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Boag FC, Dean R, Hawkins DA, Lawrence AG, Gazzard BG. Abnormalities of Liver Function during HIV Seroconversion Illness. Int J STD AIDS 2016; 3:46-8. [PMID: 1347463 DOI: 10.1177/095646249200300111] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 6 patients with a severe human immunodeficiency virus (HIV) seroconversion illness distinct abnormalities of liver transaminases were observed; in addition there was marked hepatomegaly in 5 patients.
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Affiliation(s)
- F C Boag
- John Hunter Clinic, St Stephen's Clinic, London, UK
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2
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Abstract
Infection with the human immunodeficiency virus type 1 (HIV-1) results in progressive loss of immune function marked by depletion of the CD4+ T-lymphocytes, leading to opportunistic infections and malignancies characteristic of AIDS. Although both host and viral determinants influence the rate of disease progression, the median time from initial infection to the development of AIDS among untreated patients ranges from 8 to 10 years. The clinical staging of HIV disease and the relative risk of developing opportunistic infections historically relied on the CD4+ T-lymphocyte counts. Although more recent studies have shown the importance of viral load quantitation in determining the rate of disease progression, it is still useful to categorize HIV disease stage on the basis of the degree of immunodeficiency: early disease (CD4+ > 500 cells/mL), mid-stage disease (CD4+ between 200 and 500 cells/mL), and end-stage disease (CD4+ < 50 cell/mL). This article reviews the natural history of HIV disease at each stage of HIV-1 infection with emphasis on acute infection and the major virologic and immunologic determinants of disease progression.
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Affiliation(s)
- E N Vergis
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. verge+@pitt.edu
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3
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Sasseville VG, Rottman JB, Du Z, Veazey R, Knight HL, Caunt D, Desrosiers RC, Lackner AA. Characterization of the cutaneous exanthem in macaques infected with a Nef gene variant of SIVmac239. J Invest Dermatol 1998; 110:894-901. [PMID: 9620296 DOI: 10.1046/j.1523-1747.1998.00205.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The molecularly cloned viruses known as SIVmac239/R17Y and SIVmac239/YEnef cause extensive lymphocyte activation and induce an acute disease syndrome in macaque monkeys. One manifestation of this syndrome is a severe diffuse cutaneous maculopapular exanthem that is similar to the exanthem associated with HIV-1 infection. To examine the pathogenesis of this exanthem, biopsies obtained throughout the course of clinically evident rash were examined for the presence of virus by in situ hybridization and immunohistochemistry, and the cellular infiltrate was characterized with respect to cellular immunophenotype and chemokine receptor expression. The onset of rash was associated with abundant simian immunodeficiency virus nucleic acid and protein within perivascular dermal infiltrates and occasionally within intraepithelial cells. Analysis of cellular infiltrates showed that biopsies, obtained on the day of rash onset, were composed of equal numbers of CD4+ and CD8+ lymphocytes and abundant alphaEbeta7 positive cells surrounding vessels with upregulated endothelial E-selectin. Moreover, by examining virus expression in sequential skin biopsies from the same animal, the clearance of virus and the resolution of rash were associated with an increase in the percentage of cells expressing CD8, the chemokine receptor CXCR3, and GMP-17, a marker of cytotoxic granules. These results suggest that activated cytotoxic T cells are trafficking to sites of inflammation in the skin and directly or indirectly affect levels of viral replication at these sites.
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MESH Headings
- Animals
- Antigens, Differentiation, T-Lymphocyte
- Antigens, Neoplasm
- Biopsy
- Blood Vessels/pathology
- Blood Vessels/virology
- CD8-Positive T-Lymphocytes/chemistry
- CD8-Positive T-Lymphocytes/cytology
- CD8-Positive T-Lymphocytes/virology
- Cell Division
- E-Selectin/analysis
- Exanthema/pathology
- Exanthema/virology
- Genes, Viral/genetics
- Genes, nef/genetics
- Genetic Variation/genetics
- HIV Infections/pathology
- HIV Infections/virology
- Immunohistochemistry
- Integrins/analysis
- Ki-67 Antigen/analysis
- Leukocyte Count
- Lymphocyte Count
- Macaca mulatta/virology
- Membrane Glycoproteins/analysis
- Neutrophils/chemistry
- Neutrophils/cytology
- Neutrophils/virology
- RNA, Viral/analysis
- RNA, Viral/genetics
- Receptors, CCR5/analysis
- Receptors, CXCR3
- Receptors, Chemokine/analysis
- Simian Acquired Immunodeficiency Syndrome
- Simian Immunodeficiency Virus/genetics
- Skin/blood supply
- Skin/pathology
- Skin/virology
- T-Lymphocytes, Cytotoxic/chemistry
- T-Lymphocytes, Cytotoxic/cytology
- T-Lymphocytes, Cytotoxic/virology
- Time Factors
- Vascular Cell Adhesion Molecule-1/analysis
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Affiliation(s)
- V G Sasseville
- Division of Comparative Pathology, Harvard Medical School, New England Regional Primate Research Center, Southborough, Massachusetts 01772-9102, USA
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4
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Abstract
We describe a patient with acute HIV exanthem with papulovesicular lesions and epidermal necrosis. We also review the literature regarding the histopathologic findings of acute HIV exanthem, which appears to be most commonly characterized by a perivascular lymphocytic infiltrate without epidermal change, but which may be associated with spongiosis, vacuolar alteration, or epidermal necrosis.
