As of July 3, 2005, the total number of HIV-infected patients in Japan came to 11,664. However, the actual figure was estimated to be several times as large as the official number. During the previous year 1,165 HIV-positive patients were newly registered. It was the largest ever recorded in one year. There is every indication that HIV infection is spreading outward from major metropolitan areas to suburban and rural parts of the nation. By mode of transmission, heterosexual contacts account for the largest number amongst the cases documented. In recent years, homosexual transmission has increased. In view of the rapidity with which HIV infection has spread abroad, it is urgently necessary for Japan to take effective measures against the virus, because this nation has several factors favorable for the spread of HIV disease. Nevertheless, the public is yet to be provided fully with correct information about HIV infection/AIDS. To implement prophylactic programs effectively, we, health care providers, must endeavor to diffuse the knowledge of the disease. HIV-infection, if diagnosed in an early stage before it develops into AIDS, has now been reduced to a chronic illness manageable with anti-HIV drugs. Therefore, early diagnosis by means of HIV screening has become more important than ever. Consequently, the establishment of a screening system available easily is essential not only from the viewpoint of treatment but also from a prophylactic perspective because safe-sex practices are expected to be established with public understanding of the nature of HIV deepened. Healthcare professionals have still plenty of catching-up to do in terms of arresting the spread of HIV infection.
HIV Infections ; HIV ; Japan ; Acquired Immunodeficiency Syndrome ; Cases

We report here a surgical case of sinus of Valsalva and right atrium fistula associated with acute infective endocarditis (AIE) without perivalvular abscess cavity or aneurysm of the sinus of Valsalva (ASV). A 51-year-old man, who had been given a diagnosis of rheumatic aortic stenosis and regurgitation (AsR) and mitral stenosis and regurgitation (MsR) and tricuspid regurgitation (TR) by echocardiography, had a high fever 2 months after removal of teeth and AIE was diagnosed. He was referred to our hospital because sinus of Valsalva and right atrium fistula were detected by echocardiography and congestive heart failure (CHF) deteriorated during medical treatment. Perivalvular abscess cavity and ASV were not detected by preoperative echocardiography. Medical treatment was continued after admission, and operation was done after amelioration of the CHF and infection were recognized. The aortic valve was removed together with vegetation, two areas of the aortic wall in which the tissue was fragile were cauterized by electrocautery, patch closure at the sinus of Valsalva was performed using a partial of e-PTFE graft and aortic valve replacement (AVR) and mitral valve replacement (MVR) were done. Though residual aortic-right atrium shunt was detected after the operation, the postoperative course was good with no CHF or signs of infection.