trimethoprim--sulfamethoxazole-drug-combination and AIDS-Dementia-Complex

A 31-year-old Malaysian man was presented with an episode of seizures by the roadside, after having been recently diagnosed as HIV positive accompanied with miliary tuberculosis. On physical examination, he was oriented to person, but not to time or place. There was no neck stiffness or papilloedema. The other systemic examination was unremarkable. Chest examination revealed crepitations at the upper zone of the right lung. After diagnosis suspicion, the case was confirmed as toxoplasma encephalitis by MRI and serological tests. Patient was treated with trimethoprim/sulfamethoxazole 480-2400 mg/day with folinic acid supplement for 60 days. Two months later, a repeat brain MRI showed resolution of the cerebral lesions.

Topics: Adult; AIDS Dementia Complex; Anti-Infective Agents; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Male; Toxoplasmosis, Cerebral; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculoma, Intracranial

Subacute central nervous system infection must be considered in any infant presenting with progressive encephalopathy. We present the case of an 18-month-old child with normal neuromotor development until the age of 14 months admitted for spastic hypertonia of the legs and arms associated with axial hypotonia. The mother reported that she recently had been found to be HIV-seropositive. HIV antibodies were negative during the first trimester of pregnancy. On the child's blood sample, the HIV test was positive associated with a major decrease in CD4 cell count. Viral load (ARN-PCR) was 720 copies par millilitre. On brain MRI, hypersignals were found in the white matter. HIV related encephalopathy caused by maternal fetal transmission was diagnosed. After 2 months of antiretroviral treatment (azidothymidine, lamivudine, and boosted lopinavir), the child's neurological condition improved. HIV infection must be suspected in all infants with progressive encephalopathy. The HIV test in pregnant women must be proposed at the beginning of pregnancy and repeated during the last trimester.

Topics: AIDS Dementia Complex; Anti-HIV Agents; Anti-Infective Agents; Drug Therapy, Combination; Female; Fluconazole; HIV Infections; HIV Protease Inhibitors; HIV Seropositivity; HIV-1; Humans; Infant; Infectious Disease Transmission, Vertical; Lamivudine; Lopinavir; Polymerase Chain Reaction; Pyrimidinones; Reverse Transcriptase Inhibitors; RNA, Viral; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Zidovudine

To evaluate efficacy and toxicity of intermittent trimethoprim-sulfamethoxazole (T/S) prophylaxis for Pneumocystis carinii pneumonia (PCP) our HIV-positive patients were given T/S (160 mg, 800 mg) twice daily for 3 consecutive days per week. Patients were included only if they met the CDC criteria for PCP prophylaxis, did not have intolerance to T/S, and if follow-up was 3 or more months. Thirty-eight patients received primary prophylaxis (Group I) for a mean period of 18.1 months and 26 patients received secondary prophylaxis (Group II) for a mean period of 15.5 months. Seventeen patients had adverse reactions (14 minor and 3 major reactions). PCP occurred in 1 patient in Group I after 20 months of T/S, and in 2 patients in Group II after 11 and 18 months of T/S. This pilot study suggests that intermittent T/S treatment is efficacious and relatively safe in the prophylaxis for PCP in HIV-positive patients.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS Dementia Complex; AIDS-Related Complex; Female; Humans; Male; Middle Aged; Pilot Projects; Pneumonia, Pneumocystis; Risk Factors; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

We report a four-year-old boy with HIV encephalopathy after vertical HIV infection. On the first admission to our hospital he showed ataxia, loose of expressive language and interstitial pneumonia. After treatment of the pneumonia the patient was started on oral zidovudine with 6 x 6 mg/kg bw/day, because of persisting neurologic symptoms and deep white matter lesions in the MR tomogram of the brain. Two months later he showed an improvement of the gait and the reappearance of the expressive language. Seven months after the start with zidovudine the MR tomogram of the brain revealed the disappearance of white matter lesions with exception of little areas of demyelinisation. No side effects of treatment were observed. The only persisting pathological clinical signs were developmental delay of about a half year and moderately hyperactive tendon reflexes of the lower extremities. Our case suggests that even oral treatment with zidovudine can have a beneficial effect on the HIV encephalopathy in infants.

Topics: Administration, Oral; AIDS Dementia Complex; Brain; Child, Preschool; Electroencephalography; HIV Antibodies; Humans; Magnetic Resonance Imaging; Male; Neurologic Examination; Pulmonary Fibrosis; Trimethoprim, Sulfamethoxazole Drug Combination; Zidovudine