Grapefruit juice: a possible source of variability in blood concentration of cyclosporin A.
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Biomedical subjects
Publications and source records attributed to K Lidman.
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536 Swedish residents who during the years 1988-90 were reported as having contracted HIV through sexual contacts were asked about circumstances regarding the transmission. Answers were received in 411 (76.7%) of the cases (285 homosexual men, 68 heterosexual men and 58 heterosexual women). In 282 (69%) of the cases the persons were without symptoms and in 231 (56%) cases the infection was considered to be < 3 years old. Among homosexual men and heterosexual women the infection was usually acquired in Sweden or Europe whilst heterosexual men more often acquired their infection at casual contacts on other continents.
Patients with advanced human immunodeficiency virus type 1 (HIV-1) infection who had p24 antigen despite treatment with zidovudine (AZT) for 4-28 months received 3 x 10(6) IU of native interferon-alpha (IFN-alpha) daily for 3 months. Infectious HIV was detected in the plasma of all patients, in most cases at high titers, before IFN-alpha treatment. There was no correlation between HIV titers and p24 antigen levels. Antiviral activity, as measured by significantly decreased levels of infectious virus or p24 antigen, was observed in six of eight completely treated but in only one of nine incompletely treated patients. After termination of IFN-alpha treatment, there was a significant rise of p24 antigen levels. During IFN treatment, absolute CD4 cell counts showed a tendency toward an increased rate of decline. The side effects were unexpectedly severe. Despite its anti-HIV effect in vivo, IFN-alpha in the dosages used does not seem to be a viable additional treatment for severely immunodeficient patients in ongoing AZT therapy.
Forty-four HIV-1-seropositive women and their children were followed-up and examined in connection with the course of pregnancy, mother-to-infant transmission of HIV and clinical outcome. Twelve out of 48 children were known to be infected and two children were lost to follow-up. Of the remaining 34 children, 22 are not infected, and 12 are clinically and immunologically normal at less than 18 months. There was no difference in intrauterine growth between infected and uninfected children. Forty-six per cent of the 39 mothers seen after delivery progressed to a more advanced stage of HIV infection during a mean follow-up time of 33 months after delivery. Although comparable in age, clinical and immunological status at delivery, and follow-up time, mothers of infected children had longer durations of HIV infection and were symptomatic and/or had low CD4 cell counts to a significantly greater extent at follow-up than mothers of uninfected children.
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We collected information on the development of clinical signs and laboratory results from a cohort of 58 people infected with HIV through blood transfusion. The observation time ranged from 36 to 100 months. Belonging to the older age group at the time of transfusion was found to be an important factor for rapid progression to AIDS. Sex or physical health at the time of transfusion did not influence the latency period.
1. The rate and extent of felodipine absorption from an oral solution, conventional and extended-release tablets were investigated in two groups of healthy volunteers (n = 18 + 15). 2. The antihypertensive effect of felodipine conventional tablets twice daily (n = 71) and extended-release tablets once daily (n = 76) were compared in a parallel-group study in hypertensive patients. 3. As from a solution, felodipine was completely absorbed from the two solid dosage forms. The rate of absorption increased in the order extended-release tablets, conventional tablets, solution. 4. The extended-release tablet gave more sustained plasma concentrations than the conventional tablet. 5. The extended-release tablet given once daily gave similar blood pressure control to the conventional tablet given twice daily.
The time from infection with HIV to symptoms and AIDS is an important parameter in describing the natural course of HIV infection. We here describe disease progression in a group of 389 homo- and bisexual men. Of these 102 had known dates of infection, and during an average follow-up time of 31 months (range 2-108), 28 of these progressed from being symptom-free (CDC group II and III) to having some symptom from CDC group IV; 7 progressed to AIDS. By life-table analysis, the estimated average time from seroconversion to first symptom is approximately 5 years and to AIDS approximately 8 years. Very few patients are diagnosed with AIDS the first 2 years after infection, but after that the risk seems to be 5-10% per year. Increasing use of anti-HIV medication will render studies of this kind difficult in the future.
