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

Pneumocystis carinii pneumonia continues to be the commonest opportunistic infection seen in AIDS patients. Early diagnosis and treatment have caused the one-year survival in AIDS-patients with PCP to increase steadily. However, PCP is still the cause of death in 25% of the AIDS-patients. Secondary prophylaxis with pentamidine-isethionate inhalations has reduced the risk of PCP relapse considerably. The risk of PCP is markedly increased at CD4-cell counts below 200 mio/l. Therefore, inhalations of pentamidine twice monthly, as a primary prophylaxis against PCP, can be recommended in HIV-positive patients with CD4-cell counts below this level.
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PMID:[Pneumocystitis carinii pneumonia in adult patients with AIDS]. 205 40

Enumeration of circulating T lymphocytes is crucial in the investigation of AIDS and related conditions. The single best measure of disease progression and prognosis is the absolute number of helper/inducer T lymphocytes in the peripheral blood. Although the phenotypic identification of a particular subset reflects no direct information on the function of the population, the information provided by the analysis furnishes new insight regarding racial differences in the immune deficiency associated with AIDS. The severity of the HIV illness in the African American population, as reflected by a decrease in the absolute number of circulating CD4+ lymphocytes, was marked compared to the Caucasian population with AIDS. Consequently, the CD4/CD8 ratio was lower in the African American HIV+ population. A higher level of activated mononuclear lymphocytes and NK cells in this population may indicate active disease. The incidence of life-threatening opportunistic infections such as PCP was greater in the adult/adolescent African Americans compared to Caucasians. In contrast, PGL was found more frequently in the Caucasian participants. Although the rate of HIV infection in the adult/adolescent African American population was not different from population estimates for the area under study, the incidence in the pediatric African American population was twice the population estimates for the race. This increased rate occurred in the parent-at-risk as well as in the hemophiliac group.
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PMID:Contrasting quantitative alterations in CD4+ and CD8+ lymphocytes in HIV-infected African Americans compared with the Caucasian population. 257 89

The clinical features of our cases demonstrated some of the already known characteristics of the variable spectrum of HIV infection. DA are the most important risk category in Italy. 10% of the ARC cases evolved into AIDS during a 12-month follow-up, on average. The most frequent OI in our AIDS cases were PCP, C. albicans esophagitis and chronic mucocutaneous ulcers. An high percentage of neurologic involvement from HIV was observed, and malignancies were encountered in AIDS (3 KS and 1 undifferentiated B lymphoma) as well as in ARC (1 Hodgkin's lymphoma). Statistically, significant worsening of the immunologic situation is evident as the disease progresses from LAS to AIDS. Activated B lymphocytes represent most of the cells of the germinal center during the hyperplastic stage of lymphadenopathy. Reversal of the T4/T8 ratio appears early during the initial stage of lymphadenopathy and is due to a decrease of CD4 and a relative increase of CD8. Also, destruction of the follicular dendritic cells is an early feature which becomes more evident as the disease advances and the lymph node evolves toward progressive involution. Activated B-lymphocyte augmentation with polyclonal Ig secretion appears to be related to T-independent B stimulation by coinfection such as CMV, EBV and HBV. The increase of cytotoxic/suppressor lymphocytes seems to be partly related to the excessive activation of B lymphocytes and partially directed to the cells infected by HIV or coated with its proteins (6,7,8,9). The destruction of follicular dendritic cells has been interpreted not only as a killer effect of the virus but also as a result of the intervention of CTL sensitized to the cells containing the virus (10,11). Their destruction may contribute to the impaired recognition of soluble antigen which is one of the main features of the immune deficiency of HIV infection (9,13,16).
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PMID:A clinical-immunological evaluation of AIDS cases and related syndromes. 348 82

