ABSTRACT
HISTORY AND CLINICAL FINDINGS: A 38-year-old HIV positive man suffered from right upper abdominal pain and oesophageal reflux syndromes. He was in a good general state of health and nutrition with no concomitant symptoms. INVESTIGATIONS: A small bowel tumor and slight soor esophagitis had been diagnosed by esophago-gastroduodenoscopy. The tumor was histologically classified as Burkitt?s lymphoma. TREATMENT AND OUTCOME: The patient received 6 cycles of chemotherapy according to the B-ALL protocol, and antiretroviral therapy with lamivudine (300 mg), abacavir (600 mg) und raltegravir (2 × 400 mg) was initiated immediately. After the first cycle of chemotherapy a complete remission of Burkitt?s lymphoma was achieved. Laboratory parameters recovered after completion of 6 cycles to a value of 400 CD4-positive lymphocytes/mm (3) with a viral load of HIV-1-RNA 20â-â300 copies/ml in plasma. CONCLUSION: Immediate initiation of antiretroviral therapy is essential after the diagnosis of AIDS-defining symptoms. The choice of an appropriate treatment regimen is a critical factor in order to avoid toxic drug interactions and adverse events while maintaining a highly effective treatment.
Subject(s)
Anti-HIV Agents/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Burkitt Lymphoma/drug therapy , Duodenal Neoplasms/drug therapy , HIV Seropositivity/drug therapy , Intestine, Small , Lymphoma, AIDS-Related/drug therapy , Pyrrolidinones/therapeutic use , Adult , Burkitt Lymphoma/diagnosis , CD4 Lymphocyte Count , Dideoxynucleosides/therapeutic use , Dose-Response Relationship, Drug , Drug Administration Schedule , Duodenal Neoplasms/diagnosis , HIV Seropositivity/diagnosis , Humans , Lamivudine/therapeutic use , Lymphoma, AIDS-Related/diagnosis , Male , Pyrrolidinones/adverse effects , Raltegravir Potassium , Remission Induction , Viral LoadSubject(s)
Down Syndrome/complications , Heart Defects, Congenital/complications , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , MaleSubject(s)
Heart Defects, Congenital/pathology , Pulmonary Artery/pathology , Child , Child, Preschool , HumansABSTRACT
BACKGROUND: Data on the clinical course of infection in patients with transmitted drug-resistant HIV before and after initiation of treatment are scarce. PATIENTS AND METHODS: Genotypic resistance was analysed in 504 therapy-naïve individuals with a known date of infection. Resistance was predicted using the Stanford algorithm. Clinical parameters for 80 individuals with transmitted drug-resistant HIV and for 424 patients with susceptible virus were analysed. RESULTS: In 16% of the individuals transmitted drug-resistant HIV was found. Detection of drug-resistant HIV was more likely in individuals with acute primary HIV infection [odds ratio (OR)=1.529; 95% confidence interval (95% CI) 1.001; 2.236]. At the time of infection patients with an acute infection with resistant HIV had lower viral loads. CD4 cell counts tended to be higher and the CD4 cell loss more pronounced in the group with resistant HIV. Suppression of the viral load below the detection limit was achieved in 64% of the group with resistant HIV and in 85% of the group with susceptible HIV 6 months after initiation of therapy (P=0.199). The majority of the group with resistant HIV (74%) received at least one compromised drug. CONCLUSION: First-line treatment including drugs with predicted resistance can impair virological success in some patients. Factors influencing the decision to include compromised drugs need to be investigated.
Subject(s)
HIV Infections/drug therapy , Adult , Anti-Retroviral Agents/pharmacology , Anti-Retroviral Agents/therapeutic use , Antiretroviral Therapy, Highly Active , CD4 Lymphocyte Count , Drug Resistance, Viral , Female , HIV Infections/transmission , HIV Infections/virology , HIV Seropositivity/immunology , HIV-1/drug effects , HIV-1/genetics , HIV-1/immunology , Humans , Male , Treatment Outcome , Viral LoadABSTRACT
Studies on hepatitis C virus (HCV) monoinfected patients suggest high sustained treatment response rates of up to 98% when interferon monotherapy is administered during the acute phase of HCV-infection. To clarify whether early treatment of acute hepatitis C is similarly efficient in human immunodeficiency virus (HIV) positive patients, we conducted a retrospective survey of HIV-positive patients with acute HCV infection. Eleven HIV-positive patients who had been treated with interferon or interferon/ribavirin were identified at eight HIV-specialty outpatient clinics. The patients had been treated over a median 25 weeks with standard interferon (two patients), pegylated interferon (four patients) and pegylated interferon in combination with ribavirin (five patients). A post-treatment response (negative serum HCV-RNA at the end of treatment) was seen in 10 of 11 patients and HCV-RNA remained undetectable 24 weeks after the end of treatment in all the 10 responders. Alanine aminotransferase (ALT) normalized in eight patients while two virological responders and one nonresponder showed persistent mild ALT elevations. In conclusion, early treatment of acute hepatitis C seems to achieve high sustained virological treatment response rates also in patients with HIV-infection.
Subject(s)
AIDS-Related Opportunistic Infections/drug therapy , Hepatitis C/drug therapy , Interferon-alpha/therapeutic use , Ribavirin/therapeutic use , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/epidemiology , Acute Disease , Antiviral Agents/therapeutic use , Dose-Response Relationship, Drug , Drug Administration Schedule , Drug Therapy, Combination , Female , Follow-Up Studies , Germany/epidemiology , Hepatitis C/diagnosis , Hepatitis C/epidemiology , Humans , Interferon alpha-2 , Male , Recombinant Proteins , Retrospective Studies , Risk Assessment , Sampling Studies , Severity of Illness Index , Treatment Outcome , Viral LoadABSTRACT
Cytomegalovirus (CMV) antigenemia was evaluated in 174 patients positive for human immunodeficiency virus. Antigenemia could be detected in 96.7% of patients with CMV disease, 76.9% of patients suffering from a relapse of the disease, and 11.4% of asymptomatic patients with CD4 levels of < 100 cells per microliter. No antigenemia was detected in patients with CD4 levels of 250 to 500 cells per microliter. Specificity and the positive predictive value for CMV disease were increased only if more than 5 positive cells per slide were considered. However, CMV disease may also occur in patients with low-grade antigenemia.