Humans ; AIDS Dementia Complex/pathology* ; HIV Infections

We report a 33-year-old man with AIDS dementia complex, which is one of the most common neurologic complica-tion of HIV-1 infection. The man presented with mild psychomotor slowing and episodic loss of consciousness about 5 years after the detection of the HIV-1 infection. His symptoms included forgetfulness, concentration difficulties, apathy, and psychomotor retardation which progressed rapidly evolving into the characteristic features of terminal HIV-1-asso-ciated dementia complex, such as severe dementia, mutism, incontinence, and paraparesis before death. Brain MRIrevealed diffuse confluent high signal intensity lesions in the subcortical white matter on the T2 weighted image. HIV encephalitis (AIDS dementia complex) was confirmed by a brain autopsy.
Acquired Immunodeficiency Syndrome ; Adult ; AIDS Dementia Complex* ; Apathy ; Autopsy* ; Brain ; Dementia ; Encephalitis ; HIV ; HIV-1 ; Humans ; Mutism ; Paraparesis ; Unconsciousness

OBJECTIVETo develop a safe and effective lentivirus vaccine model and provide insights into the development of other lentivirus vaccines.

METHODSIn this study, a construct of pGPT was made by deleting env gene in the infectious Equine infectious anemia virus (EIAV) molecular clone of WU57. Since the overlaping of EIAV Rev gene with env gene, there was no Rev gene in the construct of pGPT. For compensation of Rev function, the construct of pGPTC was made by inserting 4 copies of constitutive RNA transport elements (CTEs) from Mason-Pfizer monkey virus into the construct of pGPT. In addition, a construct designated pTEB expressing EIAV Env protein was made while env gene-minus viruses were made by co-transfection of pGPT/pTEB or pGPTC/pTEB into 293 cells. Western blot was used to identify the development of recombinant virus particles. Then immunofluorescence assay was used to evaluate the infectivity of recombinant virus particles in vitro.

RESULTSEIAV proteins expression was detected in the supernatant of transfected 293 cells by Western blot within pGPTC/pTEB transfected cells. However, no evidence of EIAV proteins expression was observed within pGPT/pTEB transfected cells. EIAV proteins expression was detected in the first round but not in the second round infected EK cells with EIAV(GPTC) by immunofluorescence assay.

CONCLUSIONRev/RRE was necessary for expression of viral structural proteins; CTEs from Mason-Pfizer monkey virus was functionally interchangeable with EIAV Rev/RRE to help RNAs transportation out of nucleus to express structural proteins and EIAV particles were produced in the transfected 293 cells. A live EIAV recombinant virus with single round infection had been developed.

Animals ; Blotting, Western ; Cells, Cultured ; Fluorescent Antibody Technique ; Genes, rev ; Haplorhini ; Horses ; Humans ; Infectious Anemia Virus, Equine ; genetics ; Lentivirus ; immunology ; Lentivirus Infections ; immunology ; prevention & control ; Mason-Pfizer monkey virus ; genetics ; Transfection ; Vaccines, Synthetic ; Viral Vaccines ; genetics ; immunology

OBJECTIVETo explore the clinicopathological correlation between CD4(+) T lymphocyte count and superficial lymphadenopathy HIV/AIDS patients.

METHODSA total of 1066 HIV/AIDS patients were included in this study. The incidence of superficial lymphadenopathy, peripheral blood CD4(+) T lymphocyte counts and histological features of superficial lymphadenopathy were analyzed.

RESULTSAmong 1066 patients, 126 cases (11.8%) presented with superficial lymphadenopathy. Of the 126 cases, there were 69 cases with CD4(+) T lymphocyte counts < 100/µl and clinical diagnoses including tuberculosis (37 cases), reactive hyperplasia (8 cases), AIDS-related lymphadenopathy (18 cases), penicillium diseases (12 cases), fungal infection (5 cases) and non-tuberculous mycobacterial infection (1 case). Twenty-six cases had CD4(+) T lymphocyte counts between 100/µl to 200/µl and clinical diagnosis including tuberculosis (12 cases), reactive hyperplasia (8 cases), AIDS-related lymphadenopathy(6 cases), penicillium disease (2 cases) and non-Hodgkin lymphoma (1 case). Twenty-nine cases had CD4(+) T lymphocyte counts > 200/µl and clinical diagnoses including tuberculosis (11 cases), reactive hyperplasia (12 cases), AIDS-related lymphadenopathy (3 cases), Penicillium diseases (1 case) and non-Hodgkin lymphoma (4 cases). The CD4(+) T lymphocyte counts among patients with tuberculosis, AIDS-related lymphadenopathy and Penicillium diseases were significantly different (χ(2) = 8.861, P = 0.012). A significant correlation between the incidence of superficial lymphadenopathy and CD4(+) T lymphocyte counts was found (χ(2) = 375.41, P = 0.000).

