Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Resistance of Mycobacterium tuberculosis to both isoniazid (INH) and rifampicin (RPM), the most important antituberculosis drugs, with or without simultaneous resistance to other drugs, is known as multidrug resistance (MDR). It is the main obstacle to attain the cure of patients by the specific treatment, and a threat to the tuberculosis control. Between 1994 and 1997, several Latin American countries undertook countrywide surveys or surveillance programs to determine their primary and acquired drug resistance prevalence rates. These studies followed the WHO/International Union Against Tuberculosis and Lung Diseases (IUATLD) guidelines. Percentages of not previously treated patients with tuberculosis due to MDR strains ranged from null or very small (Uruguay, Cuba, Chile) to 4% or higher (Dominican Republic, Argentina). In Argentina, a remarkable correlation between MDR tuberculosis, AIDS and the assistance in urban reference hospitals for infections diseases was observed. Coincidentally with the survey, nosocomial spread of HIV-related MDR tuberculosis occurred in two of these hospitals situated in Buenos Aires and Rosario. But, at the same time, an alarming emergence of MDR was evidenced among non HIV-infected patients with history of previous antituberculosis treatment. Directly observed treatment (DOT) should be increasingly applied, and drug supply guaranteed. Treatment as well as microscopy services for diagnosis and follow up of patients, should be decentralized from the big specialized hospitals in urban areas to the peripheral health centers, in order to make easier for the patients to attend regularly and receive their medications. These strategies will contribute to increase cure rates and to reduce the tuberculosis transmission.
 ...
PMID:[Resistance and multiresistance to antitubercular drugs in Argentina and in other Latin American countries]. 970 57

The impact of the human immunodeficiency virus (HIV) pandemic on childhood tuberculosis (TB) is unclear because of inconsistent and often contradictory findings in different types of studies. We review the evidence which supports or refutes the likelihood that HIV infection in children predisposes them to TB, and conclude that, on balance, HIV during infancy increases the risk of developing TB. Surveillance shows an association between rising TB rates among children and the HIV epidemic in some parts of the world. A number of cross-sectional studies which have taken children with TB as their starting population, have yielded high rates of association with HIV (11%-64% HIV prevalence). Similarly, cross-sectional studies of hospitalised children with HIV show that many also have TB. These rates of association are all over-estimated because of the uncertainty of diagnosis of TB. Birth cohorts of perinatally HIV-infected infants and children prospectively followed up for a few years have generally failed to detect a higher incidence of TB than anticipated. The few TB cases identified in these cohorts were usually over 15-18 months of age. In acute progressive lung disease there is no excess of TB in HIV-infected over non HIV-infected children. These inconsistencies are discussed and attributed mainly to study design and statistical artefact. However, maternal factors in HIV-positive women which might affect transmission of TB to their babies are assessed, and infant immunoparesis due to HIV which may adversely influence resistance to TB is considered.
 ...
PMID:Childhood human immunodeficiency virus and tuberculosis co-infections: reconciling conflicting data. 1059 23

Population-based active laboratory surveillance for invasive mycotic infections was conducted during 1992 and 1993 in three California counties: Alameda, Contra Costa, and San Francisco (population, 2.94 million). The cumulative incidence of invasive mycotic infections was 178.3 per million per year. Invasive mycoses were most commonly caused by Candida (72.8 per million per year), Cryptococcus (65.5), Coccidioides (15.3), Aspergillus (12.4), and Histoplasma (7.1). The clinical significance of other, less common fungi was determined by detailed chart review. The cumulative incidence was determined for zygomycosis (1.7 per million per year), hyalohyphomycosis (1.2), and phaeohyphomycosis (1.0). The most common underlying conditions were human immunodeficiency virus infection (47.4%), nonhematologic malignancy (14.7%), diabetes mellitus (9.9%), and chronic lung disease (9.3%). This represents the first population-based epidemiological assessment of invasive mycoses in the United States.
 ...
PMID:The epidemiological features of invasive mycotic infections in the San Francisco Bay area, 1992-1993: results of population-based laboratory active surveillance. 982 61

