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 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical features and results of laboratory investigations of the first 19 Indian patients with AIDS seen in our hospital are presented. Weight loss, fever, and diarrhea were the most common symptoms. Tuberculosis (TB) was the most common secondary infectious disease; among 13 patients, seven had only pulmonary TB, five had pulmonary and extrapulmonary TB, and one had only extrapulmonary TB. Oropharyngeal candidiasis was found in 11 patients. Other secondary infections were predominantly by virulent bacteria. Opportunistic infections other than candidiasis were infrequent; one patient had cryptococcosis, two had symptomatic cryptosporidiosis, one had noncoagulase-positive staphylococcus septicemia, and one had cytomegalovirus retinitis. Reduced lymphocyte counts (particularly of the CD4 subset), anemia, hypoalbuminemia, hyperglobulinemia, and elevated liver enzyme levels were frequent laboratory findings. Six patients are under follow-up, two are lost to follow-up, and 11 have died. Lymphocyte counts less than 500/mm3 were only seen in those patients who subsequently died. Response to antituberculosis therapy was good in several patients. Thus, the clinical profile of Indian patients with AIDS is not different from the common picture of patients of low socioeconomic and poor hygienic standards; patients presented with TB, undernutrition, and multiple infections. Therefore, a large population of patients with AIDS in India will not be recognized unless they are tested for evidence of HIV infection.
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PMID:Clinical and laboratory profile of AIDS in India. 802 23

Cytomegalovirus (CMV) retinitis is the most common cause of blindness in patients infected with human immunodeficiency virus (HIV). Ganciclovir, a guanosine nucleoside, has been found to be effective in the short-term treatment of CMV retinitis and in the delay of progression to recurrence of the disease. However, ganciclovir has no intrinsic activity against HIV, and patients with the acquired immune deficiency syndrome often require treatment with zidovudine, the only currently approved therapy for HIV infection. Both agents have been associated with dose-limiting granulocytopenia in such patients, and death from sepsis in the setting of profound decreases in absolute granulocyte counts has been reported. However, recent investigation suggests that with careful patient selection and monitoring, relatively safe concomitant therapy may be possible. This article reviews the toxicity issues that influence the decision to employ concomitant therapy with ganciclovir and zidovudine. An approach to dosing ganciclovir, including a schema for modifying or interrupting the zidovudine dosage based on hematologic status, is also presented. A prospective study is presently under way to determine whether combined therapy in selected patients leads to prolonged survival and a decreased incidence of recurrence of active CMV retinitis.
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PMID:Concomitant ganciclovir and zidovudine treatment for cytomegalovirus retinitis in patients with HIV infection: an approach to treatment. 184 17

Long-term management of cytomegalovirus (CMV) retinitis by intravitreal injection of ganciclovir was evaluated in ten patients with acquired immune deficiency syndrome (AIDS). Patients were unable to tolerate systemic ganciclovir because of severe neutropenia (8 cases), catheter-induced sepsis (1 case), or the need to continue therapy for human immunodeficiency virus (HIV) with zidovudine (ZDV) (1 case). All patients had a favorable response to initial treatment. Cytomegalovirus retinitis progressed in four fellow eyes in which treatment was deferred. Vision improved or remained stable in all but one eye. Patients were followed for a mean of 4 months and received an average of 16.6 intravitreal injections in each eye. Relapse occurred late in the course while on maintenance treatment in five eyes (33%). There was no evidence of toxicity from repeated intravitreal injections. Treatment was very well tolerated. The only severe complication in a total of 249 injections was a single case of Staphylococcus epidermidis endophthalmitis which responded to intravitreal antibiotic treatment. Intravitreal ganciclovir is an effective alternative to systemic ganciclovir in those patients with severe neutropenia and in those patients who desire to remain on systemic ZDV.
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PMID:Treatment of cytomegalovirus retinitis with intravitreal ganciclovir. Long-term results. 254 Apr 70