CONCLUSIONSThe most common cause of superficial lymphadenopathy in HIV/AIDS patients is tuberculosis, followed by lymph node reactive hyperplasia, AIDS-related lymphadenopathy and Penicillium disease. Low CD4(+) T lymphocyte count correlates with an increased incidence of superficial lymphadenopathy and the risk of opportunity infection. Therefore, determination of peripheral blood CD4(+) T lymphocyte count should become an integral marker for the early diagnosis and treatment of superficial lymphadenopathy in HIV/AIDS patients.

AIDS-Related Complex ; blood ; complications ; pathology ; AIDS-Related Opportunistic Infections ; blood ; complications ; pathology ; Acquired Immunodeficiency Syndrome ; blood ; complications ; pathology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; CD4 Lymphocyte Count ; Child ; Female ; HIV Infections ; blood ; complications ; pathology ; Humans ; Lymph Nodes ; pathology ; Male ; Middle Aged ; Tuberculosis ; blood ; complications ; pathology ; Young Adult

Background: Antiretroviral treatment (ART) can decreased the incidence of HIV dementia, but milder cognitive impairment may not resolve when patients receive ART. In Indonesia, cognitive screening of HIV patients is not routinely performed before starting ART. Here we assess cognitive impairment in ART- naïve HIV patients beginning treatment in Jakarta. Methods: This is a cross sectional study with inclusion criteria: HIV positive, ART naïve, CD4 T-cells below 200 cells/uL, Karnofsky Performance Score (KPS) above 70. HIV-associated neurocognitive disorder (HAND) was defined by performance at least 1 Standard Deviation (SD) below the mean of demographically adjusted normative scores in at least two cognitive areas. Results: We studied 82 subjects with median (range) age 31 (19-48) years. Fifty six subjects (68%) were males. HAND was found in 42 subjects (51%). Eight subjects (19%) had impairment in 4 domains, 15 subjects (36%) in 3 and 19 (45%) in 2. The most common domain affected was memory (63%). Conclusion: Our results show the prevalence of HAND is high among HIV naïve patients in Jakarta. This establishes the need for screening of cognitive function before initiating ART.
AIDS Dementia Complex ; HIV

HIV encephalopathy usually presents with progressive dementia. However the spectrum of neurological manifestations of HIV infection is wide. A 46-year-old man presented with gait disturbance and dysarthria. He was given a neurological examination, which indicated dysarthria, cerebellar ataxia, and pyramidal tract signs. The patient's cognitive functions were intact. On serological study, HIV test was positive. Brain MRI and CSF analyses showed no evidence of tumor or other CNS infection. The patient was treated with highly active anti-retroviral therapy. Three months after treatment, cerebellar ataxia was much improved.
AIDS Dementia Complex ; Brain ; Cerebellar Ataxia* ; Dementia ; Dysarthria ; Gait ; HIV Infections* ; HIV* ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neurologic Examination ; Neurologic Manifestations ; Pyramidal Tracts

This study aimed to explore the lived experiences of people living with HIV/AIDS in Cebu, Philippines. The study utilized Husserlian qualitative phenomenological design. Ethics clearance was acquired from Vicente Sotto Memorial Medical Center - Ethics Review Committee. There were 7 informants that were recruited through purposive sampling and research referral techniques. The researchers used an open ended interview guide where interviews were audio recorded, transcribed and analyzed using Collaizi's method. Three (3) themes have emerged in this study. The first emerging theme is, (1) Why get tested? With the following subthemes of, (a) Presence of Risky Behavior; and (b) Knowledge that lead to testing. The second theme is, (2) Challenges after diagnosis with subthemes of, (a) Psychosocial challenges; and (b) Physical Challenges. Lastly, the third theme is, (3) Response and Coping with HIV/AIDS with the following subthemes, (a) Establishing old and new networks: Support systems; (b) Socio-spiritual changes: lifestyle changes and being more religious; and (c) Moving Forward. High risk sexual patterns, knowing that a partner is HIV positive and the presence of some signs and symptoms are the factors considered for testing. PLWHA's compliant of their treatment regimen despite the undesirable side effects and opportunistic infections. Stigma results to non-disclosure of status and mental health issues are common. The presence of support groups is essential; PLWHA's are willing to adapt a healthy lifestyle; and they become advocates of the disease. There is a need to increase the promotion of safe sex practices and health education about HIV/AIDS. Continuous support is needed in order to increase visibility of support groups, and the development of self-advocacy skills of PLWHA's. Mental health should also be given attention.

