State-of-the-Art Conference on azidothymidine therapy for early HIV infection
Article Abstract:
This conference, sponsored by the National Institutes of Health, was conducted by a non-Federal panel of experts and addressed the current method of treating patients with early infections of human immunodeficiency virus (HIV), the causative agent of AIDS. Zidovudine is the only drug approved to treat HIV and other retrovirus infections, and it can delay disease progression in infected people who have no or few symptoms. Based on research and testimony, the panel concluded that a large proportion of asymptomatic and mildly symptomatic HIV-infected patients are candidates for early treatment with the drug. The recommendations of the conference are presented in this article. The results of the major controlled clinical trials which led to these conclusions are reviewed, as are results of carcinogenicity studies and studies on the resistance of HIV infections to zidovudine. Recommendations for HIV testing, monitoring of immune status, and initiation of drug therapy are described. Zidovudine therapy should be provided within the context of comprehensive primary care, including assessment of psychosocial support, housing and related issues, and treatment of other sexually transmitted diseases. The frequency of office visits, laboratory monitoring, management of adverse events, drug interactions, and consideration of zidovudine discontinuation are discussed. Future research should include long-term effects of early zidovudine treatment, different dosage formulations, response by patient subgroups, effects in pediatric and pregnant subjects, combination drug therapy, and identification of markers of immune function. The panel recognized that expansion of zidovudine use will have major social and economic implications and may intensify current problems which must be resolved before optimal care of HIV-infected patients can occur. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Relative resistance of primary HIV-1 isolates to neutralization by soluble CD4
Article Abstract:
Human immunodeficiency virus (HIV) infection causes AIDS largely through its replication in CD4 white blood cells. Therefore, CD4 cells have been a prime target of research involving the development of CD4 antiviral therapy. In the laboratory it was shown that a soluble form of CD4 (sCD4) was effective as an antiviral agent against the replication of HIV. The HIV was a laboratory strain (isolate), however, and in humans treated with the antiviral sCD4, this effect has not been observed. The suggestion that the laboratory results were not reflective of the true behavior of HIV in humans led to the current investigation of the action of sCD4 cells against HIV obtained from infected patients. In this study, 12 HIV-infected patients received various dosages of sCD4 for a minimum of 28 days. In subgroups of patients receiving 1, 3, or 9 milligrams of sCD4 per day there were no clinical benefits noted as would be indicated by a decreased blood levels of the HIV antigen known as p24. In the subgroup of patients receiving 30 milligrams of sCD4 per day, inconsistent effects were observed. Another trial of sCD4 produced similar results as did a laboratory trial using HIV virus isolated from patients. Compared with earlier laboratory studies, these findings suggest that HIV isolated from patients is significantly more resistant to sCD4 than the original laboratory strain of HIV. Furthermore, they underscore the need for more careful preclinical trials of new drugs. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Primal scream therapy: a new cause of Mallory-Weiss tear
Article Abstract:
Lacerations, or cuts, in the mucosal tissue lining the connection between the esophagus and stomach were first identified by Mallory and Weiss in 1929, and have been shown by recent studies to cause 10 to 15 percent of cases of upper gastrointestinal bleeding that require hospitalization. Mallory-Weiss tears may result from coughing, injuries, hiccuping, invasive examination of the stomach, heavy lifting, and Valsalva maneuvers, which are attempts to forcibly exhale with a closed nose and mouth. A case is described of a 55-year-old man who developed acute gastrointestinal bleeding from a Mallory-Weiss tear as a result of screaming. The patient was involved in a 25-minute forceful screaming session during primal and confrontational therapy for alcohol rehabilitation. He experienced nausea and vomiting, and was later found to have a nonbleeding Mallory-Weiss tear, inflammation of the esophagus, and a hiatal hernia, a upward bulging of the stomach into the esophageal opening of the diaphragm. The patient was admitted to the hospital and no further episodes of bleeding occurred; his condition resolved within two months. Mallory-Weiss tears may not always be associated with vomiting, coughing, or retching. Hiatal hernia also increases the risk for this condition. This case is the first report of a Mallory-Weiss tear resulting from screaming. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
User Contributions:
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