchers compared clinical and X-ray characteristics of these infections in a group of 94 HIV-infected patients, in order to improve the diagnosis and selection of antimicrobial agents used to fight these infections. Results reveal that clinical features frequently permit tuberculosis to be distinguished from MAC infection in HIV-infected persons. Differences in the clinical manifestations between M.tuberculosis and MAC may be due to the virulence of these pathogens and differences in the cell-mediated immune response. M.tuberculosis is more virulent than MAC, able to cause disease in people who have adequate immune systems, whereas MAC does not appear to strike those with adequate immune defenses. Consistent with this hypothesis is the fact that tuberculosis often precedes the diagnosis of AIDS, while MAC usually occurs only in the latter stages of the HIV infection, when the immune system is already compromised. The inability to develop an inflammatory response may explain the lack of chest X-ray findings in patients with MAC. Two important findings stem from the study, namely that tuberculosis may be a useful indicator of undiagnosed HIV infection in groups of people with a high rate of M.tuberculosis infection (e.g, certain ethnic minorities and homeless individuals), and that 83 percent of the patients with pulmonary tuberculosis had abnormalities of the lungs visible on X-ray, compared with only 22 percent of those with MAC. In tuberculosis, but not in MAC, X-ray images are diagnostically useful because the abnormalities caused by mycobacterial tuberculosis are so distinct that they cannot be confused with other opportunistic pathogens that infect HIV patients, such as P.carinii and cytomegalovirus. The use of stool smears may be a useful means of diagnosing extrapulmonary tuberculosis, that is, occurring outside the lungs, in HIV-infected patients. Researchers caution that inferences must be drawn carefully, because of imperfections in the experiment. The limitations should not, however, diminish important findings suggesting that there are clinical features distinguishing tuberculosis from MAC in HIV-infected patients. Awareness and understanding of these differences may promote early diagnosis

Research, Usage, Lungs, Lung, Tuberculosis, Mycobacterial infections, Mycobacterium infections, Diagnosis, Radioscopic, Radioscopic diagnosis

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The causes of esophageal symptoms in human immunodeficiency virus infection: a prospective study of 110 patients

Article Abstract:

Patients infected with the human immunodeficiency virus (HIV), the causal agent of AIDS, are particularly prone to opportunistic viral and bacterial infections. For example, 40 to 50 percent of HIV-infected patients complain of odynophagia (painful swallowing) or dysphagia (difficulty swallowing). Candida albicans infection or viral esophagitis, or inflammation of the esophagus, is the most common diagnosis in patients with these symptoms. With the advent of more potent anti-infective therapies, diagnosis of esophagitis is an important step in the institution of effective therapy. To determine the prevalence of infectious esophagitis in HIV-positive patients, and to assess the utility of a variety of diagnostic tools, 110 HIV-infected patients with dysphagia or odynophagia of at least two weeks' duration were enrolled in a prospective clinical case study. Blind brushing of the esophagus (a method of collecting esophageal scrapings), followed by endoscopy with esophageal brushings (site-directed scrapings from the region of esophageal lesions, nodules, or other pathological processes), was combined with esophageal biopsies, fungal stains, and viral cultures. Sixty-five percent of the patients had a total of 100 esophageal infections. C. albicans infections were present in 30 percent of the patients, C. albicans and cytomegalovirus were present in 20 percent, 1.8 percent had C. albicans, cytomegalovirus, and herpes simplex virus, 6 percent had cytomegalovirus alone, 5 percent had herpes simplex virus alone, and 1.8 percent had both viruses. The sensitivity of esophageal brushings was better (95 percent) than that of histological or tissue examinations (70 percent) in the diagnosis of C. albicans esophagitis; likewise viral cultures of brushings or biopsy specimens showed higher sensitivity (67 percent) than did histological evaluation (35 percent) in the diagnosis of viral esophagitis. (Sensitivity refers to the reliability and accuracy of a diagnosis.) Blind brushing was quite accurate as a diagnostic tool: 85 percent of the cases of infectious esophagitis and 75 percent of the cases of noninfectious esophagitis were correctly identified with this method. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, HIV infection, HIV infections, Candida albicans, Esophagitis, Deglutition disorders

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Human immunodeficiency virus-associated nephropathy

Article Abstract:

Acquired immunodeficiency syndrome (AIDS) may be complicated by a malignant kidney syndrome characterized by proteinuria or the abnormal presence of protein in the urine, rapidly advancing kidney failure, and focal and segmental glomerulosclerosis (FSGS), the formation of fiber-like tissue within the capillary blood vessels (glomeruli) of the kidney. This syndrome was reported to affect almost 10 percent of AIDS patients, occurring most often in black intravenous (IV) drug users. This kidney syndrome may be a form of heroin nephropathy or kidney disease associated with heroin abuse. One recent study examined the tissue microscopic features of the kidney lesion in AIDS-related kidney disease. The rapid deterioration of kidney function may be associated with a direct adverse effect of the human immunodeficiency virus (HIV) on the epithelial cells of the glomeruli or may be due to the progressive formation of fiber-like tissue, inflammation, and tissue degeneration observed in FSGS. Another cause of rapid kidney failure may be related to disorders of the kidney circulation. Because rapid kidney failure associated with AIDS predominantly occurs in black IV drug users, this kidney disorder was found to be more prevalent in New York and Miami than in San Francisco, where 84 percent of AIDS patients are homosexual white men. It is not clear why blacks are more susceptible to the development of FSGS than whites. A better understanding of the relation between race, risk factors for HIV infection, and development of FSGS is needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Physiological aspects, African Americans, Drug use, Drug abuse, Kidney diseases, editorial

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