An overview of HIV infection and AIDS: etiology, pathogenesis, diagnosis, epidemiology, and occupational exposure

Early Right Ventricular Dysfunction in Highly Selected (Totally Free from Cardiovascular Risk Factors and Other Comorbidities) Human Immunodeficiency Virus Patients: A Pilot Study with Advanced Echocardiography

Objective:

Human immunodeficiency virus (HIV) infection may also be associated with cardiac dysfunction, thus negatively affecting patients’ morbidity and mortality. This preliminary study aimed at evaluating whether bi-and three-dimensional (3D) strain echocardiographic facilities were able to identify alterations in the right ventricular (RV) function in highly selected – because free from cardiovascular risk factors and other comorbidities – HIV patients.

Materials and Methods:

Eight of these specific HIV patients (age: 32.0 ± 3.6 years; 7 months) treated with highly active antiretroviral therapy (HAART) were enrolled and compared with 8 sex-, age-, and cardiovascular risk profile-matched healthy individuals. All underwent clinical evaluation and transthoracic echocardiography coupled with tissue Doppler, two-dimensional (2D), and 3D speckle tracking imaging to examine their RV function.

Results:

All standard echocardiographic parameters resulted in the normal range, with no significant differences between HIV and controls. On the contrary, 2D longitudinal strain (16.1% ±1.6% vs. 17.8% ±0.9%, P = 0.02) and Global 3D strain (28.5% ±3.6% vs. 33.5% ±1.9%, P = 0.0002) were reduced in the HIV group. Moreover, Global 3D strain values showed a direct correlation with RV fractional area change values (r = 0.66, P = 0.005).

Conclusions:

2D longitudinal and 3D Global strain can identify an early asymptomatic RV impairment in HIV patients free from other risk factors and comorbidities. These findings seem to imply that also in treated with HAART and well-controlled HIV patients an early asymptomatic systolic RV dysfunction is present, as a distinctive and separated pathological entity compared with classic HIV-related pulmonary arterial hypertension and left ventricular dysfunction. In these patients, RV dysfunction is not revealed by standard echocardiography.

Implementing AORN recommended practices for sharps safety

Prevention of percutaneous sharps injuries in perioperative settings remains a challenge. Occupational transmission of bloodborne pathogens, not only from patients to health care providers but also from health care providers to patients, is a significant concern. Legislation and position statements geared toward ensuring the safety of patients and health care workers have not resulted in significantly reduced sharps injuries in perioperative settings. Awareness and understanding of the types of percutaneous injuries that occur in perioperative settings is fundamental to developing an effective sharps injury prevention program. The AORN "Recommended practices for sharps safety" clearly delineates evidence-based recommendations for sharps injury prevention. Perioperative RNs can lead efforts to change practice for the safety of patients and perioperative team members by promoting the elimination of sharps hazards; the use of engineering, work practice, and administrative controls; and the proper use of personal protective equipment, including double gloving.

Radical prostatectomy in patients infected with human immunodeficiency virus

OBJECTIVE

To present the complications and early outcomes in a small series of men infected with human immunodeficiency virus (HIV) and treated with radical prostatectomy (RP) for prostate cancer, and to review reports on surgery in HIV-positive patients.

PATIENTS AND METHODS

During 2002-2005, seven men infected with HIV underwent RP at our institution. For the five patients whose HIV status was known before surgery, we retrospectively examined preoperative variables, including HIV-specific data (clinical category, CD4+ lymphocyte count, viral load, duration of HIV diagnosis, and opportunistic infections), and the complications and early outcomes after RP.

RESULTS

Before RP all the patients were in the Center for Disease Control clinical category A (asymptomatic HIV infection). The CD4+ counts before RP ranged from 269-870 cells/microL and viral loads ranged from <50-18 700 copies/mL. Three patients were on highly active anti-retroviral therapy (HAART) at the time of surgery. After RP, two patients had incisional wound infections, including one requiring re-hospitalization for intravenous antibiotics. During the follow-up (median 26 months) none of the patients progressed to acquired immunodeficiency syndrome or developed biochemical recurrence of prostate cancer. One healthcare worker was exposed to contaminated urine and placed on prophylactic therapy, but has not sero-converted.

CONCLUSIONS

The risk of peri-operative complications in HIV-positive patients can be minimized by carefully selecting the patient and procedure, and by measuring routine and HIV-specific preoperative variables. The two infectious complications in this series were in patients with less favourable preoperative factors, i.e. the lowest CD4+ count and the highest viral load. Further experience is needed to determine whether the risk of surgical infections is higher in this cohort. However, our results are consistent with reports from other surgical specialities that surgery in asymptomatic HIV-positive patients is safe and effective.

Cardiac surgery in patients infected with the human immunodeficiency virus

BACKGROUND

Highly active antiretroviral therapy has dramatically impacted the natural history of human immunodeficiency virus (HIV) infection and may be associated with lipodystrophy and accelerated coronary artery disease. Patients with HIV are consequently increasingly likely to present for cardiac surgery.

METHODS

A retrospective review of 37 consecutive patients at two integrated centers from 1994 to 2000 was conducted. Standard database and follow-up information was supplemented with data on opportunistic infections, CD4 count, viral load, New York Heart Association status, and angina status. Risk to operating room personnel was also reviewed.

RESULTS

Median age was 41 years; 34 of 37 patients were male. Operations performed were coronary artery bypass graft ([CABG] 27), aortic valve replacement ([AVR] 4), AVR/CABG (2), AVR/mitral valve repair (1), mitral valve repair (1), excision of atrial masses (1), and tricuspid valve repair (1). Complications included death in 1 of 37 (2.7%), sepsis in 2 of 37 (5.4%), deep sternal infection in 1 of 37 (2.7%), bleeding in 2 of 37 (5.4%), prolonged ventilation in 2 of 37 (5.4%), and readmission in 8 of 37 (21.6%). Actuarial freedom from a composite end point of angina, death, myocardial infarction, repeat revascularization, and congestive heart failure was 81% at 3 years with no late deaths. Preoperative and follow-up CD4 counts and viral loads were not significantly different at a mean follow-up of 28 months. No patients progressed from HIV positive status to AIDS during the study period. Six "needle stick" injuries requiring antiretroviral prophylaxis occurred in 5 caregivers without seroconversion.

CONCLUSIONS

In selected patients infected with HIV, risks and outcomes of cardiac surgery are acceptable. With concomitant highly active antiretroviral therapy, intermediate HIV and cardiac status appear to be favorable. Needle stick injuries occur at a rate mandating optimal reduction of patient viral loads preoperatively.

The Rev/Rex homolog HERV-K cORF multimerizes via a C-terminal domain

Expression of human endogenous retrovirus K (HERV-K) is associated with germ-cell neoplasia. HERV-K encodes a protein of the Rev/Rex family, cORF, that supports cellular transformation and binds the promyelocytic leukemia zinc finger (PLZF) protein implicated in spermatogenesis. Rev/Rex function invariably depends on multimerization. Here we show that cORF likewise self-associates to form higher-order oligomers. Amino acids (aa) 47-87 in cORF are sufficient, aa 75-87 essential for self-association. Consistently, this domain is predicted to form a hydrophobic alpha-helix that may represent an oligomerization interface. The existence of a dimerization-competent cORF mutant lacking PLZF-binding activity (cORF47-87) suggests a way of dominant negative inhibition of the proposed tumor susceptibility factor cORF.