Cognitive and affective disorders associated to HIV infection in the HAART era: findings from the NeuroICONA study. Cognitive impairment and depression in HIV/AIDS. The NeuroICONA study.

OBJECTIVE: To assess the natural story of HIV-associated affective and cognitive disorders and the relationship with clinical, pharmacological, immunological and behavioural factors. METHOD: A total of 395 HIV-positive patients, naive to Highly Active Antirectroviral therapy (HAART), with no severe psychiatric disorders have been enrolled in the Neuro-ICONA Study. All participants were administered a comprehensive data collection instrument including an addiction behaviour survey, a medical problem list, a psychiatric assessment, a validated neuropsychological test battery. RESULTS: The global prevalence of cognitive impairment and of prominent depressive symptomatology were 17.9 and 15.5%, respectively. A significant difference in the prevalence of prominent depressive symptomatology was observed between patients in HAART and those not taking HAART(14.1 vs. 23.8%; P = 0.05). CONCLUSION: Depressive and cognitive disorders affect a substantial proportion of HIV-seropositive subjects. The prevalence of prominent depressive symptomatology appears to significantly vary in relationship to the therapeutic protocol.

Self-reported symptoms and medication side effects influence adherence to highly active antiretroviral therapy in persons with HIV infection.

OBJECTIVES: To identify variables predictive of nonadherence to highly active antiretroviral therapy (HAART) and to assess whether self-reported symptoms or medication side effects are related to adherence. DESIGN: Cross-sectional multicenter study Adherence Italian Cohort Naive Antiretrovirals [AdICONA] within the Italian Cohort Naive Antiretrovirals (ICONA). METHODS: Participants receiving HAART completed a 16-item self-administered questionnaire to assess nonadherence in the last 3 days as well as the type and intensity of 24 common HIV- and HAART-related symptoms experienced during the last 4 weeks. RESULTS: From May 1999 to March 2000, 358 persons were enrolled: 22% reported nonadherence and were less likely to have HIV RNA <500 copies/ml (odds ratio = 0.51; 95% confidence interval: 0.31-0.85). Frequency of moderate/severe symptoms or medication side effects in nonadherent participants ranged from 3.6% to 30%. On univariate analysis, nausea, anxiety, confusion, vision problems, anorexia, insomnia, taste perversion, and abnormal fat distribution were significantly associated with nonadherence. Nonadherent persons had a higher mean overall symptom score (12.3 +/- 9.2 versus 8.1 +/- 6.6; p <.001) and mean medication side effect score (2.9 +/- 2.7 versus 1.9 +/- 1.9; p <.001) when compared with adherent participants. In the multivariate analysis, nausea ( p =.003); anxiety ( p =.006); younger age ( p =.007); unemployment ( p <.001); not recalling name, color, and timing of drugs ( p =.009); running out of pills between visits ( p =.002); and being too busy ( p =.03) were independently associated with nonadherence in the last 3 days. CONCLUSIONS: In addition to patient characteristics, medication-related variables, and reasons for nonadherence, patient-reported symptoms and medication side effects were significantly associated with adherence to HAART.

Detection of hepatitis C virus-RNA by polymerase chain reaction in dental surgeries.

The mean prevalence of anti-hepatitis C virus (HCV) in Italy is 0.87%. It reaches 2% in Campania, Southern Italy. Approximately 50% of community acquired non-A, non-B (NANB) hepatitis cannot be associated with known parenteral exposure. A recent Italian study has shown that the only demonstrable risk factor in 9% of acute C/NANB hepatitis is dental treatment. There are no data on direct contamination by HCV of dental surgeries. Possible environmental contamination by HCV-RNA was investigated in dental surgeries after treatment of anti-HCV and HCV-RNA positive patients. Thirty-five anti-HCV and HCV-RNA positive patients with chronic hepatitis underwent dental treatment and were enrolled in this study. Eight had chronic persistent hepatitis (CPH), 23 chronic active hepatitis (CAH), and 4 cirrhosis. A total of 328 samples collected from instruments and surfaces were tested after dental treatment of 35 anti-HCV positive patients. The presence of HCV-RNA was determined by polymerase chain reaction (PCR) to evaluate contamination of instruments and surfaces in dental surgeries. Twenty (6.1%) out of 328 collected samples were positive for HCV-RNA. The positive samples were from work benches (two), air turbine handpieces (one), holders (four), suction units (one), forceps (four), dental mirrors (two), and burs (six). Our data indicate that there is extensive contamination by HCV of dental surgeries after treatment of anti-HCV patients and that if sterilisation and disinfection are inadequate there is the possible risk of transmission to susceptible individuals.

HCV-RNA survival as detected by PCR in the environment.

We have shown that HCV-RNA is resistant to drying at room temperature for at least 48 hours. This is a factor which could influence the diffusion of the virus in the general population, which epidemiological studies have shown to be surprisingly high. It should be considered in evaluating the importance of the inapparent parenteral routes of transmission.

Ultrastructural effects of PCMS on mycelial-yeast transition in Histoplasma capsulatum.

The Yeast phase of Histoplasma capsulatum has stringent growth requirements. Transition from mycelium to yeast takes place only in the presence of cysteine and can be blocked by the -SH groups inhibitor p-chloromercury-phenylsulfonic acid (PCMS). Ultrastructural studies show lysis and degeneration of PCMS treated mycelium grown at 37 degrees C for 24 hours. Only 50% of PCMS treated mycelium appear degenerate when grown at 34 degrees C for 24 hours. The remaining cells have normal morphology with only slight changes in the cell wall structure. The effect of PCMS is permanent and hereditary. Mice injected with PCMS treated mycelium do not develop disease and are resistant to virulent strains of H. capsulatum when challenged.

