Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.4.16.2 (PCP)
 3,761 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Drug allergy is the most common and significant allergic manifestation of HIV3 infection. Initially described in patients treated with SMX-TMP for PCP, allergy is now known to involve a multitude of drugs. The pathogenesis of, and risk factors for, allergy in HIV infection are poorly understood, although there is evidence suggesting that allergy is more common with advancing immunodeficiency. HIV-negative subjects with sulfonamide allergy may have drug-specific antibodies and drug metabolite-induced lymphocyte cytotoxicity, abnormalities that could partly explain the allergic mechanisms and which may have future diagnostic potential; these abnormalities have not been described in HIV-infected subjects. Therapy includes avoidance, suppressive agents such as corticosteroids, and desensitization, although the appropriate role for each is not entirely clear. Serum IgE levels have been shown to rise with progressive disease; those patients with higher levels may have a worse prognosis. The mechanisms of this rise are multifactorial, probably a combination of altered T-lymphocyte regulation of IgE synthesis and of production of specific IgE directed against microbial antigens.
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PMID:Allergic manifestations of human immunodeficiency virus (HIV) infection. 167 34

We have seen a dramatic increase in the types of antiviral strategies and numbers of specific antiviral agents that have emerged since the early 1980s when infection with the human immunodeficiency virus was first recognized. At the moment, zidovudine is the only drug approved by the FDA for treatment of HIV infection, and its indication is limited only to patients in the most advanced stages of immunodeficiency. Although zidovudine cannot "cure" HIV infection, it can significantly delay the seemingly inexorable course of immune system decline and buy some meaningful time for most HIV-1 infected patients, whether or not they have developed immunodeficiency. Other agents such as interferon alpha and the didoxynucleoside analogues, ddI and ddC, have also shown promise as antiretroviral agents, and it is hoped they will be proved, in the near future, capable of delaying the progression of immune system destruction by HIV-1. Other related treatment modalities such as the use of PCP prophylactic regimens also have succeeded in decreasing the incidence of opportunistic infections and thereby improving survival. It is likely that future strategies will involve the use of alternating, multidrug regimens both to reduce selective pressure for the development of drug resistance and to minimize the toxicity of single-agent therapy. The sum of these developments has been to change the prognosis of HIV infection. A disease once viewed as an automatic death warrant is now in the process of becoming a chronic, potentially long-term treatable illness.
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PMID:The role of antiretroviral therapy in living long and living well. 240 32

Twelve children with laboratory evidence of human immunodeficiency virus (HIV) infection underwent diagnostic flexible bronchoscopy with washings or bronchoalveolar lavage at Bellevue Hospital Center from October 1987 to April 1989. The patients included 7 boys and 5 girls ranging from age 3.5 months to 10 years 5 months. Indications for bronchoscopy included respiratory distress with or without focal changes on chest radiograph in 11 patients, and persistent but asymptomatic right middle lobe collapse in one child. The etiology of pneumonia was diagnosed in 7 children and included Pneumocystis carinii, (PCP) (17%), Streptococcus viridans (17%), mechanical obstruction (17%) and cytomegalovirus (CMV) (8%). Bronchoscopy was non-diagnostic in 5 cases. Techniques for maximal yield of information using flexible bronchoscopy in HIV-positive children are discussed.
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PMID:Diagnostic flexible bronchoscopy in human immunodeficiency virus (HIV)-positive children. 262 88

AIDS is a reliably diagnosed disease that is indicative of an underlying cellular immunodeficiency with no other cause for the disorder. To date over 2000 cases have been reported in North America and Europe and the number is rising. Patients fulfilling the definition for AIDS have included male homosexuals, IV drug abusers of both sexes, people from Haiti, heterosexual partners of AIDS patients, hemophiliacs, and some patients who fit no particular pattern. The etiology has been attributed to factors acting singly or in synergy namely that repeated exposure to CMV, semen, or other antigens results in progressive cellular immunodeficiency, or alternatively, a novel virus has an etiologic role. The epidemiology of the syndrome suggests a horizontally transmissible agent. The spectrum of opportunistic infections observed in AIDS patients is well documented. A higher incidence of KS as well as squamous carcinoma of the oral cavity, cloacogenic carcinoma of the rectum, primary lymphomas of the brain, and systemic Burkitt's-like lymphoma has been noted. Seventy-one patients with AIDS were examined and followed during the course of their disease. Forty-one patients had definite retinal lesions at the time of examination. The most common intraretinal finding was CMV retinitis which displayed the typical white, crumbly areas of retinal necrosis and hemorrhage. Optic nerve involvement was quite common. The development of retinitis was a harbinger of eventual death as it was a progressive and a nontreatable disorder, lasting about 6 months. The second most common retinal finding was cotton wool spots, the lesions were usually present during the course of PCP and were due to microvascular damage in the retina from circulating immune complexes. No organisms were demonstrated in the retina. One AIDS patient who had been an IV drug abuser developed fungal retinitis due to Candida albicans. The patient eventually died from Candida sepsis. One patient had acquired toxoplasmosis retinochoroiditis. Examination revealed a large active intraretinal focus of infection. No other retinal lesion was noted. The patient, a homosexual, died from a toxoplasmosis brain abscess. The patient with AIDS is in a continuing struggle for survival against a myriad assortment of opportunistic infectious agents. Careful initial ophthalmological examination and long-term follow-up are mandatory.
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PMID:The retinal lesions of the acquired immune deficiency syndrome. 610 Jan 47

