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)

Our objective was to evaluate the effect of rifabutin prophylaxis in patients with AIDS and CD4 counts of less than 200 per cubic millimetre using a combination of Q-TWiST (quality-adjusted time without symptoms and toxicity) and multiattribute health utility assessment. The design consisted of a secondary analysis of two previously reported multicentre, randomized, placebo-controlled clinical trials conducted in 78 academic, community and Department of Veterans Affairs HIV centres and private practices. 542 patients with AIDS and CD4 counts of less than 200 per cubic millimetre were assigned to rifabutin 300 mg/day and 562 were assigned to a placebo. A modified Q-TWiST approach was used for comparing treatments based on the occurrence and duration of time with and without severe symptoms and clinical endpoints. Health states were constructed to represent combinations of clinical events experienced by study patients. Five physicians assigned utilities for health states using a six-attribute health classification system. These utilities were used to adjust survival for QOL. The rifabutin and placebo groups were compared using estimated quality-of-life-adjusted days. The incidence of MAC was 9% for the rifabutin group and 18% for the placebo group (p < 0.001). Differences, although not statistically significant, were observed for rates of survival and hospitalization. The rifabutin group experienced less anaemia (p < 0.02), and fever and night sweats (p < 0.02) than the placebo group. Average Q-TWiST days were 325 for the rifabutin group and 309 for the placebo group (p < 0.05). Q-TWiST days were significantly lower for patients with MAC bacteraemia (p < 0.04) and hospitalizations (p < (0.003). Rifabutin prophylaxis resulted in fewer MAC infections and greater quality-of-life-adjusted days of survival compared to no rifabutin. Quality-of-life-adjusted survival, based on a combination of the Q-TWiST and multiattribute health utility index, is a feasible approach for evaluating the outcomes of medical treatment. Future studies should, however, use patient-assigned utility weights to compute Q-TWiST scores, since physician generated utilities may differ significantly from those of patients.
 ...
PMID:Evaluating the quality of life associated with rifabutin prophylaxis for Mycobacterium avium complex in persons with AIDS: combining Q-TWiST and multiattribute utility techniques. 755 Jan 79

A 1994 study reported on cases of drug-resistant tuberculosis (TB) at the Chest Service at Bellevue Hospital, in New York City. 20 years of TB laboratory susceptibility tests were reviewed in 4681 cases. Combined resistance to isoniazid and rifampicin rose from 2.5% in 1971 to 16% in 1991. Over 75% of these cases in 1991 were resistant to rifampicin, isoniazid, streptomycin, and ethambutol. Most of the patients belonged to one or more of the following groups: young, Black or Hispanic, unemployed, homeless, male, HIV-infected, and drug abuser. Clinical characteristics were: anergy, fever, cough, night sweats, weight loss, radiograph bilateral infiltrates, adenopathy, cavities, miliary shadowing, and normal chest radiograph. Overall, in 1993 in the US, 3% of all new cases and 6.9% of recurrent cases were resistant to both rifampicin and isoniazid. This resurgence of TB in industrialized countries has been ascribed to: 1) immigration of foreign populations at high risk of developing TB, 2) coinfection with HIV, and 3) an increase in high risk groups. The WHO stresses the importance of identifying meaningful denominators when discussing both primary and acquired drug resistance rates. Restriction fragment length polymorphism (RFLP) is the molecular technique that differentiates individual strains of Mycobacterium tuberculosis. Three recent studies from New York used RFLP to demonstrate the clustering of multidrug-resistant TB. Solutions to the problem consist of adequate infrastructure, i.e., a national TB program; prescription of combined preparations; inducement or enforcement of compliance using directly observed therapy (DOT) (a DOT protocol employed in Denver, Colorado, used 2 weeks of therapy followed by 24 weeks of twice weekly intermittent therapy); prevention of nosocomial spread by isolation of smear-positive cases during the first 2 weeks of treatment; rapid diagnosis of TB and drug susceptibility (within 10-21 days using radiometric culture, nucleic acid probes, and high performance liquid chromatography of mycolic acids); and treatment by five or six drugs.
 ...
PMID:Escalating threat from tuberculosis: the third epidemic. 757 Apr 62

Symptoms of Human Immunodeficiency Virus (HIV) infection and somatic symptoms of depression overlap, confounding clinical assessments of persons with HIV infection. This research examined the extent of this confounding. In Study 1, 71 persons with HIV infection demonstrated high rates of depression on the Beck Depression Inventory (BDI). However, depression scores correlated with symptoms of HIV infection. In Study 2, 63 persons with HIV infection also demonstrated high rates of depression on the BDI, and depression was again related to symptoms of HIV disease; specifically, persistent fatigue, diarrhea, night sweats, and muscle aches. Principal component factor analyses demonstrated that somatic symptoms of depression were closely associated with number of Acquired Immunodeficiency Syndrome diagnoses, number of HIV-related symptoms, and inversely related to number of T-helper cells. In contrast, cognitive-affective depression was most closely related to anxiety, hypochondriasis, and number of months since tested HIV positive. Results support the conclusion that depression scores require differential interpretations at different stages of HIV disease and that persons who have experienced HIV-related symptoms only be assessed for depression using instruments void of somatic symptoms.
 ...
PMID:Assessing persons with human immunodeficiency virus (HIV) infection using the Beck Depression Inventory: disease processes and other potential confounds. 787 94

