Nutritional status impairments in HIV-infected patients are associated with increased TNF-alpha and IL-6 serum levels but not with viral load.

BACKGROUND: Cytokines may alter metabolic pathways and contribute to malnutrition among human immunodefiency virus (HIV)-positive individuals. PATIENTS AND METHODS: Tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), soluble IL-2 receptors (sIL-2R), beta2-microglobulin serum levels and plasma viral load of 45 HIV-positive patients were determined and correlated to nutritional status impairment. Patients were grouped by CD4 counts into categories I (< 200/microl), II (200-499/microl), III (> or = 500/microl). There were 15 healthy controls. A nutritional grading system, based on anthropometric and laboratory data, was devised. Scores ranged from 0 to 5 (eutrophic to malnutrition). RESULTS: AIDS patients' cytokines and immune marker levels were significantly higher than those of the controls, but not always higher than those of other categories. AIDS patients had higher nutritional deficit grades than category III (p < 0.05) or the controls (p < 0.02) which, except for viral load, correlated with the parameters studied. CONCLUSION: Nutritional status impairments in HIV-positive individuals were associated with immune activation but not with viral load.

Search for evidence of a Th2 profile in HIV+ patients.

BACKGROUND: Hypersensitivity dermatoses are common in human immunodeficiency virus-positive (HIV+) patients, particularly as the disease progresses. Studies have shown that a switch to T-helper 2 (Th2) might represent a turning point in HIV. This study investigated whether increases in the number of skin mast cells, immunoglobulin E (IgE) serum levels, and eosinophilia, involved in the Th2 response in allergic disease, might also be present in HIV+ patients. If so, these alterations might explain one of the mechanisms of skin hypersensitivity in these patients. METHODS: Forty-five skin biopsies from the normal skin of the upper arm of HIV+ patients and 15 controls were included in the study. HIV+ individuals were classified into three equal categories according to their immunologic status: Category I (< 200/microL), Category II (200-499/microL), and Category III (> 500/microL). Anti-tryptase antibody was employed in tissue sections to show mast cells; IgE serum levels and eosinophils in peripheral blood count were investigated; delayed-type hypersensitivity (DTH) skin tests (candidin, trichophytin, and PPD 2U) were evaluated. RESULTS: Normal cutaneous mast cell and eosinophil counts were the same in all categories and in the control group, but increased IgE levels (P < 0. 01) and DTH skin test anergy (P < 0.006) were observed among acquired immunodeficiency syndrome (AIDS) patients. CONCLUSIONS: The density of skin mast cells in HIV infection was not modified in the course of the disease. Mast cells do not seem to be primarily responsible for triggering hypersensitivity dermatoses among AIDS patients, although data in support of the Th2 response, as seen in increased IgE serum levels and DTH anergy, are present.

[Ashy dermatosis. Review of the literature and report of a case]. / Dermatose cinzenta. Revisão e relato de um caso.

The authors make a review of the epidemiologic, etiopathogenic, clinical, laboratory and therapeutic aspects of ashy dermatosis, described in 1957 by Ramírez in El Salvador, of which more than 150 cases have been described up to now in different continents. The disease is exclusively cutaneous, presents peculiar clinical features with a lichenoid tissue reaction, and has no specific treatment or known etiology. The authors report a case in a Brasilian man, followed up for three years. The treatment of a T. trichiura infestation did not change the cutaneous features, as opposed to what has been reported.