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Query: UMLS:C0001175 (AIDS)
 120,706 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Relationships between nutrition and infection are generally complex, bidirectional, and not perfectly worked out. Healthy people can adapt to simple decreases in intake or increases in expenditure. However, the imposition of infection with associated cytokines may impair such adaptations, resulting in wasting of lean tissue. In human immunodeficiency virus (HIV) infection, nutritional abnormalities are common. Lean body mass depletion is associated temporally with death in a subset of acquired immune deficiency syndrome (AIDS) patients. Weakness, fatigue, and anorexia are important symptomatic complaints affecting quality of life. Pathophysiologic mechanisms remain speculative, although there is reason to suspect four theoretic factors: decreased intake, malabsorption, hypermetabolism, and altered metabolism. More than one disturbance may be necessary for clinical wasting to develop; ie, a primary abnormality plus a failure of homeostatic adaptation. Excess cytokine production also may be involved, but this is uncertain. Therapeutics remain empiric in the absence of known mechanisms. Current options are restricted to diet adjustments or supplements, treatment of underlying diseases (where possible), and rarely, parenteral alimentation. Promising investigational possibilities include an appetite stimulant (megestrol acetate) and therapies to oppose cytokine production or actions, but definitive beneficial effects on nutritional status, subjective performance, disease activity, or survival have not yet been demonstrated. Advances in clinical therapeutics await an improved understanding of pathophysiologic mechanisms and carefully designed clinical trials testing proposed interventions.
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PMID:Current approach to the treatment of human immunodeficiency virus-associated weight loss: pathophysiologic considerations and emerging management strategies. 225 24

During the early 1970s, attention was called to the changing demographics and poor prognosis of patients with miliary tuberculosis. Thirty-eight non-AIDS patients with miliary tuberculosis seen since 1975 are reviewed. Their average age was 60 years. Two-thirds of the patients had comorbid conditions. Presenting symptoms were nonspecific; fever, anorexia, sweats, and weight loss were the most frequent. Fever, tachypnea, rales, and altered mental status were the most commonly associated signs. Chest radiographs often showed miliary disease, but the remainder of the laboratory abnormalities were nonspecific. Seventy-six percent of sputum cultures, 75% of gastric aspirate cultures, 59% of urine cultures, and 54% of bronchial washings were positive for Mycobacterium tuberculosis. Biopsy specimens, including those obtained by transbronchial biopsy, were frequently abnormal histologically but were rarely culture-positive. Mortality attributable to miliary tuberculosis was 21%. Risk factors for death included female sex and altered mental status. No patient treated initially with a regimen that included streptomycin died whereas 21% of those treated with other regimens died. These data confirm and extend the results of earlier studies and suggest that miliary tuberculosis is a disease of the elderly and immunocompromised and is associated with significant morbidity and mortality. A high index of suspicion and diagnostic persistence are required for diagnosis.
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PMID:Miliary tuberculosis: epidemiology, clinical manifestations, diagnosis, and outcome. 186 61

The effects and toxicities of interferon alfa are described, and the role of the pharmacist in making decisions and providing education about biologic response modifiers (BRMs) is discussed. Interferons have both direct antitumor activity and extensive effects on the immune system. Two recombinant interferon alfa products--interferon alfa-2a and interferon alfa-2b are available commercially. Indications in FDA-approved labeling for interferon alfa include the treatment of hairy-cell leukemia, acquired immunodeficiency syndrome-related Kaposi's sarcoma, and genital warts; however, it also is being used successfully against early chronic myelogenous leukemia, low-grade non-Hodgkin's lymphoma, cutaneous T-cell lymphoma, and previously untreated multiple myeloma. Other malignancies that respond to treatment with interferon alfa are malignant melanoma, ovarian carcinoma, and renal cell carcinoma. The toxic pattern of interferon alfa consists of flu-like symptoms, which are seen at all doses, on all schedules, and in virtually all patients. After repeated dosing, the chronic toxicities of anorexia, weight loss, and malaise and fatigue may develop. Myelosuppression, central nervous system toxicity, increased hepatic enzyme concentrations, nausea and vomiting, and cardiovascular toxicity also are possible. Serum neutralizing antibodies may be formed during therapy; this phenomenon may affect the clinical outcome. Numerous BRMs are being investigated for clinical use, and pharmacists must become conversant in the issues that surround these agents. Areas in which pharmacist involvement and knowledge are important include overall cost, product similarities and differences, dosing and scheduling, drug delivery systems, ways to minimize waste, adverse effects and their management, drug interactions, storage requirements, differences in production and purification techniques among manufacturers, and education of patients and staff.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Biologic response modifiers: the interferon alfa experience. 248 96

