Salivary albumin, total protein, IgA, IgG and IgM concentrations and occurrence of some periodontopathogens in HIV-infected patients: a 2-year follow-up study.

HIV infection reduces oral defensive mechanisms and may affect mucosal integrity. Differences in salivary protein concentrations and periodontopathogenic bacteria were studied in 56 HIV-infected patients with respect to their disease phase. Thirty-three patients were followed up for 2 years. Fifty-three healthy subjects of corresponding age and sex were studied as controls. At baseline, salivary albumin, total protein, IgA, and IgM levels were significantly higher (P<0.05-0.0001) in all phases of HIV infection, except the asymptomatic (ASX) phase, when compared with the control group. IgG levels were significantly increased in all phases except the ASX phase (P<0.05). After 2 years, salivary total protein, IgG, and IgM levels were still higher (P<0.05-0.005) in all HIV phases when compared with the control group (P<0.05-0.005). The albumin level was significantly higher in the ASX phase (P<0.005) and in the AIDS-related complex phase (ARC) (P<0.05), while the increase in IgA level was significant only in the ARC phase (P<0.005). Periodontopathogenic bacteria analyzed by PCR were detected both in the patients and the non-infected, but a statistically significant difference in the carriage percentage between the follow-up lymphadenopathy syndrome phase (LAS) and the control group was found only in Porphyromonas gingivalis (P<0.05) and Bacteroides forsythus (P< 0.0001). Thus, HIV infection appeared to cause a significant increase in the studied salivary proteins, suggesting leakage of serum components into the mouth.

Voluntary caregivers' observations on the dynamics of hope across the continuum of HIV/AIDS: a focus group study.

The purpose of this study was to describe voluntary caregivers' observations on the dynamics of hope across the continuum of HIV/AIDS. Three focus group interview sessions were conducted with 10 voluntary caregivers in 1998. The data were analyzed using the grounded theory method described originally by Glaser and Strauss. Closing and opening emerged as the core categories in the dynamics of hope. Closing means closing down in despair and to the process of life, whereas opening means opening up to hope and the process of life. Nursing interventions that prevent closing and enable opening are helpful for these people. Conceptual clarification and the differentiation between the concepts of hope, wish, despair, and hopelessness presented in this study require further elaboration. Further research on the dynamics of hope in fearing HIV/AIDS or living with HIV/AIDS and being a significant other to a person with HIV/AIDS from different perspectives is also needed.

Hope, despair and hopelessness in living with HIV/AIDS: a grounded theory study.

BACKGROUND: Hope, despair or hopelessness have been detected in several research reports as important elements of the lives of persons living with human immunodeficiency virus (HIV) (PLWH) or acquired immunodeficiency syndrome (AIDS) (PLWA). However, there is an obvious gap in the literature suggesting a need to study the overall dynamics of hope (including both hope and despair or hopelessness) along the HIV spectrum from PLWHs' and PLWAs' perspective. AIM: The purpose of this study was to describe the dynamics of hope in living with HIV/AIDS. METHODS: The data were collected through interviewing 10 PLWHs/PLWAs and analysed using a grounded theory method. FINDINGS: The dynamics of hope is a multifaceted and complex combination of 'hope', 'despair' and 'hopelessness'. It comprises balancing between 'believing life to be worth living at the present and in the future', 'losing one's grip and sinking into narrowing existence vs. fighting against sinking' and 'giving up in the face of belief in nonexisting future'. A dynamic alternation between hope, despair and hopelessness takes place in the presence of factors that contribute to the 'folding' and 'unfolding' possibilities in everyday life. Factors contributing to the folding possibilities include 'losing', 'fear', 'uncertainty', 'problems in care', 'HIV/AIDS in close ones', 'difficulties in relationships' and 'negative public images and attitudes concerning HIV'. Factors contributing to the unfolding possibilities are 'constructive life experiences', 'wishing not to have HIV while uncertain', 'constructive relationships', 'ability to control one's life', 'finding the meaning of life and zest for life', 'caring', 'noticing one's improved health and the continuance of life', 'increasingly positive attitudes concerning HIV-positive people' and 'protection by law'. CONCLUSIONS: The dynamics of hope discovered in this study present new conceptualization, where hope, despair and hopelessness are viewed in relation to each other. The emerged definitions may be used in clinical practice to identify these phenomena in individuals with HIV/AIDS. The discovered factors contributing to the folding and unfolding possibilities can be used in clinical practice to help the individuals along the dynamics of hope.

