Management Of Opportunistic Infections Research Articles

Mainstreaming Hiv/Aids in Housing Developments and Planning in Swaziland

Swaziland is one of the countries with the highest Human Immune-deficiency Virus (HIV) rates in the world. Consequently, the increased need for care and support for people living with Acquired Immune-deficiency Syndrome (AIDS), as well as orphaned and vulnerable children, is unprecedented. The response to combat the HIV epidemic has been evident in many areas as the country continues its fight against the HIV epidemic. However, efforts to provide care and support - including Anti-Retroviral Therapy (ART), management of opportunistic infections, and community home-based care - have, so far, largely stemmed from the health sector. Housing care and other non-medical support is continuing to lag behind. Lack of proper housing is one of the deprivations suffered by orphaned children and people living with AIDS, which predisposes them to attacks by opportunistic infections and other vulnerabilities and disrupts the continuum of care, whilst at times denying occupants the required privacy. This paper focuses on creating an understanding of why housing care and support for HIV and AIDS affected is lagging behind in Swaziland. It suggests cultural, economic, political and policy issues as the underlying reasons for this, and, therefore, concludes that there is need for bold policy reforms in these areas. In order to create a proper framework for such reforms, the paper reviews the following: 1. The national housing policy's implications on the care and support for people living with HIV and AIDS and the orphaned and vulnerable children; and 2. The current human settlements related responses to HIV and AIDS in Swaziland's rural, peri-urban and urban areas. In this context, urban development planning paradigms and the extent to which HIV and AIDS is being integrated into the development plans are discussed.

British HIV Association and Children's HIV Association guidelines for the management of HIV infection in pregnant women 2008

Top of page Abstract Introduction 1.0 Summary of recommendations 2.0 Scenarios: interventions to reduce mother-to child transmission of HIV 3.0 Background: UK prevalence of HIV in pregnancy and risk of transmission 4.0 Antenatal HIV testing 5.0 Preconception and fertility management in men and women infected with HIV 6.0 Sexual health of HIV-positive pregnant women 7.0 Psychosocial issues 8.0 Viral load and resistance 9.0 Management of HIV-related complications in pregnancy 10.0 Antiretroviral therapy in pregnancy: efficacy 11.0 Antiretroviral therapy in pregnancy: toxicity 12.0 Antiretroviral therapy and pregnancy: pharmacokinetics 13.0 Obstetric management of pregnancy and delivery 14.0 Pregnancy in women with HIV-2 infection 15.0 HIV and hepatitis B and C coinfections 16.0 Management of infants born to HIV-infected mothers 17.0 Infant feeding and HIV transmission during breastfeeding References Appendix

Médicaments immunosuppresseurs et antirétroviraux : une association riche en interactions

The development of highly active antiretroviral therapy has greatly improved HIV-infected patient survival. However, the increased life expectancy associated with the management of opportunistic infections might favour the onset of severe organic failure that could require organ transplantation. The use of immunosuppressive drugs in association with antiretroviral therapy will generate pharmacodynamic and pharmacokinetic interactions. In this context, therapeutic drug monitoring is of great importance to improve therapeutic management of patients.

