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AIDS dementia complex (ADC) may occur at different times during the course of the disease among different patients. Early signs of ADC include memory loss and difficulty concentrating. Symptoms of later stages of ADC include confusion, distractibility and delayed verbal responses. Patients with ADC may withdraw socially and show reduced emotional spontaneity. Clumsiness and balance difficulties may also occur, but these are less common. There has been a significant decline in the incidence of ADC since the introduction of zidovudine treatment in 1989. Zidovudine appears to be effective in stopping the progress of ADC.

The prevalence of AIDS-associated non-Hodgkin's lymphoma (NHL) and Kaposi's sarcoma (KS) appears to be underreported in Italy. Beginning in 1982, reporting to the Italian AIDS Registry (RAIDS) became mandatory when an AIDS-defining condition was diagnosed in an HIV-positive patient. In 1986, a voluntary reporting system for AIDS related-tumors, the Italian Cooperative Group on AIDS-related Tumors (GICAT), was established. Records contained in the two registries were compared to determine the accuracy of reporting. A total of 288 cases of KS and 258 cases of NHL were identified on GICAT. However, only 276 (96%) of the KS cases and only 241 (93%) of the NHL cases were also found in RAIDS. A KS diagnosis did not appear in 67 (24%) of the 276 cases identified on both registries. An NHL diagnosis did not appear in 84 (33%) of the 241 NHL cases identified on both registries. Additionally, there appeared to be discrepancies in the classification of NHL tumors between the two registries.

AIDS patients with Toxoplasma gondii (T. gondii) may benefit from combination treatment with clarithromycin and minocycline or pyrimethamine. Toxoplasma gondii is a protozoan infection that often develops in AIDS patients and others with compromised immune systems. Researchers injected mice with one of two strains of T. gondii. Groups of mice were treated with different combinations and doses of clarithromycin, pyrimethamine, minocycline, and sulfamethoxazole. Combination therapy with clarithromycin and pyrimethamine or minocycline increased survival and cure rates more than solo use of any drug. Ten milligrams (mg) of pyrimethamine per kilogram (kg) of body weight combined with 300 mg/kg of clarithromycin were 100% effective in curing T. gondii and successfully prevented latent brain infections. Fifty mg/kg of minocycline combined with 300 mg/kg of clarithromycin were 100% effective in curing the disease and prevented latent brain infections.

Infection with the bacteria Pseudomonas aeruginosa (P. aeruginosa) is becoming a common, serious complication in people with advanced cases of AIDS. Over a seven-year period, researchers used medical records to identify 32 AIDS patients with P. aeruginosa infection. The number of cases increased over the course of the study, from two in 1986 to 13 in 1992. All patients were in the advanced stages of AIDS as evidenced by low CD4 counts, a history of previous illnesses that are used to diagnose AIDS, and infection with P. aeruginosa that occurred at least one year after anti-HIV drug therapy. The average survival rate after infection with the bacteria was 80 days. A comparison of AIDS patients with P. aeruginosa infection to AIDS patients without this infection showed that some AIDS treatments and prevention techniques may be associated with an increased risk for P. aeruginosa infection.

HIV wasting syndrome can be a major illness in HIV-infected individuals and may even hasten their death. The syndrome is defined as weight loss greater than 10% of body weight accompanied by chronic diarrhea or weakness and fever when no other cause of weight loss exists. Seven percent of AIDS patients reported to the CDC in a four-year period had the syndrome, and almost 11% had the syndrome and at least one other AIDS complication. HIV wasting syndrome may be caused by metabolic abnormalities, malabsorption, reduced food intake, hormonal abnormalities, or muscle disease. Several pathogenic organisms that infect the gastrointestinal tract can cause diarrhea. HIV-infected individuals are extremely susceptible to these kinds of infections. HIV itself may cause gastrointestinal disease. Several studies have reported a reduced survival rate in HIV patients with chronic weight loss. Treatment includes eliminating gastrointestinal infections, treating diarrhea, providing nutritional support and stimulating the patient's appetite.

Survival of patients infected with the Pseudomonas (P.) aeruginosa bacterium depends on the body's ability to mount a strong, rapid and specific immune response. P. aeruginosa infections are virulent, with high mortality levels. Otherwise healthy individuals with intact immune systems show high levels of serum antibodies very soon after being infected. They particularly have antibodies to toxin A and an antigen called lipopolysaccharide. The relationship between development of such antibodies and survival rates is very high. A study of 11 HIV-infected patients who were also infected with P. aeruginosa showed low levels of antibodies in their blood. Only 9% responded rapidly; 36% had no response. Treatment with several antibiotics and other medicines within 24 hours of infection was not sufficient to prevent death in six of the 11 patients.

