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)

An overview is provided of recent advances made in understanding HIV disease as it affects women, including recent information on HIV-associated gynecologic conditions. Drug blood levels in women, the effects of nelfinavir and oral contraceptives, and the problem of wasting and opportunistic infection control are explored. Nelfinavir, an approved protease inhibitor, effects the level of oral contraceptives in the blood by fifty percent. It appears that treatment drug blood levels remain greater in women than in men and that could affect the amount and severity of side effects. Wasting is still an uncertain factor in women's health, and the initiation and cessation of triple-drug therapy for women is different from men. Overall, while much can be gained from the studies that have been done so far, it appears that medical research is lagging behind in studying women and HIV.
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PMID:New developments in women and AIDS research. 1136 74

A 44-year-old man diagnosed with HIV in 1992 has become 3TC-resistant, has had adverse effects to ddI, and most likely will have the same adverse effects to d4T and ddC. The Ritonavir, Saquinavir, and Nevirapine combination he was switched to did not reduce his viral load, however, the patient was clinically stable without wasting or opportunistic infections, and his CD4 count was 220 cells/mm3. Based on past responses to medication and to the available NNRTIs, it is believed that the patient is currently cross-resistant to all first-generation protease inhibitors. It was suggested that the patient, now categorized as having virologic failure but clinical/immunologic success, is unlikely to achieve durable suppression, even with the new drugs becoming available. Mega-HAART therapy, which uses up to eight drugs, may work temporarily but appears to be intolerable in the long term for most patients. It is not known how long the patient's clinical/immunologic stability will last, but it is unlikely to continue indefinitely in the presence of high viral replication. In the case of worsening conditions, it is suggested that a phenotypic analysis be done to guide salvage therapy. In the absence of a phenotypic analysis, it is suggested to try a combination of ddI plus d4T plus Hydroxyurea plus Nelfinavir plus efavirenz.
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PMID:A patient with no options? 1136 84

To augment the limited antiviral treatments available for children, new therapies to treat children are being investigated. On recommendation from Federal guidelines, many treatment regimens approved for adults are being prescribed for children, but these have little information available about dosing and long-term effects. Ritonavir in different combinations and dose levels has shown good short-term results, and it is believed that the long-term outcomes will mirror the adult outcomes. The Pediatric AIDS Clinical Trials Group study 338 indicated that the three- drug combinations used had a similar impact on viral load when compared to the adult studies. An additional study of Ritonavir, given as a salvage therapy to children with high viral loads, illustrates that pediatric trials should use the experiences learned from adult trials to formulate beneficial regimens. Descriptions of studies for children utilizing Nelfinavir, Saquinavir, and abacavir describe the triple drug combinations that were most successful, the side effects that were experienced, and the need for liquid formulations of the drugs for easier administration. Critical issues that need to be addressed are: adherence to treatment, modifications of side effects, toxicity, and appropriate dosing. A summary of current Federal guidelines for treating children and adolescents with HIV is included.
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PMID:Antivirals and children. 1136 46

The AIDS Clinical Trials Group (ACTG) is preparing two trials for persons who are on a protease inhibitor regimen that has failed. ACTG 398 will use the experimental drug, amprenavir (141W94), in addition to three drugs from different anti-HIV medication classes, and possibly one other protease inhibitor. ACTG 400 is for people whose viral load is greater than 1,000 after 16 weeks of treatment with Viracept (Nelfinavir). Some exclusion criteria are listed. Contact information is provided.
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PMID:Trials for protease failure. 1136 84

Dr. Charles Flexner, an Associate Professor at Johns Hopkins University, discusses different issues involving drug interactions. Flexner states that some interactions exist between street drugs and HIV medications, including between benzodiazepines and Ritonavir (Norvir) or Nelfinavir (Viracept). He also reports on toxicity and death cases associated with MDMA (ecstasy) and protease inhibitors. Drugs for opportunistic infections are also described; most are not implicated in clinically significant drug interactions, nor are most over-the-counter medications. Dr. Flexner's opinions on protease-sparing regimens and lipodystrophy are also provided.
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PMID:Double jeopardy: the hazards of drug-drug interactions. 1136 84

