Evaluation of the AIDS dementia complex in clinical trials

Article Abstract:

A variety of neurological symptoms can occur in AIDS, including the AIDS dementia complex (ADC). ADC occurs frequently and is associated with dementia affecting cognitive (thinking) ability, control of movement, and behavior. ADC appears to be directly caused by the human immunodeficiency virus (HIV). How HIV causes ADC, and how the disease is related to the entire disease, is not completely understood. The goal of treatment is to prevent the development of ADC or to alleviate ADC that is already occurring. The assessment of ADC after treatment in clinical trials is important as it reflects the effectiveness of the treatment against HIV itself. Thus the status of ADC can be used as a clinical end point to evaluate the effectiveness of a treatment. Even with these reasons for the importance of evaluating ADC in clinical trials, ADC has not received sufficient attention in these trials. Methods for monitoring the effect of treatment on ADC rely on examination of the nerve cells and on psychoneurological testing of speed of movement, concentration, mental manipulation, and memory. There are abnormalities in components of the cerebrospinal fluid (CSF) that may be further developed as markers for rapid assessment of the status of ADC, including components that are indicative of immune activation. Other methods for monitoring treatment include imaging of the nervous system by the use of computed tomography and magnetic resonance imaging, and with electrophysiological methods. It appears that antiviral agents that are available may be effective in preventing and treating ADC, at least for some period of time. The assessment of ADC may, therefore, be used to evaluate the effectiveness of various treatments against HIV infection, in general. It is suggested that ADC be included when evaluating the effectiveness of these antiviral agents. (Consumer Summary produced by Reliance Medical Information, Inc.)

HIV infection, HIV infections, Cerebrovascular disease, Cerebrovascular disorders, AIDS dementia, AIDS dementia complex

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Indwelling central venous catheter infections in patients with acquired immune deficiency syndrome

Article Abstract:

Indwelling central venous catheters, which are implanted for long term use, are effective in the treatment of patients with AIDS. Access to the veins is necessary for extended intravenous treatment of infections, such as treatment with amphotericin B for fungal infections, gancyclovir for infections with cytomegalovirus that have spread throughout the body, and, among patients treated with zidovudine, for intravenous fluids, nutrition or blood products. Permanent venous access is also needed for the treatment of cancers that are related to AIDS, such as lymphoma and Kaposi's sarcoma. The types of indwelling central catheters used include the Hickman type, which is a cuffed, tunneled silicone rubber elastomer catheter, and the Port-a-cath type, which is totally implanted. The risk of infection with the Hickman and Port-a-cath catheters was examined in three groups of patients: those with AIDS; those with immunodeficiencies other than AIDS, including patients with leukemias and lymphomas; and patients whose immune systems were functioning. Because the immune system is compromised in AIDS, patients are very susceptible to infections. The rate of infection among AIDS patients with the catheters was 2.02 infections per 1,000 days of catheter use, while for those with other immunodeficiencies, the rate was 0.41. Patients with advanced AIDS and those who had previous infections with catheters were more likely to have infections. Rates of infection were similar between the Port-a-cath and Hickman type catheters. The most common bacterial infection was by gram-positive cocci, including Staphylococcus epidermidis. If the infection was in the exit site and the tunnel, the catheter had to be removed. The death rate associated with infection from indwelling catheters was very low. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Causes of, Immunodeficiency, Catheters

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Indwelling cannula for insulin administration in diabetes mellitus

Article Abstract:

The need for repeated injections of insulin may lead to patient distress and noncompliance with the treatment regimen, particularly in diabetic children of preschool age. An alternative approach to repeated insulin injections is the use of an indwelling, subcutaneous cannula, a tube-like structure that is inserted under the skin to deliver insulin into the body. This device may be beneficial for young diabetics who require a brief period of frequent insulin injections to control glucose levels. The use of an indwelling subcutaneous Teflon cannula for insulin administration in 10 diabetic children was reviewed. Over a one-year trial period, no significant complications were associated with the use of the delivery device. The only practical problem with using the indwelling subcutaneous cannula was the failure of the adhesive patch that was used to fix the cannula. Minor complications included minor skin lesions, such as pus-filled pimples at the insertion site, eczema at the fixation site, or lipohypertrophy (the overgrowth of fat tissue). These skin lesions cleared up after the cannula site was changed. This insulin delivery device is relatively expensive and should only be used for those with true needle phobia or those with problems associated with the overuse of one injection site. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Juvenile diabetes, Dosage and administration, Catheterization, Insulin, Diabetes in children

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