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

We present four cases of C. neoformans meningitis (CNM) in patients with Human Immunodeficiency Virus (HIV) infection treated with fluconazole p.o. at an initial dose of 400 mg followed by 200 mg/day during a follow up period ranging from 3 to 12 months, and who presented an excellent clinical evolution. When comparing them to our previous cases who were treated with Amphotericin-B in combination with 5-fluorocytosine, a decrease in mean hospital stay (p less than 0.001) and a smaller incidence of secondary effects were observed. Treatment with fluconazole seems to be an effective alternative in treatment of CNM. Future greater studies are needed to confirm this findings.
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PMID:[Fluconazole treatment of cryptococcal meningitis associated with HIV infection. Presentation of 4 cases]. 156 53

Fungal and mycobacterial infections are among the most common opportunistic infections in patients infected with human immunodeficiency virus (HIV). Candida infections are the bell-wether of progression to symptomatic HIV infection and candida oesophagitis often marks the onset of the acquired immunodeficiency syndrome (AIDS). More than 80% of AIDS patients have candida disease. Candida infections remain local and respond to treatment but tend to recur. Cryptococcal infections initially affect few HIV positive patients but involve 10-30% with AIDS. Meningitis is the usual presentation and dissemination is common. Amphotericin usually produces improvement but cure is infrequent, and maintenance therapy is advisable. Mycobacteria cause intracellular infections increasing in parallel with immunodeficiency. Mycobacterium avium-intracellulare is predominant, occurring with other opportunistic pathogens causing systemic and local symptoms with high bacterial density in infected cells. Multidrug treatment is best, but the results are disappointing. Tuberculosis is prevalent in certain groups of patients. It often presents with atypical clinical and pathological features. Anti-tuberculous treatment is effective and prophylaxis should be considered. Endemic fungi with mycobacteria cause sporadic infections. Opportunistic infections are the lethal arm of HIV infection. Diligent diagnosis and persistent treatment offer benefit to HIV-infected patients.
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PMID:Fungal and mycobacterial infections in patients infected with the human immunodeficiency virus. 265 13

The unilamellar liposomal formulation of amphotericin B, AmBisome, is composed of hydrogenated soy phosphatidylcholine, distearoyl phosphatidylglycerol and cholesterol. Early studies of its efficacy in an open design showed that remissions could be induced in candidosis and aspergillosis and that doses of up to 5 mg/kg could be used. Adverse events were infrequent, with the main abnormality seen being hypokalaemia in about 18% of patients. Subsequent developments have extended this work. AmBisome has been used in two open studies of patients with invasive aspergillosis; in one of these remission was achieved in 77% of 17 patients with confirmed infection who had failed to respond to conventional amphotericin B. In AIDS patients with cryptococcosis AmBisome given for 6 weeks at 3 mg/kg daily produced mycological remission of meningitis in 67%. Other infections treated with the drug include zygomycete (mucormycosis) and Fusarium infections. AmBisome has also been used as preventative therapy in bone marrow transplant recipients and was found to reduce fungal colonisation rates. There were fewer systemic fungal infections in the treated versus placebo groups although this did not achieve statistical significance. Lack of renal and liver toxicity or anaemia has been confirmed in subsequent studies. In addition febrile reactions to the AmBisome are rare. The drug has also been used effectively in children, including infants, with systemic fungal infections. In visceral leishmaniasis patients, including HIV positive individuals, remissions have been obtained using drug regimens of 1-2 mg/kg of 2.1 days and 3 mg/kg for 10 days.
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PMID:Liposomal amphotericin B, AmBisome. 807 89

Thirty-one patients with visceral leishmaniasis (VL) caused by Leishmania infantum received liposomal amphotericin B (AmBisome) in a multi-centre study. Ten immunocompetent patients (six children) received 1-1.38 mg/kg/day for 21 days, and ten (nine children) received 3 mg/kg/day for 10 days. All were cured without significant adverse events and without relapse during 12-24 months of follow-up. Eleven immunocompromised adults, including seven co-infected with HIV (four with AIDS) received 100 mg (1.38-1.85 mg/kg) daily for 21 days. All were initially considered cured, but eight relapsed clinically and parasitologically at 3-22 months. Liposomal amphotericin B is a new, safe and effective drug for the treatment of VL.
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PMID:Liposomal amphotericin B (AmBisome) in Mediterranean visceral leishmaniasis: a multi-centre trial. 815 91

The first case of Port-a-cath-related disseminated fusariosis in an HIV-infected patient is presented. Antifungal treatment with liposomal amphotericin B (AmBisome) in a dose of 2 mg kg-1 day-1 for 14 days was successful.
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PMID:Port-a-cath-related Fusarium oxysporum infection in an HIV-infected patient: treatment with liposomal amphotericin B. 876 4

A 38-year-old hemophiliac, who had been infected with HIV by the administration of blood products and had been diagnosed as AIDS by the onset of Pneumocystis carinii pneumonia, was admitted to our hospital with the complaints of headache and vomiting. After he was diagnosed as cryptococcal meningitis using the microscopy, cryptococcal antigen detection and culture of cerebrospinal fluid, treatment with amphotericin-B and fluconazole was started. As there was no clinical improvement, spinal drainage was performed and acetazolamide administered in order to reduce the intracranial pressure. Treatment was changed from AMPH-B and FLCZ to a combined therapy of AMPH-B and itraconazole. As his clinical features showed improvement, he was discharged home on a maintenance dose of ITCZ and acetazolamide after having been hospitalized for three months. This case-report may be of use in the management of cryptococcal meningitis in patients with AIDS.
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PMID:[A case of AIDS with intractable cryptococcal meningitis]. 879 10

