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Query: UMLS:C0002871 (anemia)
 52,094 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The objectives of this study were to compare the costs and benefits of recombinant human erythropoietin (r-HuEPO) relative to repeated transfusions in the treatment of zidovudine (AZT)-related anemia among HIV-infected children. The study was based on a tertiary care Canadian Pediatric Hospital Model. A decision analytic structure was used for the evaluation of cost-effectiveness. The decision tree involved two options. In option A:r-HuEPO, subjects receive r-HuEPO three times weekly at home for 1 year, whereas in B:no r-HuEPO, transfusions are given on a monthly basis in a medical short-stay unit over a 1-year period. Probabilities of various outcomes and downstream events were obtained from a literature review. The analysis was conducted from the perspective of the health-care system and utilized standard cost-effectiveness methodology. The results indicated that for every child receiving r-HuEPO, the total cost is Can $11,245 for 1 year compared with $3,130 per year for those in B:no r-HuEPO. The incremental cost effectiveness of A:r-HuEPO relative to B:no r-HuEPO is $1,373 per transfusion episode averted. The order of magnitude of the results was not significantly affected by changes in any of the assumptions used for the cost estimates or baseline probability values.
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PMID:Cost-effectiveness of recombinant human erythropoietin versus transfusions in the treatment of zidovudine-related anemia in HIV-infected children. 1136 10

Nutritional status directly affects immune competence; therefore, dietary supplements can be beneficial. Vitamin A, a fat-soluble nutrient obtained exogenously from animal protein or synthesized endogenously from carotenoids, is important in vision, epithelial tissue maintenance, reproduction, and growth. It is also an antioxidant, and can interfere with HIV-related oxidative destruction. Vitamin C, a water-soluble antioxidant important in hydroxylation reactions and required by erythrocytes for retrieving stored iron, can suppress HIV in vitro. However, this requires long-term administration, and its effect ceases upon termination of treatment. Vitamin E, fat-soluble tocopherols, can be found in plants, vegetable oils, milk, eggs, fish, meats, and cereals. A potent antioxidant because of its electron-donating ability, vitamin E reduces HIV replication. Deficiency reduces inhibition of tumor necrosis factor alpha (TNF-a) and protein kinase C, therefore limiting immunocompetence. Additionally, damaging side effects of AZT, normally reversed or minimized by vitamin E, may induce low leukocyte counts and anemia. Vitamin E acts synergistically with selenium, another antioxidant, to block the rate of lipid peroxidation. Its administration may reduce diarrhea, cramping, and weight loss, and may improve epithelial conditions and reduce the frequency of illness. N-acetylcysteine (NAC), a sulfur-containing amino acid, inhibits HIV replication by raising serum glutathione levels through inhibition of TNF-a. Finally, HIV-infected patients should consider gluten-free diets during times of acute gastric distress.
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PMID:Nutrition and HIV. 1136 99

AIDS patients are able to double their life expectancies after diagnosis. Drug treatment, an integral part in creating this improvement in life expectancy, consists of antiretroviral drugs, drugs that treat and prevent opportunistic diseases, and therapies that treat specific symptoms of AIDS, such as wasting or anemia. Five available drugs for treating HIV are AZT (Retrovir), ddI (Videx), ddC (Hivid), d4T (Zerit), and 3TC (lamivudine). Findings from studies for each drug in such areas as the drug's purpose, dosage level, effectiveness, and side effects are examined.
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PMID:What we know about anti-HIV drugs. 1136 92

A new treatment for HIV-related idiopathic thrombocytopenia purpura (ITP) has been developed. The treatment, WinRho SDTM, is a form of the intravenous immunoglobulin, IVIG. IVIG has been successful at reducing the ability of HIV antibody-fragment clusters to bind to platelets, thus preventing the body from destroying the platelets prematurely. WinRho SD was effective for HIV patients whether they were taking AZT or not. Minor side effects developed following four percent of the infusions. Anemia caused by hemolysis can also be a problem. Suggested dosing is set at 250 IU (50mg/kg bodyweight), and the infusions take about three to five minutes, as opposed to several hours for other IVIG forms.
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PMID:New treatment for ITP. 1136 5

