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Biomedical subjects

L M Frenkel

Publications and source records attributed to L M Frenkel.

52 records · Page 3Linked to original sources
PubMed1993

The epidemiology of pediatric HIV-1 infection.

While the incidence of HIV infection has leveled off in older homosexual men, infection in women, children, and adolescents is rising. Unless effective intervention measures are implemented, the number of pediatric patients with HIV and related illnesses will continue to increase. Interventions aimed at curtailing perinatal transmission potentially will have the greatest impact on decreasing the incidence of pediatric AIDS. Studies evaluating strategies aimed at this are currently underway. Educational initiatives targeting adolescents also may lower the number of pediatric patients with HIV infection. As treatments improve, the majority of HIV-infected children will survive for years and perhaps decades. The number of children with HIV infection in the upcoming decades will have a profound impact on our communities and our practice of pediatric medicine.

Adolescent↗
PubMed1992

The management of pregnancies complicated by genital infections with herpes simplex virus.

In this review we summarize current knowledge related to the identification of pregnancies that may be complicated by genital herpes and describe the consequences of maternal infections with genital herpes. We address the implications of this information for the management of genital herpes during pregnancy and at delivery and for the care of neonates exposed to herpes simplex virus at delivery. On the basis of the current data, we cannot make specific recommendations concerning many of the clinical problems that are caused by herpes simplex virus infections in pregnant women. We identify and discuss unresolved questions about optimal management.

Female↗
PubMed1992

Human immunodeficiency virus-1 seroprevalence among parturients in Los Angeles County public hospitals.

To estimate the prevalence of human immunodeficiency virus type 1 (HIV-1) among parturients in an area with a high cumulative incidence of AIDS, an HIV seroprevalence study was conducted in 1988 in Los Angeles County. Test results were available from 8485 (86.1%) of the 9860 women delivering at four public hospitals. The test results were linked to demographic and medical information available from routinely collected delivery records. Three specimens were HIV-positive, for a seroprevalence of 3.5 per 10,000. The seropositive women were all Latina. The prevalence of HIV among women delivering at all hospitals in Los Angeles County has been shown to be relatively low compared with that of other metropolitan areas with a high number of AIDS cases, such as New York city, but appears to be even lower among women delivering at public hospitals during this time period. This low prevalence is attributed to the predominance of Latinas, who may have lower levels of infection, among public hospital parturients. The relatively low prevalence of HIV among injection drug users in Los Angeles County may contribute to the overall lower prevalence among women in Los Angeles County compared with those in New York city. This study supplements county-specific data obtained from statewide blinded neonatal testing by providing details on HIV seroprevalence among the catchment populations of public hospitals in Los Angeles County.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Pharmacokinetics of acyclovir in the term human pregnancy and neonate.

Concern about neonatal herpes often leads to cesarean delivery of infants in women with a history of genital herpes. The antiviral drug acyclovir has been used effectively to suppress genital herpes simplex virus recurrences in nonpregnant adults. Its administration to pregnant women with recurrent genital herpes may reduce herpes simplex virus recurrences and thus may decrease the cesarean section rate among this population. To study the pharmacokinetics, safety, and patient tolerance of suppressive oral acyclovir, either 200 mg (n = 7) or 400 mg (n = 8) was administered orally every 8 hours to pregnant women with a history of recurrent herpes simplex virus, from 38 weeks' gestation until delivery. The mean +/- SD plasma levels for the 200 and 400 mg groups, respectively, were: first dose peak, 1.7 +/- 0.6 and 2.3 +/- 1.0 mumol/L; steady-state trough, 0.7 +/- 0.3 and 0.8 +/- 0.6 mumol/L; steady-state peak, 1.9 +/- 1.0 and 3.3 +/- 1.0 mumol/L. In late gestation maternal acyclovir pharmacokinetics were similar to those of nonpregnant adults from other studies. Acyclovir was concentrated in the amniotic fluid; however, there was no accumulation in the fetus (mean maternal/infant plasma ratio at delivery was 1.3). Acyclovir was well tolerated, and no toxicity was seen in the mothers or infants. The administration of acyclovir, 400 mg every 8 hours, appears appropriate for use in an efficacy and safety study regarding suppression of herpes simplex virus recurrences during the last weeks of pregnancy.

Acyclovir↗
PubMed1990

Antibody response to herpes simplex virus glycoproteins gB and gD.

The antibody response to herpes simplex virus (HSV) glycoproteins B and D was evaluated using these cloned glycoproteins in an ELISA assay and compared to a standard Western blotting procedure. The ELISA assay appeared to be more sensitive for detecting gB and gD antibodies. Antibodies to gB but not gD were detected in the acute sera of patients presenting with their first episode of true primary genital herpes. The geometric mean HSV gB titer (log 2) was also significantly higher than the geometric mean gD titer in the convalescent sera of these patients (7.9 +/- 0.7 vs. 5.5 +/- 0.9, P less than .003). A cross-reaction between HSV gB and varicella zoster virus (VZV) gp II was demonstrated. Thus, it is possible that a previous VZV infection could prime the immune system to respond rapidly and more vigorously to HSV gB. Indeed, in this report we demonstrated a significant correlation between the VZV ELISA absorbance and the titer to HSV gB and also detected a higher VZV ELISA absorbance and HSV gB titer in the acute sera of patients with a true primary HSV infection compared to other HSV seronegative VZV seropositive patients. Use of this quantitative assay should allow further investigation into the relationship of the immune response to these important targets and the clinical course of HSV disease.

