Dideoxyinosine in children with symptomatic human immunodeficiency virus infection

Article Abstract:

Dideoxyinosine (ddI), like zidovudine (AZT), was designed to inhibit the replication of retroviruses such as the AIDS virus. Unfortunately, such drugs are not perfect; not only is the inhibition of the virus far from total, but normal physiological processes are also affected, causing potentially serious side effects. However, although dideoxyinosine is very effective against the human immunodeficiency virus (HIV) in tissue culture experiments, its side effects seem to be milder than those of zidovudine. In a study of 43 children with symptomatic HIV infection, ddI was shown to be beneficial and to have relatively low toxicity. Sixteen of the children had been previously treated with zidovudine; ddI was effective in these cases as well. The children showed an increase in the number of CD4 lymphocytes in the blood and a decrease in the amount of the p24 viral antigen. Six patients died during the course of the study and one patient was taken off the drug regimen as his disease progressed. In addition, one patient was removed from the study due to toxicity of the ddI. The major toxicity observed was inflammation of the pancreas, which had been observed previously in trials of ddI among adults. During the course of the study, the levels of ddI in the blood were monitored, and it was found that the patients with higher blood levels tended to do better than patients with lower levels. This suggests that individual differences in the absorption of the drug in the intestine, or individual differences in the elimination of the drug, may be important in determining the response of the patient. It may be that customizing dosage procedures to the individual patient may result in a greater degree of effectiveness when treating HIV infection with dideoxyinosine. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Dosage and administration, Didanosine

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Brain growth and cognitive improvement in children with human immunodeficiency virus-induced encephalopathy after 6 months of continuous infusion zidovudine therapy

Article Abstract:

Infection with the human immunodeficiency virus (HIV) often results in neurological abnormalities. In children, the most common one is the development of encephalopathy (diseased tissues of the brain), characterized by slowed development and microcephaly (smallness of the head and underdevelopment of the brain, resulting in mental retardation). The brains of children infected with HIV were examined with computed tomography (CT) scans. Wasting or decrease in size and physiologic activity (atrophy) of the brain occurs before the slowing of development. Encephalopathy associated with HIV infection usually gets worse with time, which in turn leads to a decline in cognitive abilities. However, an improvement in thinking ability and a reduction in brain atrophy have been seen in children who are continuously treated with zidovudine (ZDV), either orally or by continuous intravenous infusion. The size of one of the ventricles (cavities) at a particular location of the brain was examined in eight children, ages two to 14, who all had HIV-induced encephalopathy. The examination was performed with CT scans, both before and after six months of treatment with continuous intravenous infusion of ZDV (CI-ZDV). The initial CT scan before treatment showed moderate to severe atrophy of the brain. In seven out of eight of the children, the size of the cavity was smaller after treatment, indicating the presence of more brain tissue. Intelligence quotients (IQs) improved. Therefore, after six months of treatment with continuous infusion of ZDV, the brains of children showed less atrophy and their mental states improved. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Complications and side effects, Physiological aspects, Zidovudine, Cognition in children, Cognitive development, Brain damage

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In the vertical transmission of HIV, timing may be everything

Article Abstract:

Of the nearly 20,000 cases of acquired immunodeficiency syndrome (AIDS) reported among women in the US, more than three quarters involve women of childbearing age. In selected urban areas, the rate of infection reaches 8 percent. In Haiti and parts of Central Africa, 5 to 30 percent of women have been infected with human immunodeficiency virus (HIV), the cause of AIDS. Nearly all children with AIDS have been infected by their mothers (vertical transmission). Reports of the rate of transmission from infected mothers have been variable, from about 13 percent in one European study to 45 percent in Nairobi, Kenya. An important question is why some infants become infected and others do not. The study by Philippe Van de Perre and his colleagues, which appears in the August 29, 1991 issue of The New England Journal of Medicine demonstrates transmission of HIV from mother to infant through breast-feeding. Vertical transmission of AIDS may be greater during the early stages of infection, because the amount of the virus in the blood is high at this time. It is still not clear exactly when during pregnancy the infection is transmitted; this information must be known before transmission can be prevented. This finding should not be used to discourage high risk mothers from breast-feeding their infants in countries where contaminated water supplies make infant formula unsafe. However, in countries where this is not a problem, infected and high-risk women should be counseled to use infant formula. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Prevention, Diseases, Disease transmission, Pregnancy, Breast feeding, AIDS (Disease) in pregnancy, Mother and infant, Mother-infant relations, HIV seropositivity, HIV positive, editorial

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