Twenty-Five Years of HIV/AIDS

![Figure][1] CREDIT: NIH On 5 June 1981, a report in the Morbidity and Mortality Weekly Report ( MMWR ) described five young and previously healthy gay men with Pneumocystis carinii pneumonia (PCP) in Los Angeles. One month later, a second report in MMWR described 26 men in New York and California with Kaposi's sarcoma and 10 more PCP cases in California. No one who read those reports, certainly not this author, could have imagined that this was the first glimpse of a historic era in the annals of global health. Twenty-five years later, the human immunodeficiency virus (HIV), the cause of acquired immunodeficiency syndrome (AIDS), has reached virtually every corner of the globe, infecting more than 65 million people. Of these, 25 million have died. The resources devoted to AIDS research over the past quarter-century have been unprecedented; $30 billion has been spent by the U.S. National Institutes of Health (NIH) alone. Investigators throughout the world rapidly discovered the etiologic agent and established the direct relationship between HIV and AIDS, developed a blood test, and delineated important aspects of HIV pathogenesis, natural history, and epidemiology. Treatment was initially confined to palliative care and management of opportunistic infections, but soon grew to include an arsenal of antiretroviral drugs (ARVs). These drugs have dramatically reduced HIV-related morbidity and mortality wherever they have been deployed. The risk factors associated with HIV transmission have been well defined. Even without a vaccine, HIV remains an entirely preventable disease in adults; and behavior modification, condom use, and other approaches have slowed HIV incidence in many rich countries and a growing number of poor ones. With most pathogens, this narrative would sound like an unqualified success story. Yet it is very clear that scientific advances, although necessary for the ultimate control of HIV/AIDS, are not sufficient. Many important challenges remain, and in several of these the global effort is failing. New infections in 2005 still outstripped deaths by 4.1 to 2.8 million: The pandemic continues to expand. Despite substantial progress, only 20% of individuals in low- and middle-income countries who need ARVs are receiving them. Worldwide, fewer than one in five people who are at risk of becoming infected with HIV has access to basic prevention services, which even when available are confounded by complex societal and cultural issues. Stigma and discrimination associated with HIV/AIDS, and sometimes community or even governmental denial of the disease, too often dissuade individuals from getting tested or receiving medical care. Women's rights remain elusive at best in many cultures. Worldwide, thousands of women and girls are infected with HIV daily in settings where saying no to sex or insisting on condom use is not an option because of cultural factors, lack of financial independence, and even the threat of violence. ![Figure][1] CREDIT: MALCOLM LINTON In the laboratory and the clinic, HIV continues to resist our efforts to find a cure (eradication of the virus from an infected individual) or a vaccine. In 25 years, there has not been a single well-documented report of a person whose immune system has completely cleared the virus, with or without the help of ARVs. This is a formidable obstacle to the development of an effective vaccine, for we will need to do better than nature rather than merely mimic natural infection, an approach that has worked well with many other microbes. The development of next-generation therapies and prevention tools, including topical microbicides that can empower women to directly protect themselves, will require a robust and sustained commitment to funding the best science. Meanwhile, as we enter the second quarter-century of AIDS, we know that existing HIV treatments and prevention modalities, when appropriately applied, can be enormously effective. Programs such as President Bush's Emergency Plan for AIDS Relief; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; and the efforts of philanthropies and nongovernmental organizations have clearly shown that HIV services can indeed be delivered in the poorest of settings, despite prior skepticism. We cannot lose sight of the fact that these programs must be sustained. As we commemorate the first 25 years of HIV/AIDS and celebrate our many successes, we are sobered by the enormous challenges that remain. Let us not forget that history will judge us as a global society by how well we address the next 25 years of HIV/AIDS as much as by what we have done in the first 25 years. [1]: pending:yes

Management of opportunistic infections in solid-organ transplantation

Solid-organ transplantation is often the last alternative in many patients with end-stage organ disease. Although advances in immunosuppressive regimens, surgical techniques, organ preservation, and overall management of transplant recipients have improved graft and patient survival, infectious complications remain problematic. Bacterial, fungal, viral, and parasitic infections are implicated after transplantation depending on numerous factors, such as degree of immunosuppression, type of organ transplant, host factors, and period after transplantation. Proper prophylactic and treatment strategies are imperative in the face of chronic immunosuppression, nosocomial and community pathogens, emerging drug resistance, drug-drug interactions, and medication toxicities. This review summarizes the pathophysiology, incidence, prevention, and treatment strategies of common posttransplant infections.

Management of opportunistic infections in solid-organ transplantation.

Solid-organ transplantation is often the last alternative in many patients with end-stage organ disease. Although advances in immunosuppressive regimens, surgical techniques, organ preservation, and overall management of transplant recipients have improved graft and patient survival, infectious complications remain problematic. Bacterial, fungal, viral, and parasitic infections are implicated after transplantation depending on numerous factors, such as degree of immunosuppression, type of organ transplant, host factors, and period after transplantation. Proper prophylactic and treatment strategies are imperative in the face of chronic immunosuppression, nosocomial and community pathogens, emerging drug resistance, drug-drug interactions, and medication toxicities. This review summarizes the pathophysiology, incidence, prevention, and treatment strategies of common posttransplant infections.

The management of opportunistic infections and cancer in HIV disease

(2004). The management of opportunistic infections and cancer in HIV disease. South African Family Practice: Vol. 46, No. 3, pp. 10-20.

The use of growth factors and cytokines to treat opportunistic infections in HIV-1 disease

The success of highly active antiretroviral therapy (HAART) in reducing AIDS-related mortality means that in regions where HAART is available, HIV infection may now be regarded as a chronic disease. However the inability of HAART to eliminate HIV-1 from various anatomical and cellular reservoirs within the body means that HIV-infected individuals require life-long treatment with therapy that can have significant side effects. Management of HIV disease is therefore increasingly focused on drug-related toxicities and the improvement of current HAART regimens. Here we review the potential use of immunomodulatory cytokines to directly or indirectly stimulate the mononuclear phagocyte system as adjuncts to current HIV treatment as well as their use in the management of opportunistic infections in individuals who develop immunodeficiency. We argue that cytokines, which stimulate mononuclear phagocyte activity against opportunistic pathogens, may be useful for the treatment of individuals who develop recurrent opportunistic infections. Cytokines may act synergistically with antimicrobial agents to improve outcomes, which is of particular importance since recurrent infections frequently result in resistance to standard antimicrobial treatments. Before their use can be advocated however, given their toxicity and significant cost, the potential benefits of cytokines must be demonstrated in larger clinical trials.