A yin-yang hypothesis is presented linking noradrenergic activity, thromboxane, melatonin, left hemisphere functioning, and cyclic AMP on the one hand, and dopamine, beta-endorphin, calcium, right hemisphere functioning, and cyclic GMP on the other. It is further suggested that there is a yoking of NA, TXA2, serotonin and melatonin in the left hemisphere, and a similar yoking of DA, BE, calcium and cGMP in the right. Evidence is presented to support the hypothesis that each element (NA, TXA2, etc.) on one side can modulate or balance a corresponding element (DA, BE, etc.) on the other. It is suggested that thromboxane is the key element in noradrenergic overactivity and that not taking this into consideration has confounded much prior research. This theory takes into account information processing models as well as pharmacological data and neurochemical theory on coupling of adenylate cyclase to its hormone receptors. Inhibiting noradrenergic overactivity can be obtained by inhibiting thromboxane and concomitantly activating opiate receptors. This protocol may have clinical utility in treating a wide range of disorders such as: anxiety, depression, schizophrenia, sleeplessness, withdrawal states, enuresis, Gilles de la Tourette syndrome, Parkinsonism, Alzheimers, dementia, anorexia, infant ruminations, essential tremor, spasticity of spinal cord injury, diarrhoea, ulcerative colitis, extrapyramidal symptoms, akathisia, neuroleptic malignant syndrome, attention deficit disorder, hyperhidrosis, and possibly AIDS.
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PMID:Inhibiting noradrenergic overactivity by inhibition of thromboxane and concomitant activation of opiate receptors via dietary means. 254 22

The acquired immune deficiency syndrome (AIDS) presents a challenge for dietitians. Changes in the immune system have a potentially detrimental effect on nutritional status as a result of conditions such as anorexia, infection, diarrhea, and drug side effects. Conversely, poor nutrition status may adversely alter the immune systems. Dietary guidelines for the management of these conditions and additional obstacles are discussed. When counseling patients with AIDS, the dietitian needs to be aware of and sensitive to alternative therapies, to evaluate their effectiveness, and to assist in determining their place in the patient's treatment. Psychosocial factors that could influence nutritional status, such as dementia, unemployment, and isolation, must also be taken into consideration. A nutrition program has been established to address the needs of AIDS patients at AIDS Project Los Angeles-Necessities of Life Program (APLA-NOLP), a food distribution center. The goal of the program is to maintain or improve the client's nutritional status by providing education and counseling. The nutrition program has been enthusiastically received, and the outcome of the program on the nutritional status of the participants is currently under study. The dietitian is in a unique position to intervene by providing resource information, food preparation tips, and individualized nutrition plans. It is imperative that the dietitian become familiar with the AIDS disease process and its implications for nutritional status to be considered an expert in the nutrition management of such patients.
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PMID:Nutritional impact of acquired immune deficiency syndrome: a unique counseling opportunity. 264 37

The clinical course of 71 patients with acquired immune deficiency syndrome (AIDS) was evaluated to determine relationships among nutritional status, gastrointestinal symptoms and survival. At baseline, weight loss was present in 98%, hypoalbuminemia (less than 3.5 g/dl) was present in 83%, and gastrointestinal symptoms included pharyngitis (54%), diarrhea (42%), nausea (23%), dysphagia (21%), and anorexia (18%). Both the magnitude of body weight loss and the serum albumin level were strongly associated with life-table analysis of survival. For weight loss, median survival of 520 vs. 48 days occurred in patients with less than 10% versus greater than 20% baseline weight loss, respectively (p less than 0.01). The substantial influence of serum albumin on survival is outlined below. (table; see text) In almost all cases, serial evaluation demonstrated progressive linear decrease in body weight and albumin. In patients with normal baseline albumin, the rate of 0.7 mg/dl albumin decrease per day was less than half that in patients with baseline hypoalbuminemia. A projected "time to develop an albumin level less than 2.5 g/dl" was calculated for patient groups based on initial albumin level and the rate of albumin decrease. The calculated interval was similar to the actual median survival time observed in these groups. We conclude that 1) nutritional status may represent a major determinant of survival in AIDS and 2) the rate of albumin decrease may define a function limiting survival of individual patients with AIDS.
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PMID:Nutritional status, gastrointestinal dysfunction, and survival in patients with AIDS. 210 28