[The clinical, histological and ultrastructural findings in a case of acute steatosis of pregnancy with a severe cholestatic syndrome]. / Rilievi clinici, istologici e ultrastrutturali in un caso di steatosi acuta gravidica con grave sindrome colestatica.

A case of acute steatosis in pregnancy featuring unusually severe cholestasis is discussed with details of the successful outcome for mother and foetus. The correspondence between clinical picture, histological and ultrasound findings is reported together with a detailed review of the latest reports in the literature and what they reveal about the true incidence of the disease, the variability of the clinical picture, whether and when it is better for both mother and child to interrupt.

[Intranuclear particles in chronic non-A, non-B hepatitis: what diagnostic significance?]. / Particelle intranucleari in corso di epatite cronica NANB: quale utilità diagnostica?

Intranuclear particles of 23-27 nm diameter have been repeatedly demonstrated in the nuclei of hepatocytes of patients with non-A, non-B hepatitis and of experimentally infected chimpanzees; however, their specificity has been challenged since they have also been observed in other pathological conditions and in healthy volunteers. We have conducted an ultrastructural study of liver biopsies from 10 patients with chronic active non-A, non-B hepatitis. The intranuclear particles, which were observed in all patients, were classified according to the aggregation patterns described by De Vos. Eight patients (80%) had particles of type 2. A reevaluation our proceeding data on Delta hepatitis demonstrated that no particles of type 2 were present. These results support the hypothesis that only type 2 particles are markers of non-A, non-B hepatitis.

Morphological and functional abnormalities in platelets exposed in vitro to ioglicinic acid, a new ionic contrast medium.

The inhibitory effect on platelet function induced by several radiographic contrast media is still poorly understood. In this study platelet abnormalities caused by in vitro addition of ioglicinic acid, a new ionic contrast medium, were evaluated. The appearance of several granules similar to dense bodies associated with shape change and internal reorganization were detected by electron microscopy techniques. A functional study revealed a marked decrease in the aggregating response of platelets to adenosine diphosphate and calcium ionophore A23187, while aggregation in response to collagen was completely normal. It is suggested that ioglicinic acid induces platelet abnormalities related to the effect on calcium movements and that studies with this contrast medium may help the understanding of some basic events of platelet activation.

The effect of 3-palmitoyl-(+)-catechin on Kupffer cells in guinea pig liver.

We report a morphometric study on the effect of 3-palmitoyl-(+)-catechin on phagocytic activity of latex particles by Kupffer cells in guinea pig liver. We found an increase in the density of latex particles in Kupffer cells of animals treated with 3-palmitoyl-(+)-catechin. The volume and density of Kupffer cells of treated animals increased (p less than 0.01); there was no significant difference in surface density of the plasma membrane. None of the parameters measured was altered in endothelial cells. These results show that 3-palmitoyl-(+)-catechin produces morphological and functional changes in Kupffer cells.

[Clinical and diagnostic considerations on a case of pancreatic plasmacytoma]. / Considerazioni clinico-diagnostiche su di un caso di plasmacitoma pancreatico.

An unusual case of obstructive jaundice due to metastatic pancreatic plasmacytoma is described. Initially post-transfusion hepatitis was suspected in the patient who suffered from multiple myeloma (IgA) and had received numerous transfusions for severe anemia. Clinical and laboratory findings indicated obstructive jaundice and the ecographic examination showed a dishomogeneous mass at the level of the pancreas. The investigators suggest that after this type of ecographic finding a percutaneous biopsy should be performed eliminating exploratory laparotomy, a high risk procedure in this type of patient, and eventually radiotherapy should be initiated since this type of tumor is radiosensitive.

[Unusual ultrastructural findings in a case of asymptomatic primary biliary cirrhosis]. / Insolito reperto ultrastrutturale in un caso di cirrosi biliare primitiva asintomatica.

The investigators report an ultrastructural study of a case of primary biliary cirrhosis histologically in stage II (Scheuer), a rare disease which has not been investigated extensively at the ultrastructural level. Biliary canaliculi are dilated and microvilli are scarce. Large granular formations are observed in the perisinusoidal cytoplasm. The plasma membrane between adjacent hepatocytes appears convoluted. The ultrastructural alterations of the biliary canaliculi which we observed have been described in the literature in cholestatic patients and ascribed to cholestasis. Our patients, however, has never suffered episodes of jaundice or itching and has no histological signs indicating cholestasis. We suggest that these are precocious alterations which precede the appearance of clinical and histological signs of cholestasis. It is necessary to study other cases in order to evaluate the significance of the large granular formations and the changes observed in the plasma membrane.

[Ultrastructural changes in hepatocytes of mice treated with morphine]. / Alterazioni ultrastrutturali negli epatocita di topi trattati con morfina.

In a study of the ultrastructure of hepatocytes in mice treated with morphine a statistically significant increase in the volume density and surface density of smooth endoplasmic reticulum (SER) was observed. Morphometric measurements using the method described by Weibel (2,3) were employed to calculate volume density of smooth and rough endoplasmic reticulum mitochondria, and surface density of rough and smooth endoplasmic reticulum membranes and of the mitochondrial envelope and cristae. Statistical analysis using the t test of Student was carried out for all parameters. Both surface density and volume density of SER in mice treated with morphine increased significantly when compared to mice of control group (P less than 0.05 for surface density of smooth endoplasmic reticulum and P less than 0.01 for volume density of smooth endoplasmic reticulum). These ultrastructural changes after administration of morphine and related opiates are not accompanied by an increase of drug metabolizing enzymes and the huge tolerance observed in mice can be a phenomenon of adaptation at the receptor site (4).