Nosocomial transmission of M. tuberculosis from other HIV-infected patients with tuberculosis caused by multiple-drug-resistant bacilli can occur. These findings have serious public health implications and demand strict adherence to acid-fast bacilli isolation precautions.
distinguish between the similar clinical findings of disseminated Guatemala; and Division of Disease Prevention, Department of histoplasmosis and disseminated tuberculosis in HIV-infected pa-Psychiatry and Behavioral Sciences, and Special Immunology, tients. Although common manifestations of disseminated tubercu-
These results suggest that IDV-RTV-based regimens may be able to overcome IDV resistance. This underscores the importance of drug adherence, potency, and exposure in determining virologic responses to antiretroviral therapy.
Our recent studies have demonstrated that in early HIV‐1 infection, elevation of plasma immunoglobulin E (IgE) levels precedes the decline of CD4 cell count and is influenced by vitamin E status. In order to further investigate the role of IgE elevation in HIV‐1 infection, we determined IgE levels in HIV‐1‐seropositive and ‐seronegative intravenous drug users (IDUs) (n = 38), in relationship to cellular and humoral immune function, liver enzymes, and vitamin E status. To examine the possible impact of the route of HIV‐1 infection on IgE levels, comparisons between the cohorts of the HIV‐1‐seropositive and ‐seronegative IDUs and homosexual men (n = 45) were also conducted. All HIV‐1‐seropositive participants had significantly higher (P = 0.003) IgE levels than the HIV‐1‐seronegative subjects. The HIV‐1‐seropositive IDUs, moreover, demonstrated significantly higher (P = 0.01) IgE levels than HIV‐1‐seropositive homosexual men, despite similar CD4 cell counts. Stepwise regression analysis was used to evaluate the possible variables contributing to the IgE variation. HIV‐1 status (P = 0.0009), intravenous drug use (P = 0.014), CD8 cell counts (P = 0.0001), plasma level of vitamin E (P = 0.006), and alcohol intake (P = 0.047) were significant, accounting for 71% of the IgE elevation. These findings suggest that IgE may serve as a sensitive marker to reflect the evolution of HIV‐1 disease in individuals from different risk groups.
A case of primary lymphoma of the liver in a patient with acquired immunodeficiency syndrome (AIDS) is presented. Persistent fever, tender hepatomegaly, and mildly abnormal liver function tests combined with an elevated lactate dehydrogenase level gave the clue for the diagnosis. High-grade, non-Hodgkin's lymphoma of B-cell phenotype was demonstrated by percutaneous liver biopsy. Primary hepatic lymphoma is a rare event among patients with AIDS. We reviewed the cases in the literature and noted that a preponderance of these patients presented with multiple lesions (a rather rare occurrence in primary lymphoma of the liver in patients not infected with the human immunodeficiency virus).
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