Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cytomegalovirus retinitis in the human immunodeficiency virus-infected patient currently requires almost daily and lifelong parenteral ganciclovir therapy. Self-preparation of ganciclovir is not an option in the majority of patients with decreased visual acuity or poor muscle coordination. Therefore, based on current stability data, patients usually receive a 5-day supply of reconstituted drug. This requirement is unfortunately associated with poor patient compliance. If the extended stability of ganciclovir was known, then more efficient regimens for outpatient therapy could be formulated. This study was designed to determine the stability of reconstituted ganciclovir between 7 and 28 days. Ganciclovir diluted with normal saline or 5% dextrose in water to final drug concentrations of 5 or 10 mg/ml was evaluated for stability by high-pressure liquid chromatography under different conditions of storage. Samples were stored at both 4 degrees C and -20 degrees C in polyvinyl chloride bags and at 4 degrees C in ADFuse syringes. Ganciclovir remained stable under these conditions for 28 days. On the basis of these data, we have recommended that patients receive a 2-week supply of reconstituted ganciclovir for parenteral outpatient therapy. We have observed high levels of patient compliance with this regimen and no unexpected progression of retinitis over a 5-month period in three patients who received the drug in this fashion.
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PMID:Extended stability of ganciclovir for outpatient parenteral therapy for cytomegalovirus retinitis. 131 95

Cotton-wool spots and cytomegalovirus (CMV) retinitis are seen frequently in AIDS patients. Human immunodeficiency virus (HIV) infection of the retina has been proposed as a mechanism for the high incidence of retinal pathology. An autopsy study of the eyes from 25 consecutive cases of AIDS was performed using gross examination, light microscopy, trypsin digestion of retinal vasculatures, and immunohistochemistry to evaluate the possible role of HIV, as well as CMV, in the pathogenesis of retinitis and retinal vasculopathy. Brain tissue was studied in the first 20 of these cases to evaluate any correlation between retinal and central nervous system pathology. CMV retinitis was observed in 15 cases (60%). Cotton-wool spots were seen in nine cases (36%). CMV encephalitis was detected in four cases, whereas HIV encephalitis was noted in five cases. We were unable to demonstrate a correlation between CMV retinitis and CMV encephalitis. However, the number of cases studied was small, and the frequency of CMV encephalitis was low. On the other hand, bilateral CMV retinitis demonstrated a correlation to HIV encephalitis (P less than 0.005, Fisher's exact test). HIV infection of the retina was not detected by typical morphologic changes or immunohistochemistry. Immunohistochemistry localized CMV infection solely to areas of active retinitis. These findings suggest that bilateral CMV may serve as a marker of HIV encephalitis, possibly indicating a severely immunodepressed state.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Role of HIV and CMV in the pathogenesis of retinitis and retinal vasculopathy in AIDS patients. 132 96

This study examines the risk of developing cytomegalovirus (CMV) retinitis as a function of the duration and degree of CD4+ lymphocyte depletion. A retrospective analysis of 135 persons infected with the human immunodeficiency virus (HIV) was performed. Kaplan-Meier estimates for the percentage of patients developing CMV retinitis during the 27-month study period were calculated. Twenty-six patients were diagnosed as having CMV retinitis. In 14 of these patients, T cell phenotyping was done within the 3 months preceding diagnosis. The mean CD4+ lymphocyte count for these patients was 15.6 cells/mm3 (range, 2-33/mm3). At 27 months, the percentage of patients developing CMV retinitis with baseline CD4+ lymphocyte counts of 0-50, 51-100, and 101-250 cells/mm3 was 41.9%, 26.3%, and 14.7%, respectively (log-rank test, p = 0.003). The odds ratio for developing CMV retinitis for those with baseline CD4+ lymphocyte counts of 0-50 cells/mm3 compared with those with CD4+ lymphocyte counts of 101-250 cells/mm3 was 4.62 (p = 0.002). Twenty-four patients had CD4+ lymphocyte counts of < or = 50 cells/mm3 for an average of 13.1 months prior to diagnosis. Twenty-two patients had an acquired immune deficiency syndrome (AIDS)-defining illness diagnosed for an average of 18.0 months prior to the onset of retinitis. CMV retinitis is most likely to develop in patients with AIDS when the CD4+ lymphocyte count is < or = 50 cells/mm3.
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PMID:Risk of developing cytomegalovirus retinitis in persons infected with the human immunodeficiency virus. 135 51

