AIDS patients

Pneumogstis carini pneumonia (PCP), the most common of the opportunistic infections, occurs in more than 80% of AIDS patients (13). Toxoplasmosis, a proto2oan infection of the central nervous system, is activated in AIDS patients when the 004 count drops and severe impairment of ceU-mediated immunity occurs. Typically, patients have a mass lesion(s) in the brain. These mass lesions usually respond well to therapy and can disappear completely. Fungal infections, such as CTyptococcalmeningitis, are extremely common in AIDS patients, and Histop/asma capsulatum appears when ceU-mediated immunity has been destroyed by the HIV vims, leading to widespread infection of the lungs, Hver, spleen, lymph nodes, and bone marrow. AIDS patients are particularly susceptible to bacteremia caused by nontyphoidal strains of Salmonella. Bacteremia may be cleared by using antibiotic therapy. 

This drug also is reported to activate macrophages, to iaduce polyclonal B-ceU activation as well as enhance specific antibody production m vivo, and to iaduce the synthesis of iaterferon and interleukin 1 (52). The iaduction of these important cytokiaes (and others) largely accounts for the profile of biological activity displayed by the pyrimidinones. Bropirimine is currentiy ia clinical evaluation for cancer, arthritis, and immunorestoration ia AIDS patients. 

Increasingly, this opportunistic disease occurs in those with a suppressed immune system, especially those with AIDS. The only effective treatment for cryptosporidiosis in AIDS patients who do not respond readily to therapy is spiramycin (48). 

Protease Inhibitors Give Life to AIDS Patients... 

Kaposi sarcoma (KS) - an angiogenic-inflammatory neoplasm - is the most prevalent cancer in HIV-infected patients and its appearance is preceded by infection with human Heipesvitus-8 (HHV-8). Although chemotherapy has become the treatment of choice approved by the FDA, there are also good response rates in patients treated with IFN-a. Fortunately, today highly active antiretroviral therapy (HAART) has dramatically decreased the incidence of KS in AIDS patients. 

Cidofovir (Fig. 2) has been formally approved for the treatment of CMV retinitis in AIDS patients, where it is administered intravenously at a dose not exceeding 5 mg/kg once weekly during the first two weeks (and every other week thereafter). Cidofovir is also used off label for the treatment of human papilloma virus (HPV) infections (i.e., cutaneous warts, anogenital warts, laryngeal and pharyngeal papilloma), polyomavirus [i.e., progressive (i.e., multifocal leukoencephalopathy (PML)], adenovirus, herpesvirus, and poxvirus (i.e., molluscum contagiosum) infections, where it can be administered intravenously (at a dose of < 5 mg/kg once weekly or every other week) or topically as a 1% gel or cream (De Clercq and Holy 2005). Especially in immunosuppressed patients (i.e., transplant recipients), local treatment of HPV-associated lesions has often yielded spectacular results (Bonatti etal.2007). 

Casado JL, Perez-Ehas MJ, Marti-Belda P, Antela A, Suarez M, Ciancas E et al. (1998) Improved outcome of cytomegalovirus retinitis in AIDS patients after introduction of protease inhibitors. J Acquir Immune Defic Syndr Hum Retrovirol 19 130-134 Catalano CE (2000) The terminase enzyme from bacteriophage lambda a DNA-packaging machine, Cell Mol Life Sci 57 128-148... 

Sarasini A, Baldanti F, Furione M, Percivalle E, Brerra R, Barbi M et al (1995) Double resistance to ganciclovir and foscamet of 4 human cytomegalovirus strains recovered from AIDS patients, J Med Virol 47 237-244... 

HIV/AIDS-patient to mortahty, progression. to increase of gross national... 

The study of Anderson and Mitchell (1997) examined whether the AIDS-specific home and community-based waiver program, which was implemented in Florida in 1990 as an alternative to institutional care, was effective in reducing Medicaid expenditures per beneficiary during its first 2 years of operation. Therefore, the authors used Medicaid claims data and country information to estimate the effect of the waiver on expenditures controlling for nonrandom program selection. Their results indicate that persons with AIDS who used waiver services incurred monthly expenditures that were on average 22-27% lower than otherwise similar nonparticipants. The authors concluded that home and community-based care for AIDS patients resulted in lower expenditures per beneficiary. 

Beck et al, (2004) Canada 1997-2001 9,445 (non-AIDS patient) 11,754 (AIDS-patient)... 

Beck et al. (2004) presented an analysis of the cost-effectiveness of highly active antiretroviral therapy in Canada. They compared the cost-effectiveness from 1991 to 1995 (pre-HAART period) with the period from 1997 to 2001 (HAART period) for non-Aids and Aids groups. For the first group, they calculate total cost of US 4265 in the pre-HAART period and US 9445 in the HAART-period, whereas 66% and 84% were spent on antiretrovirals. The incremental cost per life year gained was US 14,587, that is, the HAART technology is rather cost-effective. For the Aids patients, the total costs were US 9,099 in the pre-HAART period and US 11,764 in the HAART period, whereas 29% were for antiretrovirals in the pre-HAART era and 72% in the HAART era. The incremental cost per life year gained by introducing HAART was US 12,813, so that HAART seems cost-effective in Canada. 

The use and cost of HIV service provision in England in 1996 was analyzed by Easterbrock et al. (1998). Standardized activity and case-severity data was collected prospectively in ten English HIV clinics. 5,440 patients attended the services during the first six months of 1996 and 5,708 patients during the second term. Cost estimates per patient-year for HIV service provision in 1996 varied from US 7,324 for asymptomatic patients to US 11,864 for symptomatic non-AIDS patients, and to US 31,758 for patients with AIDS. Easterbrock et al. (1998) concluded that different combinations of antiretroviral therapy affected the cost estimates differently. 

Most of the HIV-related economic studies calculate direct costs. However, the socioeconomic costs of HI V/AIDS are far greater. For instance, patients as well as family members and friends who provide care incur costs that are not related to payments but to lost income (indirect cost). This cost category includes the loss of wages for a wage earner, the loss of labor for a non-wage earner (e.g., pensioner, household), the loss of harvest for a farmer, and other losses (e.g., loss of education and chances for children of AIDS patients). Some studies address this issue. 

In the early period of the pandemic, before the development of sensitive and reliable instruments to diagnose early infection, only patients with advanced AIDS presented to health care facilities. As a result, the estimates and projects of the costs for HIV/AIDS patients based on observed health care utilization were high. For example, Scitovsky and Rice estimated the annual costs of AIDS care in the United States in 1985, 1986, and 1991 to be US 630 million, US 1.1 billion, and US 8.5 billion, respectively these costs represented the direct and indirect costs of HIV infections (Scitovsky and Rice 1987 Scitovsky 1988, 1989). More than 80% of these costs stemmed from losses in productivity, a reflection of the fact that AIDS has afflicted primarily working-age adults. The great increase in total costs by 1991 is caused by a projected increase in the prevalence. 

Comparisons between Enropean stndies are also difficult. Tolley and Gyldmark (1993) reviewed costs of treatment, care, and support for HIV-positive and AIDS patients in eleven Enropean conntries, which were based on data from the second half of the eighties. The anthors inflated cost fignres to 1990 prices and converted them from local currency to US by using national healthcare-specific price indices and health-specific purchasing power parities. The standardized cost estimates ranged between US 1,700 (social care per HIV-positive) and US 28,200 (hospital care per AIDS person-year), with the exception of a Greek study, which produced an adjusted cost estimate for the hospital treatment and care of AIDS patients of US 70,400 per person-year. 

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