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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

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

Reports from the 1997 Fourth Conference on Retroviruses and Opportunistic Infections reveal encouraging responses to the latest antiretroviral regimens, including using protease inhibitors for treating opportunistic infections. Unfortunately, there appears to be less interest in the development and validation of newer agents and regimens for opportunistic infection treatment and prevention. Reports are presented addressing the following areas: the impact of opportunistic infections on survival in HIV-infected patients; the success of protease inhibitors and antiretroviral therapy on opportunistic infections; the relationship of viral load plus CD4+ levels and prophylactic therapy for opportunistic infections. A report indicating that patients with a history of previous febrile reactions to trimethoprim/sulfamethoxazole (TMP/SMX) may be at increased risk of recurrence of TMP/SMX hypersensitivity following initiation of protease inhibitor therapy, and studies suggesting that, in HIV-infected patients, cytomegalovirus reactivation occurs a median of six months prior to the development of clinically detectable manifestations of cytomegalovirus infection are included. Questions on the length of prophylactic therapy and the role of prophylaxis in anergic patients who are being treated for Mycobacterium disease; risk factors associated with recurrent oral candidiasis in patients who received continuous antifungal therapy for less than three months; the detection of human herpesvirus eight DNA sequences in the semen of HIV-infected men without Kaposi's sarcoma; and occurrences of cervical dysplasia and genital tract infections in HIV-infected women are also discussed.
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PMID:Opportunistic infections: stemming the tide. 1136 2

A case study of an HIV-infected Caribbean male with extrapulmonary tuberculosis details his diagnosis, treatment regimens, and follow-up. His presenting symptoms included epigastric pain and fever. Endoscopy and gastric biopsy showed gastritis and helicobacter infection, which were treated symptomatically, and TMP-SMX was given for possible salmonellosis. Serologic tests for common opportunistic infections were negative. After all other expected conditions were ruled out, concurrent symptoms were diagnosed as extrapulmonary tuberculosis, and multi-drug treatment was successfully conducted. The problem of interactions between protease inhibitors and anti-tuberculosis drugs in treating HIV and tuberculosis concurrently is discussed. Three options are addressed: (1) discontinue (or delay starting) the protease inhibitor until at least 6 months of a standard rifampin-containing tuberculosis regimen is completed; (2) discontinue (or delay starting) the protease inhibitor until 2 months of a standard rifampin-containing regimen are completed; and (3) use of rifabutin rather than rifampin.
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PMID:Pursuing a diagnosis in a Caribbean man. 1136 79

The 12th World AIDS Conference in Geneva provided evidence that STD prophylaxis/treatment does not reduce HIV transmission. New guidelines for antiretroviral therapy in terms of when to treat and when to change are also presented. Research findings and practical applications are also provided for the following areas: HIV therapeutic monitoring, immune reconstitution, prevention, TMP-SMX prophylaxis, lipodystrophy, serum lipid changes, and diabetes.
Hopkins HIV Rep 1998 Sep
PMID:Conference news at a glance. 1136 77

The Centers for Disease Control and Prevention (CDC) has determined that HIV-infected people are more likely to become infected first with Pneumocystis carinii pneumonia (PCP) than any other opportunistic infection. About 53 percent of people who died of AIDS between 1992 and 1997 had PCP. The symptoms of the disease are fever, cough, and breathing problems. PCP is thought to be spread through the air - and not through sexual transmission - so it is difficult to prevent exposure. There is no vaccine against PCP, so the most effective treatment is TMP-SMX, a drug which can prevent PCP. The effects and treatment of PCP in adults and children are described, and contact information is provided.
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PMID:Protect yourself from Pneumocystis carinii. 1136 14

