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

Oral candidiasis is a common complication of HIV-infected-individuals. The purpose of this study was to evaluate clinical and laboratory findings to assess the impact and efficacy of antifungal treatment. This preliminary report describes findings in 50 HIV-positive, candida culture-positive subjects (49 males, 1 female; mean age: 39 years). The group had been known HIV-positive for a mean of 28 months, and 19 met the CDC/WHO definition for AIDS (63%, KS, 21% PCP). Thirty-four of the fifty patients had oral signs of candidiasis, with almost half having both atrophic (red) and pseudomembranous (white) components. In quantitating the cultures, the higher colony forming unit counts in general were correlated with clinical signs and pain. The other most common oral manifestations were periodontal disease, hairy leukoplakia and xerostomia. The most common candida species was albicans (84%). Response to initial antifungal therapy was satisfactory clinically, but erratic regarding CFU quantitation, species changes, and bacterial emergence. In summary, oral candidiasis is a complex infection with uncertainties as to the significance of quantitation and achieving control.
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PMID:Findings in 50 AIDS virus-infected patients with positive oral Candida cultures. 207 28

The DATTA panelists considered aerosolized pentamidine to be both safe and effective for primary and secondary prophylaxis of PCP. T4 helper cell counts offer guidance as to the best candidates for primary prophylaxis. Patients with a T4 helper cell count of fewer than 200/mm3 are the most appropriate group to receive primary prophylaxis with aerosolized pentamidine. However, T4 helper cell counts are not an exclusive criterion for aerosolized pentamidine prophylaxis. Some DATTA panelists suggested that certain patients, such as those with Kaposi's sarcoma and lymphomas and those with concomitant human T-cell lymphotropic virus type 1 infection, might be considered candidates for aerosolized pentamidine regardless of T4 helper cell counts. There is no current literature to support this, and this opinion is based solely on clinical experience. Perhaps the use of other markers of immune function (beta 2-microglobulin, neopterin) in conjunction with T4 helper cell counts will give a better indication of when to start primary prophylaxis. Aerosolized pentamidine is not the only potential prophylactic regimen for PCP. Other drugs, including pyrimethamine and sulfadoxine, sulfamethoxazole and trimethoprim, and dapsone, are currently being evaluated. Prior diagnosis and therapy for patients with M tuberculosis must occur before initiation of the use of aerosolized pentamidine. This and other appropriate environmental precautions should reduce transmission of M tuberculosis to health care workers and other patients. Whether any prophylactic treatment of an opportunistic infection will prolong survival in HIV-infected individuals has yet to be proved. The assumption is made, however, that a reduction in opportunistic infections should lower mortality and improve the quality of life.
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PMID:Diagnostic and therapeutic technology assessment. Prophylactic treatment for opportunistic infections in HIV-positive patients: aerosolized pentamidine. 218 63

As management of HIV infection becomes more proactive, early identification of persons at risk for PCP and initiation of preventive therapy will become more routine, and the clinical impact of P. carinii may be ameliorated.
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PMID:Pneumocystis carinii pneumonia: diagnosis and management. 218 91

Pneumocystis carinii (PCP) pneumonia is the most common pulmonary infection associated with the acquired immunodeficiency syndrome (AIDS). Patients at risk for PCP have defects in T lymphocyte function and include cancer and transplant patients who are on immune suppressing agents and corticosteroids. In West Virginia, PCP accounted for 53 percent of pulmonary infections in 144 cases of AIDS from 1984 to May 1990. Nationally, at least 100,000 cases of PCP are projected for the early part of this decade. Patients with PCP may present with non-specific symptoms. The chest X-ray frequently shows diffuse bilateral infiltrates but may have atypical features. Definitive diagnosis should be established using sputum staining and various bronchoscopic techniques. Trimethoprimsulfamethoxazole and IV pentamidine are the most efficacious agents for treatment, and monthly aerosolized pentamidine is recommended for prophylaxis. Further basic science and clinical research on the biology of the P. carinii and its response to treatment strategies in HIV and non-HIV related infections is urgently needed.
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PMID:Pneumocystis carinii pneumonia. 227 Jun 82

Lung 99mTc DTPA transfer was measured in HIV antibody-positive haemophiliacs (11 smokers, 26 nonsmokers, 5 patients with Pneumocystis carinii pneumonia (PCP]. Lung 99mTc DTPA transfer as a marker of lung epithelial permeability was measured as the half time of transfer (from airspace into blood). This half time was faster in smokers compared to nonsmokers and the transfer curve was monoexponential. In nonsmokers no difference was observed between asymptomatic HIV-positive haemophiliacs and normal subjects, with the exception of the lung bases. At the lung bases in HIV-positive haemophiliac nonsmokers the transfer was faster than in normal individuals, implying increased alveolar permeability. Pneumocystis carinii pneumonia resulted in a rapid transfer of 99mTc DTPA (mean T50 of 2 minutes) and the transfer curve was biphasic, confirming previous observations in homosexual HIV antibody-positive patients with PCP. These changes returned to a monoexponential profile by 6 weeks following successful treatment. The DTPA lung transfer study may enable clinicians to instigate therapy for PCP without the need for initial bronchoscopy and provide a noninvasive method for the reassessment of patients should further respiratory signs or symptoms develop. This method is considered to be highly cost-effective in that it obviates the use of factor VIII concentrates required to cover bronchoscopic procedures and, with its early application and ease of use as a follow-up investigation, permits the evaluation of patients on an outpatient basis, thus reducing hospital costs.
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PMID:Haemophilia, AIDS and lung epithelial permeability. 234 87

