ABSTRACT
We describe four cases of a localized, granulomatous reaction to BCG including ipsilateral painful, suppurative lymphadenopathy associated with donor immune reconstitution following allogeneic haematopoietic stem cell transplant performed in infancy and preceded by uneventful, routine BCG immunisation. The management of the inflammatory disease in these cases with surgery, antimycobacterial chemotherapy and steroids, is discussed.
Subject(s)
BCG Vaccine/therapeutic use , Hematopoietic Stem Cell Transplantation , Inflammation/immunology , Lymphadenitis/immunology , Lymphadenitis/therapy , Female , Humans , Infant , Infant, Newborn , Male , Transplantation, HomologousABSTRACT
Antiretroviral (ARV) therapy in HIV patients can cause hyperlipidaemia, glucose intolerance and insulin resistance, which increase the risk of cardiovascular disease (CVD). An audit carried out in Manchester found that CVD risk factors were common among HIV patients receiving ARVs; however, the management of risk factors was not satisfactory. Adopting a formal system to identify and manage CVD risk factors as well as appropriate referral for specialist management of complications of ARV therapy would improve patient care.
Subject(s)
Cardiovascular Diseases/prevention & control , HIV Infections/complications , Medical Audit , Anti-HIV Agents/adverse effects , Anti-HIV Agents/therapeutic use , Blood Glucose , Cardiovascular Diseases/chemically induced , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Guideline Adherence , HIV Infections/drug therapy , HIV-1 , HIV-Associated Lipodystrophy Syndrome/chemically induced , HIV-Associated Lipodystrophy Syndrome/complications , HIV-Associated Lipodystrophy Syndrome/epidemiology , Humans , Hyperlipidemias/chemically induced , Hyperlipidemias/complications , Hyperlipidemias/epidemiology , Risk Factors , Smoking/adverse effects , United KingdomABSTRACT
We evaluated the management of antiretroviral treatment (ART)-naïve HIV-positive patients in Greater Manchester against the 2005 British HIV association (BHIVA) guidelines. Fifty-seven HIV patients (median age 36 years, 61% males, 53% black Africans) commenced their first ART regimen between 1 October and 31 December 2005. Most of them presented with advanced HIV disease (74% had CD4 lymphocytes <200 and 33% were Centers for Disease Control and Prevention stage C) and 51% commenced ART within three months of their HIV diagnosis. Ninety-six percent had baseline laboratory investigations performed but only 53% had baseline blood pressure estimation. Only 25% had urinalysis performed. A combination of two nucleoside reverse transcriptase inhibitors (NRTI) and one non-NRTI was chosen in 76% of patients. Eighty-two percent of patients had a clinical review and blood tests within five weeks of starting treatment.
Subject(s)
HIV Infections/drug therapy , HIV Protease Inhibitors/pharmacology , HIV Protease Inhibitors/therapeutic use , HIV-1/drug effects , Management Audit , Antiretroviral Therapy, Highly Active , Female , HIV Protease Inhibitors/adverse effects , Humans , Male , Retrospective Studies , Treatment Outcome , United Kingdom/epidemiologyABSTRACT
A case of a 31-year-old man with systemic Penicillium marneffei infection acquired in Thailand and who developed endophthalmitis is described. This presentation has not previously been reported. He responded to combined treatment with intravenous and intravitreal amphotericin.
Subject(s)
AIDS-Related Opportunistic Infections/etiology , Endophthalmitis/etiology , Penicillium/isolation & purification , AIDS-Related Opportunistic Infections/drug therapy , Adult , Amphotericin B/therapeutic use , Endophthalmitis/drug therapy , Humans , Male , Penicillium/drug effectsABSTRACT
The aim of these studies was to determine whether HIV-infected patients have a plasma thiol deficiency and whether this is associated with decreased detoxification of the toxic metabolites of sulfamethoxazole. Reduced, oxidized, protein-bound, and total thiol levels were measured in 33 HIV-positive patients and 33 control subjects by an HPLC method utilizing the fluorescent probe bromobimane. The reduction of sulfamethoxazole hydroxylamine and nitrososulfamethoxazole by plasma and the plasma redox balance in the presence of nitrososulphamethoxazole were also determined by HPLC. Reduced plasma cysteine was significantly (p<0.0001) lower in HIV-positive patients (13.0+/-3.0 microM) when compared with control subjects (16.9+/-3.0 microM). Although there was no difference in oxidized, protein-bound, and total cysteine, the thiol/disulfide ratios were lower in HIV-positive patients. Reduced homocysteine was elevated in patients. Plasma from HIV-positive patients was less able to detoxify nitrososulfamethoxazole than control plasma. These findings show that the disturbance in redox balance in HIV-positive patients may alter metabolic detoxification capacity, and thereby predispose to sulfamethoxazole hypersensitivity.
