Cytomegalovirus colitis in AIDS: presentation in 44 patients and a review of the literature

Article Abstract:

Patients with AIDS are subject to a number of opportunistic infections (which generally affect individuals with diminished immune function). Cytomegalovirus (CMV) infection of the colon causes colitis (inflammation of the colon), and is an opportunistic infection that can cause major problems in AIDS patients. It may afflict 30 percent of these individuals. Treatments are available, therefore diagnosis of this infection is very important. This study examined the signs and incidence of CMV colitis in 44 patients with AIDS. Data was obtained from male, homosexual patients who were enrolled in a study examining the treatment of CMV colitis with the antiviral drug ganciclovir. All the men were diagnosed as having CMV colitis, with 11 patients having it as their AIDS-defining event. The average interval from AIDS diagnosis to diagnosis of CMV colitis was 11.2 months. All suffered from diarrhea, which was persistent in 31 patients (70 percent). Fever was present in 35 patients (80 percent), weight loss in 39 patients (89 percent), and abdominal pain in 28 patients (64 percent). CMV was found in the urine of 31 patients and in the blood of 13 patients; 8 men did not have CMV in either blood or urine. CMV disease was found in other areas of the body in 20 of the patients. The time from AIDS diagnosis to CMV colitis was much longer in patients who were taking zidovudine (AZT) than in those who did not take it (16 months versus 3 months). Colon examinations (colonoscopy) were normal, but CMV was found in colon biopsies in 11 patients; colon biopsies revealed CMV in a localized region (the cecum) in 18 other patients. These results indicate that CMV colitis can be an important indicator in diagnosing AIDS and can occur early in the disease. Symptoms can be nonspecific, and early diagnosis and treatment are important. Multiple colon examinations and biopsies should be done on high-risk individuals since CMV infection can be localized in the colon. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Infection, Diagnosis, Causes of, Complications and side effects, Cytomegalovirus infections, Colon (Anatomy), Colon, Colitis

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Retroviral reverse transcriptase: synthesis, structure, and function

Article Abstract:

A few decades ago, the notion that a virus containing genes made from RNA could reproduce by making a DNA copy was positively heretical. Today, many such viruses, called retroviruses, have been found to use this 'backward' form of gene replication. All such viruses, including the notorious AIDS virus, transcribe their RNA genome onto a DNA copy through the action of an enzyme called reverse transcriptase (RT). Since such enzymes do not occur in the normal cell, it would seem that reverse transcriptase might be the ideal point at which to disrupt reproduction of the AIDS virus. For this reason, much research has studied the details of the structure and function of this very special enzyme. The current state of knowledge of reverse transcriptase is reviewed in detail by the author. Reverse transcriptase enzymes from a wide variety of viruses show great similarity, which suggests that they may have a common evolutionary origin. Although this enzyme is the most significant target of efforts to develop antiviral drug therapies, success has been far from complete. Azidothymidine, or AZT (now called zidovudine) blocks viral RT far more than host enzymes, but the AIDS virus is capable of developing resistant mutants. Ironically, although the mutations may be observed genetically, biochemists have been unable to identify precisely what alterations in the enzyme actually account for its resistance to AZT. A new set of reverse transcriptase inhibitors are being investigated, collectively called 'TIBO' compounds. Somewhat surprisingly, these substances inhibit the RT from HIV-1 virus, but not the same enzyme from HIV-2 virus. While the enzyme remains mysterious in some ways, the author expresses the belief that the tremendous effort being expended will make reverse transcriptase one of the best understood of all enzymes. This knowledge will certainly have significant impact on the development of therapeutic agents for patients with AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Prevention, Physiological aspects, HIV (Viruses), HIV, Genetic aspects, Retroviruses, Drug resistance, Reverse transcriptase

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