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

A 1997 conference on strategies for the prevention of mother-to-infant transmission of HIV in developing countries reveals a wide disparity in HIV infection rates and mortality between industrialized and developing countries, and explains why prevention strategies that work in industrialized nations are not feasible in poorer countries. Research concerns discussed include modification of ACTG 076 to help stem the tide of HIV transmission where few options exist for reducing perinatal HIV transmission, the importance of timing prevention strategies to coincide with the transmission of HIV from mother to infant, the difficulty in determining the efficacy of AZT in reducing maternal HIV transmission during the individual antepartum, intrapartum, and neonatal periods, and the use of clinical and immunologic status during pregnancy to determine the risk level of vertical HIV transmission. Concluding comments explore the use of antiretroviral therapy during pregnancy, the importance of vitamin A supplementation as a means to reduce childhood mortality in developing countries, the dilemma of HIV transmission through breastfeeding, and the alternatives to breastfeeding in developing countries. A table of descriptive information on international trials to prevent vertical HIV transmission is included.
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PMID:Global strategies for the prevention of vertical HIV transmission. 1136 42

Studies indicate that patients who have responded well to intensive antiretroviral therapy should continue their current treatment regimen rather than switch to less intensive therapy during the maintenance phase. Data from ACTG 343, a study to determine the sustaining of HIV suppression with fewer drugs, reveals that less intensive antiviral maintenance therapies were less effective than continuation of the triple-drug regimen; findings were statistically significant. Viral load rebound was far more prevalent in one- or two-drug maintenance regimens than in the triple-drug therapies. Further, data show viral load rebound more likely when the patient's viral load had not gone below 200 copies of HIV RNA/ml within four weeks of initiating triple-therapy. Findings from other multiple-drug trials and immune stimulating reactions from vaccine trials are summarized.
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PMID:ACTG 343: three drugs better than two for maintaining HIV suppression. 1136 88

Several ACTG adult clinical trials are being conducted at Johns Hopkins University. A list of these trials and their descriptions are provided. The list includes the following studies: treatment for HIV-1 disease, complications of HIV-1 disease, pharmacokinetics, and clinical pharmacology drug development. Also listed are trials at Johns Hopkins Neurology Program and Johns Hopkins HIV Investigation Services. Among the studies are trials evaluating hydroxyurea alone and with ddI, antiretroviral combinations as salvage therapy, and AZT, 3TC, delavirdine, and indinavir in combination. Contact information for each study is included.
Hopkins HIV Rep 1998 Jan
PMID:ACTG Adult Clinical Trials Unit at Johns Hopkins. 1136 35

Several ACTG adult clinical trials are being conducted at Johns Hopkins University. A list of the trials and their descriptions are provided. The list includes the following studies: treatment for HIV-1 disease, complications of HIV-1 disease, pharmacokinetics, and clinical pharmacology drug development. Also listed are trials at Johns Hopkins Neurology Program and Johns Hopkins HIV Investigation Services. Contact information for each study is included.
Hopkins HIV Rep 1998 Mar
PMID:ACTG Adult Clinical Trials Unit at Johns Hopkins. 1136 38

The Bay Area Perinatal AIDS Center (BAPAC) offers prenatal and HIV specialty care for HIV-positive women and for children. In the past two and a half years, BAPAC has treated 60 pregnant women, none of whom have transmitted HIV to their infants. The 62 infants born during this period will be followed for at least two years. Karen Beckerman, a physician at BAPAC, attributes the ideal transmission rate to combination therapy in the mothers, and to giving the babies AZT in compliance with ACTG 076 for six weeks. The infants also receive prophylactic treatment for Pneumocystis carinii pneumonia (PCP). Mothers in the program have seen some rises in viral load or have begun experiencing drug resistance, complicated by compliance issues. The program demonstrates the importance of counseling, testing, and aggressive treatment in women, and notes that outcomes are better when women receive care from staff experienced in dealing with HIV treatment issues.
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PMID:San Francisco group demonstrates the ability of combination anti-HIV therapy to lower PHT. 1136 67