Epoietin alfa (EPO) is a synthetic version of erythropoietin. Initially approved by the Food and Drug Administration (FDA) for treating anemia in patients on kidney dialysis, the approval was later expanded to include people with AZT-related anemia, those undergoing chemotherapy, and those undergoing surgery that requires blood transfusions. In clinical studies, EPO raised hematocrit, which indicates increased red blood cells, and therefore decreased the number of blood transfusions needed. For patients with high blood pressure, or for patients who have anemia from iron or folate insufficiency, EPO should not be used.
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PMID:Epoietin alfa (EPO) for anemia. 1136 62

We investigated the immunohematoxicities of the antiparasitic drug dapsone (DDS) and the antiretroviral drug zidovudine (ZDV, AZT) given alone or in combination in BALB/c mice. DDS is used for prophylaxis and treatment of Pneumocystis carinii infection in AIDS patients. We examined the impact of concurrent administration of these drugs on the immune and hematopoietic systems because DDS causes hematotoxicity and ZDV therapy results in bone marrow toxicity. Daily oral administration of DDS at 25 and 50 mg/kg for 28 days caused a slight anemia, marked methemoglobinemia, reticulocytosis, and a moderate leukopenia (P < 0.01 for all parameters) but had no discernible effect on platelet count. In DDS-treated mice, the proliferative response of splenic T cells to concanavalin A was > or = 35% higher than that manifested by splenocytes from vehicle-treated control mice. ZDV at 240 and 480 mg/kg was not immunosuppressive but caused low-grade macrocytic anemia, thrombocytosis, and neutropenia; these effects were drug dose-dependent and statistically significant (P < 0.01). Concurrent administration of DDS and ZDV augmented the severity of ZDV-mediated macrocytic anemia, and 7 of 12 (58%) mice did not survive treatment with the high doses of DDS and ZDV (50 and 480 mg/kg, respectively). On the other hand, co-administration of ZDV mitigated DDS-induced methemoglobinemia and the DDS-associated elevation in lymphoproliferative response. These data suggest interaction between DDS and ZDV in mice and indicate a need for caution in using DDS as long-term therapy in AIDS patients receiving ZDV.
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PMID:Immunohematotoxicity studies with combinations of dapsone and zidovudine. 1171 May 42

In vitro and in vivo prophylactic and therapeutic efficacy of AZT/3TC treatment was evaluated against feline immunodeficiency virus (FIV) infection. In vitro studies utilized FIV-infected peripheral blood mononuclear cells (PBMCs) or FIV-infected T-cell lines treated with AZT (azidothymidine) alone, 3TC alone, or AZT/3TC combination and tested for anti-FIV activity and drug toxicity. AZT/3TC combination had additive to synergistic anti-FIV activities in primary PBMC but not in chronically infected cell lines. In vivo studies consisted of four treatment groups (n=15) of SPF cats receiving AZT/3TC combination (5-75 mg/kg/drug PO BID for 8 or 11 weeks) and one control group (n=9) receiving oral placebo. Group I (n=6, 150 mg/kg/drug/day) was treated starting 3 days pre-FIV inoculation, whereas Group II (n=3, 150 mg/kg/drug/day) and Group III (n=3, 100 mg/kg/drug/day) treatments were simultaneous with FIV inoculation. Group IV treatment (n=3, 100 mg/kg/drug/day) was initiated 2 weeks post-FIV inoculation. All cats were monitored for drug toxicity and FIV infection. Eighty-three percent of cats in Group I and 33% of cats in Groups II and III were completely protected from FIV infection. A significant delay in infection and antibody seroconversion was observed in all unprotected cats from Groups I, II and III. Group IV cats had only a slight delay in FIV antibody seroconversion. Adverse drug reactions (anemia and neutropenia) were observed at high doses (100-150 mg/kg/drug/day) were reversible upon lowering the dose (20 mg/kg/drug/day). In contrast, AZT/3TC treatment had no anti-FIV activity in chronically infected cats. Furthermore, severe clinical symptoms caused by adverse drug reactions were observed in some of these cats. Overall, AZT/3TC treatment is effective for prophylaxis but not for therapeutic use in chronically FIV-infected cats.
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PMID:Is AZT/3TC therapy effective against FIV infection or immunopathogenesis? 1194 20