Fibreoptic bronchoscopy is an established diagnostic procedure for HIV-associated pulmonary infections. We retrospectively evaluated the diagnostic effectivity and safety of fibreoptic bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB) in 153 patients with late-stage HIV infection and clinical signs of pulmonary infection or abnormal chest radiograph. Bronchoscopy leads to diagnosis in 82.4% and changed therapy in 54%. 45 patients (30%) were found to have pneumocystis carinii pneumonia (PCP), the most common bronchoscopic finding, followed by bacterial lung disease (29.3%). BAL had a sensitivity of 78% for PCP. Diagnostic yield of BAL for PCP was higher in patients without previous treatment (positive results in 82%) with regard to PCP independend of the prior treatment. Serious complication occurred in 22 cases (pneumothorax: 6 (3.9%), bleeding: 12 (7.8%), hypoxaemia: 4 (2.6%)). High serum levels of lactate dehydrogenase (LDH) correlated with pulmonary complications like pneumothorax. Age, sex and kind of pulmonary infection did not influence complication rates. 6 (3.9%) episodes of spontaneous pneumothorax occurred in the further course, 3 of them concurrently with PCP or prior history of PCP. We conclude that fibreoptic bronchoscopy is of great value for diagnosing pulmonary infection in HIV-seropositive patients. TBB provides incremental diagnostic information not available from BAL, especially in patients pretreated with cotrimoxazol or pentamidin. For that reason we believe that TBB should be performed in these patients.
 ...
PMID:[Results and complications of fiber bronchoscopy in HIV positive patients]. 1002 41

The immunocompromised post-transplant HIV-positive patient is at increased risk for mycobacterial infection. Early diagnosis and aggressive therapy is critical to successful outcome. Surgical therapy may be required in patients who have complex mycobacterial lung disease, drug resistant tuberculosis, or mycobacterial infections other than tuberculosis.
 ...
PMID:Mycobacterium tuberculosis and other mycobacteria. 1007 88

Respiratory infections are a frequent burden to health despite the fact that cost-effective methods for their prevention and cure are available. Acute respiratory infections in children under 5 years of age are the most frequent cause of death from lung disease globally, causing more than 4 million deaths annually. Tuberculosis is the most frequent cause of death from a single pathogen in persons aged 15 to 49 years (a total of 2 million to 3 million deaths annually). Respiratory infections are the most frequent complications of immune deficiency (whether due to HIV infection or induced by chemotherapy). Where a "carrier state" occurs (as with many bacterial pathogens), the level of immune function is the key determinant in appearance of disease. Where there is no carrier state (as with many viruses), exposure is the key determinant. Characteristics of the pathogen, including virulence and bacterial load where there is a carrier state, also determine the probability of respiratory infections. Modifiers of these determinants include allergy and toxic exposures including tobacco smoke and ambient pollution.
 ...
PMID:Epidemiology of respiratory infectious diseases. 1022 36

Mycobacterium avium complex (MAC) is an important pathogen that can cause chronic lung disease in immunocompetent patients and disseminated disease in patients with the acquired immunodeficiency syndrome (AIDS). Treatment of MAC with antituberculosis drugs was unsatisfactory, but the introduction of the newer macrolides, clarithromycin and azithromycin, and of rifabutin has greatly improved the outcome of treatment regimens for MAC. However, these agents are also associated with many new treatment-related adverse effects and potential drug-drug interactions. Rifamycins [rifampicin (rifampin) more than rifabutin] induce cytochrome P450 enzymes and accelerate the metabolism of clarithromycin and HIV protease inhibitors. Conversely, clarithromycin inhibits these enzymes, resulting in increased rifabutin toxicity. The net results are treatment regimens that may be extremely difficult to tolerate, especially for elderly or debilitated patients. Clarithromycin and azithromycin must be administered in combination with other agents such as ethambutol to prevent the emergence of macrolide resistance. Unfortunately, not all patients respond to the combination of a macrolide, rifabutin and ethambutol, and many have significant adverse effects (mostly gastrointestinal) with this regimen. For some patients the treatment is worse than the disease. The same 3-drug regimen is also effective therapy for disseminated MAC in AIDS patients, in whom the additional problem of a rifamycin/protease inhibitor interaction may be present. Fortunately, as opposed to pulmonary MAC disease in immunocompetent patients, disseminated MAC disease is a diminishing problem because of effective prophylactic regimens for MAC and improved antiretroviral therapy for HIV. Significant progress has been made in the treatment of MAC disease with the introduction of the newer macrolides. It is to be hoped that even better drugs that are more active against MAC and are associated with less toxicity and drug-drug interactions will be introduced in the future.
 ...
PMID:Risk-benefit assessment of therapies for Mycobacterium avium complex infections. 1045 81

