Journal ArticleDOI
CMV retinitis recurs after stopping treatment in virological and immunological failures of potent antiretroviral therapy.
Francesca J. Torriani,William R. Freeman,J C MacDonald,Marietta P. Karavellas,D. M. Durand,D. D. Jeffrey,Pascal Meylan,Rachel D. Schrier +7 more
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TLDR
CMV disease recurs after virological and immunological failure of HAART if CD4 cell counts drop below 50, and anti-CMV agents should be resumed before clinical reactivation ensues, because of the risk of contralateral retinal involvement and systemic disease.Abstract:
Objectives To determine predictors of clinical relapse of cytomegalovirus (CMV) end-organ disease in a cohort of 17 HIV-infected patients with healed and treated CMV retinitis (CMVR) who responded to HAART with an increase in CD4 cell counts to above 70 cells/mm3 and discontinued CMV maintenance therapy (MT). Design Seventeen patients were monitored for reactivation of retinitis. The CD4 cell counts, HIV RNA and peripheral blood mononuclear cell (PBMC) lymphoproliferative assays to CMV at 3 month intervals were compared between patients with and without reactivation of CMVR. Positive lymphoproliferative responses were defined as a stimulation index of 3 or greater. Results Five out of 17 (29%) patients experienced a recurrence of CMVR a mean of 14.5 months after stopping CMV MT and between 8 days and 10 months after CD4 cell counts fell below 50 cells/mm3. Median CD4 cell counts and plasma HIV RNA at reactivation were 37 cells/mm3 and 5.3 log10 copies/ml. Three patients recurred at a previously active site of the retina, one had contralateral CMVR, and one a recurrence of retinitis and pancreatitis simultaneously. Mean lymphoproliferative responses to CMV were 2.4 in patients with reactivation versus 21.0 stimulation index (SI) in patients without reactivation (P= 0.01). A model incorporating four variables (CD4 cell counts and HIV RNA at maintenance discontinuation, highest CD4 cell count, nadir HIV RNA and median lymphoproliferative responses) identified correctly 88% of patients with and without reactivation. Conclusion CMV disease recurs after virological and immunological failure of HAART if CD4 cell counts drop below 50. In this situation, anti-CMV agents should be resumed before clinical reactivation ensues, because of the risk of contralateral retinal involvement and systemic disease.read more
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DatasetDOI
Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.
TL;DR: The most recent version of the guidelines for the prevention and treatment of opportunistic infections (OI) in HIV-infected adults and adolescents was published in 2002 and 2004, respectively as mentioned in this paper.
Journal ArticleDOI
Guidelines for preventing opportunistic infections among HIV-infected persons - 2002
Henry Masur,Jonathan E. Kaplan,King K. Holmes,Beverly Alston,Miriam J. Alter,Neil M. Ampel,Jean Anderson,A. Cornelius Baker,David A Barr,John G. Bartlett,John E. Bennett,Constance A. Benson,William A. Bower,Samuel A. Bozzette,John T. Brooks,Victoria A. Cargill,Kenneth G. Castro,Richard E. Chaisson,David A. Cooper,Clyde S. Crumpacker,Judith S. Currier,Kevin M. DeCock,Lawrence Deyton,Scott F. Dowell,W. Lawrence Drew,William Duncan,Mark S. Dworkin,Clare A. Dykewicz,Robert W Eisinger,Tedd Ellerbrock,Wafaa El-Sadr,Judith Feinberg,Kenneth A. Freedberg,Keiji Fukuda,Hansjakob Furrer,Jose M. Gatell,John W. Gnann,Mark J. Goldberger,Sue Goldie,Eric P. Goosby,Fred M. Gordin,Peter A. Gross,Rana Hajjeh,Richard Hafner,Diane Havlir,S D Holmberg,David R. Holtgrave,Thomas M. Hooton,Douglas A. Jabs,Mark A. Jacobson,Harold Jaffe,Edward N. Janoff,Jeffrey M. Jones,Dennis D. Juranek,Mari M. Kitahata,Joseph A. Kovacs,Catherine Leport,Myron J. Levin,Juan C. Lopez,Jens D Lundgren,Michael Marco,Eric Mast,Douglas L. Mayers,Lynne M. Mofenson,Julio Montaner,Richard A. Moore,Thomas Navin,James D. Neaton,Charles Nelson,Joseph F. O'Neill,Joel Palefsky,Alice Pau,Phil Pellett,John P. Phair,Steve Piscitelli,Michael A. Polis,Thomas C. Quinn,William C. Reeves,Peter Reiss,David Rimland,Anne Schuchat,Cynthia L. Sears,Leonard B. Seeff,Kent A. Sepkowitz,Kenneth E. Sherman,Thomas G. Slama,Elaine M. Sloand,Stephen A. Spector,John A. Stewart,David L. Thomas,Timothy M. Uyeki,Russell Van Dyke,M. Elsa Villarino,Anna Wald,D. Heather Watts,L. Joseph Wheat,Paige L. Williams,Thomas C. Wright +97 more
TL;DR: This fourth edition of the guidelines for preventing opportunistic infections (OIs) among persons infected with human immunodeficiency virus (HIV) is intended for clinicians and other health-care providers who care for HIV-infected persons.