Low-dose liposomal doxorubicin appears to be safe and effective in treating advanced Kaposi sarcoma (KS) in AIDS patients. KS is a cancer, usually affecting the skin, that commonly affects AIDS patients. Liposomal doxorubicin is an anti-cancer drug encapsulated in a fat-like substance for prolonged circulation within the body. Among 40 AIDS patients with advanced KS, 10 received biweekly treatments of liposomal doxorubicin at a dose of 10 milligrams per square meter (mg/m2), 27 at a dose of 20 mg/m2 and three at a dose of 40 mg/m2. The three patients receiving the highest dose had severe side effects after six weeks and were switched to a dose of 20 mg/m2. Some of the other patients had side effects such as nausea, mouth inflammation, hair loss and reduction in white blood cell counts. By 12 weeks, 7.5% of patients had a complete response to treatment, 85% had a partial response, and 7.5% had disease stabilization. None of the patients showed evidence of KS progression during treatment with liposomal doxorubicin.

Blood levels of oncostatin M (OM) appear to be similar in Kaposi's sarcoma (KS) patients regardless of whether the disease is AIDS-related. KS is a malignant disease that occurs primarily in three populations: elderly men and women of Eastern European descent, Africans of all ages and AIDS patients. OM is produced by certain immune system cells and acts as a growth factor for KS. Blood samples were analyzed from KS patients with AIDS, HIV-positive and -negative homosexual men and a heterosexual man. Blood samples from KS patients of Eastern European descent were compared with samples from heterosexuals. OM levels were similar between AIDS-related KS patients and HIV-positive participants. OM levels did not appear to increase as KS became more advanced in the AIDS patients. OM levels were similar between KS patients of Eastern European descent and heterosexuals in the comparison group.

Autoantibodies to brain proteins do not appear to be associated with AIDS dementia complex (ADC). Antibodies are components of the immune system produced in response to bacteria, viruses or other substances. Autoantibodies are produced in reaction to a normal constituent of a person's body. Tissue from three normal brains was used to evaluate autoantibody activity to brain proteins in cerebrospinal fluid and blood serum samples from 16 HIV-positive patients with ADC and 10 HIV-positive patients without ADC. Approximately 1/3 of samples from patients with ADC and 1/3 of samples from patients without ADC had reactions against the brain proteins. However, different proteins were recognized when different brain samples were used.

Kaposi's sarcoma (KS) in gay and bisexual men may be caused by a sexually transmitted agent, but no sexual practice has been identified conclusively as a means of transmission. A study of 1,075 Australian gay and bisexual men showed that KS as an AIDS-defining diagnosis was less common among men reporting oral-genital sex than men not reporting this practice. Little association was found between oral-anal contact ('rimming') and incidence of KS, nor did oral-fecal contact appear to be a means of transmission. No particular sexual practice appears to predict a diagnosis of KS, although relative risk for KS was higher among men practicing insertive oroanal intercourse and receptive fisting. The percentage of men with an AIDS-defining diagnosis of KS fell from 54% between 1984-85 to 24% between 1989-90.

Epstein-Barr virus (EBV) may play an indirect role in the development of AIDS-related lymphomas (ARL). The role of EBV in the development of ARLs has ben controversial. Three different molecular biology techniques were used to detect EBV in paraffin embedded and frozen specimens from 30 patients with ARL. Seventeen patients had large-cell lymphoma, 11 had small non-cleaved cell lymphoma and two had Hodgkin's disease. EBV was detected by polymerase chain reaction (PCR) in 94% of the frozen specimens, compared with 17% of the paraffin embedded samples. In situ hybridization and antibody-based immunohistochemical staining detected EBV in less than 10% of the cells in 27 specimens.

Feline immunodeficiency virus Maryland isolate (FIV-MD) may cause neurologic abnormalities similar to AIDS-associated encephalopathy in children. AIDS-associated encephalopathy is a degenerative disease of the brain. Among 12 eight-week-old kittens who were evaluated over a 16-month period, six were injected with FIV-MD and six (in the control group) were not. The infected kittens developed immunodeficiency and their growth was delayed. They also developed neurologic abnormalities characterized by repetitive and compulsive behavior as early as four weeks after infection. Three cats displayed this behavior throughout the 16-month follow-up period. Twelve months after infection, a magnetic resonance imaging (MRI) scan of the brains of infected cats revealed wasting of brain tissue and white matter lesions. Electroencephalography (EEG) and evoked potential tests were also performed to evaluate brain function. These electrodiagnostic tests were found to be more sensitive than MRI in detecting neurologic abnormalities caused by FIV-MD.

Itraconazole may be more effective than fluconazole for the treatment of histoplasmosis in AIDS patients. Histoplasmosis is an infection caused by inhaling the spores of the fungus Histoplasma. Among 20 AIDS patients with histoplasmosis, 12 took 400 milligrams (mg) of itraconazole per day and 10 took between 100 and 800 mg of fluconazole per day. Two patients treated with itraconazole had initially been treated unsuccessfully with 100 mg per day of fluconazole. Seven patients treated with itraconazole went into remission, two improved and three did not respond to treatment. Three patients treated with fluconazole went into remission, one improved and six failed to respond to treatment. No significant difference in response to treatment occurred between the patients treated with high-dose and low-dosage fluconazole.

