Respiratory symptoms and chronic bronchitis in people with and without HIV infection.

OBJECTIVES: High rates of respiratory symptoms and chronic bronchitis (CB) are reported in people with HIV infection (PWH). We investigated the prevalence of respiratory symptoms and CB in PWH and HIV-negative people in the Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) study. METHODS: Assessment of respiratory symptoms and CB was undertaken using the modified form of the St. George's Respiratory Questionnaire for chronic obstructive pulmonary disease (COPD). Univariate (χ2 tests, Mann-Whitney U tests and Spearman's rank correlation) and multivariable (linear and logistic regression) analyses were performed to consider associations of respiratory symptoms with demographic, lifestyle and HIV-related parameters, and with depressive symptoms and quality of life. RESULTS: Among the 619 participants, respiratory Symptom scores were higher in older and younger PWH compared to older HIV-negative people, with median (interquartile range) scores of 17.7 (6.2, 39.5), 17.5 (0.9, 30.0) and 9.0 (0.9, 17.5), respectively (P = 0.0001); these differences remained significant after confounder adjustment. Sixty-three participants (10.2%) met the criteria for CB [44 (14.0%) older PWH, 14 (9.2%) younger PWH, and five (3.3%) older HIV-negative people; P = 0.002], with these differences also remaining after adjustment for confounding variables, particularly smoking status [older vs. younger PWH: odds ratio (OR) 4.48 (95% confidence interval (CI) 1.64, 12.30); P = 0.004; older PWH vs. HIV-negative people: OR 4.53 (95% CI 1.12, 18.28); P = 0.03]. Respiratory symptoms and CB were both associated with greater depressive symptom scores and poorer quality of life. No strong associations were reported between CB and immune function, HIV RNA or previous diagnosis of any AIDS event. CONCLUSIONS: Respiratory symptoms and CB are more common in PWH than in demographically and lifestyle-similar HIV-negative people and are associated with poorer mental health and quality of life.

Depression, lifestyle factors and cognitive function in people living with HIV and comparable HIV-negative controls.

OBJECTIVES: We investigated whether differences in cognitive performance between people living with HIV (PLWH) and comparable HIV-negative people were mediated or moderated by depressive symptoms and lifestyle factors. METHODS: A cross-sectional study of 637 'older' PLWH aged ≥ 50 years, 340 'younger' PLWH aged < 50 years and 276 demographically matched HIV-negative controls aged ≥ 50 years enrolled in the Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) study was performed. Cognitive function was assessed using a computerized battery (CogState). Scores were standardized into Z-scores [mean = 0; standard deviation (SD) = 1] and averaged to obtain a global Z-score. Depressive symptoms were evaluated via the Patient Health Questionnaire (PHQ-9). Differences between the three groups and the effects of depression, sociodemographic factors and lifestyle factors on cognitive performance were evaluated using median regression. All analyses accounted for age, gender, ethnicity and level of education. RESULTS: After adjustment for sociodemographic factors, older and younger PLWH had poorer overall cognitive scores than older HIV-negative controls (P < 0.001 and P = 0.006, respectively). Moderate or severe depressive symptoms were more prevalent in both older (27%; P < 0.001) and younger (21%; P < 0.001) PLWH compared with controls (8%). Depressive symptoms (P < 0.001) and use of hashish (P = 0.01) were associated with lower cognitive function; alcohol consumption (P = 0.02) was associated with better cognitive scores. After further adjustment for these factors, the difference between older PLWH and HIV-negative controls was no longer significant (P = 0.08), while that between younger PLWH and older HIV-negative controls remained significant (P = 0.01). CONCLUSIONS: Poorer cognitive performances in PLWH compared with HIV-negative individuals were, in part, mediated by the greater prevalence of depressive symptoms and recreational drug use reported by PLWH.

High-risk behaviours, and their associations with mental health, adherence to antiretroviral therapy and HIV parameters, in HIV-positive men who have sex with men.

OBJECTIVES: To investigate the patterns and frequency of multiple risk behaviours (alcohol, drugs, smoking, higher risk sexual activity) among men who have sex with men (MSM) living with HIV. METHODS: Cross sectional study. RESULTS: 147 out of 819 HIV-positive MSM exhibited a high-risk phenotype (defined as >3 of smoking, excess alcohol, sexually transmitted infection and recent recreational drug use). This phenotype was associated with younger age, depressive symptoms and <90% adherence in multivariable logistic regression. CONCLUSION: In a cohort of MSM, a small, but significant proportion exhibited multiple concurrent risk behaviours.

Cognitive Impairment in people living with HIV in the ART era: A Review.