The acquired immune deficiency syndrome (AIDS) was recognized as a distinct entity in 1981. It began as a medical curiosity affecting only several dozen individuals in a restricted segment of the U.S. population. In the 12 years since its description, AIDS has become a pandemic affecting tens of millions with cases reported from all major countries. The illness is caused by a retrovirus, termed human immunodeficiency virus (HIV). It is a blood-borne disease with sexual, parenteral, and perinatal modes of transmission. Infection with the virus can be determined by a number of serologic techniques as well as viral culture. The pathophysiology of illness is incompletely understood, but is in large part related to destruction of helper, CD4 lymphocytes. This results in immune dysfunction and the development of a variety of opportunistic infections and malignancies. A great deal has been learned over the last decade, with important advances in treatment. Zidovudine (AZT) remains the most important agent in slowing progression of the disease and has resulted in prolonging survival. All organ systems can be affected by HIV, and many clinical manifestations are protein. Fever, weight loss, and diarrhea are often encountered general symptoms. The skin is frequently involved, with Kaposi's Sarcoma the most common malignancy and a variety of fungi and viruses the most frequent cause of infection. The lung is involved in the majority of patients, with Pneumocystis Carinii (PCP) and mycobacteria emerging as the most important pathogens. A variety of treatments have demonstrated efficacy for PCP. The risk of PCP is related to the decay in CD4 lymphocytes so that prophylactic treatment is recommended when CD4 counts fall below 200. Mycobacterial infection with multiresistant organisms has complicated the management of these infections and poses new risks to health care workers. Part 1 of this two-part series on AIDS discusses the pathophysiology and clinical expression, epidemiology, laboratory testing, and the general clinical manifestations of AIDS, as well as dermatologic, pulmonary, and cardiac symptoms. Part 2 will discuss the gastrointestinal, neurologic, and ocular symptoms, as well as the treatment and management of the AIDS patient.
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PMID:The acquired immune deficiency syndrome: an overview for the emergency physician, Part 1. 804 May 96

The epidemiologic shift in HIV-infected populations from homosexual men to intravenous drug users and their sexual partners, together with the wide application of antipneumocystis prophylaxis and a better understanding of the broad range of HIV-associated illnesses, has changed our concept of the spectrum of lung infections that occur in patients with HIV infection. Bacterial pneumonia, not PCP, is the most common lower respiratory infection. Newer therapies of mild-to-moderate PCP increase the treatment options. The worldwide increase in tuberculosis cases is attributable to coinfection with HIV, and multidrug-resistant tuberculosis is now a serious threat, especially in the inner cities. Fungal pneumonias occur with increased frequency in patients with HIV infection, depending on the geographic factors and the severity of immunodeficiency.
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PMID:Pneumonia in patients with HIV infection. 807 69

Mice homozygous for the mutant allele scid (severe combined immunodeficiency) have been described as excellent models for Pneumocystis carinii (Pc) pneumonia (PCP), a major health problem in patients with acquired immune deficiency syndrome (AIDS) and other immunodeficiency states. Other microorganisms have been shown to infect AIDS patients simultaneously with Pc, but whether one opportunist is able to directly influence the pathogenicity of another has not been determined previously. We have deliberately coinfected scid mice (with extent Pc infection) with a variety of primarily pneumotropic viruses and bacteria and have identified pneumonia virus of mice as causing a dramatic increase in the density of Pc organisms and the morbidity due to PCP in immunodeficient scid mice. This finding has clinical significance in the management of PCP, in that the identification and treatment of coinfecting pneumotropic pathogens may be as important as treatment targeted at Pc. A search for other synergistic (or antagonistic) microorganisms and determination of their mechanism(s) of action in altering the progression of PCP is indicated.
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PMID:Lethal exacerbation of Pneumocystis carinii pneumonia in severe combined immunodeficiency mice after infection by pneumonia virus of mice. 845 14

