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)

Antiretroviral therapy with zidovudine is indicated in patients with CD4 cell counts below 500 per mm3 (500 x 10(6) per L). Patients intolerant of zidovudine and those with advanced human immunodeficiency virus infection may benefit from newer antiretroviral agents, such as didanosine (ddl) or zalcitabine (ddC). Prophylactic therapy for Pneumocystis carinii pneumonia is indicated in patients with CD4 cell counts below 200 per mm3 (200 x 10(6) per L), in patients with CD4 cell counts less than 20 percent of the total lymphocytes and in patients with a prior history of P. carinii infection. In addition, prophylaxis is often initiated if thrush is present, even when CD4 cell counts are above 200. Trimethoprim-sulfamethoxazole is the drug of choice for Pneumocystis prophylaxis; aerosolized pentamidine is reserved for patients unable to tolerate trimethoprim-sulfamethoxazole. Oral candidiasis is treated with nystatin suspension, clotrimazole troches, ketoconazole or fluconazole, with fluconazole used for resistant or more invasive infection. Finally, acyclovir is used to treat herpes zoster or herpes simplex virus infection.
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PMID:Update on drug therapy for HIV and related infections in adults. 835 31

Trimethoprim-sulfamethoxazole (TMP-SMX) is frequently used in human immunodeficiency virus (HIV)-infected patients (HIV+) for treatment or prophylaxis of Pneumocystis carinii pneumonia (PCP). Up to 80% of those patients report adverse reactions to that drug combination. To test the hypothesis that these reactions are immunologically mediated, we quantitated specific IgG and IgE SMX-human serum albumin (HSA) antibodies and immune complexes (IC) in HIV+ patients and in HIV controls. Patients with mild HIV disease had elevated specific SMX-HSA IgG and IC levels compared with those having severe disease or with controls. Conversely, patients with severe HIV disease had statistically elevated levels of specific IgE when compared with patients having milder disease or with controls. There were no differences in either specific antibody or IC levels between patients reporting adverse reactions and those who did not. Results suggest that there are increased levels of SMX-HSA-specific antibodies in some HIV+ patients. The presence of these antibodies appears to be related to severity of disease, rather than clinically significant drug sensitivity.
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PMID:Evaluation of immune parameters in HIV+ subjects reporting adverse reactions to sulfamethoxazole. 193 83

AIDS is one of the most perplexing diseases to confront modern medicine today. AIDS will rank just behind accidents, heart disease and cancer as a major cause of potential life lost in the USA by 1991. Over half million AIDS cases are predicted by 1993 in the United States alone. There has been a great improvement in the understanding and treatment of opportunistic infections in AIDS. The most important concept is prophylactic treatment of the most common infectious complications as the immune system deteriorates. The major advance has been the prophylactic treatment of Pneumocystic Carinii Pneumonia (PCP) with either aerosolized Pentamidine or low dose Bactrim. Some experts advocate a low dose antibiotic prophylaxis for latent toxoplasma and cryptococcal infection in those patients whose immune systems are deteriorating. Prophylaxis would be instituted as the T4 helper lymphocyte count decreases. Finally, any patient found to be lately infected with either tuberculosis or syphilis, while HIV positive, must be thoroughly treated for these infections prior to any immunocompromise. The minimum follow-up of HIV positive individuals should include T4 lymphocyte counts and perhaps P24 antigen levels as well as beta 2-microglobulin levels. As these parameters worsen, patients should be directed to explore safe available treatments such as Antabuse, Naltrexone and Dextran sulfate. Any healthy patient with T4 helper counts under 400 should be directed to AIDS treatment evaluation units for enrolment in research protocols. At present over 100 drugs are being tested for the treatment of AIDS. However, researchers predict that no more than one or two drugs will be discovered over the next three years that will be helpful in the treatment of AIDS. If ever there was a more powerful argument to institute a new way of evaluating research drugs, it is this prediction. Due to the epidemic proportions of this disease, it seems reasonable to test epidemic proportions of this disease, it seems reasonable to test drugs shown to have some effect in groups of three of four drugs per patient. It is well demonstrated that AZT (Zidovudine) loses its anti-retroviral effect at about twelve to eighteen months. Drug resistance is seen in the treatment of a similar infectious agent, M. tuberculosis. Acute infection of MTB necessitates the use of three antibacterial agents. In AIDS infection, it seems logical to test two or three anti-retrovirals combined with one immunostimulant.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Acquired immunodeficiency syndrome: molecular biology and its therapeutic intervention (review). 251 41

Prophylaxis against Pneumocystis carinii pneumonia is a logical management strategy for patient populations that have a high incidence of this infectious complication. Appropriate populations for consideration would include those with human immunodeficiency virus infection, recent recipients of bone marrow or solid organ transplants, children with acute lymphocytic leukemia, and adults with T cell leukemias. Trimethoprim-sulfamethoxazole given twice daily (2.5 mg of trimethoprim/kg and 12.5 mg of sulfamethoxazole/kg every 12 hours on three or seven consecutive days per week has been shown to be effective and well tolerated in some patient populations. Pyrimethamine-sulfadoxine given once weekly and aerosolized pentamidine given once or twice monthly are promising prophylactic agents that are currently undergoing closer scrutiny to determine their efficacy and safety.
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PMID:Prevention of Pneumocystis carinii pneumonia. 269 Mar 1

