A phase I/II study of the protease inhibitor ritonavir in children with human immunodeficiency virus infection.

BACKGROUND: Ritonavir, a potent antiretroviral protease inhibitor, has been approved for the treatment of adults and children with human immunodeficiency virus (HIV) infection. In a phase I/II study, we assessed the safety, tolerability, and pharmacokinetic profile of the oral solution of ritonavir in HIV-infected children and studied the preliminary antiviral and clinical effects. METHODS: HIV-infected children between 6 months and 18 years of age were eligible. Four dose levels of ritonavir oral solution (250, 300, 350, and 400 mg/m given every 12 hours) were evaluated in two age groups (2 years). Ritonavir was administered alone for the first 12 weeks and then in combination with zidovudine and/or didanosine. Clinical and laboratory parameters were monitored every 2 to 4 weeks. RESULTS: A total of 48 children (median age, 7.7 years; range, 0.5 to 14.4 years) were included in this analysis. Dose-related nausea, diarrhea, and abdominal pain were the most common toxicities and resulted in discontinuation of ritonavir in 7 children. Ritonavir was well absorbed at all dose levels, and plasma concentrations reached a peak 2 to 4 hours after a dose. CD4 cells counts increased by a median of 79 cells/mm3 after 4 weeks of monotherapy and were maintained throughout the study. Plasma HIV RNA decreased by 1 to 2 log10 copies/mL within 4 to 8 weeks of ritonavir monotherapy, and this level was sustained in patients enrolled at the highest dose level of 400 mg/m for the 24-week period. CONCLUSIONS: The oral solution of ritonavir has potent antiretroviral activity as a single agent and is relatively well tolerated by children when administered alone or in combination with zidovudine or didanosine.

Effect of methods of tooth enamel preparation on the retentive strength of acid-etch composite resins.

The effect of three procedures of preparing enamel surface on the retentive strengths of Concise Enamel Bond. Adaptic acid etch, Restodent and Nurva-Seal/Nurva-Fil was investigated. Resins using an unfilled-filled resin combination(Concise Enamel Bond, Adaptic acid etch, and Nurva-Fil) had a significantly higher retentive strength when the enamel was prepared with a coarse diamond bur than when the surface was unprepared or prepared with a carbide bur. The different procedures of tooth preparation did not affect the retentive strength of the resin when only filled resin was used (Restodent).

Maintenance of an adequate dental hygiene education system.

Decreases in faculty size and declining enrollments in dental hygiene programs are, in part, reflections of the economic difficulties faced by educational institutions with which the programs are affiliated. Administrative decisions about the future of dental hygiene programs are often based on inadequate information about employment trends and about the importance of the dental hygienist in dental practices. Although the relationship between demand for dental care and the availability of personnel to meet that demand is now unclear, studies indicate that demand for dental hygiene services will remain high in the 1980s. The impact of dental hygienists on dental health care delivery in any given region must be studied carefully when decisions are made about dental hygiene programs, because it is very expensive to replace discontinued programs or those disabled by large budget cuts.

Toothbrush abrasion of color-corrective porcelain stains applied to porcelain-fused-to-metal restorations.

Normal toothbrushing with a common dentifrice has the ability to wear away color-corrective porcelain stains applied to the surface of porcelain-fused-to-metal restorations in as few as 10 to 12 years unless a protective layer of clear glaze is applied over the stain. The additional layer of clear glaze more than doubled the time required to abrade the stain from the surface.

A protein that binds to the regulatory region of the Escherichia coli ilvIH operon.

The ilvIH operon of Escherichia coli encodes acetohydroxyacid synthase III, an isoenzyme involved in branched-chain amino acid biosynthesis. Transcription of the ilvIH operon is repressed by growing cells in the presence of leucine (C.H. Squires, M. DeFelice, S.R. Wessler, and J.M. Calvo, J. Bacteriol. 147:797-804, 1981). A protein in crude extracts of E. coli, termed the ilvIH-binding (IHB) protein, bound specifically in vitro to DNA upstream of the ilvIH operon. The binding protein, partially purified by Polymin precipitation, gel filtration, and phosphocellulose chromatography, has a native molecular weight of 43,000 and is composed of two subunits of identical size. As determined by protection against lambda exonuclease and DNase I, the protein binds within a region -190 to -260 relative to the start point of transcription. In addition, the IHB protein binds to a site between positions -100 and -40. The following evidence suggests that binding of this protein to the region upstream of ilvIH is related to the regulation of this operon by leucine. Binding of the IHB protein to the ilvIH regulatory region in vitro was reduced by leucine but not by isoleucine, valine, or threonine. In a mutant strain isolated by M.V. Ursini, P. Arcari, and M. DeFelice (Mol. Gen. Genet. 181:491-496, 1981), transcription was not repressed by leucine. A protein in extracts of this mutant strain bound to the ilvIH regulatory region, but the complex migrated through agarose gels with a mobility different from that of the complex formed by wild-type protein. Furthermore, a concentration of leucine that substantially reduced binding of the wild-type to DNA did not affect binding of the protein from the mutant strain. A simple model consistent with these findings is that transcription from the ilvIH promoter is stimulated by binding the IHB protein to one or more sites upstream of the promoter and that leucine interferes with this binding.

Differential regulation of the activation of human eosinophils, macrophages, and neutrophils: effect of the allergic mediator release inhibitor CI-949.

The allergic mediator release inhibitor CI-949 [5-methoxy-3-(1- methylethoxy)-1-phenyl-N-1H-tetrazol-5-yl-1H-indole-2-carbox amide L-arginine salt] was evaluated for its effect on the activation of human eosinophils, macrophages, and neutrophils by the phagocytic stimulus serum-opsonized zymosan (SOZ). CI-949 inhibited the SOZ- stimulated respiratory burst of eosinophils, measured as the generation of superoxide anion, with an IC50 of 22.8 microM. At concentrations of 100 microM, CI-949 had no inhibitory effect against lysosomal enzyme release by these cells. At 100 microM, CI-949 had no inhibitory effect against release of eosinophil peroxidase while inhibiting release of the macrophage lysosomal enzyme N-acetyl-beta-D- glucosaminidase by only 11.7 percent. In contrast, CI-949 inhibited the release of the neutrophil primary granule enzyme myeloperoxidase inhibiting of 21.4 microM, while inhibiting release of lysozyme from lysosomal enzyme release from secondary granules with an IC50 of 99.3 microM. These results demonstrate that oxygen radical generation and lysosomal enzyme release by human eosinophils, macrophages and neutrophils are differentially regulated by CI-949. These results suggest that these inflammatory cells may have distinct stimulus-related coupling mechanisms.