Toxoplasmic-encephalitis associated with AIDS appears to result from reactivation of a previous Toxoplasma infection. Infection with the protozoan Toxoplasma gondii is usually mild but may cause extensive brain damage in patients with suppressed immune systems. Of 1,073 homosexual and bisexual men, 443 were HIV-positive and 117 had previously been infected with Toxoplasma. Overall, 42 men were positive for both. There was no significant difference in the incidence of Toxoplasma infection among racial groups. Only men who were both HIV-positive and who had previously been infected with Toxoplasma developed Toxoplasmic encephalitis. None of the 183 men who eventually developed AIDS and had initially tested negative for Toxoplasma developed Toxoplasmic encephalitis. Five of the 13 men with AIDS and Toxoplasma infection developed Toxoplasmic encephalitis and all died.

A reduction in cognitive function may occur in patients with severe HIV infection or AIDS who have ocular microangiopathic syndrome, an eye disease often found in AIDS patients. Among 37 individuals infected with HIV who had an ophthalmological and neuropsychological examination, 24 had AIDS. Fifteen patients with AIDS and one patient with severe HIV infection had ocular microangiopathic syndrome. Both eyes were affected by ocular microangiopathic syndrome in six patients, and one eye was affected in 10 patients. Seventeen patients had reduced cognitive function. A significant association was found between the development of ocular microangiopathic syndrome and reduced cognitive function, especially in short-term memory.

Doxorubicin may not be an effective treatment for AIDS patients who have Kaposi's sarcoma. Kaposi's sarcoma is a cancer that affects the skin and occasionally the lymph nodes and viscera, or internal organs. Among 53 AIDS patients suffering from Kaposi's sarcoma who were treated with 15 milligrams of doxorubicin per square meter once a week, 26 had cutaneous (skin) disease with no symptoms and 27 had visceral disease with fluid accumulation and a history of opportunistic infections. Of 50 patients for whom treatment response was evaluated, 10% experienced a partial response to treatment, 64% experienced a minor response, 24% experienced no response and 2% experienced disease progression. Twenty percent of the patients with cutaneous disease experienced a partial response to treatment, compared to none of the patients with visceral disease.

The drug zidovudine appears to significantly reduce the incidence of HIV-induced brain lesions and of severe dementia in AIDS patients. Of 202 people who died of AIDS, 82 were treated with zidovudine and 120 were not. The frequency of multinucleated giant cells (MGC), a sign of HIV infection of the brain, was 30.4% in treated patients compared with 48.3% in untreated patients. The combined frequency of HIV leukoencephalopathy and HIV encephalitis, both diseases of the brain, was 3.6% in treated patients and 8.3% in untreated patients. The greatest reduction in MGC frequency occurred six to 12 months after treatment with zidovudine was started, with no further benefits observed after longer periods of treatment. Among patients with HIV-induced brain lesions but no other brain diseases, 33.3% of zidovudine-treated patients had severe dementia compared with 73% of untreated patients.

Heme is the iron-carrying part of the hemoglobin molecule, present in red blood cells, which carries oxygen to the cells of the body. Porphyria cutanea tarda (PCT) is a disorder in which the synthesis of heme is impaired. Individuals with PCT become overly sensitive to light. Manifestations which occur in early stages of the disease are fragility of the skin, bruising, blistering, heavy pigmentation, and excessive body hair. Late manifestations include scarring, the formation of cysts containing keratin, and changes similar to scleroderma, where there is degeneration of the connective tissue of the skin, lungs and internal organs. A case study of a person infected with the human immunodeficiency virus (HIV) with PCT is reported, and a review of the 17 case studies of HIV-infected individuals with PCT is presented. In 71 percent of the cases, PCT was diagnosed before or at the same time as HIV infection. All of the patients had blisters of the back of the hands, and laboratory tests showed increased levels of porphyrins (iron-containing molecules) in their urine. Other symptoms present in some of the cases were abnormal liver function, heavy pigmentation, erosions, excessive hair growth and skin fragility. Symptoms rarely seen were polycythemia (an abnormal increase in red blood cells), increased iron storage, blistering and scleroderma. Treatment for HIV-infected individuals with PCT should include avoidance of exposure to the sun; elimination of agents that increase the severity of disease, such as alcohol, estrogen, iron and chlorinated hydrocarbons; and removal of some blood on a periodic basis. The cause of PCT is not certain, but it is felt that HIV is involved in the development of PCT in infected individuals. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sleep is often disrupted in individuals infected with the human immunodeficiency virus (HIV), possibly because of psychiatric conditions such as anxiety and depression, opportunistic infections and cancer, or other symptoms of HIV infection, such as diarrhea or fever. Treatment with zidovudine has also been reported to cause disruption in sleep. The quality of sleep in 50 patients who were infected with HIV was investigated by questionnaires filled out by the patients. The patients were in different stages of disease and some were being treated with zidovudine (AZT). Analysis showed that sleep disturbance was correlated to the stage of disease and was more significantly disrupted in the later, more severe stages of AIDS. The level of depression among the patients did not generally differ significantly with the various stages. Thus, sleep disturbance did not correlate with depression. AZT treatment was not found to affect sleep significantly. (Consumer Summary produced by Reliance Medical Information, Inc.)