Background: Cognitive disorders are a common issue impacting those living with human immunodeficiency virus (HIV). Effective antiretroviral treatment has lessened the severity but not the frequency of these impairments. Such deficits reduce quality of life and present a significant challenge to clinicians in the context of an ageing HIV population with a growing number of comorbidities. Sources of data: This review is based on recent published literature in the field of HIV-associated cognitive impairment (HAND). Areas of agreement: The pathogenesis of HAND is multifactorial and can be categorized into HIV viral factors, antiretroviral factors and individual factors. The risk factors associated with HAND are well documented. Areas of controversy: The prevalence of HAND in HIV populations varies and is dependent on populations studied and assessment batteries used. Disease progression is poorly understood and has important implication for screening programmes. The relative contribution of pathogenic mechanisms causing HAND is unclear, but recent papers point to inflammation as a significant contributor. Growing areas: The role of psychiatric diseases, such as depression, in the development and maintenance of HAND has recently been examined and requires clinical consideration. Furthermore, as the HIV population ages, its clinical management faces new challenges. Areas timely for developing research: Identifying biomarkers for HAND which are practical in a clinical setting and utilizing new imaging technologies to better monitor diagnosis and disease progression. Furthermore, the development of therapeutics targeting inflammation appears of increasing importance.

Associations between cognitive impairment and patient-reported measures of physical/mental functioning in older people living with HIV.

OBJECTIVES: While cognitive impairment is frequently reported in HIV-positive individuals and has historically been associated with poorer functional outcomes, the associations between cognitive impairment and patient-reported outcome measures (PROMs) in contemporary cohorts are unclear. METHODS: We tested cognitive function using a computerized battery (CogState™ ) in 290 HIV-positive and 97 HIV-negative individuals aged ≥ 50 years participating in the Pharmacokinetic and Clinical Observations in People Over Fifty (POPPY) study. Participants completed questionnaires detailing physical and mental health [Short Form Health Survey (SF-36)], cognitive function [European AIDS Clinical Society (EACS) questions], activities of daily living [Lawton Instrumental Activities of Daily Living (IADL)], depression [Patient Depression Questionnaire (PHQ-9) and Centres for Epidemiologic Studies Depression scale (CES-D)], falls and sexual desire. Cognitive impairment was defined using the Frascati criteria, global deficit score (GDS) and multivariate normative comparison (MNC). In the HIV-positive group, the classification performances of the different definitions of cognitive impairment and dichotomized questionnaire results were calculated. RESULTS: The prevalence of cognitive impairment in the HIV-positive group was 34.5% (GDS), 30.0% (Frascati) and 22.1% (MNC), with only 2% diagnosed with HIV-associated dementia. In general, the associations between cognitive impairment and PROMs were weak regardless of the definition used: mean c-statistics were 0.543 (GDS), 0.530 (MNC) and 0.519 (Frascati). Associations were similar using the global T-score to define cognitive impairment. Summary health scores (SF-36) were lower, but only significantly so for those with cognitive impairment identified using MNC, for both mental health (61.4 vs. 75.8; P = 0.03) and physical health (60.9 vs. 75.0; P = 0.03). CONCLUSIONS: The associations between cognitive impairment and PROMs were weak, possibly because impairment was mild and therefore largely asymptomatic. Further work is needed to elucidate the clinical implications of cognitive impairment in HIV-disease.

Bacille Calmette-Guerin disease following Bacille Calmette-Guerin vaccination of an HIV-infected health-care worker.

We present a case of Bacille Calmette-Guerin (BCG) lymphadenitis following immunization of a health-care worker with risk factors for HIV but undiagnosed infection. This case highlights the potential risks of BCG and clearly demonstrates the need to consider HIV testing in all patients prior to BCG vaccination.

Transient bone marrow oedema syndrome in an HIV-infected patient on highly active antiretroviral therapy.

Bone marrow oedema syndrome (BMES, also known as transient osteoporosis) is an uncommon, self-limiting condition characterized by disabling pain, reversible osteopaenia on X-rays and by bone marrow oedema pattern on magnetic resonance imaging (MRI). Here we describe the first reported case of BMES in an HIV-positive patient on highly active antiretroviral therapy.

HIV and systemic lupus erythematosus: the clinical and diagnostic dilemmas of having dual diagnosis.

We present the case of a young black African woman living in the UK who presented with systemic lupus erythematosus (SLE) and HIV. The reported coexistence of HIV and SLE is unusual with fewer than 30 published cases. We discuss some of the clinical and diagnostic challenges that face clinicians when a patient presents with both conditions. In particular, we discuss the overlap in symptoms, signs and laboratory findings, and the difficulties that this may pose in terms of making a diagnosis. The implications that having a dual diagnosis may have for treating each condition are also discussed. With increased HIV testing in a variety of clinical settings there is likely to be an increase in detection of similar cases. This case emphasizes the need for careful diagnostic testing and judicious interpretation of the validity of laboratory results in order to reach an accurate diagnosis in such patients.