The relationship of serum human immunodeficiency virus-1 (HIV-1) RNA levels to HIV-1 RNA levels in other compartments, such as the lungs, is not well characterized. The purpose of this study was to determine the viral burden of HIV-1 in the lungs by comparing HIV-1 RNA in cell-free bronchoalveolar lavage fluid (BALF) with that in serum. Specimens were examined from 77 HIV-seropositive adults (CD4(+) cell counts: 0 to 700 cells/mm(3); 48% receiving prescribed antiretroviral agents), comprising 43 asymptomatic individuals who were compared with 34 persons with active lung disease caused by Pneumocystis carinii (n = 26), bacteria (n = 3), Mycobacterium avium complex (n = 2), Nocardia sp. (n = 1), Aspergillus sp. (n = 1), or pulmonary Kaposi's sarcoma (n = 1). For serum HIV-1 RNA, the proportion of subjects with detectable levels and the mean values were similar for asymptomatic individuals and persons with active lung disease (85% versus 86%, respectively) (6.64 x 10(4) versus 1. 81 x 10(5) HIV-1 RNA copies/ml; p = 0.13). In contrast, HIV-1 RNA in BALF was more often detected (16% versus 62%; p = 0.001), and mean values were higher (1.04 x 10(5) versus 3.31 x 10(6) HIV-1 RNA copies/ml; p = 0.032), in subjects with active lung disease than in asymptomatic subjects, independent of early or advanced clinical stages of HIV-related disease. For both study groups, HIV-1 RNA levels in BALF exceeded those in serum in 56% of cases by up to 66-fold, and did not correlate with local levels of tumor necrosis factor-alpha, granulocyte-macrophage colony-stimulating factor, or interleukin-16. HIV-1 proviral DNA in cells from BALF was detected in up to 86% of subjects, more frequently in persons with advanced HIV disease (p = 0.0496), and often involved > 10% of BALF cells, but did not correlate with HIV-1 RNA detected in BALF. These data provide evidence for active HIV-1 replication in the lungs. HIV-1 replication is compartmentalized relative to serum, may be restricted, is independent of HIV-1 proviral DNA and clinical stage of HIV, and may be influenced by pulmonary disease such as P. carinii pneumonia or by other local or lung-specific factors. The lungs represent a large reservoir for HIV-1, and may present a source of persistent HIV-1 replication even during periods of apparent clinical latency of HIV-1 infection.
 ...
PMID:Enhanced in vivo human immunodeficiency virus-1 replication in the lungs of human immunodeficiency virus-infected persons with Pneumocystis carinii pneumonia. 1058 27

RSV is the most important respiratory pathogen in infants and young children. About 1% of primary RSV infections result in hospitalization. The virus is spread by large droplets of secretions or contact with contaminated secretions. Infants infected with RSV may demonstrate poor feeding, rhinorrhea, apnea, lethargy, wheezing, and respiratory distress. Diagnosis may be made by clinical signs and symptoms (especially those observed during epidemics), by chest radiographs showing hyperinflation, or by rapid antigen detection with immunofluorescence of nasopharyngeal aspirates. Risk factors for severe disease accompanied by complications include chronic heart disease, chronic lung disease, immunodeficiency, HIV, and prematurity. Immunity is incomplete and of short duration, and reinfection is common. Treatment remains supportive and consists of oxygen administration, hydration, and diligent monitoring. Use of corticosteroids, bronchodilators, antibiotics, and ribavirin is controversial and is dependent largely on physician preference. Use of ribavirin should be reserved for patients who have severe underlying conditions associated with increased mortality rates. Intravenous RSV Ig has been replaced by palivizumab, which is generally recommended for infants at high risk for severe RSV, including those with a history of prematurity and those with chronic lung disease.
 ...
PMID:RSV infection in infants and young children. What's new in diagnosis, treatment, and prevention? 1060 68

Tuberculosis (TB) is the major opportunistic infection of human immunodeficiency virus (HIV)-infected persons worldwide. Human immunodeficiency virus infection is the most potent known risk factor for reactivation of latent Mycobacterium tuberculosis infection, and TB disease appears to increase the rate of HIV progression. Pulmonary disease is seen in most patients, including a large proportion of those with extrapulmonary disease. Failure to suspect TB and to order the appropriate diagnostic tests is the most common reason for diagnostic delays. With advancing HIV infection, tuberculin skin test reactivity decreases along with reactivity to nonspecific antigens such as mumps, tetanus toxoid, and Candida; anergy testing need not be a routine component of tuberculosis screening of HIV-infected persons. The diagnosis depends on identifying the organism on smears or cultures; direct amplification tests may facilitate rapid identification of M. tuberculosis, but the relatively low sensitivity in smear-negative specimens limits their use. Also, these tests must be used in conjunction with the clinical assessment, and they must always be performed in conjunction with microscopy and standard culture. Shorter courses of combination preventive therapy of patients with latent tuberculous infection are effective, but the potential advantages of improved adherence and reduced costs of shorter courses should be balanced with an increased risk secondary to ongoing TB exposure in areas with a high TB prevalence. Six months of treatment for active tuberculosis is recommended, unless the response of a particular patient is slow or otherwise suboptimal. The use of highly active antiretroviral therapy (HAART) made a remarkable impact on the course or HIV disease, but raises several issues with respect to HIV-related TB. Drug interactions necessitate either a non-rifamycin-based regimen or a rifabutin-based regimen in patients on HAART treated for TB.
 ...
PMID:Tuberculosis in patients with human immunodeficiency virus infection. 1063 14


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>