1/32. Human immunodeficiency virus p24 antigen testing in cornea donors.PURPOSE: Testing for the p24 antigen of the human immunodeficiency virus (HIV) may detect early HIV infection in the seronegative window; however, falsely reactive results may occur in cadaver specimens. Although neither the food and Drug Administration (FDA) nor the Eye Bank association of America requires p24 testing of cornea donors, many tissue banks using other organs from cornea donors do perform this assay, and the FDA requires that eye banks reject corneal tissue if a reactive p24 assay is reported. We investigated the impact of p24 testing on eye banking and corneal transplantation. methods: Two clinical cases and records from the lions Eye Bank of delaware Valley (LEBDV) were reviewed retrospectively. RESULTS: Two corneas from the LEBDV were transplanted before the reporting of p24 reactivity by other tissue banks. In one case, because of the young age of the recipient, the surgeon elected to replace the cornea with new tissue hours after the original transplant, and later polymerase chain reaction (PCR) testing was negative. In the other case, there was not enough specimen to perform Western blot or PCR confirmatory testing. The patient was followed with periodic serologic testing for HIV and has remained seronegative. To avoid such problems in the future, the LEBDV initiated testing of all donors with p24 and other nonrequired screening tests. Over a 2-month period, 22 corneas (from 11 donors) were discarded because of these tests: 4 donors had reactive p24 tests, 6 were reactive for antibody to hepatitis b core antigen, and 1 had a reactive syphilis test. CONCLUSIONS: Results from p24 assays by other tissue banks may cause difficult clinical situations when the results are received after transplantation of the tissue, but the use of the p24 assay in the screening of cornea donors may result in excessive waste of donor tissue. Further guidance is needed regarding the management of positive results from this and other nonrequired screening tests.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
2/32. porphyria cutanea tarda and HIV: two cases associated with hepatitis c.hepatitis c virus (HCV) is a probable etiologic factor for the development of porphyria cutanea tarda (PCT), a photosensitive skin disease causing blistering, skin fragility, milia, and scarring. In a review of the literature, the hepatitis c status of patients coinfected with HIV and PCT was not known. Two patients with PCT who were seropositive for HIV and HCV are discussed herein. The appropriateness of performing porphyrin studies in patients diagnosed with HIV and photosensitivity and of prompting physicians to test for HIV and HCV infection in individuals who are diagnosed with PCT is discussed. Because HIV has been isolated from cutaneous blister fluid in patients with PCT and HIV, caregivers should be aware of the infection risk associated with the vesicles and erosions in these patients.- - - - - - - - - - ranking = 5keywords = hepatitis (Clic here for more details about this article) |
3/32. Nephron-sparing percutaneous ablation of a 5 cm renal cell carcinoma by superselective embolization and percutaneous RF-ablation.PURPOSE: To report on the nephron-sparing, percutaneous ablation of a large renal cell carcinoma by combined superselective embolization and percutaneous radiofrequency ablation. MATERIALS AND methods: A 5 cm renal cell carcinoma of a 43-year-old drug abusing male with serologically proven HIV, hepatitis b and C infection, who refused surgery, was superselectively embolized using microspheres (size: 500 - 700 microm) and a platinum coil under local anesthesia. Percutaneous radiofrequency ablation using a 7 F LeVeen probe (size of expanded probe tip: 40 mm) and a 200 Watt generator was performed one day after transcatheter embolization under general anesthesia. RESULTS: The combined treatment resulted in complete destruction of the tumor without relevant damage of the surrounding healthy renal tissue. The patient was discharged 24 hours after RF ablation. No complications like urinary leaks or fistulas were observed and follow up CT one day and 4 weeks after the radiofrequency intervention revealed no signs of residual tumor growth. CONCLUSION: The combined transcatheter embolization and percutaneous radiofrequency ablation of renal cell carcinoma has proved technically feasible, effective, and safe in this patient. It may be offered as an alternative treatment to partial or radical nephrectomy under certain circumstances.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
