Management of the hematological manifestations of HIV infection and AIDS.

Hematological abnormalities, characterized by cytopenias, are a problem commonly encountered by persons with HIV or AIDS. Cytopenias can be multifactorial in their causation and potentially life threatening to this population. An understanding of the various causes of these cytopenias and the appropriate nursing care are tantamount to nursing practice and to ensure quality of life. Goals of medical and nursing care are directed at assessment, interventions, and patient education to prevent or minimize the complications of hematological abnormalities. This article reviews current knowledge regarding the causes, pathophysiology, treatments, and nursing care of HIV/AIDS-related hematological abnormalities.

Pharmacokinetics and safety of weekly dapsone and dapsone plus pyrimethamine for prevention of pneumocystis pneumonia.

The safety and pharmacokinetics of weekly dapsone and weekly dapsone plus pyrimethamine were examined in adult patients with human immunodeficiency virus infection who were at risk for pneumocystis pneumonia because of a prior episode or a CD4+ T-cell count less than 250 cells per mm3. Groups of patients received 100, 200, and 300 mg of dapsone as a single weekly dose. The maximum tolerated dose of weekly dapsone was established as 200 mg per week in patients receiving at least 500 mg of zidovudine concomitantly. This dose of dapsone was then found to be well tolerated when combined with pyrimethamine at 25 mg. Further patients were randomized to dapsone at 200 mg or dapsone at 200 mg plus pyrimethamine at 25 mg once weekly. Twenty-six patients each were followed for a median of 33 weeks on dapsone alone and 45 weeks on the combination. Seven patients in each group withdrew because of toxicity. Five patients receiving dapsone developed documented pneumocystis pneumonia, while four and two patients receiving dapsone plus pyrimethamine developed documented and presumptive pneumocystis pneumonia, respectively. To evaluate the tolerability of a higher dose of pyrimethamine, 11 patients had their regimen changed to dapsone at 200 mg plus pyrimethamine at 75 mg, which was well tolerated by 10 of the patients for a median period of 11 weeks. The pharmacokinetics of dapsone and pyrimethamine were examined by using a population pharmacokinetic model. Decreases in the apparent volume of the peripheral compartment were observed when multiple-dose regimens of dapsone were compared with single-dose dapsone and when multiple-dose regimens of dapsone with pyrimethamine were compared with multiple-dose dapsone alone. When administered weekly, dapsone at 200 mg and dapsone at 200 mg with pyrimethamine at 25 mg are both well-tolerated regimens. This preliminary study suggests that the efficacy of these regimens in preventing pneumocystis pneumonia, however, may be less than that of trimethoprim-sulfamethoxazole.

Tuberculosis: the other epidemic.

In 1990, the number of cases of tuberculosis (TB) reported in the United States rose 6%. This is a noticeable change since, in prior years, TB had been declining. The increased incidence of TB is largely related to the HIV epidemic. TB is of particular interest in HIV-related illnesses, since it is preventable and treatable. The presentation of HIV-associated TB is different from "standard TB." Nurses need to be informed about the clinical presentation of the disease, the procedures to diagnose it, the treatments, and their potential side effects.