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Affiliation(s)
- G D Goldman
- Section of Dermatology, Veterans Administration Hospital, West Haven, CT, USA
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5
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Manifestations cliniques et biologiques de la primo-infection par le virus de l'immunodéficience humaine : revue de la littérature. Med Mal Infect 1993. [DOI: 10.1016/s0399-077x(05)81191-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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6
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de Jong MD, Hulsebosch HJ, Lange JM. Clinical, virological and immunological features of primary HIV-1 infection. Genitourin Med 1991; 67:367-73. [PMID: 1743707 PMCID: PMC1194734 DOI: 10.1136/sti.67.5.367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- M D de Jong
- Department of Internal Medicine, University of Amsterdam, The Netherlands
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7
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Clark SJ, Saag MS, Decker WD, Campbell-Hill S, Roberson JL, Veldkamp PJ, Kappes JC, Hahn BH, Shaw GM. High titers of cytopathic virus in plasma of patients with symptomatic primary HIV-1 infection. N Engl J Med 1991; 324:954-60. [PMID: 1900576 DOI: 10.1056/nejm199104043241404] [Citation(s) in RCA: 413] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Primary infection with the human immunodeficiency virus (HIV-1) frequently causes an acute, self-limited viral syndrome. To examine the relations among viral replication, the immune response of the host, and clinical illness during this initial phase of infection, we undertook a quantitative, molecular, and biologic analysis of infectious HIV-1 in the blood and plasma of three patients with symptomatic primary infection and of a sexual partner of one of them. METHODS During an eight-week period of primary infection, HIV-1 was cultured frequently in dilutions of plasma and peripheral-blood mononuclear cells (PBMC), and levels of HIV-1 antigen and antibody were determined sequentially by enzyme-linked immunosorbent assay and immunoblotting. Replication-competent HIV-1 proviruses were cloned and characterized biologically. RESULTS Six to 15 days after the onset of symptoms, high titers of infectious HIV-1 (from 10 to 10(3) tissue-culture-infective doses per milliliter of plasma) and viral p24 antigen were detected in the plasma of all three patients. These titers fell precipitously by day 27, and the decline coincided with an increase in the levels of antiviral antibodies and the resolution of symptoms. Sequential isolates of virus from plasma and PBMC obtained throughout the period of primary infection, as well as virus derived from two molecular proviral clones, were highly cytopathic for normal-donor PBMC and immortalized T cells, despite the marked reduction in the titers of virus in plasma. CONCLUSIONS Primary, symptomatic HIV-1 infection is associated with high titers of cytopathic, replication-competent viral strains, and during such infection potential infectivity is enhanced. Effective control of HIV-1 replication during primary infection implies the activation of clinically important mechanisms of immune defense that merit further examination in relation to the development of antiviral therapy and vaccines.
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Affiliation(s)
- S J Clark
- Department of Medicine, University of Alabama, Birmingham 35294
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8
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Daar ES, Moudgil T, Meyer RD, Ho DD. Transient high levels of viremia in patients with primary human immunodeficiency virus type 1 infection. N Engl J Med 1991; 324:961-4. [PMID: 1823118 DOI: 10.1056/nejm199104043241405] [Citation(s) in RCA: 533] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The rapidly evolving clinical picture of primary infection with the human immunodeficiency virus type 1 (HIV-1) suggests that a better understanding of the kinetics of viral replication in vivo during the short period before seroconversion may provide insight into the pathogenesis of the acquired immunodeficiency syndrome (AIDS). METHODS AND RESULTS Titers of infectious HIV-1 were determined by end-point-dilution culture in sequential samples of plasma and peripheral-blood mononuclear cells from four patients with primary infection, with peak titers of 1000 to 10,000 tissue-culture-infective doses per milliliter of plasma and 100 to 10,000 infective doses per 10(6) peripheral-blood mononuclear cells. The high viral burden in mononuclear cells was confirmed by quantitative studies using a polymerase-chain-reaction method. In as little as 10 days, the high HIV-1 load in both plasma and cells decreased spontaneously and precipitously, at least 100-fold, in all four patients. CONCLUSIONS Although p24 core antigenemia and viral isolation have previously been described during primary HIV-1 infection, this report documents the large viral burden during the acute phase of infection. The rapid and spontaneous decline in the viral load suggests an effective immune response in the host that, if understood, may be used to combat AIDS.