Book ChapterDOI
Manifestations of human cytomegalovirus infection: proposed mechanisms of acute and chronic disease.
TL;DR: The capacity of this virus to persist in the midst of intense inflammation suggests that its persistence could serve as a trigger for the induction of host-vs-graft responses or alternatively host responses to HCMV could contribute to the inflammatory milieu characteristic of chronic allograft rejection.
Journal Article
Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents
Jonathan E. Kaplan,Constance A. Benson,King K. Holmes,John T. Brooks,Alice Pau PharmD,Henry Masur +5 more
TL;DR: This report updates and combines earlier versions of guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents and adds malaria to the list of OIs that might be acquired during international travel.
References
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Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators.
Frank J. Palella,Kathleen M. Delaney,Anne C. Moorman,Mark O. Loveless,Jack Fuhrer,Glen A. Satten,Diane J. Aschman,Scott D. Holmberg +7 more
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A Controlled Trial of Two Nucleoside Analogues plus Indinavir in Persons with Human Immunodeficiency Virus Infection and CD4 Cell Counts of 200 per Cubic Millimeter or Less
Scott M. Hammer,Kathleen Squires,Michael Hughes,Michael Hughes,Janet M. Grimes,Lisa M. Demeter,Judith S. Currier,Joseph J. Eron,Judith Feinberg,Henry H. Balfour,Lawrence Deyton,Chodakewitz Jeffrey A,Margaret A. Fischl,John P. Phair,William Spreen,Louise Pedneault,Bach-Yen Nguyen,Jon C. Cook +17 more
TL;DR: In this article, the efficacy and safety of adding a protease inhibitor to two nucleoside analogues to treat human immunodeficiency virus type 1 (HIV-1) infection are not clear.
Journal ArticleDOI
Treatment with Indinavir, Zidovudine, and Lamivudine in Adults with Human Immunodeficiency Virus Infection and Prior Antiretroviral Therapy
Roy M. Gulick,John W. Mellors,Diane V. Havlir,Joseph J. Eron,Charles J. Gonzalez,Deborah McMahon,Douglas D. Richman,Fred T. Valentine,Leslie Jonas,Anne R. Meibohm,Emilio A. Emini,Chodakewitz Jeffrey A +11 more
TL;DR: In most HIV-infected patients with prior antiretroviral therapy, the combination of indinavir, zidovudine, and lamivudine reduces levels of HIV RNA to less than 500 copies per milliliter for as long as one year.
Journal ArticleDOI
Positive Effects of Combined Antiretroviral Therapy on CD4+ T Cell Homeostasis and Function in Advanced HIV Disease
Brigitte Autran,Guislaine Carcelain,T.S. Li,Catherine Blanc,Dominique Mathez,R. Tubiana,C. Katlama,Patrice Debré,Jacques Leibowitch +8 more
TL;DR: In this article, a three-phase T cell reconstitution was demonstrated after HAART, with an early rise of memory CD4(+) cells, a reduction in T cell activation correlated to the decreasing retroviral activity together with an improved CD4+ T cell reactivity to recall antigens.
Journal ArticleDOI
Incidence and Natural History of Cytomegalovirus Disease in Patients with Advanced Human Immunodeficiency Virus Disease Treated with Zidovudine
Joel E. Gallant,Richard D. Moore,Richard D. Moore,Douglas D. Richman,Douglas D. Richman,Jeanne C. Keruly,Jeanne C. Keruly,Richard E. Chaisson,Richard E. Chaisson +8 more
TL;DR: As new anti-CMV drugs become available, prophylaxis should be targeted at individuals with CD4 cell counts < 0.1 x 10(9)/L, which are significantly associated with subsequently developing CMV disease.