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

Adenotonsillar hypertrophy has been identified as an early manifestation of human immunodeficiency virus (HIV) disease. Three patients with HIV disease were identified with obstructive sleep apnea (OSA) due to adenotonsillar hypertrophy. In order to examine the relationship between HIV-induced adenotonsillar hypertrophy and OSA, 134 patients with asymptomatic HIV disease were screened with a self-administered sleep survey designed to detect OSA and excessive daytime somnolence. Patients meeting trigger score criteria were studied with overnight polysomnography and nine additional patients were identified with OSA. The only consistent risk factor for OSA in this young and primarily nonobese population was the presence of adenotonsillar hypertrophy, found in 11 of 12 patients with OSA. Three patients had tonsillar biopsy or tonsillectomy and all displayed benign follicular lymphoid hyperplasia. Scores on the Epworth Sleepiness Scale (ESS) were significantly higher for patients with OSA, indicating a greater degree of hypersomnolence (mean ESS scores: OSA+ = 11.4 +/- 3.6, OSA- = 7.8 +/- 4.6, p = 0.012). In our population, patients with HIV disease had a prevalence of OSA of 7%. HIV-induced adenotonsillar hypertrophy is a risk factor for the development of OSA. HIV patients with complaints of excessive daytime sleepiness and snoring who are found to have adenotonsillar hypertrophy on exam should undergo a sleep evaluation to rule out the presence of OSA.
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PMID:Obstructive sleep apnea in patients with human immunodeficiency virus (HIV) disease. 767 71

We report a 29-year-old HIV-positive patient admitted with dysarthria, ataxia and somnolence. Imaging findings were typical of Wernicke's encephalopathy, but autopsy revealed cytomegalovirus encephalitis and primary cerebral lymphoma.
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PMID:Cytomegalovirus encephalitis and primary cerebral lymphoma mimicking Wernicke's encephalopathy. 912 41

Thalidomide (alpha-N-phthalimidoglutarimide), a potent inhibitor of tumor necrosis factor alpha (TNF-alpha), is proving to be a promising drug in the treatment of a number of inflammatory, autoimmune, and HIV-associated disorders. The pharmacokinetics and hemodynamic effects of two single oral doses of thalidomide (100 and 200 mg) were investigated, using a randomized, two-period crossover design, in a group of asymptomatic, male HIV-seropositive subjects. Thalidomide pharmacokinetics were linear at the doses studied, and were best described by a one-compartment model with first-order absorption and elimination processes. The drug was rapidly absorbed, with a mean absorption half-life of 0.95 hr (range, 0.16-2.49 hr) and 1.19 hr (range, 0.33-3.53 hr) after 100- and 200-mg doses, respectively. The corresponding mean Cmax values were 1.15+/-0.24 microg/ml (100 mg) and 1.92+/-0.47 microg/ml (200 mg; p<0.001), which were achieved (Tmax) at 2.5+/-1.5 h and 3.3+/-1.4 hr, respectively. Plasma concentrations of thalidomide declined thereafter, in a log-linear manner, with elimination half-lives of 4.6+/-1.2 hr (100 mg) and 5.3+/-2.2 hr (200 mg). The apparent volumes of distribution (Vdss/F) were 69.9+/-15.6 liters (100 mg) and 82.7+/-34.9 liters (200 mg) while total body clearances (Cl/F) were 10.4+/-2.1 and 10.8+/-1.7 liters/hr, respectively. Significant dose-dependent decreases in supine systolic and diastolic blood pressures were seen for up to 2 hr postdosing; somnolence, headache, dizziness, and confusion were also reported more frequently at the higher dose of thalidomide.
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PMID:Pharmacokinetics and hemodynamic effects of single oral doses of thalidomide in asymptomatic human immunodeficiency virus-infected subjects. 1046 24

This study used the Symptom Experience dimension of the revised UCSF Symptom Management Conceptual model to examine correlates of sleep quality in HIV-infected persons. According to this model, person, health/illness, and environment categories influence perception of a symptom. The average person in the sample (N = 58) reported being HIV-infected for 8.5 years and was 46 years old, not working, and a person of color. Depending on the level of data, either chi square or Pearson correlations were computed between the person, health/illness, and environment categories and the dependent variable, sleep quality, as measured by the Pittsburgh Sleep Quality Index. Person variables significantly related to sleep quality were employment status, trait anxiety, and general well-being. Health/illness variables significantly related to sleep quality were length of time living with HIV disease and five health status measures (depressive symptoms, state anxiety, symptom severity, daytime sleepiness, and functional status). The environmental variables associated with sleep quality were sleeping alone, having a separate bedroom, and sleeping in a noisy room. Correlates of better sleep quality are positive general well-being, less anxious personality trait and emotional state, less daytime sleepiness, less depressive symptoms, and less symptom severity. Correlates of worse sleep quality are impaired functional status and longer duration of living with HIV disease.
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PMID:Correlates of sleep quality in persons with HIV disease. 1121 69

Thalidomide has been reported to be an effective therapy for painful oral (mouth) ulcerations associated with AIDS that do not respond to the usual treatment options available. Thalidomide was first developed and marketed in Germany in the 1950s as a sedative. It was withdrawn in 1962 when it was recognized to cause birth defects. Possessing no antibacterial activity, thalidomide is now used to treat a variety of diseases with an autoimmune character. It is unclear how it works to modulate the immune system or whether or not it will accelerate the deterioration of the immunological status of HIV-positive patients. One study suggests that it may suppress HIV viral replication and decrease viral burden. Thalidomide inhibits tumor necrosis factor (TNF). It affects the nervous system, often causing side effects such as drowsiness, dizziness, decreased libido and mood changes, as well as peripheral neuropathy. However, most of the neuropathy cases occurred in patients who had received a high dose for longer than six months. Response to thalidomide occurs at doses ranging from 100mg a day to 400 mg a day, with ulcer pain resolving within two to four days. Randomized placebo-controlled, double-blinded studies are needed to evaluate the efficacy of thalidomide in HIV-positive persons with aphthous ulcers. The AIDS Clinical Trials Unit is doing a six month study comparing thalidomide to placebo for treatment of aphthous ulcers of mouth and esophagus.
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PMID:Thalidomide: an alternative therapy for treatment of apthous ulcers (canker sores). 1136 97

