Clinical research in the lay press: irresponsible journalism raises a huge dose of doubt.
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Antifungal Agents↗
Biomedical subjects
Zelalem Temesgen
Publications and source records attributed to Zelalem Temesgen.
Interleukin-2 therapy and CD4+ T cells in HIV-1 infection.
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Antineoplastic Agents↗
Comprehensive Health Enhancement Support System (CHESS) for people with HIV infection.
We investigated the utility and the pattern of use of the Comprehensive Health Enhancement Support System (CHESS), an Internet based consumer health informatics system for people living with HIV/AIDS. Eight patients utilized CHESS for 4 months. The total number of log-ins ranged between 1 and 93 (median 21), with a median of 4.6 per month (0.2-21.8). Discussions Group was the service most frequently accessed; the Referral Directory and Fat Assessment services were requested the least. The barriers to using CHESS were difficulty in using the laptop, being too busy, and the discussion group size being too small. Most participants agreed that CHESS was easy to use and helped them cope with and understand more about their disease. They also felt comfortable asking questions and felt more involved in their health care.
Adolescent↗
Approach to salvage antiretroviral therapy in heavily antiretroviral-experienced HIV-positive adults.
Despite dramatic declines in HIV-associated morbidity and mortality as a result of highly active antiretroviral therapy, management of heavily treatment-experienced patients remains complex and challenging. Treatment response rates with subsequent antiretroviral regimens are lower than with initial antiretroviral therapy. Additionally, increased mortality has been associated with multidrug-resistant HIV. We review data relevant to management of such patients and offer a systematic approach to constructing a salvage antiretroviral regimen.
Antiretroviral Therapy, Highly Active↗
Rhino-orbitocerebral mucormycosis caused by Apophysomyces elegans.
Rhino-orbitocerebral mucormycosis (ROCM) caused by more common zygomycetes (e.g., Mucor) is known to cause rapidly fatal infections in immunocompromised patients. Apophysomyces elegans is an emerging zygomycete that has been reported to cause invasive cutaneous and rhino-orbitocerebral infections in immunocompetent individuals. Limited data exist describing the syndrome of ROCM caused by A. elegans. We describe a recent case and performed a comprehensive literature review to delineate the clinical characteristics of ROCM caused by A. elegans. Our case is a 50-year-old man with diabetes mellitus who presented with facial pain and right eye proptosis. Endoscopic sinus sampling revealed A. elegans. He was treated with liposomal amphotericin B and multiple debridements, with no disease on 1.5-year follow-up examination. Seven cases were identified on literature review, including the present case. Most patients (86%) were male, with a mean age of 40 years. Most patients (71%) did not have predisposing medical conditions. Three patients had predisposing head trauma. All presented with facial and/or periorbital pain. All had magnetic resonance imaging or computed tomography of the head showing intraorbital and/or sinus inflammation. Diagnosis was confirmed by histopathology and deep tissue culture in all cases. All patients required eye exenteration and extensive surgical debridement, in addition to intravenous amphotericin B. Six of the seven patients (86%) recovered. ROCM caused by A. elegans is rarely reported in the literature. Most such infections occurred in immunocompetent patients, often after facial trauma. Survival in ROCM caused by A. elegans is favorable in reported cases, with prompt surgical debridement and antifungal therapy.
Adult↗
Current status of antiretroviral therapy.
At present, there are 22 FDA-approved antiretroviral agents, which are categorised into four classes of drugs. Several others are in various stages of basic and clinical development. The authors of this paper review the general characteristics of each class of antiretrovirals, as well as individual investigational agents that are in advanced clinical development. A brief synopsis of US and WHO antiretroviral treatment guidelines is also provided.
Antiretroviral Therapy, Highly Active↗
Human immunodeficiency virus-associated peripheral neuropathies.
Peripheral neuropathy has emerged as the most common neurologic complication of human immunodeficiency virus (HIV) infection. It will continue to play an Important role in HIV Infection given the fact that HIV-infected Individuals are living longer, are at risk of long-term metabolic complications, and face an Increasing exposure to potentially neurotoxic antiretroviral drugs. We review the various types of peripheral neuropathy that have been associated with HIV infection, including distal symmetrical polyneuropathy, toxic neuropathy from antiretroviral drugs, diffuse infiltrative lymphocytosis syndrome, inflammatory demyelinating polyneuropathies, multifocal mononeuropathies, and progressive polyradiculopathy.
Antiretroviral Therapy, Highly Active↗
Drug evaluation: bevirimat--HIV Gag protein and viral maturation inhibitor.
Panacos Pharmaceuticals Inc is developing the HIV Gag protein and viral maturation inhibitor bevirimat for the potential oral treatment of HIV infection. Phase II clinical trials are underway and phase III trials expected to commence in 2007.
Animals↗
The latest in antiretroviral therapy.
The XVI International AIDS Conference (AIDS 2006), organized by the International AIDS Society (IAS), took place August 12-18 in Toronto, Canada. It was attended by over 26,000 participants from more than 170 countries and featured more than 4,500 abstracts as well as an array of community and cultural activities. The theme of the meeting was "Time to deliver", emphasizing the continued need and urgency in bringing effective HIV prevention and treatment strategies to those living with and affected by HIV/AIDS. The meeting's agenda was broad and included policy and programmatic topics as well as scientific research. This report focuses on reports presented at the conference that directly deal with antiretroviral therapy. This is primarily because of the nature of the venue where it is intended to be published (Drug News & Perspectives) as well as the expertise of the author. It is not a lack of recognition of the other equally important topics and discussions that took place at AIDS 2006. The author is solely responsible for the selection of topics and presentations to be included in this report.