Infection due to the Mycobacterium avium complex (MAC) is the most common opportunistic disease of bacterial origin among patients with AIDS in the United States. The incidence of disseminated disease due to MAC (DMAC) has risen dramatically in recent years. The risk of developing DMAC increases as the CD4+ lymphocyte count declines to < 100/mm3. Preliminary analyses of several studies suggest that gender, racial or ethnic group, and individual risk factors for human immunodeficiency virus infection do not influence the incidence of DMAC but that prior Pneumocystis carinii pneumonia, the development of severe anemia, or the interruption of antiretroviral therapy may increase risk. Both the respiratory and the gastrointestinal tracts probably serve as portals of entry for MAC. Colonization may potentiate the risk of DMAC but does not always precede dissemination. Patients with AIDS and DMAC have a shorter duration of survival than do those with AIDS but without DMAC. While treatment for DMAC may extend survival, no well-controlled, prospective, randomized clinical trial has documented this point. Most patients with AIDS and DMAC have disseminated multiorgan disease; the most frequently described symptoms include fever, night sweats, weight loss or wasting, diarrhea, and abdominal pain. The most commonly identified laboratory abnormalities are anemia and elevated serum levels of alkaline phosphatase. Localized disease syndromes related to MAC infection occur less often.
 ...
PMID:Disease due to the Mycobacterium avium complex in patients with AIDS: epidemiology and clinical syndrome. 820 73

Beginning in January 1989, consecutive female admissions to the ARTC MMTP Clinics in NYC were interviewed about their medical, drug, sexual and social experiences during 6 distinct historical years. Bloods were drawn and each sample tested for HIV via ELISA and Western Blot analysis. The data for 256 females was analyzed. The sample was predominantly Black (56%) and Hispanic (36%). Fifty-four percent (140) were between the ages of 31 and 40; 35% (91) were between the ages of 18 and 30; and 10% (27) were 41 or older. The majority, 179 (69%), had less than a high school education, while 79 (31%) had a high school education or greater. The seropositivity for this sample of females was 60.4%. Aside from the common types of illnesses often seen in gay men infected with the HIV virus (i.e., pneumonia, night sweats, sore throat and swollen glands) our sample of females presented with symptoms such as abnormal discharges from the vagina, infections or abscesses of the veins, kidney or bladder infections, bleeding from the bowels and hepatitis infections. The most commonly reported risk factors among our sample of HIV positive females were sharing injecting materials (38%); injecting drugs in the veins (37.2%); dividing an injection (24.3%); and blood transfusions (10.9%). Of our HIV positive females, 42 of 97 (43.3%) reported having sex with a man they shared needles with only one time so that having sex with a man who is potentially infected with the HIV virus only once may be enough for a female to seroconvert. One limitation of this data is that there is no knowledge of when the HIV positive women seroconverted. Some of the behaviors reported could be due to exposure to AIDS education, and not to the knowledge to their HIV serostatus.
 ...
PMID:Demographic, medical history and sexual correlates of HIV seropositive methadone maintained women. 829 33

We investigated the long-term health effects of HIV-1 infection in homosexual men not close to developing AIDS by comparing 916 HIV-1-seropositive (SP) men at least 1.67-3.67 years prior to a clinical AIDS diagnosis to 2,161 HIV-1-seronegative (SN) controls. The SP group reported a higher total of 12 distinct symptoms (fatigue, shortness of breath, night sweats, rash, cough, diarrhea, headache, thrush, skin discoloration, fever, weight loss, and sore throat/mouth) than did the SN group (p < 0.0001), corresponding to at least 5.6 more days/year of such symptoms. The SP group had lower body mass index (p < 0.0001) and lower hemoglobin (p < 0.0001). The SP group was more depressed, as measured by CES-D score (p = 0.047), before knowledge of one's serostatus was likely, and became even further depressed (p = 0.038 for increase in depression) after the HIV-1 serostatus test was accessible to high-risk groups. These associations remained unchanged in multivariate models, incorporating other covariates.
 ...
PMID:Signs and symptoms of "asymptomatic" HIV-1 infection in homosexual men. Multicenter AIDS Cohort Study. 826 59

Atypical pulmonary manifestations of Pneumocystis carinii infection and fair numbers of extrapulmonary and disseminated infections have lately been documented in patients with human immunodeficiency virus infection treated prophylactically with inhalative pentamidine. We report the case of a 32-year-old homosexual patient who was assessed for complaints of night sweats, weight loss, and progressive malaise. The patient denied any respiratory tract symptoms such as cough, sputum production, pleuritic chest pain, or shortness of breath. Chest X-ray revealed two large round noncavitating lesions in the lower lobe of the right lung. Pneumocystomas were diagnosed by fine-needle aspiration. A 3-week course of intravenous high-dose cotrimoxazole resulted in amelioration of symptoms but no change in the radiographic appearance of the pulmonary lesions. Four months later the patient is alive and stable and is being treated with pentamidine inhalation of 300 mg per 2 weeks and two tablets of pyrimethamine sulfadoxine per week.
 ...
PMID:A novel variety of atypical Pneumocystis carinii infection after long-term prophylactic pentamidine inhalation in an AIDS patient: large lower lobe pneumocystoma. 847 17

