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

A substantial body of evidence provides support (but not definitive proof of efficacy) for the use of antiretroviral agents as postexposure prophylaxis for occupational exposures to HIV in the healthcare workplace. Despite the lack of definitive evidence of the efficacy of these agents in this setting, over the past decade this intervention has become the standard of care for healthcare workers who sustain occupational exposures to HIV. Administration of these agents--even for a relatively short 28-day postexposure course--is often fraught with difficulty. All of the agents currently used for postexposure prophylaxis regimens have substantial adverse effects, and significant adverse effects occur in more than two-thirds of individuals electing prophylaxis. This manuscript reiterates current US Federal Government guidelines for the administration of postexposure prophylaxis, specifically noting that zidovudine plus lamivudine (with or without a protease inhibitor) remains the recommended regimen. The paper summarises the significant toxicities associated with nucleoside reverse transcriptase inhibitors (primarily nausea, vomiting, diarrhoea and bone marrow suppression), non-nucleoside reverse transcriptase inhibitors (rash, fever, gastrointestinal symptoms and hepatitis, including hepatic decompensation necessitating liver transplantation) and protease inhibitors (nausea, vomiting, diarrhoea, abdominal pain, hyperglycaemia, hyperlipidaemia, headache and anorexia). As a class, the antiretroviral agents have an extraordinary number of drug interactions. The non-nucleoside reverse transcriptase inhibitors and the protease inhibitors are metabolised through the cytochrome P450 pathway, and the effects of concomitant administration of protease inhibitors with other agents in the same class are discussed, as well as the effects of concomitant administration of protease inhibitors with non-nucleoside agents. The potential for numerous and medically risky drug interactions emphasises the importance of planning antiretroviral prophylaxis in consultation with practitioners or clinical pharmacists who are skilled in the use of these agents and knowledgeable about the potential for significant drug interactions that could either reduce the benefit of prophylaxis or increase the potential for toxicity. Another common problem encountered by individuals managing postexposure prophylaxis programmes relates to the administration of chemoprophylaxis to a pregnant healthcare worker who has sustained an occupational exposure to HIV. We address what is known about the potential for toxicity and emphasise the recently published warning concerning the deaths of pregnant women and their offspring from lactic acidosis while receiving regimens containing stavudine and didanosine.
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PMID:Tolerability of postexposure antiretroviral prophylaxis for occupational exposures to HIV. 1148 Apr 91

Antiretroviral compounds differ from most other new pharmaceutical agents in that they have become widely prescribed in pregnancy in the absence of proof of safety. They are prescribed for the treatment of the mother and to reduce the risk of transmission of HIV to the fetus. In the animal models tested to date, no increased risk of malformations has been demonstrated for some compounds whereas others have been associated with malformations or developmental abnormalities in rats, mice or rabbits and, in the case of efavirenz, monkeys. Zidovudine monotherapy is still prescribed to reduce the risk of mother-to-child transmission of HIV. Combinations of 3 or more compounds are recommended when treatment of the mother is deemed necessary because of advanced HIV infection. Until recently, in vitro toxicity studies relevant to pregnancy were restricted to single agents; no animal teratogenicity or carcinogenesis studies of combination therapy have been published. Despite many thousands of women having taken antiretroviral therapy to reduce the risk of transmission, documented experience in human pregnancy remains sadly lacking, with the possible exception of zidovudine which has been prescribed in clinical trials to several hundred mother-infant pairs. For other compounds and for the numerous permutations of combination therapy, data are available only from small phase I/II studies, from retrospective investigations and from the prospective arm of the Antiretroviral Pregnancy Register (i.e. pregnancies in women taking antiretrovirals who were registered before delivery and then followed up). Antiretroviral monotherapy and combination therapy is widely prescribed in pregnancy because: (i) with appropriate management, which includes antiretroviral therapy, the risk of mother-to-child transmission can be reduced from 15 to 25% to less than 1%; (ii) pregnant women with advanced HIV infection require therapy; (iii) combination therapy with at least 3 compounds significantly reduces morbidity and mortality compared with dual or monotherapy; and (iv) the benefits of therapy for both the mother and the infant outweigh the risk. The choice of antiretroviral therapy in pregnancy may be influenced by the indication (prevention of transmission or maternal treatment), past antiretroviral therapy exposure/drug resistance, effects of pregnancy on the pharmacokinetics of the drug and factors influencing tolerability and adherence. In pregnancy, tolerability may be even more important than usual, especially if therapy exacerbates common complications of pregnancy, such as vomiting and glucose intolerance.
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PMID:Antiretroviral therapy in pregnancy: a focus on safety. 1152 21

