Clinical Manifestations of AIDS in the Era of Pneumocystis Prophylaxis

Hoover, Donald R.; Saah, Alfred J.; Bacellar, Helena; Phair, John P.; Detels, Roger; Anderson, Roger; Kaslow, Richard A.

doi:10.1056/nejm199312233292604

Cited by 396 publications

(135 citation statements)

References 13 publications

Supporting

Mentioning

129

Contrasting

Unclassified

Order By: Relevance

“…Such considerations are difficult to quantify but they underscore that the increased risk ofwasting should be of concern. Wasting is a relatively frequent condition in the later stages of HIV infection in industrialized countries (HOOVER et al, 1993) and 'slim disease' is one of the most important AIDS-defining events in many African and other lessdeveloped countries (GRANT et al, 1997).…”

Section: Discussionmentioning

confidence: 99%

Increased risk of wasting syndrome in HIV-infected travellers: prospective multicentre study

Furrer

Chan

Weber

et al. 2001

Transactions of the Royal Society of Tropical Medicine and Hygi

View full text Add to dashboard Cite

HIV-infected patients from moderate regions who travel in tropical countries may experience clinical disease progression due to exposure to bacteria (including mycobacteria), fungi and parasites. In the Swiss HIV Cohort Study we examined the hypothesis that travelling increases the risk of tuberculosis, wasting syndrome, cryptosporidiosis, isosporiasis, cryptococcosis, coccidiomycosis, histoplasmosis and Salmonella septicaemia. A total of 4549 participants were included (in 1988-98) ofwhom 596 (13' 1%) travelled at least once. During 16 800 person-years of follow-up 23 1 patients developed at least 1 of the diseases of interest. Wasting syndrome was the only diagnosis significantly associated with travelling (hazard ratio 2.16, 95% confidence interval 1.09 to 4.30). The risk ofwasting syndrome ('slim disease') should be taken into account when counselling HIV-infected patients intending to travel in tropical regions.

show abstract

Section: Discussionmentioning

confidence: 99%

Increased risk of wasting syndrome in HIV-infected travellers: prospective multicentre study

Furrer

Chan

Weber

et al. 2001

Transactions of the Royal Society of Tropical Medicine and Hygi

View full text Add to dashboard Cite

show abstract

“…As many as 45% of individuals infected with the human immunodeficiency virus (HIV) will develop disease due to cytomegalovirus (CMV) by the end of their lives (8). Two antiviral agents, ganciclovir and foscarnet, are available to treat CMV disease.…”

mentioning

confidence: 99%

Anticytomegaloviral activity and safety of cidofovir in patients with human immunodeficiency virus infection and cytomegalovirus viruria

Polis

Spooner

Baird

et al. 1995

Antimicrob Agents Chemother

129

View full text Add to dashboard Cite

Cidofovir {HPMPC; (S)-1-[3-hydroxy-2-(phosphonylmethoxy)propyl]cytosine} is a nucleotide analog with activity against human cytomegalovirus (CMV).A phase I/II dose escalation trial was conducted with asymptomatic human immunodeficiency virus (HIV)-infected patients with CMV viruria to determine its pharmacokinetics, maximally tolerated dose, and preliminary antiviral activity against CMV. Qualitative CMV blood and urine cultures were monitored weekly to assess anti-CMV activity. Twenty-one HIV-infected persons with CD4 counts from 0 to 389 cells per l (median, 39) were enrolled in six dose-ranging groups. The first five groups enrolled four patients each to receive cidofovir infusions either weekly or biweekly for 4 weeks or every 3 weeks for 12 weeks. The sixth group enrolled one patient who received infusions of 5 mg/kg of body weight every other week. Patients receiving 0.5 or 1.5 mg/kg twice weekly experienced no serious toxicity. The first two patients who received 5 mg/kg twice weekly developed glycosuria and 2؉ proteinuria. Subsequent patients received concomitant probenecid to attempt to ameliorate renal toxicity. Seventeen patients experienced proteinuria on one or more occasions; 6 of them experienced at least 2؉ proteinuria. Four patients did not complete the study as planned because of renal toxicity. Positive CMV urine cultures reverted to negative in 2 of 8 patients receiving doses of Յ1.5 mg/kg twice weekly and 11 of 13 patients receiving higher doses. Cidofovir has in vivo anti-CMV activity demonstrated by prolonged clearing of CMV viruria, although this observation is tempered by the fact that clearance of viremia could not be demonstrated. The dose-limiting toxicity is renal; however, concurrent administration of probenecid may be protective. The maximally tolerated weekly intravenous dose with probenecid is approximately 5 mg/kg. Efficacy trials with CMV disease will define the therapeutic utility and optimal dosing interval for cidofovir.

show abstract

“…59 In fact, recent studies have shown an increasing incidence of CMV disease paralleling the widespread use of prophylaxis for Pneumocystis carinii pneumonia. 5,6 CMV disease typically occurs when immunode®ciency is severe (CD4 lymphocyte count < 100/mm 3 ); in these patients, the incidence of disease may approach 21% at 2 years. 60 Although the retina is the most common target for CMV, gastrointestinal involvement remains important because of its frequency and morbidity.…”

Section: Cytomegalovirusmentioning

confidence: 99%

The therapy of gastrointestinal infections associated with the acquired immunodeficiency syndrome

Wilcox

Mönkemüller

1997

Aliment Pharmacol Ther

View full text Add to dashboard Cite

Although there have been dramatic strides in the therapy of human immunodeficiency virus infection over the last few years, the number of infected people world‐wide is tremendous and, at least in developing countries, continues to expand. Complications which involve the gastrointestinal tract are common in these patients, because the gut is a major site for involvement by opportunistic infections and neoplasms in patients with the acquired immunodeficiency syndrome. It is important to recognize the clinical spectrum of gastrointestinal diseases, as well as the appropriate and most cost‐effective diagnostic strategies, as therapies for a number of these disorders are both widely available and highly effective. This review summarizes the major gastrointestinal infections which are seen in patients with the acquired immunodeficiency syndrome, and their treatment.

show abstract

Clinical Manifestations of AIDS in the Era of Pneumocystis Prophylaxis

Abstract: M. avium complex disease, esophageal candidiasis, wasting syndrome, and cytomegalovirus disease are more common in HIV-infected patients who have received prophylaxis against P. carinii than in those who have not. Prophylaxis may delay the first AIDS illness for 6 to 12 months.

Cited by 396 publications

References 13 publications

Increased risk of wasting syndrome in HIV-infected travellers: prospective multicentre study

Increased risk of wasting syndrome in HIV-infected travellers: prospective multicentre study

Anticytomegaloviral activity and safety of cidofovir in patients with human immunodeficiency virus infection and cytomegalovirus viruria

The therapy of gastrointestinal infections associated with the acquired immunodeficiency syndrome

Contact Info

Product

Resources

About