Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019693 (HIV)
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This descriptive study assessed 34 caregivers of people with HIV/AIDS to learn their perceived needs, concerns, and use of services. Results indicated the most common health problems of the care recipient were fatigue and weight loss; care recipients needed help with climbing stairs, walking, and bathing; caregivers helped with the household chores, transportation, and companionship; caregivers were concerned about coping with loss and responsibilities; caregivers had help from family, case manager, and neighbor; caregivers wanted help such as a companion and counseling. Discussion relates to the implications of the study for health care professionals.
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PMID:Needs assessment of caregivers of people with HIV/AIDS. 924 71

1. Fatigue is a real symptom of HIV infection, and up to two thirds of clients with HIV report symptoms of depression. 2. Depression and fatigue, besides being closely related in HIV cases, have an adverse effect on quality of life. 3. Treating depression and underlying causes of fatigue will improve the quality of life for patients with HIV, who now have an extended life span.
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PMID:Fatigue, depression, and quality of life in HIV-positive men. 929 63

People with HIV or AIDS who are experiencing pain, fatigue, sexual dysfunction, bowel and bladder dysfunction, and self-care deficits are being cared for by rehabilitation nurses in the home setting. The home care rehabilitation nurse provides instruction and care to clients, their families, and caregivers regarding physical manifestations of the disease and issues such as the importance of involving the client in household activities and activities of daily living. In addition to working with an interdisciplinary team to meet clients' needs, home care rehabilitation nurses work and consult with the generalist nursing staff to offer recommendations about rehabilitation nursing care for clients with HIV or AIDS.
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PMID:The rehabilitation nurse in the home care setting: care of the client with HIV or AIDS. 934 44

The combination of abnormally low plasma cystine and glutamine levels, low natural killer (NK) cell activity, skeletal muscle wasting or muscle fatigue, and increased rates of urea production defines a complex of abnormalities that is tentatively called "low CG syndrome." These symptoms are found in patients with HIV infection, cancer, major injuries, sepsis, Crohn's disease, ulcerative colitis, chronic fatigue syndrome, and to some extent in overtrained athletes. The coincidence of these symptoms in diseases of different etiological origin suggests a causal relationship. The low NK cell activity in most cases is not life-threatening, but may be disastrous in HIV infection because it may compromise the initially stable balance between the immune system and virus, and trigger disease progression. This hypothesis is supported by the coincidence observed between the decrease of CD4+ T cells and a decrease in the plasma cystine level. In addition, recent studies revealed important clues about the role of cysteine and glutathione in the development of skeletal muscle wasting. Evidence suggests that 1) the cystine level is regulated primarily by the normal postabsorptive skeletal muscle protein catabolism, 2) the cystine level itself is a physiological regulator of nitrogen balance and body cell mass, 3) the cyst(e)ine-mediated regulatory circuit is compromised in various catabolic conditions, including old age, and 4) cysteine supplementation may be a useful therapy if combined with disease-specific treatments such as antiviral therapy in HIV infection.
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PMID:Role of cysteine and glutathione in HIV infection and other diseases associated with muscle wasting and immunological dysfunction. 936 43

Recent advances in our understanding of the pathogenesis of human immunodeficiency virus (HIV) disease and the important role that viral load plays in the initial selection of antiretroviral therapy significantly alters our management of this disease. Guidelines from the British HIV Association, International AIDS Society-USA, and United States Public Health Service panels regarding the selection of appropriate antiretroviral therapy, and from the Centers for Disease Control and Prevention on prophylaxis for opportunistic infections, have recently been published. Despite tremendous advances in treating the disease and its related complications, a comprehensive, long-term disease management plan that includes recognition of patient concerns about quality of life is lacking. New approaches to managing HIV disease must now include strategies that address patient concerns about fatigue, gastrointestinal distress, malnutrition, and weight loss. Patients must become more involved in decisions about selection of specific drugs and drug regimens and must be consulted about their expectations and needs. We have made significant strides in the treatment of HIV disease. We can readily reduce the viral burden to virtually undetectable levels, and we must continue to develop even more potent and tolerable treatment regimens. We can make patients live longer. Helping patients live better quality lives deserves further study.
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PMID:HIV infection and AIDS: new biology, therapeutic advances, and clinical implications. Introduction. 938 14

Fatigue is a common and troubling symptom in patients with cancer or HIV/AIDS, resulting in significant disability and adverse effects on quality of life. Its etiology remains complex and is most likely multifactorial. Despite its impact and prevalence, fatigue is often overlooked and undertreated in these patient populations. The general perceptions of fatigue are that its etiology cannot be determined, it is an inevitable manifestation that must be endured, and few interventions are available. Efforts are ongoing to better understand the etiology, characteristics, and consequences of fatigue in patients with cancer or HIV/AIDS. New practical methods of assessing it in cancer patients are now available. In order to improve the quality of life in these patients, physicians need to reassess their perceptions of fatigue and their approach to its diagnosis and management. There are recognizable causes and correlates for which interventions can be beneficial. These include anemia, pain, infection/fever, hormonal or nutritional deficiencies, depression/anxiety, sleep disturbances, and excessive inactivity or rest. Physicians should fully evaluate patients to identify the factors amenable to management. Fatigue is also seldom discussed by patients and their physicians. Improved communication with and counseling of patients and their caregivers can play an important role in the effective assessment and management of fatigue in patients with cancer or HIV/AIDS. Many patients may benefit from wider implementation of recent advances in the understanding and treatment of fatigue in these oncologic and infectious conditions.
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PMID:Fatigue in cancer and HIV/AIDS. 953 84

