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1/3. Necrotizing granulomatous vasculitis in advanced hiv infection.

    We describe the first case of granulomatous necrotizing vasculitis not restricted to the central nervous system in an hiv-infected patient. No mycobacteria or drugs potentially associated with granuloma formation were involved in this patient, suggesting that the cause of this vasculitis was probably autoimmune. The development of granulomatous vascular inflammation in this patient with less than 200 CD4 cells/microl might have been due to immune overactivation. After starting potent antiretroviral therapy a profound immune deactivation was observed and the vasculitis did not relapse. ( info)

2/3. Reduction of glutamate levels in hiv-infected subjects treated with acetylcarnitine.

    The excitotoxic amino acid glutamate, which is elevated in blood and cerebrospinal fluid from subjects with aids dementia complex, is crucially implicated in the neurotoxicity of hiv infection. We describe a subject with aids dementia complex who showed a significant motor and cognitive improvement after a course of intravenous acetylcarnitine therapy. The clinical improvement was paralleled by a significant reduction of glutamate concentrations in both blood and cerebrospinal fluid. A prospective pilot study confirmed that acetylcarnitine administration resulted indeed to reduce the blood levels of glutamate in AIDS patients treated with acetylcarnitine therapy in order to prevent the neurotoxicity of nucleoside analogs. Even though the mechanisms responsible for the reduction of glutamate concentrations remain to be established, we suggest that acetylcarnitine should be added to the list of drugs under investigation for the treatment of aids dementia complex. The anti-apoptotic activity of carnitines and their safety profile further support this view. ( info)

3/3. Cerebral aneurysmal arteriopathy associated with hiv infection in an adult.

    Human immunodeficiency virus (hiv)-associated cerebral aneurysmal arteriopathy is described in the pediatric medical literature and features diffuse fusiform aneurysms of the arteries of the circle of willis. We present the first report (to our knowledge) of this disease entity in an adult, a 29-year-old woman with acquired immunodeficiency syndrome who presented with subarachnoid hemorrhage. ( info)

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