Glutathione and cysteine in HIV-infected hemophiliacs.

A cross-sectional study was designed to determine whether plasma concentrations of glutathione and cysteine in HIV-infected hemophiliacs vary according to the progression of the disease and to compare them with those obtained in HIV negative hemophiliacs. Cysteine, total glutathione and glutathione disulphide were measured in plasma of HIV-infected hemophiliacs at different stages of HIV infection and in plasma of HIV-negative hemophiliacs. CD4 and CD8 T-cell counts, leukocyte and lymphocyte counts, beta 2-microglobulin and p24 antigen values were recorded for HIV positive hemophiliacs at the time of the study. The hemophiliac HIV-positive group showed a decrease in total glutathione levels (-18%) and an increase of glutathione disulphide (8.18 vs. 14.90%) compared to the HIV-negative group. The cysteine levels found in HIV-positive hemophiliacs were not different from those found in the HIV-negative group. There were no differences with statistical significance in total glutathione, glutathione disulphide and cysteine among HIV-infected hemophiliacs according to the different clinical stage of the disease (AIDS vs. non-AIDS). The interest of evaluating plasma concentrations of glutathione and cysteine in HIV-infected patients is limited from the point of view of considering them as markers of progression of the disease. Interest in a therapeutic strategy designed to replenish or normalize glutathione plasma levels is also limited.

[Progression of HIV infection in a cohort of hemophiliacs over an 11-year period]. / Progresión de la infección por el virus de la inmunodeficiencia humana en una cohorte de hemofílicos durante un período de 11 años.

BACKGROUND: The progression of HIV infection in a cohort of hemophiliacs was evaluated taking into consideration the particularities of the natural history of HIV in this population and comparing the same with that described for other series of hemophiliacs and other risk groups for HIV infection. METHODS: A cohort of 141 hemophiliac patients with HIV infection controlled in a Hemophilia Unit since January 1983 was studied. The accumulated incidence of AIDS and the mortality at 11 years of follow up were evaluated. Likewise, the association of prognostic factors such as age, type of hemophilia or previous treatment with antihemophilic factors were evaluated. RESULTS: The accumulated incidence of AIDS at the end of follow up was 56% with a mortality rate of 33%. The evolution showed statistically significant differences with regard to age (p = 0.00048) and previous treatment (p = 0.00239). No differences were observed concerning the type of hemophilia or its severity. CONCLUSIONS: HIV infection in the cohort of hemophiliacs studied presented similar accumulated AIDS incidence and mortality to those described in other series of hemophiliacs. These values are apparently more favorable than those referred for other risk groups, possibly due to the particular epidemiologic characteristics.

[The administration of factor VIII concentrates to hemophiliacs by continuous perfusion pump]. / Administración de concentrados de factor VIII a hemofílicos mediante bomba de perfusión continua.

BACKGROUND: The administration of factor VIII (FVIII) in continuous infusion (CI) to hemophiliac inpatients is a therapeutic approach made possible by the development of new commercial preparations. METHODS: In the present study the outcome of 14 treatment courses of FVIII in CI to 12 patients with hemophilia A (2 of them with inhibitor) was evaluated. A computer program developed by the authors is presented. This program is simple and can be executed in any compatible personal computer, permitting the calculation of initial and maintenance doses and individual pharmacokinetic parameters. RESULTS: The hemostatic result was excellent: constant FVIII plasma levels were achieved, and unnecessary overdoses were prevented. Mean infusion rates of 1.99 +/- 0.45 IU/kg/h, 1.47 +/- 0.28 IU/kg/h, and 0.86 +/- 0.12 IU/kg/h were enough to maintain FVIII plasma levels of 1 IU/ml, 0.3 IU/ml, and 0.3 IU/ml, respectively. This represents a saving of 20-50% of the requirements of the traditional intermittent method. CONCLUSIONS: The infusion of intravenous CI of FVIII and the use of a computer program permitting an easy individualization of the treatment schedule resulted in the same hemostatic effectiveness as with the traditional intermittent method, but using a smaller replacement dose.