Cases reported "HIV Seropositivity"

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1/34. thrombotic microangiopathies and HIV infection: report of two typical cases, features of HUS and TTP, and review of the literature.

    Haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are thrombotic microangiopathies increasingly reported in patients with HIV infection. However, characteristic features of thrombotic microangiopathies associated with HIV disease have not been defined yet. The typical courses of HUS and TTP in two patients are presented. The data as well as the analysis of cases published in the literature demonstrate the association of thrombotic microangiopathies with late-stage HIV disease. Moreover, differences between HUS and TTP can be detected. patients with HUS present with more severe immunologic deterioration. Although clinical symptoms are fewer, HUS implicates a very poor prognosis. life expectancy rarely exceeded 1 year after diagnosis. HUS and TTP should therefore be added to the international AIDS classification.
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2/34. Multicystic autoimmune thyroiditis-like disease associated with HIV infection. A case report.

    BACKGROUND: Human immunodeficiency virus (HIV) infection and resulting acquired immunodeficiency syndrome (AIDS) may involve virtually every organ system, including the endocrine glands. Thyroid dysfunction most commonly reflects advanced disease and generally resembles euthyroid sick syndrome. Rarely do opportunistic infections, hemorrhage, neoplasms and drugs account for alterations in thyroid tissue. Multiple lymphoepithelial cysts of parotid gland and thymus have been identified, but similar findings in thyroid gland have not been reported. CASE: A 41-year-old, HIV-seropositive woman, asymptomatic for seven years, developed a squamous cell carcinoma of the cervix with local-regional extension. At the same time, bilateral complex thyroid cysts and high titers of antimicrosomal antibodies (1/6,400) were detected. Ultrasound-guided fine needle aspiration biopsy of the thyroid showed a heterogeneous lymphocytic population with a reactive appearance and occasional groups of epithelial cells with an immature squamous pattern, along with cytologic features of autoimmune thyroiditis. Immunocytochemistry was positive for CD20, CD3 and CD5. Immunoglobulin heavy chain gene rearrangement by polymerase chain reaction from cytologic material showed a polyclonal lymphoid population. External radiotherapy resulted in a significant reduction in the pelvic lesion. Four months after diagnosis, abdominal ultrasound displayed multiple hepatic metastasis, the patient's condition rapidly deteriorated, and she died about a month later. CONCLUSION: This case had unique features and probably represented an AIDS-related lesion and distinct entity.
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3/34. True histiocytic lymphoma of the esophagus in an HIV-positive patient: an ultrastructural study.

    A 56-year-old white woman, seropositive for human immunodeficiency virus for 18 months without signs of acquired immunodeficiency syndrome, presented with retrosternal pain and progressive dysphagia secondary to an exophytic esophageal mass. Biopsies of the tumor showed a malignant neoplasm composed of pleomorphic, noncohesive cells growing in a diffuse, sheet-like fashion. Immunohistochemically, tumor cells were nonreactive with epithelial, lymphoid, neural, and monocyte/macrophage markers. Despite the noncontributory immunohistochemical findings, ultrastructural study of the tumor cells revealed convincing histiocytic features. Individual cells possessed long, slender filopodial projections, prominent golgi apparatus, residual bodies, rare lysosomes, and prelysosomes. Immunoglobulin heavy chain and T-cell receptor gamma gene rearrangement studies detected no evidence of a clonal gene rearrangement. The patient responded poorly to chemotherapy and died 5 months after her initial symptom of dysphagia.
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4/34. Experiences of breastfeeding and vulnerability among a group of HIV-positive women in Durban, south africa.

    While international guidelines are currently being drawn up about HIV and infant feeding practices, and national and regional guidelines are under discussion in south africa, there have been remarkably few studies that have sought to elicit HIV-positive mothers' experiences of breastfeeding and of paediatric infection. There is an urgent need to document this 'grass roots' knowledge in different sites, and for this data to be used to inform policy development, and for advocacy and counselling purposes. This qualitative investigation reports on the experiences and decisions taken around breastfeeding by a peer support group of 13 HIV-positive mothers meeting at King Edward VIII Hospital, Durban. In this study, the particular focus of information-giving and decision-making as to breast or formula feed is concerned with the impact on individual HIV-positive women and their babies. The most significant finding is that at no stage during their pregnancy were any of these mothers given information about the risks of HIV transmission through breastmilk. The study data were elicited in an in-depth group discussion, and individual women were invited to re-enact their stories in a follow-up discussion for clarification purposes. The women also discussed how they dealt with problems surrounding confidentiality in cases where few have been able to disclose their status to the extended family. There have been renewed calls for further investment in counsellors, with an enhanced role for community activists as peer educators. While there are severe resource constraints and low morale among many overworked nurses, one of the general problems in hospital settings remains the vertical health paradigm. This does not accommodate women's experiences, preferences, social networks and lay knowledge, and inhibits many women from becoming full participants in decisions affecting their own and their family's health.
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5/34. Five cases of melanoma in HIV positive patients.

