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

Tumor necrosis factor (TNF, cachectin), a cytokine secreted by macrophages and T-cells, mediates inflammatory and immune responses, and is associated with wasting in persons with malignancies or AIDS. In inflammation, TNF attracts and activates neutrophils, stimulating phagocytic function of neutrophils and macrophages. TNF also increases hepatic cell resistance to damaging parasitic effects; enhances endothelial permeability, causing edema; aids in wound healing by stimulating tissue and vascular growth; enhances lymphocytic activity through cytokine activation; acts with interleukin (IL) to produce fever, anorexia, lethargy and sleep; and possesses antitumor activity, particularly against the presumed origin of Kaposi's sarcoma, capillary endothelial cells. The host has an acute phase response (APR) following TNF- and IL-induced immunologic activation. TNF and IL decrease production and activity of lipoprotein lipase (LPL), resulting in reduced uptake and improper storage of fat; and they stimulate anabolism of fatty acids, causing hypertriglyceridemia. This "futile cycling" causes shuttling of fatty acids between adipose tissue and the liver, and use of muscle protein as the main fuel source. This, along with further muscular breakdown due to the increased caloric demands of fever, may affect cachexia. TNF benefits the HIV-infected through selective killing of HIV-infected cells, although effects may be dose and time dependent. The negative effects of TNF may be impeded by anti-cytokine therapy. Possible therapies include dietary N-3 fatty acid (fish oil), an inhibitor of TNF and IL production in vitro; pentoxifylline (Trental), another TNF production inhibitor; anti-TNF monoclonal antibodies; and soluble TNF receptors.
STEP Perspect 1995
PMID:Tumor necrosis factor: its role in HIV/AIDS. 1136 96

Thalidomide has been reported to be an effective therapy for painful oral (mouth) ulcerations associated with AIDS that do not respond to the usual treatment options available. Thalidomide was first developed and marketed in Germany in the 1950s as a sedative. It was withdrawn in 1962 when it was recognized to cause birth defects. Possessing no antibacterial activity, thalidomide is now used to treat a variety of diseases with an autoimmune character. It is unclear how it works to modulate the immune system or whether or not it will accelerate the deterioration of the immunological status of HIV-positive patients. One study suggests that it may suppress HIV viral replication and decrease viral burden. Thalidomide inhibits tumor necrosis factor (TNF). It affects the nervous system, often causing side effects such as drowsiness, dizziness, decreased libido and mood changes, as well as peripheral neuropathy. However, most of the neuropathy cases occurred in patients who had received a high dose for longer than six months. Response to thalidomide occurs at doses ranging from 100mg a day to 400 mg a day, with ulcer pain resolving within two to four days. Randomized placebo-controlled, double-blinded studies are needed to evaluate the efficacy of thalidomide in HIV-positive persons with aphthous ulcers. The AIDS Clinical Trials Unit is doing a six month study comparing thalidomide to placebo for treatment of aphthous ulcers of mouth and esophagus.
STEP Perspect 1995
PMID:Thalidomide: an alternative therapy for treatment of apthous ulcers (canker sores). 1136 97

Nutritional status directly affects immune competence; therefore, dietary supplements can be beneficial. Vitamin A, a fat-soluble nutrient obtained exogenously from animal protein or synthesized endogenously from carotenoids, is important in vision, epithelial tissue maintenance, reproduction, and growth. It is also an antioxidant, and can interfere with HIV-related oxidative destruction. Vitamin C, a water-soluble antioxidant important in hydroxylation reactions and required by erythrocytes for retrieving stored iron, can suppress HIV in vitro. However, this requires long-term administration, and its effect ceases upon termination of treatment. Vitamin E, fat-soluble tocopherols, can be found in plants, vegetable oils, milk, eggs, fish, meats, and cereals. A potent antioxidant because of its electron-donating ability, vitamin E reduces HIV replication. Deficiency reduces inhibition of tumor necrosis factor alpha (TNF-a) and protein kinase C, therefore limiting immunocompetence. Additionally, damaging side effects of AZT, normally reversed or minimized by vitamin E, may induce low leukocyte counts and anemia. Vitamin E acts synergistically with selenium, another antioxidant, to block the rate of lipid peroxidation. Its administration may reduce diarrhea, cramping, and weight loss, and may improve epithelial conditions and reduce the frequency of illness. N-acetylcysteine (NAC), a sulfur-containing amino acid, inhibits HIV replication by raising serum glutathione levels through inhibition of TNF-a. Finally, HIV-infected patients should consider gluten-free diets during times of acute gastric distress.
STEP Perspect 1995
PMID:Nutrition and HIV. 1136 99

