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Byline: J.R. Bogner (1), R. Walli (1), F.-D. Goebel (1) Keywords: Key Words HIV infection; Lymphnode; Interleukin; Th1/Th2; Immunopathogenesis Abstract: Background: An expansion of CD8+60+ cells with Th2 type helper function has been observed in HIV-infected individuals. A Th1/Th2 shift in late HIV infection might be related to the functional activity of this subset. Our objective was to test the ability of lymph node (LN) lymphocytes to produce cytokines of the Th1 and Th2 type. Patients and Methods: LN cells were stimulated with PMA in the presence of ionomycin and brefeldin A. After surface staining for CD4, CD8 and CD60 and intracellular staining for interferon I3 (IFNI3), interleukin 2(IL-2) or IL-4 and IL-10, the percentage of cytokine producing lymphocytes (CPL) was determined by flow cytometry. LN of nine individuals in the early stage of HIV infection were compared to late stage patients. Results: CD4+ subset: in early stage of HIV infection the percentage of Th1 CPL was 1.9 times higher than that of Th2 CPL. In late stages of infection the Th1 responding cells were not found more frequently than Th2 cells. CD8+ subset: no Th1/Th2 shift was detected during early or late stages of HIV infection. CD60+ subset: a maximum of 32.1 +- 7.8% of double positive cells of the CD8+60+ type produced Th2 type cytokines. A small percentage (&lt 8%) of CD60+ cells also produced Th1 cytokines. No shift in the cytokine production was seen in early or late stages of infection. Conclusion: At single cell level a shift in cytokine production in LN cells can only be detected in the CD4+ subset. Thus, the CD60+ subset does not seem to contribute to the putative Th1/Th2 shift attributed to the immunopathogenesis of HIV-induced destruction of the immune system. Author Affiliation: (1) Med. Poliklinik, Dept. of Infectious Diseases, University of Munich, Pettenkoferstr. 8a, D-80336 Munich, Germany Phone: (+49/89) 5160-3598, Fax: -3593, e-mail: jobogner@pk-i.med.uni-muenchen.de, DE Article note: Received: December 12, 1999 * Revision accepted: October 13, 2000

Byline: S. Wolf (1), L. Leitritz (2), C. Rupp (1), D. Schlondorff (1), J.R. Bogner (1) Keywords: Key Words Infectious diseases; Cost; Reduction; Consultation Abstract: Background: In 1997 an infectious disease service (IDS) similar to those in the US was established at a university hospital in Munich, Germany. Patients and Methods: We assessed the economic impact of the new policy by performing a cost comparison analysis. Inpatients with pneumonia, skin infections/cellulitis, urinary tract infections (UTI) and bacteremia/sepsis were assigned to two groups: patients from a 6-month period after the establishment of the IDS (post-IDS group) were compared with similar patients before the implementation of the ID-servide (pre-IDS group). Costs of microbiological investigation (MB), antibiotic treatment (AB), clinical imaging (CI), total costs and length of antibiotic therapy were analyzed. Results: Patients with UTIs in the post IDS-group had 39% fewer MBs (p &lt 0.05) than patients in the pre-IDS group, resulting in a 33% decrease in average MB costs (p &lt 0.05). In the total group, in which subgroups with pneumonia, skin infection and UTI were summarized, the post-IDS group had 37% fewer MBs (p &lt 0.05) resulting in MB cost reductions of 34% (p &lt 0.05). There were no significant differences in expenditures for AB and CI and in the average length of antibiotic therapy. Conclusion: This study shows that continuous consultation by an IDS does not increase diagnostic and treatment costs, but results in significant cost reductions. Author Affiliation: (1) Medizinische Poliklinik, Ludwig Maximilians University of Munich Hospital, Pettenkoferstr. 8a, D-80336 Munich, Germany Phone (+49/89) 5160-3598, Fax: -3593, e-mail: jobogner@pk-i.med.uni-muenchen.de, DE (2) Max von Pettenkofer Institute of Hygiene and Medical Microbiology, Ludwig Maximilians University of Munich, Pettenkoferstr. 9a, D-80336 Munich, Germany, DE Article note: Received: March 13, 2000 * Revision accepted: July 28, 2000

Byline: B. Rolinski (1), A. Heigermoser (1), E. Lederer (2), J.R. Bogner (2), O. Loch (2), F.D. Goebel (2) Abstract: In a cross-sectional, non-randomized, prospective study in an outpatient clinic a possible relationship between the cerebrospinal fluid (CSF) concentrations of the potent vasoconstrictor peptide endothelin-1 (ET-1) and prevalence and degree of HIV-encephalopathy was studied. Forty-eight CSF samples from HIV-infected patients ET-1 was also measured in plasma. Patients were investigated clinically and staged with respect to HIV encephalopathy. Patients with arterial hypertension, diabetes or acute opportunistic infections were excluded from the study. In the remaining, 18 of the CSF samples were from patients with normal neurological findings (grade 0--0.5), whereas 30 were from patients with HIV encephalopathy (grade 1--3). The mean CSF ET-1 concentration was significantly elevated (P = 0.001) in patients with HIV encephalopathy (1.97 +- 2.33 pmol/l) as compared to those patients without encephalopathy (0.57 +- 0.67 pmol/l). Moreover, there was a significant correlation between ET-1 CSF concentrations and the degree of HIV encephalopathy (r = 0.49, P &lt 0.001). In addition, there was a significant correlation between ET-1 levels in the CSF and the IgG serum to CSF ratio. However, we found no correlation between HIV encephalopathy and neither CSF ratio of IgG or albumin. In conclusion, we could demonstrate a close relationship between CSF ET-1 concentrations and the degree of HIV encephalopathy. Thus, by virtue of its long-lasting and potent vasoconstrictor activity ET-1 might contribute to the pathogenesis of HIV encephalopathy. Author Affiliation: (1) Children's Clinic and Children's Outpatient Clinic, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Lindwurmstr. 4, D-80337 Munich, Germany, DE (2) Medical Policlinic, Ludwig-Maximilians-University, Pettenkoferstr. 8a, D-80336 Munich, Germany, DE Article note: Received: Februrary 23, 1999 * Revision accepted: June 30, 1999