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)

Anemia is common in patients infected with the human immunodeficiency virus (HIV). The etiology is often multifactorial and may include the HIV infection itself, opportunistic infections, cancer, medications (particularly zidovudine and sulfa-containing drugs), or anemia of chronic disease. Epoetin alfa therapy may play a supportive role in some HIV-infected patients by increasing hemoglobin, decreasing fatigue, and reducing the need for exposure to red blood cell transfusions. A large, placebo-controlled trial in the United States for anemic patients with the acquired immunodeficiency syndrome taking zidovudine demonstrated a statistically significant improvement in hematocrit in patients treated with epoetin alfa compared with placebo. Transfusion requirements decreased in epoetin alfa-treated patients over a 3-month period compared with placebo with a trend toward improvement in quality of life. Epoetin alfa was effective, however, only in patients whose pretreatment erythropoietin levels were less than 500 mU/mL. These advantages of epoetin alfa treatment may become especially important as HIV becomes more of a chronic disease, with the concern that red blood cell transfusion may accelerate progression of HIV.
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PMID:Experience with epoetin alfa and acquired immunodeficiency syndrome anemia. 967 34

Data derived from studies conducted before 1996 consistently showed that anemia was a common occurrence in patients with human immunodeficiency (HIV) Infection and an Independent risk factor for early death. Correction of anemia was associated with reversal of this increased risk. Highly active antiretroviral therapy (HAART) has been shown to reduce HIV disease progression and mortality. In the HAART era, HIV-related anemia is still common and independently associated with decreased survival, with a decreased risk of mortality associated with recovery from anemia. Epoetin alfa treatment has been shown to correct anemia and significantly improve quality of life (QOL) in patients with HIV disease. Additional data on the effect of correction of anemia with epoetin alfa treatment on survival in patients with HIV infection are needed.
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PMID:Anemia and human immunodeficiency virus disease in the era of highly active antiretroviral therapy. 1106 52

Recombinant human erythropoietin (r-HuEPO, epoetin alfa) is used for treatment of anemia associated with chemotherapy for non-myeloid malignancies, chronic renal failure and zidovudine treatment in patients infected with the human immunodeficiency virus and for anemic patients undergoing elective, noncardiac, nonvascular surgery. Epoetin alfa has been shown to safely increase preoperative hemoglobin (Hb) levels in anemic patients undergoing elective noncardiac, nonvascular surgery and is more effective than preoperative autologous blood donation in reducing the need for perioperative blood transfusions in orthopedic surgery patients. Epoetin alfa was shown to significantly increase Hb levels and decrease transfusion requirements in gynecologic cancer patients undergoing chemotherapy. A once-weekly regimen of 40,000 IU per dose was effective in these patients. In addition to decreasing transfusion requirements and increasing Hb, epoetin alfa for relieving anemia-related fatigue and improving quality of life was demonstrated in clinical trials in anemic cancer patients receiving chemotherapy. With regard to quality of life in orthopedic surgery patients, a novel instrument to measure the effect of Hb management on postoperative recuperative power (i.e., vigor, functional ability) has been validated and may prove to be useful in optimizing rehabilitation and discharge planning. Extensive clinical experience with epoetin alfa in anemic patients undergoing major elective orthopedic surgery or those with gynecologic cancer provides a strong basis for its use in gynecologic surgery.
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PMID:Clinical experience with epoetin alfa in the management of hemoglobin levels in orthopedic surgery and cancer. Implications for use in gynecologic surgery. 1139 87

