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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fluconazole is a triazole antifungal agent which is now an established part of therapy in patients with immune deficiencies. It is effective against oropharyngeal/oesophageal candidiasis (candidosis) when used orally once daily either as treatment or secondary prophylaxis in patients with AIDS or as treatment or primary prophylaxis in neutropenia associated with cancer therapy. Fluconazole also resolves symptoms in up to 60% of patients with cryptococcal meningitis and AIDS. However, in this infection its efficacy as treatment relative to that of amphotericin B is equivocal, and its major role is as the drug of choice for maintenance therapy following amphotericin B induction. In this regard, fluconazole has been proven superior to amphotericin B and to itraconazole 200 mg/day. Comparisons with other drugs used for the treatment of mucosal candidiasis in patients with AIDS show fluconazole to be superior to nystatin, similar to itraconazole and at least as effective as clotrimazole and ketoconazole; it was more so than the latter azole in 1 study. In patients undergoing chemotherapy or bone marrow transplantation, fluconazole as primary prophylaxis has produced greater clinical benefit than a clotrimazole regimen. The incidence of adverse events appears to be somewhat higher in patients with AIDS compared with HIV-negative cohorts, but the qualitative pattern of events is similar. The most frequent events are gastrointestinal complaints, headache and skin rash: rare exfoliative skin reactions and isolated instances of clinically overt hepatic dysfunction have occurred in patients with AIDS. Issues yet to be clarified include: the use of fluconazole in children with AIDS, in whom results have been promising; its efficacy against other fungal infections encountered in immunocompromised patients; whether the drug influences mortality, as has been suggested by one placebo-controlled trial in patients undergoing bone marrow transplant; and the appropriateness of its potential for use as primary prophylaxis against cryptococcal meningitis in patients with AIDS, where it shows efficacy but there is concern over increasing risk of development of secondary resistance. Notwithstanding these undefined aspects of its clinical profile, fluconazole is now confirmed as an important antifungal drug in the management of fungal infections in patients with immune deficiencies. In patients with AIDS it is the present drug of choice as maintenance therapy against cryptococcal meningitis and is a preferred agent for secondary prophylaxis against candidal infections; it is also a favoured agent for primary prophylaxis in patients at risk because of neutropenia associated with chemotherapy or bone marrow transplantation .
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PMID:Fluconazole. An update of its pharmacodynamic and pharmacokinetic properties and therapeutic use in major superficial and systemic mycoses in immunocompromised patients. 853 53

Mucosal candidiasis (oropharyngeal, esophageal, and vulvovaginal candidiasis) has been among the most prominent opportunistic infections in persons infected with human immunodeficiency virus (HIV). Esophageal candidiasis, an AIDS-defining illness, accounted for 15% of the AIDS-defining illnesses in adults and adolescents diagnosed in the United States through 1992. The diagnosis of oropharyngeal and vaginal candidiasis is based on clinically consistent signs and symptoms and a positive culture or a positive gram, KOH, or calcofluor stain, whereas the diagnosis of esophageal and pulmonary candidiasis is based on histopathology. Although a prospective controlled trial showed that prophylaxis with fluconazole can reduce the risk of mucosal candidiasis in patients with advanced HIV disease, routine primary prophylaxis is not recommended because of the effectiveness of therapy for acute disease, the low mortality associated with mucosal candidiasis, the potential for development of drug-resistant candidal infection, and the cost of prophylaxis. The probability of recurrences increases as CD4 counts decline. Nonetheless, many experts do not recommend chronic prophylaxis to prevent recurrent oropharyngeal and vulvovaginal candidiasis, for the same reasons that primary prophylaxis is not recommended. However, if recurrences are frequent or severe following documented esophageal candidiasis, long-term suppressive therapy with fluconazole should be considered.
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PMID:Opportunistic candidal infections in patients infected with human immunodeficiency virus: prevention issues and priorities. 854 20

