European Journal of Medical Research - Deutsche AIDS ...

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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 disor- ders (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).
58 EUROPEAN JOURNAL OF MEDICAL RESEARCH June 27, 2007 B.15 (Vortrag) Comorbidity of restless legs syndrome and HIV infection Evers S. 1 , Happe S. 1 , Kundmüller L. 1 , Husstedt I.W. 1 1 Universitätsklinikum Münster, Klinik für Neurologie, Münster, Germany The life-time prevalence of restless legs syndrome (RLS) is about 10% in the general population. The association of RLS with HIV infection is unknown. We aimed to investigate the prevalence of RLS in HIV positive patients and to define predictors. A standardized questionnaire was presented to 228 HIV infected patients of the HIV outpatient clinic at the Department of Neurology, University of Münster, Germany. 129 patients (57% recall; 15% female, 44 ± 9 years; mean CD4+ cell count 333 ± 274/�l, 82% under highly active antiretroviral treatment) were included in the statistical analysis. 100 age- and sex-matched controls (20% female, 42 ± 13 years) were recruited from waiting relatives of surgical patients. Beside demographic and disease-specific data, the questionnaire included the diagnostic questions for RLS and the RLS severity scale by the International RLS Study Group. Diagnosis of RLS was confirmed by experienced neurologists. 33.3% of the HIV infected patients and 7.0% of the controls (p
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