A 27-year old female from Nairobi was admitted to the medical wards of the Kenyatta National Hospital in May 1991. She presented with a 4-week history of productive cough, fever, weight loss, and night sweats. She acknowledged a history of contact with a patient known to have pulmonary tuberculosis. She has never received a blood transfusion. She was single and para 3 + 0. Examination revealed a sick patient, with moderate pallor, fever of 38 degrees Celsius, and who was wasted with moderate dehydration and oral thrush. There was no finger clubbing, lymphadenopathy, or pedal edema. Chest examination revealed bilateral basal pneumonia. The spleen was palpable 4 cm below the costal margin; the liver was not enlarged. The rest of the examination was normal. On admission, complete blood count showed a haemoglobin of 5.4 g/dl, total white cells were 12.5 x 10-9/L, with 82% polymorphonuclear cells and 18% lymphocytes, erythrocyte sedimentation rate (ESR) was 85 mm/hour, and platelet count was normal. The anemia was normocytic, normochromic, and no malaria parasites were seen. Urea and electrolytes and liver function tests were normal. Sputum showed no acid fast bacilli on Ziel-Neelson Stain. HIV-1 antibodies were positive by enzyme-linked immunosorbent assay (ELISA) and Western blot. Bone marrow aspirate revealed a hypercellular marrow with reversed M:E ration, dyserythropoesis, reticulum cell hyperplasia, plentiful golden yellow pigment, and clumps of Histoplasma capsulatum. Chest X-ray showed bilateral basal pneumonia. She was treated with antibiotics and intravenous fluids, but she remained febrile, her general condition progressively deteriorated, and she died a week after admission. Treatment for histoplasmosis had not been commenced, and no postmortem examination was carried out.
 ...
PMID:Disseminated histoplasmosis in a patient with acquired immunodeficiency syndrome (AIDS): a case report. 851 33

All patients with a positive reaction to the tuberculin skin test should be evaluated for weight loss, night sweats, fever, chronic cough and other signs of active tuberculosis. Chest radiographs should also be obtained in these patients. All converters receiving isoniazid should be examined monthly for signs of hepatitis and neurotoxicity. Liver function tests should be obtained at initiation of isoniazid therapy and again during the first two to four months in patients age 35 or older or with a history of alcoholism, liver disease or intravenous drug use. All cases of active tuberculosis should be reported to the local public health department. Most patients with active tuberculosis should receive isoniazid, rifampin, ethambutol and pyrazinamide daily for two weeks, followed by directly observed administration twice weekly for six additional weeks. If sputum cultures show no resistance after two months of therapy, pyrazinamide and ethambutol may be discontinued, with isoniazid and rifampin taken for an additional 16 weeks. Patients with human immunodeficiency virus infection or acquired immunodeficiency syndrome should receive the initial treatment for at least nine to 12 months, and isoniazid and rifampin for at least six months after culture conversion has occurred.
 ...
PMID:Outpatient management of tuberculosis. 862 77

The Pulmonary Complications of HIV Infection Study is a prospective, multicenter, observational study evaluating pulmonary disease among HIV-infected persons. For approximately 52 mo, 1,182 HIV-infected subjects were followed. All participants were evaluated for pulmonary disease on a predetermined schedule. There were 145 episodes of Pneumocystis carinii pneumonia (PCP). Low CD4 count correlated with risk of PCP (p < 0.0001); 79% had CD4 counts less than 100/microl and 95% had CD4 counts less than 200/microl. Subtle changes in diffusing capacity for carbon monoxide (DLCO) were associated with PCP. Univariate analysis identified recurrent undiagnosed fevers, night sweats, oropharyngeal thrush, and unintentional weight loss to be associated with risk among persons with CD4 counts above 200/microl. Subjects in whom CD4 counts declined to below 200/microl and who were not receiving preventive therapy were nine times more likely to develop PCP within 6 mo compared with subjects who received such therapy. A strong trend toward differences between the sexes was detected. Black subjects had less than one third the risk of developing PCP as did white subjects (p < 0.0001). There was no significant difference in risk by HIV transmission category, study site, frequency of follow-up, age, education, smoking history, or use of antiretroviral therapy. Multivariable analysis revealed low CD4 lymphocyte count (p < 0.0001), use of prophylaxis (p < 0.0001), racial differences (p < 0.0001), and declining DLCO (p = 0.015) to influence risk. Constitutional signs and symptoms indicate increased risk for PCP among HIV-infected persons with CD4 counts above 200/microl.
 ...
PMID:Predictors of Pneumocystis carinii pneumonia in HIV-infected persons. Pulmonary Complications of HIV Infection Study Group. 900 Dec 90


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