Frequently, individuals with AIDS have diarrhea. Intestinal infections are thought to cause it usually, but the microorganisms responsible for diarrhea cannot be isolated in the majority of the patients. Abnormalities in the middle portion of the intestines, the jejunum, have been observed. The tissues of the jejunum, obtained by biopsy, of 49 patients from Brazil who were infected with the human immunodeficiency virus (HIV) were examined for abnormalities and for the presence of microorganisms. Thirty-seven of the patients had AIDS and 23 of these individuals had diarrhea. Abnormalities in the jejunal tissues were seen primarily in the patients with diarrhea. Fewer than normal numbers of lymphocytes, which fight off infection, were present. Infectious microorganisms could not be found in the majority of the patients, which is especially unusual for patients living in a tropical country. The genus of infectious microorganism most often isolated was Cryptosporidium, found in 22 percent of the cases. Therefore, the cause of diarrhea in most of the patients with AIDS is not known. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cryotherapy, or the application of very cold substances, such as liquid nitrogen, to the skin, has been used to destroy benign and malignant skin tumors. A phase II clinical trial was conducted to assess the treatment of skin lesions with liquid nitrogen in 20 patients with Kaposi's sarcoma (KS). KS is a type of cancer that can develop with human immunodeficiency virus (HIV) infection. (HIV is the virus associated with AIDS.) Subjects were treated every three weeks for approximately 11 weeks. Results revealed that 80 percent of the KS lesions were completely destroyed; the lesions lasted for a minimum of 6 weeks after the treatment period. An additional 5 percent of KS lesions responded partially. Response was not related to: the stage of HIV infection, as indicated by the number of CD4+ helper T cells (which are destroyed in later stages of infection); whether or not the individual was tolerant to the drug zidovudine, which is used in the treatment of HIV infection; the development of opportunistic infections during the treatment period; or previous treatment with other types of chemotherapy. However, subjects who did not have a history of opportunistic infections, which readily occur in patients with KS, responded better to the cryotherapy. (Opportunistic infections occur in patients with poor immune function, and are common among individuals with HIV infection.) Side effects of the treatment were minimal, and included blistering and limited local pain, which was treated with acetaminophen (Tylenol). However, when tissues from the treated area were examined microscopically, residual cancerous tissue was often seen, especially deep in the skin. This indicates that the lesions may reappear on the skin and cryotherapy may have to be continued. Therefore, cryotherapy with liquid nitrogen is recommended for KS lesions that respond slowly or have a poor cosmetic result after systemic treatment for KS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Symptoms affecting the brain occur in many patients who are infected with the human immunodeficiency virus (HIV), which causes AIDS. The autonomic nervous system, which regulates involuntary function of various organs, appears to be defective in patients with AIDS. When uninfected individuals are exposed to stressful stimuli, levels of catecholamines (molecules involved in autonomic responses) are increased in the blood. A study was conducted testing the responses of 95 homosexual men: 76 who had HIV infection, but were in the early stages of disease; and 19 who were not infected. The test used the physiological stress stimuli called the cold pressure test, which involves immersion of a hand in ice water for one to two minutes. The level of the catecholamine norepinephrine was measured several minutes after the test and was found to be reduced in the HIV-infected men. Further study showed that the time of increase in norepinephrine was different among infected and noninfected individuals. Those with HIV infection had earlier increases in norepinephrine compared with those who were not infected. This study concludes that the norepinephrine response is abnormal in individuals in the early stages of HIV infection. This defect may be involved in the neurologic dysfunction seen in HIV-infected individuals and AIDS patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Because patients who are infected with the human immunodeficiency virus (HIV) have defective immune systems, so-called opportunistic infections often develop. Infection with the fungus Aspergillus (aspergillosis) can occur when the ability of neutrophils and macrophages, cells of the immune system, to destroy or engulf invading organisms (phagocytosis) becomes impaired. Phagocytosis in patients with AIDS is defective. However, aspergillosis is not common in patients with AIDS. Between May 1983 and June 1984, 3,170 cases of AIDS were reported to the Centers for Disease Control, with only five of these cases involving aspergillosis (0.16 percent). Two case studies of patients with AIDS who had invasive aspergillosis are reported, and other cases described in the literature are reviewed. Infection with aspergillus is serious and survival rates are very low, even with antifungal therapy and surgical resection. Risk factors for the development of aspergillosis include low numbers of neutrophils, treatment with corticosteroids, and prior underlying lung disease. AIDS patients who receive drugs that adversely affect neutrophils, and those who have underlying lung disease (usually pneumonia caused by Pneumocystis carinii), must be aware of the possibility of the development of the serious, and often fatal aspergillosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection with the bacterial organism Campylobacter, campylobacteriosis, is the most common cause of acute bacterial diarrhea in the United States. The bacteria can be acquired by consumption of unpasteurized milk, undercooked chicken, untreated water, or by contact with cats. The incidence of campylobacteriosis among patients with AIDS has not been well studied. Using registries, the incidence and characteristics of campylobacteriosis among AIDS patients in Los Angeles County, California from 1983 to 1987 were analyzed. Campylobacteriosis was reported in 0.7 percent (29 out of 4,433) of the AIDS patients. This was 39 times the rate of that of the general population. The increased rate of infection in AIDS patients is a consequence of their compromised immune systems. Campylobacteriosis was more common in female than male AIDS patients. Infection occurred with seasonal variation, with a greater occurrence in July and November. The average survival time of AIDS patients who had campylobacteriosis was shorter than for AIDS patients without the disease (14 months compared with 21 months). However, other factors, such as other infections and/or treatment may also play a role in the decreased survival rates. AIDS patients who had campylobacteriosis had higher risk of the bacteria getting into the bloodstream, and a greater number required hospitalization than uninfected patients. Potential sources of campylobacteriosis should be identified and avoided by AIDS patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pneumocystis carinii pneumonia (PCP) is an opportunistic infection that often occurs in patients with AIDS, and causes high morbidity (illness) and mortality. A number of drug therapies have been developed that are effective in preventing PCP in AIDS patients. Some use a combination of drugs that have little or no effect alone, but are highly effective when administered together, thus providing a synergistic effect. This study examined a combination of erythromycin and sulfisoxazole treatment to prevent PCP in an animal model. Rats were given a drug to suppress their immune systems and increase their vulnerability to the development of PCP. The rats were grouped and either given no drug, azithromycin, clarithromycin, erythromycin, sulfisoxazole, or a combination of erythromycin and sulfisoxazole. None of the drugs alone had much effect in preventing PCP; 80 to 100 percent of the rats in each group developed PCP infection. When erythromycin and sulfisoxazole were given in combination, only 10 percent of the rats developed PCP. This drug combination has been safely used in humans for other diseases for a number of years. Drug models using animals have worked well for PCP studies. The results from this study indicate that the combination therapy of erythromycin and sulfisoxazole should be examined as a means of preventing PCP in patients with AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Mycobacterium is a family of disease-causing bacteria, and includes the tubercle bacillus which causes tuberculosis. Mycobacterial infections are increasing in the United States, especially among patients with AIDS. Mycobacterium kansasii (MK) occurs in about 3 percent of AIDS patients who have a nontuberculous mycobacterial infection. Increased rates of MK infection in particular geographic regions might be expected to closely follow rates of HIV-1 (the agent that causes AIDS) for that region. This study examined the incidence of MK infection in the New Orleans area because MK is endemic to the area (it is usually found there, but causes low mortality). It was expected that increased rates of MK infection would reflect the incidence of HIV-1 infection. The study compared patients who tested positive for MK infection with patients who tested positive for HIV infection. Tests for the former were conducted at a mycobacteriology laboratory in New Orleans, while information about the latter was obtained by reviewing state public health lists. The tests were conducted from the period beginning in June, 1983 and ending in June, 1988. Results revealed that 72 patients tested positive for MK during the study, meaning they has been infected with the agent. The number of positive MK tests were relatively stable for each year of the period. Of the 72 MK-positive patients, 23 (31.9 percent) were also HIV positive. The first year of the study, none of the patients who tested positive for MK were positive for HIV, but by the last year, 50 percent of those positive for MK were also HIV-positive. Disseminated disease (found outside the area of the body where a disease is normally seen) due to MK occurred in 6 of the 23 HIV-infected patients, but in only 1 of the 49 patients not infected with HIV. Chest X-rays were abnormal in 12 of 19 of the HIV-infected patients. These results indicate a relation between infection with HIV and MK, but the specifics are unclear. Present treatments for MK should be given with the awareness that resistance varies among the drugs used to treat this infection. A better treatment of MK for AIDs patients needs to be formulated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Individuals who are infected with the human immunodeficiency virus (HIV) have an increased incidence of non-Hodgkin's B-cell lymphomas. This type of malignant tumor is extremely aggressive and metastasizes to many sites in the body. Tumors from multiple sites from three patients who died with AIDS-associated lymphomas were analyzed to see if the tumors were monoclonal (originating from one cell) or polyclonal (originating from more than one cell). All the lymphomas were B cells which secreted the immunoglobulin M (IgM) and were at similar stages in maturation. The clonality of the cells was tested by the examination of genetic rearrangements of the immunoglobulin gene, which would be different in different cells. The majority of B-cells tested were polyclonal, with only a minority of the cells being monoclonal. This polyclonality of B-cells associated in lymphomas has not been seen in other studies. In one case, but not the other two, the Epstein-Barr virus (EBV), which is associated with another type of lymphoma, Burkitt's lymphoma, often seen associated with HIV infection, was present. The oncogene (a gene implicated in the development of some cancers) C-myc, which is rearranged in Burkitt's lymphoma, was not altered in these lymphomas. Therefore, polyclonal B-cell lymphoma not associated with EBV may be a newly described disease associated with HIV-infection. Further study is needed to identify the possible factors that would cause multiple clones of B cells to become cancerous. (Consumer Summary produced by Reliance Medical Information, Inc.)

