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Biomedical subjects

D Vittecoq

Publications and source records attributed to D Vittecoq.

At least 55 records · Page 3Linked to original sources
PubMed1992

Passive immunotherapy in AIDS: a randomized trial of serial human immunodeficiency virus-positive transfusions of plasma rich in p24 antibodies versus transfusions of seronegative plasma.

To assess the place of passive immunotherapy in the treatment of AIDS, a randomized study was conducted that evaluated the safety and short-term efficacy of serial transfusions of human immunodeficiency virus type 1 (HIV-1) seropositive plasma in 18 patients. Heat-inactivated anti-HIV antibody-rich plasma was compared with seronegative fresh-frozen seronegative plasma given in addition to zidovudine and other conventional prophylactic treatments. Seven transfusions every 2 weeks of immune plasma significantly reduced (2 vs. 8, P = .016) the number of opportunistic infections. Antigenemia became undetectable. When transfusions were stopped, positive p24 antigenemia returned at a level higher than before treatment and was correlated with a severe clinical deterioration, suggesting a rebound effect. This trial suggests that passive immunotherapy is promising in AIDS treatment. It confirms also that plasma donation does not affect donors' CD4 cell count over a 1-year period. In patients with severe immunodeficiency, special attention should be paid to withdrawal of an effective therapy as virologic relapse may be explosive and poorly tolerated.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Vapreotide, a somatostatin analogue, in cryptosporidiosis and other AIDS-related diarrhoeal diseases.

OBJECTIVE: To evaluate the efficacy and tolerance of vapreotide, a new somatostatin analogue, in the treatment of refractory AIDS-related diarrhoea. DESIGN: An open, non-comparative pilot trial. SETTING: The trial was conducted in 10 medical centres in France. PATIENTS, PARTICIPANTS: Thirty-four AIDS patients with chronic diarrhoea unresponsive to conventional antidiarrhoeal therapy were enrolled. Cryptosporidiosis was diagnosed in 21 out of 30 evaluable patients. Mean number of stools prior to therapy was 10.1 +/- 4.9 per day (range, 3-20 stools per day). INTERVENTION: After initial baseline studies, patients received subcutaneous vapreotide at escalating doses of 400 (23 patients) or 500 micrograms (seven patients), between two and six times daily. MAIN OUTCOME MEASURES: Efficacy was assessed after 14 days of therapy, when it was found to be effective. Responders were offered the opportunity to continue receiving therapy. RESULTS: Four patients demonstrated a complete response and 12 a partial response with greater than 50% reduction in daily stool emission. Fourteen patients did not respond to doses up to 2400 micrograms/day. Patients with conditions other than cryptosporidiosis had a significantly higher probability of response (P = 0.013), as did those with milder diarrhoea (less than 10 stools per day). Median duration of response was 1.5 months (range, 0.5-5 months); relapse occurred in five out of eight responders despite maintenance therapy. Toxicity was minimal. CONCLUSIONS: We conclude that AIDS patients with diarrhoea not caused by Cryptosporidium may benefit from vapreotide therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1991

[Passive immunotherapy in AIDS: transfusion of plasma rich in anti-p25 antibody (phase I trial)].

The present study is a therapeutic trial of phase I, based on the principle of passive immunotherapy in acquired immunodeficiency syndrome (AIDS). Eighteen patients with full blown AIDS (stage IV C2 of CDC) were subdivided into two groups: nine receiving every two weeks 300 ml of plasma collected from HIV-1 seropositive symptomless (stage II or III of CDC) individuals, and nine (control group) receiving 300 ml of seronegative plasma at the same rythm and for the same period. Each patient received seven transfusions. Clinical and biological results during the transfusional and post-transfusional periods are reported.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Polymerase chain reaction (PCR) in various stages of HIV infection. Relationship to disease progression.

In order to establish whether the Polymerase Chain Reaction (PCR) may constitute a new marker of evolution towards AIDS in symptomless HIV infected subjects, we used PCR with three primer pairs (in the gag, pol and LTR regions) in 223 seropositive individuals at different stages of HIV infection. Among 176 symptomless seropositive individuals, 174 (98.8%) were positive with at least one primer pair. The subjects negative with at least one primer pair had a CD4 lymphocyte count significantly higher (p less than 0.01), and serum immunoglobulin G, immunoglobulin A, neopterin and beta-2-microglobulin concentrations significantly lower (p less than 0.01) than the individuals positive with the three primer pairs. Among 73 seropositive individuals followed over a two year period, 59 presented the same PCR pattern over this time period, while PCR showed different results in 14. Forty-seven AIDS patients were positive with the three primer pairs. The number of PCR negative with at least one primer pair was significantly fewer (p less than 0.001) in symptomatic individuals than in symptomless individuals. We conclude that the percentage of positive PCR results in HIV infected individuals is linked to the clinical stage of infection and to the disease progression.