We investigated the association of clinical and demographic factors on survival of the 901 AIDS cases diagnosed until 31 December 1992 and reported to the Austrian Health Authorities up to 20 January 1994. The overall estimated median survival of patients with AIDS increased substantially from 8 months in 1987 to 16 months in 1988, although this increase was not significant by the log-rank test. However, the differences in hazard rates were larger at the beginning of the survival curve: between 1987 and 1988 the proportion surviving at 1 year increased from 41 to 62%, compared to an increase of the proportion surviving at 2 years from 30 to 35% (Breslow test, p value 0.008). AIDS patients diagnosed between 1988 and 1992 (n = 755) were analyzed in more detail. Multivariate survival analysis revealed a shorter survival for those with residence in Eastern Austria, recipients of blood products, individuals with unknown transmission risk, those presenting with two AIDS indicator diseases and those with higher age at AIDS diagnosis. Candidal esophagitis as AIDS indicator disease was associated with longer survival. One hundred eighty-eight of the 755 AIDS patients (24.9%) died within the first 3 months after diagnosis of AIDS. We conclude that the survival time for AIDS patients has improved considerably after 1987, but survival is still very poor. Several factors have been shown to predict survival of patients with AIDS in Austria. Death within the first 3 months after the diagnosis of AIDS occurred at a relatively high frequency in Austrian AIDS patients. This may be caused by difficulties in the use of health care facilities or by the lack of awareness of HIV infection before diagnosis of AIDS either by patient or care provider.
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PMID:Survival differences in Austrian patients with the acquired immunodeficiency syndrome. 854 25

In a cohort of HIV-infected patients, this study compares the clinical and immunological features at the time of AIDS diagnosis of patients who either received primary Pneumocystis carinii prophylaxis (P+; n = 335) or who did not (P-; n = 289). Frequency of P carinii pneumonia was lower in P+ than in P- patients (14.9% vs 26.0%; p < 0.001). Conversely, toxoplasmic encephalitis, esophageal candidiasis, cytomegalovirus disease and M avium complex disease were more frequent in P+ patients. CD4+ count (median/mm3) at the time of AIDS diagnosis was lower in P+ than in P- patients: 22 vs 97 (p < 0.001); this suggests that early intervention delays the onset of AIDS for about one year. While searching for new prevention strategies against other opportunistic infections, efforts should be expanded to improve prophylaxis of P carinii pneumonia which remains in France the most frequent first AIDS-related illness.
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PMID:[Effect of primary prevention of Pneumocystis carinii pneumonia on the inaugural clinical and biological presentation of AIDS: 624 cases (Aquitaine Cohort, 1985-1994)]. 857 Sep 37

Since the diagnosis of AIDS was first made, a lot of efforts have been made to improve survival. Different studies have found varied results, both geographically as well as over periods of time. During the period 1.1.1985 to 31.12.1993 142 patients that were HIV-positive were seen in the geographically well defined area of Funen. During the period 1.1.1985 to 31.12.1990 the median time elapsed between the patient being found to be HIV-positive and the patient presenting with an AIDS-defining disease was found to be 8.8 years. In the period 1.1.1991 to 31.12.1993 it was 2.6 years (95% CL 1,3-?). The AIDS defining diseases were Pneumocystis carinii pneumonia in 43% of the cases, and oesophageal candidiasis in 24%. The median survival time after being diagnosed with AIDS was 2.0 years (95% CL 1,7-2,4). Heterosexual infection seems more pronounced in our material than for the country as a whole.
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PMID:[Survival time after the diagnosis of AIDS in the county of Funen]. 864 9

A retrospective study of 55 HIV-1 seropositive African patients living in the UK, seen between January 1986 and November 1993, showed a total of 26 (47%) patients with AIDS. Thirty-one (56%) had symptomatic HIV disease at the time of presentation of whom 19 (34.5%) had an AIDS defining condition. Tuberculosis was the most common AIDS defining illness, accounting for 27% of all initial AIDS diagnoses, followed by by Pneumocystis carinii pneumonia and oesophageal candidiasis in 19% each and chronic mucocutaneous genital herpes in 15%. The mean CD4 count at the time of the first AIDS defining event was 91 x 10/mm3 (range 4-320 x 10/mm3). The profile of AIDS defining illnesses was different to published data of homosexual men and injecting drug users in the UK. This has practical implications when considering differential diagnoses and screening as well as prophylaxis for opportunistic infections in this group of patients.
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PMID:AIDS defining conditions in Africans resident in the United Kingdom. 865 11

