Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound

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Query: UMLS:C0042963 (vomiting)
31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Nucleoside analog reverse transcriptase inhibitors (NRTI) have been used to treat HIV-infected patients for >10 years. Some severe adverse events have been attributed to mitochondrial dysfunction. Since 1991, cases of severe lactic acidosis have been reported in association with nucleoside therapy. Our objective was to report two cases of metabolic acidosis and hepatic steatosis in patients receiving stavudine (d4T) and to review the literature. A male and a female, 47 and 45 years of age, respectively, presented with abdominal pain, nausea, vomiting, and weakness after 9 and 6 months, respectively, of treatment with stavudine. At presentation, both patients had severe metabolic acidosis and liver failure. Ultrasonography showed hepatic steatosis (confirmed by biopsy in one case). All antiretroviral drugs were withdrawn and patients were treated with bicarbonate. Both patients developed fulminant liver dysfunction and multiple organ failure. We reviewed the literature and found 75 cases of lactic acidosis and hepatic steatosis associated with use of NRTI; 57 of these patients received d4T (76%). Of all cases reported in association with nucleoside therapy, 63% were females and mortality was 47%. General weakness, hepatic enzyme elevation, and liver steatosis are data that should alert physicians to this serious adverse event and to respond with prompt interruption of antiretroviral drugs and measurement of lactic acid in plasma. It is important to report serious adverse events in commercially released drugs to know prevalence in an exposed population. Physicians should be aware of risk and early signs of this serious adverse event.
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PMID:Metabolic acidosis and hepatic steatosis in two HIV-infected patients on stavudine (d4T) treatment. 1260 78

The difference between adherence to non- nucleoside reverse transcriptase inhibitor (NNRTI) and protease inhibitor (PI)-based regimens was investigated. Better adherence was found in NNRTI-treated patients, especially when efavirenz was included in the regimen, compared with single PI-treated patients and in those with CD4 cell counts less than 200 x 10(6)/l. By contrast, younger age, self-report of active drug use, fatigue or vomiting negatively affected adherence. Self-reported sexual dysfunction was significantly associated with non-adherence only in PI-treated individuals.
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PMID:Adherence to highly active antiretroviral therapy is better in patients receiving non-nucleoside reverse transcriptase inhibitor-containing regimens than in those receiving protease inhibitor-containing regimens. 1270 Apr 67

The triple combination tablet containing lamivudine (150 mg), zidovudine (300 mg) and abacavir (300 mg, as abacavir sulfate) is a new formulation of three nucleoside analogue reverse transcriptase inhibitors. Two studies in treatment-naive patients (one double-blind, one nonblind) have reported that lamivudine/zidovudine (dual combination tablet) plus abacavir showed efficacy similar to that of lamivudine/zidovudine plus indinavir. In both studies, similar numbers of patients in each treatment group had plasma HIV RNA levels </=400 copies/mL at week 48 (51% vs 51% and 64% vs 50%). In treatment-experienced patients with baseline plasma HIV RNA levels <50 copies/mL, switching to lamivudine/zidovudine/abacavir (triple combination tablet) was as effective as remaining on highly active antiretroviral treatment (mainly protease inhibitor [PI]-based). Virological failure, the primary endpoint, defined as two consecutive plasma HIV RNA values >400 copies/mL, was reported in 22% of patients in both treatment groups at week 48. Treatment-naive patients receiving lamivudine/zidovudine/abacavir combination therapy experienced several adverse events, including nausea, malaise/fatigue and vomiting.
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PMID:Lamivudine/zidovudine/abacavir: triple combination tablet. 1274 41

Clinical manifestations of primary human immunodeficiency virus (HIV) infection (acute retroviral syndrome) and virologic characteristics of HIV-1 have rarely been described in Taiwan. Medical records of patients followed at the National Taiwan University Hospital between June 1994 and September 2003 were retrospectively reviewed to identify HIV-infected patients who were diagnosed with primary HIV infection. Blood specimens obtained at the diagnosis of primary HIV infection were submitted for viral subtyping and genotypic resistance assay. Twenty out of 940 patients were diagnosed with acute retroviral syndrome during the study period. All of the patients were males, with a median age of 31 years (range, 23 to 42 years); all were men who had sex with men. The most common clinical manifestations were fever (95%), generalized lymphadenopathy (75%), pharyngitis (70%), skin rashes (70%), and gastrointestinal symptoms (60%) including nausea, vomiting, and diarrhea. Thrombocytopenia (35%), leukopenia (35%), and elevated liver function test (50%) were seen in the laboratory tests. The median CD4 lymphocyte count was 312 cells/microL (range, 112-520 cells/microL), and the plasma HIV RNA load by reverse transcriptase-polymerase chain reaction was 230,500 copies/mL (range, 602 --> 750,000 copies/mL). No major resistance mutations on protease or reverse transcriptase were identified in the 11 available viral isolates. We conclude that primary HIV infection was rarely diagnosed in the designated hospital for HIV care in Taiwan. More education of health care providers and counseling of persons at risk to increase awareness of HIV infection are urgently needed in Taiwan in order to facilitate earlier diagnosis of primary HIV infection and prevent further transmission.
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PMID:Clinical presentations and virologic characteristics of primary human immunodeficiency virus type-1 infection in a university hospital in Taiwan. 1549 7