Background: We recently observed that a short course of trimethoprim 300 mg b.i.d. in healthy volunteers can cause a substantial increase in fasting plasma homocysteine levels, up to concentrations reportedly associated with atherothrombotic complications. The purpose of this study was to determine whether primary Pneumocystis carinii prophylaxis (PCP) with trimethoprim-sulphamethoxazole (TMP-SMX) adversely affects serum homocysteine levels in HIV-positive patients. Methods: We studied 34 subjects [29 male, 5 female, mean age 36.8+/-7.9 (S.D.) years] with no prior AIDS-defining disease who required primary PCP prophylaxis (CD4+ T-cell count <200/mm(3)). The common dose of TMP-SMX was 80/400 mg (80 mg trimethoprim and 400 mg sulphamethoxazole) once daily. Serum total homocysteine levels were determined in four samples: two collected prior to the start of TMP-SMX and two collected on average 2.6+/-2.2 and 5.3+/-3.5 months into the first year of prophylactic therapy. Results: Mean serum homocysteine was 13.9+/-3.7 &mgr;mol/l pre-treatment and 14.4+/-5.0 &mgr;mol/l during treatment with TMP-SMX, a non-significant increase of 0.5 &mgr;mol/l (95% CI: -0.5 to +1.4, P=0.34). Folate levels were equally unaffected by TMP-SMX (13.1+/-6.5 nmol/l versus 13.3+/-5.3 nmol/l, before and during therapy, respectively). Baseline folate levels did not predict the response of homocysteine to TMP-SMX, and neither did age, gender, or serum creatinine. Conclusion: Long-term therapy with 80/400 mg TMP-SMX does not adversely affect homocysteine levels.
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PMID:Trimethoprim-sulphamethoxazole as primary Pneumocystis carinii prophylaxis does not increase serum homocysteine levels in HIV-positive subjects. 1139

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

Prophylaxis against Pneumocystis carinii pneumonia (PCP) is an essential part of the management of children with human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS). No dose-ranging studies were ever performed; therefore, the amount of trimethoprim-sulfamethoxazole (TMP-SMX) needed to suppress PCP in children with HIV/AIDS is not known. The dose recommended by the Centers for Disease Control (CDC) has been thought to be just above the threshold needed for prevention, based on anecdotal breakthrough PCP in cancer patients who were improperly dosed. We have been giving prophylaxis based on body weight rather than surface area, and this, combined with growth of our children, has led to a large experience with dosages lower than the currently recommended 150 mg/m2. The medical records of children with HIV who met CDC guidelines for institution of PCP prophylaxis were reviewed. To ascertain the per square meter (m2) dosage each child was receiving, body surface area was calculated from height and weight measurements. Dosages were recalculated every 6 months and at each dosage change. Data regarding PCP infection, bacterial infections, and side effects of TMP-SMX were extracted. Data were compiled from 1,719.5 child-months of TMP-SMX prophylaxis, including 1,532.5 child-months below the currently recommended dose. Sixty-seven percent of our child-months were at or below two-thirds the CDC recommended dose. There were no cases of proven or suspected PCP. Incidence of other serious bacterial infections was low. Bacteremia and sepsis with Streptococcus pneumoniae was the most common proven bacterial infection, at a rate of 5.5 episodes per 100 child-years. The incidence of bacterial infection did not vary by the dose of TMP-SMX. TMP-SMX prophylaxis was well tolerated; most reactions were mild and self-limited and did not recur with re-institution of the drug. Only 6.1% of this cohort had TMP-SMX prophylaxis discontinued due to perceived toxicity. These data show that the currently recommended dose of TMP-SMX (150 mg/m2) may not be required to prevent PCP in children with HIV/AIDS. The drug is well tolerated at all dosage levels. The incidence of serious bacterial infection in this cohort of patients did not depend upon the amount of TMP-SMX prescribed. A prospective, controlled clinical trial of low-dose TMP-SMX for children with HIV infection is warranted.
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PMID:Successful prophylaxis against Pneumocystis carinii pneumonia in HIV-infected children using smaller than recommended dosages of trimethoprim-sulfamethoxazole. 1153 Jul 67

Pneumocystis carinii pneumonitis (PCP) is one of the most important opportunistic infections in children and adolescents with cancer. Its high frequency and a considerable mortality have led to primary chemoprophylaxis in patients with hematological malignancies and following allogeneic hematopoietic stem cell transplantation. Although less well characterized, patients with autologous stem cell transplantation and patients with dose-intensive chemotherapy for pediatric solid tumors may have a similarly high risk for PCP based on their profound T-cell depletion. For more than two decades, effective chemoprophylaxis for PCP has been available. Trimethoprim and sulfamethoxazole (TMP/SMX) is the prophylactic modality of first choice. The combination has been shown to be almost 100 % efficacious in pediatric cancer patients at highest risk, and it is usually well tolerated in this setting. Secondary alternatives to TMP/SMX include oral dapsone, oral atovaquone, and aerosolized pentamidine-isethionate. These modalities are less effective than TMP/SMX, and have been evaluated predominantly in HIV-infected patients. This article reviews epidemiology and current approaches to chemoprophylaxis for PCP in children and adolescents with cancer and/or hematopoietic stem cell transplantation, and provides evidence-based guidelines for indications and modalities of PCP prophylaxis in this population.
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PMID:[Guidelines for Prevention of Pneumocystis carinii Pneumonitis in Children and Adolescents with Cancer]. 1157 63


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