Human Immunosuppressive Virus

This chapter discusses the problem of Human Immunosuppressive Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) in relation to drug abusers and how the risks of infection in this group can be reduced. It deals with how to counsel people before and after an antibody test, and looks at the working environment and the future prospects for drug agencies. 

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). 

Risk factors for salmonellosis include extremes of age, alteration of the endogenous bowel flora of the intestine (e.g., as a result of antimicrobial therapy or surgery), diabetes, malignancy, rheumatologic disorders, human immunodeficiency virus (HIV) infection, and therapeutic immunosuppression of all types. 

There is clear evidence linking defects of the immune system to the development of NMSC. For example, it is observed that patients receiving chronic immunosuppressant therapy for organ transplantation have a 50% risk of developing SCC within 20 years of transplantation, and 30% of these cancers are highly aggressive.21 Additionally, patients with human immunodeficiency virus (HIV) infection are predisposed to melanoma.18 Data also support the idea that UV radiation... 

HGMV, a betaherpes virus, is an opportunistic pathogen that commonly afflicts immunocompromised (human immunodeficiency virus, HIV) or immunosuppressed persons <2003BML3483>. 

People of any age who have required regular medical follow-up or hospitalization in the prior year because of chronic metabolic diseases, including diabetes, renal dysfunction, hemoglobinopathies, or immunodeficiency, including medication-induced immunosuppression and human immunodeficiency virus. 

Yarosh, D. B., Alas, L., Kibitel, A. L., and Ullrich, S. E., Urocanic acid, immunosuppressive cytokines, and the induction of human immunodeficiency virus, Photodermatol. Photoimmunol. Phtotomed. 9, 127-130, 1992. 

Secondary immunodeficiencies (9) are much more common than primary ones and frequently occur as a result of immaturity of the immune system in premature infants, immunosuppressive therapy, or suigery and trauma. Illnesses, particularly when prolonged and serious, have been associated with secondary immunodeficiencies, some of which may be reversible. Acquired immune deficiency syndrome (AIDS) (10—12) may be considered a secondary immunodeficiency disease caused by the human immunodeficiency viruses HIV-1 or HIV-2. Hitherto unknown, the disease began to spread in the United States during the latter part of the 1970s. The agent responsible for this infection has been isolated and identified as a retrovirus. 

Other viruses with affinity for the liver are human immunodeficiency virus (HIV) and cytomegalovirus (CMV). CMV-DNA has been found in hepatocytes, bile ducts, and vascular cells. CMV is a dormant virus but may be reactivated, for instance, on immunosuppressive therapy after organ transplantation. It may cause vanishing bile duct syndrome and (allograft) rejection [125,126], The main... 

For a number of overt, broad spectrum immunosuppressive xenobiotics (e.g., azathioprine) there is sufficient clinical experience to indicate the types of neoplasms for which there is an increased risk. These tumor types are listed in Table 27.1. Also listed are the tumors that occur in the unfortunate experiment of nature, namely patients infected with human immunodeficiency virus type 1 (HIV-1) and the tumors that may occur at higher incidence with more selective yet strong immunosuppressants (e.g., cyclosporin, sirolimus, and tacrolimus). Compared to the broad spectrum immunosuppressive agents listed above, most IMBPs express a highly selective regulatory influence on the immune system modulating the activity of host defense systems rather than mediating frank immunosuppression. 

Additionally, a number of biologically significant molecules have in their structure a chiral nonracemic sulfinyl group. Among these molecules (Fig. 1), it is worth noting the new immunosuppressive thiaspirane sulfoxide Nuphar alkaloid type la and lb,13 the gastric antisecretory omeprazole 2,14 the new potassium channel activators of Rhone Poulenc aprikalim 3,15 the cyclic hexapeptide waiakeamide 4,16 the ACAT inhibitor 5,17 and the potent human immunodeficiency virus type 1 protease inhibitor 6.18... 

The management of chronic follicular conjimctivitis associated with molluscum contagiosum is removal of the dermatologic lesion to prevent further spread of virus particles into the eye. This treatment is curative, and no further intervention is required. Multiple or recurrent molluscum lesions may be associated with systemic immunosuppression and may be a sentinel lesion in patients with human immunodeficiency virus infection. 

Caiaffa WT, Vlahov D, Graham NM, Astemborski J, Solomon L, Nelson KE, Munoz A (1994) Drug smoking, Pneumocystis carinii pneumonia, and immunosuppression increase risk of bacterial pneumonia in human immunodeficiency virus-seropositive injection drug users. Am J Respir Crit Care Med 150 1493-1498... 

Measles and varicella vaccination is recommended for children with asymptomatic or mildly symptomatic human immunodeficiency virus (HIV) infection but is contraindicated for persons with severe immunosuppression from HIV or any other immunosuppressive disorder. 

Bacteriostatic antibiotics inhibit bacterial growth and proliferation, while bactericidal antibiotics actually kill bacteria. Many antibiotics are bacteriostatic at low concentrations and bactericidal at higher concentrations. This distinction is often not important clinically. If bacteria are prevented from multiplying, they will eventually be destroyed by the normal immune reaction of the host. Infections in inmiunocompromized individuals (for example, those with human immunodeficiency virus (HIV) infection and those on systemic corticosteroid, anticancer or immunosuppressant therapy) have to be treated with potent bactericidal drugs. 

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