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W Brandon

Publications and source records attributed to W Brandon.

14 recordsLinked to original sources
PubMed1995

Comparison of multiple drug therapy regimens for HIV-related disseminated Mycobacterium avium complex disease.

In June 1993, the United States Public Health Service (USPHS) made recommendations for treatment of disseminated Mycobacterium avium complex (MAC) in patients infected with the human immunodeficiency syndrome (HIV). It was suggested that every treatment regimen include either azithromycin or clarithromycin plus one or more of the following drugs: ethambutol, clofazimine, rifabutin, rifampin, ciprofloxacin, or amikacin. This study compares the effect of multiple drug therapy regimens on the survival of patients of the HIV outpatient department of the Medical Center of New Orleans, Louisiana. A retrospective chart review of 122 confirmed cases of MAC was conducted. Three treatment groups were considered: no/monotreatment (n = 40), multitreatment without clarithromycin (n = 32), and multitreatment with clarithromycin (n = 50). Azithromycin, amikacin, and rifabutin were not used in this clinic during the study period. Both multitreatment without clarithromycin (p < 0.03) and multitreatment with clarithromycin (p < 0.005) were significantly protective for survival after adjusting for CD4 cell count at time of diagnosis, nonadherence to treatment, number of concomitant opportunistic infections at diagnosis, and weight loss > 10%. Neither of the groups that received multidrug therapy were significantly less likely to have MAC-related symptoms than the no/mono group at 3 and 6 months postdiagnosis. These findings support the USPHS recommendation for multiple drug treatment either with or without clarithromycin. Prospective controlled clinical trials will clarify the optimal regimen for disseminated MAC disease.

AIDS-Related Opportunistic Infections↗
PubMed1995

Predictors of HIV disease progression in women.

A retrospective cohort study was conducted to analyze variables predictive of acquired immunodeficiency syndrome (AIDS), as defined by the Centers for Disease Control (CDC) in 1987, and death in 224 women infected with the human immunodeficiency virus (HIV) who were evaluated through two HIV outpatient programs in New Orleans between January 1987 and December 1991 and followed through February 1993. Variables predictive of AIDS in a multivariate proportional hazards model were an entry CD4 cell count < 200/mm3 (adjusted RR 8.2, 95% CI 3.2, 20.9) and rapid CD4 cell count decline (adjusted RR 6.0, 95% CI 2.4, 15.5). A baseline AIDS diagnosis (by the CDC 1987 definition) was highly predictive of death (RR 36.3, 95% CI 15.7, 70.1). In multivariate analyses none of the relative risks for predictive variables remained significant if adjusted for a diagnosis of AIDS at entry. Although immunological parameters were predictive of early HIV disease progression, an AIDS diagnosis was the strongest prognostic indicator of death in a cohort of North American women.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Evaluation of a program to remove barriers to public health care for women with HIV infection.

To facilitate access to care for HIV-infected women, a maternal-child program was started at an HIV outpatient clinic in New Orleans. The program consisted of free child care and transportation, separate waiting and examination rooms, female care providers, merged visits for mother and child, and on-site colposcopy services. This study evaluates the efficacy of the program on improving attendance at the clinic by follow-up of 143 women and 557 men (serving as controls). Multivariate models were adjusted for history of intravenous drug abuse, race, age, CD4 cell count, staging of disease, and time in the clinic. Half of the clients achieved high attendance rates. Women were as likely as men to achieve high attendance rates before the interventions, but more likely to do so at both 6 months and 1 year postintervention (after adjustment for the other variables). These results suggest that responding to special gender-related needs can improve women's attendance for clinic visits.

Adult↗
PubMed1995

Compliance with public sector HIV medical care.

