Showing papers by "James D. Neaton published in 2002"

Guidelines for preventing opportunistic infections among HIV-infected persons - 2002

Abstract: In 1995, the U.S. Public Health Service (USPHS) and the Infectious Diseases Society of America (IDSA) developed guidelines for preventing opportunistic infections (OIs) among persons infected with human immunodeficiency virus (HIV); these guidelines were updated in 1997 and 1999. This fourth edition of the guidelines, made available on the Internet in 2001, is intended for clinicians and other health-care providers who care for HIV-infected persons. The goal of these guidelines is to provide evidence-based guidelines for preventing OIs among HIV-infected adults and adolescents, including pregnant women, and HIV-exposed or infected children. Nineteen OIs, or groups of OIs, are addressed, and recommendations are included for preventing exposure to opportunistic pathogens, preventing first episodes of disease by chemoprophylaxis or vaccination (primary prophylaxis), and preventing disease recurrence (secondary prophylaxis). Major changes since the last edition of the guidelines include 1) updated recommendations for discontinuing primary and secondary OI prophylaxis among persons whose CD4+ T lymphocyte counts have increased in response to antiretroviral therapy; 2) emphasis on screening all HIV-infected persons for infection with hepatitis C virus; 3) new information regarding transmission of human herpesvirus 8 infection; 4) new information regarding drug interactions, chiefly related to rifamycins and antiretroviral drugs; and 5) revised recommendations for immunizing HIV-infected adults and adolescents and HIV-exposed or infected children.

Pulse pressure and cardiovascular disease-related mortality: follow-up study of the Multiple Risk Factor Intervention Trial (MRFIT).

Abstract: ContextThe sixth Joint National Committee (JNC-VI) classification system of blood pressure emphasizes both systolic blood pressure (SBP) and diastolic blood pressure (DBP) for cardiovascular disease risk assessment. Pulse pressure may also be a valuable risk assessment tool.ObjectiveTo compare relationships of SBP, DBP, and pulse pressure, separately and jointly, with cardiovascular disease-related mortality in men.Design and SettingData from the Multiple Risk Factor Intervention Trial (MRFIT), which screened men aged 35 to 57 years from 1973 through 1975 at 22 US centers, was used to assess cardiovascular disease-related mortality through 1996.ParticipantsA total of 342 815 men without diabetes or a history of myocardial infarction were divided into 2 groups based on their age at MRFIT screening (35- to 44-year-olds and 45- to 57-year olds). Participant blood pressure levels were classified into a JNC-VI blood pressure category based on SBP and DBP (optimal, normal but not optimal, high normal, stage 1 hypertension, stage 2-3 hypertension), and pulse pressure was calculated.Main Outcome MeasureCardiovascular disease-related mortality.ResultsThere were 25 721 cardiovascular disease-related deaths. Levels of SBP and DBP were more strongly related to cardiovascular disease than pulse pressure. Relationships of SBP, DBP, and pulse pressure to cardiovascular disease-related mortality varied within JNC-VI category. Concordant elevations of SBP and DBP were associated with a greater risk of cardiovascular disease-related mortality for both age groups of men. Among men aged 45 to 57 years, higher SBP and lower DBP (discordant elevations) also yielded a greater risk of cardiovascular disease-related mortality.ConclusionIn both age groups, cardiovascular disease risk assessment was improved by considering both SBP and DBP, not just SBP, DBP, or pulse pressure separately.

Clinical evaluation of dietary modification for treatment of spontaneous chronic renal failure in dogs.

Abstract: Objective—To determine whether a diet used for dogs with renal failure (renal food [RF]) was superior to an adult maintenance food (MF) in minimizing uremic crises and mortality rate in dogs with spontaneous chronic renal failure. Design—Double-masked, randomized, controlled clinical trial. Animals—38 dogs with spontaneous chronic renal failure. Procedure—Dogs were randomly assigned to a group fed adult MF or a group fed RF and evaluated for up to 24 months. The 2 groups were of similar clinical, biochemical, and hematologic status. The effects of diets on uremic crises and mortality rate were compared. Changes in renal function were evaluated by use of serial evaluation of serum creatinine concentrations and reciprocal of serum creatinine concentrations. Results—Compared with the MF, the RF had a beneficial effect regarding uremic crises and mortality rate in dogs with mild and moderate renal failure. Dogs fed the RF had a slower decline in renal function, compared with dogs fed the MF. Conclusions and Clinical Relevance—Dietary modifications are beneficial in minimizing extrarenal manifestations of uremia and mortality rate in dogs with mild and moderate spontaneous chronic renal failure. Results are consistent with the hypothesis that delay in development of uremic crises and associated mortality rate in dogs fed RF was associated, at least in part, with reduction in rate of progression of renal failure. (J Am Vet Med Assoc 2002;220: 1163–1170)

Both baseline HIV-1 drug resistance and antiretroviral drug levels are associated with short-term virologic responses to salvage therapy

Abstract: Background: To determine the impact of HIV-1 drug resistance at baseline and antiretroviral drug levels (DL) during follow-up on virologic response to the next antiretroviral regimen. Methods: Baseline genotypic and phenotypic susceptibility was obtained for plasma virus from patients failing a protease inhibitor-containing regimen. Untimed plasma antiretroviral DL were performed and the distribution of DL after 12 weeks of follow-up was classified as above (DL High ) or below (DL Low ) the median. Inhibitory quotients [IQ = (DL at week 12)/(fold change in IC 50 to wild-type)] were determined for each drug in the regimen. Primary outcome was change in log 10 plasma HIV-1 RNA viral load (AVL) from baseline to 12 weeks. Results: There were 137 patients who had baseline resistance data available for the antiretroviral drugs used in the salvage regimen, and DL at week 12. Each drug with DL High was associated with ΔVL = -0.40 (P= 0.0002) while each drug with DL Low had ΔVL = -0.16 (P= 0.11). In multivariate models ΔVL associated with each active drug (defined by genotype) with DL High was -0.48 log 10 (P median, compared to -0.58 for one drug, -1.06 for two drugs, -0.86 for three drugs, and -1.44 for four or five drugs with IQ > median (P < 0.0001 for trend). Conclusions: In salvage therapy, both the number of active drugs and the DL for each drug in the new regimen determine the antiviral response.