We retrospectively studied the acute toxicity of corticosteroid therapy in 23 episodes of PCP occurring in the setting of AIDS and determined the incidence of HIV-related complications following these and 16 other contemporaneous episodes of AIDS-related PCP treated with antimicrobials alone. The mean duration of corticosteroid therapy was 5.4 days and the mean total dose was 660 mg of methylprednisolone. Cryptococcus neoformans and Listeria monocytogenes infection each occurred once within one month of therapy in corticosteroid-treated patients; no other noteworthy acute corticosteroid toxicity was noted. Since all patients with imminently lethal PCP received corticosteroids, we could not assess the effect of these agents on acute mortality. After six months the rates of new AIDS-related diagnoses and of post-hospitalization mortality were equivalent in the two groups. We also have critically reviewed the available literature regarding this use of corticosteroids.
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PMID:Complications of corticosteroid therapy in patients with the acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia. 236 10

We have seen a dramatic increase in the types of antiviral strategies and numbers of specific antiviral agents that have emerged since the early 1980s when infection with the human immunodeficiency virus was first recognized. At the moment, zidovudine is the only drug approved by the FDA for treatment of HIV infection, and its indication is limited only to patients in the most advanced stages of immunodeficiency. Although zidovudine cannot "cure" HIV infection, it can significantly delay the seemingly inexorable course of immune system decline and buy some meaningful time for most HIV-1 infected patients, whether or not they have developed immunodeficiency. Other agents such as interferon alpha and the didoxynucleoside analogues, ddI and ddC, have also shown promise as antiretroviral agents, and it is hoped they will be proved, in the near future, capable of delaying the progression of immune system destruction by HIV-1. Other related treatment modalities such as the use of PCP prophylactic regimens also have succeeded in decreasing the incidence of opportunistic infections and thereby improving survival. It is likely that future strategies will involve the use of alternating, multidrug regimens both to reduce selective pressure for the development of drug resistance and to minimize the toxicity of single-agent therapy. The sum of these developments has been to change the prognosis of HIV infection. A disease once viewed as an automatic death warrant is now in the process of becoming a chronic, potentially long-term treatable illness.
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PMID:The role of antiretroviral therapy in living long and living well. 240 32

Enumeration of circulating T lymphocytes is crucial in the investigation of AIDS and related conditions. The single best measure of disease progression and prognosis is the absolute number of helper/inducer T lymphocytes in the peripheral blood. Although the phenotypic identification of a particular subset reflects no direct information on the function of the population, the information provided by the analysis furnishes new insight regarding racial differences in the immune deficiency associated with AIDS. The severity of the HIV illness in the African American population, as reflected by a decrease in the absolute number of circulating CD4+ lymphocytes, was marked compared to the Caucasian population with AIDS. Consequently, the CD4/CD8 ratio was lower in the African American HIV+ population. A higher level of activated mononuclear lymphocytes and NK cells in this population may indicate active disease. The incidence of life-threatening opportunistic infections such as PCP was greater in the adult/adolescent African Americans compared to Caucasians. In contrast, PGL was found more frequently in the Caucasian participants. Although the rate of HIV infection in the adult/adolescent African American population was not different from population estimates for the area under study, the incidence in the pediatric African American population was twice the population estimates for the race. This increased rate occurred in the parent-at-risk as well as in the hemophiliac group.
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PMID:Contrasting quantitative alterations in CD4+ and CD8+ lymphocytes in HIV-infected African Americans compared with the Caucasian population. 257 89

3'-azido-3'-deoxythymidine is a thymidine analogue with an in vitro as well as in vivo efficacy towards HIV-mediated infection. Zidovudine exerts its action, following an intracellular three-step phosphorylation, through viral reverse transcriptase inhibition. Its half-life is approximately one hour. Oral biodisponibility is 65%, and passage through blood-brain barrier results in therapeutic levels is CSF. Clinical evaluation has enabled demonstration of a beneficial effect on survival of stage IV AIDS patients, when treated after a PCP episode. In this setting, aggregate survival ratios reach 73% after one year of follow-up, and 41% after 2 years. In addition, zidovudine activity has been demonstrated in treatment of HIV-induced thrombopenias as well as HIV-related central nervous system disorders. Presently, zidovudine therapeutic evaluation proceeds through the following main axes: dosage tuning (either by lowering of standard dose, and/or dose interval modification); combination with other antiviral therapies; lastly, patient treatment et an early stage of disease.
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PMID:[Zidovudine. The current status of its evaluation]. 269 36

Lymphocytic interstitial pneumonia is a common complication of HIV infection in children, but uncommon in adults. It is characterized clinically by the presence of cough and dyspnea, diffuse pulmonary infiltrates on chest x-ray, restrictive pulmonary dysfunction, and hypoxemia. This constellation of findings usually erroneously suggests PCP, and a lung biopsy is necessary to establish the diagnosis. Typical microscopic findings include diffuse infiltration of the pulmonary interstitium with a mixture of lymphocytes and plasma cells; immunohistologic studies reveal that in association with HIV infection, these lymphocytes are T cells. The pathogenesis of LIP in patients with HIV infection is not known. It is believed that it represents a tissue response to EBV infection, HIV infection of the lung, or both. Although patients with LIP may respond dramatically to corticosteroid therapy, others may improve with no treatment. Unfortunately, most patients eventually succumb to other complications of HIV infection.
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PMID:Lymphocytic interstitial pneumonia. 304 82


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