Profile of HIV disease in an American border city.

A previous study on patterns of migration of HIV-infected persons suggested that most patients in a rural setting in eastern Tennessee acquired their disease in an urban area, typically during a period of prolonged residence. Disease and disability were the most common reasons for returning to their hometown. We studied our urban, border-city HIV clinic population to see whether similar patterns of migration were discernible. Fifty-one of the 103 patients studied lived outside the El Paso/Juarez area when they contracted HIV infection. The major reason cited for returning home was a desire to return to family (25%). Those who returned and those who had never left showed no statistically significant difference in age, race, or risk factors. This study suggests that migration of HIV-infected patients back to their hometown does not appear to be an exclusively rural phenomenon.

Bacterial bronchitis and bronchiectasis in human immunodeficiency virus infection.

BACKGROUND: Bacterial pneumonia and sinusitis are important causes of morbidity in patients with human immunodeficiency virus (HIV) infection. We noted an increased incidence of bacterial bronchitis and bronchiectasis in our patients with HIV infection. METHODS: This study was conducted on persons with HIV infection at a county hospital and clinic. Bronchiectasis was diagnosed by bronchogram and computed tomography in one patient and by computed tomography alone in two others. Bacterial bronchitis was defined by a Gram's stain showing an abundance of neutrophils with a predominance of one or more bacteria and by a confirmatory sputum culture. Bronchoscopy with broncho-alveolar lavage was performed in patients with bronchitis to eliminate other causes of bronchial inflammation. RESULTS: Eighteen episodes of bacterial bronchitis in 10 patients are described. The mean CD4 lymphocyte counts for these patients was 0.061 x 10(9)/L (range, 0.001 to 0.203 x 10(9)/L). The most common pathogens in 18 episodes of bacterial bronchitis were Haemophilus influenzae and Streptococcus pneumoniae (five episodes each) and Pseudomonas aeruginosa (four episodes). Response to antibiotic therapy was usually rewarding though recurrences were frequent. Three patients with well-defined bronchiectasis who appeared to have developed, or who became symptomatic during the course of, HIV infection are described. Their mean CD4 cell count was 0.03 x 10(9)/L (range, 0.024 to 0.037 x 10(9)/L). Haemophilus influenzae, Staphylococcus aureus, Pseudomonas cepacia, and P aeruginosa were recovered from these patients; the P aeruginosa was a mucoid strain. CONCLUSIONS: Recurrent bacterial bronchitis should be added to the list of bacterial infections that occur with increased frequency with HIV infection. Repeated bacterial bronchitis may lead to bronchiectasis, which may be more common in HIV infection than generally appreciated.

Disseminated cutaneous cryptococcosis. Comparison of clinical manifestations in the pre-AIDS and AIDS eras.

A review of the literature suggests some differences in the cutaneous manifestations of cryptococcosis present in patients in the pre-acquired immunodeficiency syndrome (AIDS) era compared with those manifestations that are present in today's AIDS era. In both periods, cutaneous manifestations can precede and be the sole clue to disseminated cryptococcal infection. Today, cutaneous cryptococcal involvement is often mistaken for molluscum contagiosum or Kaposi's sarcoma. We describe a patient with disseminated cryptococcosis who presented with skin lesions mimicking molluscum contagiosum, and who was subsequently shown to have AIDS.