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Query: UMLS:C0019693 (HIV)
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The field of psychoneuroimmunology has been evolving over the past thirty years and is based on connecting the mind and body using a concept known as hardiness. Hardiness generally consists of three main parameters: commitment, control, and challenge, but in working with HIV-infected patients, a fourth parameter, community, is added. Various mental health scales are used to assess how patients cope with stress; effects of stress on the immune system can also be assessed by determining proliferation of various types of lymphocytes. Various studies conducted on asymptomatic HIV-positive subjects prior to and following notification of HIV-1 antibody status measured immune system function in patients that were or were not involved in aerobic exercise or group, cognitive, or behavioral modification. Those who participated in interventions had lower or minimal decreases in immunologic parameters compared to controls. A University of Miami research team theorizes that in the absence of aerobic conditioning or behavioral restructuring, a cascade of events occurs which decreases the individual's immunologic endocrine and neuropathic functioning. The patients' hardiness is what keeps them from falling under a medical hex, that is, keeps them from allowing the person in power (the doctor) to take away their hope, which would cause the cascade to occur. Support groups are good ways to help patients develop hardiness within a trusting atmosphere.
STEP Perspect 1995
PMID:Psychoneuroimmunology and HIV. 1136 22

Research on HIV viral loads and combination therapy was presented at the 35th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). Research has shown that ten billion HIV particles are produced daily in an infected individual's body. The HIV particles live freely for about eight hours before infecting CD4 cells, which live for 2.2 days before dying. The virus replicates in about 1.2 days. This is a faster rate of replication than previously thought. The specific proteins needed for cytotoxic lymphocytes to recognize an infected CD4 cell may not be available with so many viral mutations constantly occurring. Combination therapies are believed to decrease drug-resistant strains of HIV by reducing replication and by increasing the number of mutation sites needed for new HIV virions to be produced. A research study, ACTG 175, compared four treatments: zidovudine (ZDV) alone, ddI alone, ZDV plus ddI, and ZDV plus ddC. The results showed that ZDV alone was the least effective treatment, even when it was the initial treatment. ZDV plus ddI was the most effective for people who had previously taken ZDV, and ZDV plus ddC was the most effective for ZDV-naive participants. Delta, a European and Australian trial, reported similar results.
STEP Perspect 1995
PMID:Review of viral load and combination therapy data from 35th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy. 1136 80

Protease inhibitors (PRIs) are a diverse group of drugs which block an HIV-1 enzyme needed for the production of new viruses. PRIs stop the production of HIV in newly- or chronically-infected cells. There are currently six PRIs in clinical phase I or II trials: ritonavir, indinavir, Invirase, AG1343, U-103017, and VX 478; and there are four newly-identified PRIs soon to begin clinical trials: CGP 53 437, CGP 57 817, KNI-272, and A-80978. Eleven monotherapy studies of PRIs presented at the 35th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) are described.
STEP Perspect 1995
PMID:Protease inhibitors. 1136 81

People with HIV/AIDS have very different nutritional needs than people who are HIV-negative. From diet to exercise, the advice for people with HIV/AIDS is almost the exact opposite of that for HIV-negative people. HIV/AIDS-infected people should eat more saturated fats to raise their blood cholesterol level. Red meat provides protein and is also a good source of iron, zinc, and vitamin B-6. Eggs also provide protein. Pork is the best source of B-1, a vitamin needed to digest carbohydrates. If diarrhea is a concern, high fiber foods, such as salads, should be avoided. To avoid eating foods contaminated with germs, thoroughly cook all meats and eggs, and wash raw vegetables and fruits. Keep aerobic exercise to a minimum; it burns calories unnecessarily. Muscle-building resistance training seems to help protect infected people from HIV/AIDS-related wasting.
STEP Perspect 1995
PMID:Nutrition power "upside-down". 1136 83

There are two types of vaccines: T-cell dependent, those that require well-functioning T-cells to achieve immunity, and T-cell independent, those that do not. Recent studies have questioned these vaccines' potential stimulation of HIV activity. These results show that the effectiveness of using T-cell dependent vaccines, such as flu vaccines, for HIV-positive people depends on their CD4 counts. People with 300 or higher CD4 counts can benefit from these vaccines. There is only some risk to persons with CD4 counts of 100 to 300. However, T-cell dependent vaccines are not recommended for people with 100 or lower CD4 counts because the immunity produced is low and the risk of HIV stimulation is high. T-cell independent vaccines, such as Pneumovax (the vaccine for pneumonia), are still recommended because morbidity from these diseases is high and the effectiveness of these vaccines is independent of CD4 counts.
STEP Perspect 1995
PMID:Current views on vaccination. 1136 84

Studies have shown that the differences between men and women with HIV have more to do with access to health care than to biological differences. HIV-positive women have a higher mortality rate than HIV-positive men because they are less likely to be treated with drugs such as AZT. Women are at a greater risk for developing toxoplasmosis, herpes, neuropathy, and wasting syndrome. HIV-positive women with human papillomavirus are four times more likely to develop premalignant conditions, and they have a higher rate of recurrence of cervical dysplasia. Pelvic inflammatory disease is more common and more severe in HIV-positive women. HIV screening should be offered to every woman presenting with pregnancy or any sexually-transmitted disease, and women with CD4 counts below 500 should have Pap smears every six months.
STEP Perspect 1995
PMID:A review of the Conference on HIV Infection in Women. 1136 85

A study is underway at the University of Washington to determine factors predominant in the progression of HIV to AIDS. Information on this subject has been limited because few studies targeted people shortly after seroconversion. Seroconversion to HIV usually occurs 10 to 14 days after exposure, and symptoms are frequently mistaken for mononucleosis. CD4 changes, HIV viral load levels, and potential drug therapy (with its associated side effects) are discussed in relation to primary HIV infections.
STEP Perspect 1996
PMID:Primary HIV infection. 1136 89

Nutritional adequacy is essential in treating HIV/AIDS, where gastrointestinal problems are common. Patients need to consider taking nutritional supplements if their appetite diminishes or mouth sores create a special difficulty in maintaining an adequate diet. All parts of the digestive tract are affected by HIV/AIDS, causing pain and malabsorption of nutrients and drugs. Patients are cautioned to monitor and control their diets to insure that they are not becoming malnourished.
STEP Perspect 1996
PMID:Nutrition Power. Gut drama: malabsorption. 1136 91

The Food and Drug Administration (FDA) approved two new protease inhibitors for treatment of AIDS. Ritonavir (Norvir) and indinavir (Crixivan) have been approved for both monotherapy and combination therapy, and appear to have relatively few side effects. Reports on clinical trials of both drugs are reported. Saquinavir (Invirase) also has FDA approval, but currently has a low absorption rate; better formulations are expected to increase absorption. Early trials indicate that triple drug combinations may suppress HIV replication to very low levels.
STEP Perspect 1996
PMID:FDA approves 2 new protease inhibitors: ritonavir (Norvir) and Crixivan (Indinavir sulfate). Food and Drug Administration. 1136 92

Issues presented at the International AIDS Conference included basic science, treatments, and social service needs of people with HIV. Topics highlighted include global epidemiology issues, the impact of AIDS on women, viral dynamics, viral load and resistance, immunologic factors, therapy guidelines and approved medications, treatment of people recently infected, viral eradication, and implications of managed care in the quality treatment of people with AIDS.
STEP Perspect 1996
PMID:A STEP summary of the XIth International AIDS Conference. 1136 60


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