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Jayaweera DT, Scerpella E, Robinson M, Rode R, Campo R, Rodriguez A, Asthana D, Tanner T, Kolber MA. The safety and efficacy of indinavir and ritonavir (400/400 mg BID) in HIV-1-infected individuals from an inner-city minority population: a pilot study. Int J STD AIDS 2016; 14:732-6. [PMID: 14624734 DOI: 10.1258/09564620360719750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We evaluated the safety and efficacy of indinavir 400 mg and ritonavir 400 mg twice daily (RIT/IND 400/400) in HIV-1-infected individuals, using an open label, proof of concept study. All patients received indinavir 400 mg and ritonavir 400 mg twice daily. Patients were followed up to 48 weeks. Nineteen subjects were enrolled, 11 (58%) men and eight (42%) women. The majority were American Black (nine; 47%) or Haitian (eight; 42%). The median baseline plasma HIV-1 viral load (VL) was 5.13 log10 copies/mL and the median CD4 cell count was 112 cells/mm3. The proportion of compliant patients with VL <400 copies/mL at week 24 was 60% compared with 0% for non-compliant patients ( P=0.011 [intent-to-treat] or P=0.085 [on-treatment]). VL at week 4 predicted week 24 VL response. Compliant patients had a median average CD4 cell count increase of 83.2 cells/mm3 compared with 42.0 cells/mm3 for non-compliant patients (P=0.010). The median average changes in triglycerides and cholesterol were significantly higher in compliant patients. This is a potent, safe combination for the treatment of HIV-1. VL at week 4 is predictive of viral outcome at week 24. Fasting serum cholesterol and triglycerides were significantly elevated during the study.
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Affiliation(s)
- D T Jayaweera
- Division of Infectious Diseases, University of Miami School of Medicine, 1500 NW 12th Ave, 8th Floor West, Miami, FL 33136, USA.
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Baum MK, Sales S, Jayaweera DT, Lai S, Bradwin G, Rafie C, Page JB, Campa A. Coinfection with hepatitis C virus, oxidative stress and antioxidant status in HIV-positive drug users in Miami. HIV Med 2011; 12:78-86. [PMID: 20500231 DOI: 10.1111/j.1468-1293.2010.00849.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The pathogenesis of HIV/hepatitis C virus (HCV) coinfection is poorly understood. We examined markers of oxidative stress, plasma antioxidants and liver disease in HIV/HCV-coinfected and HIV-monoinfected adults. METHODS Demographics, medical history, and proof of infection with HIV, hepatitis A virus (HAV), hepatitis B virus (HBV) and HCV were obtained. HIV viral load, CD4 cell count, complete blood count (CBC), complete metabolic panel, lipid profile, and plasma concentrations of zinc, selenium, and vitamins A and E were determined. Malondialdehyde (MDA) and glutathione peroxidase concentrations were obtained as measures of oxidative stress. Aminotransferase to platelet ratio index (APRI) and fibrosis index (FIB-4) markers were calculated. RESULTS Significant differences were found between HIV/HCV-coinfected and HIV-monoinfected participants in levels of alanine aminotransferase (ALT) (mean±standard deviation: 51.4±50.6 vs. 31.9±43.1 U/L, respectively; P=0.014), aspartate aminotransferase (AST) (56.2±40.9 vs. 34.4±30.2 U/L; P<0.001), APRI (0.52±0.37 vs. 0.255±0.145; P=0.0001), FIB-4 (1.64±.0.91 vs. 1.03±0.11; P=0.0015) and plasma albumin (3.74±0.65 vs. 3.94±0.52 g/dL; P=0.038). There were no significant differences in CD4 cell count, HIV viral load or antiretroviral therapy (ART) between groups. Mean MDA was significantly higher (1.897±0.835 vs. 1.344± 0.223 nmol/mL, respectively; P=0.006) and plasma antioxidant concentrations were significantly lower [vitamin A, 39.5 ± 14.1 vs. 52.4±16.2 μg/dL, respectively (P=0.0004); vitamin E, 8.29±2.1 vs. 9.89±4.5 μg/mL (P=0.043); zinc, 0.61±0.14 vs. 0.67±0.15 mg/L (P=0.016)] in the HIV/HCV-coinfected participants than in the HIV-monoinfected participants, and these differences remained significant after adjusting for age, gender, CD4 cell count, HIV viral load, injecting drug use and race. There were no significant differences in glutathione peroxidase concentration, selenium concentration, body mass index (BMI), alcohol use or tobacco use between groups. Glutathione peroxidase concentration significantly increased as liver disease advanced, as measured by APRI (β=0.00118; P=0.0082) and FIB-4 (β=0.0029; P=0.0177). Vitamin A concentration significantly decreased (β=-0.00581; P=0.0417) as APRI increased. CONCLUSION HIV/HCV coinfection is associated with increased oxidative stress and decreased plasma antioxidant concentrations compared with HIV monoinfection. Research is needed to determine whether antioxidant supplementation delays liver disease in HIV/HCV coinfection.
