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The incidence of HD appears to have increased in HIV-infected individuals, with HIV-seropositive intravenous drug users most likely to develop the disorder. All groups at risk for HIV, however, may develop HD. The pathologic spectrum of HD in the setting of HIV infection is distinct from that seen in "de novo" HD in the United States, with the majority of patients diagnosed with the mixed cellularity subtype, as opposed to the more usual occurrence of nodular sclerosis in "de novo" disease. The presence of fibrohistiocytic stromal cells within involved tissues is also a distinct characteristic of HIV-associated HD. Epstein-Barr viral genome has been detected within tumor cell nuclei, and it may be involved in the pathogenesis of disease. Clinically, patients often present with systemic "B" symptoms and widely disseminated extranodal disease, seen in 75% to 90%. Bone marrow is involved in 40% to 50% of cases at diagnosis. Complete remission may be achieved in approximately 50% of patients after use of combination chemotherapy, but median survival is short, in the range of 12 to 18 months. Death is often due to bacterial or opportunistic infection (or both), often occurring in the setting of chemotherapy-induced neutropenia.

Compromised oral health holds significant implications for the general health of medically vulnerable, HIV infected individuals. Past studies have reported that these individuals frequently suffer from oral opportunistic infections and have a tendency to develop severe periodontal disease. This study extends past research by examining the prevalence of oral infections according to patient characteristics and by reporting, for the first time, the level of perceived dental need in a large, multi-site sample of individuals with symptomatic HIV disease. Data for this study come from a survey of 857 clients of the Robert Wood Johnson Foundation's AIDS Health Services Program in 9 U.S. cities. More respondents (52%) reported a need for dental care than for any other service need. Multivariate analysis showed that clients who were white, in low-income groups, used intravenous drugs, or had a past history of oral opportunistic infections were more likely to report dental need. Relations between age, gender, insurance status, or disease status and perceived need were statistically nonsignificant. Forty-seven percent of the clients reported they had an oral opportunistic infection, the second outcome variable examined in this study. Statistically significant differences (P less than 0.05) were found in the prevalence of oral opportunistic infections among race and disease severity groups. Whites and the more severely ill were more likely to report an infection than their respective counterparts.

The objective of this study was to determine whether there are measurable differences in neuropsychometric performances between HIV-positive asymptomatic subjects and high-risk HIV-negative individuals. We carried out concurrent neuropsychological testing of HIV-positive subjects screened for drug treatment protocols at a clinical research center and HIV-negative subjects seeking confidential testing. Fifty HIV-negative and 33 HIV-positive subjects who did not admit to use of central nervous system (CNS)-active drugs, more than one drink of alcohol per day, or drug use comprised the final group for analysis. A neuropsychological test battery designed to evaluate verbal memory, motor function, orientation and attention was administered to all subjects. In addition, affective state was assessed with the Beck depression inventory. Multivariate analysis of variance indicated no difference in the performance of the two groups. Only one subtest, the Wechsler Adult Intelligence Scale digit span (forward) reached a level of significant difference (P less than 0.05) by univariate analysis. We conclude that neuropsychometric performance of asymptomatic HIV-positive subjects cannot be distinguished from that of high-risk HIV-negative subjects by a battery of traditional neuropsychological tests.

A longitudinal study of serum IgG and IgA antibody titers to Epstein-Barr virus (EBV) viral capsid antigen (VCA) was carried out in 218 homosexual men at various stages of human immunodeficiency virus (HIV) infection. The serum samples tested were obtained from the following groups: 24 HIV seroconverters, 41 persistently HIV-seropositive asymptomatic individuals, 22 seropositives who developed AIDS-related complex (ARC), 29 HIV seropositives who developed lymphadenopathy syndrome (LAS), 35 HIV seronegatives with LAS, 36 asymptomatic HIV seronegatives, and 31 AIDS patients. Blind-tested samples were titrated for IgG and IgA EBV-VCA antibodies by immunoperoxidase assay (IPA). Cross-sectional analysis indicated that all HIV-seropositive subjects exhibited significantly elevated EBV IgG and IgA antibody titers compared with HIV-seronegative subjects. The proportions with EBV-VCA IgA antibodies at a titer of greater than or equal to 128 rose during the course of HIV infection and progression of the disease: 8% in HIV seronegatives, 11% in HIV seronegatives with LAS, 25% in HIV seronegatives prior to HIV seroconversion, 44% in asymptomatic HIV seropositives, 34% in LAS, 50% in ARC, and 58% in AIDS patients. An increase in EBV-VCA IgG and IgA titers was detected following HIV seroconversion and in samples obtained 6 months before disease progression to LAS. These data suggest the possible involvement of EBV in the natural history of HIV infection and disease progression. The possibility that EBV-VCA IgA antibody levels would be of value in prediction of progression of HIV-related illness is discussed.

Acute respiratory failure has a high mortality in patients with acquired immunodeficiency syndrome (AIDS). This study was undertaken to determine the etiology of acute respiratory failure and the outcome of children with AIDS and AIDS-related complex. Records of 31 children with AIDS or AIDS-related complex admitted to the pediatric intensive care unit for acute respiratory failure throughout a 46-month period were reviewed. Acute respiratory failure was due to Pneumocystis carinii pneumonia in 13, cytomegalovirus pneumonia in six, bacterial pneumonia in five, severe bacterial sepsis in four, Candida pneumonia in two, and a giant cell pneumonia in one patient. In addition, 11/19 patients with acute respiratory failure due to P carinii pneumonia or cytomegalovirus had superinfections with bacteria or Candida. Of the total of 19 primary and secondary bacterial infections, Pseudomonas aeruginosa was responsible in ten and Klebsiella pneumoniae in three children. Five children (16%) survived until pediatric intensive care unit discharge; three died within 6 months. The causes of acute respiratory failure were not significantly different in survivor and nonsurvivor groups. It is concluded that, in addition to P carinii pneumonia and cytomegalovirus pneumonia, bacterial infections (especially due to Pseudomonas and other Gram-negative organisms) are important causes of respiratory failure. The high mortality and grim ultimate prognosis seen may have implications for pediatricians attempting to identify the proper limits of medical intervention for this group of patients.