Document 0718
 DOCN  M94A0718
 TI    Ian Thompson Memorial Lecture. Opportunistic infections in people with
       HIV.
 DT    9412
 AU    van der Horst C; University of North Carolina.
 SO    Annu Conf Australas Soc HIV Med. 1993 Oct 28-30;5:21 (abstract no.
       TPI-6). Unique Identifier : AIDSLINE ASHM5/94348937
 AB    In the last 10 years of the HIV epidemic therapeutic advances on the
       frontier of opportunistic infections have done more to prolong the
       quality and length of life for affected people than anti-retrovirals.
       Pneumocystis carinii pneumonia is less often seen due to widespread
       prophylaxis with trimethoprim-sulfamethoxazole one double strength
       tablet daily when a person's CD4 drops below 200 cells/mm3. Two other
       commonly used regimens for prophylaxis include monthly aerosolized
       pentamidine (300 mg) and daily dapsone 50 mg along with pyrimethamine 50
       mg once each week. Systemic regimens although more toxic offer the added
       benefit of prophylaxis against Toxoplasma gondii encephalitis, a disease
       of increasing incidence in seropositive individuals whose CD4 count
       drops below 100 cells/mm3. The treatment of PCP is still problematic.
       The drug of choice is tmp/smx 15-20 mg/kg (trimethoprim component) in 4
       doses for 21 days with the addition of prednisone for those patients
       with a pO2 less than 70. The next drug remains intravenous pentamidine
       3-4 mg/kg daily. Although it can be highly toxic I think it is still
       superior to all the other oral regimens which include atovaquone (poorly
       absorbed), clindamycin/primiquine and dapsone/trimethoprim (less well
       studied), or aerosolized pentamidine (only for mild disease). The
       diagnosis of toxoplasma encephalitis has moved away from brain biopsy to
       empiric therapy with either sulfadiazine/pyrimethamine or
       clindamycin/pyrimethamine for patients with ring enhancing lesions on CT
       scan and positive serology for toxo. Cryptococcal neoformans meningitis
       unlike the above 2 diseases is not a reactivation of a childhood
       illness. Rather this disease results when an immunocompromised person
       inhales the yeast. Any patient with a fever and headache warrants a
       workup for this infection. Some patients present with fever alone and a
       positive cryptococcal antigen test. With a 10 week mortality of 20%
       aggressive therapy is warranted and all patients should receive a 2 week
       induction with amphotericin 0.7 mg/kg daily and flucytosine 25 mg/kg 4
       times each day. If the patient clinically improves and is alert this can
       be followed by 8 weeks of fluconazole 400 mg per day or more. Culture of
       CSF at week 10 should determine the total length of this aggressive
       regimen. Disseminated mycobacteria avium complex is often the last major
       infection of people with HIV infection. The recently completed trials of
       rifabutin prophylaxis for MAI have not convinced most US investigators
       to use this agent widely. Patients with unexplained fevers, weightloss,
       anemia and a rising alkaline phosphatase should have their blood
       cultured for MAI and be started on a regimen of clarithromycin 1000 mg
       twice each day, clofazimine 100 mg daily and ethambutol 15 mg/kg daily.
 DE    Adult  Anti-Infective Agents/ADVERSE EFFECTS/*THERAPEUTIC USE
       AIDS-Related Opportunistic Infections/*DRUG THERAPY/ETIOLOGY  Child
       Cryptococcus neoformans/DRUG EFFECTS  Dose-Response Relationship, Drug
       Drug Administration Schedule  Drug Therapy, Combination  Human
       Meningitis, Cryptococcal/DRUG THERAPY  Mycobacterium
       avium-intracellulare Infection/DRUG THERAPY  Pneumonia, Pneumocystis
       carinii/DRUG THERAPY  Trimethoprim-Sulfamethoxazole Combination/ADVERSE
       EFFECTS/  THERAPEUTIC USE  MEETING ABSTRACT

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       protected by Copyright Law (Title 17, U.S.Code).