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Affiliation(s)
- E S Daar
- Department of Medicine, Cedars-Sinai Medical Center, UCLA School of Medicine
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9
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Affiliation(s)
- K L Herman
- Department of Dermatology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19105
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10
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Hulsebosch HJ, Claessen FA, van Ginkel CJ, Kuiters GR, Goudsmit J, Lange JM. Human immunodeficiency virus exanthem. J Am Acad Dermatol 1990; 23:483-6. [PMID: 2120292 DOI: 10.1016/0190-9622(90)70245-d] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The human immunodeficiency virus (HIV) exanthem can be the primary manifestation of HIV infection. We report three cases of an exanthematous skin eruption associated with acute HIV infection. HIV antigen (p24 core antigen) was present, whereas results of the HIV antibody test were negative.
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Affiliation(s)
- H J Hulsebosch
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, The Netherlands
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11
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Paton P, Poly H, Gonnaud PM, Tardy JC, Fontana J, Kindbeiter K, Tête R, Madjar JJ. Acute meningoradiculitis concomitant with seroconversion to human immunodeficiency virus type 1. RESEARCH IN VIROLOGY 1990; 141:427-33. [PMID: 2080315 DOI: 10.1016/0923-2516(90)90043-i] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We report a case of acute regressive meningoradiculitis concomitant with HIV1 primoinfection. The clinical symptoms were mild and disappeared spontaneously. Electromyographic studies confirmed the regressive demyelinating-type process. The biological diagnosis of HIV1 infection was demonstrated by viral antigen detection, by the presence of the integrated proviral DNA after gene amplification by a polymerase chain reaction, and in particular, by the steady progression in the appearance of different HIV1-specific antibodies. This was shown using three different Western blot kits whose performances were compared.
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Affiliation(s)
- P Paton
- Hôpital de l'Hôtel-Dieu, Service de Médecine Interne, Lyon, France
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12
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Abstract
Human immunodeficiency virus (HIV) infection in children has emerged as a major, rapidly growing public health problem. The majority of children become infected by perinatal transmission of the virus from an infected mother. The disease is frequently associated with progressive neurologic dysfunction and with opportunistic infections. The cutaneous manifestations of pediatric HIV infection include a wide variety of fungal, bacterial, and viral infections of the skin. These diseases tend to be less responsive to conventional therapies than in the healthy child. In addition, severe seborrheic dermatitis, vasculitis, and drug eruptions are sometimes signs of HIV infection.
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Affiliation(s)
- N S Prose
- Department of Medicine (Dermatology), Duke University Medical Center, Durham, NC 27710
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13
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Balslev E, Thomsen HK, Weismann K. Histopathology of acute human immunodeficiency virus exanthema. J Clin Pathol 1990; 43:201-2. [PMID: 2332516 PMCID: PMC502329 DOI: 10.1136/jcp.43.3.201] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Acute exanthema occurs in patients who are human immunodeficiency virus (HIV) positive before they become seropositive. The patients have influenza like symptoms and a macular skin rash on the upper trunk. Histopathological investigation of skin punch biopsy specimens from four patients with acute HIV exanthema showed a normal epidermis and a sparse dermal, mainly perivascular, lymphocytic/histiocytic infiltrate around vessels of the superficial plexus. Histopathological changes of the exanthema of acute HIV infection are non-specific and resemble those of other acute viral exanthema, but when both the histopathological features and the clinical picture are suggestive, the clinician should take into consideration the possibility of HIV infection.
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Affiliation(s)
- E Balslev
- Bispebjerg Hospital, Copenhagen, Denmark
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Cumming PD, Wallace EL, Schorr JB, Dodd RY. Exposure of patients to human immunodeficiency virus through the transfusion of blood components that test antibody-negative. N Engl J Med 1989; 321:941-6. [PMID: 2779616 DOI: 10.1056/nejm198910053211405] [Citation(s) in RCA: 163] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The risk of transmission of the human immunodeficiency virus to recipients of blood transfusions exists chiefly during the period between the time a donor is infected and the time he or she has a positive blood test for HIV antibodies. Estimating the chance that blood will be donated during this period is an effective way to define the risk of HIV infection from transfusion. Using this approach, and employing data from over 17 million American Red Cross blood donations, we estimate that during 1987 the most likely number of units of blood infected with undetected HIV that were transfused was 131 (range, 67 to 227). For a patient, the odds of contracting HIV infection were 1:153,000 per unit transfused. A patient who received the average transfusion (5.4 units) had odds of 1:28,000. The risk has been decreasing by more than 30 percent a year. We estimate that donor-recruitment practices plus careful education and screening are eliminating 49 of every 50 donors likely to be HIV-positive and that testing is 92 to 97 percent effective, for a combined effectiveness of 99.9 percent. The risk of undetected infectious units can probably be further reduced by transfusing fewer units and units from fewer donors, recruiting more women and fewer men as new donors, and encouraging more frequent donations from donors who have been tested repeatedly.
