Search

We present a case of a 39-year-old woman from Thailand. She presented with dizziness and signs of raised intracranial pressure. Magnetic resonance scanning revealed multiple cysticercs in cerebrum and cerebellum, and one of the cysticercs compressed the cerebral aqueduct resulting in hydrocephalus. The patient was transferred to an infectious disease department, where appropriate treatment with albendazol was initiated. Surprisingly she was found HIV-positive with a CD4 count of approx. 10 m/l. The patient deteriorated over the following week and died due to raised intracranial pressure.

We present a case in which a patient infected with human immunodeficiency virus (HIV) developed a sensorineural hearing loss and tinnitus due to inner-ear syphilis affection. The patient had normal otomicroscopy, tympanometry, ear, nose & throat examination, caloric test and intracranial magnetic resonance imagining. Relevant serological blood samples and lumbal puncture indicated syphilis in its secondary stage or the early latent phase. Audiometry demonstrated a considerable improvement and tinnitus decreased after ten days of treatment with antibiotics and prednisone.

Kaposi's sarcoma of the breast is rare but has been reported to imitate breast lumps or gynaecomastia, usually accompanied by Kaposi's sarcoma of the skin. We report a case of a patient presenting with mastitis of the breast as the first symptom of Kaposi's sarcoma and AIDS. Although uncommon, the diagnosis should be considered in patients with mastitis without other obvious causes.

Introduction: Counselling and partner notification play significant roles in the prevention of HIV. In Denmark, there is no overall strategy or monitoring concerning partner notification and the results of partner notification are unknown. The primary purposes of the study were to describe the present organisation and conditions concerning partner notification in Denmark., Materials and Methods: Information about organizational factors was collected through a questionnaire and supplementary interviews. The study population was all consecutive, newly-diagnosed HIV positive persons in the period from 1 May 2005 to 1 June 2006. During this period 254 were diagnosed with HIV., Results: The study showed significant differences in the organisation of partner notification. A total of 123 index cases were offered partner notification. The stated number of partners per index case was 2.4, and 1.4 partners were traced per index case and 0.28 new HIV positives were found per index case., Conclusion: Partner notification was offered to approximately half of the newly-diagnosed HIV positives. Partner notification is carried out very differently in Danish hospitals. Every fourth traced partner was HIV positive without knowing it. A more intensive and uniform effort with regard to partner notification is necessary.

The study describes the use of postexposure antiretroviral prophylaxis (PEP) after occupational exposure to HIV in Denmark in the period 1/1 1997-31/12 1998. Forty-seven accidentally exposed persons received PEP in this period, of whom 14 were nurses, 13 physicians and 11 were not employed in the health care system. In 23 cases side effects to PEP were described. In 18 cases the index person was i.v. drug abuser and in 11 cases homosexual/bisexual men. In 18 cases the HIV status of the index person was unknown at the time of exposure. Ten of these index persons were subsequently tested and all found HIV-negative. It is concluded, that the frequency of occupational exposure to HIV is unacceptably high. Further it is emphasised that in cases where the HIV status of the index person is unknown, PEP should only be instituted if the index person is at risk of being HIV infected and has signs of HIV infection.

We describe the changes in the period of knowledge of HIV positivity before AIDS in the light of the new anti-retroviral treatment regime among all notified Danish AIDS patients 1988-1997. Overall, 29% of the patients were diagnosed with AIDS less than four months after the first positive HIV test, a proportion that decreased through 1988-1995, but then increased. However, the proportion with over five years between positive HIV test and AIDS diagnosis increased from 9% in 1988-1990 to 48% in 1994-1995. A similar trend was seen among men, who have sex with men (MSM). Relatively more heterosexually infected than MSM had less than four months between first positive HIV test and AIDS (44% vs. 25%, p < 0.00001). Among persons known as HIV infected less than four months before AIDS, 51% were notified with Pneumocystis carinii pneumonia, a proportion that was 25% (p < 0.00001) among those known over five years before AIDS. We conclude, that the proportion of Danish AIDS patients known as HIV-infected for less than four months before AIDS recently has increased after several years of decrease, probably due to anti-retroviral treatment.

More children will be born infected with HIV in the years to come. Children with early symptoms will come into quick contact with a hospital, while others may be infected for up to ten years without presenting HIV-related symptoms. HIV infection can be diagnosed early with a combination of methods that are currently available (viral culture, ELISA antigen testing), and also with methods that are at present only used in research (DNA and RNA detection with PCR). Together with the clinical picture, it should be possible to have a reliable diagnosis no later than six months after birth. The general development of the children can be followed at frequent out-patient visits, while prophylactic measures can quickly be put into motion when necessary. The course of the illness can be followed and predicted with the help of different laboratory investigations. The medical treatment of HIV positive children follows the pattern of adult HIV positive patients. Children with an increased risk of bacterial infections can receive intravenous immune globulin as prophylaxis. HIV infected children can be given the common vaccinations, but BCG and oral anti-polio vaccine should not be given to children with symptomatic HIV infection. Prophylaxis of vertical transmission of HIV should be aimed at HIV testing of all pregnant women, to prevent this route of transmission. As long as there is no efficient treatment of HIV infection, termination of pregnancy must be recommended early after conception to all HIV positive women. Children born of HIV positive mothers should not be breast-fed.

Four cases with an apoplectic debut of AIDS are reported. Two of the patients had not earlier been identified as being HIV-positive. In three patients, the underlying cause was probably cerebral toxoplasmosis. It is important to consider AIDS in the differential diagnosis of stroke, particularly in young adults.