Four hundred and eighty six infected adults (90.7% men) were prospectively followed from 1988 to 1993 at a multiprofessional center in Santiago, Chile. 87.8% of male patients (pts)--84% of them homo/bisexual--and 64.4% of women acquired the infection sexually. At the beginning of the follow up (F/U) 51% of men and 71% of women were asymptomatic and 30% of the total group had AIDS. (AIDS definition: CDC 1993, excluded CD4 lymphocyte count < 200 x mm3). 240/486 (49.4%) had developed AIDS at the end of the study (12/31/93). AIDS defining events (ADE) were: interstitial pneumonia (confirmed or suggestive as caused by P. carinii [PCP]), 25%; tuberculosis (all forms), 22.1%; wasting, 13.8%; Kaposi Sarcoma, 9.2%; esophageal candidiasis, 6.7%; isosporiasis, 5.4%. Of all PCP cases, 72% were ADE, the rest, post.AIDS'. As expected, AIDS pts continued having major complications (mainly bacterial pneumonias, PCPs, esophagitis, tuberculosis and diarrhea due to I. belli and Cryptosporidium. Less frequently, but also observed, were toxoplasmic encephalitis and cryptococcal meningitis). Known mortality (excluded abandonment of F/U) was 27% for the whole group and varied from 5.8%, 51.6% to 69.2% for the first, 4th and 6th year of F/U respectively. For II-III CDC pts the mortality was 5% and 57% and for IV CDC pts it was 38% and 100% during the first and 6th year of F/U respectively. 36%, 53%, 74% and 85% of the pts followed for 1, 3, 5 and 6 years respectively had developed AIDS by the end of 1993. Multifactorial causes with either diarrhea, wasting or both were responsible for the death in half the pts in whom this was known, 15% died of respiratory complications and 5.7% of cryptococcal meningitis. 80% of AIDS pts survived their ADE. This study has provided information about the clinical profile of the HIV infection and natural history of the disease in Chile.
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PMID:[Clinical characteristics and natural history of human immunodeficiency virus infection. Study in a Chilean population served at a multiprofessional pilot center]. 756 47

To investigate the local immunological situation in the lung of HIV-infected patients with Pneumocystis carinii pneumonias (HIV-PCP), we analyzed the proportion and the distribution of lymphocyte subpopulations and their state of activation in bronchoalveolar lavage (BAL) and peripheral blood of 21 HIV-PCP patients (CDC classification group IV) compared to 24 HIV-negative patients with interstitial lung diseases (ILD). Peripheral blood lymphocytes (PBL) and BAL cells were stained with monoclonal antibodies. Two-color cytofluorometric analysis (flow cytometry) was performed with a cytofluorograph (Epics Profile, Coulter Corp., Hialeah, Fla., USA). In BAL from HIV-PCP patients the number of CD3-positive lymphocytes was significantly increased, yet there was no difference in the number of macrophages and neutrophils when compared to patients with ILD. Quantification of lymphocyte subpopulations showed that the increased number of BAL CD3-positive lymphocytes in HIV-PCP patients was mainly due to a significantly increased number of CD8-positive T cells, while the pulmonary CD4-positive T cells were decreased both in relative and absolute numbers. As a consequence, an inverted pulmonary CD4/CD8 ratio resulted for HIV-infected patients with PCP. Analysis of in-vivo-activated T cells in BAL and peripheral blood when measured by the expression of IL-2R, HLA-DR and VLA-1 revealed increased numbers of IL-2R and HLA-DR bearing CD8-positive T cells but significantly decreased numbers of IL-2R and HLA-DR bearing CD4-positive T cells as well as a higher number of CD8/CD57 double positive T cells in HIV-infected individuals when compared to patients with ILD.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:High proportion of gamma-delta T cell receptor positive T cells in bronchoalveolar lavage and peripheral blood of HIV-infected patients with Pneumocystis carinii pneumonias. 769 76