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Affiliation(s)
- P D Cumming
- Blood Services, National Headquarters, American Red Cross, Washington, D.C
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15
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 33-1989. A 26-year-old woman with fever, diarrhea, leukopenia, thrombocytopenia, and hypoxemia. N Engl J Med 1989; 321:454-63. [PMID: 2761579 DOI: 10.1056/nejm198908173210707] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Lindhardt BO, Lauritzen E, Ulrich K, Kvinesdal B, Pedersen C, Gaub J, Wantzin GL, Scheibel E. Serological markers of primary HIV infection. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1989; 21:491-6. [PMID: 2587952 DOI: 10.3109/00365548909037876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
39 persons with an incidentally discovered seroconversion from HIV antibody negative (Ab-) to antibody positive (Ab+) state as measured by an enzyme-linked immunosorbent assay (ELISA) were investigated for the presence of (1) HIV antigen (Ag) and (2) immunoblotting test (IBT) Ab in serum samples collected within the year before seroconversion. 13 (33%) of the patients were HIV Ag+ at some time before seroconversion. However, the collection of samples was not done systematically and the samples from patients who had at least 1 sample collected within 3 months before seroconversion were thus compiled separately. This group consisted of 58 samples from 19 patients and among these none were HIV Ag+ earlier than 11 weeks before seroconversion, but the prevalence of HIV Ag+ samples was rising towards seroconversion and 10 patients (53%, 95% confidence limits: 29-76%) became HIV Ag+ in this 11-week period. Further, among all patients 13 (33%) were IBT Ab+ 4-50 days (median: 14 days) before seroconversion. Finally, among 18 patients with signs and symptoms consistent with an acute HIV infection 10 were HIV Ag+, as opposed to 4 HIV Ag+ patients among 21 without symptoms (p = 0.041).
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Affiliation(s)
- B O Lindhardt
- Laboratory of Tumor Virology, Fibiger Institute, Hvidovre Hospital, Copenhagen, Denmark
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18
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Affiliation(s)
- G Lisby
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
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19
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Penneys NS. AIDS in Black Patients. Dermatol Clin 1988. [DOI: 10.1016/s0733-8635(18)30655-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tindall B, Cooper DA, Donovan B, Penny R. Primary Human Immunodeficiency Virus Infection. Infect Dis Clin North Am 1988. [DOI: 10.1016/s0891-5520(20)30187-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Valle SL. Dermatologic findings related to human immunodeficiency virus infection in high-risk individuals. J Am Acad Dermatol 1987; 17:951-61. [PMID: 2963041 DOI: 10.1016/s0190-9622(87)70284-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A variety of dermatologic disorders have been associated with human immunodeficiency virus (HIV) infection. This prospective study reports the frequency of mucocutaneous findings in 237 individuals at high risk for HIV infection, 33 of whom were HIV seropositive, during a follow-up of 5 to 36 months; 12.1% of the study population, all of them HIV seronegative, were devoid of any pathologic changes of the skin or mucous membranes, whereas all HIV-seropositive individuals exhibited one or several pathologic conditions during the observation period. Oral candidiasis, seborrheic and infectious eczematoid dermatitis, and acquired ichthyosis were among the most frequently encountered dermatologic disorders among the HIV-seropositive individuals, and a worsening of the skin symptoms accompanied the clinical deterioration of the patients.
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Wantzin GR, Lindhardt BO, Weismann K, Ulrich K. Acute HTLV III infection associated with exanthema, diagnosed by seroconversion. Br J Dermatol 1986; 115:601-6. [PMID: 3466637 DOI: 10.1111/j.1365-2133.1986.tb05771.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We report three homosexual men who developed malaise, fever and a roseola-like exanthema which disappeared over 2 weeks. During 3 months follow-up, all three patients felt well and had no symptoms. HTLV III seroconversion was detected several weeks after the acute HTLV III infection. In two of the three cases the Western blot technique was able to detect HTLV III antibodies before they were detectable by the ELISA technique.
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Piette AM, Tusseau F, Vignon D, Chapman A, Parrot G, Leibowitch J, Montagnier L. Acute neuropathy coincident with seroconversion for anti-LAV/HTLV-III. Lancet 1986; 1:852. [PMID: 2870330 DOI: 10.1016/s0140-6736(86)90956-6] [Citation(s) in RCA: 105] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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