Failure of zidovudine prophylaxis after accidental exposure to HIV-1

Article Abstract:

A placebo-controlled trial (one involving an inactive drug) of the prophylactic effects of zidovudine (AZT) has begun to assess its ability to prevent AIDS in people who are accidentally exposed to HIV-1 (human immunodeficiency virus, the virus associated with AIDS). AZT is the only drug currently approved for treating AIDS in the United States. A tragic mistake in a hospital allowed examination of this issue in a most direct manner. A 58-year-old monogamous heterosexual man, hospitalized for an intestinal problem, was inadvertently transfused with a minute amount (100 to 200 microliters) of blood from a homosexual man who was infected with HIV-1. Zidovudine treatment was begun within 45 minutes after transfusion, and was continued for several months. An antigen (foreign substance) associated with HIV-1 was detected in the patient's blood 30 days after the transfusion; HIV-1 antibodies appeared in the blood at 41 days, and the patient's lymphocyte counts dropped. Although zidovudine is currently recommended for accidental exposure to HIV-1, it does not appear that the drug prevented infection in this case. On the other hand, an accidental needle stick would result in a much smaller inoculum of virus than the 100 microliters that this patient received; it is possible that zidovudine could be an effective prophylactic in such cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Prevention, Disease transmission, AIDS (Disease)

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A short-term study of the safety, pharmacokinetics, and efficacy of ritonavir, an inhibitor of HIV-1 protease

Article Abstract:

Ritanovir may inhibit the activity of HIV-1 and increase CD4 counts in infected individuals in the short-term, but may or may not improve overall patient condition. Eighty-four HIV infected people were randomly assigned to receive either ritanovir or a placebo for four weeks followed by ritanovir. Initially, different doses of ritanovir, which ranged from 300 milligrams per 12 hours (mg/12 hr) to 600 mg/12 hr, all significantly reduced the levels of HIV-1 RNA in blood plasma and increased CD4 counts. However, after 16 weeks these measures returned to their pretreatment levels in all but the group receiving 600 mg/12 hr. In this dosage group, after 32 weeks the median CD4 count was was still elevated and an average drop in viral RNA persisted. Side effects were common and included nausea and abnormal sensation in the mouth.

HIV infection, Drug therapy, HIV infections, Protease inhibitors

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Patterns of T-cell repopulation, virus load reduction, and restoration of T-cell function in HIV-infected persons during therapy with different antiretrovial agents

Article Abstract:

Some AIDS drugs may boost the number of immune cells but may not restore their function. This was demonstrated in a study of HIV patients who took zidovudine, nevirapine, or the protease inhibitor ritonavir. Ritonavir increased T cell levels the most but did not improve their function.

Statistical Data Included, Physiological aspects, Ritonavir, Immune response

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