Trimethoprim-sulfamethoxazole and parenteral pentamidine isethionate are effective in 60 to 80 per cent of AIDS patients with pneumocystis pneumonia. Adverse reactions are frequent with both agents, but because the adverse reactions are less severe with trimethoprim-sulfamethoxazole, this agent is the drug of choice for patients who are not known to be intolerant of it. The recommended duration of therapy is 21 days. Aerosolized pentamidine and intravenous trimetrexate are investigational agents that show considerable promise, but their role in the therapy of pneumocystis pneumonia will have to be demonstrated in controlled trials. For patients who fail to respond to conventional agents after 5 to 10 days of therapy, therapeutic alternatives to consider would be trimetrexate, DFMO, or high-dose corticosteroids, the latter given with conventional agents. Prophylaxis against pneumocystis pneumonia is appropriate for HIV-infected patients with fewer than 300 T4 lymphocytes per cu mm, even if they are receiving zidovudine (Retrovir). It also should be considered in patients with a prior history of this infection, irrespective of the T4 count. The efficacy of trimethoprim-sulfamethoxazole, pyrimethamine-sulfadoxine, or aerosolized pentamidine has not yet been substantiated. Many patients cannot tolerate the first two combinations chronically.
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PMID:Treatment and prophylaxis of Pneumocystis carinii pneumonia. 306 May 26

Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line drug for prophylaxis and treatment of Pneumocystis carinii pneumonia (PCP) and for prophylaxis of toxoplasmosis in HIV-infected patients. Evidence indicating intolerance related to the dose of SMX led us to examine the efficacy of altered TMP-SMX ratios in a corticosteroid-treated rat model. Infections were assessed by counting P. carinii cysts in lung and by titration of Toxoplasma gondii burdens in tissue culture. For prophylaxis, the reference regimen of 20 mg/kg TMP plus 100 mg/kg SMX was effective. Reduced doses of SMX (5 and 20 mg/kg) effective against PCP were effective against toxoplasmosis, provided the TMP dose was increased to 100 mg/kg. For curative treatment, the reversed ratio of 100 mg/kg TMP plus 20 mg/kg SMX was not effective. These results may provide a basis for altering the TMP-SMX ratios in setting of prophylaxis for both infections, especially in HIV infected patients who often poorly tolerate sulfonamides.
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PMID:Altered trimethoprim-sulfamethoxazole ratios for prophylaxis and treatment of Toxoplasma gondii and Pneumocystis carinii dual infections in rat model. 889 64

Trimethoprim-sulfamethoxazole (TMP-SMX) is widely used for Pneumocystis carinii pneumonia prophylaxis in human immunodeficiency virus (HIV)-infected patients, but little is known about the effects of this practice on the emergence of TMP-SMX-resistant bacteria. A serial cross-sectional study of resistance to TMP-SMX among all clinical isolates of Staphylococcus aureus and 7 genera of Enterobacteriaceae was performed at San Francisco General Hospital. Resistance among all isolates was <5.5% from 1979 to 1986 but then markedly increased, reaching 20.4% in 1995. This was most prominent in HIV-infected patients: resistance increased from 6.3% in 1988 to 53% in 1995. The largest increases in resistance were in Escherichia coli (24% in 1988 to 74% in 1995) and S. aureus (0% to 48%) obtained from HIV-infected patients. A rapid increase in the use of prophylactic TMP-SMX in HIV disease was also observed during this time in San Francisco and is likely responsible for the increase in TMP-SMX resistance.
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PMID:Emergence of trimethoprim-sulfamethoxazole resistance in the AIDS era. 1055 35

Trimethoprim-sulfamethoxazole (TMP/SMX) is recognized as the superior agent for Pneumocystis carinii pneumonia (PCP) prophylaxis but a high incidence of adverse drug reactions, which may be due to toxic drug metabolites, limits its use. AIDS Clinical Trials Group protocol 268 was a randomized, double-blind, controlled two-arm trial designed to determine whether gradual initiation of TMP/SMX suspension reduced the incidence of treatment-limiting adverse drug reactions compared with routine initiation of double-strength (DS; 160 mg/800 mg) tablets. In all, 372 HIV-1-infected study subjects with a CD4+ cell count <250 x 10 cells/mm3 who had not previously received TMP/SMX for PCP prophylaxis were randomized to receive either daily TMP/SMX DS tablets or a gradually increasing dose of TMP/SMX suspension. The suspension dose was increased to reach the equivalent of a DS tablet by study day 13. During the first 2 weeks, study subjects also received a matching placebo tablet/suspension. After week 2, all study subjects received TMP/SMX tablets for the next 10 weeks. There were significantly fewer study subjects who discontinued prophylaxis during the first 12 weeks when TMP/SMX therapy was initiated gradually (17%) than when initiated in DS tablet formulation (33%) (p =.0002). Gradual initiation was also associated with significantly fewer adverse drug reactions. Gradual initiation of TMP/SMX for primary PCP prophylaxis reduces the incidence of its treatment-limiting adverse effects.
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PMID:Reduced toxicity with gradual initiation of trimethoprim-sulfamethoxazole as primary prophylaxis for Pneumocystis carinii pneumonia: AIDS Clinical Trials Group 268. 1101 50

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


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