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

Infections and malignancies account for most deaths in patients with AIDS and will continue to do so as long as HIV-induced immunosuppression is progressive and irreversible. Co-trimoxazole has emerged as the preferred agent for prevention of Pneumocystis carinii pneumonia. As appropriate broad-spectrum agents are developed, multiple opportunistic pathogen prophylaxis could become effective.
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PMID:Current status of HIV therapy: II. Opportunistic diseases. 152 56

Physicians at a district general hospital in London, England admitted a 26 year old pregnant political refugee from Uganda complaining of shortness of breath, fever, and a productive cough for 1 week. She was at 10 weeks gestation and had not yet sought prenatal care. 6 years earlier she had a child and her pregnancy and delivery were normal. They diagnosed an interstitial pneumonia based on an X ray, arterial gases, and quick breathing and administered intravenous (IV) ampicillin and erythromycin for 3 days. Her condition deteriorated nevertheless, so they had her blood tested for HIV. She tested positive and suspected pneumocystosis (later confirmed) and began treatment with IV Septrin and hydrocortisone. She worsened, and by the 10th day of this treatment she was receiving 60% oxygen. They changed her treatment to IV pentamidine and oral rifampicin and isoniazid. By this time, her white blood cell count was 28.7x109/1 and hemoglobin concentration 8.2g/dl. Her condition would not allow her to undergo general anesthesia so an abortion requested by the patient was not performed. Additional treatment included continuous infusion of eflornithine, but she died despite it. This case poses 2 questions. Could she have lived if there had not been a delay in HIV diagnosis? Research shows that CD4 lymphocytes cell counts fall considerably during pregnancy in HIV positive women. So some advocate prophylaxis earlier in these women than other immunocompromised patients. Was it indeed her pregnancy that contributed to the severity of her illness and its inability to respond to treatment? Some researchers find pregnancy accelerates the progress of HIV infection, but researchers do not yet know if it also accelerates the progress of opportunistic infections. If so, terminating pregnancy may be considered.
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PMID:A maternal death caused by AIDS. Case report. 188 2

Pneumocystis carinii is a common cause of pneumonia in individuals who are immunosuppressed by HIV infection. Use of molecular biological techniques show that P. carinii is a fungus and that infection in man is not a zoonosis. Invasive tests such as sputum induction or bronchoscopy are used to make the diagnosis of P. carinii pneumonia. Life long primary prophylaxis is given to HIV positive individuals with CD4+ lymphocyte counts < 0.20 x 10(9)/L or a CD4: total lymphocyte ratio of < 1.5, constitutional symptoms, or with other AIDS defining diseases. Secondary prophylaxis is given after a first episode to prevent a recurrence. First choice for primary and secondary prophylaxis is oral co-trimoxazole 960 mg od or three times a week. In patients who are intolerant to co-trimoxazole, nebulised pentamidine or dapsone (with or without pyrimethamine) are second and third choices. In a patient with acute PCP disease, severity should be assessed using clinical, radiographic and blood gas criteria as those with moderate or severe disease will benefit from adjuvant glucocorticoids. Co-trimoxazole (120 mg/kg/day in divided doses for 21 days) is first choice therapy for PCP of all degrees of severity. In patients who fail to respond to co-trimoxazole or who are intolerant to it, second line treatment is iv pentamidine in those with severe disease and oral dapsone with trimethoprim, oral clindamycin with primaquine or iv pentamidine in those with mild or moderately severe disease.
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PMID:Pneumocystis carinii infection: current treatment and prevention. 881 28

Co-trimoxazole (trimethoprim-sulphamethoxazole) is an effective prophylactic agent against Pneumocystis carinii pneumonia (PCP). However, it is associated with a high frequency of adverse reactions in immunocompromised patients which may preclude its use. Fourteen patients with a definite history of adverse reactions to co-trimoxazole on standard PCP prophylactic dosage were selected for desensitization using a regimen of gradual incremental exposure over an 11-day period. Eight (57.1%) were successfully desensitized and have continued on oral co-trimoxazole at maximum 21 months' follow-up. This report demonstrates that oral desensitization as an outpatient procedure is an effective and safe option for both primary and secondary PCP prophylaxis in HIV-seropositive patients with previous adverse drug reactions.
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PMID:Co-trimoxazole desensitization in HIV-seropositive patients. 953 Sep 1