The efficacy and tolerance of high dose intravitreal foscarnet for cytomegalovirus retinitis in patients with AIDS was studied. Foscarnet in a dose of 2400 micrograms was injected directly into the vitreous of 11 patients (15 eyes). Five patients had active retinitis (eight eyes, 53.3%), and received a 3 week induction therapy of six injections as the first step. Six patients had initial inactive retinitis (seven eyes, 46.7%), and received only maintenance therapy which consisted of a weekly injection. The main indications for intravitreal therapy were: myelosuppression, kidney toxicity, catheter related sepsis, or refusal of intravenous therapy. The patients were followed for a mean period of 16 weeks (range 8-28 weeks) and received a total of 304 injections. Vitreous foscarnet levels were measured by high performance liquid chromatography. After a 3 week course of induction therapy, complete resolution of the active retinitis was seen in 62.5% (5/8 cases), while 37.5% (3/8 cases) had partial resolution. No cases failed to respond or progress. The rate of relapse on maintenance therapy was 33% (five of 15 eyes) by 20 weeks, and two of these eyes did not respond to reinduction and progressed in involvement of the macula or optic nerve. Neither important local complications nor intraocular drug toxicity were observed. Vitreous foscarnet levels in two different patients were 896 mumol/l and 74.9 mumol/l at 22 3/4 hours and 42 1/2 hours after the injection. Intravitreal foscarnet appears to be a safe, effective, and useful alternative in patients with intolerance to intravenous and viral therapy.
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PMID:High dose intravitreal foscarnet in the treatment of cytomegalovirus retinitis in AIDS. 812 19

Cytomegalovirus retinitis is a major cause of morbidity in patients with AIDS. The conventional treatment approach has involved insertion of a central venous catheter and intravenous administration of ganciclovir and/or foscarnet. This has been associated with systemic toxicity, line-related sepsis, and implications for patient quality-of-life. An oral formulation of ganciclovir has now been licensed for use as maintenance therapy in CMV retinitis. Multicentred trials comparing oral and intravenous ganciclovir have suggested that although the efficacy may be marginally reduced with the oral formulation, the associated toxicity is significantly lower. With careful and informed decision-making by both clinician and patient, the opportunity exists to enhance the quality of life in this patient group.
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PMID:Oral ganciclovir: a new option for patients with CMV retinitis. 865 3

Outpatient i.v. antibiotic therapy is well developed in the United States, largely because of pressures from third-party payers to reduce costs of medical care. We have developed an outpatient i.v. antibiotic programme in Oxford, that has evolved from a desire to provide high quality i.v. therapy to AIDS patients with cytomegalovirus retinitis. We describe the rationale of the service and report on our first two years' experience. We treated 67 consecutive patients (eight with HIV infection) at home with i.v. antibiotics. This resulted in a saving of 2275 hospital days for those patients without HIV infection. HIV positive patients received 69 months of home i.v. therapy. Minor intravascular catheter complications occurred in only five patients (7.5%). The only serious complications were three episodes of catheter-related sepsis (4.5%), all occurring in AIDS patients who had lines in for more than six months. We have shown that home i.v. antibiotic therapy can be delivered safely to patients with a wide variety of infectious problems using the existing network of community nurses in the National Health Service. Essential components to the programme include a multidisciplinary team working between the hospital and community and a written shared care protocol. Such a programme can result in reduced lengths of hospital stay and patient, community nurse and physician satisfaction.
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PMID:Safe intravenous antibiotic therapy at home: experience of a UK based programme. 873 54

