1/68. High frequency of cytomegalovirus-specific cytotoxic T-effector cells in HLA-A*0201-positive subjects during multiple viral coinfections.How the cellular immune response copes with diverse antigenic competition is poorly understood. Responses of virus-specific cytotoxic T lymphocytes (CTL) were examined longitudinally in an individual coinfected with human immunodeficiency virus type 1 (hiv-1), Epstein-Barr virus (EBV), and cytomegalovirus (CMV). CTL responses to all 3 viruses were quantified by limiting dilution analysis and staining with HLA-A*0201 tetrameric complexes folded with hiv-1, EBV, and CMV peptides. A predominance of CMV-pp65-specific CTL was found, with a much lower frequency of CTL to hiv-1 Gag and Pol and to EBV-BMLF1 and LMP2. The high frequency of CMV-specific CTL, compared with hiv-1- and EBV-specific CTL, was confirmed in an additional 16 HLA-A*0201-positive virus-coinfected subjects. Therefore, the human immune system can mount CTL responses to multiple viral antigens simultaneously, albeit with different strengths.- - - - - - - - - - ranking = 1keywords = cytomegalovirus (Clic here for more details about this article) |
2/68. Severe cytomegalovirus-triggered autoimmune hemolytic anemia complicating vertically acquired HIV infection.The association of acute cytomegalovirus infection with severe autoimmune hemolysis has not yet been reported in patients with HIV infection. The case is described of a 9-month-old infant with congenital hiv-1 infection who presented with severe autoimmune hemolysis and a high cytomegalovirus viral plasma load. Alternative causes of the hemolysis, such as drugs or other infections, were ruled out. After birth and after successful therapy of hemolysis, cytomegalovirus was not detected in the plasma, strongly suggesting a causal relationship between the hemolysis and cytomegalovirus infection. Severe autoimmune hemolysis should thus be considered as a cytomegalovirus-associated complication in HIV infection.- - - - - - - - - - ranking = 1.8keywords = cytomegalovirus (Clic here for more details about this article) |
3/68. Perianal cytomegalovirus ulcer in an HIV infected patient: case report and review of literature.We report the case of a 25-year-old man with acquired immunodeficiency syndrome, presenting with perianal ulcer and diarrhea. He had positive immunocytochemical tests for Cytomegalovirus (CMV) in circulating polymorphonuclear cells (PMN). The biopsy specimen was suggestive of CMV infection, and specific immunoperoxidase for CMV antigens positively stained endothelial cells and fibroblasts. In this report we review cutaneous CMV infection in immunocompromised patients.- - - - - - - - - - ranking = 0.8keywords = cytomegalovirus (Clic here for more details about this article) |
4/68. Immunorestitution disease involving the innate and adaptive response.Immunorestitution disease (IRD) is defined as an acute symptomatic or paradoxical deterioration of a (presumably) preexisting infection that is temporally related to the recovery of the immune system. We report the temporal sequence of events that led to IRD caused by pneumocystis carinii and aspergillus terreus in 2 human immunodeficiency virus (HIV)-negative patients soon after the recovery of adaptive and innate immunity, respectively, and we review episodes noted in the English-language literature that fit the definition of IRD (109 episodes in 107 patients). The median time from the recovery of neutrophil counts or termination of steroid therapy to the development of IRD was 8 days in cases of pulmonary aspergillosis (23 episodes) and hepatosplenic candidiasis (8) and 21 days for viral diseases such as hepatitis B (24) and viral pneumonitis (6). For IRD due to mycobacteriosis (27 episodes) and cryptococcosis (4) in HIV-positive patients, the median interval between the initiation of highly active antiretroviral therapy (HAART) and the onset of IRD was 11 days; for viral infections, including those due to cytomegalovirus (14), hepatitis b virus (1), and hepatitis c virus (2), the median interval was 42 days. As an emerging clinical entity, IRD merits further study to optimize treatment of immunosuppressed patients.- - - - - - - - - - ranking = 0.2keywords = cytomegalovirus (Clic here for more details about this article) |
5/68. Isolation of cytomegalovirus-specific cytotoxic t-lymphocytes from gut-associated lymphoid tissue (GALT) of HIV type 1-infected subjects.Cytomegalovirus (CMV) can be an important opportunistic infection in hiv-1-infected patients, particularly when the CD4 T-cell count drops below 50 lymphocytes/mm3. CMV-associated disease, including retinitis, pneumonitis, gastroenteritis, and encephalitis, is estimated to affect up to 40% of AIDS patients. We have studied the cellular immune response to CMV in gut-associated lymphoid tissue (GALT) of hiv-1-infected patients. Two patients with chronic diarrhea of unknown etiology were examined by flexible sigmoidoscopy and upper endoscopy. biopsy specimens were obtained from lymphoid-associated tissue sites in rectum and duodenum. Both patients were seropositive for CMV IgG, but had not been treated with ganciclovir, and neither had clinical signs of CMV disease. Mononuclear cell cultures were established from GALT and blood and assayed for the presence of CMV-specific CD8 T cells. CD8 T-cell phenotype and function were assessed by MHC Class I tetramer staining, using an HLA-A*0201 tetramer complex specific for peptide 495-503 (NLVPMVATV) of CMV lower matrix protein pp65, and by a standard 51Cr release assay. CMV pp65-specific cytotoxic lymphocytes (CTL) were detected in GALT and blood MNC from both patients. These results demonstrate that hiv-1-infected subjects seropositive for CMV, but without active CMV gastrointestinal disease, harbor CMV-specific CTL in intestinal lymphoid tissue. This is the first report of isolation of CMV-specific CTL in GALT and will lead to greater understanding of the pathogenesis of CMV disease in human mucosal tissue.- - - - - - - - - - ranking = 0.84872770451105keywords = cytomegalovirus, retinitis (Clic here for more details about this article) |
