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

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

Persons with HIV need to be aware that exposure to the sun can do more than increase their risk of skin cancer; it can interfere with the actions of several drugs that are common treatments for HIV. The most common drug-induced reaction is a rash that looks like sunburn, which may appear in areas exposed to the sun (phototoxic) or everywhere (photoallergic). Photosensitivity occurs with these drugs: Ambien, Bactrim, Benadryl, Cipro, Compazine, Dapsone, Elavil, Hismanal, Lasix, Minocin, Motrin, Norpramin, some oral contraceptives, Periactin, Seldane, Sumycin, Tegretol, Tofranil, Velban, Zithromax, and Zoloft.
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PMID:Fun in the sun? 1136 6

AIDS treatment costs are astronomical, and insurance considerations have forced many HIV-positive persons into managed care programs. In many cases of treating opportunistic infections, the most effective treatment is also the least costly. Prophylaxis with Bactrim dramatically reduces the incidence of Pneumocystis carinii pneumonia (PCP), and is significantly less expensive than the care of acute PCP. A study by the Community Medical Alliance (CMA) in Boston evaluated treatment options provided by teams of home care professionals and found that the treatments worked well for manageable infections like PCP. It is unclear if this system will work as well for conditions such as CMV and wasting.
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PMID:Health care quality versus economics in HIV. 1136 37

A great deal of attention at the XI International Conference on AIDS was focused on new approaches to managing and preventing AIDS-related opportunistic infections (OIs). Aside from a similar prevalence of Pneumocystis carinii pneumonia (PCP) in developed countries, a different spectrum of OIs is seen in less developed areas, such as Latin America, where many endemic diseases are included among OIs. Candidiasis has been the most common fungal pathogen, but a broader spectrum of mycoses is being seen, with fluconazole and itraconazole being the mainstays for treating these infections. Ganciclovir and foscarnet are still used to treat cytomegalovirus retinitis, but introduction of cidofovir represents a significant advance in treating this disease. Mycobacterium avium complex (MAC) is the third most common OI in developed countries, and delays in diagnosis and starting treatment are common. Trimethoprim-sulfamethoxazole (TMP/SMX) remains the drug of choice for PCP prophylaxis. Liposomal doxorubicin with or without other chemotherapy agents has been approved for treating Kaposi's sarcoma. A three-drug regimen of amphotericin B, flucytosine, and itraconazole is effective for treatment of HIV-infected patients with cryptococcosis. Bacterial infections can be treated with appropriate antibiotics, but adding intravenous immune globulin may decrease the occurrence of infections and increase the time between new infections.
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PMID:Opportunistic infections: the growing challenge. 1136 8

Bactrim/Septra is a drug used for treating and preventing PCP (Pneumocystis carinii pneumonia) and toxoplasmosis. However, people with HIV are more likely to develop hypersensitivity reactions to Bactrim/Septra. NAC (N-acetyl-cysteine) is being studied to determine if its detoxifying properties could reduce the risk of hypersensitivity to Bactrim/Septra. However, a Canadian study found no statistically significant difference in the rates of hypersensitivity among the nearly 200 subjects.
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PMID:Study finds NAC fails to prevent Bactrim/Septra hypersensitivity. 1136 23

Trimethoprim-sulfamethoxazole (TMP-SMZ) is widely prescribed as prophylaxis for Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus (HIV)-infected persons. Its efficacy against other infections has not been thoroughly evaluated. To compare the risk for infectious diseases for persons who were prescribed TMP-SMZ with that for patients who were not prescribed TMP-SMZ, we examined data collected from the medical records of HIV-infected patients (January 1990 through September 1999) who were enrolled in the Adult and Adolescent Spectrum of HIV Disease Project. During intervals when patients had CD4(+) T lymphocyte counts of <200 cells/microL (19,081 persons; 22,801 person-years), prescription of TMP-SMZ was associated with significant protection from toxoplasmosis, salmonellosis, infection with Haemophilus species, invasive or any staphylococcal infection, and PCP, but not from Shigella, pneumococcal or nonpneumococcal Streptococcus, Klebsiella, or Pseudomonas species. We demonstrate that prescription of TMP-SMZ for PCP prophylaxis in persons with HIV infection is associated with significantly decreased risk for several infectious diseases. These findings may be of interest to HIV prevention programs in resource-poor countries.
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PMID:Prophylaxis with trimethoprim-sulfamethoxazole for human immunodeficiency virus-infected patients: impact on risk for infectious diseases. 1143 10

