Patients with AIDS

Another dideoxypyrimidine nucleoside active against human immunodeficiency vims is 3 -azido-2/3 -dideoxyuridine [84472-85-5] (AZDU or CS-87, 64) C H N O. Since its synthesis, (167) CS-87 has been identified as a promising antiHIV agent (168) and is currentiy undergoing phase I clinical trials in patients with AIDS and AIDS-related complex. It appears to be less potent than AZT against HIV in a peripheral blood mononuclear (PBM) cell screening system and in MT-4 cell lines. This lower activity in PBM cells appears to be related to a lower affinity of CS-87 for the enzyme responsible for its initial phosphorylation (169). However, CS-87 has significantly lower toxicity on bone marrow cells than AZT (170) and penetration of the CNS as a 5 -dihydropyridine derivative. 

Vitravene Study Group (2002) A randomized controlled chnical trial of intravitreous fomivirsen for treatment of newly diagnosed peripheral cytomegalovirus retinitis in patients with AIDS, Am J Ophthalmol 133 467 74... 

From the early beginning of treating HIV/AIDS, most health economic studies focussed on the calculation of provider costs. During the first years there had been a clear dominance of research on hospital costs for patients with AIDS, in particular,... 

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. 

Scitovsky AA, Rice DP (1987) Estimates of the direct and indirect costs of acquired immunodeficiency syndrome in the United States, 1985, 1986, and 1991. Pubhc Health Rep 102 5-17 Scitovsky AA, Cline M, Lee PR (1986) Medical care costs of patients with AIDS in San Francisco. JAMA 256 3103-3106... 

Ohagen A, Devitt A, Kunstman KJ, Gorry PR, Rose PP, Korber B, Taylor J, Levy R, Murphy RL, Wolinsky SM, Gabuzda D (2003) Genetic and functional analysis of full-length human immunodeficiency virus type 1 env genes derived from brain and blood of patients with AIDS. J Virol 77(22) 12336-12345... 

There is a similar high prevalence of peripheral neuropathy (34%) in the pediatric population infected with HIV (Araujo et al. 2000). The frequency of IDP in the HIV-infected population is unknown but is thought to be rare (Wulff et al. 2000). In an outpatient population of HIV positive patients, mononeuritis multiplex and lumbosacral polyradiculopathy were found in less than 1% of patients with AIDS (Fuller et al. 1993). HIV-associated autonomic nervous system dysfunction is also not uncommon as up to 66% of patients have papillary involvement and 15% have sympathetic and parasympathetic involvement causing orthostatic hypotension and respiratory sinus arrhythmia (Gluck et al. 2000). 

Makela and colleagues described the occurrence of a probable recurrent GBS six weeks after initiation of HAART and after a striking increase in CD4 cell count in an HfV-infected individual (Makela et al. 2002). Piliero and colleagues described an HIV-infected patient with AIDS who developed GBS, 26 days after initiation of a 6-drug HAART regimen, which had led to an impressive immune reconstitution (a rise in CD4 cell count from 31 to 602 cells/pL) (Piliero et al. 2003). Puthanakit and colleagues identified a child who developed GBS, 3 weeks after initiation of efavirenz-based HAART in a cohort of HIV-infected Thai children (Puthanakit et al. 2006). 

Cornblath DR, Hoke A (2006) Recent advances in HIV neuropathy. Curr Opin Neurol 19(5) 446-450 Cornblath DR, McArthur JC (1988) Predominantly sensory neuropathy in patients with AIDS and AIDS-related complex. Neurology 38(5) 794-796 Cornblath DR, McArthur JC et al (1987) Inflammatory demyeUnating peripheral neuropathies associated with human T-cell lymphotropic virus type III infection. Ann Neurol 21(l) 32-40 Corral I, Quereda C et al (1997) Acute poly radiculopathies in HIV-infected patients. J Neurol 244(8) 499-504... 