For diagnosing pulmonary disease on 82 occasions in 68 patients (64 males) aged 39 (23-73) years infected with HIV-1 we used flexible fiberoptic bronchoscopy (FFB) with bronchoalveolar lavage (BAL) or washing with or without transbronchial lung biopsy (TBB) and brushing. A clinical diagnosis of lower respiratory tract disease was obtained in 68/82 episodes (83%). An etiological diagnosis was reached by FFB in 59/82 episodes (72%). Pneumocystis carinii (PC), the dominating pathogen causing pneumonia in 54/82 episodes (66%), was detected by FFB in 51/54 (94%). In spite of being isolated in bronchoscopy material in 36/82 episodes (44%) cytomegalovirus (CMV) seemed to be the cause of pneumonia only in 2/36 (5%) episodes. Except PC and CMV, only bacteria (including mycobacteria) were found as infectious etiological agents. Kaposi's sarcoma and pulmonary edema were diagnosed in one patient each. For detection of PC in 37 episodes we compared staining of BAL fluid with indirect immunofluorescence (IF) using monoclonal antibodies (MoAB) with staining of BAL material by silver methenamine (Grocott). Staining with IF MoAB alone of BAL fluid only seemed to be even more sensitive than silver methenamine staining of BAL, TBB and brushing material. When using IF MoAB staining of BAL fluid, TBB and brushing added nothing to the result, except in the patient with Kaposi's sarcoma, diagnosed by TBB. Sputum investigation using IF MoAB for detection was increasingly adopted during the study time. It was very useful (sensitivity approximately 74%) and reduced the number of required FFBs.
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Since 1970 pregnant women with contagious infections in the country of Stockholm have been delivered at the Danderyd Hospital, the only hospital in the area which has departments of obstetrics and pediatrics as well as infectious diseases. This paper presents data from a prospective study carried out during a period of 10 years (1975-1984). The study includes 303 women and their newborns who for various reasons were transferred to the Department of Infectious Diseases (DID) before or after delivery. A comprehensive microbiological investigation was made in order to establish an etiological diagnosis in all women included in the study. A possible transmission of the infection from the mother to her fetus/child before or after delivery was also investigated. Only 0.17% of the pregnant women in the area needed care at the DID at delivery or in the puerperal period. 9% of the deliveries occurred at another hospital, 32% at the DID and the remaining at the obstetrical department, Danderyd Hospital. The rate of complications, including cesarean sections, was 12%. Of the 165 women suffering from an infectious disease at the time of delivery, 40% had a verified viral disease--in most cases varicella or mumps, 28% had a bacterial infection and for 32% no etiology of the disease could be established. The study population also includes women suspected either to be incubated with a contagious disease or to be carriers of infectious agents, as well as healthy mothers whose newborns were expected to be carriers of infectious agents such as rubella and varicella. None of the women died during the study period but 5 were seriously ill and 3 needed intensive care. The rate of stillbirths was the same as reported among all births in the country of Stockholm but the perinatal mortality rate was significantly higher (see also a following article, ref. 27). Our routines prove the necessity to take special care of pregnant women carrying a contagious infectious agent at term.
Data are presented from a long-term follow-up study of 308 live born children to women admitted post partum to the Department of Infectious Diseases (DID), Danderyd Hospital, Sweden, during a 10-year period (1975-1984) for avoiding nosocomial transmission of infections in the obstetrical wards. The rate of stillbirths (1/309 deliveries) was not higher than reported for all births in Stockholm. 20% of the live born children were transferred within 24 h after birth to the pediatric department for observation, but half of them could return to their mothers at the DID within 6 days (generally 3 days). Four newborns were treated at an intensive care unit. Only 3 fatalities occurred, all of them among newborns to mothers with an overt infection at delivery. The fatality rate (1.8%) was significantly higher among the newborns of these mothers than normally (0.3%) noted among all children born in Stockholm county during the period studied. Two of the 3 newborns, who all died within 3 days of life, had a low birth weight (600 and 1,000 g). The total number of newborns with low birth weights (less than 2,500 g) was, however, not higher in the above-mentioned group of newborns than for all children born in Stockholm county 1980. None of the 3 fatalities was caused by infection transmitted from the mother. No further deaths occurred. Infections in pregnancy at term, at birth or post partum were transmitted from the women to 41 (13%) of their newborns.(ABSTRACT TRUNCATED AT 250 WORDS)