Lamivudine-induced pure red cell aplasia.

The aim of this report is to describe five patients with lamivudine-induced pure red cell aplasia, an association not previously described. We describe patients with unresponsive anemia in whom a complete study including blood cell counts, reticulocyte counts, hemolysis tests, and bone marrow aspiration was performed. Pure red cell aplasia was considered when anemia was associated with normal leukocyte and platelet counts with a corrected reticulocyte count below 1% and less than 5% bone marrow erythroid progenitors in the absence of positive hemolysis tests. Complete remission was considered when bone marrow erythroid progenitors were at least 16%. Five male patients had pure red cell aplasia with a median age of 32 years (range 29 to 37 years). Before lamivudine, they had hemoglobin >11.8 g/dl without transfusion requirements. After receiving the drug, hemoglobin dropped to 5.2 g/dl (4.3 to 6.1 g/dl) with high transfusion requirements and mean bone marrow erythroid progenitors of 1.84% (0 to 4%). Withdrawal of lamivudine was attempted to confirm the diagnosis. Seven weeks after stopping lamivudine, hemoglobin rose up to 12.8 g/dl (11 .3 to 13.8 g/dl) and bone marrow erythroid progenitors increased up to 25.6% (21 to 40%) without transfusion requirements. Lamivudine-induced pure red cell aplasia may be a cause of anemia unresponsive to conventional treatment in AIDS. Since lamivudine use in Mexico has been relatively short, we expect more cases to appear in the future.

Usefulness of a low-dose intravenous immunoglobulin regimen for the treatment of thrombocytopenia associated with AIDS.

Infection with the human immunodeficiency virus (HIV) frequently is complicated with thrombocytopenia (HIV-Thr) during all stages of the infection. The treatments for autoimmune thrombocytopenic purpura (ITP) are used in HIV-Thr; however, their effects upon the immune status of patients with acquired immunodeficiency syndrome (AIDS) are unknown. Intravenous immunoglobulin (IVIg) is used in patients with ITP and HIV-Thr; however, its usefulness in thrombocytopenic AIDS patients has not been directly addressed. We used a low-dose IVIg regimen (0.04 g/kg per week during five weeks) for the treatment of HIV-Thr complicating AIDS. Thirteen patients received IVIg. We observed a response to IVIg in 13 patients by the end of week one and in 10 patients by the end of week five. Long-term response, evaluated three months after stopping IVIg, was present in four cases. IVIg was well tolerated and no opportunistic infections were observed during the study period. Compared with previous reports, we used 10% of the previously proposed dosage with an important decrease in the cost of treatment. Our results suggest that this low-dose IVIg regimen is a highly effective, nonexpensive alternative in treating HIV-Thr in AIDS. If sustained responses can be obtained with a similar low-dose maintenance regimen, IVIg may be the first choice for the treatment of HIV-Thr in AIDS patients.

[Chronic diarrhea and Cryptosporidium in diabetic patients with normal lymphocyte subpopulation. 2 case reports]. / Diarrea crónica y Cryptosporidium en pacientes diabéticos con subpoblación linfocitaria normal. Informe de dos casos.

Two cases of diabetic patients with normal TCD4+ cell count with chronic diarrhoea and Cryptosporidium are described herein. In both cases serologic tests for HIV were negative. The fact that these patients developed a pathology usually seen in presence of low TCD4+ cell counts suggests that some immune defect other than cellular might be involved in the pathogenesis of this infection. Authors concluded that intentional search for Cryptosporidium should be considered in the study of the diabetic patient with chronic diarrhoea.

[Prevention of coronary atherosclerosis. (V). Prevalence of non-stenotic atheromatous rigidity in men accidentally killed in Mexico City]. / Prevención de la aterosclerosis coronaria. (V). Prevalencia de rigidez ateromatosa no estenótica en hombres muertos accidentalmente en la ciudad de México.

The presence of rigid coronary arterial segments was detected during a survey for coronary atherosclerosis in men who died of violent causes. These lesions which traditionally are considered of non-clinical significance, in the absence of stenosis are probably responsible of the clinical and electrocardiographical abnormalities as seen in patients with "normal" coronary arteries using coronary angiography, the best current procedure for the detection of isolated coronary atherosclerosis. We propose these lesions are to be considered as functional lesions and consequently that these lesions should be considered by both, the pathologist and the clinician. Our hypothesis is to be tested in the near future when new diagnostic advances with the possibility of detection of coronary pathology in vivo, appear. The prevalence of these abnormalities in different age-groups as well as the topography are presented. The concordance of these lesions with coronary stenosis is also presented.

[Prevention of coronary atherosclerosis: (IV): Prevalence of aortic atherosclerosis in Mexico, D.F. Its relation to coronary atherosclerosis]. / Prevención de la aterosclerosis coronaria: (IV): Prevalencia de la aterosclerosis aórtica en México, D.F. su relación con la aterosclerosis coronaria.

The severity and prevalence of coronary and aortic atherosclerosis was studied in 174 subjects who died from violent causes in Mexico City. As in other geographic areas, fatty streaks were found early in life (12 years old). Fibrolipid plaques were present in the thoracic aorta at age 15 and at age 19 in the abdominal segment. Complicated lesions were detected in the aorta after age 25. Because of the obvious clinical significance we looked for severe aortic lesions in the abdominal bifurcation. The prevalence of severe lesions in the bifurcation was 0 between 15 to 24 years and raised to 23.3% in the 45-54 age group. A moderate correlation was found between the severity of coronary and aortic lesions. The discordance most often found was the presence of severe coronary lesions without severe aortic involvement.