Infection patient resistance

Labrosse B, Morand-Joubert L, Goubard A, Rochas S, Labemardiere JL, Pacanowski J, Meynard JL, Hance AJ, Clavel E, Mammano E (2006) Role of the envelope genetic context in the development of enfuvirtide resistance in human immunodeficiency virus type 1-infected patients. J Virol 80 8807-8819... 

Poveda E, Rodes B, Lebel-Binay S, Faudon JL, Jimenez V, Soriano V (2005) Dynamics of enfuvir-tide resistance in HIV-infected patients during and after long-term enfuvirtide salvage therapy. J Clin Virol 34 295-301... 

Moatti JP, Spire B, Kazatchkine M (2004) Drug resistance and adherence to HIV/AIDS antiretroviral treatment against a double standard between the north and the south, AIDS I8 S55-S6I Moore RD, Chaisson RE (1997) Costs to Medicaid of advancing immunosuppression in an urban HIV-infected patient population in Maryland, J Acquir Immune Defic Syndr Hum Retrovirol 16 223-231... 

Perea S, JL Lopez-Ribot, WR Kirkpatrick, RK McAtee, RA Santillan, M Martinez, D Calabrese, D Sanglard, TP Patterson (2001) Prevalence of molecular mechanisms of resistance to azole antifungal agents in Candida albicans strains displaying high-level fluconazole resistance isolated from human immunodeficiency virus-infected patients. Antibicrob Agents Chemother 45 2676-2684. 

Treatment guidelines developed by the Sinus and Allergy Health Partnership reflect antibiotic choices that are likely to result in favorable clinical and bacteriologic outcomes based on pathogen distribution, spontaneous resolution rates, and nationwide resistance patterns.310 These guidelines (Figs. 69-3 and 69-4) stratify therapy based on severity of disease and risk of infection with resistant organisms, defined as mild disease in patients with prior antibiotic use within 4 to 6 weeks. Other risk factors for resistance include day-care attendance or frequent... 

Rifampin Daily for 4 months For persons who are contacts of patients with isoniazid-resistant rifampin susceptible TB. In HIV-infected patients, protease inhibitors or NNRTIs generally should not be administered concurrently with rifampin rifabutin can be used as an alternative for patients treated with indinavir, nelfinavir, amprenivir, ritonavir, orefavirenz, and possibly with nevirapine or soft-gel saquinavir5 B (II) B (III)... 

Twenty percent of HIV-infected patients develop fluconazole-resistant Candida albicans isolates after repeated exposure to fluconazole.33 To treat fluconazole-resistant oropharyngeal candidiasis, daily itraconazole for 2 to 4 weeks may be used. Oral itraconazole solution exhibits a mycological cure rate of 88% and a clinical cure rate of 97% in immunocompromised patients.34 Fluconazole-resistant esophageal candidiasis should be treated with intravenous amphotericin B or caspofungin. 

Acute HIV Infection Diagnosis of acute HIV infection is difficult, since many patients are asymptomatic, or have nonspecific clinical symptoms similar to other common respiratory infections. If acute HIV infection is suspected, HIV antibody tests and a plasma HIV RNA concentration should be obtained. A clear diagnosis is made when an HIV antibody test is negative and the plasma HIV RNA concentration is high. There are limited outcomes data for treating acutely infected patients. Treatment of acute infection can decrease the severity of acute disease and decrease the viral set point this may decrease progression rates and reduce the rate of viral transmission.18-22 Limitations include an increased risk of chronic drug-induced toxicides and the development of viral resistance. 

The development of antiretroviral therapy has been a major challenge since the discovery of the human inununodeficiency virus (HIV). Early successes with nucleoside and non-nucleoside reverse transcriptase (RT) inhibitors, as well as the development of protease inhibitors have facilitated, in recent years, a highly active antiretroviral therapy (HAART), where a combination of drugs is simultaneously administered. In spite of significant improvements in the morbidity and mortality of HIV-infected patients, the rapid appearance of resistant HIV-variants, as well as adverse effects and high cost of contemporary drugs necessitate the continuous development of independent classes of anti-HIV agents. ... 

Severe staphylococcal Infections - Severe staphylococcal infections (including methicillin-resistant staphylococci) in patients who cannot receive or who have failed to respond to penicillins and cephalosporins, or who have infections with resistant staphylococci. Infections may include endocarditis, bone infections, lower respiratory tract infections, septicemia, and skin and skin structure infections. 

