Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:2.7.7.49 (reverse transcriptase)
 31,746 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The Centers for Disease Control and Prevention issued new guidelines for preventing and treating tuberculosis (TB) in persons with HIV. The guidelines recommend that all people with HIV be tested for TB and be treated if necessary. Also, the drug Rifampin, which can be used to treat TB, should not be used with protease inhibitors or with non-nucleoside reverse transcriptase inhibitors, as it impairs the effectiveness of those drugs. However, Rifabutin can be used with antiretroviral treatments. The guidelines also mention that there is a 2-month preventive treatment, which may be an alternative to the traditional 1-year Isoniazid treatment regimen.
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PMID:New TB guidelines for persons with HIV. 1136 63

Clinically significant interactions occurring during antituberculous chemotherapy principally involve rifampicin (rifampin), isoniazid and the fluoroquinolones. Such interactions between the antituberculous drugs and coadministered agents are definitely much more important than among antituberculous drugs themselves. These can be associated with consequences even amounting to therapeutic failure or toxicity. Most of the interactions are pharmacokinetic rather than pharmacodynamic in nature. The cytochrome P450 isoform enzymes are responsible for many interactions (especially those involving rifampicin and isoniazid) during drug biotransformation (metabolism) in the liver and/or intestine. Generally, rifampicin is an enzyme inducer and isoniazid acts as an inhibitor. The agents interacting significantly with rifampicin include anticoagulants, anticonvulsants, anti-infectives, cardiovascular therapeutics, contraceptives, glucocorticoids, immunosuppressants, psychotropics, sulphonylureas and theophyllines. Isoniazid interacts principally with anticonvulsants, theophylline, benzodiapines, paracetamol (acetaminophen) and some food. Fluoroquinolones can have absorption disturbance due to a variety of agents, especially the metal cations. Other important interactions of fluoroquinolones result from their enzyme inhibiting potential or pharmacodynamic mechanisms. Geriatric and immunocompromised patients are particularly at risk of drug interactions during treatment of their tuberculosis. Among the latter, patients who are HIV infected constitute the most important group. This is largely because of the advent of new antiretroviral agents such as the HIV protease inhibitors and the non-nucleoside reverse transcriptase inhibitors in the armamenterium of therapy. Compounding the complexity of drug interactions, underlying medical diseases per se may also contribute to or aggravate the scenario. It is imperative for clinicians to be on the alert when treating tuberculosis in patients with difficult co-morbidity requiring polypharmacy. With advancement of knowledge and expertise, it is hoped that therapeutic drug monitoring as a new paradigm of care can enable better management of these drug interactions.
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PMID:Clinically significant interactions with drugs used in the treatment of tuberculosis. 1188 53

This report summarises the ATC/CDC recommendations on the diagnosis and treatment of latent tuberculosis infection. Based on the sensitivity and specificity of the tuberculin skin test and the prevalence of TB in different groups, 3 cut-off levels have been proposed for defining a positive tuberculin reaction: > or =5 mm, >/=10 mm and > or =15 mm of induration. Treatment can be carried out mainly with Isoniazid, but there are alternatives such as Rifampin plus Pyrazinamide in the following cases: when Isoniazid-resistant M. tuberculosis appears and when the treatment is to be shortened; Rifampin alone for persons who cannot tolerate Pyrazinamide. Rifabutin can be substituted for Rifampin in HIV+ patients taking some protease inhibitors and non-nucleoside reverse transcriptase inhibitors. In persons who have been infected with multidrug resistant strains, Ethambutol and Pyrazinamide or Pyrazinamide and a fluoroquinolone can be prescribed. On the other hand, for a general prophylaxis BCG vaccination is not usually recommended due to its variable effectiveness, except in children and health care workers exposed continually to an untreated patient or to one with multidrug resistant M. tuberculosis strains. In order to achieve a new vaccine, a programme is currently being developed in the European Union called "The cluster for Tuberculosis vaccine development", which involves four main projects: optimisation and preclinical evaluation of TB vaccines, development of new live attenuated vaccines, non-protein antigens for TB vaccine and identification of mechanisms and indicators of protective immunity.
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PMID:[New recommendations and perspectives for the control of tuberculosis]. 1287 91

A toxic sensory neuropathy associated with exposure to inexpensive nucleoside analogue reverse transcriptase inhibitors (NRTIs) [particularly stavudine (d4T)] causes dilemmas in the management of patients with HIV, especially in resource-poor settings. Here patients (n = 96) attending Pokdisus AIDS Clinic at the Cipto Mangunkusumo Hospital, Jakarta who had been treated with d4T were screened for symptomatic neuropathy. Clinical, demographic, and genetic factors were considered as possible neuropathy risk factors. DNA from saliva was used to examine alleles of TNFA-308, BAT1 (intron 10), TNFA-1031, IL1A+4845, and IL12B (3' UTR). The prevalence of neuropathy (symptoms and signs) was 34%. On multivariate analysis, neuropathy following d4T exposure was associated with increasing age, increasing height, and TNFA-1031*2 (model p = 0.0009). Isoniazid exposure (present in 56% of patients) was not associated with neuropathy in this cohort, where all patients had received pyridoxine coadministration. These data suggest that a simple algorithm based on patient age, height, and TNF genotype could be used to predict the individual's risk of symptomatic neuropathy prior to prescription of d4T.
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PMID:Can we predict neuropathy risk before stavudine prescription in a resource-limited setting? 1883 21