Initial infection with hepatitis B virus (HBV) may develop into chronic infection more frequently among patients whose cellular immune systems are impaired, such as in patients who are infected with the human immunodeficiency virus (HIV). However, it has been shown that the natural course of HBV infection in those that are infected with HIV may be altered, in that the replication time of HBV seems to be longer than normal and less severe liver infection develops. The outcome of HBV infection depends on the stage of HIV infection. Two hundred eleven patients with advanced HIV infection, including those with AIDS, AIDS-related complex (ARC) or those with a very low helper CD4+ T cell count, were examined for HBV infection. At the beginning of the study, 138 patients (65 percent) had antibodies to HBV in their blood, indicating past infection and 16 (8 percent) had detectable HBsAg, a protein associated with the virus, indicating infection with the virus. Fourteen of the 16 had chronic HBV infection. Six of the 57 patients who did not have antibodies to HBV at the start of the study became infected during the follow-up period, which was an average of 18 months later. Four out of the six (67 percent) developed chronic infection, with only two recovering from an acute infection. Therefore, the development of HBV infection is not infrequent among HIV-infected individuals. The course of infection is modified, with an increased risk of infection developing into a chronic state. Reactivation of HBV to cause recurring infections was not seen in the patients with advanced HIV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Individuals with AIDS often develop pneumonia caused by Pneumocystis carinii. The pneumonia is most commonly treated with either high doses of trimethoprim-sulfamethoxazole or pentamidine. However, because both therapies may cause toxic side effects, other treatments are needed. The effectiveness of the drug dapsone (diaminodiphenylsulfone) was evaluated as a single treatment for pneumocystis pneumonia in patients with AIDS. Although the drug did not cause any adverse effects, it was not very effective, successfully treating only 61 percent of 18 patients. Studies have suggested that a higher dose of dapsone may be more effective, specifically 200 milligrams per day instead of the previous dose of 100 milligrams per day. Seven AIDS patients with mild cases of pneumocystis pneumonia were treated with 200 milligrams of dapsone daily. On the fifth day of treatment, two patients suffered respiratory failure and died. Four others experienced major adverse effects, such as difficulty breathing, kidney problems, internal bleeding, anemia and high fever. The study was ended prematurely because of the toxic reactions and lack of evidence of effective treatment for pneumocystis pneumonia. Patients had received 5 to 14 days of treatment with dapsone. These findings demonstrate that dapsone, administered as a single agent in high doses, is not effective and should not be used to treat Pneumocystis carinii pneumonia in patients with AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Long-term treatment with zidovudine (ZVD, also known as AZT) can lower the risk of developing opportunistic infections and reduce the death rate of patients with AIDS. (Opportunistic infections affect patients with impaired immune function; they often signal the development of AIDS and are a common cause of death.) However, long-term treatment with ZVD can also lead to the development of toxic side effects, including adverse effects on bone marrow cells that develop and mature to red and white blood cells, including lymphocytes, which are involved in the immune response. The effects of long-term treatment with ZVD on the growth and multiplication of immune cells and the production of lymphokines were analyzed in 15 patients with AIDS who had opportunistic infections. (Lymphokines are produced by lymphocytes and are important in immune reactions.) Lymphocytes were obtained from the patients prior to treatment with ZVD, and again after three and six months of treatment. The cells were treated with various agents, called mitogens, that induce growth and multiplication of lymphocytes; the production of lymphokines was then analyzed. The growth response of lymphocytes did not change significantly after treatment with mitogens. The production of the lymphokine interleukin-2 increased after treatment, while the production of two types of another lymphokine, gamma-interferon and alpha-interferon, decreased significantly. These findings suggest that treatment with ZVD did not cause adverse effects on the proliferation of lymphocytes, or on the production of interleukin-2, but did affect the production of gamma- and alpha-interferon. This could negatively affect the immune response of patients with AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Neurological disorders, including dementia (confusion), often occur in patients with AIDS. Studies have shown that the human immunodeficiency virus (HIV, which causes AIDS) can directly infect brain cells. HIV can also be grown outside of the body in neuroblastoma cell lines. Neuroblastomas are highly cancerous tumors of neurons (nerve cells) that spread to other parts of the body. The HIV-infected neuroblastoma cells were examined and found to have large amounts of the virus. Neuroblastomas contain the protein CD4, which HIV uses to enter the cells. In the laboratory, when antibody molecules to CD4 were added to the neuroblastoma cells and HIV, the antibodies blocked infection. These findings demonstrate that neuroblastomas can be used as a tissue culture system to study the interactions of HIV and brain cells. In addition, HIV-infected neuroblastomas can be used to evaluate the effectiveness of various therapies against HIV infection in brain cells. (Consumer Summary produced by Reliance Medical Information, Inc.)