Activity coefficients of the peptide and the electrolyte in ternary systems water+glycylglycine+NaCl, +NaBr, +KCl and +KBr at 298.2 K.

The activity coefficients of glycylglycine in four aqueous electrolyte solutions (+NaCl, +NaBr, +KCl and +KBr) were obtained at 298.2 K. The mean ionic activity coefficient of the electrolyte in aqueous solutions containing the peptide was determined from measurements of the potential differences of a cation and an anion ion-selective-electrode, each vs. a double junction reference electrode. The results show that the nature of the anion has a major effect on the activity coefficients of glycylglycine. Comparison of activity coefficient data for glycylglycine with literature data for glycine, both in aqueous NaCl solutions, indicates that the effect of the electrolyte is larger for the peptide than for the amino acid. For the peptide, in all cases, the effect of the electrolyte is more important at low molalities of the electrolyte. The Wilson equation was used to correlate the activity coefficient data obtained. The correlation results were satisfactory for the region of concentrated electrolyte.

Effect of the cation and the anion of an electrolyte on the solubility of DL-aminobutyric acid in aqueous solutions: measurement and modelling.

The solubilities at 298.2 K of dl-aminobutyric acid in aqueous solutions of NaCl, KCl, NaNO(3) and KNO(3) were measured. The solubility of DL-aminobutyric acid was found to be influenced by the concentration and by the nature of both the cation and the anion of the electrolyte. Comparison of the results obtained in this study and those for other amino acids reported in the literature, indicates that the structure of the hydrocarbon backbone of an amino acid plays an important role in the interactions of an amino acid with an electrolyte. A thermodynamic model has been used to correlate the solubilities of DL-aminobutyric acid in aqueous electrolyte solutions. The activity coefficients of the amino acid in the electrolyte solutions, were represented by a model proposed by Khoshkbarchi and Vera [M.K. Khoshkbarchi, J.H. Vera, AIChE J. 42 (1996) 2354; M.K. Khoshkbarchi, J.H. Vera, Ind. Eng. Chem. Res. 35 (1996) 4755]. This model, which considers a combination of both long- and short-range interactions, contains only two adjustable parameters. All other parameters are available in the literature. The model can accurately correlate the solubility of dl-aminobutyric acid in aqueous solutions of electrolytes.

Activity coefficients of the electrolyte and the amino acid in water + NaNO(3) + glycine and water + NaCl + DL-methionine systems at 298.15 K.

The activity coefficients at 298.15 K of glycine in water + NaNO(3) + glycine system and dl-methionine in water + NaCl + dl-methionine system are reported. The measurements were performed in an electrochemical cell with two ion selective electrodes, a cation and an anion ion selective electrode, each versus a double junction reference electrode. The concentrations of the electrolytes and the amino acids studied covered up to 1.0 molality electrolyte, 2.4 molality glycine and 0.2 molality dl-methionine. The results of the activity coefficients of glycine are compared with the activity coefficients of glycine in water + NaCl + glycine and water + KCl + glycine systems, obtained from the previous studies. The results show that the nature of both the cation and the anion of an electrolyte have significant effects on the activity coefficient of glycine in aqueous electrolyte solutions. The results also show that there are attractive interactions between the molecules of glycine and NaNO(3) and repulsive interactions between the molecules of dl-methionine and NaCl.

Effect of the concentration of DODMAC and 1-decanol on the behavior of reverse micelles in the extraction of amino acids.

The concentrations of dioctyldimethyl ammonium chloride (DODMAC) and 1-decanol in isooctane needed to form reverse micelles by phase contact have been determined. The behavior of these reverse micelles in the extraction of aspartic acid, glutamic acid, and threonine was studied by analyzing all of the ionic species in the aqueous phase. The amino acid is extracted from the aqueous phase by exchanging with the Cl(-) counterions of DODMAC in the reverse micelles. The ionic species in the reverse micelles tend toward their undissociated states as the water uptake by the reverse micelles decreases. The effect of 1-decanol on the extraction of the amino acids with two negative charges is due to the change in the water uptake of the reverse micelles. The concentration of DODMAC has no effect on the ion exchange of the amino acid with one negative charge with the Cl(-) counterions of DODMAC in the reverse micelles. Higher molar ratios of decanol to DODMAC favor the selective separation of amino acids with different charge numbers. (c) 1995 John Wiley & Sons, Inc.

Identification of a previously undetected source of systematic error in capillary viscometry measurements.

A new analysis of the factors affecting the driving head within a capillary viscometer has identified a previously undetected source of error due to surface tension. In contrast to the well-known capillary rise correction to the effective driving head, this additional effect requires that a correction be made to the apparent head of liquid. Calculations show that this source of error may be responsible for deviations in experimental results as large as 1%. A new calibration equation which compensates for both surface tension effects is recommended.