Acquired Immunodeficiency Syndrome↗
PubMed1990

DNA amplification of HIV-1 in seropositive individuals and in seronegative at-risk individuals.

We assessed the HIV-1 status of seropositive and seronegative at-risk individuals by the polymerase chain reaction. Fifty-four out of 55 HIV-1-seropositive samples scored positive. However, HIV-1 proviral DNA was not detected in 16 seronegative homosexuals, 20 seronegative polytransfused haemophiliacs and 20 seronegative thalassaemic children, 20 individuals with isolated and persistent anti-core antibodies and 74 seronegative blood donors. These data indicate that positive HIV-1 DNA is likely to be an exceptional phenomenon in HIV-seronegative people.

Adult↗
PubMed1989

Possible correlation between exposure to AIDS risk factors, clinical presentation in AIDS, and subsequent prognosis.

AIDS-related Kaposi's sarcoma (KS) has a better prognosis than other presentations of AIDS. It is more frequent among homo-bisexual men than in other risk groups. This has raised the possibility of specific etiological agent(s) or co-factor(s) which induce its development. However, this suggestion is confusing since it implies that exposure to such agent(s) or co-factor(s) would result in an improved prognosis. Recent virological studies indicate that the HIV itself could be responsible for the induction or growth of KS. Since HIV antigenemia and the immunosuppression are lower among KS cases than among those with opportunistic infections (OI), we could expect a lower level of exposure to AIDS-related factors in KS cases as compared to OI cases. To investigate this possibility, we compared 25 cases with Kaposi's sarcoma alone (KS) with 25 cases having OI without KS, among homo-bisexual men. The KS cases were more likely than OI cases to have a higher educational level. They were less likely to have inhaled nitrites, to have had repeated syphilis and repeated gonorrhoea, and to be promiscuous. In the multivariate analysis, the factors which best discriminated the groups were nitrite inhalations, history of repeated syphilis, and anonymous promiscuity ("one-night stands"). Our study does not support the hypothesized association between nitrite inhalations and Kaposi's sarcoma. We found that cases with opportunistic infections - that is, with a poor prognosis - had been exposed to AIDS-related risk factors (e.g. history of venereal diseases, nitrite inhalations, promiscuity) at higher levels than cases with Kaposi's sarcoma alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1989

Impaired in-vitro proliferation of hemopoietic precursors in HIV-1-infected subjects.

Patients with acquired immunodeficiency syndrome (AIDS) and persistent lymphadenopathy syndrome (LAS) display significant hematological abnormalities of one or more cell lineages. In order to understand the pathophysiologic mechanisms leading to these abnormalities we studied the proliferation capacity of pluripotent and committed hemopoietic precursors using in-vitro colony assays. Anemia, leukopenia and thrombopenia were relatively frequent findings in HIV-infected subjects irrespectively of the patients' clinical status. The colony growth capacity of AIDS patients' GM-CFU and BFU-E was significantly decreased whereas no GEMM-CFU colonies could be obtained. There was no correlation between the number of BFU-E and GM-CFU colony number and the hemoglobin or the absolute number of polynuclear cells, respectively. The plating efficiency of both committed and pluripotent hematopoietic precursors from HIV infected patients could not be enhanced when additional exogenous recombinant GM-CSF, human interleukin 3 or erythropoietin were added in contrast to normal patients' cells. In addition, the impaired colony growth of these precursors could not be restored after adherent or T-cell depletion or the addition of normal allogenic irradiated adherent or/and T cells. Since this colony growth abnormality was also detected in HIV seropositive asymptomatic subjects our findings strongly suggest that the in-vitro growth of hematopoietic precursors is affected early after HIV-1 infection.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[DNA amplification using the polymerase chain reaction method applied to the detection of HIV-1 in seropositive subjects and in seronegative subjects at risk].

Polymerase Chain Reaction (PCR) allows the amplification of specific segments of Human Immunodeficiency Virus (HIV) genome. This technique is of interest for direct detection of HIV-1 DNA sequences in peripheral blood mononuclear cells. In our study, 54 out of 55 HIV-1 seropositive subjects were found positive with PCR assay. No detection of HIV DNA was observed in 36 seronegative at risk subjects (16 homosexuals and 20 polytransfused haemophiliacs), in 20 subjects with isolated and persistent anti-core antibodies, in 20 thalassemic polytransfused children and in 74 HIV seronegative blood donors (negative controls). These results are consistent with those of classical HIV serology and indicate that latent HIV-1 infection in seronegative at risk subjects is not a frequent event, if it exists.