Over the past 15 years, factors suh as corticosteroid treatment, cytotoxic chemotherapy, excessive use of broad spectrum antibiotics and HIV have led to an increased risk of serious fungal infections in both adults and pediatric patients. This increase in invasive fungal infections poses increasing difficulty in their treatment. Three new lipid formulations of amphotericin B are now available in the U.S.: amphotericin B lipid complex (Abelcet), amphotericin B colloidal dispersion (Amphotec), and liposomal amphotericin B (AmBisome). These newer formulations are substantially more expensive, but allow patients to receive higher doses for longer periods of time with decreased renal toxicity than conventional amphotericin B. The properties of these new agents are summarized in this review. Discussion of current national guidelines as well as those used at our institution are presented to provide guidance for the development of institution specific guidelines for the most cost-effective drug for most patients, some may benefit more from one of the newer lipid formulations.
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PMID:A comparative review of conventional and lipid formulations of amphotericin B. 1047 83

We have treated seven patients with cryptococcal spondylitis. Five presented with a neurological deficit and one was HIV-positive. Amphotericin-B and 5-flucytosine were used in five patients and ketoconazole was given orally in the remaining two. Three patients made a complete neurological recovery. Since these lesions mimic spinal tuberculosis, which is commonly seen in our environment, we draw attention to the importance of obtaining a tissue diagnosis.
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PMID:Cryptococcal osteomyelitis of the spine. 1087 66

The leishmaniases are protozoan diseases caused by Leishmania parasites. The first-line treatment of its visceral forms is pentavalent antimony (meglumine antimoniate or sodium stibogluconate), but toxicity is frequent with this drug. Moreover antimony unresponsiveness is increasing in Leishmania infantum and L. donovani foci, both in immunocompetent and in immunosuppressed patients. Amphotericin B is a polyene macrolide antibiotic that binds to sterols in cell membranes. It is the most active antileishmanial agent in use. Its infusion-related and renal toxicity may be reduced by lipid-based delivery. Liposomal amphotericin B (AmBisome); Gilead Science, Paris, France) seems to be less toxic than other amphotericin B lipid formulations (Amphocil); Liposome Technology Inc., Menlo Park, CA, USA, Amphotec); Ben Venue Laboratories Inc., Bedford, OH, USA). Optimal drug regimens of AmBisome) vary from one geographical area to another. In the Mediterranean Basin, a total dose of 18 mg/kg (3 mg/kg on days 1-5 and 3 mg/kg on day 10) could be used as first-line treatment of visceral leishmaniasis in immunocompetent patients. In immunocompromised patients, especially those co-infected with HIV, relapses are frequent with AmBisome), as with other drugs.
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PMID:Liposomal amphotericin B in the treatment of visceral leishmaniasis in immunocompetent patients. 1266 28

The visceral and the different spectrum of cutaneous leishmaniases have been incriminated to be among the opportunistic infections co-existing with HIV/AIDS. In co-infections, leishmaniases surface in high prevalence, present frequently atypically, pose difficulties to be detected by routine diagnostic tests, most often result in an unfavorable response to treatment, frequent relapses and in premature deaths. Such presentations and management difficulties shall be highlighted in this review. To extract information on the scope of manifestations and responses to management, literature was surveyed utilizing the Pub Med electronic literature search. In due course, pertinent characteristics surfacing in HIV/AIDS and leishmaniasis co-infections comprising of clinical presentations and parasitological and serological findings were tracked. Investigation options, management approaches, outcomes of various treatment regimen and other intervention strategies were as well explored. Visceral leishmaniasis and HIV-1 are both associated with a depression of T cell response and similar disturbances of cytokine networks. The appearance of HIV has led to numerous atypical clinical manifestations of leishmaniasis among immunocompromised patients to include, recurrences, lingual, cervical, esophageal, mucocutaneous and presentations in other unusual sites. The common clinical presentations of the disease might not always be present being masked by other associated opportunistic infections. Spleen aspiration is more sensitive in immuno-competent visceral visceral leishmaniasis suspects, however, bone marrow aspirate remains the safest and the most frequently employed diagnostic technique in co-infected patients. Several species of Leishmania are incriminated in affecting HIV infected subjects, including formerly unknown zymodemes. In spite of the high number of reported cases of HIV-related VL, the treatment of choice, the best dosage and the duration of therapy appear not to be properly established. The pentavalent antimonials still remain the first line of therapy for co-infected cases. Amphotericin-B, especially the liposome formulation (Ambisome) was found to be relatively less toxic and more potent compared to pentamidine. A broad spectrum of other drugs have as well been used. The widespread use of HAART are envisaged to contribute to a progressive decrease in the morbidity and mortality of HIV-associated visceral leishmaniasis. There is no effective chemoprophylaxis or immuno-prophylaxis to prevent leishmanial infection. In the events of co-infections with HIV/AIDS, the need for policy provisions to control both diseases needs to be underlined. It is as well of a paramount importance that factors influencing co-infection are understood for effective treatment against leishmaniasis in co-infected patients. The need for improved diagnostic tests and new more effective and less toxic drugs is also apparent.
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PMID:Leishmaniases and HIV/AIDS co-infections: review of common features and management experiences. 1280 30


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