In people infected with the human immunodeficiency virus (HIV) both the CD4 T-cell count and the viral load are used to monitor disease progression to acquired immunodeficiency syndrome (AIDS). CD4 counts of <500/mm(3) are associated with opportunistic infections and certain malignancies, so-called 'AIDS-defining' conditions. Highly active antiretroviral therapy, using combinations of reverse transcriptase inhibitors and/or protease inhibitors, can improve considerably the prognosis of people who are HIV-positive, but such therapy is not yet widely available in many developing countries. People with AIDS are predisposed to urinary tract infection (UTI) by uncommon bacteria and pathogens, e.g. fungi, parasites and viruses, which may affect any urogenital organ; treatment should be culture-specific and long-term, because there is a tendency to recurrence, infection with multiple organisms and resistant isolates. Voiding dysfunction in patients with AIDS is usually a result of neurological complications caused by opportunistic infections, and has a poor prognosis. Of patients with AIDS, 30-50% develop a cancer, especially Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL). KS may involve any urogenital organ, but is usually part of systemic disease. Small lesions on the external genitalia can be treated with laser, cryotherapy or surgical excision, larger lesions with radiotherapy, and disseminated or visceral KS with multidrug chemotherapy. NHL may involve the kidneys, testes and retroperitoneal lymph nodes, thus obstructing the ureters, which may require ureteric stenting or percutaneous nephrostomy. NHL can be treated with radiotherapy and combination chemotherapy. Urolithiasis in patients with AIDS may be caused by indinavir, a protease inhibitor, but the more common types of stones may also occur. Fluid-electrolyte and acid-base disturbances are common in patients with advanced AIDS, secondary to vomiting, diarrhoea, malnutrition or septicaemia. HIV-associated nephropathy occurs in 10-30% of patients, and often leads to renal failure. Testicular atrophy is common, leading to infertility, erectile dysfunction (ED) and decreased libido. Treatment for ED must include counselling about strategies to reduce the transmission of HIV. The risk of HIV transmission after parenteral exposure to blood from an HIV-positive patient is relatively low (0.2-0.4%); the urologist can reduce the risk of transmission during surgery by adopting certain precautions. After occupational exposure to HIV, chemoprophylaxis with antiretroviral medication can significantly reduce the probability of HIV transmission.
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PMID:The urological management of the patient with acquired immunodeficiency syndrome. 1692 74

(1) The current first-line treatment for HIV infection is a combination of at least two nucleoside (or nucleotide) inhibitors of HIV reverse transcriptase, and one non nucleoside inhibitor or at least one HIV protease inhibitor. (2) Emtricitabine is the eighth nucleoside/nucleotide inhibitor to be marketed in France. It has a similar chemical structure to lamivudine. (3) Evaluation of emtricitabine use in adults contains data from four comparative trials, two in treatment-naive patients and two in patients who were already receiving a virologically effective treatment. Emtricitabine combination therapy was no more effective than lamivudine combination therapy on either viral load or the CD4+ lymphocyte count. (4) Only non comparative trials are available in children. (5) In clinical trials, the adverse effects of emtricitabine were similar to those of lamivudine, including headache, pain, fatigue, fever, abdominal pain, nausea, vomiting, and diarrhea. (6) Viral strains resistant to emtricitabine are also resistant to lamivudine, and vice versa. (7) Emtricitabine, like other nucleoside inhibitors (lamivudine, didanosine, tenofovir), can be taken once a day by mouth. (8) In practice, emtricitabine is indistinguishable from lamivudine and does not offer any advance for patients living with HIV/AIDS.
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PMID:Emtricitabine: new preparation. An antiretroviral very similar to lamivudine. 1587 41

A concurrent prospective study was conducted from 2001 to 2003 to assess factors associated with adverse reactions among individuals initiating antiretroviral therapy at two public referral HIV/AIDS centers in Belo Horizonte, MG, Brazil. Adverse reactions were obtained from medical charts reviewed up to 12 months after the first antiretroviral prescription. Cox proportional hazard model was used to perform univariate and multivariate analyses. Relative hazards (RH) were estimated with 95% confidence intervals (CI). Among 397 charts reviewed, 377 (95.0%) had precise information on adverse reactions and initial antiretroviral treatment. Most patients received triple combination regimens including nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease inhibitors. At least one adverse reaction was recorded on 34.5% (N = 130) of the medical charts (0.17 adverse reactions/100 person-day), while nausea (14.5%) and vomiting (13.1%) were the most common ones. Variables independently associated with adverse reactions were: regimens with nevirapine (RH = 1.78; 95% CI = 1.07-2.96), indinavir or indinavir/ritonavir combinations (RH = 2.05; 95% CI = 1.15-3.64), female patients (RH = 1.93; 95% CI = 1.31-2.83), 5 or more outpatient visits (RH = 1.94; 95% CI = 1.25-3.01), non-adherence to antiretroviral therapy (RH = 2.38; 95% CI = 1.62-3.51), and a CD4+ count of 200 to 500 cells/mm3 (RH = 2.66; 95% CI = 1.19-5.90). An independent and negative association was also found for alcohol use (RH = 0.55; 95% CI = 0.33-0.90). Adverse reactions were substantial among participants initiating antiretroviral therapy. Specially elaborated protocols in HIV/AIDS referral centers may improve the diagnosis, management and prevention of adverse reactions, thus contributing to improving adherence to antiretroviral therapy among HIV-infected patients.
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PMID:High incidence of adverse reactions to initial antiretroviral therapy in Brazil. 1661 73

