Infections, opportunistic

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. 

The immunorestorative potential of inosiplex has been evaluated in several clinical conditions, including post-surgical trauma, cancer patients with concurrent viral infections, and cancer patients receiving radiotherapy or chemotherapy. For example, most (84%) of the surgery patients remained immunologicaHy depressed, but 56% of the inosiplex-treated surgery patients had complete restoration of normal skin test reactivity (probability level < 0.0005). The use of inosiplex as an adjuvant to chemotherapy or radiotherapy appears to be valuable in the prophylaxis against opportunistic infections. 

Nonspecific immunosuppressive therapy in an adult patient is usually through cyclosporin (35), started intravenously at the time of transplantation, and given orally once feeding is tolerated. Typically, methylprednisone is started also at the time of transplantation, then reduced to a maintenance dose. A athioprine (31) may also be used in conjunction with the prednisone to achieve adequate immunosuppression. Whereas the objective of immunosuppression is to protect the transplant, general or excessive immunosuppression may lead to undesirable compHcations, eg, opportunistic infections and potential malignancies. These adverse effects could be avoided if selective immunosuppression could be achieved. Suspected rejection episodes are treated with intravenous corticosteroids. Steroid-resistant rejection may be treated with monoclonal antibodies (78,79) such as Muromonab-CD3, specific for the T3-receptor on human T-ceUs. Alternatively, antithymocyte globulin (ATG) may be used against both B- and T-ceUs. 

AIDS (acquired immunodeficiency syndrome) is the final stage of disease caused by infection with HIV. In this stage, the vims infection has severely affected the immune system, causing a depletion of CD4+ T-helper cells. AIDS is characterized by the manifestation of typical diseases caused by opportunistic infections (Pneumocystis carinii pneumonia, CMV retinitis, candidiasis of the esophagus, cerebral toxoplasmosis), neurological manifestations, cachexia, or certain tumors (Kaposi sarcoma of the skin, B-cell lymphoma). 

Nausea, skin rash, pruritus, stomatitis, vomiting, anemia, leukopenia, neutropenia, arthralgia, alopeda, asthenia, fever, infections Diarrhea, nausea, vomiting, flushing, myalgia, arthralgia, fever, peripheral neuropathy, opportunistic infections Leukopenia, nausea, vomiting, paresthesias, malaise, weakness, mental depression, headache, hypertension, alopecia, diarrhea, constipation... 

Herandez J, Amador L, Amantea M, Chao H, Hawley P, Paradise L (2000) Short-course monotherapy with AG1549, a novel non-nucleoside reverse transcriptase inhibitor (NNRTI), in antiretroviral naive patients. In 7th conference on retroviruses and opportunistic infections. San Francisco, CA, Abstract 669... 

Hanna G, Lalezari J, HelUnger J, Wohl D, Masterson T, Fiske W, Kadow J, Lin P, Giordano M, Colonno R, Grasela D (2004) Antiviral activity, safety, and tolerability of a novel, oral smaU-molecule HlV-1 attachment inhibitor, BMS-488043, in HIV-1-infected subjects a novel, oral small-molecule HlV-1 attachment inhibitor, BMS-488043, in HIV-1-infected subjects. In 11th conference on retroviruses and opportunistic infections, San Francisco, CA... 

Gable et al. (1996) estimated lifetime costs of treating a person with HIV to be US 94,726, using an expert panel and several cost data sources to produce treatment protocols for opportunistic infections and primary antiretroviral therapy. 

Gable CB, Tierce JC, Simison D et al (1996) Costs of HIV-f/AIDS at CD4+ counts disease stages based on treatment protocols, J Acquir Immune Defic Syndr Hum Retrovirol 12 413 20 Gebo K, Fleishman J, Conviser R et al (2(X)6) Contemporary costs of HIV health care in the HAART era. In Presentation at the 13th conference of retroviruses and opportunistic infections,... 

HIV is neuroinvasive, neurovirulent, but is not especially neurotrophic (Manji and Miller 2004). It can potentially affect all areas of the neuroaxis, either directly, producing distinct neurological syndromes, or indirectly, by causing immunodeficiency with resultant susceptibility to opportunistic infections. General principles... 

The earliest reports of neurological complications of AIDS described distal symmetrical, painful sensory neuropathy occurring in HIV patients (Snider et al. 1983). Dysimmune inflammatory polyneuropathy was subsequently recognized as a complication of AIDS (Lipkin et al. 1985). Progressive polyneuropathy associated with cytomegalovirus (CMV) infection was documented as the first truly opportunistic infection of the peripheral nerve (Eidelberg et al. 1986). 