Interleukin-2 (IL-2) is a cytokine that induces the proliferation and cytotoxic activation of CD8+ antigen-specific T cells and natural killer (NK) cells, stimulating the clearance of viral-infected and tumor cells. It has a stimulatory effect upon cell-mediated immunity; therefore, reduced IL-2 production may underlie the loss of immune responses in AIDS. These properties make it a desirable therapeutic agent. Clinical trials using IL-2 for the treatment of cancer found that it helped diminish certain types of tumors, but its side effects included capillary leak syndrome, hypotension, fever, and rash. Reduction of these detrimental effects via low doses or intermittent administration of IL-2 has been aided by construction of the hybrid IL-2/polyethylene glycol (PEG) molecule. This has a longer half-life in vivo than IL-2 alone, thus facilitating low dose administration. One potential drawback of IL-2 therapy is that it can stimulate HIV viral production; it is imperative to co-administer an anti-viral agent with IL-2 to offset this effect. A recent study of PEG/IL-2 and AZT yielded evidence of increased CD4+ counts, CD8+ activity, and NK activity. There was no indication of accelerated HIV production. Similar results were obtained in an earlier study. Thus, the use of IL-2 is encouraged as a co-treatment to slow the progression of HIV or as a treatment for HIV-related opportunistic infections.
STEP Perspect 1995
PMID:Interleukin-2. 1136

HIV-related Kaposi's sarcoma is a progressive, frequently visceral disease that is postulated to be infectious. Its growth is accelerated by corticosteroids, Oncostatin M, the HIV-tat protein, Interleukin-6, fibroblast growth factor, interleukin-1, and tumor necrosis factor. It represents a proliferative disorder of mesenchymal cells in response to HIV and dysregulation of immune mediators from HIV infection, in conjunction with an unidentified infectious agent. It is multicentric and has varying rates of progression, though rapid growth may occur during heightened immunosuppression. Problematic lesions can cause alterations in appearance, result in edema, or occur in the lungs or gastrointestinal tract. Epidemic Kaposi's sarcoma is incurable. Immediate initiation of therapy is not necessary, but is justified by life-threatening or symptomatic disease, or a cosmetically unacceptable lesion. Small, localized lesions may be treated with intralesional vinblastine, topical liquid nitrogen, and modest doses of radiation therapy. Palliation is usually temporary, and tumors may soon recur in previously treated sites. Extensive or rapidly progressive disease, especially when involving internal organs, can be treated with single and combination therapies. Initial treatment involves the well-tolerated vincristine, vinblastine, and bleomycin; and etoposide, doxorubicin or interferon-a are used when disease progresses. The best results are seen in patients with CD4+ counts greater than 200/ml, who are less likely to suffer from therapy-induced bone marrow suppression and hair loss. Promising new treatments, particularly liposomal doxorubicin and LGD 1069, are being investigated.
STEP Perspect 1995
PMID:The epidemiology, pathogenesis and treatment of Kaposi's sarcoma. 1136 1