A phase I trial was conducted with 56 patients who were infected with the human immunodeficiency virus type 1 (HIV-1) and had Kaposi's sarcoma (KS). The safety, maximum dose that could be tolerated, and effectiveness of treatment with interferon-alpha given at the same time as zidovudine were evaluated. Interferon-alpha is a cytokine (a cellular factor) which has been shown to cause increased immune reactions against the Kaposi's sarcoma tumor and to inhibit the replication of the virus. Zidovudine has also been shown to inhibit HIV-1 and improve the disease status of those infected with HIV, including prolonging life. Both drugs together are thought to increase the rate of inhibition of the virus. The drugs were given together in various dose combinations for eight weeks, with a 48-week follow-up. At higher doses of the combination of the two treatments, an increase in the number of CD4+ helper T cells was seen, as well as suppression of the presence of viral proteins, indicating the inhibition of the infection. Anemia (destruction of red blood cells), neutropenia (destruction of white blood cells), and hepatotoxicity (destruction of liver cells) occurred at toxic levels of the drugs. The highest dose at which neutropenia was not seen was 1,200 milligrams (mg) of zidovudine and 9 mu of interferon-alpha per day. The highest dose at which hepatotoxicity was not seen was 600 mg of zidovudine and 27 mu of interferon-alpha per day. With the three types of toxicities taken into consideration, 600 mg of zidovudine and 18 mu of interferon-alpha per day were determined to be the maximum tolerated doses for the combination of the two drugs. Tumor regression was seen in 47 percent of the patients, and was associated with greater survival rates. This study shows that an intermediate dose of interferon-alpha and low doses of zidovudine do not appear to be toxic to patients with HIV-1 infection and Kaposi's sarcoma and can lead to improvement in disease status, including tumor regression and increased survival. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infections with viruses such as the cytomegalovirus (CMV), a member of the herpesvirus group, cause sickness and death in patients with AIDS. CMV leads to a number of clinical syndromes, including diseases affecting the nervous system. Although uncommon, polyradiculomyelitis (inflammation of the nerve roots and the spinal cord) which is thought to be caused by CMV has been seen in a number of patients infected with HIV-1. The presence of polymorphonuclear leukocytes (PMNs), a type of white blood cell, in the cerebrospinal fluid (CSF) of AIDS patients was evaluated. CMV-induced-polyradiculomyelitis was found in four out of 241 patients who were infected with HIV and had neurological disease. All four patients had increased numbers of PMNs. In all of the 241 patients with neurological symptoms, only seven, including the four that had CMV-induced-polyradiculomyelitis, had large numbers of PMNs in their CSF. Therefore, it is concluded from this study that a predominance of PMNs in the CSF could indicate that the neurological condition is caused by CMV infection. The CMV infection could then be rapidly treated with drugs effective against cytomegalovirus. (Consumer Summary produced by Reliance Medical Information, Inc.)