Opportunistic infection, eg. CMV Progressive polyradiculopathy AIDS Acute, subacute Multiple, asymmetric mononeuropathies, usually painful CMV infection, Schwann cell infection demyelinating neuropathy... 

In advanced AIDS, MM is usually associated with opportunistic infections such as CMV (Said et al. 1991 RouUet et al. 1994 Kolson and Gonzalez-Scarano 2001) or is secondary to lymphoma (Fuller et al. 1993). Despite a role for other herpes viruses in AIDS-associated myelitis, no substantive evidence has been published in support of a role for other vimses in the development of HIV-associated MM, including herpes simplex 1 or 2, varicella zoster, or Epstein Barr vims (Kolson and Gonzalez-Scarano 2001). MM can occur secondary to hepatitis B and C viruses, which are common co-infections of HIV-infected patients, particularly when there is an associated cryoglobulinemia (Taillan et al. 1993 Caniatti et al. 1996). Rarely... 

Parasitic diseases, such as trypanosomiasis, malaria, and leishmaniasis, affect himdreds of millions people around the world, mainly in underdeveloped countries. They are also the most common opportunistic infections that affect patients with acquired immunodeficiency syndrome (AIDS). Globally, malaria occupies the first place, but in Latin America, Chagas disease (American Trypanosomiasis) is the most relevant parasitic disease that produces morbidity and mortahty in low-income individuals. 

Impaired wound healing and susceptibility to opportunistic infections... 

The improved short-term outcomes gained from induction therapy come with a degree of risk. By using these highly immunosuppressive agents, particularly the antilymphocyte antibodies (ALAs), muronomab-CD3 (OKT-3), and the antithymocyte antibodies, the body loses much of its innate ability to mount a cell-mediated immune response, which increases the risk of opportunistic infections and cancer.7,10... 

After T cell lysis, there is a cytokine release. Owing to this phenomenon, ATG is associated with several adverse reactions.7,8,11 The most common include fever (63%), chills (43%), headache (35%), back pain (43%), nausea (28%), diarrhea (32%), dizziness (25%), malaise (4%), and myelosuppression [leukopenia (30%) and thrombocytopenia (44%)]. Overall incidence of opportunistic infections is 27%, with cytomegalovirus (CMV) disease occurring in 11% of patients.7,8,11... 

Oropharyngeal candidiasis remains the most common opportunistic infection in patients with HIV. Eighty to ninety percent of HIV-positive patients develop oropharyngeal candidiasis.27 For 70% of these patients, it is the first manifestation of HIV infection.28 The incidence of oropharyngeal infection increases with decreasing CD4 lymphocyte counts, with an incidence of 60% in patients with a CD4 count less than 200 cells/mm3. 

Marr KA, Boeckh M, Carter RA, et al. Combination antifungal therapy for invasive aspergillosis. Clin Infect Dis 2004 39 797-802. Masur H, Kaplan JE, Holmes KK, et al. 1999 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus. Clin Infect Dis 2000 30 S29-S65. 

O The treatment goals for HIV infection are to maximally and durably suppress HIV replication, avoid the development of drug resistance, restore and preserve immune function, prevent opportunistic infections, and minimize adverse effects. 

HIV RNA plasma concentrations and CD4+ T-cell counts are used to assess risk of progression to AIDS (or risk for opportunistic infection) and to monitor efficacy and durability of treatment. 

Effective and complete treatment of HIV infection involves a multidisciplinary approach, which includes pharmacists, clinicians, social workers, and others. Treatment of HIV infection always requires combination prescription antiretroviral therapy, and may include prescription treatment or prophylaxis for opportunistic infections, and prescription or nonprescription treatment for adverse effects. 

The acquired immune deficiency syndrome (AIDS) was first recognized in 1981, and described in a cohort of young homosexual men with significant immune deficiency. Since then, human immunodeficiency virus type 1 (HIV-1) has been clearly identified as the major cause of AIDS.1 HIV-2 is much less prevalent than HIV-1, but also causes AIDS. HIV primarily targets CD4+ lymphocytes, which are critical to proper immune system function. If left untreated, patients experience a prolonged asymptomatic period followed by rapid, progressive immunodeficiency. Therefore, most complications experienced by patients with AIDS involve opportunistic infections and cancers. 

Patients with acute HIV infection may display symptoms described as "acute retroviral syndrome." Patients with chronic HIV infection may present with these same nonspecific symptoms and/or opportunistic infections. 

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