Development of opportunistic lesions in patients with HIV infection in the absence of pronounced immunodeficiency.

AIM: Statistical data concerning patients with opportunistic infections depending on parameters of immunity and the description of a number of clinical cases of development of opportunistic lesions in patients with HIV infection in the absence of the expressed immunodeficiency. MATERIALS AND METHODS: Medical records of the patients with HIV infection hospitalized in 2012-2015 in the Infectious Diseases Clinical Hospital No. 2 of Moscow, and the clinical cases of patients with development of opportunistic lesions with satisfactory indicators of the immune status. RESULTS: The distribution of patients with HIV infection who had opportunistic infections, depending on the number of CD4+ lymphocytes at the time of development of the disease revealed a significant group of patients with a sufficiently large number of CD4+ cells. Statistical data on the development of various opportunistic lesions with different parameters of the immune status are presented. The authors describe a number of relevant clinical cases. The possible causes of the development of opportunistic diseases and their recurrence in patients with HIV infection with a satisfactory amount of CD4+ lymphocytes are discussed. In the pathogenesis of this phenomenon are important not only quantitative but also qualitative parameters of immunity, as well as the characteristics of the causative agents of opportunistic lesions.

[Follow-up study of HIV-infected patients with prior cerebral toxoplasmosis].

AIM: To assess follow-up study results in human immunodeficiency virus (HIV)-infected patients with prior cerebral toxoplasmosis (CT). SUBJECT AND METHODS: Follow-up study results were assessed in HIV-infected patients with prior CT. RESULTS: The fate of only 97 out of 137 (66% of the hospitalized) patients discharged from hospital is known, as 40 convalescents have been lost to follow up. Thereafter, relapses developed in 19 patients, of whom 6 died. Eleven more patients with HIV infection died due to its progression and development of other secondary lesions. Five more patients died from narcotic overdose, staphylococcal sepsis, and acute pancreatic necrosis. The main peak of fatal outcomes was within the first 2 years after discharge. 3.5-year survival rates after TC were 75%. The causes of recurrent and progressive HIV infection were non-compliance with secondary prevention of CT and low adherence to an antiretroviral therapy regimen, the blame of which fell not only on the patients, but also their attending physicians and specialists who had advised how to enhance treatment motivation. CONCLUSION: Further follow-up of convalescent CT patients calls for closer attention to the possible development of recurrences within the first three years after discharge in particular, regardless of CD4 cell counts.

[Location of foci in cerebral toxoplasmosis in HIV-infected patients].

AIM: To analyze the data of magnetic resonance imaging (MRI) of the brain in its toxoplasmosis in HIV-infected patients. SUBJECT AND METHODS: The clinical picture of cerebral toxoplasmosis was studied in 207 patients aged 18-76 years with Stage 4B HIV infection concurrent with the disease. Brain MRI using an Obraz-1 low-field (0.12 T) MRI scanner (Russia) was carried out in 115 (55.5%) patients. This investigation was conducted in 74 (65%) treated patients over time. RESULTS: Brain T2-weighted and FLAR MRI scans most frequently revealed higher-signal polymorphic foci and T1-weighted MRI scans showed lower-signal ones predominantly involving the white matter or white-grey matter border. Perifocal edema was often recorded. Intravenous gadolinium contrast study indicated that these foci accumulated the contrast agent around the periphery following the target patterns. Sixty-four (86.5%) patients were observed to have significant positive changes: reductions in the number and sizes of foci and the area of perifocal edema; in 29 patients, the inflammatory foci changed into cysts as a favorable outcome of necrotizing encephalitis. The foci resolved completely only in 7% of the patients. CONCLUSION: MRI is of great importance in intensive care, neurology, or neurosurgery units where patients with cerebral toxoplasmosis mimicking an acute cerebrovascular accident or a brain tumor are particularly frequently admitted to.

[Cerebral toxoplasmosis in the pattern of secondary CNS involvements in HIV-infected patients in the Russian federation: clinical and diagnostic features].

The incidence of cerebral toxoplasmosis (CT) among all brain involvements was determined in patients with Stage 4B HIV infection (AIDS) in 2003-2009. Clinical and laboratory parameters were estimated in 156 patients to reveal diagnostic criteria. As a result, CT was shown to be a leading cause of neurologic diseases in patients with late-stage HIV infection (34.7% of cases of brain involvement). In 11.5%, it took place as a generalized process. CT concurrent with cytomegalovirus infection, tuberculosis, or other secondary lesions was frequently diagnosed. Of importance in the diagnosis of CT are magnetic resonance imaging results in addition to basic, clinical data that can assume this diagnosis. The high and moderate serum concentrations of T.gondii IgG are of diagnostic value, which may be used as an auxiliary method to verify the diagnosis.