Rotaviruses were detected by enzyme-linked immunosorbent assay (ELISA) in 92 out of 374 faecal samples collected between November 2003 and October 2004 at the Markaz Tebbi Koudakan Hospital, Tehran, Iran, from children aged 6 months to 5 years. Analysis of clinical and disease severity data showed a significant association between rotavirus infection and diarrhoea, vomiting and severe dehydration. Ninety-two samples (64 rotavirus ELISA-positive and 28 ELISA-negative samples) were sent to the Enteric Virus Unit, Virus Reference Department, Centre for Infection, Health Protection Agency, UK for rotavirus characterization by G-typing, P-typing and subgrouping (SG) using reverse transcriptase (RT)-PCR, semi-nested PCR and sequencing methods. In this study, both common and uncommon rotavirus genotypes were detected. The most prevalent types were G1P[8], SGII (59.2%) followed by G9P[8] SGII (15.5%) which has not been previously reported from Iran. Unusual genotypes G1P[10] SGI (2.8%) and G12P[8] SGII (1.4%) and strains derived from reassortment between common co-circulating genotypes such as G1P[4] SGII represented 5.6% of strains. Mixed infections with combinations of G1+G4P[8] SGII and G1+G9P[8] SGII were also found. This contrasts with previous reports from Iran in which a small number of common rotavirus strains (G1 and G4) were found. This study highlights the need for continued surveillance and characterization of rotaviruses to take account of the rapid evolution and introduction of novel rotaviruses into the human population.
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PMID:Rotavirus VP7, VP4 and VP6 genotypes co-circulating in Tehran, Iran, between 2003 and 2004. 1710 72

(1) After failure of several successive antiretroviral regimens, HIV-infected patients are normally treated with an optimised regimen based on resistance profiling, combined with tipranavir or darunavir and also an antiretroviral belonging to another class (maraviroc, enfuvirtide or raltegravir); (2) Etravirine is a non-nucleoside reverse transcriptase inhibitor first authorized for sale in the European Union in 2008; (3) Its clinical evaluation is based on two double-blind trials of identical design in a total of 1200 patients with multiple prior treatment failures. The patients received an optimised antiretroviral regimen including darunavir and ritonavir, plus either etravirine or placebo. After 24 weeks of treatment the proportion of patients whose viral load was below 50 copies/ml was higher in the etravirine group than in the placebo group (56.3% versus 33.6%), provided enfuvirtide was not introduced at the same time as etravirine; (4) The main known adverse effect of etravirine is potentially severe skin rash; nausea, vomiting and hypercholesterolaemia can also occur; (5) Etravirine has a high potential for drug-drug interactions, due to its inducing and inhibitory effects on various cytochrome P450 isoenzymes; (6) Etravirine is an additional option for HIV-infected patients with multiple treatment failure.
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PMID:Etravirine: new drug. Multidrug-resistant HIV: another option. 1963 14

Although an estimated 1 million persons in the United States are chronically infected with hepatitis B virus, the prevalence of hepatitis B has declined since the implementation of a national vaccination program. Hepatitis B virus is transmitted in blood and secretions. Acute infection may cause nonspecific symptoms, such as fatigue, poor appetite, nausea, vomiting, abdominal pain, low-grade fever, jaundice, and dark urine; and clinical signs, such as hepatomegaly and splenomegaly. Fewer than 5 percent of adults acutely infected with hepatitis B virus progress to chronic infection. The diagnosis of hepatitis B virus infection requires the evaluation of the patient's blood for hepatitis B surface antigen, hepatitis B surface antibody, and hepatitis B core antibody. The goals of treatment for chronic hepatitis B virus infection are to reduce inflammation of the liver and to prevent complications by suppressing viral replication. Treatment options include pegylated interferon alfa-2a administered subcutaneously or oral antiviral agents (nucleotide reverse transcriptase inhibitors). Persons with chronic hepatitis B virus infection should be monitored for disease activity with liver enzyme tests and hepatitis B virus DNA levels; considered for liver biopsy; and entered into a surveillance program for hepatocellular carcinoma.
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PMID:Hepatitis B: diagnosis and treatment. 2038 72


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