Search

The two-ritonavir/indinavir regimens in the treatment of HIV-infected individuals are compared. Both regimens exhibited similar tolerability and response rates and high toxicity with a low response suggests that the optimum IDV/RTV combination would include an RTV dose

Adding a second protease inhibitor to highly active antiretroviral therapy (HAART) may benefit some HIV patients, according to a study of 481 patients. About one-third of the patients achieved viral blood levels below 200 copies/mL., Context: Management of antiretroviral treatment failure in patients receiving protease inhibitor (PI)-containing regimens is a therapeutic challenge. Objective: To assess whether adding a second PI improves antiviral efficacy of a 4-drug combination in patients with virologic failure while taking a PI-containing regimen. Design: Multicenter, randomized, 4-arm trial, double-blind and placebo-controlled for second PI, conducted between October 1998 and April 2000, for which there was a 24-week primary analysis with extension to 48 weeks. Setting: Thirty-one participating AIDS (acquired immunodeficiency syndrome) Clinical Trials Units in the United States. Participants: A total of 481 human immunodeficiency virus (HIV)-infected persons with prior exposure to a maximum of 3 PIs and viral load above 1000 copies/mL. Intervention: Selectively randomized assignment (per prior PI exposure) to saquinavir (n = 116); indinavir (n=69); nelfinavir (n = 139); or placebo twice per day (n = 157); in combination with amprenavir, abacavir, efavirenz, and adefovir dipivoxil. Main Outcome Measures: Primary efficacy analysis involved the proportion with viral load below 200 copies/mL at 24 weeks. Other measures were changes in viral load and CD4 cell count from baseline, adverse events, and HIV drug susceptibility. Results: Of 481 patients, 148 (31%) had a viral load below 200 copies/mL at week 24. The proportions of patients with a viral load below 200 copies/mL in the saquinavir, indinavir, nelfinavir, and placebo arms were 34% (40/116), 36% (25/69), 34% (47/139), and 23% (36/157), respectively. The proportion in the combined dual-PI arms was higher than in the amprenavir-plus-placebo arm (35% [112/324] vs 23% [36/157], respectively; P=.002). Overall, a higher proportion of nonnucleoside reverse transcriptase inhibitor (NNRTI)-naive patients had a viral load below 200 copies/mL compared with NNRTI-experienced patients (43% [115/270) vs 16% [33/ 211], respectively; P Conclusions: In this study of antiretroviral-experienced patients with advanced immunodeficiency, viral load suppression to below 200 copies/mL was achieved in 31 % of patients with regimens containing 4 or 5 new drugs. Use of 2 PIs, being naive to N NRTIs, and baseline hypersusceptibility to efavirenz were associated with a favorable outcome.

A new type of herpes virus called Kaposi's sarcoma-associated herpes virus (KSHV) appears to be linked to Kaposi's sarcoma. In a study of HIV-infected men with and without Kaposi's sarcoma, 80% of those with Kaposi's sarcoma had antibodies against KSHV, compared to 18% of those without Kaposi's sarcoma. None of the control group consisting of 122 blood donors, 22 Epstein-Barr virus-infected people and HIV-infected hemophiliacs had antibodies to KSHV. Half of the HIV-infected men with Kaposi's sarcoma became KSHV-positive 6 months to 6 years before developing Kaposi's sarcoma.