[Use of immunological and molecular biological methods to diagnose cerebral toxoplasmosis in HIV infection].

Cerebral toxoplasmosis is one of the leading causes of neurologic diseases with high mortality rates in patients with HIV infection. Invasion was difficult to diagnose for a number of objective reasons. The objective of the investigation was to determine the clinical sensitivity of different laboratory techniques as both a single study and their various combinations to verify the diagnosis of cerebral toxoplasmosis in HIV-infected patients. Blood and cerebrospinal fluid were tested in 51 patients with Stage 4B HIV infection (AIDS) with the verified diagnosis of cerebral toxoplasmosis. Separate determination of specific antibodies of IgG, IgM, IgA and toxoplasma DNA in the blood and cerebrospinal fluid was shown to have an insufficient clinical sensitivity (37.3-68.6%). The benefits of various combinations of immunological and molecular biological assays enhancing the diagnostic efficiency up to 76.5-96.1% are demonstrated.

[Features of epidemiology and diagnostics of toxoplasmosis during HIV-infection].

AIM: Comparative assessment of effectiveness of serologic methods for toxoplasmosis diagnostics in patients with HIV-infection. MATERIALS AND METHODS: Sera and CSF samples from 166 patients with AIDS stage IIIB were tested for antibodies to Toxoplasma gondii by indirect immunofluorescence, ELISA and immunoblotting. Results of serological tests were compared with clinical, pathological data as well as with results of MRI and PCR. RESULTS: Clinical value of IgG detection in blood and CSF by ELISA was shown--high level of antibodies marked reactivation of the invasion. IgG antibodies in CSF were detected only if high levels of IgG were present in the blood. Detection of antigenic determinants with molecular mass 18 - 20 and 65 - 70 kDa in immunoblotting was proposed as a criterion of cerebral toxoplasmosis reactivation. CONCLUSION: Complex laboratory serologic tests along with data obtained by MRI, PCR and microscopy of T. gondii cysts enhances the effectiveness of toxoplasmosis diagnostics. Knowledge of toxoplasmosis reactivation criteria in patients with AIDS will allow to develop the optimal protocol of toxoplasmosis diagnostics and substantiate measures for its prevention.

[The pattern of central nervous system lesions in HIV-infected patients of the specialized unit in infectious disease hospital].

AIM: To define the incidence and features of brain lesion (BL) in HIV-infected inpatients. SUBJECTS AND METHODS: Four hundred and fifty-eight patients with Stage 4B HIV infection (AIDS) and central nervous system (CNS) lesion admitted to Infectious Diseases Hospital Two, Moscow, were followed up in 2003-2009. The authors used cerebrospinal fluid (CSF) microscopic and bacteriological assays for DNA of T. gondii, M. tuberculosis, herpes simplex virus (HSV) types 1 and 2, cytomegalovirus (CMV), HSV type 6, and varicella-zoster virus, Cr. neoformans, C. albicans, C. glabrata, and C. krusei. Blood and CSF were tested for IgM and IgG T. gondii antibodies; brain magnetic resonance imaging was carried out. RESULTS: In patients with late-stage HIV infection, the principal cause of neurological diseases was cerebral toxoplasmosis (34.7% of BL cases) and a generalized process involving the brain, lung, heart, liver, and eyes in 11.5%. There was commonly cerebral toxoplasmosis concurrent with CMV infection with clinical manifestations. 16-32% of the inpatients developed tuberculosis meningoencephalitis that was a manifestation of hematogenous disseminated tuberculosis involving the lung. There was a rise in the incidence of cancers (brain lymphomas, astrocytomas) running with CNS lesion. Mental disorders progressing to dementia were a distinctive property of CMV ventriculoencephalitis, one of the leading factors in the development of AIDS dementia complex. Molecular diagnostic techniques are needed to ascertain the etiology of BL in HIV infection. CONCLUSION: The CSF test for DNA of causative agents is a specific and most sensitive method for diagnosing a relevant CNS lesion.

[Spectrum, clinical features, diagnosis of opportunistic and comorbid pathology in HIV-infected patients admitted to infection hospital of Moscow].