Dynamically fluctuating hope, despair and hopelessness along the HIV/AIDS continuum as described by caregivers in voluntary organizations in Finland.

The purpose of this study was to describe the dynamics of hope in a) people fearing a diagnosis of HIV or living with HIV/AIDS and b) their significant others, from the perspective of caregivers working in voluntary organizations in Finland. Individual interviews with eight caregivers were analysed using the grounded theory method. Living with the fluctuating waves of hope, despair, and hopelessness based on factors constructing them emerged as the core category describing the dynamics of hope in a person fearing a diagnosis of HIV, becoming aware of HIV contagion, and living with HIV/AIDS. Mirroring the fluctuating waves of hope, despair, and hopelessness based on factors constructing them emerged as the core category describing the dynamics of hope in a significant other of a person fearing a diagnosis of HIV, or living with HIV/AIDS. It is important to take into consideration the dynamics of hope in taking care of people fearing a diagnosis of HIV or living with HIV/AIDS and their significant others.

Systemic inflammation in hemorrhagic fever with renal syndrome correlates with hypotension and thrombocytopenia but not with renal injury.

Systemic inflammation is common in patients with nephropathia epidemica (NE), a European form of hemorrhagic fever. Markers of inflammation were studied in a patient with NE with respiratory insufficiency (patient 1), 18 other patients with NE, and 13 patients with a viral infectious disease other than NE. Neutrophil and monocyte CD11b expression levels, determined by flow cytometry; soluble interleukin (IL)-2 receptor (sIL-2R), IL-6, and IL-8 concentrations, determined by means of Immulite; and soluble E-selectin, determined by ELISA, were higher in patients with NE than in healthy subjects. The findings were not specific for NE and did not correlate with serum creatinine levels, but the findings correlated inversely with mean arterial pressure (sIL-2R and monocyte CD11b expression) and minimum platelet count (sIL-2R, IL-6, neutrophil, and monocyte CD11b expression). Monocyte CD11b expression in patient 1 was extremely high, suggesting that monocytes may contribute to development of lung injury. Severity of inflammation in patients with NE is related to hypotension and platelet consumption but not to renal injury.

Ethical considerations in a grounded theory study on the dynamics of hope in HIV-positive adults and their significant others.

The purpose of this article is to describe and reflect ethical challenges in a grounded theory study on the dynamics of hope in HIV-positive adults and their significant others. It concentrates on the justification of a research problem, sensitive research and the relationship between the researcher and the participants in data collection. The basis of ethically sound nursing research on the dynamics of hope in these two vulnerable groups lies in the relationship between the researchers and the participant. However, it is also obvious that the content, the process, the methods used and the ethics of the study cannot be divorced from this relationship. In conducting grounded theory research on the dynamics of hope in this research population, the researcher has to consider the surrounding world, that is, the reality in which these people live in hope or despair.

72-kDa and 92-kDa gelatinases in saliva of patients with human immunodeficiency virus infection.

Human immunodeficiency virus (HIV) infection has been associated with periodontal diseases in HIV-seropositive patients. In periodontal diseases, matrix metalloproteinases (MMPs) may play key roles in the extracellular matrix, basement membrane, serpin degradation, and modification of cytokine action. We characterized the 72 kDa type IV collagenase (gelatinase A, MMP-2) and 92 kDa type IV collagenase (gelatinase B, MMP-9) in the saliva of HIV-seropositive patients and seronegative healthy controls by activity measurements and quantitative immunoblotting. Immunoblot analysis with specific antibodies against MMP-2 and MMP-9 and their tissue inhibitors (TIMP-1, TIMP-2) disclosed that, independent of the phase of the patients' HIV infection, their salivary samples contained higher amounts of MMP-2 and MMP-9 immunoreactivities in pro- and active forms and the TIMP-1 and TIMP-2 inhibitors than did the control samples. Healthy control saliva contained only slight immunoreactivities for gelatinases and TIMPs. However, as judged by the studied clinical and microbiologic indicators, HIV-seropositive patients showed only a slight tendency to develop periodontitis. Overall, an increased amount of gelatinases in saliva may reflect increased host response and defense activities in HIV infection.