Adult↗
PubMed1987

Treatment of cytomegalovirus retinopathy with ganciclovir.

Ganciclovir is an experimental antiviral drug with activity against human cytomegalovirus (CMV). Forty patients with acquired immune deficiency syndrome (AIDS) and CMV retinopathy were treated with ganciclovir on a compassionate protocol basis. Initial treatment doses ranged from 5.0 to 14.0 mg/kg/day for 9 to 26 days. Signs of drug response were a halt to enlargement of lesions, decreased opacification of retinal tissue, and resolution of hemorrhage and vasculitis. Complete response was seen in 88% of patients and incomplete response was seen in 9%. Vision improved or remained stable in 88% of patients. Initial treatment did not eradicate live virus from the eye. To prevent reactivation of disease, 26 patients received low-dose maintenance therapy ranging from 1.5 to 7.5 mg/kg/day, once or twice daily, 3 to 7 days per week. Reactivation of disease developed for unknown reasons in 50% of patients on continuous, uninterrupted maintenance therapy for longer than 3 weeks. Reversible neutropenia, requiring cessation of treatment, developed in 30% of patients on initial treatment and in 38% of patients on maintenance therapy. Rhegmatogenous retinal detachment was a late complication in seven patients. By reducing or delaying visual loss, ganciclovir appears to be useful in the management of CMV retinopathy in patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Treatment of cytomegalovirus retinopathy in patients with acquired immunodeficiency syndrome. Use of the experimental drug 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine.

Cytomegalovirus (CMV) retinopathy, a relentlessly progressive disease that results in permanent blindness, is the most common opportunistic infection of the eye in patients with the acquired immunodeficiency syndrome. Twenty patients with the acquired immunodeficiency syndrome with CMV retinopathy were treated with a new, experimental, antiviral drug, 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine (BW B759U), in dosages ranging from 5.0 to 14.0 mg/kg/d for a ten- to 20-day course. In 19 patients (95%), treatment halted the progression of infection and decreased retinal opacification, hemorrhage, and vasculitis. Vision remained stable in most cases. Six patients received no additional treatment. Fourteen patients received continued treatment with a lower maintenance dosage. Retinal disease reactivated in all patients who did not receive maintenance therapy immediately after initial treatment, indicating persistence of live virus despite drug therapy. Reactivation of disease also developed in four (40%) of ten patients receiving continuous, uninterrupted maintenance therapy for longer than three weeks. Reversible neutropenia, requiring cessation of treatment, developed in five (25%) of 20 patients on initial treatment and five (36%) of 14 patients receiving maintenance therapy. Rhegmatogenous retinal detachment was a late complication in four patients. BW B759U appears to be useful in the management of CMV retinopathy by reducing or delaying visual loss.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Pediatric human immunodeficiency virus type 1 infection: updates on prevention and management.

A greater understanding of perinatal HIV-1 transmission has resulted in a marked decrease in the incidence of pediatric HIV-1 infection in several affluent nations. Advances in treatment have led to a decrease in HIV-1-related morbidity and mortality in some HIV-1-infected children. Studies are ongoing to determine methods to sustain the salutary effects of treatment. A goal of child advocates is to translate these advances to communities with few resources. Efforts are underway to make infant chemoprophylaxis widely available and to define strategies to reduce exposure to maternal virus. Likewise, there is the need to increase the access of children to treatment.

Antiretroviral Therapy, Highly Active↗
PubMedDate not supplied

Detection and quantification of multiple drug resistance mutations in HIV-1 reverse transcriptase by an oligonucleotide ligation assay.

OBJECTIVES: To develop an assay for the early detection and quantification of minor human immunodeficiency virus-1 populations bearing multiple drug resistance (MDR) mutations. STUDY DESIGN/METHODS: The oligonucleotide ligation assay (OLA) is based on ligation of probe and detector oligonucleotides annealed to a polymerase chain reaction amplicon strand with detection by an enzyme immunoassay. In OLA-MDR, oligonucleotides were designed to detect MDR mutations. The method was validated with wild-type and MDR mutant clones mixed at different proportions. RESULTS: K103N mutants were detected as minor populations (5%-30%) by OLA in 6 of 18 samples from patients treated with nonnucleoside reverse transcription inhibitors and classified as wild type by sequencing. In one patient, the kinetics of the increase of MDR mutants could be followed in sequential samples, with K103N being detected earlier by OLA than by sequencing. Q151M mutants were detected as minor populations (13%-24%) by OLA but not by sequencing in 4 samples. CONCLUSIONS: Oligonucleotide ligation assay MDR exhibits higher sensitivity than sequencing for detection of minor MDR mutant populations.

Drug Resistance, Multiple, Viral↗
PubMedDate not supplied

Pediatric HIV disease: new developments in treatment and prevention.

Despite the continued increase in the number of HIV-1-infected children, there is optimism that with the prospective identification of HIV-1-infected pregnant women, the incidence of infection can be diminished through prevention of mother-to-child transmission both by use of antiretroviral agents as well as by improved obstetrical management. Also, insight into viral dynamics and the advent of more potent antiretroviral agents provides hope for better treatment strategies and thus the ability to slow disease progression of HIV-1-infected children.

AIDS-Related Opportunistic Infections↗