1/154. Persistently negative hiv-1 antibody enzyme immunoassay screening results for patients with hiv-1 infection and AIDS: serologic, clinical, and virologic results. Seronegative AIDS Clinical Study Group.OBJECTIVE: To describe persons with HIV infection and AIDS but with persistently negative HIV antibody enzyme immunoassay (EIA) results. DESIGN: Surveillance for persons meeting a case definition for hiv-1-seronegative AIDS. SETTING: united states and canada. patients: A total of eight patients with seronegative AIDS identified from July 1995 through September 1997. MAIN OUTCOME MEASURES: Clinical history of HIV disease, history of HIV test results, and CD4 cell counts from medical record review; results of testing with a panel of EIA for antibodies to hiv-1, and hiv-1 p24 antigen; and viral subtype. RESULTS: Negative HIV EIA results occurred at CD4 cell counts of 0-230 x 10(6)/l, and at HIV rna concentrations of 105,000-7,943,000 copies/ml. Using a panel of HIV EIA on sera from three patients, none of the HIV EIA detected infection with hiv-1, and signal-to-cut-off ratios were < or = 0.8 or all test kits evaluated. Sera from five patients showed weak reactivity in some HIV EIA, but were non-reactive in other HIV EIA. All patients were infected with hiv-1 subtype B. CONCLUSIONS: Rarely, results of EIA tests for antibodies to hiv-1 may be persistently negative in some hiv-1 subtype B-infected persons with AIDS. physicians treating patients with illnesses or CD4 cell counts suggestive of HIV infection, but for whom results of HIV EIA are negative, should consider p24 antigen, nucleic acid amplification, or viral culture testing to document the presence of HIV.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/154. Distinguishing immunosilent AIDS from the acute retroviral syndrome in a frequent blood donor.BACKGROUND: There are seven reports of "immunosilent AIDS" in which there was a lack of development of anti-HIV for more than 6 months. Thus, when a frequent blood donor presented with clinical findings highly suggestive of overt AIDS, there was concern that he may have had a prolonged immunosilent infection. CASE REPORT: A 24-year-old man who had donated blood six times in the previous year was diagnosed as having AIDS; he presented with fever, nausea, vomiting, diarrhea, weight loss, and oral candidiasis. The anti-HIV enzyme immunoassay was positive, the Western blot was indeterminate (gp160 only), the CD4 count was 174 per mL, the HIV polymerase chain reaction was positive (2.8 x 10(6) copies/mL), and the HIV p24 antigen assay was positive. Twelve components from previous donations had been transfused, and 2 units of fresh-frozen plasma were still in inventory. Repeat donor testing 57 days after donation indicated seroconversion with a positive anti-HIV enzyme immunoassay, a positive Western blot, a negative HIV p24 antigen assay, and a positive test for HIV by polymerase chain reaction (89,000 copies/mL). Both units of fresh-frozen plasma tested negative for HIV by polymerase chain reaction. Four transfusion recipients had died, and the remaining eight are anti-HIV negative with >6 months' follow-up. CONCLUSION: The donor had an unusually severe acute retroviral syndrome and presented with findings that were difficult to distinguish from overt AIDS.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
3/154. AIDS in an HIV-seronegative Ghanaian woman with intersubtype A/G recombinant hiv-1 infection.A 29-year-old Ghanaian woman who developed AIDS while being HIV-antibody seronegative was investigated during a collaborative study aimed at the identification of viral causes of a HIV-seronegative AIDS syndrome in West africa. plasma was screened with a panel of EIA tests for antibodies to HIV and hiv-1 p24 antigen. Retroviral infection was investigated by detection of reverse transcriptase (RT) activity in plasma, viral rna amplification and quantification, and virus isolation. Positive amplification products were sequenced and phylogenetic analyses were carried out. Most EIA tests were unable to demonstrate the presence of anti-HIV anti-bodies, whereas confirmatory assays yielded inconclusive results. Retroviral infection was documented by detection of RT activity, hiv-1-specific genomic amplification and virus isolation. This virus was hiv-1 subtype A with an unusual six amino acid insertion in the gp120 V4 loop and with the nef gene of subtype G. The patient's plasma did not react with either autologous or heterologous viral lysates or hiv-1 peptides, whereas antibodies to other viral antigens were present. In conclusion, the Ghanaian patient exhibited a rare subtype A/G recombinant hiv-1 infection with a near absence of a HIV-specific humoral response. The lack of detectable antibody response might be due to either a highly pathogenic, rapidly fatal, hiv-1 infection preventing the development of the typical humoral immune response or to a host-related dysfunction of the immune system. Direct antigenemia or genomic detection of the virus should be undertaken when clinical or biological data suggests an HIV infection in the absence of serological evidence.- - - - - - - - - - ranking = 1.5keywords = antigen (Clic here for more details about this article) |
