European Journal of Medical Research - Deutsche AIDS ...

June 27, 2007 EUROPEAN JOURNAL OF MEDICAL RESEARCH
57
a) whether perturbation of glutamate neurotransmission is evident
during progression of immunodeficiency disease,
b) what are the mechanisms underlying this impairment and
c) what are the consequences on neuronal function.
Disease progression both in the periphery and in the brain
was documented by clinical and general pathological examination,
plasma and CSF viral RNA load, T-cell analysis and
brain histopathology. We report for the first time disruption of
amino acid transporters (EAATs) during SIV infection and a
break down of EAATs associated with development of rapid
AIDS. This great impairment is accompanied by increases in
glutamate levels and changes in the expression of NMDA
subunits during disease progression. In accordance to a recent
study reporting that TNF-alpha downregulates EAAT2, we
found higher TNF-alpha production in microglia isolated
from these animals. TNF-alpha production was correlated
with activation status of microglia. In these settings, we found
dramatic decrease in function of cholinergic neurons without
an effect on GABA neurons in the putamen of animals with
AIDS. Our data on SIV-infected macaques support the glutamate
hypothesis for HIV dementia and suggest that the pathogenetic
mechanism for the neurodysfunction is the break
down of glutamate clearing which occurs in the stage of AIDS
and which is associated with high levels of TNF-alpha produced
by activated microglia.
B.13 (Poster)
Impairment of sexual well-being in HIV-positive
women
Sonnenberg-Schwan U. 1 , Müller M. 2 , Kästner R. 2 ,
Gingelmaier A. 2
1 German AIDS Society (DAIG e.V.), Section ALL AROUND
WOMEN special, Munich, Germany, 2 Gynecological Hospital,
University Ludwig - Maximilian, Munich, Germany
Objectives: Sexual dysfunctions (SD) or impairment of sexual
well-being are often reported by HIV positive men and
women. Studies in male patients show associations of SD
with HAART, but also with psychosocial factors. In women,
impairment of sexual well-being is especially pronounced after
HIV diagnosis. Data on the prevalence or variety of SD in
HIV positive women is scarce. We assume That SD is associated
with multiple bio-medical and psychosocial factors. The
study is aiming at Identifying factors influencing sexual wellbeing
in HIV-positive women
Methods: In a cross-sectional approach, from 09.2002 –
04.2006 77 HIV-positive and a control group of 63 HIV-negative
women were examined using a set of semi-standardised
and standardised questionnaires comprising socio-demographics,
partnership, reproduction, physical and psychological
symptoms, impairment of sexual well-being, body image,
QoL, and gynaecological and laboratory parameters.
Results: Mean age of the study group was 37.9 years (range
22-63), of the control group 33.4 (range 19–64). 77% were
taking ARVs. 14% vs. 3% were migrant women, 62% vs.
76% were living in a partnership, 44% vs. 34% had children.
40% vs. 24% reported their sexual well-being as being often
or always impaired. Sexual abuse had occurred in 35% vs.
24%. Complete withdrawal from sexual activities after HIV
diagnosis occurred in 31% of the study group. Although sexual
well-being improves over time, HIV-positive women reported
a wide range of psychological and physical symptoms:
mainly peripheral fat loss (26%) fatigue (26%), mood disorders
(22%) and lack of sexual desire (21%) (only symptoms
marked as “severe”). 23% felt their sexual life was impaired
by side-effects of HAART.
Discussion: HIV-positive women showed a greater impairment
of sexual well-being than HIV-negative women. Findings
stress the variety of factors associated with sexual health
and identify a range of physical and psychological symptoms.
Due to the small study population, associations with HAART
could not be analysed. Health practitioners should include the
assessment of sexual well-being of HIV-positive women and
intervention strategies as important factors of living and coping
with HIV/AIDS. Attributing SD to HAART might interfere
with adherence.
B.14 (Poster)
Dysphagia and cervical lymphadenopathy in
homsexual men
Karcher H. 1 , Halleck P. 2 , Loddenkemper C. 3 , Zeitz M. 1 ,
Schneider T. 1
1 Charité-University Medicine, Campus Benjamin-Franklin,
Department of Gastroenterology, Rheumatology and
Infectiology, Medical Clinic I, Berlin, Germany, 2 Charité-
University Medicine, Campus Benjamin-Franklin, Department
of Otorhinolaryngology and Head and Neck Surgery, Berlin,
Germany, 3 Charité-University Medicine, Campus Benjamin-
Franklin, Department of Pathology, Berlin, Germany
Two homosexual male patients (32 and 48 years old) presented
after 3-4 weeks of recurrent fever, fatigue, painless left
cervical swelling and dysphagia. One patient was HIV-infected
(CDC stage B3). Cervical computed tomography revealed
left pharyngeal wall swelling and enlarged lymph nodes in
both patients (figure, A, arrow). One patient also had an enlarged
left tonsil. Further exploration was performed to exclude
a malignant lymphoma. In one patient, fiberoptic panendoscopy
showed a mucosal ulcer extending from the left
pharyngeal base of the epiglottis into the false vocal fold
(figure, B); biopsies were taken from the ulcer. An ulcer was
detected in the left tonsil of the other patient after a bilateral
tonsillectomy. Histopathology showed follicular hyperplasia
and ulcerated tonsillar epithelium as well as endothelial cell
swelling and a chronic inflammatory infiltrate containing
many plasma cells (figure, C, hematoxylin-eosin x 100). The
Warthin-Starry silver stain disclosed numerous coiled spirochetes
(figure, C, inset, oil x 1000). Both patients had similar
histopathologic findings. The diagnosis of primary syphilis
was serologically confirmed. Both patients recovered completely
after penicillin treatment. Cervical lymphadenopathy
with recurrent fever for several weeks is indicative for a malignant
lymphoma and this life-threatening disease must be
excluded by histopathologic examinations. A Warthin-Starry
stain and serologic examinations may be helpful in differential
diagnosis. A throat ulcer combined wih cervical lymphadenopathy
is a relatively untypical oral manifestation of
primary syphilis since ulcers are usually seen in the lips,
tongue, palate or in the buccal mucosa. Moreover, oral ulcers
occur more frequently in the secondary disease stage. Due
to increasing rates of syphilis infections especially in homosexual
men and the popular pratice of unsafe oral-genital
sex untypical manifestations as described here will probably
increase. Clinicans should be aware of this important
differential diagnosis in cervical lymph node swelling (Figure
1A-C).