Therapeutic options expand, take new directions

Article Abstract:

Infection with HIV, the AIDS virus, begins a slow progression towards the failure of the immune system and eventual death. Drug therapy can slow this process, and indications are that newer emerging therapies will slow the progression of the disease even more. It is already established that the drug zidovudine (AZT) can slow the progress of the disease, but some physicians may be prescribing the drug too late. The progression of HIV infection is often monitored by counting the number of T cells expressing the CD4 antigen; many physicians prescribe zidovudine for their patients once the CD4 cell count has fallen below 200 per cubic millimeter of blood. However, some authorities suggest that beginning therapy earlier, as soon as the count falls below 500, may have substantial benefit for the patient. Earlier treatment may permit the immune system to function longer at a more effective level. In addition, there are indications that the virus itself will develop resistance to zidovudine more slowly if the drug is administered earlier when the rate of viral replication is slower. New research projects are evaluating the effectiveness of zidovudine in combination with newer antiviral drugs, including didanosine (DDI) and zalcitabine (DDC). It is hoped that these new combinations will slow even further the rate of progression of HIV infection. Patients infected with HIV are now often given prophylactic antibiotics to help prevent the occurrence of Pneumocystis carinii pneumonia and cryptococcal meningitis, two diseases which commonly affect AIDS patients. Indeed, there are HIV-infected patients still functioning with a CD4 count of zero, testament to the effectiveness of prophylactic therapy. The improvements in drug therapy will have a potentially misleading effect on AIDS statistics. Since the reporting of new AIDS cases to the Centers for Disease Control is based on the occurrence of one or more of a set of diseases, including P. carinii pneumonia, the effective delay of these conditions will result in a decline in the reported number of new AIDS cases. However, this decline should not obscure the fact that the number of patients infected with the virus is going up, and that those already infected with HIV will eventually progress to AIDS. The symptoms of AIDS are being only temporarily delayed. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Recommendations for zidovudine: early infection

Article Abstract:

On March 3 and 4, 1990, the State-of-the-Art Conference on AZT (zidovudine) Therapy for Early HIV (human immunodeficiency virus) Infection was held. This conference was sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health. Recommendations were made as follows, given the currently available research data. HIV testing is recommended for all individuals at risk for HIV infection because early medical interventions are now available to treat asymptomatic, HIV-infected persons. A protocol for monitoring immune status is outlined: when HIV infection is diagnosed, obtain baseline CD4 lymphocyte count and if over 600, repeat test every six months. CD4 count should be taken more often (every three to four months) if the count is approaching the point at which treatment decisions are made. AZT therapy is recommended when the CD4 count falls below 500, whether the patient is symptomatic or asymptomatic; the daily dose should be 500 mg. If the initial CD4 count is in the range of 400 to 600, the test should be repeated before AZT treatment is begun. To be certain of the indication for zidovudine, two CD4 counts under 500 should be obtained consecutively at least one week apart. In patients with CD4 counts below 200, the decision has generally been made to initiate both AZT and prophylactic treatment for Pneumocystis carinii pneumonia, and so there is no reason to repeat CD4 cell counts. Guidelines are presented for scheduling follow-up visits and laboratory tests for patients taking AZT. Unanswered questions about AZT and HIV that need to be researched are also discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Conferences, meetings and seminars, Measurement, Testing, AIDS patients, Dosage and administration, T cells, Zidovudine

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Ditiocarb sodium (diethyldithiocarbamate) therapy in patients with symptomatic HIV infection and AIDS: a randomized, double-blind, placebo-controlled, multicenter study

Article Abstract:

So far, treatment for acquired immunodeficiency syndrome (AIDS) has concentrated on antiviral drugs or drugs to treat opportunistic infections (OIs; infections that develop in the presence of a compromised immune response) and cancers. Development of vaccines, and therapies to reverse immunological abnormalities, has not made much progress. Ditiocarb, the sodium salt of diethyldithiocarbamate, improves the depressed immune responses of mice, and reduces the toxic reaction to some anti-tumor drugs. It has been reported that ditiocarb reduced the symptoms and improved the immunologic response of patients with AIDS and AIDS-related complex (ARC). Three hundred eighty-seven HIV-infected patients were enrolled in a study of the effectiveness of ditiocarb. Approximately half received ditiocarb, and half were given a placebo. Ditiocarb therapy reduced OIs in patients with symptomatic HIV infections and AIDS. Ditiocarb may be given with zidovudine or aerosolized pentamidine, standard AIDS therapies, without increasing the number of adverse reactions. There were actually more adverse reactions with the placebo. So far, drug therapy for AIDS has concentrated on mitigating the effects of opportunistic infections and cancers, but therapies to correct immunologic abnormalities would be more effective. The problem with this approach is the potential for increased HIV replication, but ditiocarb would avoid this potential complication. Several studies have now shown ditiocarb to be safe and effective for the prevention of new opportunistic infection in patients infected with HIV. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Opportunistic infections

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