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Purpose: To assess the tolerability and efficacy of intravitreal injections of foscarnet in cytomegalovirus (CMV) retinitis in acquired immunodeficiency syndrome (AIDS)., Methods: Patients with CMV retinitis resistant and/or intolerant to intravenous foscarnet and ganciclovir and resistant to intravitreal ganciclovir were included. The induction therapy consisted of intravitreal injections of 2,400 micrograms of foscarnet twice a week. The assessment was performed by clinical examination and photographies of the fundus., Results: Three patients (four eyes) have been included. Three eyes were administered seven and one eye eight intravitreal injections. The tolerability was good, but the efficacy was mere: the retinal lesions became less edematous, but they still extended., Conclusion: In these four eyes with CMV retinitis resistant to intravitreal ganciclovir, intravitreal injections of foscarnet were well tolerated but did not stop the progression of the retinitis.

We reviewed the records of 15 Human Immunodeficiency Virus (HIV) infected patients with pulmonary cryptococcosis (PC). PC was the first AIDS-defining manifestation in nine patients. HIV infection was identified simultaneously with the onset of PC in 4 patients. The CD4+ lymphocyte count was low in all cases (median, 24/m3). Chest radiography showed interstitial infiltrates in 13 instances, associated with pleural effusion in 5 cases and hilar adenopathy in 2 cases. In one case, chest-X-ray showed isolated pleural effusion and was normal in one patient. For 11 of 12 patients, bronchoalveolar lavage fluid culture was positive for Cryptococcus neoformans. Seven of 15 patients had evidence of extrapulmonary cryptococcal disease with positive cerebrospinal fluid culture. Serum cryptococcal antigen was detected in all 15 patients. Concomitant lung infection with Pneumocystis carinii was diagnosed in 4 patients. First-line regimen was fluconazole in 10 patients and amphotericin B in 4 patients. Fluconazole has been prescribed in 7 patients as a permanent suppressive therapy and should be continued indefinitely.

Unlabelled: This study tries to demonstrate the importance of using follow-up trials and taking anxio-depressive status into account while interpreting cognitive impairment in HIV-infected subjects. Subjects included were: 18 HIV carriers, mostly homosexual, belonging to CDC groups II (4), III or IVC2 (7) and IV (7), selected within a cohort of 63, as having been assessed 3 times, with no focal or identified brain disease at entry. Our methods were: 1) psychiatric interview based on DSM III-R criteria, clinical scales (Spielberger's STAXI and the MADRS) and cognitive questionnaires; 2) neuropsychological evaluation including 16 subtests screening attention, memory, visuo-spatial function, motor dexterity, psychomotor speed, and language; 3) repeated assessment within a period ranging from 6 to 21 months., Results: At entry, cognitive status was impaired for 14 subjects (2 II, 5 III or IVC2, 7 IV). Disorders had disappeared for 7 subjects (2 II, 2 IVC2 and 3 IV) at following assessments allowing us to conclude on a psychogenic origin. For 7 subjects, cognitive status had either remained constant (3 III and 2 II) or had worsened within 7 to 17 months (2 IV), whereas psychiatric symptoms had decreased, implying HIV encephalopathy. Follow-up trials including 3 neuropsychological and psychiatric assessments and neuroimagery, if necessary, were required to ascertain the causes of cognitive impairment consequently attributed to anxio-depressive symptoms or HIV encephalopathy in 14 subjects.

Between 1989 and 1990, 10 HIV-infected patients with renal involvement (proteinuria and/or renal failure) were followed. The 5 men and 5 women black (4 Haitians, 3 Zairians, 2 Congolese and 1 Angolan). Their mean age was 31.7 +/- 4 years. No known risk factor was identified and transmission was probably heterosexual. When renal disease was diagnosed, 4 patients had AIDS, 5 had ARC and 1 was asymptomatic. Kidney biopsies were performed in 7 patients: 4 HIV-associated nephropathies (HIV AN) with segmental and focal hyalinizations, 1 thrombotic angiopathy, and 2 interstitial nephropathies, 1 with proliferative glomerulonephritis. The clinical, biological and radiographic patterns of 2 of the remaining 3 patients were suggestive of HIV AN. Four of the 6 patients with HIV AN developed end-stage renal disease within 5 +/- 2.5 months; renal function in the other 2 remained stable for 25 and 41 months, respectively, while they were receiving zidovudine, but deteriorated rapidly within weeks of withdrawing this drug. Zidovudine may have delayed the evolution of the nephropathies in these patients.

