Search

To determine the recent trends in AIDS-defining cancers in Western Europe, we analyzed the June 2002 European Non-Aggregate AIDS Data Set. We obtained the percentage of people with AIDS aged 15 years or older (n = 125,691; males, 99,560, females, 26,131) who had cancers as the initial AIDS-defining illness in 17 European countries. Overall, from 1994 through 2001, declines were noted in the number of people with AIDS (25,324 to 8929), the proportion of people with AIDS who were homosexual/bisexuals (38.8% to 26.6%) or intravenous drug users (male, 41.7% to 34.8%; female, 50.2% to 26.4%). Among males, between 1994 and 2001, the percentage with any AIDS-defining, cancers declined (14.4% to 13.1%, p for trend = 0.091) because of a decline in Kaposi's sarcoma (KS; 10.7% to 7.9%) mostly among homosexual/bisexual men (22.7% to 18.8%) (p for trends < 0.05). Between 1994 and 2001, the percentage of males with all types of lymphomas increased (3.8% to 5.2%, p for trend = 0.012). Among females, AIDS-defining cancers increased (7.3% to 8.5%) due to increase in lymphomas (all types, 2.6% to 4.0%) (p for trend = 0.05). Cervical cancer remained the most common cancer among females, the percentage of which declined between 1994 and 2001 (2.8% to 2.0%, p for trend = 0.37) mostly among women who were 15 to 29 years old, most of whom acquired HIV heterosexually. In summary, declines were noted for the two leading AIDS-defining cancers at initial AIDS diagnosis among certain population groups. KS declined among men who had sexually transmitted HIV infection. Cervical cancer declined among young females and heterosexuals.

Non-Hodgkin's lymphoma (NHL) is an important and common AIDS-related neoplasm. AIDS-related NHL can be defined by its anatomic distribution as systemic (nodal and extra-nodal masses), primary central nervous system, and occasionally body cavity-based lymphomas (BCBL). Radiologic imaging plays an important role in differentiating the varied appearances of AIDS-related NHL, particularly regarding BCBL: patients' images demonstrate only fluid in the pleural, pericardial, and/or peritoneal spaces. Imaging of a case of BCBL is presented, including simultaneous pericardial, pleural, and peritoneal effusions.

About one percent of AIDS patients with non-Hodgkin's lymphoma have a T-cell lymphoma rather than a B-cell lymphoma. It is not clear if AIDS patients have a higher risk of T-cell lymphoma than other people or if people who develop AIDS come from a country where T-cell lymphoma is more common than it is in other countries.

Inositol-phosphoryl ceramide synthase 1 (IPC1) roles in pathogenesis of Cryptococcus neoformans, a common invasive opportunistic fungal pathogen in AIDS patients, are discussed. Expression of the essential gene was studied by modulating expression in C. neoformans using a galactose inducible promoter. Down-regulation of IPC1 gives a growth defect in vivo via a pH-dependent mechanism. Ipc1 has a vital role in fungal pathogenesis.

Measuring the amount of antibody against Toxoplasma gondii in blood cells can be an accurate diagnostic technique for detecting this parasite in HIV patients. The parasite often affects the brain, and this diagnostic technique can also be used to monitor the response to treatment.

A 49-year-old male HIV patient was admitted to a hospital with a three-month history of pain in his left knee. He had fractured his left shin bone 12 years earlier. An X-ray of his left leg and a bone scan both showed an abnormality in his left leg close to the knee. A bone biopsy showed that he had a bone infection called osteomyelitis and the organism responsible was Mycobacterium avium complex. This bacterium is a common cause of opportunistic infection in AIDS patients.

OBJECTIVE: To compare the HIV/AIDS epidemics in Australia and sub-Saharan Africa, to outline reasons for differences, and to consider implications for the Asia and Pacific region. METHODS: Comparison of key indicators of the epidemic in Australia, and Africa viewed largely through the experience of the Hlabisa health district, South Africa. RESULTS: To the end of 1997, for all Australia, the estimated cumulative number of HIV infections was approximately 19,000, whereas in Hlabisa 31,000 infections are estimated to have occurred. Compared with the low and declining incidence of HIV in Australia (80% of HIV infected people receive antiretroviral therapy whereas in Hlabisa these drugs are not available. IMPLICATIONS: It seems possible that Asia and the Pacific will experience a similar HIV/AIDS epidemic to that in Africa. Levels of HIV are already high in parts of Asia, and social conditions in pads of the region might be considered ripe for the spread of HIV. As Australia strengthens economic and political ties within the region, so should more be done to help Pacific and Asian neighbours to prevent and respond to the HIV epidemic.

Blood levels of lactate dehydrogenase, alkaline phosphatase, and white blood cells can be used to distinguish disseminated histoplasmosis from Mycobacterium avium complex in AIDS patients. This was the conclusion of a study of 90 AIDS patients.