Between January 1988 and May 1991 intravenous ganciclovir (GCV) treatment was administered to eight male AIDS-patients with unilateral cytomegalovirus (CMV)-retinitis. Despite of continuous therapy with at least the recommended dose of GCV, three patients developed slowly progressive CMV-retinitis in the fellow eye after 4 to 13 months. The progression could not be stopped by GCV and thus bilateral blindness resulted after 12 to 22 months. The number of CD4-lymphocytes in the blood was reduced in all patients, but particularly in patients with progressive disease. Treatment failure was partly related to the duration of CMV-retinitis and partly to the degree of immunodeficiency. Intravenous treatment with GCV alone can not stop the progression of CMV-retinitis in long-term survivors and in those with advanced immunodeficiency.
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PMID:Failure to control AIDS-related CMV-retinitis with intravenous ganciclovir. 136 18

Foscarnet exerts its antiviral effects via reversible inhibition of viral polymerases. Pharmacodynamic data indicate that herpesvirus and human immunodeficiency virus replication is inhibited by therapeutically achievable concentrations of foscarnet; however, the concentrations of foscarnet required for such inhibition have been found to vary widely. Pharmacokinetic data indicate that foscarnet is eliminated via the renal route, undergoes negligible metabolism, and appears to be distributed widely from the circulation. However, the available data indicate that the pharmacokinetics of the drug varies among patients and within the individual patient, particularly with regard to plasma drug levels; furthermore, such factors as the intracellular kinetics of the drug have yet to be well characterized. It is thus difficult to formulate optimal dosing regimens on the basis of what is known of foscarnet pharmacodynamics and pharmacokinetics. Nevertheless, dosages that produce clear-cut therapeutic benefits without unacceptable toxicity have been identified in clinical trials of foscarnet in acquired immunodeficiency syndrome (AIDS) patients with cytomegalovirus (CMV) retinitis.
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PMID:Clinical pharmacology: foscarnet. 137 Oct 39

We present our findings in 14 patients with a serologically verified diagnosis of ocular syphilis. Although most patients had iridocyclitis, other ocular findings included episcleritis, scleritis, vitritis, retinitis, papillitis, panuveitis, cystoid macular edema, and retinal detachment. Most patients had only ocular manifestations of syphilis with no other definitive symptoms. Without the use of specific treponemal serologic tests, the diagnosis of ocular syphilis would have been missed in at least 20% of patients. Furthermore, 80% of patients were negative for antibody to syphilis in the cerebrospinal fluid, and therefore, this test should not be used to determine treatment for ocular syphilis. Currently, the most effective therapy for ocular syphilis is the same as that for neurosyphilis (i.e., high-dose intravenous penicillin G 12 to 24 million units/day for ten to 14 days). Human immunodeficiency virus-positive patients should receive a full 14 days of high-dose intravenous penicillin G plus intramuscular benzathine penicillin 2.4 million units weekly for three weeks because their immune defenses are likely to be impaired.
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PMID:Acquired ocular syphilis: diagnosis and treatment. 159 Jun 33