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

Preliminary evidence suggests that a CD4 cell count < 50 cells/mm3 is associated with a particularly poor short-term prognosis, and is both necessary and sufficient for death associated with HIV infection. We sought to validate these findings in a cohort of 1,415 zidovudine (ZDV)-treated patients, with advanced HIV infection, and to examine more closely the profile of CD4 cell decline over the 2 years prior to death. As of December 31, 1991, 432 patients had died. The cumulative 2 year survival of patients once their CD4 cell count fell to < or = 50 cells/mm3 (median survival = 17.3 months) was substantially shorter at 25.7%, than from when their CD4 cell counts first fell within the range 51-100/mm3 (51.4%); 101-150/mm3 (67.3%); or 151-200/mm3 (76.5%). The percent of patients with a CD4 count < 50 cells/mm3, increased from 33% at 24 months prior to death to 58% at 12 months and 86% at 1 month. Patients with a CD4 count > or = 50 cells/mm3 in the month prior to death, were significantly older (p < 0.001) and had higher CD4 cell counts (p < 0.05) at initiation of ZDV compared to those with a CD4 count < 50 cells/mm3. There were no important differences in HIV risk category, duration of ZDV therapy or use of PCP prophylaxis between the two groups. These findings highlight the importance of more intensive monitoring of patients with CD4 counts < 50 cells/mm3, since life-threatening opportunistic infections are more likely to supervene at this stage. A CD4 count < 50 may also be a useful surrogate endpoint for survival in clinical trials.
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PMID:Progressive CD4 cell depletion and death in zidovudine-treated patients. 810 Feb 72

This Quick Reference Guide for Clinicians contains highlights from the Clinical Practice Guideline on Evaluation and Management of Early HIV Infection, which was developed by a private-sector panel of health care providers and consumers. Selected aspects of evaluating and managing patients, both adults and children, who are in the early stages of human immunodeficiency virus infection are presented. Topics covered include disclosure of HIV status, monitoring of CD4 lymphocyte counts, prevention of Pneumocystis carinii pneumonia and infection with Mycobacterium tuberculosis, initiation of antiretroviral therapy, treatment of syphilis, eye and oral care, performance of Papanicolaou smears, diagnosis of HIV infection in infants and children, preventive therapy for PCP and assessment of neurologic problems in HIV-infected children, pregnancy counseling, and development of a comprehensive case management system. Algorithms are included that show the sequence of events related to evaluating and managing early HIV infection in adults and children, as well as drug dosing tables for antiretroviral, PCP, and M. tuberculosis therapies.
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PMID:Managing early HIV infection. Agency for Health Care Policy and Research. 814 62

Pneumocystis carinii colonization was studied in 90 men using the polymerase chain reaction. These comprised ten heterosexual controls; ten HIV-seronegative homosexual controls; 20 HIV-seropositive homosexuals with blood CD4 count > 400 x 10(6) l-1; 20 HIV-seropositive homosexuals with CD4 < 400 x 10(6) l-1; ten HIV-seropositive homosexuals with CD4 < 60 x 10(6) l-1 receiving PCP chemoprophylaxis; and 20 HIV-seropositive homosexuals with respiratory symptoms but without PCP. Induced sputum was obtained from all but the last group, who had bronchoalveolar lavage, and all specimens were tested for P. carinii using the polymerase chain reaction. The first four groups received no pneumocystis chemoprophylaxis, and all but the last group were asymptomatic. P. carinii colonization did not occur in the two control groups. P. carinii colonization rates were significantly different in the CD4 > 400, CD4 < 400, and CD4 < 60 groups (10%, 20%, and 40% respectively) (P < 0.025). Two patients (one each from CD4 < 400 and CD4 < 60) developed PCP 4-6 weeks after sputum induction, both had previously had high levels of P. carinii on sputum induction. Two patients from the CD4 < 400 group had high levels of P. carinii but did not develop PCP. In the symptomatic group, two subjects had low levels of P. carinii, but did not develop PCP. We have demonstrated P. carinii colonization in HIV-seropositive homosexuals in association with a low peripheral CD4 count. The polymerase chain reaction may be a useful technique for determining the need and efficacy of anti-pneumocystis chemoprophylaxis.
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PMID:DNA amplification by the polymerase chain reaction to detect sub-clinical Pneumocystis carinii colonization in HIV-positive and HIV-negative male homosexuals with and without respiratory symptoms. 826 40

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


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