AIM: To analyse structure, clinical features, diagnosis of opportunistic and concomitant diseases in patients with HIV infection admitted to infection hospital of Moscow. MATERIAL AND METHODS: A total of 4155 patients with HIV infection (1518 of them with AIDS) most of them (89%) at the age of 20-39 years were treated in Moscow AIDS hospital in 2006-2007. The examination included standard blood and urine tests, device diagnosis, immunological, bacteriological and molecular investigations of biological materials for detection of opportunistic infections. Cell-mediated immunity was also studied. HIV infection resulted in a lethal outcome in 255 (6.1%) inpatients. RESULTS: Leading causes of hospitalization of patients at early stages of HIV infection were bacterial bronchitis or pneumonia, hepatic pathology (chronic viral hepatitides, alcohol-associated diseases), sepsis. One-third of the inpatients were at AIDS stage characterized by tuberculosis (66.3%), visceral candidosis (12%), manifest cytomegalovirus infection (10.1%), cerebral toxoplasmosis (9.2%), pneumocystic pneumonia (5.5%). The number of HIV-infected persons with atypical mycobacteriosis, lymphoproliferative diseases, brain tumors increased. Chronic hepatitis C prevailed among liver damage cause in HIV infection, it also often caused hospitalization and death of patients. 60.3% patients having HIV infection who died without AIDS stage had hepatic cirrhosis. Tuberculosis was a leading cause of severe pulmonary pathology, most frequent opportunistic disease, main cause of death in patients with HIV infection. One-third of patients had generalized tuberculosis. Tuberculosis was diagnosed in more than 40% HIV-infected patients with pulmonary lesion, in 65% AIDS patients, 36% dead AIDS patients. CONCLUSION: To render effective anti-HIV treatment, infection hospital must be equipped with facilities providing device tests, molecular diagnosis, modern etiotropic and pathogenetic medication.

[Cerebral toxoplasmosis in HIV-infected patients].

AIM: To detect clinical characteristics of cerebral toxoplasmosis in HIV-infected patients, to clarify diagnostic role of detection of DNA and antibodies to Toxoplasma gondii in the cerebrospinal fluid (CSF) and blood. MATERIAL AND METHODS: Diagnostic procedures were performed in 156 patients with HIV infection at the stage IVB (AIDS) in 2003-2006. All the patients suffered from diseases of the central nervous system (CNS). Toxoplasmosis was diagnosed in 57 (36%) cases. Lumbar puncture, MR imaging of the brain, reaction of indirect immunofluorescence, polymerase chain reaction and enzyme immunoassay were made to identify IgM and IgG to T. gondii. RESULTS: Typical for HIV-infected patients with cerebral toxoplasmosis were focal symptoms of CNS affection, hemipareses, adynamia, mental disorders, intoxication symptoms. CONCLUSION: MR imaging data are very important. Toxoplastosis is characterized by multiple destructive foci in the hemispheres and cerebellum with great amount of the parasites along the periphery of brain tissue necrosis. Detection of the infective agent DNA and specific IgG antibodies in cerebrospinal fluid confirms the presence of toxoplasmosis but sensitivity of the markers is low. IgG antibodies to T. gondii have diagnostic implications if they occur in high and moderate titers.

[Differential diagnosis of lymphadenopathy in HIV/AIDS].

AIM: To determine the role of histological diagnosis of lymphadenopathy (LAP) associated with clinico-laboratory picture in patients with HIV infection/AIDS. MATERIAL AND METHODS: Target biopsy of the peripheral lymph node was made in 80 HIV-infected patients from 2002 to 2005. Histological diagnosis was made in all the patients with light microscopy, in some patients at immunohistological examination. RESULTS: Most of the patients had peripheral blood CD4 lymphocytes under 200 cell/mcl. Viral load was hundred thousands copies in mcl. Tuberculosis was diagnosed in 33 (41%) patients, lymphomas--in 23(29%), lymphogranulomatosis--in 5 (6%), reactive lymphadenopathy--in 15 (19%), germinogenic tumors--in 3 (4%), sarcoidosis--in 1 (1%). Histologically, LAP was represented by follicular hyperplasia (n = 9), involution (n = 2), bacterial lymphadenitis with necrosis (n = 4). CONCLUSION: Biopsy of peripheral lymph nodes is an early, safe, reliable and cost-effective method of LAP diagnosis in patients with AIDS.