Squamous intraepithelial lesions (SILs) and HPV associated changes in HIV infected women or at risk of HIV. DIANAIDS Cooperative Study Group.

OBJECTIVES: The study concerns the prevalence of squamous intraepithelial lesions (SILs) and the specific cervical cytopathological features of a group of HIV-positive and a group of HIV-negative women recruited in a multicentric cohort study. The assessment of HPV-DNA genotypes was carried out in both groups. METHOD: 459 women, 266 HIV-positive and 193 HIV-negative women at risk were examined in an Italian multi-institutional study involving 14 gynaecological centres. RESULTS: In our samples, the risk of SILs was 29.4% for HIV-positive women and 10% for HIV-negative women (O.R. = 3.90, C.I. 95%: 2.20-6.98) while HPV-DNA-PCR genotypes had a high prevalence in both groups of HIV-positive and HIV-negative women. Cytopathological features of SILs in HIV-positive women were: a higher number of koilocytes and a more marked atypia of high grade neoplastic cells. CONCLUSIONS: A higher prevalence of SILs as well as a specific cervical cytopathology might suggest HIV infection.

Risk of invasive cervical cancer among women with, or at risk for, HIV infection.

Although invasive cervical cancer (ICC) has been included among the AIDS-defining conditions since 1993, it remains controversial whether HIV infection increases the risk of developing such neoplasm. In this study, ICC risk was longitudinally investigated among 1,340 HIV-positive intravenous drug user (IDU), 811 HIV-negative IDU, and 801 HIV-positive heterosexual women. These women, aged 15-49 years, were followed up at the Italian HIV Seroconverter Study, at the San Patrignano Community (Rimini, North Italy), and in South-eastern France (the DMI-2 study). The number of observed cases of ICC was compared with the expected one, based on ICC incidence rates among women of the same age in the general population of Italy or France, and standardized incidence ratios (SIR) were computed; 9,070 person-years of observation were accumulated among HIV-positive women and 2,310 among HIV-negative ones. Ten cases of ICC were diagnosed among HIV-positive women (SIR = 12.8): ICC risk was apparently higher among HIV-positive IDU (SIR = 16.7) than among heterosexual women (SIR = 6.7). No cases of ICC were diagnosed among HIV-negative IDU women admitted to the San Patrignano Community (0.15 cases were expected). Our findings confirm previous suggestions showing an increased risk of ICC among HIV-infected women and have important implications at the individual and public health levels.

Clinical cryptosporidiosis and human immunodeficiency virus (HIV)-induced immunosuppression: findings from a longitudinal study of HIV-positive and HIV-negative former injection drug users.

The natural history of cryptosporidiosis was investigated during a waterborne outbreak among 1731 members of a drug rehabilitation community in Italy; 19.6% of the members were positive for human immunodeficiency virus (HIV). Demographic and clinical information and pre-outbreak serum samples were available. Clinical data were analyzed, stratifying the study population by HIV serostatus and CD4 cell count. The attack rate of clinical cryptosporidiosis was 13.6% among HIV-negative individuals and 30.7% among HIV-positive individuals, although in the latter, it varied according to CD4 cell count. Clinical symptoms and their duration were also related to CD4 cell count. Chronic symptoms were observed in only 16 individuals (15.4%), who all had <150 CD4 cells at the onset of the illness. Among a systematic sample of 198 individuals, 14.1% already had anti-Cryptosporidium antibodies before the outbreak, and 51.2% developed specific antibodies during the outbreak. The development and clinical manifestations of cryptosporidiosis were strongly influenced by the level of HIV-induced immunosuppression.

Determinants of squamous intraepithelial lesions (SIL) on Pap smear: the role of HPV infection and of HIV-1-induced immunosuppression. DIANAIDS Collaborative Study Group.

This study aimed to identify risk factors for squamous intraepithelial lesions (SIL) in women with known HIV status and to explore the association between SIL, HPV subtype, and HIV-induced immunosuppression. The study population consisted of women with known HIV serological status who were attending a network of 16 clinical centres in Italy. Detailed behavioural data, clinical and laboratory parameters, and samples for diagnosis of SIL by Papanicolau smear and HPV infection using a polymerase chain reaction (PCR) were obtained from each study participant. The strength of the association between SIL and possible risk factors was assessed calculating crude and adjusted odds ratios derived from univariate analysis and multivariate models. We enrolled 236 women, of whom 135 (57.2%) were HIV-infected. SIL was diagnosed in 57 women (24.1%); of these, 48 (35.6%) were HIV-infected and 9 (8.9%) were HIV-negative. HPV-DNA was detected in 41 (72%) women with SIL and in 45 (25%) women without SIL. HPV-DNA was more often detected among HIV-infected women than among HIV-negative women (40% vs. 32%), but the difference was not statistically significant. Women infected with high-risk types or with low-risk-uncharacterised types of HPV both had a higher risk of SIL compared with HPV-negative women (respectively, AOR: 17.53 and AOR: 2.89). HIV-infected women with severe or moderate immunosuppression were more likely to have SIL than HIV-negative women (respectively, AOR: 7.29 and AOR: 3.09) also independently from HPV infection. Women reporting use of a contraceptive pill had a 2.5 times higher risk of SIL compared with those who never used hormonal contraceptives. The results confirm that high-risk HPV types are strongly associated with SIL, and that HIV infection may strengthen the effect of HPV at cervical level. The use of oral contraceptives may slightly increase the risk of SIL in women with at-risk behaviour for HIV infection.