Certain HIV drugs have significant side effects. There have been reports from Europe that some hemophiliacs using protease inhibitors suffered from spontaneous bleeding. Clofazimine, sold as Lamprene, has been shown to cause harm when used with clarithromycin and ethambutol to treat MAC. Lamprene may cause internal bleeding, nausea, diarrhea, dizziness, drowsiness, and dry skin. Results of a Taiwanese trial of thymosin-alpha indicate that it did not help treat Hepatitis B in a statistically significant way. NAC, an antioxidant, may increase glutathione levels and indirectly increase survival.
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PMID:Pot shots. 1136 15

Even with the introduction of highly active antiretroviral therapy (HAART), the expected eradication of HIV wasting syndrome has not materialized. Patients who gain weight on HAART seem to gain it as fat, with the body apparently unable to restore lean body mass, even with strenuous exercise programs. It may be that in addition to HAART, an anabolic or anti-inflammatory agent may be needed to reset body chemistry that was damaged by HIV. Serostim, Serono's brand of growth hormone, has been approved to treat wasting, and although it does seem to increase lean body mass and decrease fat in some patients, many patients were not compliant with taking the drug. Testosterone and anabolic steroids were also effective in causing weight gain. Thalidomide is being studied to attack the underlying cause of wasting, namely the overproduction of tumor necrosis factor alpha. In studying thalidomide, however, viral load went up slightly, and reduction of tumor necrosis factor levels was not documented; side effects included skin rash and sleepiness. Research is continuing in this area, with the need to use body composition measurements as a means to gain faster approval of therapies for wasting.
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PMID:No attrition in research on wasting therapies. 1136 78

Studies have found that people with HIV have significant reductions in S-adenosylmethionine (SAMe). SAMe is an important ingredient in reactions used to make a substance that holds myelin, the coating on nerve fibers, together. SAMe also has been shown to have value in treating fibromyalgia and Alzheimer's disease. The drug may have potential use in fighting liver disease as well by increasing glutathione production and reducing the symptoms of cholestasis. Methionine, a substance made into SAMe by the body, might help improve HIV-related myelopathy. A study is currently enrolling patients with HIV to evaluate methionine's effectiveness in treating myelopathy. Side effects of methionine include nausea, vomiting, drowsiness, and irritability. Contact information is provided.
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PMID:SAMe as it ever was? 1136 83

Fatigue, a common presenting complaint in primary care, is described as a lack of energy, sleepiness, tiredness, exhaustion, an inability to get enough rest, or weakness. Thus, fatigue affects quality of life. The prevalence rate of fatigue among patients with HIV infection is estimated to be 20% to 60%, and as the disease worsens, fatigue may become even more prevalent. The causes of HIV-related fatigue may be multifactorial and may include lack of rest or exercise, or improper or inadequate diet; psychological stress including depression and anxiety; the use of recreational substances; anemia; abnormalities of the thyroid gland and hypogonadism; infections; side effects of medications; sleep disturbances; and fever. This article reviews the common causes of HIV-related fatigue and briefly discusses options for reducing fatigue.
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PMID:Assessment and treatment of HIV-related fatigue. 1156 35

Thalidomide, administered as a sedative and antiemetic decades ago, was considered responsible for numerous devastating cases of birth defects and consequently was banned from markets worldwide. However, the drug remarkably has resurfaced with promise of immunomodulatory benefit in a wide array of immunologic disorders for which available treatments were limited. It is approved by the Food and Drug Administration for erythema nodosum leprosum (ENL). Although the relative paucity of leprosy and ENL worldwide may perceivably limit interest in and knowledge about thalidomide, increasing numbers of new and potential uses expand its applicability widely beyond ENL. Thalidomide, an inhibitor of tumor necrosis factor a, is the best known agent for short-term treatment of ENL skin manifestations, as well as postremission maintenance therapy to prevent recurrence. For this indication, it is effective as monotherapy and as part of combination therapy with corticosteroids. Studies of thalidomide in chronic graft-versus-host disease showed benefit in children and adults as treatment, but not as prophylaxis. The agent has been administered successfully for treatment of cachexia related to cancer, tuberculosis, and human immunodeficiency virus infection, although evidence of efficacy is inconclusive. Thalidomide monotherapy effectively induced objective response in trials in patients with both newly diagnosed and advanced or refractory multiple myeloma. Combination therapy with thalidomide and corticosteroids was also effective in these patients, as well as in treatment of aphthous and genital ulcers. Limited evidence supports the drug's benefit in treatment of Kaposi's sarcoma. Other thalidomide applications include Crohn's disease, rheumatoid arthritis, and multiple sclerosis. Somnolence, constipation, and rash were the most frequently cited adverse effects in studies, but thalidomide-induced neuropathy and idiopathic thromboembolism were critical causes for drug discontinuation. Thalidomide is still contraindicated in pregnant women, women of childbearing age, and sexually active men not using contraception. Clinicians should be conversant with thalidomide in ENL (its primary application) in the natural course of leprosy, as well as in the agent's other applications.
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PMID:Thalidomide for erythema nodosum leprosum and other applications. 1268 Apr 78


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