Carlos Alberto Morais-de-Sá

Macrocytosis in Patients on Stavudine

We retrospectively reviewed the effects on the erythrocyte mean corpuscular volume (MCV) of the use of stavudine-including antiretroviral regimens in both zidovudine-naive and zidovudine-experienced HIV-infected patients. Macrocytosis was commonly observed among patients on stavudine-based regimens although the MCV usually stabilized at a lower level than that observed with zidovudine.We retrospectively reviewed the effects on the erythrocyte mean corpuscular volume (MCV) of the use of stavudine - including antiretroviral regimens in both zidovudine-naive and zidovudine-experienced HIV-infected patients. Macrocytosis was commonly observed among patients on stavudine-based regimens although the MCV usually stabilized at a lower level than that observed with zidovudine.

Paradoxical reaction to the treatment of tuberculosis uncovering previously silent meningeal disease

The development of paradoxical clinical worsening following initiation of tuberculosis treatment may complicate the clinical course of both HIV-infected and uninfected patients. We report a severe manifestation of the so called paradoxical reaction to the treatment of tuberculosis that unmasked previously silent meningeal disease in a 34-year-old HIV-infected male patient.

Mycobacterial spindle cell pseudotumor of the appendix vermiformis in a patient with AIDS

Mycobacterial pseudotumor (MP) is a rare pathologic presentation of both Mycobacterium tuberculosis and non-tuberculous mycobacterial disease, hitherto reported to occur only in immunosuppressed patients with or without human immunodeficiency virus infection. This lesion shares close pathologic resemblance to certain mesenchymal neoplasms, particularly Kaposis sarcoma (KS), from which it must be properly differentiated due to distinct prognosis and therapy. We report a case of MP obliterating the lumen of the appendix vermiformis in a 34-year-old patient who died of complications of AIDS at our hospital in Rio de Janeiro. A total of 24 cases of MP (including our patient) have been described in the literature. MP has been found especially in lymph nodes, but extranodal lesions have been described in the skin, spleen, lung, bone marrow, brain and, in our patient, the appendix vermiformis. We offer a review of the other 23 published case reports of MP in both HIV-infected and uninfected patients and discuss the pathologic features that differentiate MP from KS.

Highly aggressive squamous cell carcinoma in an HIV-infected patient

Unusually aggressive forms of cutaneous squamous cell carcinoma are being increasingly recognized as a complication of HIV infection. We report the case of a 59-year-old male patient with advanced HIV infection who presented with a highly aggressive SCC lesion over the scalp area with destruction of the underlying parietal bone and fulminant clinical progression.

Normal plasma antithrombin activity in patients with relapsing-remitting and secondary progressive multiple sclerosis.

OBJECTIVE Multiple sclerosis (MS) is an inflammatory disease characterized by multifocal areas of central nervous system (CNS) demyelination. Activation of coagulation factors and fibrin deposition are observed around CNS blood vessels in experimental autoimmune encephalomyelitis, an animal model of MS. Antithrombin (AT) is a potent anticoagulant with remarkable anti-inflammatory properties, and its inhibitory effects on coagulation and inflammation may play a role in the pathogenesis and clinical course of MS. We studied the association between plasma AT activity and clinical forms of MS. PATIENTS AND METHODS A total of 69 patients, 37 with relapsing-remitting and 32 with secondary progressive MS, were included in the study. A control group (CG) of 34 normal subjects was also studied. Plasma AT activity (Stachrom ATIII) was quantified using a chromogenic activity assay with normal reference values ranging from 70% to 120% of AT activity. RESULTS We found no difference between plasma AT levels in patients and those in CG. We also found no association of AT levels with activity of disease, duration of disease progression, level of neurological disability, and treatment. CONCLUSION We found no association between plasma AT activity and RRMS or SPMS. It remains to be studied whether exists or not an association between abnormal plasma AT activity and other MS forms.

Changes in hepatitis A virus seroepidemiology in HIV-infected Brazilian patients

Shifting of hepatitis A virus (HAV) epidemiology from a high towards an intermediate endemicity pattern and use of antiretroviral therapy increased the risk of HIV/HAV coinfection in developing countries. The aim of this study was to investigate the presence of HAV markers in a cohort of HIV-infected patients from 1988 to 2004. The presence of serum anti-HAV antibodies and HAV-RNA by real-time polymerase chain reaction was investigated in 581 patients. Total anti-HAV antibodies was found in 464/581 (79.8%) patients, however, achanging epidemiologic pattern of hepatitis A among HIV-infected patients from 1988 to 2004 was observed. Among patients susceptible to HAV (n = 117), 5 (4.2%) were co-infected with HAV, all of them had IgM anti-HAV antibodies and were serum HAV-RNA-positive. The high prevalence of anti-HAV antibodies in HIV-infected patients suggests that screening tests for anti-HAV antibodies should be performed before implementation of hepatitis A vaccination, especially in those patients from endemic countries.

Acute gouty arthritis as a manifestation of immune reconstitution inflammatory syndrome after initiation of antiretroviral therapy

Immune reconstitution inflammatory syndrome (IRIS) in HIV-infected subjects initiating antiretroviral therapy most commonly involves new or worsening manifestations of previously subclinical or overt infectious diseases. Reports of non-infectious IRIS are much less common but represent important diagnostic and treatment challenges. We report on a 34-year-old HIV-infected male patient with no history of gout who developed acute gouty arthritis in a single joint one month after initiating highly active antiretroviral therapy.

Recurrent oedema associated with the co-formulation of lopinavir and ritonavir

1. Serviço de Alergia e Imunologia Clínica do Hospital Universitário Gaffrée e Guinle da Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ. Address to: Prof. Jorge Francisco C. Pinto. Hospital Universitário Gaffrée e Guinle/10 enfermaria/UNIRIO. Rua Mariz e Barros 775, 20270-004 Rio de Janeiro, RJ. e-mail: pintojf@uol.com.br Recebido para publicação em 26/3/2004 Aceito em 31/5/2004 To the Editor:

Estudo dos transtornos cognitivos decorrentes da infecção pelo HIV-1

Abstract In its early stages, HIV-1 infection involves the Central Nervous System causing neuropsychological manifestations. With the ai m of studyingthe cognitive functions in HIV-1-infected patients, a total of 20 patients infected with HIV-1 with CD4 + lymphocyte count >200 cells/mm 3 were studied in accordance with the Wechsler Adult Intelligence Scale (WAIS-III). The present study comprised 20 patients, 5 (2 5%) male and15 (75%) female, with a mean age of 39.65 and standard deviation of 10.15 years. The mean CD4 + lymphocyte count was 467.20 with astandard deviation of 215.45 cells/mm 3 . Amongst the 14 patients who received highly active anti-retroviral therapy (HAART), we noted 1case in which the performance of the cognitive functions, attention span and learning, was considered to be very low according to WAIS-III,and the remaining (n=13) patients who were treated with HAART demonstrated a perfo rmance that was not considered to be outsideof the WAIS-III mean. By using WAIS-III testing, it was possible to detect performance of the cognitive functions considered to be verylow in HIV-1 infected individuals, even with those receiving HAART.Uniterms