A controlled trial comparing foscarnet with vidarabine for acyclovir-resistant mucocutaneous herpes simplex in the acquired immunodeficiency syndrome

Article Abstract:

Herpes simplex infection is common, causing outbreaks called 'cold sores', which occur around the mouth as well as the lesions of genital herpes. In most people, the infection remains latent most of the time and only recurs occasionally. However, herpes simplex infection is a very serious problem for patients with AIDS, who cannot mount the effective immune response necessary to prevent the recurrent infections from progressing. In AIDS patients, the herpes sores become a source of great pain and disfigurement. Eventually, the sores provide a starting point for bacterial infection. Herpes simplex may be treated with the antiviral drug acyclovir. However, in many AIDS patients, the virus develops a resistance to acyclovir. A study was conducted to compare the effectiveness of two other antiviral drugs, foscarnet and vidarabine, in the treatment of acyclovir-resistant herpes simplex. Fourteen AIDS patients were randomly assigned into the experimental groups; eight were treated with foscarnet and six with vidarabine. An additional 11 patients were not randomized and were treated with foscarnet. The experiment did not follow the original design; when the herpes lesions responded to foscarnet treatment in all eight randomized patients, the vidarabine treatment was discontinued due to lack of effectiveness. Foscarnet reduced the healing time and the size of the lesions, as well as the pain experienced by the patients. Adverse reactions were common among the patients receiving foscarnet, but were not sufficiently severe to warrant discontinuation of treatment in any of the patients. Conversely, three patients taking vidarabine experienced significant deterioration of mental status, which was severe in one patient. The results of the study indicate that foscarnet is superior to vidarabine in treating herpes simplex resistant to acyclovir. However, it was also observed that the herpes simplex recurred an average of 42.5 days after the foscarnet was discontinued. (Consumer Summary produced by Reliance Medical Information, Inc.)

Antiviral agents, Herpes simplex, Foscarnet, Vidarabine

---

Oral therapy for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome: a controlled trial of trimethoprim-sulfamethoxazole versus trimethoprim-dapsone

Article Abstract:

Pneumocystis carinii pneumonia is the most common condition AIDS patients contract in association with their disease, as well as the most prevalent infection among AIDS patients. It can be treated with reasonable effectiveness by certain drugs, but two of these agents, trimethoprim-sulfamethoxazole and pentamidine, produce severe side effects in many patients. A controlled, randomized study compared the effectiveness of trimethoprim plus dapsone (an anti-leprosy drug) with that of trimethoprim plus sulfamethoxazole in treating first episodes of P. carinii pneumonia of mild-to-moderate severity in 60 AIDS patients. The treatment period lasted 21 days and the drugs were administered orally. The results demonstrated that the drug combinations were equally effective: two patients in the trimethoprim-dapsone group and three in the trimethoprim-sulfamethoxazole group failed to respond to treatment and suffered pulmonary deterioration. However, the rate of adverse reactions differed for the two regimens, with patients receiving trimethoprim-sulfamethoxazole experiencing almost two times the number of major reactions (17) as those receiving trimethoprim-dapsone (9). Severe hepatitis and neutropenia (reduced number of neutrophils, a type of white blood cell) were especially common in patients in the trimethoprim-sulfamethoxazole group. Other toxic effects included intolerable rash and severe nausea, which occurred with equal frequency in the two drug groups. A discussion of the complications that accompany these drugs is provided. A suggested treatment protocol for mild-to-moderate P. carinii pneumonia involves hospitalization for the first few days, then twice-weekly blood testing on an outpatient basis while continuing therapy with oral medication against the disease. Because of its lower incidence of side effects, the combination of trimethoprim and dapsone is recommended. Optimal dose levels remain to be determined. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pneumocystis carinii pneumonia, Dapsone, Co-trimoxazole, Trimethoprim-sulfamethoxazole (Drug combination), Trimethoprim

---

Acyclovir-resistant herpes simplex virus infections in patients with the acquired immunodeficiency syndrome

Article Abstract:

Patients with AIDS are often infected with herpes simplex virus (HSV). Acyclovir, an antiviral agent, is the drug of choice in the treatment of HSV infections, but acyclovir-resistant strains have been isolated in some individuals who have received prolonged therapy with the drug. Twelve cases of AIDS patients with HSV and ulcerative lesions which failed to respond to acyclovir therapy are cited. These cases provide evidence of the growing problem of acyclovir-resistant HSV infections, which require alternative forms of therapy, especially among AIDS patients. AIDS patients with ulcerative HSV that does not respond to acyclovir therapy should be evaluated promptly for the presence of a resistant virus, although no alternative therapy can be recommended presently.

Research, Acyclovir, Drug resistance, column

Similar abstracts:

• Abstracts: An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome
• Abstracts: Brief report: primary infection with zidovudine-resistant human immunodeficiency virus type 1. Progressive disease due to ganciclovir-resistant cytomegalovirus in immunocompromised patients

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.