Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The AZT part of a study (ACTG 152), examining three different treatments for children (aged 3 months to 18 years) with sympomatic HIV infection, was stopped because the interim results showed AZT alone was the least effective of the three treatments, and children taking AZT alone had higher rates of side effects. The groups of children taking ddI alone and ddI with AZT will be continued. Further analysis will be conducted in 1995 after the study ends.
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PMID:AZT and children. 1136 95

A study (ACTG 204) involving the effect of valacyclovir in preventing CMV disease in persons with advanced HIV infection (CD4 count under 100) was stopped because there were more deaths in the valacyclovir arm than in either (high dose/low dose) acyclovir arms of the study. There is no obvious explanation. It is believed the high doses of valacyclovir used were too high for this patient population; this may have led to side effects and resulting breaks in treatment that could have adversely affected survival. A greater survival effect may have been seen with acyclovir due to greater time on treatment, or greater consistency of treatment. However, two studies presented at the Human Retroviruses conference in Washington, D.C. failed to find a survival benefit of acyclovir. Further investigation into ACTG 204's design and findings are underway.
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PMID:Valacyclovir study stopped -- worse survival. 1136 6

Merck & Co. has announced it will launch a sizable expanded access program for its protease inhibitor compound MK-639. This is surprising since less than a month earlier it claimed it could not make any substantial quantity of the drug available for at least another year. Citing limits of its present 3TC production, Glaxo has established a quota system of 350 new enrollments per week in its 3TC/AZT combination study. Some believe this is a way Glaxo has found to limit a financial commitment when it is spending $16 billion to buy out Burroughs Wellcome. The Food and Drug Administration (FDA) is expected to approve the 3TC/AZT combination next Fall. Genentech has announced it will supply its human nerve growth factor (NGF) to a government-sponsored trial (ACTG 291) of the compound in AIDS-related peripheral sensory neuropathy. NGF promises to actually reverse the nerve damage caused by extended dosages of such anti-HIV drugs as ddI, d4T, and especially, ddC.
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PMID:Treatment briefs. 1136 67

The National Institute of Allergies and Infectious Diseases (NIAID) has altered its pediatric HIV study (ACTG 152) to eliminate the AZT only arm because children taking AZT alone were progressing faster to opportunistic infections and death than children in the other drug groups. This has caused similar alterations in other trials using AZT alone, but it has also lent credence to the notion that AZT has little or no benefit used as a single agent in children. Additionally, the ACTG 152 results will most likely mean a stronger emphasis on individualized care that depends less on clinical trial data and more on clinical practice. No clinical trials directly compare to the results of ACTG 152, however. In adults, AZT generally appeared either equivalent or better than the AZT/ddI combination. Several questions about ddI therapy in children, such as dosage tolerance, convenience, cost, and choosing the right therapy for the child, remain unanswered. ACTG 152 results (available in 1995) will not provide all the answers that parents of HIV-infected children will need. There is hope that experts in pediatric HIV infection who previously met to develop anti-HIV and prophylaxis guidelines for children will reconvene in anticipation of final ACTG 152 analysis.
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PMID:Now we know our AZTs, is it safe for kids and me? 1136 7

The Data Safety and Monitoring Board recommended that the AZT alone arm be dropped in a trial (ACTG 152) of HIV-infected children comparing AZT alone, AZT plus ddI, and ddI alone. Children receiving AZT alone were experiencing higher rates of disease progression and drug-associated toxicity. Other studies involving children and AZT alone are being modified as a result. It is likely that the ACTG 152 preliminary results will also cause a change in the pediatric standard-of-care involving AZT monotherapy. Physicians are encouraged to call the National Pediatric HIV Resource Center Physician's hotline at 1-800-362-0071 for guidance in treatment decision-making. Study ACTG 076 has shown that HIV-positive women who took AZT alone significantly reduced the rate of HIV transmission to their child. The loss of an AZT-alone arm in antiretroviral combination therapy studies will not answer the question of which regimen (AZT/ddI or ddI alone) being tested is less toxic. Women interested in ACTG 076 are encouraged to call the Project Inform Hotline at 1-800-822-7411 and ask for the Women and AIDS Fact Sheet and PI Perspective, No. 14. A final issue involves problems in accurately dividing adult ddI doses into appropriate doses for children; use of a different dosage form is suggested to solve this problem.
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PMID:Results of pediatric study present new questions. 1136 18