A 4-year-old FeLV-positive cat with a 1-year history of intermittent diarrhea and subsequent anorexia, depression, and weight loss had enteric cryptosporidiosis at necropsy. Cryptosporidium sp is an important cause of gastroenteritis and diarrhea in various species, including human beings with acquired immunodeficiency syndrome. A major determinant of the severity of the disease caused by Cryptosporidium sp is the immunologic status of the affected animal. Cryptosporidiosis should be included in the differential diagnosis of protracted diarrhea in FeLV-positive cats. Because cryptosporidiosis now is recognized as a zoonosis, cats with this disease should be considered a potential source of human infection.
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PMID:Cryptosporidiosis in a feline leukemia virus-positive cat. 282 11

In the course of a prospective immunoepidemiological study of homosexual men in Sydney, seroconversion to the AIDS-associated retrovirus (ARV) was observed in 12 subjects. Review of the clinical files defined an acute infectious-mononucleosis-like illness in 11 subjects. The illness was of sudden onset, lasted from 3 to 14 days, and was associated with fevers, sweats, malaise, lethargy, anorexia, nausea, myalgia, arthralgia, headaches, sore throat, diarrhoea, generalised lymphadenopathy, a macular erythematous truncal eruption, and thrombocytopenia. In 1 subject an incubation period of 6 days after presumed exposure to ARV was determined and in 3 subjects seroconversion took place 19, 32, and 56 days after onset. Comparison of T-cell subsets before and after the acute illness showed inversion of T4:T8 ratio in 8 subjects, due to increased numbers of circulating T8+ cells. These findings support the notion of an acute clinical, immunological, and serological response to infection with ARV which should be considered in the differential diagnosis of mononucleosis-like syndromes in groups at high risk for the development of AIDS.
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PMID:Acute AIDS retrovirus infection. Definition of a clinical illness associated with seroconversion. 285 99

AIDS patients often develop a conspicuous although functionally ineffective hypergammaglobulinaemia. We have treated four patients affected by AIDS or AIDS-related complex (ARC) with repeated courses of plasmaexchange coupled with immunoglobulin infusions. The schedule of each course was as follows: one plasmapheresis treatment once a week for 5 consecutive weeks, each treatment amounting to an average exchange of 3000 ml of plasma, replaced by plasma/protein and 5% albumin/physiological saline solutions, and followed by infusion of 15 gr of human immunoglobulins. Each plasmapheresis course was completed by additional weekly administrations of the same amount of human immunoglobulins. In each patient we noted fast cessation of fever, weight gain, and an overall clinical amelioration with decrease of infections, asthenia, and anorexia. Haematological, serological, and immunological parameters (particularly IgG serum levels) also significantly improved after treatment.
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PMID:Plasmaexchange plus immunoglobulins for treatment of hypergammaglobulinaemic patients with AIDS and AIDS-related complex (ARC). 318 Jan 33

Cachexia can be a severe problem in the management of patients with cancer and other illnesses because it produces an ever-increasing spiral of anorexia, undernutrition, loss of tissue mass, muscle wasting, and increased susceptibility to infection and treatment toxicity. Megestrol acetate has been observed to produce weight gain in patients with hormone-sensitive tumors and has recently been noted to produce a similar degree of weight gain in those with hormone insensitive tumors. A review of our experience in a phase I-II study of escalating doses of megestrol acetate for advanced breast cancer revealed that weight gain occurred in more than 80% of all treated patients and in 90% of those patients who received treatment for 6 or more weeks. The median maximum weight gain was 5.5 kg, with a range of -5.6 to 44 kg. Subjective improvement in appetite occurred in most patients. These data provided the impetus for a series of further studies of the role of megestrol acetate in the control of cachexia, including a randomized study in cancer cachexia, AIDS cachexia, and anorexia nervosa. In addition, a number of laboratory trials seeking the mechanism of action have been initiated, as well as whole-animal studies to define the compartment of increased weight. Our data and the preliminary observation of weight gain in patients with hormone insensitive tumors suggest that megestrol acetate has a potential role in producing a possibly dose-related subjective improvement and an increase in appetite and weight. Further research is necessary to understand the mechanism of appetite stimulation and anabolic effect.
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PMID:Studies of high-dose megestrol acetate: potential applications in cachexia. 328 86


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