We report a 40-year-old man with sloughing off of the colonic due to tuberculous associated with HIV infection. He presented with lump in the abdomen, distention and vomiting suggestive of intestinal obstruction. Proximal loop ileostomy with closure of colonic perforation was performed, with good recovery. This was followed by antitubercular chemotherapy.
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PMID:Colonic wall necrosis due to tuberculosis in HIV-seropositive patient. 1167 35

We evaluated generic sodium stibogluconate (SSG) (International Dispensary Association, Amsterdam) versus Pentostam (sodium stibogluconate, GlaxoWellcome, London) under field conditions in Ethiopian patients with visceral leishmaniasis (VL; kala-azar). The 199 patients were randomly assigned to Pentostam (n = 104) or SSG (n = 95) in 1998/99; both drugs were given at 20 mg/kg intra-muscularly for 30 days. A clinical cure after 30-days treatment was achieved in 70.2% (Pentostam) and 81.1% (SSG). There were no significant differences between the 2 drugs for the following parameters: frequency of intercurrent events (vomiting, diarrhoea, bleeding or pneumonia) or main outcome (death during treatment and death after 6-month follow-up; relapse or post kala-azar dermal leishmaniasis at 6-months follow-up). Twenty-seven patients had confirmed co-infection with HIV. On admission, HIV co-infected VL patients were clinically indistinguishable from HIV-negative VL patients. The HIV co-infected VL patients had a higher mortality during treatment (33.3% vs 3.6%). At 6-month follow-up, HIV-positive patients had a higher relapse rate (16.7% vs 1.2%), a higher death rate during the follow-up period (14.3% vs 2.4%), and more frequent moderate or severe post kala-azar dermal leishmaniasis (27.3% vs 13.3%). Only 43.5% of the HIV-positive patients were considered cured at 6-months follow-up vs 92.1% of the HIV-negative patients. HIV-positive patients relapsing with VL could become a reservoir of antimonial-resistant Leishmania donovani.
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PMID:Ethiopian visceral leishmaniasis: generic and proprietary sodium stibogluconate are equivalent; HIV co-infected patients have a poor outcome. 1181 42

Anti-retroviral therapy has still many difficulties for the continuous viral suppression, although it has markedly improved the prognosis of the patients with HIV/AIDS. It is essential that anti-retroviral therapy requires strict adherence of the patients. More than 95% of adherence to have medicine is required for the success of the therapy. Severe and frequent adverse reactions, many pill burden, food restriction and patients' poor recognition to the therapy influence adherence. Of those, adverse reaction of the drugs is the strongest factor for disturbing adherence. Digestive tract symptoms such as nausea, vomiting, abdominal pain and/or diarrhea are common and affect to reduce adherence. Recently, lactic acidosis/hepatic steatosis and lipodystrophy syndrome have been recognized as novel and important adverse reactions with anti-retroviral medicines. Physicians should be aware of the importance of adherence, and assist the patients to improve it with multiple approaches.
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PMID:[Challenges of the anti-retroviral therapy]. 1196 83

The purpose of this study was to explore HIV/AIDS patients' symptom experiences and self-care symptom management strategies using a semi-structured questionnaire. Concurrently, the investigators gathered information about patients' symptom management strategies from healthcare providers. A total of 134 HIV-infected persons and 31 healthcare providers voluntarily participated in this study. Nausea, pain, anxiety, vomiting, diarrhea, fear and lack of appetite were described frequently by HIV-infected participants. Nausea, anxiety, diarrhea, fever, fear, pain and vomiting were observed frequently by healthcare providers. The management strategies used by these patients are presented and the differences in findings between Taiwan and Western cultures are discussed. In general, the results indicated that healthcare providers hold limited knowledge about self-care symptom management of HIV/AIDS. Filling this knowledge gap is an essential task for all healthcare providers in Taiwan.
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PMID:Symptom management in Taiwanese patients with HIV/AIDS. 1199 99