Anti-HIV Agents↗
Tipranavir.
Tipranavir is a newly approved protease inhibitor that belongs to the class of 4-hydroxy-5,6-dyhydro-2-pyrones. It exhibits potent in vitro activity against both human immunodeficiency virus (HIV)-1 and HIV-2, including clinical isolates with multiple protease inhibitor-resistant mutations. Tipranavir requires coadministration with ritonavir to achieve clinically meaningful serum concentration. In randomized, phase III, open-label trials, it was found to be superior to the currently available boosted protease inhibitors in highly treatment-experienced patients with multiple protease inhibitor mutations. Thus, it provides a welcome new option for salvage antiretroviral therapy. The most common adverse effects associated with tipranavir are diarrhea, nausea and vomiting. Common laboratory abnormalities include elevations of total cholesterol, triglycerides and liver enzymes.
Clinical Trials as Topic↗
Intestinal spirochetosis and diarrhea, commensal or causal.
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AIDS-Related Opportunistic Infections↗
HIV and drug allergy.
Twenty individual antiretroviral drugs and two coformulation products are approved by the US Food and Drug Administration for the treatment of HIV-infected individuals. Many of these drugs have been associated with allergic/hypersensitivity reactions to varying degrees. The antiretroviral drugs that are most commonly associated with these types of reactions are abacavir, all of the nonnucleoside reverse transcriptase inhibitors, and amprenavir. Trimethoprim-sulfamethoxazole, although not an antiretroviral drug, is extensively used for the treatment and prophylaxis of HIV-related opportunistic infections and has been associated with a significant rate of adverse reactions. The authors provide an overview of these drug-related reactions and discuss their pathogenesis and management.
Antiviral Agents↗
Initial antiretroviral therapy in chronically-infected HIV-positive adults.
Currently, there are 20 individual antiretroviral drugs and two co-formulation products that are approved by the FDA for the treatment of HIV-infected individuals. It is widely accepted that the selection of an appropriate first-line regimen is critical in assuring durable treatment response. This article reviews the factors that should be considered in the selection of an initial antiretroviral regimen and present the currently available evidence regarding the status of individual antiretroviral agents and treatment strategies relative to these factors.
Adult↗
Osteoarticular infection complicating enterococcal endocarditis.
Despite the common occurrence of musculoskeletal complaints in patients with infective endocarditis, infectious osteoarticular complications are diagnosed infrequently. Moreover, although enterococcal infection is the third most common cause of infective endocarditis, infectious osteoarticular complications are rare. We report a case of disk space infection in a patient with enterococcal endocarditis. Blood cultures and an L3-4 aspirate grew Enterococcus faecalis, and transthoracic echocardiography revealed a large vegetation on the posterior mitral valve leaflet. The osteoarticular infection resolved with antimicrobial treatment, but worsening heart failure necessitated valve replacement surgery. The patient had an uneventful recovery with no evidence of recurrence or complications. A review of the medical literature from 1966 through 1998 identified 13 additional cases, only 8 of which provided clinical and treatment data. We present the clinical and laboratory findings reported in these cases, along with data from our patient. This report highlights the rare occurrence of osteoarticular infection in the setting of enterococcal endocarditis and emphasizes early recognition and treatment.
Anti-Bacterial Agents↗
SARS: epidemiology, clinical presentation, management, and infection control measures.
Severe acute respiratory syndrome (SARS) is a recently recognized febrile respiratory illness that first appeared in southern China in November 2002, has since spread to several countries, and has resulted in more than 8000 cases and more than 750 deaths. The disease has been etiologically linked to a novel coronavirus that has been named the SARS-associated coronavirus. It appears to be spread primarily by large droplet transmission. There is no specific therapy, and management consists of supportive care. This article summarizes currently available information regarding the epidemiology, clinical features, etiologic agent, and modes of transmission of the disease, as well as infection control measures appropriate to contain SARS.
Animals↗
Antiretroviral therapy in HIV.
The advent of highly active antiretroviral therapy (HAART) has led to a significant decline in HIV-associated morbidity and mortality. Despite these recent advances, the majority of patients with HIV/AIDS worldwide are still lacking access to treatment. To date, there are 21 approved antiretrovirals divided into four categories based on their mechanism of action. We review the basic characteristics of these antiretrovirals. We also briefly discuss current guidelines regarding the use of antiretrovirals in general as well as in special populations such as in pregnant women, in occupational exposure and non occupational exposure.
Adult↗
HIV-associated opportunistic infections. Bacterial infections.
Bacterial infections are the most common opportunistic infections in HIV. Since the advent of highly active antiretroviral therapy (HAART), the incidence of these infections is on the decline. However, globally there is a significant lack of access to care among HIV patients because of limited drug availability and cost of treatment. Furthermore, non-compliance and drug resistance can hinder viral suppression, predisposing patients to opportunistic infections. We review the major bacterial opportunistic infections in HIV positive patients including tuberculosis, Mycobacterium avium complex infections, syphilis, bacterial enteric disease, bacterial pneumonia and bartonellosis. Epidemiology, clinical presentation, diagnosis, treatment and prophylaxis are also reviewed.
AIDS-Related Opportunistic Infections↗
Opportunistic infections in patients with HIV and AIDS. Fungal and parasitic infections.
Since the advent of highly active antiretroviral therapy (HAART), the incidence of specific fungal and parasitic opportunistic infections as observed in HIV disease has been in decline. However, in many parts of the world, and in areas where access to HAART is limited, these specific opportunistic infections are still observed in HIV patients. In this manuscript, we review the epidemiology, clinical manifestations, diagnosis, and treatment of common fungal and parasitic opportunistic infections.
AIDS-Related Opportunistic Infections↗