Document 0697
 DOCN  M95A0697
 TI    Management of late-stage AIDS grows more complex. 
 DT    9510
 SO    AIDS Alert. 1995 Apr;10(4):50-2. Unique Identifier : AIDSLINE
       AIDS/95700224
 AB    The question of what to do for patients with late-stage AIDS becomes
       more complicated as new research reinforces the value of early treatment
       and prophylaxis for HIV patients. Decisions ranging from cost and
       quality of life to toxicity and multiple drug interactions all must be
       taken into account. Pneumocystis carinii pneumonia (PCP) still is the
       most common adverse event in the last six months of life, with wasting
       syndrome being second, followed closely by Mycobacterium avium complex
       (MAC) and cytomegalovirus (CMV). Although prophylaxis trials for
       opportunistic infections have shown significant reduction in disease
       prevalence, preventive therapy has not been shown to improve survival to
       any significant degree except when given for PCP. Studies indicate that
       for patients with PCP, trimethoprimsulfamethoxazole (TMP-SMX) is most
       effective, followed by Dapsone and aerosole pentamidine. MAC, rifabutin,
       and, more recently, clarithromycin are each effective in reducing MAC
       bacteremia by one-half. But survival benefits from MAC prophylaxis are
       not clear. Similarly, oral ganciclovir reduces the incidence of CMV
       retinitis; however, there is no definitive data yet for increased
       survival when used as a prophylaxis. Other studies provide insight about
       how certain opportunistic infections predispose patients to future
       infections. One study found that patients who developed PCP had a
       fivefold increased risk of subsequently developing MAC or CMV and a two-
       to threefold increased risk of developing invasive fungal infections.
 DE    AIDS-Related Opportunistic Infections/*COMPLICATIONS/PREVENTION &
       CONTROL  Acquired Immunodeficiency Syndrome/*COMPLICATIONS/DRUG THERAPY
       Antiviral Agents/THERAPEUTIC USE  Disease Progression  Disease
       Susceptibility  Human  Pain/ETIOLOGY  Survival  NEWSLETTER ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).