Researchers have seen a dramatic drop in mother-to-child HIV transmissions due to medical breakthroughs and the role of AZT. ACTG protocols 076 and 185 provided further information on the association between maternal viral load and vertical transmission. Dr. Lynne Mofenson of the National Institute of Child Health and Human Development at the National Institutes of Health followed treatment-naive and treatment-experienced pregnant women through a three-part AZT regimen. The regimen was administered during the last two-thirds of pregnancy, during delivery, and to the newborn for six weeks. The studies showed that transmission took place across all levels, however, the women taking AZT reduced vertical transmission by two-thirds at each viral load level. Dr. Mofensen concluded that reducing viral load to low levels in pregnant women receiving AZT treatment will further reduce transmission. Other studies presented at the 5th Conference on Retroviruses and Opportunistic Infections concluded that predicting HIV transmission based on maternal viral load is more accurate for groups of untreated, rather than treated, mothers. In Thailand, a short-course treatment alternative of administering AZT near the end of gestation and during delivery, but not to the newborn, showed a 51 percent reduction in the rate of transmission. Although not proven, it is assumed that this is the period when most transmission occurs.
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PMID:Vertical transmission research at the Retrovirus Conference. 1136 91

Several clinical trials are underway for both adults and children. ACTG 377 is studying four different drug combinations in pediatric patients up to 17 years of age. The drugs are 3TC (Epivir, lamivudine), d4T (Zerit, stavudine), nelfinavir (Viracept), nevirapine (Viramune), and ritonavir (Norvir). The Phase I/II study is testing for safety and efficacy. FDA 285A is studying the experimental second generation protease inhibitor ABT-378, in combination with ritonavir and 3TC or d4T. Researchers at the National Institutes of Health (NIH) are studying the effectiveness of once-daily dosing of ddI in combination with d4T, in treatment-naive people, and they are also pursuing a study to determine where HIV hides in the body. Enrollment criteria and contact information are included for each study.
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PMID:Drug studies for children and adults. 1136 82

Clinical trials being conducted at the Harvard/Boston City Medical Center, AIDS Clinical Trials Unit (ACTU) are described. Criteria for inclusion in the study are included, as well as the status of the trial and contact information to enroll. Also included is a list of other Boston clinical trials. Current HIV trials include ACTG 388, which is comparing four-drug regimens to three-drug regimens; ACTG 384, which is studying when protease inhibitor therapy should be initiated; and ACTG 359, which is studying viral loads in patients who have received at least six months of treatment. Treatment studies are also underway for immune-based therapies, Kaposi's sarcoma, and AIDS wasting syndrome.
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PMID:Harvard/Boston City Medical Center AIDS Clinical Trials Unit. 1136 52

The approval of nitazoxanide (NTZ, Cryptaz) was rejected by the Food and Drug Administration (FDA) due to insufficient evidence of its beneficial uses in the treatment of cryptosporidial diarrhea. The incidence of cryptosporidiosis, and other opportunistic infections, has diminished due to the use of powerful anti-HIV therapies, and as a result, there are fewer participants available for trials of drugs used to treat opportunistic infections. The ACTG 336 study, designed to study treatments for cryptosporidiosis, was shut down due to insufficient enrollment. The reduction in the number of people affected by such infections has reduced the incentive for companies to continue developing these types of drugs. Consideration for FDA approval of NTZ will require a new trial to support its efficacy. Project Inform suggests that Unimed apply to the FDA for a Treatment Investigational New Drug (IND), thus enabling NTZ to be available to patients, and allowing Unimed to recoup some of their development costs. Concurrently, a new efficacy study design could be developed which could lead to approval by the FDA. Information on how to obtain NTZ is provided.
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PMID:FDA panel rejects drug for cryptosporidial diarrhea. Food and Drug Administration. 1136 68

Research to eliminate mother-to-child HIV transmission was a highlight at the 12th World AIDS Conference. ACTG 076 demonstrated that a three-part course of AZT can reduce the vertical transmission rate by 67 percent. Studies assessing the effectiveness of Cesarean section (C-section) deliveries are inconclusive, although it appears that surgical delivery, prior to the rupture of membranes, reduces transmission rates. Studies on HIV positive pregnant women, who did or did not receive drug treatment, and had elective C-sections, emergency C-sections, or vaginal deliveries are compared. Combination therapy may be the most effective treatment for the mother, but there is not enough data to judge the safety of these treatments on an infant. Treatment risks for newborns are addressed.
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PMID:Working to improve pregnancy outcomes. 1136 19


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