PubMed Health⌕ Search

Biomedical subjects

P Volberding

Publications and source records attributed to P Volberding.

At least 37 records · Page 2Linked to original sources
PubMed1991

Effects of zidovudine therapy in minority and other subpopulations with early HIV infection.

UNLABELLED: OBJECTIVE--The purpose of this study was to determine whether the beneficial effects of zidovudine seen overall in two recently completed placebo-controlled clinical trials are also apparent in blacks, Hispanics, women, and intravenous drug users. DESIGN--Two double-blind placebo-controlled randomized clinical trials, protocols 016 and 019, conducted by the AIDS Clinical Trials Group. SETTING--University-based referral centers. PARTICIPANTS--Two thousand forty-eight persons with asymptomatic or mildly symptomatic human immunodeficiency virus infection were analyzed. Of these, 155 were black, 190 were Hispanic, 144 were women, and 221 were intravenous drug users. All randomized subjects were included in the analysis. INTERVENTION--Participants in the AIDS Clinical Trials Group protocol 016 were assigned to receive a placebo or a 1200-mg daily dose of zidovudine. Participants in the AIDS Clinical Trials Group protocol 019 were assigned to receive a placebo, a 500-mg daily dose of zidovudine, or a 1500-mg daily dose of zidovudine. MAIN OUTCOME MEASURE--Progression to AIDS. RESULTS--The rates of progression to AIDS in subjects receiving zidovudine were significantly lower than those in subjects receiving a placebo among blacks (P = .03), whites (relative risk [RR] = 2.3, 95% confidence interval [CI] = 1.5 to 3.6, P less than .0001), Hispanics (RR = 4.4, CI = 1.2 to 16.8, P = .02), non-Hispanics (RR = 2.3, CI = 1.5 to 3.6, P = .0002), men (RR = 2.5, CI = 1.6 to 3.8, P less than .0001), and non-intravenous drug users (RR = 2.5, CI = 1.6 to 4.0, P less than .0001). The rates of disease progression for subjects receiving zidovudine were not statistically different from those receiving placebo for women (RR = 3.3, CI = 0.3 to 36.3, P = .31) or for intravenous drug users (RR = 2.0, CI = 0.7 to 6.2, P = .21); however, in both instances the estimated RRs were similar to those for men and non-intravenous drug users. CONCLUSIONS: -Although the two studies used for this analysis were not specifically designed to assess the effects of zidovudine in each separate subpopulation, the data suggest that the beneficial effects of zidovudine reported for the entire study population also apply to the subpopulations of blacks, Hispanics, women, and intravenous drug users.

Acquired Immunodeficiency Syndrome↗
PubMed1991

The management of early human immunodeficiency virus infection.

The outcome of treatment in patients with early asymptomatic HIV disease has recently improved. Clinical trials with zidovudine have demonstrated efficacy and greatly reduced toxicity when the drug is used in asymptomatic HIV-infected persons who have fewer than 500 CD4+ cells/mm3, and resistance to this drug in these patients is less frequent and severe. Also, the optimum dosage of zidovudine is less than previously believed, probably in the range of 500-600 mg daily given in oral divided doses. The use of antibiotics to prevent Pneumocystis carinii pneumonia is also of clear value in HIV-infected asymptomatic or symptomatic persons with fewer than 200 CD4+ cells/mm3. Oral regimens such as trimethoprim/sulfamethoxazole or dapsone alone appear to be effective and are gaining preference over aerosolized pentamidine that is considerably more expensive. Together these medical advances argue for the encouragement of voluntary HIV testing to enable early diagnosis and, hence, optimum medical monitoring and appropriate intervention. These issues and recommendations for laboratory and clinical monitoring will be provided in this review.

HIV Infections↗
PubMed1991

Increasing CD8+ T lymphocytes predict subsequent development of intraoral lesions among individuals in the early stages of infection by the human immunodeficiency virus.