Gastrointestinal (GI) symptoms are part of the most frequent complaints in HIV disease. A methodical effort is required to identify treatable syndromes. Progressive immunodeficiency is associated with increased prevalence of opportunistic or non-opportunistic infections and neoplasms. Dysphagia and odynophagia, in the majority due to candida esophagitis, are best evaluated by endoscopy. In the presence of diarrhea, upper GI endoscopy is indicated if evaluations of stool and endoscopy of the lower GI tract are negative and may uncover proximal small-bowel infection by Cryptosporidium, Microsporidium or Mycobacterium avium. HIV-associated neoplasias (Kaposi's sarcoma, non-Hodgkin lymphomas), not rarely affecting the upper GI tract and sometimes leading to obstruction or bleeding, are reliably diagnosed only by endoscopy. Since visible lesions mostly are nonspecific and normal-appearing mucosa may harbor pathogens, biopsies for pathology and cultures are crucial for correct diagnosis in GI diseases of HIV-infected patients.
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PMID:[Endoscopy of the upper gastrointestinal tract in HIV disease]. 865 96

A retrospective analysis was conducted of HIV/AIDS cases registered at the University Hospital in Kuala Lumpur, Malaysia. There were 104 such cases, but, due to incomplete data or lost to follow up, the analysis included only 66 HIV/AIDS cases. The age of the 66 HIV/AIDS cases ranged from 0 to 60 years. 89.4% were 21-40 years old. The female to male ratio was 1:10. 53.8% of the HIV/AIDS cases had acquired HIV via intravenous drug use. The next most common HIV transmission modes were heterosexual and homosexual intercourse (20% and 13.8%, respectively). There were 73 episodes of AIDS-defining illness among the 66 patients. The most common illnesses were Pneumocystis carinii pneumonia (PCP) (32.9%) and esophageal candidiasis (16.4%). Of the 28 patients who had at least 1 CD4+ measurement, 54% had a CD4+ count less than 500/mcl. 66% of them had at least 1 AIDS-defining illness. 17 HIV/AIDS patients had already died. The leading causes of death were fulminant pneumonia (23.5%) and PCP (17.6%). The probability of survival at 2.7 years after HIV diagnosis was 50%. The probability of survival free from AIDS-defining illness at 2 years was also 50%. Reasons for poor survival included delay in HIV diagnosis, presentation late in the course of HIV disease (the case in 50% of HIV/AIDS patients at the hospital), poor compliance to follow-up, and non-availability of zidovudine until recently.
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PMID:HIV infection in Malaysia: a report of cases seen at the University Hospital, Kuala Lumpur. 866 46

This study identified the ENT symptoms of 66 HIV infected children over an 8 year period (1986-1993) at Great Ormond Street Hospital for Children. The incidence, nature and age of onset of ENT symptoms were investigated; 91% of the children had ENT symptoms, the most common being cervical lymphadenopathy, oro-oesophageal candidiasis and otitis media. The HIV infected children suffered from the common ENT diseases of childhood. They also presented with specific conditions such as diffuse parotid swelling. Therefore, their clinical features differed from HIV infected adults as well as non-infected children. An increasing incidence of paediatric HIV infection was demonstrated by the study. Most were due to vertical transmission. ENT surgeons are likely to see more HIV infected children in future, either with the usual ENT diseases of childhood (to which they seem more susceptible) or with HIV-specific conditions. Although the diagnosis of HIV may be known, the ENT condition could be the initial presentation suggestive of immunodeficiency.
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PMID:The ENT manifestations of HIV infection in children. 867 20

Up to 70% of individuals with primary HIV infection will develop symptoms of an acute illness. The most common symptoms reported are fever, generalized lymphadenopathy, arthralgia and myalgia, headache, pharyngitis, enanthema, skin rash, diarrhoea, and mucocutaneous ulcerations. More rarely, oesophageal candidiasis, meningoencephalitis, rhabdomyolysis and epiglottitis have been reported. The diagnosis of the acute HIV infection syndrome can be established by demonstrating antibodies to HIV or by demonstration of HIV antigen positivity. Detection of virus through culture or PCR may prove to be more sensitive, but are not yet used as routine methods. The course of the primary infection has prognostic importance for the subsequent course of HIV infection. This probably reflects the importance of both the viral phenotype and of the initial immune response to HIV. Primary HIV infection should be considered in any patient with possible exposure to HIV presenting with fever of unknown cause.
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PMID:[Primary HIV infection]. 868 4


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