Human immunodeficiency virus (HIV)-infected patients experience a range of haematological complications including anaemia, neutropenia, lymphopenia and thrombocytopenia. Anaemia is a prognostic marker of future disease progression or death, independent of CD4 and viral load. Recovery from anaemia reduces the risk of disease progression to approximately the same level as seen among patients who have never had anaemia. Additionally, anaemia impacts a range of dimensions of quality of life, most commonly through fatigue. Anaemia can be caused by a range of mechanisms including infections, neoplasms, dietary deficiencies, blood loss and medication. Histologically, bone marrow hypoproliferation and dysplasia are the most commonly seen. Both AZT and d4T induce macrocytosis, however, AZT, but not d4T, has broader myelosuppressive effects both in vitro and in vivo. The management of anaemia typically includes correction of the underlying cause(s) and blood transfusion or erythropoietin. However, blood transfusions and iron supplementation may activate HIV expression and possibly worsen immunosuppression. Recombinant human erythropoietin (rHuEPO) is an effective means of improving haemoglobin and reducing transfusion requirements in patients who have low (< 500 IU/L) endogenous erythropoietin levels.
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PMID:Anaemia in persons with HIV infection: prognostic marker and contributor to morbidity. 1199 79

Azidothymidine (AZT)-induced anemia in mice can be reversed by the administration of IGF-IL-3 (fusion protein of insulin-like growth factor II (IGF II) and interleukin 3). Although interleukin 3 (IL-3) and erythropoietin (EPO) are known to act synergistically on hematopoietic cell proliferation in vitro, injection of IGF-IL-3 and EPO in AZT-treated mice resulted in a reduction of red cells and an increase of plasma EPO levels as compared to animals treated with IGF-IL-3 or EPO alone. We tested the hypothesis that the antagonistic effect of IL-3 and EPO on erythroid cells may be mediated by endothelial cells. Bovine liver erythroid cells were cultured on monolayers of human bone marrow endothelial cells previously treated with EPO and IGF-IL-3. There was a significant reduction of thymidine incorporation into both erythroid and endothelial cells in cultures pre-treated with IGF-IL-3 and EPO. Endothelial cell culture supernatants separated by ultrafiltration and ultracentrifugation from cells treated with EPO and IL-3 significantly reduced thymidine incorporation into erythroid cells as compared to identical fractions obtained from the media of cells cultured with EPO alone. These results suggest that endothelial cells treated simultaneously with EPO and IL-3 have a negative effect on erythroid cell production.
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PMID:Antagonism between interleukin 3 and erythropoietin in mice with azidothymidine-induced anemia and in bone marrow endothelial cells. 1209 Jul 60

Treatment for people with HIV attempts to prevent HIV from reproducing, boost the immune system, or cure opportunistic infections. The chemical structure of anti-viral drugs is similar to that of DNA. Since HIV bonds with the drugs rather than DNA, it cannot replicate itself. The most widely used anti-viral drug is zidovudine or AZT (brand name, Retrovir), but it does not help HIV infected persons who are still healthy. A recent trial shows that a combination of anti-viral drugs is more likely to delay opportunistic infections and death than AZT alone. When pregnant women use AZT before and during delivery and when their newborns receive AZT therapy, the likelihood of HIV transmission to the newborn is reduced by about 66%. Follow-up studies are needed, however, since AZT is toxic. Disadvantages of anti-viral drugs include resistance, toxicity, side effects (e.g., nausea and anemia), which are particularly severe at high doses, and accessibility of regular and expensive monitoring tests. Protease inhibitors are in the early stages of development. They deactivate the HIV enzyme which allows HIV to attach to white blood cells. Imuthiol (DTC) aims to increase the number of white blood cells so the body can fight HIV longer, but it appears that it has no benefit and may even facilitate development of opportunistic infections. Interleuken 2 may increase the number of CD4 cells. Alternative approaches to strengthening the immune system are lifestyle changes, improved diet, reduced stress, Chinese medicine and acupuncture, herbal medicines, and relaxation exercises. HIV/AIDS therapies are very expensive and often induce side effects. Many HIV positive people in developed countries are opting out of these treatments, even though they have access to them. Prevention and treatment of opportunistic infection remain the best strategies for most HIV-infected persons.
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PMID:Slow progress against HIV. 1229 May 61


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