4/32. Hepatotoxicity after short-term trazodone therapy.OBJECTIVE: To report a case of severe hepatotoxicity from a four-day course of trazodone in a patient being treated according to protocol in a detoxification center. CASE SUMMARY: A 46-year-old HIV-positive man with a past medical history of intravenous drug abuse and hepatitis c, who was well controlled with HIV medications, was admitted for cocaine withdrawal. The patient was started on a standard protocol at the detoxification center with methadone 50 mg/d, clonidine 0.1 mg twice daily for four days, and trazodone 200 mg/d for four days. Laboratory results showed acute hepatitis and cholestasis five days following admission. trazodone and clonidine were discontinued at that time. His methadone and HIV regimens remained unchanged. liver function test results were greatly improved 10 days after trazodone and clonidine discontinuation. DISCUSSION: This is the first case report of trazodone-induced liver damage after only a few days of therapy. Previous reports describe hepatitis developing after weeks to months of trazodone therapy. All comorbidities thought to affect the described laboratory abnormalities were ruled out as a cause by a hepatologist. The observation of the sudden rise and fall of liver enzymes is characteristic of a drug reaction in the absence of trauma and severe shock. CONCLUSIONS: Due to the temporal relationship of the introduction and withdrawal of trazodone in the medication regimen and the elevations in liver enzymes, we conclude that this patient experienced acute hepatitis induced by trazodone 200 mg/d therapy for four days. The findings of this case warrant caution and closer monitoring in a patient with multiple risk factors for liver damage.- - - - - - - - - - ranking = 4keywords = hepatitis (Clic here for more details about this article) |
5/32. Prolonged hepatitis A infection in an hiv-1 seropositive patient.hepatitis a virus (HAV) is a worldwide disease; in most cases, it causes an acute self-limited illness that does not lead to a chronic state. The course of HAV viremia in a homosexual male with human immunodeficiency virus type 1 (hiv-1) and the correlation between HIV and HAV viral load, alanine aminotranferase (ALT) level, and CD4( ) lymphocyte count were investigated during the course of the infection. HAV rna was detected quantitatively up to 256 days after clinical onset. To our knowledge, this specific case is the first report of a prolonged infection with hepatitis A in a male with hiv-1. The ALT levels decreased gradually; however, 286 days after clinical onset of hepatitis, ALT levels were three times higher than normal values. HIV viral load was not affected by the infection with HAV and CD4( ) cell count was stable during the course of the co-infection. The duration and the high-titer viremia of hepatitis a virus in an immunodeficient patient constitute a serious risk of the spread of hepatitis A within this population. As inactivated HAV vaccine is safe in HIV-positive subjects, it would be wise to establish a strategy of preventive vaccination in this high-risk group.- - - - - - - - - - ranking = 8keywords = hepatitis (Clic here for more details about this article) |
6/32. Acute HIV seroconversion in a patient receiving pegylated interferon for treatment of hepatitis c.hepatitis c is diagnosed frequently in persons with HIV infection. However, the diagnosis of HIV infection during treatment of hepatitis c has not been reported. We present a case of acute HIV seroconversion in a patient who was not responding to interferon therapy for treatment of hepatitis c.- - - - - - - - - - ranking = 6keywords = hepatitis (Clic here for more details about this article) |
7/32. erythema elevatum diutinum in an HIV-positive patient.A 53-year old man with HIV infection and hepatitis c infection presented with multiple, firm nodules on the hands and ankles. erythema elevatum diutinum is a rare, chronic cutaneous vasculitis that may be associated with hematologic, autoimmune, and infectious diseases, which include HIV infection. First-line therapy includes dapsone, as well as treatment of any underlying cause or infection.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
8/32. role of the psychiatrist in the care of patients with hepatitis c and HIV/AIDS.hepatitis c and HIV/AIDS are among the most significant infectious diseases of our time. Psychiatric patients are often part of the higher risk population to contract these diseases, and patients who have contracted these diseases experience a wide variety of psychiatric problems associated with the underlying infection and with its treatment. The authors provide an overview of these infectious diseases and then describe the varying roles psychiatrists have in caring for these patients in the various settings of their work. The complexity of these patients presents a unique challenge to, and opportunity for, psychiatrists to integrate and coordinate their interventions with those of other medical providers and thereby enhance the patient's cooperation with all aspects of care.- - - - - - - - - - ranking = 4keywords = hepatitis (Clic here for more details about this article) |