    BACKGROUND: Kaposi's sarcoma, high grade B-cell non-Hodgkin lymphoma and invasive carcinoma of the cervix are all AIDS-defining illnesses according to the CDC staging criteria classification. A number of other malignancies, not traditionally associated with HIV infection, such as Hodgkin's disease, cancers of the rectum, anus, and germ-cell tumours, appear to occur more often than would be expected in these patients. Malignant cutaneous lesions, including basal cell, squamous-cell carcinomas, bowen's disease, and cutaneous melanoma (CM) have been less often reported. patients AND methods: We retrospectively evaluated the clinical data of 5 HIV seropositive patients and CM observed at the "M. Bufalini" Hospital, Cesena, italy from 1994 to 2000. RESULTS: All the 5 subjects had a history of intense sun exposure and sunburns. Four patients reported homosexuality as their risk factor for HIV disease. Reviewing the international literature on the subject HIV infected homosexuals appear the group at higher risk of developing CMM, accounting for 80% of cases. CONCLUSION: As patients' life expectancy appears to be prolonged after the advent of the HAART therapy, skin cancers will probably become more frequent in the near future. Clinicians should keep close medical surveillance to promptly diagnose new cases of melanoma and non-melanoma skin cancers and advise their HIV-infected patients on the risk of prolonged sun exposure and severe sun burns for the development of skin cancers.
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6/34. Immunologic and virologic analyses of an acutely HIV type 1-infected patient with extremely rapid disease progression.

    The immunologic and virologic factors that impact on the rate of disease progression after acute infection with human immunodeficiency virus (HIV) type 1 are poorly understood. A patient with an extraordinarily rapid disease course leading to AIDS-associated death within 6 months of infection was studied intensively for the presence of anti-HIV immune reactivities as well as changes in the genetic and biologic properties of virus isolates. Although altered humoral responses were evident, the most distinctive immunologic feature was a nearly complete absence of detectable HIV-specific CTL responses. In addition to a rapid decline in CD3 CD4 cells, elevated percentages of CD8 CD45RA and CD8 CD57 cells and diminished CD8 CD45R0 and CD8 CD28 cells were evident. Primary viral isolates recovered throughout the course of infection exhibited limited sequence diversity. Cloned viral envelopes were found to have unusually broad patterns of coreceptor usage for cell-cell fusion, although infectivity studies yielded no evidence of infection via these alternative receptors. The infectivity studies demonstrated that these isolates and their envelopes maintained an R5 phenotype throughout the course of disease. The absence of demonstrable anti-HIV CTL reactivities, coupled with a protracted course of seroconversion, highlights the importance of robust HIV-specific immune responses in the control of disease progression.
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7/34. 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.
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8/34. Socio-economic implications of the management of HIV positive pregnant women--a review of four cases in Ile-Ife, nigeria.

    AIDS constitutes a major public health problem in developed and developing countries. The experience at Obafemi Awolowo University teaching hospitals Complex (O.A.U.T.H.C.), Ile-Ife, nigeria has shown that HIV/AIDS is not uncommon. Screening of pregnant women with symptoms and signs suggestive of HIV/AIDS revealed 5 cases in three years (1996-1998). Four of these cases were reviewed to highlight the socio-economic implications and the burden of the disease on maternal and child health in our environment. It was shown that the socio-economic status of the women could not support adequate management of their conditions resulting in poor outcomes namely abortion, increased risk of infection to the baby and debts from hospital bills among others. Improvement in the socio-economic conditions of the populace and community health education on HIV/AIDS will enhance the outcome of management in pregnancy. In addition to emphasising preventive measures, research into appropriate mode of management of HIV/AIDS in pregnancy is urgently needed in our environment.
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9/34. Recent experience with human immunodeficiency virus transmission by cellular blood products in germany: antibody screening is not sufficient to prevent transmission.

    BACKGROUND AND OBJECTIVES: A case of transfusion-related human immunodeficiency virus-1 (hiv-1) transmission was not detected by standard HIV antibody screening. MATERIALS AND methods: In a look-back procedure, the preceding donations were extensively analyzed by nucleic acid amplification technology (NAT) screening and alternative serological tests. RESULTS: The chain of infection could be demonstrated by the analysis of HIV-specific amplicon sequences from the donor and the recipient. CONCLUSION: This case report clearly indicates that the remaining risk of transfusion-related transmission of HIV could be severely reduced, not only by the use of NAT screening but even by HIV antigen screening or more sensitive HIV antibody assays.
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10/34. breast cancer in HIV-positive women: a report of four cases and review of the literature.

    Only 16 cases of breast carcinoma in human immunodeficiency virus (HIV) seropositive patients have been reported in the literature. We report four cases of breast cancer in women seropositive for the HIV and review the literature. breast cancer is not an acquired immunodeficiency syndrome (AIDS)-defining disease and its incidence is not increased in HIV patients. Most patients reported had a CD4 count, which was above the threshold considered critical for significant immunosuppression suggesting that, HIV related immunocompromise does not have a direct tumorigenic role. Alternatively, the biology of breast cancer appears to be more aggressive in HIV-positive women suggesting a permissive role of the virus in the progression of the cancer. The aggressiveness of the breast carcinoma in HIV-positive women justifies every effort to preserve the dose intensity of treatment in those patients, especially in the current era of more effective HIV treatment which leads to improved survival.
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