HIV encephalopathy

Cytomegalovirus retinitis (with loss of vision) Encephalopathy, HIV-related Herpes simplex chronic ulcer(s) (duration >1 month) or bronchitis, pneumonitis, or esophagitis Histoplasmosis, disseminated or extrapulmonary Isosporiasis, chronic intestinal (duration >1 month) Kaposi s sarcoma... 

The major 1987 changes were to include patients with laboratory evidence of HIV infection and also have HIV encephalopathy, HIV wasting syndrome, and one of the range of AIDS-indicating diseases (cancers and opportunistic infections), provided immunodeficiency for other causes is excluded. 

Xu Y, Kulkosky J, Acheampong E, Nunnari G, Sullivan J, Pomerantz RJ (2004) HIV-l-mediated apoptosis of neuronal cells proximal molecular mechanisms of HIV-l-induced encephalopathy. Proc Natl Acad Sci U S A 101 7070-7075... 

Western blot A method to detect protein in a given sample of tissue homogenate or extract. It uses gel electrophoresis to separate denatured proteins by mass. Some diagnostic applications for the Western blot include Lyme disease, bovine spongiform encephalopathy, and human immunodeficiency virus (HIV) (it is considered the gold standard for HIV diagnostic testing). 

Thiamine deficiency results in early decreases in activity of the mitochondrial enzyme a-ketoglutarate dehydrogenase in brain. Wernicke s encephalopathy, also known as the Wernicke-Korsakoff syndrome is a neuropsychiatric disorder characterized by ophthalmoplegia, ataxia and memory loss. Wernicke s encephalopathy is encountered in chronic alcoholism, in patients with HIV-AIDS and in other disorders associated with grossly impaired nutritional status. The condition results from thiamine deficiency. 

Xu, Y. et al., HIV-1-mediated apoptosis of neuronal cells Proximal molecular mechanisms of HIV-1-induced encephalopathy, Proc. Natl. Acad. Sci. U SA, 101, 7070, 2004. 

Infectious Dementias. One hundred years ago, the most common cause of dementia was an infection syphilis. Today, syphilis is well treated and seldom left to linger long enough to infect the brain and cause dementia, but a blood test for syphilis remains a routine part of the assessment for patients newly diagnosed with dementia. Today, the most common infectious cause of dementia is HIV/AIDS. Other, rare forms of infection-caused dementia include Creutzfeld-Jakob disease (spongiform encephalopathy) and subacute sclerosing panencephalitis (SSPE), the latter caused by the measles virus in unvaccinated children. 

Albumin (human) Epoetin alfa contains albumin, a derivative of human blood. Based on effective donor screening and product manufacturing processes, it carries an extremely remote risk for transmission of viral diseases. No cases of transmission of viral diseases or Creutzfeldt-Jakob disease have ever been identified for albumin. Anemia Not intended for CRF patients who require correction of severe anemia epoetin alfa may obviate the need for maintenance transfusions but is not a substitute for emergency transfusion. Not indicated for treatment of anemia in HIV-infected patients or cancer patients due to other factors such as iron or folate deficiencies, hemolysis, or Gl bleeding, which should be managed appropriately. Hypertension Up to 80% of patients with CRF have a history of hypertension. Do not treat patients with uncontrolled hypertension monitor blood pressure adequately before initiation of therapy. Hypertensive encephalopathy and seizures have occurred in patients with CRF treated with epoetin. 

Cesena, M., Lee, D.O., Cebollero, A.M., and Steingard, R.J. (1995) Case study behavioral symptoms of pediatric HIV-1 encephalopathy successfully treated with clonidine./ Am Acad Child Adolesc Psychiatry 34 302-306. 

According to the CDC, the diagnosis of AIDS constitutes certain opportunistic infections, neoplasms, encephalopathy or wasting syndrome in the presence of HIV infection. In 1993, the CDC expanded the criteria to also include CD4+ T-cell count below 200 cells/p,l in the presence of HIV infection. The most common opportunistic infections includepneumocystis carinii pneumonia, pneumonitis, toxoplasmosis, mycobacterial disease, recurrent herpes simplex virus infection and/or cytomegalovirus infection. Kaposi s sarcoma is the most common form of cancer. HIV-related nervous system diseases include acute septic meningitis, AIDS dementia complex, subacute encephalitis, HIV encephalopathy and CNS opportunistic infections and neoplasm. 

Note AIDS is caused by HIV, which impairs both cellular and humoral immune functions, and this results in increased susceptibility to opportunistic infection and certain malignancies. The medical aspects of HIV infection include AIDS-related complex (weight loss, chronic diarrhea, fever, thrush, herpes zoster, fatigue), opportunistic infections and cancer, end-stage renal disease, blindness (cytomegalovirus), HIV encephalopathy, and dementia. The psychological aspects of HIV infection include major depression, regression, and suicidal impulses, delirium, substance abuse, antisocial personality, and bereavement. 

Ketamine also shares a close chemical kinship to prescription drugs Tiletamine and Memantine. Tileta-mine is used in combination with zolazepam as a veterinary anesthetic under the brand names Zoletic and Tela-zol. Memantine is derived from the anti-influenza drug amantadine, and also works to block NDMA receptors. Memantine has been approved for use in Parkinson s disease and dementia in the elderly. It is also being used experimentally with AIDS patients for the treatment of HIV encephalopathy. 

Filippi CG, Sze G, Farber SJ, Shahmanesh M, Selwyn PA (1998) Regression of HIV encephalopathy and basal ganglia signal intensity abnormality at MR imaging in padents widi AIDS after die initiation of protease inhibitor dierapy. Radiology 206 491 98. 

Neuenburg JK, Brodt HR, Hemdier BG, Bickel M, Bacchetti P, Price RW, Grant RM, Schlote W (2002) HIV-related neuropathology, 1985 to 1999 Rising prevalence of HIV encephalopathy in the era of highly active antiretroviral therapy. I Acquir Immune Defic Syndr 31 171-177. 

Sanchez-Ramon S, Bellon JM, Resino S, Canto-Nogues C, Gurbindo D, Ramos JT, Munoz-Femandez MA (2003) Low blood CD8 + T-lymphocytes and high circulating monocytes are predictors of HIV-1-associated progressive encephalopathy in children. Pediatrics 111 E168-175. 

Delayed central nervous system virus suppression during highly active antiretroviral therapy is associated with HIV encephalopathy, but not with viral drug resistance or poor central nervous system drug penetration. AIDS 17 1897-1906. 

Anderson E, Zink W, Xiong H, Gendeknan HE (2002) HIV-1-associated dementia A metabolic encephalopathy perpetrated by... 

Liver biopsies performed in patients with chronic HBV infection are classified as chronic persistent hepatitis, chronic active hepatitis, and cirrhosis. Histologic results do not correlate with symptoms and often patients are asymptomatic until the development of cirrhosis. " Cirrhosis is manifested by interlacing strands of fibrous tissue with nodules of regenerating cells resulting in a characteristic small and knobby-appearing liver. This form of injury is irreversible and can be exacerbated by heavy alcohol consumption and concomitant infection with HCV or HIV. Hepatic decompensation as a result of cirrhosis includes ascites, jaundice, variceal bleeding, and hepatic encephalopathy. The 5-year risk of decompensation after the development of cirrhosis is estimated to be 20%. ... 

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