The theory that in early HIV infection the virus remains hidden within cells or lymph nodes waiting for a signal to replicate and then causes the disease to progress, has been disputed. Current testing methods have shown that HIV can be detected in the blood of almost all HIV-infected patients throughout the course of the disease. Blood tests that allow detection of HIV include the branched DNA test (bDNA) and the quantitative polymerase chain reaction (QPCR). Both of these tests measure HIV RNA; Food and Drug Administration (FDA) approval of both test methods is expected within a year. Upon approval, people may obtain an HIV RNA test through their physician, and insurance companies may pick up the cost of the test. Analysis of HIV RNA has been shown to be the best predictor of progression to AIDS, even better than the CD4 count. Long-term non-progressors with no immune system deterioration were found to have very low to non-detectable levels of plasma HIV. These tests may potentially be used for guidance in antiviral therapies and for monitoring the risk of maternal-fetal transmission of HIV. Information on obtaining either of these tests and costs for each are provided.
STEP Perspect 1995
PMID:HIV RNA--should you get a quantitative HIV test today? 1136 16

With the recent increase in tuberculosis (TB) cases, especially among AIDS patients, it has been projected that TB will be the leading cause of death in this population by the year 2000. It is vital that TB be considered by clinicians when diagnosing and treating HIV infection. Since HIV-infected people have immune systems that do not respond normally, criteria for TB positivity in HIV-infected people differ from those in immunocompetent people. False negative diagnoses are an area of concern since immunocompromised people develop anergy, that is, they are unable to mount an immune response. Treatment to prevent transition of TB infection into symptomatic TB disease includes multiple drugs and a treatment period of nine to eighteen months, depending on whether the TB is resistant to multiple drugs. Because the treatment regimen is difficult, clinicians must negotiate treatment plans with the patient and their family. In some cases, a health care worker must directly observe the patient taking medications, in others, incentives are given to comply with treatment. Proper precautions must also be taken to avoid transmission of TB to visitors and health care workers.
STEP Perspect 1995
PMID:Tuberculosis and HIV infection. 1136 17

Persons with HIV may have previous or concurrent liver impairment as a result of injection drug use, hepatitis, alcohol abuse, and damage from medications. Additional stress is placed on the liver by low-grade opportunistic infections and hemophilia. It is especially important that persons with HIV care for their liver to help this organ remain physiologically normal during chronic and acute management of HIV infection. Although modern pharmaceutical medicine does not provide liver tonics or supportives, herbal medicines have been used to ease liver stress for ages. Readily available liver protectants and their actual mechanism of action, including thioctic acid, glycyrrhizin, and Silybum marianum, are described.
STEP Perspect 1995
PMID:Liver function and HIV-1 infection. 1136 18

Disseminated Mycobacterium Avium-complex (DMAC) usually occurs in people with advanced HIV infection CD4 and T-lymphocyte counts under 100 cells/ml. Recommendations for treating and preventing DMAC in adults and adolescents were made by a U.S. Public Health Service Task Force. The recommendations are: 1) all patients diagnosed with DMAC should be treated; 2) treatment regimens outside a clinical trial should include at least two agents; 3) arithromycin or clarithromycin should be included as the primary drug of every regimen; 4) ethambutol is often preferred as the second drug of the regimen; 5) addition of one or more of clofazimine, rifabutin, rifambin, ciprofloxacin, amikacin; 6) isoniazid and pyrazinamide are not effective for treating DMAC; 7) therapy should continue life long if clinical and microbiologic improvement is observed. Other agents under investigation include sparfloxacin, tumor necrosis factor, interleukin-2, interferon-v, and liposomally-encapsulated drugs.
STEP Perspect 1995
PMID:Disseminated MAC: current treatment strategies. 1136 19

During the HIV epidemic, alternative forms of medicine have leaked into mainstream medicine. It has become clear that a system of integrated care needs to be developed to combine conventional and alternative treatments. In January, 1995, the Integrated Care Clinic at Bastyr University was created. Modalities used include acupuncture, Chinese herbal medicine, and naturopathic treatment, with doctors involved to consult about diagnoses from a Western point of view and to provide an interface with the patient's allopathic doctors. The current clientele of the Clinic have been limited to twenty patients. The treatment plan includes nutritional possibilities and recommendations, psycho-emotional-spiritual information and a set of negotiated plans created by the patient care team. The plan is then presented to the patient for further discussion and negotiations. This integrated treatment method empowers all concerned and involves the patient as an active member of the team.
STEP Perspect 1995
PMID:The integrated care clinic for HIV/AIDS. 1136 21


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