All cases of HIV-associated gingival ulceration seen at a dedicated dental clinic in a 5-year period were reviewed and compared against other patients attending the clinic. 94 (7.1%) of 1308 patients had 146 episodes of gingival ulceration. 89 patients had 140 episodes similar to acute necrotising ulcerative gingivitis (ANUG) and responded well to conventional treatment for ANUG. The cases were compared with 269 controls in logistic regression. Gingival ulceration was associated with oral candidiasis, lower age and lack of AIDS diagnosis possibly due to a protective effect of co-trimoxazole medication. 5 patients with neutropenia had extensive ulceration without the microflora of ANUG. Histopathology, viral and bacterial culture revealed non-specific changes. The ulcers did not respond to the treatment regimen for ANUG but responded to treatment of their neutropenia. Gingival ulceration is not common in HIV infection. Most cases resemble severe ANUG. It is more frequent in younger people, those with oral candidiasis and without AIDS. Co-trimoxazole may be protective. A minority of cases with ulceration and associated neutropenia resembled the non-specific oral ulceration associated with HIV.
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PMID:Gingival ulceration in HIV infection. A case series and case control study. 954 97

A HIV seropositive patient with chronic diarrheic syndrome, in which oocysts of Isospora belli were detected in feces by the modified technique of Ziehl-Neelsen was studied. Other coproparasitological techniques were applied and cultures were applied made with negative results. Any other infectious origin was excluded from the picture. The patient was treated with 2 tablets of Co-trimoxazole (trimethoprin 80 mg, sulphamethoxazole 400 mg) every 6 hours for ten days, with referral of the symptoms.
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PMID:[HIV infection and isosporiasis. Presentation of a case]. 968 79

An HIV-infected person describes his self-directed treatment for AIDS. He explains his feelings and physical manifestations from the use of treatments such as AZT, ddC, aerosolized pentamidine, Septra, ddI, Zovirax, Trental, and combinations of drugs. The author also shares his experiences with weight lifting to increase his body mass. Currently, the 52-year-old, who has been HIV-positive since 1981, says he feels as good as he's ever felt in 15 years. He works out three times a week and says the results are better than he had hoped. He is now attempting to acquire 3TC which seems to work better than anything else to date when used in combination with AZT. According to the author, the best sources of knowledge are reading AIDS Treatment News, which he gets on his computer via a modem; calling the buyer's clubs in New York, Atlanta, etc.; and keeping a folder on Compuserve using the key word "AIDS" so that all the news articles containing the word AIDS are saved for him. He invites readers who have been living with HIV infection and AIDS for a number of years to write him and to tell him what they've been doing to stay alive. He concludes by saying that meditation has had a dramatic and positive effect on concentration, relaxation, and dealing with stress.
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PMID:One person's story. 1136 91

Pneumocystis carinii pneumonia (PCP) is common in children and adults who are HIV-positive. More than half of the babies who have PCP never received preventive drugs. It is suggested that a greater number of HIV-exposed infants must be identified at an earlier stage, and preventive medication should be prescribed. It is further recommended that HIV testing and monitoring be made more available to infants at risk so that preventive PCP medication can be given at four to six weeks of age, regardless of the CD4 count and HIV test results. The first choice of treatment is Bactrim or Septra. More information can be obtained by calling the Network at (800) 734-7104.
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PMID:PCP prevention for children. 1136 97

In July 1993, the United States Public Health Service and the Infectious Disease Society of America gave a set of recommendations for early intervention and prevention of opportunistic infections in HIV-positive people. These guidelines follow CD4 counts. According to the guidelines, CD4 counts above 500 should be monitored every 4 to 6 months and screenings for tuberculosis, sexually transmitted diseases, and other diseases should also be done. At a CD4 count of 75, a prophylaxis of rifabutin against Mycobacterium avium complex (MAC) is advised. Oral ganciclovir has been effective in preventing or delaying cytomegalovirus in people with CD4 counts below 50. HIV-positive patients should be vaccinated for streptococcal pneumonia, hepatitis B, and influenza and avoid alcohol, drugs, and nicotine. AZT is still considered the first line therapy when symptoms appear or when CD4 counts fall. Combination antiretroviral therapies (AZT and ddI, AZT and ddC, and AZT and 3TC) are thought to be the best way to fight HIV. If symptoms include thrush, a prophylaxis against Pneumocystis carinii pneumonia should be started, such as TMP-SMX (Bactrim or Septra), dapsone, or aerosolized pentamidine.
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PMID:Early intervention and prevention options. 1136 17

Pneumocystis carinii pneumonia (PCP) is a principal cause of death in AIDS patients. Symptoms include breathing difficulty, dry cough, and fever. Medications such as Bactrim, Septra, Dapsone, or NebuPent may prevent or reduce PCP's symptoms. If a person is HIV-positive, a T-cell level blood test can alert a physician to prescribe medication to prevent PCP. Telephone numbers for a Spanish health forum in Florida are listed.
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PMID:[Prevention of pneumonia related to HIV--pneumocystis carinii pneumonia (PCP)]. 1136 4


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