Primary prophylaxis against opportunistic infections is a capital advance in the management of HIV-infected patients. In cases with pneumocystosis prophylaxis is recommended when the number of T4 cells reaches 200/mm3 or 15 to 20% and constitutes a major incitation to apply for detection of seropositivity. It can be predicted that other prophylaxis of this type will be available for other main opportunistic infections whose proportion is increasing due to extension of the patient's life expectation (e.g. toxoplasmosis). Research in this field relies on new drugs, on the use of older drugs, and above all on experimental models providing a good preclinical evaluation. The development of combined prophylactic treatments against several opportunistic infections is a priority target. Maintenance treatments are systematically given after a first opportunistic infection.

The diagnosis of Pneumocystis carinii pneumonia (PCP) rests on the isolation of this micro-organism in patients whose latest blood count, less than 2 months old, shows less than 250 CD4 lymphocytes per cubic mm and who present with signs of impaired lung function. Bronchoalveolar lavage (BAL) is the reference diagnostic method, but induced expectoration may be the initial examination, in which case BAL is performed only when the latter fails or gives negative results. Prognostic factors are those of any interstitial pneumonia plus those specific to PCP and those associated with HIV infection. It is only when no initial severity factor is present that cure can be contemplated, provided the effectiveness of treatment is evaluated daily. Cotrimoxazole is the reference drug for comparisons with all new treatments; the indications of corticosteroid therapy and the necessity of intensive care techniques are now better determined. The frequency of PCP and its mortality rate should be reduced, and one may look forward to a time when this disease will be rare and atypical, thereby raising other diagnostic and therapeutic problems.

In order to determine the extent of liver abnormalities occurring during acquired immunodeficiency syndrome, the available histological analyses of liver samples (32 biopsies, 52 autopsies) from 71 AIDS patients, for the period 1982-1986, were studied retrospectively. Hepatomegaly was the most common clinical symptom (23 patients, 32.4%), while jaundice was rare, being seen in only 5 cases (7%). Progressive anicteric cholestasis was the most frequently observed biological anomaly (29/52, 55.7%). Ten patients had liver infections: 2 Mycobacterium tuberculosis, 8 Mycobacterium avium intracellulare. Cytomegalovirus was present in 3 patients and 1 individual was infected with Cryptococcus neoformans. Granulomatous hepatitis was associated with these infectious agents in 11 patients, but remained unexplained in 11 others. Three patients had cholangitis (2 with CMV inclusions, 1 unexplained). Among the 32 biopsies, 5 elucidated the origin of unexplained fever. Kaposi's sarcoma of the liver was found in 10/52 autopsy samples (19%) and hepatic lymphoma in 2 cases. Non-specific histological lesions were common: inflammation of the portal spaces (48 cases, 67.6%), steatosis (32 patients, 45%), peliosis hepatis (9 cases, 12.6%) and sinusoidal dilations (39 cases, 54.9%).

In the temperate climate countries, AIDS is defined as the occurrence of opportunistic infections and/or Kaposi's sarcoma in adults, mostly homosexuals. It can be preceded by a related state of asthenia, loss of weight, adenopathies, diarrhoea, but which is far from always developing into AIDS. The immune syndrome is specified by cutaneous anergy , lymphopenia with an elective decrease of OKT4. The etiology is not known and, if one often refers to retro-viruses (specific disease), the role of multiple and repeated infections ( plurifactorial syndrome) can not be discarded. Cases of AIDS exist in Haiti and possibly in Equatorial Africa, the latter may be different from the occidental cases. The planning for a survey in Africa is suggested.