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Affiliation(s)
- M K Baum
- Florida International University, R. Stempel College of Public Health and Social Work, Miami, FL 33199, USA.
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Vrouenraets SME, Wit FWNM, Fernandez Garcia E, Moyle GJ, Jackson AG, Allavena C, Raffi F, Jayaweera DT, Mauss S, Katlama C, Fisher M, Slama L, Hardy WD, Dejesus E, van Eeden A, Reiss P. Randomized comparison of metabolic and renal effects of saquinavir/r or atazanavir/r plus tenofovir/emtricitabine in treatment-naïve HIV-1-infected patients. HIV Med 2011; 12:620-31. [PMID: 21819530 DOI: 10.1111/j.1468-1293.2011.00941.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of the study was to compare the effects on lipids, body composition and renal function of once-daily ritonavir-boosted saquinavir (SQV/r) or atazanavir (ATV/r) in combination with tenofovir/emtricitabine (TDF/FTC) over 48 weeks. METHODS An investigator-initiated, randomized, open-label, multinational trial comparing SQV/r 2000/100 mg and ATV/r 300/100 mg once daily, both in combination with TDF/FTC, in 123 treatment-naïve HIV-1-infected adults was carried out. The primary endpoint was to demonstrate noninferiority of SQV/r compared with ATV/r with respect to the change in fasting cholesterol after 24 weeks. Secondary outcome measures were changes in metabolic abnormalities, body composition, renal function, and virological and immunological efficacy over 48 weeks. Patients who had used at least one dose of trial drug were included in the analysis. RESULTS Data for 118 patients were analysed (57 patients on SQV/r and 61 on ATV/r). At week 24, changes in lipids were modest, without increases in triglycerides, including a significant rise in high-density lipoprotein (HDL) cholesterol and a nonsignificant decrease in the total:HDL cholesterol ratio in both arms with no significant difference between arms. Lipid changes at week 48 were similar to the changes observed up to week 24, with no significant change in the homeostasis model assessment (HOMA) index. Adipose tissue increased regardless of the regimen, particularly in the peripheral compartment and to a lesser extent in the central abdominal compartment, with an increase in adipose tissue reaching statistical significance in the ATV/r arm. A slight decline in the estimated glomerular filtration rate (eGFR) was observed in both arms during the first 24 weeks, with no progression thereafter. The immunological and virological responses were similar over the 48 weeks. CONCLUSIONS Combined with TDF/FTC, both SQV/r 2000/100 mg and ATV/r 300/100 mg had comparable modest effects on lipids, had little effect on glucose metabolism, conserved adipose tissue, and similarly reduced eGFR. The virological efficacy was similar.
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Affiliation(s)
- S M E Vrouenraets
- Center for Poverty-related Communicable Disorders, Center for Infection and Immunity, and Amsterdam Institute for Global Health and Development, Academic Medical Center, Amsterdam, the Netherlands.