Determining the progression of human immunodeficiency virus (HIV) type 1 infection based on cellular and clinical markers has become increasingly important. Although a number of studies have shown a relationship between the presence of certain oral lesions and progression to AIDS, few data exist regarding the association with T lymphocyte counts. In this study, the question of whether intraoral lesions preceded or were the consequences of changes in T lymphocyte counts was examined. A total of 116 HIV-infected patients participating in two randomized double-blind placebo-controlled trials of zidovudine at the University of Minnesota AIDS Clinical Trials Unit (ACTU) were enrolled in a prospective dental study. Patients were examined for the presence of hairy leukoplakia, candidiasis, herpes simplex, herpes zoster, aphthae, atypical gingivitis, HIV-associated periodontitis, and necrotizing ulcerative gingivitis, as well as other oral lesions, every 3 months for a maximum of four examinations over a 1-year period. T lymphocyte counts before and after each patient's oral examination were obtained. No significant differences were found at examination 1 for differences in gender, race, age, education, tobacco smoking status, ethanol consumption habits, duration in ACTU drug protocol, duration in dental study protocol, or mean T lymphocyte counts between individuals with or without oral lesions at any time in the dental study.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol Drinking↗
PubMed1991

Chemotherapy for AIDS-associated Kaposi's sarcoma.

Clinical staging and response criteria for AIDS-associated Kaposi's sarcoma (AIDS-KS) are not well-developed, but classifying patients into limited or extensive disease categories allows a clinician to select appropriate local or systemic therapy. A prospective staging system has been proposed to uniformly evaluate pretreatment patient characteristics and subsequent clinical responses. Combination chemotherapy is effective, but its use is often limited by toxicities. Antiretroviral medications, if clinically tolerated, should be continued during combination chemotherapy. Future therapies will evaluate the utility of ddI or ddC with combination chemotherapy. A second area of research involves combination therapy using chemotherapy and antiretroviral agents along with growth factors to limit myelotoxicity.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Fine-needle aspiration biopsy of patients with acquired immunodeficiency syndrome (AIDS): experience in an outpatient clinic.

One hundred twenty-one fine-needle aspiration biopsies of lymph nodes were done on 113 men followed in the AIDS (acquired immunodeficiency syndrome) Outpatient Clinic of the San Francisco General Hospital. The cytologic diagnoses on these 121 biopsies included 60 (50%) hyperplasias, 24 (20%) non-Hodgkin lymphomas, 21 (17%) mycobacterial infections, 12 (10%) cases of Kaposi sarcoma, and 1 each of Hodgkin disease, giant cell carcinoma, nasopharyngeal carcinoma, and squamous cell carcinoma. No false-positive results occurred in this series, but five false-negative results were seen in the 10 patients with hyperplasia on fine-needle aspiration biopsy specimens who subsequently had open surgical biopsy. From our experience, we believe fine-needle aspiration biopsy is a useful, cost-effective initial method to evaluate lymphadenopathy in patients seen at an AIDS outpatient clinic.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Effect of zidovudine on serum human immunodeficiency virus core antigen levels. Results from a placebo-controlled trial.

We assessed the effect of antiviral therapy on serum human immunodeficiency virus core antigen (HIV-Ag) levels in patients enrolled in the phase II trial on zidovudine for acquired immunodeficiency syndrome (AIDS) and AIDS-related complex. Human immunodeficiency virus core antigen was detected in 45% of subjects at entry (59% with AIDS and 37% of patients with AIDS-related complex). Median HIV-Ag levels in zidovudine-treated subjects fell from 111 pg/mL at entry to 46 pg/mL at four weeks, while levels in placebo recipients did not change significantly. Decline in HIV-Ag in zidovudine recipients was sustained through 16 weeks of treatment and was significantly different from the placebo group. Anti-p24 antibody levels did not change in either group. We conclude that in patients with HIV-antigenemia changes in HIV-Ag level are an important marker of anti-retroviral activity.

AIDS-Related Complex↗
PubMed1987

Tumor necrosis factors alpha and beta in acquired immunodeficiency syndrome (AIDS) and aids-related complex.