Injecting drug users represent a pivotal and increasing component of acquired immunodeficiency syndrome (AIDS) case reporting in the United States. This article describes the natural history of human immunodeficiency virus (HIV) disease in a New York City cohort of 328 HIV-infected injecting drug users. The study sample of nearly two-thirds men (predominately African Americans and Latino Americans) underwent follow-up from December 1988 through December 1993. Male injecting drug users reported a longer injecting drug use history and were more likely to share needles/works than female injecting drug users. Eighty-nine of 328 study subjects died during the 5 years of observation. Comparing African Americans and Latinos, race/ethnicity was not related to survival. Survival was related to baseline CD4 count and hemoglobin level. Zidovudine use and PCP prophylaxis did not predict survival. Because of the continuing and increasing impact of HIV disease on injecting drug users and communities of color, there remains an unquestionable need to develop effective prevention programs, to understand the natural history of HIV disease, and to develop appropriate therapeutic interventions to treat those with HIV disease.
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PMID:Natural history of HIV-1 infection and predictors of survival in a cohort of HIV-1 seropositive injecting drug users. 858 91

To determine whether patient and hospital characteristics were significantly associated with variations in Pneumocystis carinii (PCP) care and outcomes, we analyzed the use of diagnostic tests, intensive care units (ICUs), anti-PCP medications for persons hospitalized with human immunodeficiency virus (HIV)-related PCP, and hospital discharge status. We conducted retrospective chart reviews of a cohort of 2,174 patients with PCP hospitalized in 1987-1990. Outcomes included process of care for PCP and in-hospital mortality rates. Persons with PCP who were more severely ill at admission were more likely to have early medical care, to receive care in an intensive care unit, and to die in hospital. After we adjusted for differences in this severity of illness, we noted that Medicaid patients, injection drug users (IDUs), and patients treated at VA or county hospitals were significantly less likely than others to have diagnostic bronchoscopies and that persons covered by Medicaid, with a previous diagnosis of acquired immunodeficiency syndrome (AIDS), who did not receive prior zidovudine (AZT) or who received care in a VA hospital had the highest chances of in-hospital death. Insurance and risk group characteristics, severity of illness, and hospital characteristics appear to be the most important determinants of the intensity and timing of medical care and outcomes among patients hospitalized with PCP.
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PMID:Predictors of resource utilization for hospitalized patients with Pneumocystis carinii pneumonia (PCP): a summary of effects from the multi-city study of quality of PCP care. 867 47

The opportunistic infections, malignancies, and causes of death related to acquired immunodeficiency syndrome (AIDS) are changing, perhaps as a result of improved treatment, prophylaxis, and education. With its high percentage of persons who acquired the human immunodeficiency virus from intravenous drug (IVD) use, the population of patients with AIDS in the Bronx is potentially unique. All of the 257 consecutive adult human immunodeficiency virus and/or AIDS cases from two Bronx teaching hospitals from 1982 through 1995 were collected. The reports were reviewed for patient demographics, opportunistic infections, malignancies, and causes of death. One hundred thirteen cases from 1982 through 1988 were compared with 144 cases from 1989 through 1995, separated by the institution of antiretroviral therapy and Pneumocystis carinii (PCP) prophylaxis in the latter period. Male homosexuality as a risk factor significantly decreased from 24.8% of the cases in our study from the 1982/88 period to 12.5% during the 1989/95 period (P = 0.014), but IVD use cases showed no change. Cases of AIDS in heterosexual patients increased from 23.9 to 36.1% (P = 0.041) but did not achieve statistical significance unless the unknown risk category (a population shown to be infected predominantly through heterosexual transmission) was included. The prevalence of PCP at autopsy as an opportunistic infection decreased from 37.2 to 25% (P = 0.04), and its prevalence as a cause of death decreased from 31.9 to 13.9% (P = 0.007). This decrease was seen in the homosexual and heterosexual populations but not in the population of IVD users. The homosexual population, as opposed to the population of IVD users, may have taken greater advantage of PCP treatment and prevention. As a result, bronchopneumonia, not PCP, is now the leading cause of death among the patients with AIDS in this study. These findings have important implications for therapy and prophylaxis to control the spread of AIDS and its related infections, particularly in an inner city population troubled by drug use and poverty.
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PMID:Comparison of changing autopsy trends in the Bronx population with acquired immunodeficiency syndrome. 890 38


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