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Baum MK, Rafie C, Sales S, Lai S, Duan R, Jayaweera DT, Page JB, Campa A. C-reactive protein: a poor marker of cardiovascular disease risk in HIV+ populations with a high prevalence of elevated serum transaminases. Int J STD AIDS 2008; 19:410-3. [PMID: 18595880 DOI: 10.1258/ijsa.2007.007207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Blood lipids and high-sensitivity C-reactive protein (hsCRP) are used to assess cardiovascular disease (CVD) risk. We evaluated in a cross-sectional design the relationship of hsCRP to markers of liver function (aspartate and alanine transaminases [AST and ALT, respectively]), CVD risk factors and HIV-disease progression markers in 226 HIV-1 sero-positive drug users. hsCRP showed a significant inverse relationship with ALT and high-density lipoprotein, independent of age, gender, viral load, CD4 cell-count and antiretroviral (ARV) use, and was not significantly associated with HIV-disease progression markers. Serum markers of liver damage, AST and ALT, were associated with lower hsCRP, total cholesterol, low-density lipoproteins and triglycerides. Elevated liver enzymes (> or =40 IU/L) were predictive of hsCRP levels that are considered a low risk for CVD. In conclusion, hsCRP may not be a reliable marker of CVD risk in populations with HIV at-risk for elevated liver enzymes due to high hepatitis B virus/hepatitis C virus prevalence and ARV use.
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Affiliation(s)
- M K Baum
- Robert R Stempel School of Public Health, Florida International University, Miami, FL 33199, USA.
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Belloso W, Ivalo S, Benetucci J, Pugliese D, Garone D, Cahn P, Krolewiecki A, Casiro A, Cassetti I, Bologna R, Duran A, Toibaro J, Rieger A, Vago B, Clumeck N, Kabeya K, Cooper C, Dufresne S, Lalonde R, Walmsley S, Gerstoft J, Mathiesen L, Nielsen H, Obel N, Pedersen C, Lazzarin A, Castagna A, Bruun JN, Gatell JM, Arnaiz J, Blaxhult A, Flamholc L, Gisslén M, Vernazza P, Bingham J, Peters B, Gazzard B, Nelson M, Johnson M, Youle M, Weber J, Scullard G, Brar I, Bouzi V, Brutus A, Jayaweera DT, Mogyoros M, Rodwick BM, Stein D, Wiznia A, Schwartz R, Vandenberg-Wolf MG, Tedaldi E, Dragsted UB, Gerstoft J, Youle M, Fox Z, Losso M, Benetucci J, Jayaweera DT, Rieger A, Bruun JN, Castagna A, Gazzard B, Walmsley S, Hill A, Lundgren JD. A Randomized Trial to Evaluate Lopinavir/Ritonavir versus Saquinavir/Ritonavir in HIV-1-Infected Patients: The Maxcmin2 Trial. Antivir Ther 2005. [DOI: 10.1177/135965350501000608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To assess the rate of protocol-defined treatment failure and safety of lopinavir/ritonavir (LPV/r) and saquinavir/ritonavir (SAQ/r). Design Open-label, prospective, randomized (1:1), international multi-centre trial. Methods Adult HIV-1-infected patients were assigned LPV/r 400/100 mg twice daily or SAQ/r 1000/100 mg twice daily with two or more nucleoside reverse transcriptase inhibitors (NRTIs)/non-NRTIs. All patients, whether on or off the assigned treatment, were followed for 48 weeks. Results Of 339 randomized patients, 324 initiated assigned treatment (intention-to-treat/exposed [ITT/e] population). At 48 weeks, treatment failure occurred in 29/163 (18%) and 53/161 (33%) of patients in the LPV/r and SAQ/r arms, respectively (ITT/e, P=0.002, log rank test). In an analysis that also considered those patients who discontinued treatment as having failed treatment (ITT/e/discontinuation=failure), 40/161 (25%) LPV/r-treated individuals versus 63/161 (39%) SAQ/R-treated individuals failed treatment ( P=0.005, log rank test). Discontinuation of the assigned treatment occurred in 23/163 (14%) patients in the LPV/r-treated group, compared with 48/161 (30%) in the SAQ/r-treated group (ITT/e; P=0.001). The primary reasons for premature discontinuation were non-fatal adverse events (LPV/r: 12/163; SAQ/r: 21/161) and patients’ choice (LPV/r: 7/163; SAQ/r: 8/161). In the on-treatment analysis of time to treatment failure, no difference was observed between the two arms ( P=0.27, log rank test). Conclusion LPV/r had better antiretroviral effects compared with SAQ/r at the doses and in the formulations studied. This may have been a result of patients’ preferences and ability to adhere to assigned therapy, rather than a result of differences in the intrinsic potency of the study protease inhibitors.