Miguelez M, Correa-Nazco VJ et al (1999) [Lumbosacral polyradiculomyelitis caused by herpes simplex virus (HSV) in a patient with AIDS]. An Med Interna 16(8) 417 19 MiUer RJ, Meucci O (1999) AIDS and the brain is there a chemokine connection Trends Neurosd 22(10) 471-479... 

Patients with AIDS and other immunocompromised hosts may be managed with chemotherapeutic regimens similar to those used in immunocompetent individuals, although treatment is... 

Narita M, Ashkin D, Hollender ES, Pitchenik AE. Paradoxical worsening of tuberculosis following antiretroviral therapy in patients with AIDS. Am J Respir Crit Care Med. 1998 158 157-161. 

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. 

Since the ANPs are only slowly taken up by the cells and poorly absorbed following oral administration, some efforts have been directed toward the development of prodrugs (esters) that would be better taken up by the cells. These efforts have yielded the bispivaloyloxymethyl [bis(pom)] derivative of PMEA (Fig. 6) [56]. Bis(pom)-PMEA shows a cellular uptake increased more than a hundredfold, as well as fivefold better oral bioavailability than the parent compound [57], Both PMEA (given intravenously) and bis(pom)-PMEA (given perorally) are now in clinical trials in patients with AIDS. 

Pialoux G, Youle M, Dupont B, Gazzard B, Cauwenbergh GFMJ, Stoffels PAM, Davies S, De Saint Martin J, Janssen PAJ. Pharmacokinetics of R82913 in patients with AIDS or AIDS-related complex. Lancet 1991 338 140-143. 

Aguila, C. D. P., C. G. Moura, H. Silva, A. J. D. Leitch, G. J. Moss, D. M. Wallace, S. Slemenda, S. B. Peiniazek, N. J. Wisvesvara, G. S. Ultrastructure, immunofluorescence, Western blot, and PCR analysis of eight isolates of Encephalitozoon (Septata) intestinalis established in culture from sputum and urine samples and duodenal aspirates of five patients with AIDS. J. Clin. Microbiol. 1998, 36, 1201-1208. 

Beal JE, Olson R, Laubenstein L, Morales JO, Bellman P, Yangco B, Lefkowitz L, Plasse TF and Shepard KV (1995). Dronabinol as a treatment for anorexia associated with weight loss in patients with AIDS. Journal of Pain and Symptom Management, 10, 89-97. 

Intestinal infections that cause persistent diarrhea normally result in histopathological changes to the intestine including villus blunting, crypt hypertrophy and inflammatory infiltrate in the lamina propria. These histopathological disarrangements are seen in Cryptosporidium, Cy-clospora and microsporidial infections [28], Furthermore, it has been documented that there are substantial disruptions of intestinal barrier function as measured by lactu-lose mannitol permeability ratios in patients with AIDS... 

Interestingly, in a small study on patients with AIDS, rifaximin was found to be effective against infectious diarrhea with stool cultures positive for protozoal pathogens, such as Cryptosporidium parvum and Blastocystis hominis [34], The favorable effects of rifaximin on protozoal diarrhea have been also reported in a recent multicenter study on patients with travelers diarrhea [33], In fact, patients with pretreatment stools positive for Cryptosporidium infections obtained a clinical improvement with rifaximin significantly superior to the placebo-treated subjects. 

A patient with AIDS is treated with a combination of agents, which includes zidovudine. What is the mechanism of action of zidovudine ... 

The most common opportunistic diseases and their frequencies found before death in patients with AIDS between 1990 and 1994 were Pneumocystis carinii pneumonia (PCP), Mycobacterium avium complex, and cytomegalovirus disease. 

P. jiroveci pneumonia is the most common life-threatening opportunistic infection in patients with AIDS. The taxonomy of the organism is unclear, having been classified as both protozoan and fungal. 

The early addition of adjunctive glucocorticoid therapy to anti-PCP regimens has been shown to decrease the risk of respiratory failure and improve survival in patients with AIDS and moderate to severe PCP (Pa02 <70 mm Hg or [alveolar-arterial] gradient >35 mm Hg). 

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