4/154. Occult thyroid pathology in a child with acquired immunodeficiency syndrome. Case report and review of the drug-related pathology in pediatric acquired immunodeficiency syndrome.A 11-year-old boy with acquired immunodeficiency syndrome (AaS), Varicella-zoster virus (VZV) infection and long-term antiviral treatment suffered from a disorder of contractility of the left ventricle of the heart. Following severe unmanageable vomiting, the patient died and the postmortem examination showed marked involution of the lymphatic system, multiple foci of fibrosis of both ventricles of the heart, and regressive changes of the thyroid gland. Biochemical values of the thyroid gland function were, however, not altered. Neither human immunodeficiency virus-related p24 antigen, nor VZV dna sequences were found in the thyroid gland. Regressive changes of the thyroid gland can probably occur before its function fails. By analyzing the possible etiologies, the endocrine toxicity of a long-term antiviral treatment should be taken into account.- - - - - - - - - - ranking = 0.5keywords = antigen (Clic here for more details about this article) |
5/154. Case report. recurrence of increased intracranial pressure with antiretroviral therapy in an AIDS patient with cryptococcal meningitis.We present the case of an AIDS patient with cryptococcal meningitis who, after an excellent clinical and mycological response to antifungal therapy, developed an exacerbation of signs and symptoms, including elevated intracranial pressure and an increase in cerebrospinal fluid cryptococcal antigen and white blood cells, following the initiation of highly active antiretroviral therapy (HAART). Cultures yielded no growth and the patient responded to repeated lumbar punctures without changing or intensifying antifungal therapy. To our knowledge, this is the first report of symptomatic elevated intracranial pressure occurring during HAART-related immune recovery in a patient with cryptococcal meningitis. Exacerbation of symptoms does not necessarily reflect mycological failure that requires a change in antifungal therapy, but may relate to acutely increased intracranial pressure that will respond to simple measures, such as repeated lumbar punctures.- - - - - - - - - - ranking = 0.5keywords = antigen (Clic here for more details about this article) |
6/154. Residual risk of hiv-1 transmission: the case of a seroconverter.In the present report we describe the case of a repeat blood donor infected with hiv-1. In January 2000 the donor was found to be repeatedly reactive to HIV1/2 antibodies and hiv-1 rna screening tests. The donation was confirmed to be hiv-1 positive by Western blot. During the post-test counselling session, the donor reported a risk sexual behaviour denied during the pre-donation interview, and he recalled that in May 1998 he had undergone a check-up including the test for the detection of HIV1/2 antibodies, which was negative. This check-up was dated four months the next to the donor's previous donation in January 1998, which had been found HIV1/2 antibody negative, too. serum and plasma specimens, properly stored at -80 degrees C, were available at the hospital where the donor had undergone the HIV antibody test in May 1998. Thus, the specimens dated May 1998 and the specimen of the last donation in January 2000 were investigated again by using the most sensitive tests currently available in the setting of donation screening. On the whole, the results suggest that in May 1998 the donor was in the pre-seroconversion period for hiv-1 infection. The case reported here stresses that a residual risk for HIV transmission through blood products still relies on the possibility that an individual may be accepted as blood donor during the asymptomatic pre-seroconversion window period of hiv-1 infection. Actually, this phase of the infection cannot be detected by the routine antibody/antigen-based HIV1/2 screening tests but only by using more sensitive techniques such as genomic screening.- - - - - - - - - - ranking = 0.5keywords = antigen (Clic here for more details about this article) |