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Affiliation(s)
| | | | - S Ivalo
- Hospital Italiano de Buenos Aires
| | | | | | | | | | | | | | | | | | | | | | - A Rieger
- University of Vienna Medical School, AKH
| | - B Vago
- University of Vienna Medical School, AKH
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- Aarhus University Hospital
| | | | | | | | | | | | | | | | | | - M Gisslén
- Sahlgrenska University Hospital/Östra
| | | | | | | | - B Gazzard
- Chelsea and Westminster Healthcare Trust
| | - M Nelson
- Chelsea and Westminster Healthcare Trust
| | | | | | | | | | - I Brar
- Henry Ford Hospital Center
| | - V Bouzi
- Brookdale University Hospital
| | | | | | | | | | | | | | | | | | | | | | | | - Mike Youle
- Royal Free Hospital, London, United Kingdom
| | - Zoe Fox
- Hvidovre University Hospital, Copenhagen, Denmark
| | | | | | | | - Armin Rieger
- University of Vienna Medical School - AKH, Vienna, Austria
| | | | | | - Brian Gazzard
- Chelsea and Westminster Healthcare Trust, London, United Kingdom
| | - Sharon Walmsley
- Toronto Hospital, University Health Network, Toronto, Canada
| | - Andrew Hill
- University of Liverpool, Liverpool, United Kingdom
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Jayaweera DT, Kolber MA, Brill M, Tanner T, Campo R, Rodriguez A, Chu HM, Garg V. Effectiveness and tolerability of a once-daily amprenavir/ritonavir-containing highly active antiretroviral therapy regimen in antiretroviral-naïve patients at risk for nonadherence: 48-week results after 24 weeks of directly observed therapy. HIV Med 2004; 5:364-70. [PMID: 15369512 DOI: 10.1111/j.1468-1293.2004.00236.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine the safety and effectiveness of a once-daily highly active antiretroviral therapy (HAART) regimen in patients at risk for poor adherence using directly observed therapy (DOT) for 24 weeks followed by weekly phone contact for another 24 weeks. METHODS A prospective, open-label pilot study was carried out. Antiretroviral-naïve patients with advanced HIV disease were treated with once-daily amprenavir 1200 mg, ritonavir 200 mg, didanosine 400 mg and lamivudine 300 mg. After 24 weeks, DOT was substituted by weekly phone contact. Measurements of viral load and CD4 cell count, and safety laboratory measurements, were taken regularly for 48 weeks. RESULTS Twenty-two patients were enrolled in the study, of whom 19 completed at least 4 weeks of treatment. Seventeen patients completed 24 weeks and 13 completed 48 weeks. None discontinued treatment as a result of adverse events. The median baseline HIV viral load was 5.29 log(10) HIV-1 RNA copies/mL and the median CD4 cell count was 20 cells/microL. At weeks 24 and 48, 74% of the patients had viral loads <400 copies/mL. At 48 weeks, the median decrease in viral load from baseline was 3.06 log(10) copies/mL, and the median increase in CD4 cell count was 118 cells/microL. The median trough plasma amprenavir concentrations at weeks 1 and 24 were 1.87 and 1.42 microg/mL, respectively. CONCLUSIONS This study suggests that DOT followed by weekly patient contact results in good treatment outcome in this challenging population. The median trough plasma amprenavir concentrations were above the effective concentration of drug that resulted in 90% inhibition of viral load in vivo (EC(90)) for wild-type HIV.
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Affiliation(s)
- D T Jayaweera
- Division of Infectious Diseases, University of Miami School of Medicine, 1500 NW 12th Avenue, 8th Floor West, Miami, FL 33136, USA.
