Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings

Clinical, Laboratory, and Radiologic Manifestation of SARS

Severe acute respiratory syndrome (SARS) is a highly contagious and predominantly pneumonic illness caused by a novel coronavirus now commonly known as SARS-CoV. This article describes the key diagnostic clinical features, radiologic features, and investigation profiles of affected patients. We summarize our understanding from anecdotal experience and limited published data on the use of antiviral and corticosteroid therapy in the management of this highly contagious disease.

Consideration of highly active antiretroviral therapy in the prevention and treatment of severe acute respiratory syndrome

We observed that 0 of 19 patients with human immunodeficiency virus type 1 (HIV-1) infection, including those with acquired immunodeficiency syndrome (AIDS), who were hospitalized together and who had close contact with 95 patients with severe acute respiratory syndrome (SARS) on the same hospital floor contracted SARS, whereas 6 of 28 medical workers who served on this floor contracted SARS while caring for these patients. Our investigation found that most of the patients with HIV-1/AIDS were receiving treatment of highly active antiretroviral therapy (HAART) during hospitalization. Coincidentally, a research group from Hong Kong recently reported that patients with SARS who received treatment with the anti-HIV-1 drug lopinavir-ritonavir experienced significantly better clinical outcomes than did those who did not receive lopinavir-ritonavir. On the basis of these observations and studies, we propose that HAART should be considered for patients with SARS and their close contacts when the SARS epidemic reemerges.

Management of Critically Ill Patients with Severe Acute Respiratory Syndrome (SARS)

Severe acute respiratory syndrome (SARS) is frequently complicated with acute respiratory failure. In this article, we aim to focus on the management of the subgroup of SARS patients who are critically ill. Most SARS patients would require high flow oxygen supplementation, 20-30% required intensive care unit (ICU) or high dependency care, and 13-26% developed acute respiratory distress syndrome (ARDS). In some of these patients, the clinical course can progress relentlessly to septic shock and/or multiple organ dysfunction syndrome (MODS). The management of critically ill SARS patients requires timely institution of pharmacotherapy where applicable and supportive treatment (oxygen therapy, noninvasive and invasive ventilation). Superimposed bacterial and other opportunistic infections are common, especially in those treated with mechanical ventilation. Subcutaneous emphysema, pneumothoraces and pneumomediastinum may arise spontaneously or as a result of positive ventilatory assistance. Older age is a consistently a poor prognostic factor. Appropriate use of personal protection equipment and adherence to infection control measures is mandatory for effective infection control. Much of the knowledge about the clinical aspects of SARS is based on retrospective observational data and randomized-controlled trials are required for confirmation. Physicians and scientists all over the world should collaborate to study this condition which may potentially threaten human existence.