6/68. Detection of HIV-rna in aqueous humor and subretinal fluid in an HIV carrier with rhegmatogenous retinal detachment.BACKGROUND: Although human immunodeficiency virus (HIV)-related ocular complexes are commonly observed in acquired immune deficiency syndrome (AIDS) patients, it has not been previously reported that HIV had already invaded the ocular tissues of HIV carriers. CASE: A 56-year-old woman was diagnosed as having rhegmatogenous retinal detachment with a retinal tear in the 6-o'clock position in her right eye. No signs of ocular manifestations except the retinal detachment were observed. A blood examination revealed that she was already infected with hiv-1, and she was categorized as an HIV carrier. OBSERVATIONS: aqueous humor and subretinal fluid samples were obtained at the time of surgery for rhegmatogenous retinal detachment. Reverse-transcription polymerase chain reaction and Southern blotting at three regions of the HIV, LTR, gag, and env, confirmed the HIV infection in both aqueous humor and subretinal fluid. During the approximately 2-year follow-up after surgery, the patient did not show any signs of retinitis, uveitis, or other ocular manifestations. CONCLUSIONS: This is the first report to reveal that HIV can invade the eye in the early stage of HIV infection. This infection may be related to HIV-related ocular complexes, which suppress the local immunological response.- - - - - - - - - - ranking = 0.048727704511053keywords = retinitis (Clic here for more details about this article) |
7/68. Resolution of recalcitrant human papillomavirus gingival infection with topical cidofovir.Cidofovir, a purine nucleotide analogue of cytosine, is a promising new drug that acts against a wide number of dna viruses. In 1997, the food and Drug Administration approved intravenous cidofovir for the treatment of cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome. Recent studies have shown cidofovir (1% gel or cream) to be effective for the treatment of recalcitrant and unmanageable viral cutaneous lesions induced by herpes, pox, and papillomavirus families. We report the case of a 45-year-old man who had been diagnosed as having acquired immunodeficiency syndrome in 1995. Recalcitrant to conventional therapies, the human papillomavirus lesions on his gingival mucosa were successfully treated with cidofovir 1% cream. To the best of our knowledge, this is the first case in which topical cidofovir has been used for the treatment of a human papillomavirus infection of the oral mucosa.- - - - - - - - - - ranking = 1.3446044533809keywords = cytomegalovirus retinitis, cytomegalovirus, retinitis (Clic here for more details about this article) |
8/68. Recurrences of cytomegalovirus retinitis in a human immunodeficiency virus-infected patient, despite potent antiretroviral therapy and apparent immune reconstitution.We describe a 42-year-old man with human immunodeficiency virus infection who developed multiple recurrences of cytomegalovirus (CMV) retinitis despite receiving highly active antiretroviral therapy and having apparent immune reconstitution as evidenced by CD4( ) T lymphocyte counts of > 200 cells/mm(3). Laboratory investigation during one recurrence of retinitis confirmed that there was active CMV replication in the plasma and vitreous fluid. In addition, lymphoproliferative responses to CMV antigens were absent despite evidence of reactivity to candida antigen and pokeweed mitogen. The clinical significance of this case and of other recently reported cases is discussed.- - - - - - - - - - ranking = 5.6758732225457keywords = cytomegalovirus retinitis, cytomegalovirus, retinitis (Clic here for more details about this article) |
9/68. Frosted branch angiitis in a child with HIV infection.PURPOSE: In adults with human immunodeficiency virus (HIV) infection, frosted branch angiitis is commonly associated with cytomegalovirus retinitis and responds to anti-cytomegalovirus therapy. We describe the first pediatric case of HIV-associated frosted branch angiitis. methods: Case report. RESULTS: A 7-year-old HIV-infected male with frosted branch angiitis was refractory to induction doses of intravenous ganciclovir and foscarnet over a 2-month period. Although cytomegalovirus antigenemia resolved, the angiitis only improved after subsequent treatment with systemic corticosteroids. CONCLUSION: Frosted branch angiitis in this patient was not attributed to cytomegalovirus. The pathogenesis of HIV-associated frosted branch angiitis may differ between children and adults.- - - - - - - - - - ranking = 1.9446044533809keywords = cytomegalovirus retinitis, cytomegalovirus, retinitis (Clic here for more details about this article) |
10/68. Loss of cytomegalovirus-specific CD4 T cell responses in human immunodeficiency virus type 1-infected patients with high CD4 T cell counts and recurrent retinitis.Clinical histories are reported for 2 patients treated with highly active antiretroviral therapy (HAART) who experienced multiple relapses of cytomegalovirus (CMV) retinitis, despite suppression of human immunodeficiency virus type 1 (hiv-1) viremia and improvement in CD4 T cell counts (to >400 cells/microL). CMV-specific CD4 T cell immune reconstitution was measured directly, using cytokine flow cytometry, which revealed persistent deficits in CMV-specific CD4 T cell responses in both patients. CMV-specific T cells constituted 0.14% and 0.05% of the total CD4 T cell count in these patients, which is significantly lower than the percentages for 34 control subjects (0.6%-46%; CD4 T cell count range, 7-1039 cells/microL; P=.019). Deficits in pathogen-specific immune responses may persist in some individuals, despite suppression of hiv-1 replication and substantial increases in circulating CD4 T cells after HAART, and such deficits may be associated with significant morbidity from opportunistic infections.- - - - - - - - - - ranking = 1.2436385225553keywords = cytomegalovirus, retinitis (Clic here for more details about this article) |
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