Polypharmacy among patients attending an AIDS clinic: utilization of prescribed, unorthodox, and investigational treatments

Article Abstract:

Physicians prescribe medications for treatment of individuals who are infected with the human immunodeficiency virus (HIV, which causes AIDS) and to those whose disease has progressed to AIDS. Other ''alternative'' or unorthodox treatments are available from lay healers and through patient networks, and investigational agents are provided through clinical drug trial (testing) programs. The effectiveness of these alternative treatments is unproven, and little is known about how often the unproven drugs are used. Patients with AIDS may also obtain drugs from more than one medical provider. This practice is known as polypharmacy. The use of prescribed, over-the-counter and investigational drugs, unorthodox treatments, and recreational drugs was studied in 197 individuals who attended the University of California, San Francisco, Medical Center AIDS Clinic. The patients in the study were mostly homosexual men in their thirties who were well educated and had financial resources available to them. During the three months prior to the beginning of the study, 96 percent (180 of 197) of the participants used 1 to 24 prescription drugs. Thirty-one percent participated in drug trials and 18 percent were in more than one drug trial. Twenty-nine percent used unorthodox treatments. Those in more advanced stages of illness were more likely to use more than one prescribed medication and unorthodox treatment. Forty percent received a prescribed treatment from a medical provider other than their primary provider. Therefore, the use of more than one drug and the use of unorthodox treatments are common among some patients with AIDS. This practice may increase the risk for adverse drug reactions and interactions and may alter the results of clinical trials. The behavior of well educated, homosexual, male AIDS patients with financial resources must be taken into consideration by the physicians who treat them and by researchers who conduct clinical trials. Findings of drug testing programs in which participants practice polypharmacy can not be extended to other populations who have AIDS, such as minorities, women, children, and intravenous drug users. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Analysis, Clinical trials, Drug therapy, Alternative medicine, Drug use, Drug utilization, Drug monitoring

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The association between human papillomavirus deoxyribonucleic acid status and the results of cytologic rescreening tests in young, sexually active women

Article Abstract:

Infection with human papillomavirus (HPV) is a risk factor for developing cervical neoplasia (tumors) that often develops into cancer. These tumors are presently screened for by the Pap smear, but this test is fairly insensitive, detecting only 50 to 80 percent of the cases of cervical neoplasia. A test that would identify those infected with HPV could be used to detect those at high risk for these tumors, who could then undergo the more time-consuming and more costly, but more accurate, colposcopy exam for these abnormalities. A test that identifies HPV DNA (hybridization) has been developed to detect infection with HPV. Studies have shown that not all infected with the virus have abnormal Pap smear results and vice versa. It is thought that a Pap smear in combination with an HPV DNA test may be most useful in determining who should be further examined by colposcopy. This study examined the association between HPV DNA results and Pap smear results to see if rescreening is useful for those that are HPV-positive. The tests were performed in 125 women. HPV results were not known by those examining the Pap smear results, two pathologists and a private cytologic laboratory. HPV DNA test results were positive for 24 subjects (19 percent). The private cytology laboratory read 6 of the 24 Pap smears from HPV-positive women as abnormal, but only 3 of 101 from HPV-negative individuals were read as abnormal. On the other hand, one pathologist read 15 of the 24 Pap smears from HPV-positive patients as abnormal, while 8 of 101 smears from HPV-negative individuals were considered atypical. A second pathologist read 11 of the 24 and 7 of the 101, respectively, as abnormal. Cervical epithelial neoplasia was diagnosed in none of the HPV-positive Pap smears by a private laboratory, in 40 percent by the first pathologist, and in 20 percent by the second. These results indicate that rescreening the Pap smear results of those who test positive for HPV-infection is useful and is likely to uncover a significant number of additional cases of cervical intraepithelial neoplasia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, DNA, Cervix dysplasia, Pap test

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Anal intraepithelial neoplasia and anal papillomavirus infection among homosexual males with group IV HIV disease

Article Abstract:

Infection with the human papilloma virus (HPV) has been clearly linked to cancer of the cervix, vagina and vulva and also to cancer of the penis. Recent research has confirmed that HPV is also associated with cancer of the anus. Factors that appear to increase the risk of anal cancer include homosexuality, the practice of receptive anal intercourse, and smoking. The rate of anal cancer in male homosexuals is rising, and may be related to immunosuppression, which is caused by HIV (human immunodeficiency virus, which is associated with AIDS). It is known that the risk of developing cancer of the cervix or vulva from HPV infection is dramatically increased if the patient's immune function is impaired; patients infected with HIV would most likely be especially vulnerable to anal cancer if exposed to HPV. A group of 97 male homosexuals with either AIDS or group IV HIV disease (based on distinctions among HIV patients made by the Centers for Disease Control) were examined for anal HPV infection and anal cancer. Fifty-two patients were infected with HPV; 38 had abnormalities of the cells lining the anus, and 15 had anal intraepithelial neoplasia, which includes precancerous and cancerous stages. There was a significant association between the presence of HPV and abnormalities of anal tissue; patients infected with one type of HPV (there are many varieties) had 4.6 times the rate of anal abnormalities as patients not infected with HPV. Many patients were infected with more than one variety of the human papilloma virus, and they were at much greater risk (39 times that of patients not infected with HPV) for abnormalities of anal tissue. Those individuals with tissue abnormalities had worse immune function, as indicated by lower T4 counts. The results demonstrate that male homosexuals with HIV infection may have increased risk for anal cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Anal cancer, Colorectal diseases, Intestinal diseases, Homosexuality, Male, Male homosexuality

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