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Chirgwin K, Hafner R, Leport C, Remington J, Andersen J, Bosler EM, Roque C, Rajicic N, McAuliffe V, Morlat P, Jayaweera DT, Vilde JL, Luft BJ. Randomized phase II trial of atovaquone with pyrimethamine or sulfadiazine for treatment of toxoplasmic encephalitis in patients with acquired immunodeficiency syndrome: ACTG 237/ANRS 039 Study. AIDS Clinical Trials Group 237/Agence Nationale de Recherche sur le SIDA, Essai 039. Clin Infect Dis 2002; 34:1243-50. [PMID: 11941551 DOI: 10.1086/339551] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In this international, noncomparative, randomized phase II trial, we evaluated the effectiveness and tolerance of atovaquone suspension (1500 mg orally twice daily) plus either pyrimethamine (75 mg per day after a 200-mg loading dose) or sulfadiazine (1500 mg 4 times daily) as treatment for acute disease (for 6 weeks) and as maintenance therapy (for 42 weeks) for toxoplasmic encephalitis (TE) in patients infected with human immunodeficiency virus. Twenty-one (75%) of 28 patients receiving pyrimethamine (95% lower confidence interval [CI], 58%) and 9 (82%) of 11 patients receiving sulfadiazine (95% lower CI, 53%) responded to treatment for acute disease. Of 20 patients in the maintenance phase, only 1 experienced relapse. Eleven (28%) of 40 eligible patients discontinued treatment as a result of adverse events, 9 because of nausea and vomiting or intolerance of the taste of the atovaquone suspension. Although gastrointestinal side effects were frequent, atovaquone-containing regimens are otherwise well tolerated and safe and may be useful for patients intolerant of standard regimens for toxoplasmic encephalitis.
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Affiliation(s)
- Keith Chirgwin
- Department of Medicine, State University of New York at Brooklyn, NY, USA.
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Jacobson JM, Hafner R, Remington J, Farthing C, Holden-Wiltse J, Bosler EM, Harris C, Jayaweera DT, Roque C, Luft BJ. Dose-escalation, phase I/II study of azithromycin and pyrimethamine for the treatment of toxoplasmic encephalitis in AIDS. AIDS 2001; 15:583-9. [PMID: 11316995 DOI: 10.1097/00002030-200103300-00007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the safety, tolerance and activity of increasing doses of azithromycin in combination with pyrimethamine for the treatment of toxoplasmic encephalitis (TE) in patients with AIDS. DESIGN A phase I/II dose-escalation study of oral azithromycin in combination with pyrimethamine. SETTING Eight clinical sites in the United States. PATIENTS Forty-two adult HIV-infected patients with confirmed or presumed acute TE. METHODS Patients were enrolled into three successive cohorts receiving azithromycin 900, 1200 and 1500 mg a day with pyrimethamine as induction therapy. The induction period was 6 weeks followed by 24 weeks of maintenance therapy. MAIN OUTCOME MEASURES Patient response was evaluated clinically and radiologically. RESULTS Of the 30 evaluable patients, 20 (67%) responded to therapy during the induction period. Ten experienced disease progression. Of the 15 patients who received maintenance therapy, seven (47%) relapsed. Six patients discontinued treatment during the induction period as a result of reversible toxicities. Treatment-terminating adverse events occurred most frequently among the patients receiving the 1500 mg dose. CONCLUSION The combination of azithromycin (900-1200 mg a day) and pyrimethamine may be useful as an alternative therapy for TE among patients intolerant of sulfonamides and clindamycin, but maintenance therapy with this combination was associated with a high relapse rate. The combination was safe, but low-grade adverse events were common.