We evaluated the association between the severity of primary human immunodeficiency virus type 1 (HIV-1) illness and HIV-1 plasma virus load before seroconversion using stored plasma samples obtained from 74 prostitutes in Mombasa, Kenya. Fever, vomiting, headache, fatigue, arthralgia, myalgia, sore throat, skin rash, or being too sick to work were each associated with significantly higher virus loads before HIV-1 seroconversion, and each additional symptom or sign was associated with an increase in virus load of 0.4 log(10) copies/mL.
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PMID:Virus load during primary Human Immunodeficiency Virus (HIV) type 1 infection is related to the severity of acute HIV illness in Kenyan women. 1206 Aug 78

Pyrimethamine is used for the treatment of toxoplasmosis and the prophylaxis of malaria. Among the well-documented side effects are megaloblastic anemia, leukopenia, thrombopenia, rash, vomiting, and diarrhea. Hyperpigmentation is a very rare side effect. In some patients, associated HIV infection makes it difficult to distinguish the reasons for the etiology. We herein describe an HIV-negative patient who developed hyperpigmentation after pyrimethamine use.
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PMID:Hyperpigmentation due to pyrimethamine use. 1218 45

50 children under the age of 15 years were studied who had been hospitalized in two hospitals in the Dominican Republic with HIV diagnosed by the presence of biphasic hyperbilirubinemia and elevation of glutamic-pyruvic and glutamic-oxalacetic transaminases. The sera of the patients were examined for the presence of leptospirotic immunoglobulin M (IgM) antibodies by means of the enzymatic immunoassay method (UREASA-ELISA). The Leptospira-positive sera were also investigated for the presence of hepatitis B surface antigen (HBsAg) and for the IgM antibody (ab) of the hepatitis A virus (ab-HAV) by ELISA. 5 cases were positive for IgM Leptospira antibodies (10%), not finding in this percentage the presence of HBsAg; 3 of the 5 Leptospira-positive samples demonstrated the presence of ab-HVA-IgM. Only 2 cases (4%) presented IgM Leptospira antibodies. Out of the 5 cases with IgM antibodies, males predominated (3/5). When compared to negative cases, however, there were more rural elements among them than in negative cases: regarding origins (10% vs. 16%), agricultural workers (40% vs. 20%), contact with cattle and fresh water (80% vs. 40%), and daily contact with humid soil in living quarters (60% vs. 48%). The clinical picture of the 5 positive cases featured myalgia (p = 0.05) and abdominal pain (p = 0.05). The stiffness of neck was relatively more frequent in positive cases (20%) than in negative cases (7%); also, fever (100% vs. 80%), vomiting (60% vs. 22%), headache (80% vs. 56%), constipation (20% vs. 9%), and hepatomegaly (100% vs. 71%). There was clear evidence that leptospirotic infection must be watched and also its association with acute infectious hepatitis.
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PMID:[IgM Leptospira antibodies in acute infectious hepatitis cases in children]. 1229 May 51

This article reflects the experiences of a Red Cross worker in Kenya diagnosed as HIV positive. Before being diagnosed with AIDS in 1989, the author suffered from vomiting, diarrhea, stomach aches, loss of appetite, painful joints, and swollen glands. Upon the diagnosis of HIV infection, suicidal thoughts were considered. With the help of a counselor, the suicidal thoughts were replaced with positive thoughts. By sharing fears of the disease, death, and related issues, it is hopes that other HIV infected persons will be better able to cope with AIDS. An organization should be established in Kenya for AIDS patients in which they can share their experiences Positive thoughts and attitudes can serve as a source of strength for HIV infected patients.
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PMID:Living positively. 1234 11


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