Because cytomegalovirus (CMV) can be isolated from pulmonary secretions of human immunodeficiency virus (HIV)-infected patients without causing disease, its clinical significance as a cause of pneumonia in this patient population is frequently questioned. In a 22-month period, CMV pneumonia was diagnosed in 17 (8%) of 210 HIV-infected patients who underwent lung biopsy on the basis of microbiological and histologic criteria. The clinical presentations of these patients were nonspecific, including fever (100% of patients), shortness of breath (71%), cough (76%), and Pao2 of < 75 mm Hg (88%). A high correlation in the degree of viral burden in lung biopsy specimens was demonstrated by histologic examination, immunohistochemical analysis, and in situ hybridization. No other pulmonary pathogens were identified for nine patients, whereas other possible causes of pneumonia were present in eight: 11 patients had evidence of extrapulmonary CMV disease at presentation. Most patients initially responded to specific anti-CMV therapy; the overall mean survival +/- SD was 3.1 +/- 2.5 months. CMV should be considered as a possible cause of pneumonia in patients with advanced AIDS especially if CMV infection is documented at other sites.

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Stavudine was well tolerated and delayed progression of HIV disease in patients who had previously received 6 or more months of zidovudine treatment. Benefits were apparent in all CD4+ cell strata and clinical stages of HIV disease. Stavudine is an important agent to consider for trials of combination chemotherapy.

Medical grade silicone rubber (MGSR) is composed of polydimethylsiloxane (PDMS) as well as silica filler, oxidation products from the curing process, and other components. In a test that excludes air-blood interfaces, PDMS radiation cured under nitrogen has a whole blood clotting time 22% longer than MGSR. Curing the PDMS under oxidizing conditions maintains a 10% prolongation, but addition of silica filler to the PDMS returns the clotting time to that of MGSR. Extracting MGSR with solvents other than water appreciably lowers the clotting time. These results indicate the "pure" PDMS has an intrinsically high thromboresistance. Thrombogenicity is increased by the use of silica filler and oxidizing cure, as in MGSR.