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Affiliation(s)
- J M Jacobson
- Department of Medicine, Mt Sinai Medical Center, New York, NY 10029, USA
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Cheung TW, Jayaweera DT, Pearce D, Benson P, Nahass R, Olson C, Wool GM. Safety of oral versus intravenous hydration during induction therapy with intravenous foscarnet in AIDS patients with cytomegalovirus infections. Int J STD AIDS 2000; 11:640-7. [PMID: 11057934 DOI: 10.1258/0956462001914995] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We undertook a study to compare the safety of intravenous (i.v.) versus oral hydration to prevent nephrotoxicity associated with the use of foscarnet for induction therapy of cytomegalovirus (CMV) infection in HIV-infected persons. Patients, given foscarnet at a dose of 90 mg/kg every 12 h, were randomized to receive either i.v. or oral hydration. Thirty-seven patients were given i.v. hydration and 44 were given oral hydration. Median duration of therapy for both groups was 17 days. There was no difference between the 2 groups in either serious adverse events or rise of creatinine to > or = 2.0 mg/dl. However, serum creatinine, while generally remained within normal limits, increased more in patients who received oral hydration after 10 days of therapy (significant only by slope analysis, P < 0.05). Although i.v. hydration provided better protection against nephrotoxicity, oral hydration was relatively safe and convenient provided that creatinine clearance (CrCl) is monitored closely.
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Affiliation(s)
- T W Cheung
- Mount Sinai Medical Center, New York, USA.
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Affiliation(s)
- A Verma
- Department of Neurology, University of Miami School of Medicine, FL, USA
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Jayaweera DT, Cassetti LI, Espinoza L, Lopardo GD, Hansman-Whiteman ML, Scerpella EG. [Cytomegalovirus polyradiculomyelopathy in AIDS]. Medicina (B Aires) 1998; 58:135-40. [PMID: 9706245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
To evaluate the efficacy of ganciclovir, foscarnet, or the combination of both for the treatment of cytomegalovirus polyradiculomyelopathy (CMV-PRAM), we reviewed the records of seven patients with AIDS, diagnosed with CMV-PRAM. Muscle strength was graded according to the Medical Research Council (MRC) scale. Response to treatment was also classified according to MRC scale, based on the degree of improvement in muscle strength. Six of 7 patients had a good response to treatment, reaching the MRC scale of 4, or improving at least 3 degrees in the same scale. CMV-PRAM may be treated with ganciclovir alone or in combination with foscarnet.
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Affiliation(s)
- D T Jayaweera
- Department of Medicine, University of Miami School of Medicine, Florida, USA
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Haubrich R, Lalezari J, Follansbee SE, Gill MJ, Hirsch M, Richman D, Mildvan D, Burger HU, Beattie D, Donatacci L, Salgo MP, Berry P, Frechette G, LeFebvre; E, Torres R, Rachlis A, Loveless M, Tai E, Jensen P, Brand D, Hauptman S, Pollard R, Collier A, Hardy WD, Johiro AK, Mitsuyasu RT, Martin M, Klimas N, Gordin F, Gilbert C, Hyslop N, RamirezRonda C, Beall G, Miller S, Thompson M, Smaill F, Henry D, Volberding P, Cohen S, Dobkin J, Pottage J, Powderly W, Spotkov J, Koletar S, Skolnik P, Marlowe S, Hammer S, Baxter J, Kaufman D, Cooper R, Fischl M, Jayaweera DT, Scerpeila E, Sargent S, Turner P, Tsoukas C, MacArthur R, Remick S, Cunniff D, Henry K, Clark R, Snyder R, Boswell S, Sax P. Improved Survival and Reduced Clinical Progression in HIV-Infected Patients with Advanced Disease Treated with Saquinavir plus Zalcitabine. Antivir Ther 1998. [DOI: 10.1177/135965359800300103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this randomized, double-blind, controlled multicentre study was to evaluate the efficacy of saquinavir alone or in combination with zalcitabine compared to zalcitabine monotherapy in reducing progression of human immunodeficiency virus (HIV) disease. Nine hundred and forty HIV-infected patients with more than 16 weeks of prior zidovudine therapy and pre-study entry CD4 cell counts between 50 and 300 cells/mm3 were randomized to saquinavir 600 mg every 8 h, zalcitabine 0.75 mg every 8 h or the combination of both drugs. In an intent-to-treat analysis, the treatment arms were balanced with respect to demographics, baseline HIV RNA (mean 5.0 log10 copies/ml) and CD4 lymphocyte count (mean 170 cells/mm3). More patients in the zalcitabine arm stopped therapy because of toxicity than in the other two arms (25% versus 16%; P=0.005). Peripheral neuropathy was the most common treatment-limiting toxicity. Fifty-one patients in the saquinavir plus zalcitabine group developed an AIDS-defining event or died compared to 84 and 88 in the saquinavir and zalcitabine monotherapy groups respectively. Combination treatment with saquinavir plus zalcitabine reduced the risk of progression to AIDS by 49% (95% confidence interval 0.36 to 0.72, P=0.0001) and reduced death by 68% (95% confidence interval 0.16 to 0.64, P=0.001) compared to zalcitabine monotherapy. The addition of saquinavir to zalcitabine resulted in a significant reduction in progression to AIDS or death compared with zalcitabine alone.