ACTG 076 demonstrated that the frequency of perinatal HIV transmission can be reduced by administering AZT to HIV-infected pregnant women and their newborns. The rate of vertical transmission in ACTG 076 was approximately eight percent, or one-third of the rate among infants of untreated mothers. This information has affected the clinical management of HIV-infected pregnant women. Commonly raised questions address the validity of HIV testing and counseling for all pregnant women; the effects of pregnancy on HIV disease progression; the times in pregnancy when AZT treatment is appropriate; the relation of CD4 counts to AZT administration; the administration of other antiviral medications to women who have developed resistance to AZT; the recommended prophylactic therapy for opportunistic infections; the prevention of primary toxoplasma and CMV infection; the management of labor; and the benefits of AZT. These questions are answered in the context of clinical, ethical, and cost-benefit issues as they relate to pregnant women and their infants.
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PMID:Management of HIV infection during pregnancy: new options, new questions. 1136 65

The following HIV-associated fungal infections, their causes, symptoms, and treatment options are discussed: mucocutaneous candidiasis, cryptococcosis, histoplasmosis, coccidioidomycosis, aspergillosis, and blastomycosis. Also included are fungal infections that are less common or less invasive, such as sporotrichosis, fungi that can cause allergies, seborrheic dermatitis, dermatophytid tinea infections, and tinea corporis (ringworm). The increasing prevalence of microbial fluconazole resistance in people with HIV is examined, and ACTG 981 results showing prophylactic use of fluconazole decreasing the incidence of infections but having no impact on survival are highlighted. A set of ad hoc prophylactic guidelines developed by a San Francisco medical group on preventing disseminated cryptococcosis or cryptococcal meningitis are also explored.
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PMID:Treatment for HIV-related fungal infections. 1136 39

The results of ACTG 076, published last November in the New England Journal of Medicine, continue to cause debate over the HIV counseling and testing of pregnant women. ACTG 076 showed a significant reduction in the rates of perinatal HIV transmission among pregnant women taking AZT. Since that time, the Centers for Disease Control and Prevention (CDC) issued draft recommendations for HIV counseling and testing for pregnant women and is expected to issue final recommendations soon. In addition, the results of ACTG 076 spurred debate over the CDC's blinded seroincidence survey of newborns and caused them to suspend the entire serosurvey, officially known as the HIV Survey in Childbearing Women. The CDC recommendations call for noncoercive HIV counseling for all pregnant women with the goal of the counseling to provide information on HIV infection, pregnancy and testing so that each woman can make an informed, personal decision about HIV testing. Many AIDS activists applaud their recommendation against mandatory testing.
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PMID:AZT use by pregnant women stirs policy debate. 1136 46

On July 7, 1995, the Centers for Disease Control and Prevention (CDC) issued new guidelines for testing pregnant women for HIV infection to prevent perinatal transmission of the disease, and such measures mandating testing seems likely to pass Congress. ACTG 076 results that show expectant mothers given AZT significantly reduced vertical transmission has prompted belief in testing. Questions surrounding the use of AZT, how high a level of HIV in the mother creates transmission, and other drugs that could be potentially safer and more effective than AZT have not stopped the CDC from issuing the guidelines. A three-part AZT regimen is recommended, however, it will make a difference in outcome in only one out of six babies, and its safety is not yet resolved. Women rejecting the regimen may be reported to child welfare authorities. The CDC advocates training medical professionals to help counsel women in a supportive and sensitive manner. The author suggests that mandated testing adds a threat of coercive medical care without providing any protection against abuse of power by medical practitioners.
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PMID:CDC recommends HIV testing for all pregnant women. Centers for Disease Control and Prevention. 1136 58

Two years after the breakthrough study, ACTG 076, showed that zidovudine (AZT) therapy can dramatically reduce HIV transmission from mother to child, the U.S. Public Health Service has issued guidelines for health care workers that stress non-directive, volunteer counseling and testing for all pregnant women. Highlights of the recommendations include: pre-test counseling following guidelines for HIV counseling; consent for testing obtained according to prevailing legal requirements; and post-test counseling which includes an explanation of the clinical implications of testing positive and the need for early intervention services. In addition, recommendations for HIV-infected pregnant women include assessing patients in the same way as other HIV-infected persons as to their need for antiretroviral therapy, antimicrobial prophylaxis, and other treatment; advisement against breast-feeding; counseling about possible negative effects of HIV infection; and encouragement to obtain HIV testing for any children born after infection. The Centers for Disease Control and Prevention (CDC) estimates that 7,000 HIV-infected women in the United States bear children each year. Up to one-third of these children may become infected after birth. Transmission from mother to child can occur during labor, delivery, and after birth through breast-feeding. Two known factors that decrease the chances of transmission are cesarean-section delivery and administration of AZT therapy during pregnancy.
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PMID:The basics of counseling and testing pregnant women. 1136 82


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