Community-acquired pneumonia in a cohort of former injection drug users with and without human immunodeficiency virus infection: incidence, etiologies, and clinical aspects.

Although the association among bacterial pneumonia, human immunodeficiency virus (HIV) infection, and injection-drug use seems to have been well established, accurate estimates of the risk of community-acquired pneumonia among HIV-positive and HIV-negative injection-drug users (IDUs) are still needed. To estimate the incidence of pneumonia in a community of former IDUs, we followed 4,236 persons between 1991 and 1994; 1,114 (26.3%) were HIV-positive and 3,122 (73.7%) were HIV-negative. All patients were evaluated for pneumonia by standard criteria, a serum sample was obtained from each participant at least once a year, and laboratory values were monitored. Overall, 149 episodes of pneumonia occurred among HIV-positive patients and 61 among HIV-negative patients; incidence rates were 90.5 and 14.2 (per 1,000 person-years), respectively. The most common etiologic agents were Streptococcus pneumoniae, Chlamydia pneumoniae, and Haemophilus influenzae. Among the HIV-positive former IDUs, there was a 1.37-fold increase in the relative risk of pneumonia for every decrease of 100/mm3 in the CD4 cell count (95% confidence interval, 1.16-1.61). The incidence of community-acquired pneumonia was markedly higher among HIV-positive participants than among HIV-negative ones, a finding similar to that concerning the general population.

[Cystic adventitial disease (histopathological contribution of a case in the ilio-femoral region)]. / La malattia cistica avventiziale (contributo anatomopatologico su un caso a sede iliaco-femorale).

Cystic adventitial disease is a rare vascular pathology mostly affecting the popliteal artery in disease is a rare vascular pathology mostly affecting the popliteal artery in men. An unusual case, located in the ilio-femoral region of a young woman, is reported. The authors claim that the cystic adventitial formations are similar to the ganglia that originate from tendon-sheaths, as structure, configuration and, probably, histogenesis are concerned. Moreover the authors suggest that cystic adventitial disease can be located among "histogenic dystrophic arteriopathies" in the pathokinetic classification of angiopathies.

Ruptured aneurysms of the abdominal aorta.

The experience with ruptured aneurysms of the abdominal aorta is reported. Out of 395 aneurysms observed, 78 were ruptured. A review of case histories and an analysis of the causes of death demonstrate the importance of prompt diagnosis and early operation: delay and the use of complicated (TC) or invasive (angiography) instrumental examinations does not appear justified since clinical symptoms, plain standard abdominal films and ultrasound almost always lead to prompt diagnosis. Notwithstanding the improvements in resuscitation and intensive care procedures, a significant difference persists between the mortality rate of elective surgery (3 to 8%) and that of emergency surgery. There were 28 deaths (36%) for emergency surgery as against 3.4% for operations performed for non-ruptured aneurysms. This confirms the need for preventive treatment of aneurysmal lesions of the abdominal aorta, since even aneurysms smaller than 5 cm may rupture.

Quantitative evaluation of carotid blood flow before and after surgery.

Blood flow in 49 patients suffering from stenosing lesions of the supraaortic trunks was measured using an ultrasonic volume flow metre (VFM) before and after operation. Results showed a statistically significant increase in the values of carotid flow, after operation. This non-invasive quantitative determination of blood flow provides the surgeon with often essential information for correct operation and subsequent follow-up.

Surgery of carotid stenoses associated with contralateral obstruction.

Surgical correction of stenosing lesions of the extracranial cerebral arteries, responsible for reduced encephalic perfusion, may prevent neurological damage, even when there is bilateral involvement of carotid arteries (stenosis + obstruction). Moreover in these patients poor haemodynamical conditions are thought to be responsible for high perioperatory neurological morbidity and mortality. From case histories with no mortality and low neurological morbidity, other authors state that revascularization of a stenotic carotid artery may be carried out with a reasonable safety margin, even when there is an obstructive lesion of the contralateral carotid artery. On the basis of the 64 cases of revascularization carried out in patients with obstructions of an internal carotid artery associated with a stenotic lesion of the contralateral, we have made a survey of the results, indications and possibilities of treatment in these patients.

Vascular access for hemodialysis: Thomas' shunt.

The immediate and long-term results obtained by the use of a Thomas' shunt as a vascular access through which periodical hemodialysis can be performed, are reported. The lower incidence of septic and thrombotic complications due to the iliac instead of the femoral implantation of the shunt, is stressed.