The drug alitretinoin appears to be effective in treating a complication of AIDS called Kaposi's sarcoma, according to a study of 268 AIDS patients. This drug is a form of retinoic acid, which is effective in treating many other skin diseases.

The authors collected data on admissions of HIV-infected patients over 14 years old who were admitted to an infectious disease hospital. Of the 3,112 HIV-positive patients, they discovered a large proportion of cryptococcosis, tuberculosis, and wasting syndrome.

AIDS-associated Kaposi's sarcoma (AIDS-KS) cells have been found to express surface interleukin-4 (IL-4) receptors in a study using nude mice. IL-4 toxin (IL-4(38-37)-PE38KDEL) is specifically toxic to the cells. Metabolic changes brought on by KS tumors were prevented by IL-4 toxin treatment. These included lymphopenia and cachexia.

There are many treatments for the wasting syndrome that occurs in many AIDS patients. Wasting syndrome is diagnosed if the patient has lost more than 10% of body weight and also has diarrhea, weakness or fever. Nutritional supplements and appetite stimulants may be effective as can testosterone and other anabolic steroids. Growth hormone may be beneficial in high doses but the safety of long-term use is unknown. Exercise may be beneficial but the effects of regular exercise in people with wasting syndrome is unknown. The development of more effective AIDS drugs may reduce the risk of wasting syndrome.

A 19-year-old man infected with HIV was admitted to a hospital with fever, chills, cough, weight loss and pneumonia. He had emigrated to the US from Honduras, where he had been a farmer. Because of his severe immunodeficiency, his doctors suspected histoplasmosis, a fungal infection which is common in Central America. This was confirmed by blood and urine tests. He was treated with the antifungal drug amphotericin B followed by itraconazole.

Prophylactic treatment can be cost-effective for preventing many opportunistic infections in AIDS patients. Researchers used a mathematical simulation to determine the cost-effectiveness of preventing Pneumocystis carinii pneumonia (PCP), toxoplasmosis, Mycobacterium avium complex (MAC) infection, and cytomegalovirus (CMV) infections in AIDS patients. Patients with very low T cell counts who received no preventive treatment had a quality-adjusted life expectancy (QALY) of 39 months. Preventive treatment for PCP and toxoplasmosis increased QALY and appeared to be cost-effective but this was not true for CMV preventive treatment., Context.--Multiple options are now available for prophylaxis of opportunistic infections related to the acquired immunodeficiency syndrome (AIDS). However, because of differences in incidence rates as well as drug efficacy, toxicity, and costs, the role of different types of prophylaxis remains uncertain. Objective.--To determine the clinical impact, cost, and cost-effectiveness of strategies for preventing opportunistic infections in patients with advanced human immunodeficiency virus (HIV) disease. Design.--We developed a Markov simulation model to compare different strategies for prophylaxis of Pneumocystis carinii pneumonia (PCP), toxoplasmosis, Mycobacterium avium complex (MAC) infection, fungal infections, and cytomegalovirus (CMV) disease in HIV-infected patients. Data for the model were derived from the Multicenter AIDS Cohort Study, randomized controlled trials, and the national AIDS Cost and Services Utilization Survey. Main Outcome Measures.--Projected life expectancy, quality-adjusted life expectancy, total lifetime direct medical costs, and cost-effectiveness in dollars per quality-adjusted life-year (QALY) saved. Results.--For patients with CD4 cell counts of 0.200 to 0.300 x [10.sup.9]/L (200-300/ [micro] L) who receive no prophylaxis, we projected a quality-adjusted life expectancy of 39.08 months and average total lifetime costs of $40 288. Prophylaxis for PCP and toxoplasmosis with trimethoprim-sulfamethoxazole for patients with CD4 cell counts of 0.200 x [10.sup.9] /L (200/ [micro] L) or less increased quality-adjusted life expectancy to 42.56 months, implying an incremental cost of $16 000 per QALY saved. Prophylaxis for MAC for patients with CD4 cell counts of 0.050 x [10.sup.9]/L (50/ [micro] L) or less produced smaller gains in quality-adjusted life expectancy; incremental cost-effectiveness ratios were $35 000 per QALY saved for azithromycin and $74 000 per QALY saved for rifabutin. Oral ganciclovir for the prevention of CMV infection was the least cost-effective prophylaxis ($314 000 per QALY saved). Results were most sensitive to the risk of developing an opportunistic infection, the impact of opportunistic infection history on long-term survival, and the cost of prophylaxis. Conclusions.--The cost-effectiveness of prophylaxis against HIV-related opportunistic infections varies widely, but prophylaxis against PCP or toxoplasmosis and against MAC delivers the greatest comparative value. In an era of limited resources, these results can be used to set priorities and explore new alternatives for improving HIV patient care. JAMA 1998;279: 130-136