A prospective radiologic and neurologic follow-up study of 61 HIV-1 -infected subjects: early beginning and slow progression of brain atrophy.

The course of the organic brain disease caused by human immunodeficency virus (HIV-1) was evaluated in a follow-up study. The primary material included 200 consecutive HIV-1 infected persons. Sixty-one subjects, in whom other brain-affecting factors were excluded, consented to the follow-up. They underwent 278 radiologic examinations: computed tomography, magnetic resonance imaging, or a combination of both (mean 4.6 examinations/subject). Clinical neurologic status and, in 40 subjects, cognitive performance were repeatedly evaluated. Sixteen subjects were followed up until death and 11 of them were autopsied. Median follow-up time was 27 mo (range 2.5-66 mo). The most common radiologic finding was atrophy, found in 19 subjects at study entry and developing in 10 subjects during the study. Twenty-four subjects (39%) showed the development and/or progression of atrophy. Atrophic changes progressed most rapidly in acquired immunodeficiency syndrome (AIDS), but mild developing/progressive atrophy was found even in 33% of asymptomatic or neurologically intact subjects. Cognitive and radiologic worsening were simultaneous in 6/7 subjects with declining neuropsychologic test performance. Signal intensity changes including HIV-1 leukoencephalopathy appeared in AIDS patients with clear cognitive decline.

Ocular characteristics in nephropathia epidemica or Puumala virus infection.

PURPOSE: We documented the largest series so far concerning the ocular characteristics of nephropathia epidemica. METHODS: A total of 37 consecutive nephropathia epidemica patients underwent a comprehensive ophthalmic examination during hospitalization for systemic infection, and a control examination after recovery. RESULTS: The most common ocular symptoms were: frontal headache or periocular pain (75.6%), blurred vision (54.1%) and photophobia (10.8%). The best corrected visual acuity of 7 patients (18.9%) was reduced during the acute phase as compared to the later control examination. Myopic shift was found in 15 patients (40.5%), three of whom (8.1%) developed real transient myopia. There were no attacks of angle closure glaucoma in this series. On the contrary, the intraocular pressure was decreased in 49 eyes (66.2%) during the acute stage of the disease. Lid edema was present in 28 eyes (37.8%), conjunctival injection in 20 eyes (27.0%), chemosis in 8 eyes (10.8%) and subconjuctival bleeding in 3 eyes (4.1%). Signs of acute anterior uveitis were found in 10 eyes (13.5%), however, this resolved without treatment. In one eye retinal edema with hemorrhages was detected. Ultrasonography revealed narrowing of the anterior chamber during the acute phase in 69 eyes (93.2%) and thickening of the crystalline lens in 64 eyes (86.5%). CONCLUSION: Ophthalmic findings in nephropathia epidemica are not uncommon. The symmetry of the clinical manifestations reflects the systemic nature of the underlying infection.

Matrix metalloproteinases-1, -3 and -8 and myeloperoxidase in saliva of patients with human immunodeficiency virus infection.