Cytovene (ganciclovir) capsules were approved by the Food and Drug Administration (FDA) on December 22, 1994 as an alternative to the intravenous formulation for maintenance therapy of CMV retinitis in patients with HIV disease. This treatment is limited to those whose retinitis is stable following appropriate IV induction therapy, and where the risk of more rapid disease progression is balanced by the benefit of avoidance of daily infusion. FDA approval also allows physicians to prescribe the capsules off-label as a prophylaxis against CMV retinitis. Clinical studies have shown that in patients taking the Cytovene capsules, the mean time to CMV retinitis progression was 5-12 days less than in those patients on the IV formulation. The major side effects of the Cytovene capsules were the same as those associated with IV formulation: granulocytopenia, anemia, and thrombocytopenia. Side effects unique to the oral treatment include diarrhea, fever, leukopenia and nausea. The benefits of Cytovene capsules are fewer serious incidents of sepsis, fewer catheter-related infections, and a lower incidence of both anemia and leukopenia.
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PMID:Cytovene capsules approved. 1136 95

A study published in the journal, AIDS, reveals that ganciclovir capsules (oral Cytovene) are a safe and effective alternative to the intravenous (IV) formulation of the drug for maintenance treatment of cytomegalovirus (CMV) retinitis. The 20-week randomized trial of 159 HIV-infected patients also showed that the oral therapy greatly reduces incidences of sepsis, and catheter-related complications. This oral formulation is helpful to individuals with AIDS who suffer from CMV retinitis because it eliminates daily infusions via a catheter implanted in the chest. The maker of ganciclovir, Syntex, recently announced that it has submitted an application to the Food and Drug Administration (FDA) to market oral ganciclovir to prevent CMV in people at high risk for developing the condition.
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PMID:Oral ganciclovir effective for CMV. 1136 80

The widespread use of antiviral prophylaxis or preemptive therapy among orthotopic liver transplantation (OLT) recipients has reduced the occurrence of early cytomegalovirus (CMV) disease. Late disease is increasingly reported. Little is known about CMV disease occurring beyond the first year after transplantation. The aim of this study was to evaluate the occurrence of CMV disease two or more years after OLT and to determine its risk factors and clinical features. Eighty-one consecutive OLT recipients followed for 2 years or longer after transplantation were included in the study. Data were collected on demographic and clinical variables, clinical presentation, treatment, and outcome of late CMV disease. Late CMV disease occurred in 7/81 liver recipients (8.5%) at a mean time of 5.9 years after OLT (range: 3.5--9.3, median: 6.3 years). All seven patients were women, with a mean age of 47.7 years (range: 26--60, median: 59 years). There was no association between the development of late CMV disease and the occurrence of rejection episodes, treatment with corticosteroids, or the early use of antiviral prophylaxis. Clinical presentation included fever and disturbed liver functions in all patients, one patient had concurrent CMV pneumonitis and one CMV retinitis. Though all patients responded to ganciclovir, two had recurrent disease episodes and one patient died of secondary bacterial sepsis. Late-onset CMV disease can occur several years after OLT. Although it manifests classic clinical features of early disease, it is not associated with traditional risk factors and its pathogenesis may differ from that of early disease.
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PMID:Late cytomegalovirus disease following liver transplantation. 1290 46

Cost advantages of the oral route of drug therapy administration over the intravenous route for managing cytomegalovirus (CMV) disease are described. The overall costs usually are lower for the oral route of administration than for the intravenous route, although the cost to the patient depends on insurance coverage. Other advantages of the oral route include greater safety and convenience, which may improve patient adherence and quality of life. In patients with acquired immunodeficiency syndrome (AIDS), the use of oral ganciclovir instead of intravenous ganciclovir to treat the maintenance phase of CMV retinitis reduced the incidence of neutropenia and sepsis, outpatient and inpatient resource use, and costs. Oral therapy also improved patient quality of life. A cost-effectiveness model for liver transplant recipients found that CMV prophylaxis is warranted for all patients, ganciclovir is preferred over CMV immune globulin i.v. and oral acyclovir for prophylaxis, and the oral route of administration is more cost-effective than the intravenous route for ganciclovir. Valganciclovir, the oral prodrug of ganciclovir, was not included in this model. Oral maintenance therapy is usually cost-effective, safer, and more convenient than intravenous therapy in the management of CMV.
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PMID:Cost advantages of oral drug therapy for managing cytomegalovirus disease. 1468 29


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