Despite the availability of free or low-cost public sector human immunodeficiency virus (HIV) health-care services, important inequities in utilization exist. This study examined two measures of compliance with HIV medical care: attendance of scheduled outpatient visits and use of the emergency room. Clients of two public HIV outpatient clinics were followed from time of health-care initiation to either death or the end of the study. The association of race, sex, age, and injection drug use (IDU) with these measures were examined in multivariate logistic regression. Models were adjusted for disease staging at time of entry and for length of follow-up time in clinic. Of 1824 clients followed, 15% failed to attend scheduled visits and 18.1% had at least one emergency room visit. Clients who missed visits were more likely to be African American, to have a history of IDU, and to have a CD4 cell count < 500/mm3 or an acquired immunodeficiency syndrome (AIDS)-defining opportunistic infection at entry. They were also more likely to have > or = 12 months of follow-up time in the HIV clinic, but were less likely to have entered into health care from an early intervention clinic. Clients who had at least one emergency room visit were more likely to be African American, female, IDU, and under 22 years of age; these clients were also more likely to have entered with CD4 < 200/mm3 or with an opportunistic infection, and to have > or = 12 months of follow-up in the clinic.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Clinical manifestations of infection with the human immunodeficiency virus in women in Louisiana.

To better understand the clinical manifestations of human immunodeficiency virus (HIV) infection in women in Louisiana, we conducted a retrospective review of the records of HIV-infected women who presented to the largest HIV outpatient clinic in Louisiana as well as to a tertiary care university hospital in New Orleans between January 1987 and December 1991. A total of 224 women were evaluated. Gynecologic examinations revealed that 17.5% had cervical intraepithelial neoplasia and that 35% had evidence of candidal vulvovaginitis or colonization. The following conditions were diagnosed among indicated percentages of patients: syphilis, 22.2%; Neisseria gonorrhoeae infection, 7.2%; Chlamydia trachomatis infection, 12.3%; pelvic inflammatory disease, 5.3%; trichomonal vulvovaginitis, 26.9%; genital ulcers due to herpes simplex virus, 16.5%; and clinically evident genital human papillomavirus infections, 16.5%. Both trichomonal vulvovaginitis and syphilis were more common among intravenous drug users. A total of 82 opportunistic processes were observed in 55 women. Pneumocystis carinii pneumonia was the most frequent complication of AIDS, followed by candidal esophagitis and wasting syndrome. Over 85% of women had received a diagnosis of AIDS before death. Gynecologic diseases occurred often in this population; the frequency of AIDS-defining events was similar to that reported previously in the literature.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Hematogenous dissemination of Mycobacterium tuberculosis in patients with AIDS.

Proof of hematogenous dissemination of Mycobacterium tuberculosis was initially reported in the early 1900s and was noted to be most frequent in patients with miliary tuberculosis. More recently, M. tuberculosis bacteremia has been reported in human immunodeficiency virus (HIV)-infected patients. We describe 13 adult HIV-infected patients in whom hematogenous M. tuberculosis dissemination was evident. Although for most patients whose bone marrow aspirate cultures yielded M. tuberculosis a chest roentgenogram revealed a miliary pattern, roentgenograms for those with M. tuberculosis bacteremia usually revealed evidence of lobar or diffuse infiltrates. Most patients with M. tuberculosis bacteremia had other risk factors for M. tuberculosis, and many had a rapid death, suggesting acute fulminant infection. Our own experience suggests that there are various syndromes associated with hematogenous dissemination in patients infected with M. tuberculosis.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Changing treatment regimens for HIV infection: impact on referral patterns and training needs of family physicians.

BACKGROUND: New antiviral medications and laboratory testing have revolutionized the care of patients infected with the human immunodeficiency virus (HIV). The development of complex treatment regimens has intensified debate about whether care should be restricted to experts in HIV care. Few studies detail how these new treatment regimens are affecting family physicians' desire to continue providing care or need for additional training. METHODS: A questionnaire eliciting personal, training, and practice demographics and attitudinal information was distributed to family physicians attending the 1996 Scientific Assembly of the American Academy of Family Physicians who completed an HIV continuing education workshop. RESULTS: The questionnaires were completed by 202 family physicians from 48 states. More than 60 percent had received training or had practiced in states with a high rate of HIV, and 143 (70 percent) had cared for at least 1 HIV-infected patient in the previous 6 months. Ninety-five percent did not expect to curtail their provision of care and believed that family physicians should become more active in the care of HIV-infected patients. Medical journals were the most requested format for ongoing education in this area, with combination antiviral therapy and new staging laboratory tests the most requested topics. CONCLUSION: The recent changes in HIV care regimens did not appear to have a major impact on family physicians' desire to continue to provide care for HIV-infected patients. Professional societies responsible for certification and continuing education might be interested in additional surveys to validate these results among larger samples nationwide.

Adult↗