OBJECTIVE: Human immunodeficiency virus (HIV)-seropositive patients have frequently severe gingival inflammation and/or attachment loss. In addition many infectious diseases affect their periodontium with varying clinical manifestations. Matrix metalloproteinases seem to play a key role in physiological periodontal remodelling and pathological tissue destruction. The aim of the present study was to characterize the presence, molecular forms, cellular sources, activities, and relative amounts of fibroblast-type (matrix metalloproteinase [MMP]-1) and neutrophil (MMP-8) collagenases, as well as their potential activator stromelysin-I (MMP-3) and myeloperoxidase in saliva of HIV-seropositive patients at different phases of HIV-infection. HIV-seronegative, healthy, age-matched patients served as controls. PATIENTS AND METHODS: Saliva samples were characterized by Western blotting using antibodies specific for MMP-1, MMP-3 and MMP-8. Interstitial collagenase activities were measured using quantitative sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis/laser densitometry assay. Myeloperoxidase was analysed using quantitative dot blotting. RESULTS: Clinical and microbiological evaluation of HIV-seropositive patients' periodontium showed the presence of putative periodontopathogens ie Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Peptostreptococcus micros (Psm) and Campylobacter rectus (Cr) in their periodontal pockets. The amount of Candida increased with the severity of HIV-infection. Clinical and microbiological findings of HIV-seropositive patients suggested that they have a tendency to develop periodontal disease. Interstitial collagenase activities were found to be increased in saliva of different phases of HIV-infected patients compared to the controls. Independent of the phase of HIV-infection saliva samples contained pro- and active forms of MMP-1, -3 and -8 using Western blotting. Saliva samples from healthy controls were found to contain hardly any immunoreactivities for MMP-1 or MMP-8, but considerable amounts of MMP-3 were detected. Quantitative dot blotting demonstrated increased amounts of myeloperoxidase in HIV-patients' saliva relative to controls. CONCLUSION: The present results showed increased amounts of MMP-1, -3, -8 and myeloperoxidase in HIV-patients' saliva. MMP-1 and -8 may have been activated by MMP-3 and/or oxidants generated by myeloperoxidase. The increased amounts of MMPs and myeloperoxidase may reflect and directly participate in HIV-infection associated periodontitis.

Cognitive decline in patients with symptomatic HIV-1 infection. No decline in asymptomatic infection.

Thirty-six HIV-1-infected predominantly well-functioning subjects were followed up for one year by repeated neuropsychological, clinical neurological, neuroradiological, and immunological examinations. Changes in cognitive performance related to the severity of HIV-1 infection as well as to neuroradiological or immunological changes were studied. A decline in cognitive speed and flexibility was found in symptomatic subjects (ARC, AIDS). The impairment was especially pronounced in patients with progression of brain atrophy. These findings suggest a brain pathology underlying the cognitive decline in ambulatory outpatients with symptomatic HIV-1 infection. A practice effect was found in asymptomatic subjects (ASX, LAS) and in those with unchanged CT/MRI scans. No systematic relationship was found between cognitive change and immunological change.

Intraocular pressure changes in nephropathia epidemica. A prospective study of 37 patients with acute systemic Puumala virus infection.

BACKGROUND: Nephropathia epidemica is a zoonose in the group of hemorrhagic fevers with renal syndrome and is caused by Puumala virus in Hantavirus genus. The purpose of this study is to find out how the intraocular pressure (IOP) is affected by the acute phase of this disease and how it relates to the previous case reports on angleclosure glaucoma attacks. PATIENTS AND METHODS: The prospective study documents IOP and anterior chamber depth measurements in 37 patients during the winter epidemic of nephropathia epidemica from 1992 to 1993. Ocular examinations were performed during the acute systemic infection and after clinical recovery. RESULTS: The IOP was lower and the anterior chamber shallower in the acute phase than after the clinical recovery of nephropathic epidemica. The mean differences in IOP were 1.8 mmHg in the right eye and 1.9 mmHg in the left (P < 0.001) and the mean differences in the anterior chamber depth were 0.22 mm in the right eye and 0.20 mm in the left (P < 0.001). No acute angle-closure attacks with highly elevated IOP were encountered in this study. The mean IOP did not rise higher than 14.3 mmHg in both eyes after the clinical recovery of systemic infection. CONCLUSION: In contradistinction to earlier assumptions, Puumala virus infection decreases the IOP. Shallowing of anterior chamber and narrowing of the anterior chamber angle in the acute phase of nephropathia epidemica did not lead to angle-closure attacks in this series.