A case of AIDS due to HIV/LAV2 is reported. The patient was a 32 year old man from Guinea-Bissau with no known risk factors. He had brain toxoplasmosis, oral thrush and chronic genital herpes. Investigations for IgG anti-HIV/LAV1' (Elisa, Western Blot, Ripa) were negative. Antibodies to HIV/LAV2 were found and cultures of peripheral blood lymphocytes and cerebro-spinal fluid were positive. HIV/LAV2 seems to be similar to STLV-III (mac), STLV-III (agm), and probably HTLV-IV.

A pharmacokinetic study of flubendazole was carried out, using a radioimmunological method, in patients with hydatid disease about to undergo surgery; there was no evidence of drug penetration into the walls or contents of the cysts. Another study, carried out simultaneously in subjects without hydatid disease, showed very high concentrations of the drug in liver tissue and in bile. These results should not be taken as arguments against the effectiveness of flubendazole, but should encourage the setting up of further randomized pharmacokinetic studies.

A case of P. aeruginosa septicaemia originating from a pace-maker electrode is described. Cure was obtained by surgical ablation of the contaminated electrode by a right thoracotomy and monotherapy with cefsulodin, an antibacterial agent. Nephrotoxicity was observed during treatment and regressed after its withdrawal. No other potentially nephrotoxic drug was used. The therapeutic indications of new beta-lactamase stable cephalosporins are reviewed.

The authors report three cases of eosinophilic granulomatous hepatitis observed among 325 liver puncture biopsies. The patients had urinary bilharziasis and had just been treated with oltipraz. These cases were probably due to eosinophilic reactions which sometimes follow treatment of schistosomiasis.

The authors report two additional cases of malaria due to chloroquine-resistant Plasmodium falciparum, one from Tanzania, the other from Kenya. In addition to the in vivo observations, these strains were thoroughly investigated by chloroquine assay and evaluation of ED50 using an original method (in vitro semi-microtest).

Digestive manifestations of AIDS were studied retrospectively in 87 patients with respect to clinical, microbiological, endoscopic and histological data. Chronic or intermittent diarrhea was observed in 62 p. 100 of patients and frequently associated with major weight loss. The digestive opportunistic infections were: oesophageal candidiasis (42 p. 100), cryptosporidiosis (24 p. 100), cytomegalovirus infections (22 p. 100), isosporiasis (3.4 p. 100), atypical mycobacteriosis (2.2 p. 100), toxoplasmosis (2.2 p. 100). Thirty non-opportunistic agents were detected in 26 patients. Gastrointestinal Kaposi sarcoma occurred in 18 p. 100 of cases. The etiology of diarrhea remained unknown in 16 p. 100 of patients. The value of endoscopy is discussed: esophagogastroduodenal fibroscopy, is usually required to assess oesophageal candidiasis, colonoscopy is required to assess cytomegalovirus colitis on histological data.

Halofantrine is a 9-phenanthrene-methanol effective against multiresistant strains of Plasmodium falciparum. It is extremely effective and well-tolerated in treating cases of malaria imported into France. 1,500 mg in 3 doses at 8 hour intervals produced 100% cure rate in semi-immune patients. This dosage could be repeated after 14 days in order to obtain the same cure rate in non-immune patients. Side-effects are minor and include epigastric pain, nausea and one case of skin rash.

Central nervous system toxoplasmosis was diagnosed in 12 immunosuppressed patients, eleven of whom had AIDS. Fever (9/12), confusion (7/12) and focal neurological manifestations (6/12) were the main clinical signs. Lumbar puncture yielded abnormal cerebrospinal fluid in 6/6 cases. Cerebral computed tomographic scan abnormalities, homogenous (2/12) or ring-like (9/12) contrast-enhancing mass lesions and/or low density lesions (6/12), were present in all patients. Brain biopsy confirmed T. gondii infection in 7/8 cases. The combination pyrimethamine-sulfadiazine accounted for complete resolution (4/8) or partial improvement (4/8) in eight out of 12 patients. Mean duration of therapy was 6.5 months (1-21.5 months) in 11 patients. No relapse was observed. In three cases spiramycin was ineffective in the prevention of neurotoxoplasmosis.