The incidence of Kaposi's sarcoma (KS) is higher among homosexual and bisexual men with AIDS than among individuals with AIDS in other risk groups. It is thought that sexually transmitted cofactors for the development of KS may exist which are acquired more frequently by homosexual men than by other people. In recent years, the incidence of KS has been shown to be decreasing. A group of 6,705 homosexual and bisexual men from the San Francisco City Clinic was studied to determine whether the incidence of KS was declining, and if so, why KS was less prevalent. Of the total group, 1,341 men had AIDS. The proportion of men who had KS as the first clinical indicator of AIDS declined from 79 percent in 1981 to 25 percent in 1989. In a subgroup of 250 men, it was found that the incubation period from seroconversion (development of antibodies to the human immunodeficiency virus) until AIDS diagnosis was shorter (77 months) for men who developed KS as the initial sign of AIDS than for men who were diagnosed with AIDS because of other clinical symptoms (86 months). There was no difference between men who did and did not develop KS in the number of sexual partners, history of certain sexually transmitted or intestinal diseases, use of specific recreational drugs (such as nitrite inhalants), or participation in specific sexual practices. In conclusion, this study documents a decline in KS over time among homosexual and bisexual men. Agents that are thought to act as cofactors for the development of KS were not found to be involved in the occurrence of KS in this group of individuals, but cofactors may indeed exist and need to be identified. (Consumer Summary produced by Reliance Medical Information, Inc.)

