Bactrim/Septra (B/S) is considered the best product for preventing the appearance of the life-threatening lung infection PCP (Pneumocystis carinii Pneumonia). Unfortunately some people with HIV/AIDS (PHAs) seem unusually sensitive to the drug -- between "44% to 69% [can have] skin rash, nausea and fever."
As part of their normal activity, cells produce highly active molecules called "free radicals" (or ROS; reactive oxygen species). Under carefully controlled conditions, free radicals can be useful. Indeed, the immune system used free radicals to destroy germs. However, uncontrolled production of free radicals can cause problems because these highly active molecules can damage cells and increase production of HIV.
Infections with herpes viruses can cause painful sores. Treatment with the drug acyclovir usually provides relief by allowing the sores to heal as viral activity is shut down. Since PHAs immune system's may not always be able to contain the infection, daily use of acyclovir (Zovirax) may be necessary to stop the sores from re-appearing.
Bactrim/Septra (B/S) is considered the best product for preventing the life-threatening lung infection PCP. Some PHAs may not be able to tolerate B/S. Despite successful therapy to help them tolerate the drug (called desensitization), some PHAs relapse and once more become intolerant of B/S. Options include use of other anti-PCP drugs -- dapsone, Mepron or AP (aerosol pentamidine).
IL-2 is a chemical produced by the immune system that can cause T cells to divide and produce copies of themselves. Since HIV/AIDS is associated with less than normal levels of CD4+ cells, some researchers think infusions of IL-2 will increase the CD4+ cell count, perhaps delaying or stopping the development of AIDS.
The use of the protease inhibitors indinavir and ritonavir in combination with other anti-HIV drugs has caused a dramatic decline in the amount of HIV in the blood of treated subjects. As well, there are reports of recovery from chronic infections. There are many questions about these products for which there are no answers
Doctors in Milan recently reported some interesting data from a study of health care workers. For the past 6 years, standard policy at their hospital is to offer AZT 1,000 mg/day for 40 days to health care workers who accidentally stick used needles (which may contain HIV) into their skin, in the hope of containing HIV infection.
In late 1994 two teams of virologists were studying the effect of anti-HIV drugs, specifically changes in CD4+ cell counts and levels of HIV. Working together with scientists trained in mathematics, the teams developed some ideas about the interaction between HIV and the immune system, and came to a number of conclusions: "As many as 10 billion new HIVs are produced each day"
Long before the CD4+ (T4+) cell counts fall below the normal range in HIV-infected people, defects in the immune system's defences appear. One example of such a defect is that T cells may not detect and fight invading germs. One research team in Denmark has reported promising results when they tested an antidepressant in people with HIV infection
As part of an experiment on nutrition, a group of researchers infected monkeys with SIV (simian immunodeficiency virus) and the animals eventually developed AIDS. These monkeys were otherwise healthy and well fed.
The drug cimetidine (Tagamet ) is used to treat ulcers. In the late 1980s, German researchers reported that cimetidine raised the CD4+ cell counts of their subjects with HIV infection. This German study was not placebo-controlled. American researchers who have also been testing cimetidine have finally had their results published
In the time before the widespread use of preventive doses of antibiotics in PHAs, the most common life-threatening infection was PCP. In women with HIV infection, yeast infections in the mouth/throat and sores/ulcers caused by herpes viruses are more common than in men
Some people with HIV/AIDS (PHAs) are also infected with the hepatitis B virus (HBV). Continuous, low-level infection of the liver by HBV can severely damage that organ, destroying it and even causing liver cancer. Interferon-alpha, a chemical made by the immune system, helps cells resist attack by certain viruses and has also been used to treat people with hepatitis B and HIV infections
Over the past 5 years doctors in the US have found that increasing numbers of their patients have their medical bills paid for by agencies called HMOs (health maintenance organizations). Today HMOs are large, covering tens of thousands of patients, are increasingly influential, and can force doctors to reduce their fees.
Doctors in Ottawa enrolled 12 HIV-infected men to test the effect of rifabutin 300 mg/day on the amount of saquinavir that is absorbed and ends up in the blood. They found that rifabutin reduces levels of saquinavir in the blood by 40%. So doctors treating PHAs taking this combination are going to have to increase their dose of saquinavir, perhaps by 40%
Another American team in Chicago conducted a study on 18 PHAs in the AIDS ward of a hospital to find out if they received their medicine as prescribed by the hospital's doctors.
Absorption of food and certain drugs is reduced in some PHAs because of intestinal damage caused by HIV or other microbes. As well, some PHAs don't produce enough acid in their stomachs to properly digest food. Lower-than-normal levels of stomach acid affects absorption of the antifungal drug itraconazole (Sporanox(R)).
Doctors in San Diego recruited 35 volunteers (subjects) with AIDS who also had CMV-retinitis. These subjects "did not benefit from or could not tolerate or refused iv (intravenous) ganciclovir or foscarnet."
In North America, PHAs who have less than 50 CD4+ cells are at high risk for the development of CMV retinitis but not everyone with such a low cell count gets retinitis. Several research teams are developing tests to detect CMV in the blood of PHAs.
Doctors in the US recruited 323 HIV-infected women who had less than 300 CD4+ cells for this study. One hundred and sixty-two received fluconazole 200 mg/week and 161 received fake fluconazole (placebo). Researchers monitored 50% of subjects for 2 and a half years
Infection with the parasite C. parvum can cause life-threatening diarrhea in PHAs. Doctors have tried many drugs to treat people infected with this parasite, including azithromycin, garlic enemas, paramomycin (Humatin) but use of these drugs do not work in every PHA.
Lamisil (terbinafine) is a new antifungal drug licensed for treating fungal infections of the nails. As more reports of fungal infections resistant to fluconazole or itraconazole appear, doctors are beginning to consider combination antifungal therapy .
Doctors in the US recruited 231 HIV-infected subjects, half of whom had 40 CD4+ cells, to test the ability of fluconazole to prevent the life-threatening brain infection crypto. Although none of the subjects had crypto in the past, 60% had experienced other life-threatening infections before entering this study.
One of the life-threatening brain infections PHAs can develop is 'crypto' (Cryptococcal meningitis). Standard treatment is iv AmB (amphotericin B) followed by oral fluconazole as maintenance. AmB can be toxic for the kidneys so researchers have been developing new forms of AmB one of which is called AmBisomer.
Gilead Sciences which makes the anti-CMV drug cidofovir is also developing a treatment called adefovir (Bis-POM PMEA) for hepatitis B infection. Although most people quickly recover from HBV (hepatitis B virus) infection, a few develop continuous (chronic), low-level HBV infection in the liver.
IL-2 is a chemical produced by the immune system which stimulates the growth of T cells and helps them fight infections. Most studies testing IL-2 in PHAs have used large doses -- millions of units per day.
In North America, people with HIV/AIDS who have less than 100 CD4+ cells and who have been exposed to the parasite (T. gondii) are considered to be at high risk for developing toxo.
This information is designed to support, not replace, the relationship that exists between you and your doctor.