9/32. Initial low CD4 lymphocyte counts in recent human immunodeficiency virus infection and lack of association with identified coinfections.Initial CD4 lymphocyte counts were studied in 244 patients with human immunodeficiency virus (HIV) seroconversion. The CD4 cell counts at initial presentation after seroconversion were normally distributed (mean, 579/mm3; SD, 252). The mean percentage of CD4 cells was 26.1% (SD, 5.6). CD4 cell counts were < 500/mm3 in 41% and < 200/mm3 in 4%. The mean calculated duration of HIV infection was 7.7 months, which was not significantly different between the highest and lowest CD4 count quartiles (8.1 vs. 7.9). Age, sex, race, and serologic evidence of toxoplasmosis, cytomegalovirus, hepatitis b, syphilis, and varicella-zoster virus were not associated with initial low CD4 cell counts; however, never-married men were significantly overrepresented in the lowest quartile. These findings suggest that extensive CD4 lymphocyte depletion is common in early HIV infection and that frequent screening is necessary to identify newly infected patients who would benefit from antiretroviral therapy.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
10/32. Acute human immunodeficiency virus syndrome in an adolescent.Acute human immunodeficiency virus (HIV) seroconversion illness is a difficult diagnosis to make because of its nonspecific and protean manifestations. We present such a case in an adolescent. A 15-year-old boy presented with a 5-day history of fever, sore throat, vomiting, and diarrhea. The patient also reported a nonproductive cough, coryza, and fatigue. The patient's only risk factor for HIV infection was a history of unprotected intercourse with 5 girls. physical examination was significant for fever, exudative tonsillopharyngitis, shotty cervical lymphadenopathy, and palpable purpura on both feet. Laboratory studies demonstrated lymphopenia and mild thrombocytopenia. Hemoglobin, serum creatinine, and urinalysis were normal. The following day, the patient remained febrile. physical examination revealed oral ulcerations, conjunctivitis, and erythematous papules on the thorax; the purpura was unchanged. Serologies for hepatitis b, syphilis, HIV, and Epstein-Barr virus were negative. Bacterial cultures of blood and stool and viral cultures of throat and conjunctiva showed no pathogens. Coagulation profile and liver enzymes were normal. Within 1 week, all symptoms had resolved. The platelet count normalized. Repeat HIV serology was positive, as was HIV dna polymerase chain reaction. Subsequent HIV viral load was 350 000, and the cd4 lymphocyte count was 351/mm3. HIV is the seventh leading cause of death among people aged 15 to 24 in the united states, and up to half of all new infections occur in adolescents. Our patient presented with many of the typical signs and symptoms of acute HIV infection: fever, fatigue, rash, pharyngitis, lymphadenopathy, oral ulcers, emesis, and diarrhea. Other symptoms commonly reported include headache, myalgias, arthralgias, aseptic meningitis, peripheral neuropathy, thrush, weight loss, night sweats, and genital ulcers. Common seroconversion laboratory findings include leukopenia, thrombocytopenia, and elevated transaminases. The suspicion of acute HIV illness should prompt virologic and serologic analysis. Initial serology is usually negative. Diagnosis therefore depends on direct detection of the virus, by assay of viral load (HIV rna), dna polymerase chain reaction, or p24 antigen. Both false-positive and false-negative results for these tests have been reported, further complicating early diagnosis. Pediatricians should play an active role in identifying HIV-infected patients. Our case, the first report of acute HIV illness in an adolescent, emphasizes that clinicians should consider acute HIV seroconversion in the appropriate setting. Recognition of acute HIV syndrome is especially important for improving prognosis and limiting transmission. It is imperative that we maintain a high index of suspicion as primary care physicians for adolescents who present with a viral syndrome and appropriate risk factors.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
| | Next -> |