Other factors besides infection with the human immunodeficiency virus (HIV) appear to be involved in the development of Kaposi's sarcoma (KS) in AIDS patients. The incidence of KS is much higher in homosexual and bisexual men than in other AIDS risk groups such as heterosexuals, hemophiliacs, and intravenous drug abusers. Thus agents, or cofactors, other than HIV infection are thought to be involved in the development of KS. Possible cofactors include: infection with cytomegalovirus; other sexually transmitted infectious agents; and the use of nitrite inhalants. Nitrite inhalants are used more commonly by homosexual men than by other groups of individuals. Studies have shown that extensive use of nitrite inhalants is associated with the development of KS in individuals with AIDS. An increased frequency of KS lesions has been observed on the face (especially the nose) and the chest, areas which are more likely to be exposed to the nitrite vapors. Nitrites cause dilation of blood vessels, and it is possible that this favors the transmission of some type of infectious agent. The identification of cofactors involved in the development of KS is important in order to prevent KS in groups at high risk. More research is needed to understand possible interactions between HIV infection and use of nitrite inhalants. Until more information is available, homosexual patients should be told not to use nitrite inhalants. (Consumer Summary produced by Reliance Medical Information, Inc.)

The number of individuals with AIDS that develop Kaposi's sarcoma is declining in the United States, and the reason for the decline is not known. The number of cases of AIDS-related Kaposi's sarcoma in San Francisco was reviewed through August 31, 1990. Of the 7,119 patients with AIDS who were reported, 2,346 (33 percent) were diagnosed as having KS. In 73 percent of the KS cases, the development of KS was the first clinical symptom of AIDS, and in the other 27 percent of the cases it was a later symptom. Eight-eight percent of the patients with KS were homosexual or bisexual men without previous use of intravenous drugs, while 12 percent were homosexual or bisexual men who had used intravenous drugs. The total number of patients with AIDS and the number of cases of KS have both increased from 1981 to August 1989. However, the proportion of AIDS patients with KS has declined from 55 to 19 percent in this time period. It is concluded that the decline is not due to underreporting of KS compared with other manifestations of AIDS, and that the proportion of KS cases to AIDS cases is indeed declining. (Consumer Summary produced by Reliance Medical Information, Inc.)

Autoimmune hemolytic anemia (AIHA) is only rarely seen in patients infected with the human immunodeficiency virus (HIV). There have been 12 reports of patients with AIHA and HIV infection. A case study is described of a patient with AIDS-related complex who developed AIHA with reticulocytopenia (reduced numbers of reticulocytes, immature red blood cells). The patient had severe hemolysis (lysis of red blood cells), including anhaptoglobinemia, the lack of a blood protein that binds and is involved in the removal of free hemoglobin (the pigment-carrying protein of red blood cells). He also had microspherocytosis (irregularly shaped red blood cells) and splenomegaly, an enlarged spleen. It is thought that treatment with azidothymidine (AZT) for the HIV infection may have made his anemia worse, but that AZT was not the cause of the anemia. The patient's spleen was surgically removed, resulting in remission of the AIHA after a period of time. The AIHA went into remission even though the patient was still being treated with AZT. Autoimmune antibodies (antibodies made against normal body components) produced against red blood cells are thought to be the cause of AIHA in patients with HIV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hyponatremia is a disturbance in the body's metabolism resulting in a low concentration of sodium in the blood. Hyponatremia may be caused by abnormal secretion of the antidiuretic hormone (ADH) by the adrenal gland, in possible combination with an increased intake of water and decreased removal of water by the kidneys. Hyponatremia causes confusion and tiredness, and can lead to convulsions and coma. The prognosis of patients with AIDS and hyponatremia is poor. The incidence, clinical significance, and prognosis of hyponatremia were studied in 96 patients with AIDS-related complex or AIDS. Hyponatremia was seen in 31 percent (30 out of 96) of the patients with AIDS-related complex or AIDS. Twenty out of 57 patients (35 percent) developed hyponatremia outside of the hospital when the they were being treated on an outpatient basis, and 10 out of 39 (27 percent) developed hyponatremia when they were in the hospital. Patients with hyponatremia had a greater frequency of opportunistic infections, including Pneumocystis carinii pneumonia and cytomegalovirus infections. The death rate of AIDS patients with hyponatremia was 70 percent, which was twice that of patients without hyponatremia. The length of time that 50 percent of patients survived after diagnosis of HIV infection was 11.5 months for those with hyponatremia compared with 39 months for those without hyponatremia. The length of time after the development of hyponatremia that 50 percent of patients survived was 4.5 months. Two patients developed Addison's disease (a serious disease caused by partial or complete failure of the adrenal gland), and 15 had high levels of sodium in their urine but did not have any evidence of problems with their kidneys or adrenal glands. The cause of the high levels of urinary sodium was not determined. This study showed that hyponatremia commonly occurs in patients with AIDS-related complex and AIDS, and is associated with an increased incidence of complications and death. Hyponatremia is not a symptom characteristic of the terminal stages of AIDS, since it also occurred in patients with AIDS-related complex. (Consumer Summary produced by Reliance Medical Information, Inc.)