Sulfadiazine and sulfisoxazole still play a useful role in the prophylaxis of group A streptococcal infections in patients with rheumatic fever who are hypersensitive to penicillin. This is tempered with the potential for toxicity and infection with resistant Streptococcus pyogenes. 

Although ribavirin monotherapy is ineffective against HCV, oral ribavirin in combination with inter-feron-a (Rebatron) is approved for this indication and is effective in patients resistant to interferon therapy alone. Intravenous ribavirin may be useful in the therapy of Hantaan virus infection, Crimean or Congo virus hemorrhagic fever, Lassa fever, and severe adenovirus infection. 

A. Liposomal amphotericin B was approved by the US. Food and Drug Administration to treat visceral leishmaniasis. Pentavalent antimony compounds, pentamidine, amphotericin B, and aminosi-dine (paromomycin) have all been demonstrated efficacious here. The liposomal amphotericin appears to be better taken up by the reticuloendothelial system, where the parasite resides, and partitions less in the kidney, where amphotericin B traditionally manifests its toxicity. In addition to being better tolerated by patients, it has proved to be very effective in India, where resistance to antimony drugs is widespread. This patient appears to have acquired his infection there, where many infected patients develop darkening of the skin, hence the name kala-azar, or black sickness. Albendazole, an anthelmintic, has no role here. Atovaquone, a naphthoquinone, is used to treat malaria, babesiosis, and pneumocystosis. Pyrimethamine-sulfadoxine is used to treat malaria and toxoplasmosis. Proguanil inhibits the dihydrofolate reductase of malaria parasites and is used in combination with atovaquone. 

Nonprescription topical antifungal agent not effective in the treatment of deeper fungal infections of the skin, nor is it reliable in the treatment of fungal infections involving the scalp or nail beds Candida is resistant useful for patients desiring self-medication of mild tinea infections patients must be advised of limitations... 

Rifabutin is derived from rifamycin and is related to rifampin. It has significant activity against M tuberculosis, M avium-intracellulare, and M fortuitum (see below). Its activity is similar to that of rifampin, and cross-resistance with rifampin is virtually complete. Some rifampin-resistant strains may appear susceptible to rifabutin in vitro, but a clinical response is unlikely because the molecular basis of resistance, rpoB mutation, is the same. Rifabutin is both substrate and inducer of cytochrome P450 enzymes. Because it is a less potent inducer, rifabutin is indicated in place of rifampin for treatment of tuberculosis in HIV-infected patients who are receiving concurrent antiretroviral therapy with a protease inhibitor or nonnucleoside reverse transcriptase inhibitor (eg, efavirenz)—drugs that also are cytochrome P450 substrates. 

A critical issue is that true drug resistance among schistosomes in the field is almost always masked by an expected failure rate of 5-30%. As an illustration, consider a village in which the schistosomes have a normal susceptibility to praziquantel. Treatment might cure 85% of the infected patients (and reduce the egg burden in the other 15%). But, this could be quantified as a 15% drug failure rate. In a parallel village where 2% of the worm population is resistant to the recommended dose of prazi-... 

Dyslipidemia is a common accompaniment of the lipodystrophy syndrome observed in HIV-infected patients. This syndrome presents as a combination of peripheral lipoatrophy and the metabolic syndrome (central adiposity, insulin resistance, and dyslipidemia). The term lipodystrophy syndrome was first used in two case reports to describe a clinical picture of subcutaneous fat wasting in the face and limbs of HIV infected patients treated with indinavir, reminiscent of the rare congenital lipodystrophy syndromes (138,139). In addition, benign symmetric lipomatoses on the trunk and neck were described. A systematic study of this syndrome in the Australian HIV cohort showed co-existence of peripheral lipoatrophy with abdominal visceral obesity, dyslipidemia, and insulin resistance in HIV-infected patients with or without treatment with protease inhibitors (140). 

Micheh V, Carosi G Resistance and Dosage Adapted Regimens Study Group of the MASTER Cohort. Lipid abnormalities in HIV-infected patients are not correlated with lopinavir plasma concentrations. J Acquir Immune Defic Syndr 2004 35(3) 324-6. 

Dieterle C, Bogner JR, Landgraf R, Goebel FD. Treatment with protease inhibitors associated with peripheral insulin resistance and impaired oral glucose tolerance in HIV-1-infected patients. AIDS... 

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