Although enthusiasm for measuring health-related quality of life (HRQL) in clinical trials exists, information is limited on the meaning of scores. We examined the relation between scores from the 34-item Medical Outcomes Study HIV Health Survey (MOS-HIV) and the more detailed HIV Overview of Problems-Evaluation System (HOPES) using the responses of 318 HIV-infected outpatients being treated in Los Angeles and Baltimore. With the HOPES problem statements as independent variables, statistically significant predictors of the variation in MOS-HIV scores for the Physical Function, Mental Health, and Energy/Fatigue scales were identified using stepwise regression. Approximately 60% to 70% of the variation in each of the scores was explained by five to seven different HOPES problem statements, with a single item explaining 47% to 59% of the variation. We created illustrative profiles for each of the three MOS-HIV scales using the HOPES items identified in the regressions. Independent of the scale, persons scoring in the top MOS-HIV quartile tended to report few if any problems, whereas a decline in score to the next quartile was characterized by functional difficulties (e.g., "HIV interferes with work"). The onset of specific problems might trigger further evaluation and potential intervention from health care providers to help maintain patient functioning.
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PMID:Toward a better understanding of health-related quality of life: a comparison of the Medical Outcomes Study HIV Health Survey (MOS-HIV) and the HIV Overview of Problems-Evaluation System (HOPES). 956 46

Lower extremity symptoms are caused by lesions at any level of the neuraxis, from cortex to muscle. HIV affects virtually every level of the nervous system, either directly or indirectly. The presence of pathology at multiple levels and by multiple processes further complicates the bedside diagnosis of a patient with AIDS and neurologic symptoms. Many neuropathies and other conditions that affect the lower extremities can be identified with careful history and physical examination, confirmed with limited testing, and can be treated successfully. Distal symmetric polyneuropathy is the most common lower extremity disorder, but it must be distinguished from similar-appearing neuropathies caused by medications, B12 deficiency, or vasculitis. Diffuse infiltrative lymphocytosis syndrome also causes a painful peripheral neuropathy that must be distinguished from distal symmetric polyneuropathy. Inflammatory demyelinating polyneuropathies are characterized by muscle weakness. They occur in early, asymptomatic HIV infection and respond to plasmapheresis or steroids. Mononeuropathies in patients with CD4 counts more than 200 often resolve on their own. Multiple mononeuropathies, which occur in patients with CD4 counts less than 50, are often associated with cytomegalovirus infection and may follow a rapidly progressive course unless treated promptly and aggressively. Progressive polyradiculopathy occurs late in the course of AIDS, is often caused by cytomegalovirus, is rapidly progressive, and generally is fatal unless recognized and treated promptly. Muscle weakness, myalgia, and fatigue are common in HIV and have multiple causes. Lower extremity spasticity may be caused by treatable etiologies such as spinal cord abscess, tumor, disc compression, B12 deficiency, or ischemia. Gait disturbances are common but nonspecific and may be caused by treatable neurologic disorders at any level of the neuraxis.
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PMID:Neurologic problems of the lower extremity associated with HIV and AIDS. 957 54

Abacavir is a nucleoside analogue reverse transcriptase inhibitor that inhibits clinical isolates of HIV in vitro with a potency similar to that of zidovudine. Resistance to abacavir develops relatively slowly. Cross-resistance between abacavir and didanosine, zalcitabine or lamivudine, but not zidovudine or stavudine, has been reported in vitro. Abacavir has good oral bioavailability, as demonstrated in animals, and penetrates the CNS. Treatment with abacavir, alone or in combination with other anti-HIV agents (zidovudine, lamivudine, nevirapine, amprenavir and/or other protease inhibitors), decreased viral load and increased CD4+ cell count in patients with HIV infection. Effectiveness was maintained for at least 48 weeks. In early phase I/II trials, headache, gastrointestinal disturbances, rash, malaise, fatigue and/or asthenia were the most common adverse events reported with abacavir alone or in combination with other anti-HIV agents. Hypersensitivity reactions lead to discontinuation of therapy in 2 to 3% of patients.
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PMID:Abacavir. 958 69

Malnutrition and weight loss are clinically significant complications of both human immunodeficiency virus (HIV) infection and cancer. Over the last two decades, multiple abnormalities in energy and protein metabolism have been documented in patients with cancer and, more recently, in HIV infection. In HIV infection, studies of the components of energy balance have demonstrated that weight loss results primarily from decreased energy intake, coupled with a failure to consistently reduce resting energy expenditure. Although several studies have shown that resting energy expenditure is elevated in many patients with HIV infection, other studies have shown that not all patients with HIV infection are hypermetabolic. Likewise, protein turnover is increased, decreased, or unchanged in patients with HIV infection and varies with the physiologic state of the patient. In cancer patients, studies of resting energy expenditure have produced similarly varying results, depending in part on tumor type and dietary intake. Protein turnover studies in patients with cancer suggest that support of the tumor may occur at the expense of host skeletal muscle. Abnormalities of glucose and lipid metabolism have been noted as well. Thus, pharmacologic intervention may be needed to restore weight and lean tissue in patients with weight loss associated with either HIV infection or cancer.
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PMID:Energy expenditure and protein metabolism in human immunodeficiency virus infection and cancer cachexia. 962 89


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