Trimethoprim-sulfamethoxazole has been recommended as part of the standard package of care for people with HIV and AIDS in Africa. A similar antifolate combination, sulfadoxine-pyrimethamine, is now the first-line antimalarial drug in several of the African countries with the highest rates of HIV infection. We present evidence of Plasmodium falciparum cross-resistance between trimethoprim and pyrimethamine at the molecular level. The impact of trimethoprim-sulfamethoxazole on the efficacy of sulfadoxine-pyrimethamine needs to be assessed urgently, and alternative antimalarial treatment should be considered for people on trimethoprim-sulfamethoxazole prophylaxis.
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PMID:Plasmodium falciparum cross-resistance between trimethoprim and pyrimethamine. 1180 21

Sinusitis is commonly occurring in patients infected with Human Immunodeficiency Virus I (HIV), but the occurrence and etiology have not been established. The purpose of this study was prospectively to determine the occurrence, site and type of paranasal sinus abnormalities seen on MRI in HIV-infected patients with fever, to relate the abnormalities to clinical and immunological parameters, and to determine the microbiological agents found in the sinus aspirates. MRI was performed in 54 HIV-infected patients with 70 evaluable episodes of fever. Patients receiving antibiotics were excluded. Bactrim was permitted, when given as prophylaxis of Pneumocystis carinii pneumonia. If abnormalities were found on MRI, sinus aspiration was performed and the aspirate investigated. MRI abnormalities were found in 54.3% of the patients with a significantly higher occurrence of pathological changes in AIDS patients compared with HIV-infected without AIDS. In approximately 2/3 of the aspirates a probable, etiologic agent was found. However, 1/3 of these agents were atypical such as cytomegalovirus and mycobacteriae; in one patient Non-Hodgkin's lymphoma was found. The high occurrence of sinusitis in HIV-infected patients and the atypical findings in the sinus aspirates stress the importance of searching for sinusitis and the etiology to ensure the correct treatment.
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PMID:The occurrence of sinusitis in HIV-infected patients with fever. 1172 3

A 30-year old man of Myanmar origin was admitted to our hospital because of productive cough, anorexia, weight loss and fever. Sputum smear was strongly positive for M. tuberculosis (Gaffky 6) and sputum culture proved M. tuberculosis. Caseous necrosis with Langhans giant cells was observed in the biopsied specimens of the liver and bone marrow. He was diagnosed as miliary tuberculosis. Treatment with combined use of isoniazid, rifampicin, ethambutol and streptomycin was started. After one month, his cough resolved, fever subsided and chest X-ray findings improved. Two months later, non-productive cough and fever recurred. Chest radiograph and computed tomographic scan of the chest revealed diffuse ground-glass opacity. Specimens taken by transbronchial biopsy showed pneumocystis carinii in alveoli. Pulsed use of methyprednisolone with Trimethoprim-sulfamethoxazole was started. The symptoms and chest X-ray findings disappeared and he recovered uneventfully. Tests for HIV infection were negative. Anti-HTLV antibody was negative. There were no other suggestive evidences of immune suppression. CD4+T cell count was low, when Pneumocystis carinii pneumonia occurred. The relation between miliary tuberculosis, Pneumocystis carinii pneumonia and CD4-T lymphocytopenia has remained unelucidated.
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PMID:[A case of Pneumocystis carinii pneumonia during treatment for miliary tuberculosis]. 1260 38


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