Adult↗
PubMed1989

Prognosis of ruptured intracranial mycotic aneurysms: a review of 12 cases.

Intracranial mycotic aneurysms (IMA) occur in 1-3% of all infective endocarditis. Although spontaneous resolution was evidenced on serial angiograms in many asymptomatic cases, the prognosis, if they rupture, is reported to be worse and partly contingent on the therapeutic approach. Among 12 patients (six acute and six subacute endocarditis) with ruptured IMA, six were treated surgically and four were treated medically. Two patients died during rupture before any treatment could be started. Six patients had a sudden rupture manifested by coma, less clear consciousness seizures, hemiparesis unilateral mydriasis. CT-Scan showed intracerebral, intraventricular and subarachnoid haemorrhage. Ten angiograms showed 11 IMA. For patients with ruptured IMA, the decision for surgical treatment was made in the presence of deepening coma and extensive mass-lesion on CT-scan (one of six died in the postoperative period). Others received medical treatment (four cases: all survived) and were followed-up with serial angiographies. Of the nine patients who survived, five remained free of any disability 1-4 years later. We suggest that the prognosis of ruptured IMA (25% mortality rate) is not as bad as previously reported if surgery following angiography is performed early in the presence of deepening coma and extensive lesion.

Adolescent↗
PubMed1989

Lack of HPA-23 antiviral activity in HIV-infected patients without AIDS.

A randomized study of 12 treated patients and seven controls was conducted in order to evaluate HPA-23 anti-HIV activity in HIV-infected patients. The antiviral activity was assessed by determining HIV p24 antigenemia. A persistence or even increase in antigenemia was shown in treated patients and thrombocytopenia was observed in nine out of the 12 patients. This suggests that HPA-23 should not be used in anti-HIV therapy.

Antimony↗
PubMed1989

Treatment of AIDS-associated heart disease.

Although the diagnosis of AIDS-associated heart disease is becoming routine, its treatment has not been reported except in anecdote. Also, it has been unclear whether the odds of successful treatment are altered because of the presence of cardiac involvement per se. This communication reports the authors' treatment of 18 patients with AIDS-associated heart disease. Their results are combined with the treatment results of all patients reported in the literature to date with AIDS-associated heart disease. Treatment success, defined as eradication of the organism and no relapse, was achieved in their patients with M. tuberculosis (M. tb), cardiac cryptococcosis, and Salmonella typhimurium. M. tb required emergency pericardiectomy (well tolerated in all patients), then administration of rifampin, isoniazid, and ethambutol. Cryptococcosis was treated acutely with amphotericin B and flucytosine, then with maintenance amphotericin B. The response, which included resolution of congestive heart failure, occurred within a week. Salmonella endocarditis was cured with administration of ampicillin and netilmicin for one month. When the patients' data were combined with those of patients from the literature, the authors found that the odds of successful treatment for tuberculous pericarditis were somewhat lower than if the tuberculosis was extracardiac (50% vs 67%). With cryptococcal heart disease, the odds of successful treatment were actually significantly better than when only extracardiac disease was present. The authors conclude that infectious forms of AIDS-associated heart disease are often treatable. Although some cardiac infections are less likely to respond to treatment if there is cardiac involvement, mostly the response to treatment is similar to the response with only extracardiac involvement.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Reverse transcriptase activity (RTA) in lymphocyte cultures of HIV-infected patients receiving short treatments of HPA 23. A biological evaluation.

Ammonium tungsto antimoniate (HPA 23) is a potent inhibitor of nucleic acid polymerases and reverse transcriptases of retroviruses. Its in vivo activity as an HIV inhibitor was previously published. However, its clinical use is limited by pharmacological parameters (short half-life and intravenous administration) and significant side effects (thrombocytopenia). In order to evaluate the place of this drug in the therapeutic strategy of HIV-infected patients, we administered 1.5 mg/kg of HPA 23 in 15 infected patients at various stages of the disease twice a day during 14 days. A significant decrease of reverse transcriptase activity (less than 15% of the initial value) was noticed in 13 patients. This activity remained low at least 6 weeks after the end of the treatment in 8 patients. Thrombocytopenia was the only significant side effect reported and was always transient. This study suggests that HPA 23 can be used as an induction treatment in patients infected by HIV. A maintenance treatment has to be defined, as well as the association to other drugs.

Acquired Immunodeficiency Syndrome↗