Human immunodeficiency virus (HIV) infection is associated with abnormalities of both T-cell and B-cell immunity in patients with acquired immunodeficiency syndrome (AIDS). Previous studies demonstrated deficient production of the cytokines interleukin-1 (IL-1), interleukin-2 (IL-2), and gamma interferon (IFN-gamma). Tumor necrosis factor alpha and tumor necrosis factor beta have not been previously investigated in AIDS. In this study we demonstrate that peripheral blood mononuclear cells from patients with HIV infection who have either AIDS-related complex or acquired immunodeficiency syndrome are deficient in the production of tumor necrosis factor alpha and tumor necrosis factor beta. These cytokines, derived predominantly from monocytes or lymphocytes, respectively, function as immunoregulatory, antitumor, and antiinfective proteins. A deficiency in their production may therefore be responsible for many of the complications associated with HIV infection in patients with AIDS-related complex or acquired immunodeficiency syndrome.

AIDS-Related Complex↗
PubMed1987

Therapy of acquired immune deficiency syndrome with recombinant interleukin-2.

Recombinant human interleukin-2 (rIL-2) was administered to 87 patients with the acquired immune deficiency syndrome (AIDS) to test the hypothesis that this lymphokine would correct the underlying qualitative and quantitative deficiency in cellular immunity. Patients were divided into two groups by the presence or absence of Kaposi's sarcoma and subjects within each of these groups received intravenous rIL-2 three times weekly for eight weeks. Subjects received one of several doses which ranged from 1,000 to 2,000,000 units per square meter body surface area. Toxicity at high doses consisted of flu-like symptoms and hypotension at highest doses. Partial objective tumor regression was observed in three patients with Kaposi's sarcoma. Seventeen patients had progression of disease (new opportunistic infection or increase in Kaposi's sarcoma) during therapy. No improvement in immunologic status was observed. This study does not suggest a role for single-agent rIL-2 therapy of established AIDS but its use in less symptomatic persons or in conjunction with antiretroviral agents such as azidothymidine should be investigated.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Exposure to hair dyes and polychlorinated dibenzo-p-dioxins in AIDS patients with Kaposi sarcoma: an epidemiological investigation.

Fifty male AIDS patients with Kaposi sarcoma and 50 matched controls were interviewed about occupation, exposure to pesticides, Vietnam service, smoking habits, etc. No difference in use of pesticides was seen. One case but no control had served in Vietnam and was thereby exposed to agent orange. Dioxins are known to be immunosuppressive in animals. No significant difference in exposure to dioxin-containing products was found between cases and controls, however. Of interest was the fact that four cases but no control were occupationally exposed to hair dyes, some of which have been reported to be carcinogenic.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Intensive care of patients with the acquired immunodeficiency syndrome. Outcome and changing patterns of utilization.

Eighty-two patients with the acquired immunodeficiency syndrome (AIDS) were admitted to the intensive care units (ICUs) at San Francisco General Hospital (SFGH) between March 1981 and December 1985. Of these patients, 69% died in the hospital, as did 87% of patients who required mechanical ventilation because of Pneumocystis carinii pneumonia and respiratory failure. Although the number of hospital admissions of patients with AIDS has increased steadily since the fourth quarter of 1982 (12 admissions) through the fourth quarter of 1985 (158 admissions), the number of admissions to the ICUs peaked at 17 in the second quarter of 1984 and decreased steadily, averaging 5 per quarter in 1985. This decrease was not explained by a reduction in the number of patients with P. carinii pneumonia or an improvement in their treatment. A survey of physicians at SFGH indicated that physicians are aware of the poor prognosis of patients with AIDS with P. carinii pneumonia and respiratory failure, believe that mechanical ventilation is infrequently indicated for this condition, and have become increasingly likely to discuss issues of resuscitation with their patients with AIDS. Therefore, possible explanations for this trend in ICU utilization include changing physician attitudes, in addition to more effective patient counseling and increased availability of hospital and community-based support services that provide alternatives to terminal intensive care.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Treatment of Kaposi's sarcoma in acquired immunodeficiency syndrome with an alternating vincristine-vinblastine regimen.

Twenty-four patients with acquired immunodeficiency syndrome and Kaposi's sarcoma (KS) were treated with a regimen alternating vincristine with vinblastine on a weekly basis. Objective responses to this regimen were observed in nine patients (45%), and seven (35%) had stabilization of progressive KS. Few toxic effects were observed. Alternating vincristine-vinblastine therapy is well-tolerated and effective palliative treatment for KS in acquired immunodeficiency syndrome.

Acquired Immunodeficiency Syndrome↗