HIV-infected patients who have severely compromised immune systems appear to be more likely than other HIV-infected patients to develop Pneumocystis carinii pneumonia (PCP) despite preventive drug therapy. PCP is a parasitic infection that may occur in people with damaged immune systems, particularly those with HIV infection. Researchers followed 476 HIV-infected homosexual men who took various drug regimens to prevent PCP between July 1989 and January 1993. Nineteen percent subsequently contracted PCP. Patients with helper T-cell counts below 50, which is indicative of severe immune system suppression, were nearly three times more likely to develop PCP than patients with helper T-cells counts between 100 and 200. Patients taking trimethoprim-sulfamethoxazole to prevent PCP and patients who smoked had approximately half the risk of developing PCP as the other patients. Those with fever were more than twice as likely to develop PCP as the other patients., Objective. - To identify clinical and epidemiological factors associated with failure of Pneumocystis carinii pneumonia (PCP) prophylaxis in those receiving primary and secondary prophylaxis. Design. - Longitudinal cohort study of participants infected with human immunodeficiency virus type 1 in the Multicenter AIDS Cohort Study who used PCP prophylaxis regimens after their T-helper lymphocyte counts had decreased to less than 0.200X[10.sup.9]/L (200/[mu]L). Main Outcome Measure. - Occurrence or recurrence of PCP. Results. - A total of 476 participants reported taking one or more of the following regimens: trimethoprim-sulfamethoxazole (TMP-SMX), dapsone, and/or aerosolized pentamidine - 367 as primary prophylaxis and 109 as secondary prophylaxis after a previous episode of PCP. A total of 92 (20%) developed PCP despite prophylaxis. The mean failure rates per person-year of follow-up were 16.0% for those receiving primary prophylaxis and 12.1% for those receiving secondary prophylaxis phylaxis (P=.19). Median times to death after initiation of primary or secondary prophylaxis were 2.0 and 1.2 years, respectively. The main predictor for failure of PCP prophylaxis was profound T-helper lymphocytopenia; 86% of failures occurred after T-helper cell counts decreased to less than 0.075 X [10.sup.9]/L and 76% occurred after counts decreased to less than 0.050 X [10.sup.9]/L. In multivariate time-dependent analysis, when compared with counts between 0.100 X [10.sup.9]/L and 0.200 X [10.sup.9]/L, the risk ratio for failure with counts less than 0.050 X 109/L was 2.90 (P

Treatment to prevent Pneumocystis (P.) carinii may delay the onset of AIDS, but increases the risk of certain other diseases in HIV-infected individuals. Among 844 homosexual men with AIDS, 138 had received preventive treatment against P. carinii and 706 had not. Men who received preventive treatment were more likely to develop four particular diseases as their first AIDS-defining illness than those who did not. These diseases were Mycobacterium (M.) avium complex disease, wasting syndrome, cytomegalovirus disease and esophageal candidiasis. Esophageal candidiasis is an infection of the esophagus caused by a fungus in the genus Candida. M. avium complex was the most prevalent disease among men who received preventive treatment. Men who received preventive treatment had lower CD4 T cell counts during the six months before being diagnosed with AIDS.

Using a case-control study of untreated men, we investigated the physical, mental, and economic effects of human immunodeficiency virus (HIV-1) infection prior to the diagnosis of acquired immunodeficiency syndrome AIDS). Beginning 2 to 2.5 years prior to AIDS, case subjects reported more of l2 HIV-1 related symptoms and during the year prior to AIDS, at least 30.6 extra days of these symptoms than did control subjects. Within the 6 months preceding AIDS, case subjects' unemployment rose to 9% (P [is less than or equal to] .05) and depression to 34.2% (P [is less than or equal to] .001). At 6 to 12 months and within 6 months before AIDS, 17.1% and 31.5%, respectively, were anemic, while 37.7% and 64.7% had [CD4.sup.+] counts less than 200 x [10.sup.6]/L. Diagnosing AIDS at [CD4.sup.+] counts less than 200 x [10.sup.6]/L could significantly reduce pre-AIDS morbidity. Other implication of these findings are discussed. (Am J Public Health. 1992;82:1538-1541)

Pneumonia due to the Pneumocystis carinii organism is extremely common in patients infected with the human immunodeficiency virus, HIV. The organism is found everywhere and more than 80 percent of the population show evidence of infection at sometime during their lives. Individuals whose immune systems are compromised, such as malnourished newborns, transplant patients and patients suffering from AIDS or other immunodeficiencies, are often infected. It is estimated that 75 percent of all individuals who test positive for HIV will at one time or another develop Pneumocystis pneumonia. Current statistical analysis projects 40,000 cases of this pneumonia during 1990, and more than 60,000 cases are anticipated during 1992. The data in this study on the risk of developing Pneumocystis pneumonia were derived from a large multicenter study of 1,665 homosexual and bisexual men who were known to be infected with HIV (AIDS Cohort Study), but who had not developed acquired immunodeficiency syndrome (AIDS). During a 48-month period, 168 men (or approximately 10 percent of the study group) developed their first episodes of Pneumocystis pneumonia. The development of Pneumocystis carinii pneumonia was found to strongly correlate with a reduced number of circulating helper T cells (or CD4+ cells), below 200 for each cubic milliliter of blood. These white blood cells are involved in the body's cellular immune reaction which is responsible for identifying and destroying foreign organisms such as Pneumocystis carinii. Thus, Pneumocystis pneumonia primarily affects HIV-infected individuals who have an insufficient level of T helper cells. (Consumer Summary produced by Reliance Medical Information, Inc.)