Hydroxyurea in combination with didanosine and stavudine in antiretroviral-experienced HIV-infected subjects with a review of the literature.

The safety and efficacy of hydroxyurea with didanosine in combination with stavudine in nucleoside reverse-transcriptase inhibitor (NRTI)-experienced patients was investigated. Entry criteria included HIV-1 infected, NRTI-experienced adults, with CD4(+) counts 50-550 cells/mm(3) and viral loads >or=12,500 copies/mL. Subjects were treated with didanosine 200 mg twice a day (BID), stavudine 40 mg BID, and hydroxyurea 1000 mg daily for 16 weeks. Thirty-one HIV-1 subjects with mean bDNA viral load 1x10(5) log(10) copies/mL and mean CD4(+) T-cell counts of 231 cells/mm(3) were enrolled. A 1.3 log(10) decrease in mean viral load was seen at 12 weeks of therapy. Prior didanosine use resulted in a more rapid response to therapy compared with prior zidovudine use. Side effects consisting of neutropenia, pancreatitis, and peripheral neuropathy occurred in four subjects and resolved upon withdrawal of therapy. This non-randomized study in subjects with a mean CD4(+) T-cell count of 230 cells/mm(3) demonstrates the antiviral activity of hydroxyurea+didanosine and stavudine. Toxicities related to therapy need to be followed closely. The results support the need for a randomized, prospective study to determine the safety and efficacy of hydroxyurea plus didanosine in antiretroviral-experienced patients with CD4(+) cell counts below 300 cells/mm(3).

Effective decision-making/problem-solving training with mothers who have mental retardation.

Nine mothers with mental retardation received group training in decision-making using vignettes describing child-raising situations. A multiple baseline procedure was used to assess the effectiveness of training in how to identify and apply decision-making steps to trained and untrained vignettes. Significant changes in step identification and use were observed and maintained for a month for both types of vignettes. Although training included nothing to improve the appropriateness of decisions, there was significant improvement for the high-risk situations used in training. Results suggest that parents with mental retardation are able to learn and apply basic steps of decision-making.

Mothers with mental retardation who do or do not abuse or neglect their children.

Mothers with mental retardation with or without a history of child abuse and/or neglect were compared on a number of demographic variables. The reasons why children were or were not removed also were examined. The demographic comparisons showed that while those mothers with such a history generally had higher IQs, they were similar to the mothers without such a history. Twice as many of those with a history of abuse and/or neglect were married, lived independently, and had at least two children, one of which often had problems, in comparison to those without such a history. Examination of the reasons for child removal showed that removal occurred if the mother had a problem in addition to her retardation or if she was unwilling to attend and actively participate in a training program and/or did not have someone who could provide support. If a mother was willing and did attend training and had support, children were either not removed initially or were returned upon evidence that the mother was actively participating. In comparison to those mothers with a history of abuse and/or neglect, those without such a history functioned at a lower intellectual and functional level and were living with a relative who shared child-care responsibilities.

Prevalence of serum antibody to the type-specific glycopeptidolipid antigens of Mycobacterium avium in human immunodeficiency virus-positive and -negative individuals.

An enzyme-linked immunosorbent assay was constructed by using as antigens the type-specific immunodominant glycopeptidolipids of selected serotypes of Mycobacterium avium. This assay system was used to determine the prevalence of raised antibody levels to these antigens in groups of controls, human immunodeficiency (HIV)-negative and -positive homosexual men, and HIV-negative patients with active M. avium infections as a possible indicator of potential exposure and/or colonization by M. avium in these individuals. The results indicate that while antibody levels were raised in only 2.4% of control individuals, 33% of HIV-negative homosexual men and 44% of HIV-positive patients exhibited raised levels. Moreover, further examination of the HIV-positive group revealed no correlation between antiglycopeptidolipid antibody activity and helper T cell numbers. These data indicate that exposure to M. avium is prevalent among the homosexual male population, regardless of their HIV status. Moreover, the data are suggestive that the emergence of disseminated M. avium disease in HIV-positive patients may sometimes arise from earlier colonization, rather than as a newly acquired infection during terminal immunodeficiency.