7/154. Multiple nevoid malignant melanomas in a patient with AIDS: the role of proliferating cell nuclear antigen in the diagnosis.The rapid growth of lesions clinically resembling compound nevi in patients with HIV/AIDS should alert physicians to the possibility of malignant melanomas. immunohistochemistry for proliferating cell nuclear antigen can be helpful in the diagnosis of these tumors. A case of multiple primary nevoid melanomas in a patient with HIV/AIDS is reported.- - - - - - - - - - ranking = 2.5keywords = antigen (Clic here for more details about this article) |
8/154. Intestinal cryptosporidiosis as an initial manifestation in a previously healthy Japanese patient with AIDS.BACKGROUND: cryptosporidium parvum infection has been recognized as one of the pathogens causing severe and persistent diarrhea in immunodeficient patients, such as those with AIDS, worldwide. However, in japan, the frequency of this infection has been rare, except for environmental contamination through the water supply. In this communication, we describe a Japanese patient with AIDS presenting with intestinal cryptosporidiosis as an initial manifestation. methods: The oocysts of cryptosporidium parvum in his stool were detected by the Ziehl-Neelsen method and electron microscopy. The antigen-specificity was proved by immunostaining, using a fluorescein isothiocyanate (FITC)-labeled monoclonal antibody and enzyme-linked immunosorbent assay (ELISA), using Cryptosporidium-specific antibody. RESULTS: A 28-year-old Japanese homosexual man was admitted to our hospital because of severe watery diarrhea of 1-week duration. Numerous oocysts of cryptosporidium parvum were observed in his stool. cryptosporidium parvum antigen was detected in stool samples. Serological examinations revealed that anti-hiv-1 antibody was positive, and HIV rna was positive at a high level. He was diagnosed as having AIDS associated with intestinal cryptosporidiosis. The circulating CD4 T-cell count was 152/microl. His diarrhea was not alleviated by administration of loperamide and an ordinary antibiotic agent, but ultimately resolved by the administration of the macrolide antibiotic agent, clarithromycin. CONCLUSIONS: We emphasize that the presence of cryptosporidium parvum infection should be kept in mind in searching for pathogens causative of severe diarrhea in AIDS patients.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
9/154. Cutaneous EBV-related lymphoproliferative disorder in a 15-year-old boy with AIDS: an unusual clinical presentation.Lymphomas are a well-known malignancy in individuals with human immunodeficiency virus type 1 (hiv-1) infection. Most lymphomas are of B-cell lineage and cutaneous involvement is rare. Cutaneous T-cell lymphomas have been previously described in adults with hiv-1 infection but are exceptional in hiv-1 infected-children. The authors report here the extremely rare case of a large-cell cutaneous lymphoproliferation of T-cell lineage expressing Epstein-Barr virus (EBV) antigens in a 15-year-old boy with AIDS and his uncommon clinical presentation. The atypical clinical evolution with a nonaggressive treatment emphasizes that for immunosuppressed patients, the diagnosis of immunosuppression-related lymphoproliferative disorder should be considered before giving the diagnosis of malignant lymphoma when tumoral lymphoid cells express EBV antigens.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
10/154. Detection of an early hiv-1 infection by HIV rna testing in an Italian blood donor during the preseroconversion window period.BACKGROUND: The implementation of NAT technologies for HIV screening has further reduced the diagnostic window in recent HIV infection. There is still a debate regarding the cost effectiveness of genomic screening of blood donations for transfusion-transmitted viruses (HBV, HCV, HIV). STUDY DESIGN AND methods: Since October 2001, at the Transfusion Service of Verona, single-donation NAT testing for HCV and hiv-1 (Procleix TMA hiv-1/HCV Assay) of all blood donations has been performed. CASE REPORT: A case of acute hiv-1 infection detected by HIV NAT in a repeat blood donor who donated during the preseroconversion window period is reported. All blood components donated were discarded, and the donor started antiretroviral therapy 2 weeks after blood donation. hiv-1 p24 antigen was still negative 10 days after the hiv-1 rna-positive blood donation. Seroconversion was documented by Day 41 after donation. CONCLUSION: This case report testifies that HIV NAT screening of blood donation is effective in preventing the transmission of HIV infection through blood components.- - - - - - - - - - ranking = 0.5keywords = antigen (Clic here for more details about this article) |
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