In patients with end-stage renal disease (ESRD), viral or bacterial infections are postulated to abolish or impair response to recombinant erythropoietin (Epogen). However, previous reports revealed that response to Epogen among hemodialysis patients with a particular viral infection--human immunodeficiency virus (HIV)--seems to be variable and is independent of illness severity. To further explore the issue of response to Epogen in hemodialysis patients with viral infection, we retrospectively studied four patients with hepatitis B virus infection over a 3 month period to compare their response to Epogen and endogenous erythropoietin levels with those of a control group of patients without hepatitis B virus infection. Weekly predialysis hematocrit, and monthly serum albumin concentration, transferrin saturation as well as percent reduction of urea were obtained from patient records, and mean values were calculated for each subject. Mean age of the patients (n = 4) was 63 +/- 7.5 years compared with 55 +/- 23 years for the control subjects (n = 4)(p = 0.02). The mean hematocrit of the study patients was 33.7 +/- 2.8% compared with 34.7 +/- 4.9% in the control subjects (p = 0.49), and the mean endogenous erythropoietin level in the study patients was 27 +/- 22 mlU/ml compared with 5.7 +/- 1.9 mlU/ml in the control group (p = 0.001). The mean dose of thrice weekly Epogen, both at onset of the study and when endogenous erythropoietin was measured, was 61 +/- 19 U/kg body weight in the patients, compared with 74 +/- 8 U/kg body weight in the control subjects (p = 0.002). We conclude that patients with ESRD and hepatitis B surface antigenemia respond to Epogen as well as their counterparts without hepatitis B virus infection. In addition, patients with hepatitis B surface antigenemia have much higher serum levels of endogenous erythropoietin and require less exogenous erythropoietin injections than their counterparts.
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PMID:Hepatitis B virus infection and the response to erythropoietin in end-stage renal disease. 1157 40

Anemia management programs typically strive to maintain hemoglobin (Hb) levels in the target range of 11 to 12 g/dL recommended by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI). Although nephrology clinicians are constantly alert for conditions that cause hyporesponse to Epoetin alfa therapy, management protocols generally focus on assessing and managing acute disorders that affect the production of red blood cells. A more difficult clinical challenge is how to systematically manage patients with conditions that chronically affect the erythropoietic response and are intractable to routine therapies. This article addresses the etiology and management of chronic conditions that require a specialized anemia management approach to ensure that patients can achieve targeted Hb levels and associated clinical and quality of life benefits. Examples include chronic inflammatory disorders, severe secondary hyperparathyroidism, malignancies, human immunodeficiency virus (HIV), and kidney transplant failure.
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PMID:Anemia management in patients with chronic conditions that affect erythropoiesis. Case study of the anemic patients. 1259 7

Anemia is a multifactorial problem in patients with human immunodeficiency virus (HIV) infection, cancer, and hepatitis C virus (HCV) infection. New insights regarding anemia symptoms and quality of life (QOL) have prompted reassessment of traditional triggers for anemia treatment to increase hemoglobin (Hb) and improve QOL. In HIV-positive patients, anemia is independently associated with disease progression and survival. Many HIV-positive patients receiving highly active antiretroviral therapy (HAART) still develop mild to moderate anemia and associated QOL impairment. Epoetin alfa effectively increases Hb and improves QOL in these patients. Many HIV-positive patients are coinfected with HCV. Standard HCV therapy (interferon alfa/ribavirin) can cause anemia that may result in treatment alterations and compromised virologic outcome. Epoetin alfa therapy in anemic HCV patients increases Hb levels and may provide other benefits. Neuroprotective effects of epoetin alfa in preclinical models of central nervous system disorders have recently been demonstrated, implying a new therapeutic role for this cytokine.
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PMID:Implications of anemia in human immunodeficiency virus, cancer, and hepatitis C virus. 1458 97

Hepatitis C virus (HCV) infection is a significant worldwide health care problem. Nearly one-third of all patients infected with human immunodeficiency virus (HIV) are coinfected with HCV. Compared with HIV-monoinfected persons, coinfected individuals experience more rapid progression of fibrosis and higher incidence of cirrhosis and death as a result of liver disease. Treatment for HCV infection includes ribavirin (RBV) plus interferon alfa (IFN-alpha) or pegylated IFN, a combination treatment associated with anemia that may require RBV dose reduction or discontinuation. IFN-RBV-associated anemia is more profound among coinfected patients, who have a high prevalence of pretreatment anemia and may also be taking other medications causing anemia. Epoetin alfa administration to HCV-infected patients with IFN-RBV-related anemia can significantly increase hemoglobin levels and maintain significantly higher RBV doses compared with patients treated with RBV dose reduction alone. Higher RBV doses and adherence to HCV therapy have been associated with higher sustained virologic response (SVR) rates. Maintenance of RBV dose with epoetin alfa may improve adherence, thereby affecting SVR.
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PMID:Anemia in the treatment of hepatitis C virus infection. 1458