Three cases of cerebral toxoplasmosis as the presenting manifestation of AIDS are reported. The initial diagnoses were brain tumors because of the cerebral mass lesions which resembled glioblastoma. In the light of the increasing occurrence of AIDS, attention is drawn to cerebral toxoplasmosis as a differential diagnosis from glioblastoma multiforme.

By 31.12.1990, a total of 726 patients with AIDS were diagnosed and notified including 679 men (94%) and 47 women (6%). The first diagnosis was made in 1980. Since then, an annual increase in the number of notified AIDS patients has been observed although the increase has declined from 1989 to 1990. During the years, homo/bisexual men have constituted a decreasing proportion of the annual number of notified AIDS patients (p less than 0.001): from 87% in 1980-1986 to 72% in 1989-1990. The proportion of heterosexually infected patients and intravenous drug users increased during the period of study from 3% and 0.7%, respectively, during the period 1980-1986 to 11% and 7%, respectively, during the period 1989-1990. The number of women with AIDS also increased during the period and constituted 9% of notified patients in 1990. The figures are, however, limited. AIDS patients have been notified from all counties but 72% of the patients live in the Copenhagen region. During the period 1987-1990, approximately 2/3 of the notified AIDS patients had been recognized as HIV-positive for more than one year before the diagnosis of AIDS was established. A stable proportion of approximately 1/4 were HIV tested for the first time and found positive around the time the diagnosis of AIDS was established.(ABSTRACT TRUNCATED AT 250 WORDS)

Different methods have been developed for the diagnosis of HIV infection, i.e. detection of antibodies, antigen and proviral DNA. ELISA methods for detecting HIV-1 antibodies are widely used as screening assays. A sample which is repeatedly positive with ELISA is re-tested with a confirmatory test, e.g. western blot. Antibodies to HIV-1 are not detectable until 2-3 months after infection, but antigens may be detectable during the last weeks of this initial period, though they disappear with the appearance of the antibodies. In the later stages of HIV infection, HIV antigen is again detectable in a proportion of patients. Detection and quantitation of HIV antigen are used as indicators of disease progression and for monitoring the antiviral efficacy of therapeutic interventions. When no antibodies or antigens can be detected in persons suspected of having HIV infection, culture of HIV can be performed. For research purposes, detection of small amounts of proviral DNA can be made with polymerase chain reaction (PCR). The method is not yet applicable in routine diagnosis of HIV infection.

This study evaluated three rapid test kits for HIV antibody detection. Thirty consecutive blood specimens from the infectious diseases outpatient clinic were examined by three house officers who tested each specimen twice in a blind and randomized experiment. HIV-Chek (Du Pont) and HIV-1/HIV-2 TestPack (Abbott) were easy to handle and gave good intra- and interobserver agreement and good agreement with routine ELISA. Recombigen (BioScience) was difficult to interpret and gave poorer intra- and inter-observer variation. We suggest that HIV-Chek and TestPack can be used for assessment of patients' HIV antibody status in emergency circumstances with only minimal instruction of the staff.

Three cases of visceral leishmaniasis (kala-azar) are presented. One of these was in a 43-year-old patient with AIDS who was infected in Southern Spain. Another was in a man aged 25 years infected in West Africa. These cases are the first two adults to be reported in Denmark. The third case was an 18 month old previously healthy boy, infected in Southern Spain. The symptomtology, diagnosis and treatment of the disease are discussed and it is stressed that serological diagnostic tests have limited value in HIV positive patients.

During the period April 17-July 14, 1989, 820 pregnant women were offered HIV-antibody testing at the antenatal clinic, Aarhus Municipality Hospital. Seven hundred and seventy-nine (95%) agreed to complete a questionnaire concerning, among other things, previous HIV-antibody testing. 20% of the participants had been tested previously, half of them because they were blood donors. More than 3% had been tested because of self-perceived risk behaviour or a risk environment. In three women, the previous test had shown HIV-antibodies to be present, and three further women refused to report the test result. 81% of the women consented to be tested. Acceptance declined during the project period. Those who had not been tested previously consented more frequently than those who had. Students were less willing to consent than others. Nineteen out of 20 women (2.6%), who considered themselves at high risk, accepted the offer to be tested. Thirty-eight (5%) of the 150 women who declined to be tested, would have accepted if their general practitioner had suggested it. None of the women tested at present were found to be HIV-antibody positive. When the project was terminated, a total of 87% of the women had been HIV-antibody tested previously or at present. We suggest routine HIV surveillance of pregnant women by use of voluntary HIV-antibody testing in combination with anonymous testing (AUT technique) in case the women does not want to know the test result.

Two cases of fatal Pneumocystis carinii pneumonia in middle aged homosexual men, not previously suspected of HIV-infection are presented. Neither had consciously considered himself at risk of contracting AIDS which emphasizes the need for differentiated information campaigns as well as vigilance on the part of the medical profession outside specialized centers.

The surgical team is at risk of transmission of human immunodefiency virus (HIV) from the patient, which could progress to AIDS and death. In our hospital, we have estimated a probability of 0.20% per year, and 5.82% for 30 years in surgery. In view of this we have designed new procedures for surgical handicraft to reduce the risk from splash or injury to the surgical team. The surgeon must handle tissue with instruments only and minimize the use of fingers. Sharp instruments should, if possible be replaced by blunt types. The nurse loads needles to the needle carrier using a forceps. Sharp instruments are placed in a neutral zone on the nurse's stand so that the surgeon and nurse never touch the same sharp instrument at the same time. Movements must be controlled and accompanied by eye contact. The measures to prevent injury would hardly affect the individual skill of the surgeon or prolong operation time. We consider that the new routines suggested prevent transmission of HIV during surgical procedures better than by knowing the HIV status, of the patients.