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Affiliation(s)
- Richard Haubrich
- University of California, San Diego, Department of Medicine, San Diego, California
| | - Jacob Lalezari
- University of California, San Francisco, Mt Zion Hospital, San Francisco, California
| | | | - M John Gill
- Department of Medicine, University of Calgary, Alberta, Canada
| | - Martin Hirsch
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Douglas Richman
- University of California, San Diego, Departments of Medicine and Pathology, University of California, San Diego and San Diego Veterans Affairs Medical Center, La Jolla, California
| | | | | | | | | | | | - Paul Berry
- Pacific Oaks Medical Group, Sherman Oaks California:
| | | | | | | | | | - Mark Loveless
- Oregon Health Sciences University, Portland, Oregon:
| | - Edmund Tai
- Camino Medical Group, Sunnyvale, California:
| | - Peter Jensen
- Veterans Administration, San Francisco, California:
| | | | | | | | - Ann Collier
- University of Washington, Seattle Washington:
| | - W David Hardy
- University of California, Los Angeles, CARE Center, Los Angeles, California:
| | - Anna K Johiro
- University of California, Los Angeles, CARE Center, Los Angeles, California:
| | - Ronald T Mitsuyasu
- University of California, Los Angeles, CARE Center, Los Angeles, California:
| | - Maureen Martin
- University of California, Los Angeles, CARE Center, Los Angeles, California:
| | - Nancy Klimas
- Veterans Administration Medical Center, Miami, Florida:
| | - Fred Gordin
- Veterans Administration Medical Center, Washington, DC:
| | | | | | | | - Gildon Beall
- Harbor UCLA Medical Center, Torrance, California:
| | | | | | - Fiona Smaill
- McMaster University Medical Center, Hamilton, Ontario:
| | - David Henry
- Tuttelman Cancer Center, Philadelphia, Pennsylvania:
| | | | - Stuart Cohen
- University of California, Davis, Sacramento, California:
| | | | | | | | - Jared Spotkov
- Kaiser Foundation Hospital, Harbor City, California:
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- St Paul Ramsey Medical Center, St Paul Minnesota:
| | | | - Ron Snyder
- University of California, San Diego, Department of Medicine, San Diego, California:
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el-Dalil AA, Jayaweera DT, Walzman M, Radcliffe KW, Richmond R, Wade AA, Shahmanesh M. Hepatitis B markers in heterosexual patients attending two genitourinary medicine clinics in the West Midlands. Genitourin Med 1997; 73:127-30. [PMID: 9215096 PMCID: PMC1195788 DOI: 10.1136/sti.73.2.127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the prevalence of hepatitis B virus (HBV) infection in heterosexual patients attending two genitourinary medicine (GUM) clinics in the West Midlands and to examine whether heterosexual activity is a risk factor for acquiring HBV infection with the view to extend HBV vaccination policies to cover this group. DESIGN HBV markers were determined in the GUM study group and compared with that of the control groups. Responses to a questionnaire were used to examine sexual behaviour patterns that may be related to heterosexual acquisition of HBV infection. SETTING The West Midlands, UK April 1992-January 1993. SUBJECTS 788 male patients and 688 female patients attending GUM clinics were compared with 498 male blood donors and 563 females attending antenatal clinics for the seroprevalence of HBV markers. Potential risk factors related to heterosexual activity were assessed in 1436 patients in the study group. MAIN OUTCOME MEASURES Prevalence of HBV markers in the GUM study group and the controls. The possible use of the risk factors examined as predictors for acquiring HBV infection. RESULTS The seroprevalence of hepatitis B core antibody (anti-HBc) in GUM patients was 1.9% and 0.5% in the control group. In the study groups the prevalence of anti-HBc from Birmingham was 3.2% while that from Coventry was 0.8%. The low seroprevalence of HBV prevented a multiple logistic analysis. A limited regression analysis showed that being non-white (p < 0.001) and duration of sexual activity (p = 0.013) were risk factors for HBV infection. However, these two factors were poor predictors of the risk to exposure to HBV infection. CONCLUSION The prevalence of HBV infection in heterosexual patients in the West Midlands is very low and does not provide any indications to broaden HBV vaccination into heterosexual patients attending GUM clinics. Risk factors were poor predictors of the exposure to HBV infection. This is partially due to the low prevalence of HBV infection in this study. Further studies are required before definitive conclusions are made regarding the potential predictive value of risk factors.
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Abstract
This article suggests ways to manage the dose-limiting adverse reactions caused by foscarnet so that this agent may be used with confidence as first-line therapy in patients with cytomegalovirus (CMV) disease. Foscarnet (trisodium phosphonoformate) has been used for the treatment of CMV disease in patients who are infected with HIV. Some physicians who treat patients with CMV infection are reluctant to use foscarnet because of the serious adverse effects that may occur, especially during the induction period. The most frequently reported serious adverse effects are nephrotoxicity, electrolyte disturbances, nausea, penile ulcerations and seizures. The nephrotoxicity associated with foscarnet is attributable to renal tubular damage, and may be minimised by calculating and infusing the appropriate dose after hydrating the patient. Monitoring serum electrolyte levels and replacing electrolytes before symptoms occur may limit the development of dosage-limiting toxicities. Nausea occurring during foscarnet infusions may be ameliorated by using antiemetics and slowing the infusion rate. Seizures associated with the use of this agent are mostly a result of the simultaneous presence of other CNS pathologies. Penile ulcers are best managed by stopping the infusion until the ulcers heal; they may be prevented by paying careful attention to personal hygiene.
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Affiliation(s)
- D T Jayaweera
- University of Miami School of Medicine, Florida, USA
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Huengsberg M, Jayaweera DT, Wagstaffe S, Opaneye AA, Wade AA, Shahmanesh M. Toxoplasma seroprevalence in HIV-positive patients in West Midlands. Int J STD AIDS 1995; 6:223. [PMID: 7647131 DOI: 10.1177/095646249500600319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
A review of all the patients diagnosed to have Pediculosis pubis (P pubis) during a 2 year period 1989-1991 was carried out. They constituted the index group and were compared with 140 consecutive patients seen during the month of June 1990, who served as controls. Both groups were comparable with respect to age and use of modern contraception. Coexisting sexually transmitted diseases (STDs) were found in 37% of the index group. Incidence of STDs was 51% among the controls. In the preceding 3 months, patients in the index group had significantly more sexual partners p < 0.005. These findings emphasize the need to offer full STD screening and health education to sexually active people who present with P pubis.
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Affiliation(s)
- A A Opaneye
- Department of Genitourinary Medicine, Coventry & Warwickshire Hospital
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Barlow M, Jayaweera DT, Wade AA, Walzman M. Laboratory techniques for the diagnosis of chlamydia infections. Genitourin Med 1991; 67:522. [PMID: 1774060 PMCID: PMC1194781 DOI: 10.1136/sti.67.6.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Jayaweera DT, Vinasithambi S, Abeyawardane BY, Nimalasuriya A, Mihindukulasuriya JC, Perera SM, Machado V, Dharmadasa K. Extrapyramidal manifestations in cerebral malaria. Ceylon Med J 1977; 22:64-5. [PMID: 630656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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