Human ; Hiv Seropositivity ; Philippines ; Acquired Immunodeficiency Syndrome

OBJECTIVETo study the genetic diversity of HIV-1 nef genes from a patient with AIDS dementia complex(ADC) , so as to research the amino acid variability and the pathogenesis of ADC.

METHODSThe nef gene was amplified with PCR from genomic DNA which was extracted from spleen and different brain tissues(basal ganglia, frontal gray matter, meninges, temporal lobe)of a patient who died of ADC. PCR products were cloned into the pMD19-T vector, after transformation and selection by ampicillin and blue/white spotting. Five of positive clones were sequenced and confirmed with BLAST. HIV-1 nef sequences were processed with BioEdit and MEGA4 to do Neighbor-Joining tree, p-Distances, and values of ds/dn.

RESULTSThe samples were all identified as HIV-1 B and genetic variation exists in HIV-1 nef gene isolated from different tissues compared with HXB2. In addition,part of the changes were different between periphery and brain.

CONCLUSIONVariations exist in the HIV-1 nef gene extracted from the ADC patient and the variations from peripheral and central nerve tissues were different,these variations may change the function of Nef,and it needs more research.

AIDS Dementia Complex ; virology ; Adult ; DNA, Viral ; genetics ; Genetic Variation ; HIV Infections ; virology ; HIV-1 ; genetics ; Humans ; Male ; nef Gene Products, Human Immunodeficiency Virus ; genetics

INTRODUCTIONHIV-associated neurocognitive disorders (HAND) comprise a wide spectrum of cognitive, motor, and mood abnormalities prevalent in people living with HIV and AIDS (PLWHAs). This field of HIV medicine has gained renewed prominence in recent years with evidence contending that anti-retroviral agents with increased central nervous system (CNS) penetration may improve neurocognitive outcomes in those affected. This review aims at evaluating the available evidence and postulating further study direction in Singapore.

MATERIALS AND METHODSA PubMed search was carried out for original articles and systematic reviews on the subject of HIV-associated neurocognitive disorders, and the results reviewed by the authors.

RESULTSThere is a growing body of evidence that HAND is not uncommon, and the advent of highly active anti-retroviral therapy has increased its prevalence by improving the prognosis of HIV infection, and hence increasing the likelihood of diagnosing of this neurocognitive condition. Screening and diagnosing HAND is important, and requires clinical suspicion as well as validated test batteries for optimal accuracy. The authors recommend strategies for detection in the local context involving stepwise targeted screening. Anti-retroviral agents with good CNS penetration and activity, as well as adjunctive neuro-rehabilitative interventions, may improve the impairments experienced by affected individuals.

CONCLUSIONIncreased awareness of HAND, with earlier diagnosis and targeted, multi-disciplinary management of this challenging condition, may lead to better all-round outcomes for people living with HIV and AIDS in Singapore.

AIDS Dementia Complex ; Anti-HIV Agents ; therapeutic use ; Anti-Retroviral Agents ; therapeutic use ; Antiretroviral Therapy, Highly Active ; HIV Infections ; drug therapy ; Humans ; Neurocognitive Disorders ; Prevalence

Authors report the first autopsy case of acquired immune deficiency syndrome in Korea. The patient was a 26 years old Korean male who died of respiratory failure due to mixed pulmonary infections. He had history of homosexual contacts with partners of both domestic and foreign nationalities. Initial presentation was unexplained fever for two months. Serological test and western blot test for anti-HIV were positive and T-cell subset analysis revealed T3/T4/T8 to be 73/8/67%. Pulmonary tuberculosis with mediastinal lymphadenopathy and esophagonadal fistula and oral candidiasis were presented. Respiratory infection progressed gradually and he died seven months after the initial symptom. Autopsy findings were generalized severe lymphoid cell depletion, especially of T-cell population and mixed pulmonary infections with Pneumocystis carinii and cytomegalovirus (CMV). The CMV infection involved lungs and adrenals. Oral candidiasis was also demonstrated.
AIDS-Related Complex/complications/diagnosis/pathology ; Acquired Immunodeficiency Syndrome/complications/*diagnosis/pathology ; Adult ; Autopsy ; Candidiasis/complications/diagnosis/pathology ; Humans ; Male ; Pneumonia, Pneumocystis/complications/diagnosis/pathology ; Tuberculosis, Pulmonary/complications/diagnosis/pathology