Rhinoscleroma, an inflammatory tumour due to Klebsiella rhinoscleromatis, is rare in France but the few known cases have been observed among immigrants. A case of a Malian is reported here; to our knowledge this is the first described case from Mali. The clinical, histological and epidemiological aspects of the disease in Africans is reviewed.

Fecal samples of 61 patients were investigated for Cryptosporidium: it was identified in four cases of acquired immunodeficiency syndrome, five cases of lymphadenopathic syndrome, one case of immunosuppressive therapy. One person was immunocompetent but in close contact with one of the patient. The authors report clinical and epidemiological characteristics of the 11 patients.

We studied the gastrointestinal manifestations in 26 cases of AIDS. The patients belonged to two different epidemiological groups: the first group included thirteen french homosexual men, the second group included 6 Haitians, 6 Africans and a Pakistanian, none of them admit homosexual activity. The clinical manifestations were: chronic watery diarrhea in 17 cases, bloody diarrhea in 2 cases; loss of weight in the 26 cases; dysphagia in five cases; jaundice in one patient (due to Kaposi sarcoma of the ampulla of Vater). The digestive lesions found, alone or associated, were necrotizing enteritis (2), ulcerative colitis (1), pseudomembranous colitis (1), Candida esophagitis (10), erythematous duodenitis (6), proctitis (4), Kaposi sarcoma (3), diffuse (2) or localized (1). Thirteen patients out of the 26 presented opportunistic digestive infections due to one or several germs. These were 10 cases of esophageal infection (due to Candida albicans) and 8 cases of enterocolonic infection due to Cytomegalovirus (3 cases), Cryptosporidium (3 cases), Mycobacterium avium intracellulare (1 case), Cryptococcus neoformans (1 case). The other digestive infections cases were due to non-opportunistic pathogens: Entamoeba histolytica (3 cases); Giardia lamblia (3 cases); Strongyloides stercoralis (2 cases); Salmonella typhi (2 cases); Shigella (1 case); Herpes simplex virus (1 case). No difference was noticed between the homosexual and the heterosexual groups with respect to the nature and the frequency of the digestive infections.

The authors present a series of 51 cases of buccopharyngeal Kaposi's sarcoma observed in patients with AIDS. The diagnosis of Kaposi's sarcoma is generally obvious due to its appearance, its constantly violaceous colour and its site, especially palatine and velar. When Kaposi's sarcoma is the first manifestation of the disease, it appears to be associated with a relatively favourable pejorative connotation when the nevertheless extremely modest median survival of these patients is compared with that of patients who initially presented with an opportunistic infection not associated with Kaposi's sarcoma. Buccopharyngeal Kaposi's sarcoma is usually only an epiphenomenon. It is rare that the local course requires any tumour reduction treatment. When such treatment is required, radiotherapy with 35 Gys is currently considered to be the best solution.

An anti-erythrocyte autoimmunization with anti-I specificity was shown in patients previously exposed to malaria (falciparum malaria in 98.7% of cases). An anti-I antibody was eluted from red cells in 14.6% of 41 patients with an acute P. falciparum infection. The frequency of the anti-I immunisation was found to be correlated to the rate of the antimalarial antibodies among the 152 patients without parasitaemia, coming from areas endemic for falciparum malaria: this frequency was 5.2% for a rate below 1/64, 9.7% for a rate between 1/64 and 1/256, and 34% for a rate above 1/1,024. Anti-I antibodies were more often noted in African patients coming from forest areas, considered as chronically infected with P. falciparum, and in other patients who have been in France for less than a month. No anti-I antibodies were found in the control group, composed of 52 Caucasian healthy subjects with no previous exposure to malaria. This anti-I immunisation was transitory and its disappearance was usually accompanied by a lowering of anti-malarial antibodies.

Albendazole, given as a 28 day course of 800 mg/day at 15 days intervals can be effective in the treatment of liver and lung hydatic cysts in adults of average weight. On average, six courses are required to obtain a satisfactory result (negative serological results, decrease in volume of scanner images). The treatment must be monitored and should only be prescribed in case of surgical contraindication or refusal by the patient to undergo surgery.