We analysed the correlation between ophthalmic and systemic findings in 125 subjects with AIDS and 50 subjects with AIDS-related complex (ARC). Positive eye findings were defined as the presence of cotton-wool spots (CWS) or cytomegalovirus (CMV) retinitis. The presence of positive eye findings was significantly more frequent in AIDS than in ARC (P = 0.0001). Both lowest haematocrit and lowest T-helper cell count were significantly lower in AIDS than in ARC, and also lower in subjects with positive eye findings than in those with negative eye findings. No association was found between ocular findings and the following: risk factors for human immunodeficiency virus (HIV) transmission; positive titres for CMV, herpes simplex, Epstein-Barr virus (EBV), and toxoplasmosis; systemic infections; and intake of azidothymidine (AZT). Patients with AIDS and CWS were similar to patients with AIDS and CMV retinitis in viral serology, haematocrit, T-helper count, and survival. Positive eye findings, low haematocrit, and low T-helper count are poor prognostic signs for survival in AIDS.
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PMID:Ocular-systemic interrelationships in acquired immunodeficiency syndrome. 164 4

We examined five patients infected with the human immunodeficiency virus who developed a rapidly progressive necrotizing retinitis characterized by early patchy choroidal and deep retinal lesions and late diffuse thickening of the retina. In all but one case, the retinitis began in the posterior pole with little or no clinical evidence of vasculitis. All five patients had relentless progression of disease and were left with atrophic and necrotic retinae, pale optic-nerve heads, and narrowed vasculature. None of the patients developed aqueous or vitreal inflammation or retinal detachment. Clinical and laboratory evidence suggested that varicella-zoster virus was the causal agent in all five cases. First, the onset of retinitis in four cases either succeeded or was coincident with an eruption of dermatomal zoster. Second, varicella-zoster virus was cultured from the two chorioretinal specimens and varicella-zoster virus antigen was detected in the vitreal aspirate from one case. Third, by means of immunocytochemistry, varicella-zoster virus antigen was found in the outer retinae of both enucleation specimens. Fourth, viral capsids with the size and shape of herpesviridae were found in the outer retinae of both enucleation specimens. The clinical features observed in this study are distinct from those described for the acute retinal necrosis syndrome and appear to constitute a new and highly characteristic pattern of varicella-zoster virus-induced disease.
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PMID:Varicella-zoster virus retinitis in patients with the acquired immunodeficiency syndrome. 165 Oct 54

During a seven-year period, symptomatic cytomegalovirus (CMV)-infection was diagnosed in 21.5% (n = 10) of all AIDS patients at the National Hospital of Norway (retinitis n = 8, colitis n = 3, pneumonitis n = 2, gastritis n = 1). Symptomatic cytomegalovirus-infection was associated with a poor long-term prognosis (median survival 174 days, range 10-415). Median CD4+ lymphocyte counts at onset of symptomatic cytomegalovirus-infection was 24 x 10(6)/l (range 6-68). Regular ophthalmological examination of HIV-infected patients with severe immunodeficiency, and endoscopy with multiple mucosal biopsies in patients with suspected cytomegalovirus-infection of the gastrointestinal tract, were of major importance in diagnosing symptomatic cytomegalovirus-infection. Six patients received an induction course of ganciclovir, and foscarnet was administered in two patients due to leukopenia. Problems of toxicity to the available anti-CMV agents make the development of additional therapeutic approaches desirable.
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PMID:[Symptomatic cytomegalovirus infection in patients with acquired immunodeficiency syndrome]. 166 53

Ocular syphilis is rare in human immunodeficiency virus infected individuals. We think that syphilis should be considered in evaluating such patients presenting with uveitis. Most often, ocular syphilis includes retinitis associated with anterior or posterior uveitis, sometimes with optic neuritis. Concurrent neurosyphilis is frequent and may be more aggressive; it may progress more rapidly and cause more atypical signs than in patients without human immunodeficiency virus infection. This suggests the need for lumbar puncture in the evaluation of coinfected patients. The standard serological tests for syphilis (in blood and cerebrospinal fluid) may be nonreactive in human immunodeficiency virus seropositive patients. It may be because of the alteration of immunologic response of such patients. All coinfected patients with human immunodeficiency virus and syphilis should be treated with high-dose intravenous penicillin G sodium as recommended for neurosyphilis. We describe two human immunodeficiency virus infected patients with ocular syphilis and neurosyphilis.
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PMID:[Syphilitic uveitis and human immunodeficiency virus infection]. 179 9


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