The 38th Interscience Conference on Antimicrobial Agents and Chemotherapy featured information on new antiretroviral treatments, changes in dosing, and new vaccine information. Adefovir dipivoxil (Preveon) is a new nucleoside reverse transcriptase inhibitor that is administered once daily. A study of adefovir dipivoxil is described and the side effects are detailed. A clinical trial of the protease inhibitor Nelfinavir (Viracept) has shown that dosing twice a day may be as effective as the currently prescribed three times a day. Since lower dosing tends to increase a patient's adherence to treatment, it may have a long-term positive effect on treating HIV. Other drug treatments and possible changes in dosing are presented. A pneumococcal vaccine study is described, and it was found that the vaccine did not lead to an increase in viral load. Immunization against Pneumococcus is suggested for all adults who are HIV-infected.
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PMID:Antimicrobial agents and chemotherapy: highlights of the 38th Interscience Conference. 1136 34

Four protease inhibitors are compared: Saquinavir (Invirase, Fortovase), Indinavir (Crixivan), Ritonavir (Norvir), and Nelfinavir (Viracept). Key questions are answered on how dosages change when combined with nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and other protease inhibitors. Information on administration and storage and the impact of each drug on disease development are reviewed. Drug interactions between protease inhibitors and other HIV drugs and non-HIV medications are described. Side effects are also discussed. Pediatric use is addressed, including suggested dosages. Contact information for each manufacturer is provided, along with approximate annual price for treatment.
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PMID:Protease inhibitors at a glance.... 1136 98

Two recent reports indicate that the anti-HIV drugs Viramune (Nevirapine) and Sustiva (efavirenz) can reduce levels of Methadone, sometimes causing withdrawal. Other drugs already known to reduce Methadone levels include Norvir (Ritonavir) and Viracept (Nelfinavir), while Crixivan (Indinavir) and Fortovase (Saquinavir) may increase them. Another study has shown that Methadone may lower levels of ddI (Videx), suggesting a need to increase ddI dosages in those taking Methadone.
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PMID:Methadone and anti-HIV drugs. 1136 5

Third line therapy refers to any treatment that is initiated after the first two initial rounds of treatment have proven unable to maintain HIV suppression. Increased viral loads may be due to drug resistance or a patient's inability to tolerate the medications. The first drug of its class, T-20 (pentafuside) is a fusion inhibitor that works by blocking the virus from fusing with an immune cell. The drug appears to be effective in suppressing HIV even in people who have developed resistance to other drugs. Another study has examined megaHAART (mega Highly Active AntiRetroviral Therapy), in which patients received between five and seven anti-HIV drugs in combination. Results were promising after 24 weeks, but patients had to be able to tolerate extraordinary numbers of drugs, and not have previously used or developed resistance to NNRTIs, to achieve successful viral suppression. Other studies have addressed therapy options for when Nelfinavir fails, and for continuing to take 3TC even when the virus becomes resistant to the drug.
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PMID:Third line therapy options. 1136 43

Nelfinavir has been recently approved as a twice-daily (BID) dose regimen, but no evaluation of the influence of this regimen change on patients' protease inhibitor exposure has been published. The aim of this study was to compare trough plasma concentrations of nelfinavir obtained under the 1250-mg b.i.d regimen with the levels achieved with the original 750-mg three-times-daily (TID) regimen in 56 HIV-infected patients. Blood samples were obtained at steady state before the morning dose of nelfinavir. Plasma levels were measured by high-performance liquid chromatography. Eleven and 45 patients were following TID and BID regimens, respectively. Trough concentrations ranged from 0.14 to 11.74 mg/L and from 0.36 to 10.57 mg/L under TID and BID regimens, respectively. Large interpatient (coefficient of variation: 153%) and modest intrapatient (45%) variabilities of nelfinavir levels were observed. Twenty-one patients (38%) and six patients (11%) had levels above and below, respectively, the trough nelfinavir range (1.0--3.0 mg/L) recommended by the manufacturer. Trough levels are not affected by the dosing regimen; they mainly reflect the important interindividual variability, while remaining fairly stable over time. Many subjects had plasma levels repeatedly outside the assumed therapeutic range. Dose adjustment based on therapeutic drug monitoring may contribute to optimizing antiretroviral therapy.
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PMID:Nelfinavir plasma levels under twice-daily and three-times-daily regimens: high interpatient and low intrapatient variability. 1147 22


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