The safety and efficacy were assessed of 5-day cycles of subcutaneous (sc) interleukin-2 (IL-2) every 8 weeks in human immunodeficiency virus type 1-infected outpatients with >200 CD4 cells/mm3. Immunologic, virologic, and toxicity parameters were measured in 18 patients receiving standard antiretrovirals plus 5-day courses of sc IL-2 (3-18 MIU/day) every 2 months. Systemic toxicities established the maximally tolerated dose (MTD) of IL-2 as 15 MIU/day. CD4 cell responses appeared to correlate directly with baseline CD4 cell counts, with several patients experiencing a dramatic rise after 3 cycles. Virus load increased only transiently in the peri-injection period. It was concluded that serial cycles of outpatient sc IL-2 can be administered safely, with an MTD of 15 MIU/day. Patients with higher baseline counts appear to have a greater CD4 cell response to sc IL-2 therapy.
Many individuals who experience chronic pain are able to return to work in some capacity but continue to suffer from ongoing pain problems resulting in increased absenteeism and reduced productivity on the job. These individuals continue to require ongoing medical interventions. Monthly follow-up visits to a physician rarely provide effective treatment strategies that patients can use at home. The challenge is to develop an effective and inexpensive treatment program that will assist patients in regaining or maintaining employment and decrease reliance on health care facilities. A program of this type has been developed for chronic pain sufferers, primarily those with low back and cervical spine pain. The treatment is a six-week interdisciplinary program including relaxation training, gradually increasing exercise, and significant education on behavioral and exercise strategies and nutrition for long-term pain management. This program is inexpensive, cost efficient, and may be implemented easily in a variety of settings.
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