Occurrence and Management of Opportunistic Infections Associated with HIV/AIDS in Asia

Illnesses, diseases and malignancies occur among HIV-infected individuals along a continuum. These are directly correlated with the degree of immune suppression and are caused by common patho gens and opportunistic infections. In decreasing order offrequency, frequent opportunistic infections and malignancies that occur in Asia are: Mycobacterium tuberculosis, Cryptococcus neoformans, Candida spp., Herpes simplex, Cryptosporidium parvum, Pneumocystis carinii, Toxoplasma gondii, non-Hodgkin's lymphoma and Kaposi's sarcoma. The association of morbidityand mortality due to co-infection with HIV and M.tuberculosis has become more evident in the region. Natural history studies conducted in Mumbai and Bangkok have reported incubation periods from infection to AIDS of eight and nine years respectively. Despite the advent of antiretroviral therapy (ART) and improved affordability of the generic drugs, only 30,000 (2 to 3 per cent) of the estimated 1.3 million eligible persons with AIDS in South Asia are presently on AR T. Apparently, the focus of the low-cost care in the region still continues to be of care and management of prevalent opportunistic infections. As care practices start to include ART over the next few years, there will be consequent change in the occurrence of opportunistic infections and need for their prophylaxis.

Management of opportunistic infections in pediatric HIV.

Human immunodeficiency virus (HIV) causes a chronic infection that leads to profound immunosuppression. A hallmark of this process is the depletion of CD4+ lymphocytes, which predisposes the patient to develop a variety of opportunistic infections and certain neoplasms. The CD4+ lymphocyte count is the best validated predictor of the likelihood of developing opportunistic infections (OI). Susceptibility to OI increases as HIV induced immunosuppression becomes more severe. The management of HIV infection hence involves not only inhibiting viral replication using antiretroviral drugs, but also treating OI. This article focuses on the management of such commonly occurring OI in HIV infected patients.

The management of lymphoma in the immunosuppressed patient

Two forms of acquired immunodeficiency have dominated the last quarter of the twentieth century and are responsible for the majority of lymphomas in the immunosuppressed: post-transplantation lymphoproliferative disorders (PTLD) and AIDS-related lymphomas (ARL). The central role of Epstein–Barr virus in PTLD has led to novel treatment strategies designed to enhance immunity to this virus both as prevention and therapy. This is achieved by reducing iatrogenic immunosuppression and adoptive immunotherapy with allogeneic cytotoxic T-lymphocytes. Improved immune function in HIV seropositive patients treated with highly active antiretroviral therapy appears to be reducing the relative risk of AIDS-related lymphoma. However, ARL will remain a frequent diagnosis with the rapidly rising incidence of HIV throughout the world. The clinical management requires expertise in both the lymphoma chemotherapy and the treatment of HIV, including antiretroviral therapy and opportunistic infection management. Modest improvements in survival have been achieved recently for ARL.

Treatment of Fungal Infections With ABLC in the Home-Care Setting

Invasive fungal infections are an important cause of morbidity and mortality in HIV-infected individuals. The management of opportunistic infections in a home-care setting offers many psychological and economic advantages over hospitalization. Amphotericin B, the gold standard treatment for invasive fungal infections, is associated with significant adverse reactions, particularly nephrotoxicity, that make it difficult to administer as home infusion therapy. Lipid formulations of amphotericin B offer therapeutic alternatives to the parent compound with comparable efficacy, significantly lower rates of nephrotoxicity, and decreased infusion times versus the conventional form. Clinical experience with amphotericin B lipid complex injection in the treatment of fungal infections demonstrates its usefulness as an effective alternative to conventional amphotericin B in home infusion therapy.

EARLY DIAGNOSIS IN POST RENAL TRANSPLANT OPPORTUNISTIC INFECTIONS: A FRESH LOOK

A total of 86 renal transplant patients who were transplanted with live related donor (LRD) and live unrelated donor (LURD) kidneys were studied for opportunistic infections. Immune diagnosis of Toxoplasma, Cytomegalovirus (CMV), Herpes-simplex virus type II (HSV-2), Aspergillosis and Tuberculosis was carried out in these patients along with sputum examination, CSF studies and biopsy of lymphnode and other tissues in few cases. A high degree of Toxoplasma, CMV & HSV-2 positivity was seen in transplanted patients. However sensitivity of serological diagnosis of tuberculos was found to be low with standard criteria, which increased significantly when modified criteria were used. It is concluded that regular immunological monitoring should be carried out in transplanted patients so as to reach an early diagnosis and management of opportunistic infections.

Management of CMV retinitis in HIV infected patients.

common opportunistic manifestation of HIV disease ranging from 10% to 40% during AIDS.'2 CMV retinitis is most common manifestation. From 1991 to 1996, CMV infection had been diagnosed in 632/1971...

Opportunistic Infection and Immunologic Function in Patients with AIDS-Associated Lymphoma Treated with Chemotherapy

The incidence of systemic non-Hodgkin's lymphoma (NHL) is higher in the human immunodeficiency virus (HIV)-infected population than in the uninfected population. Standard treatment for this cancer involves the administration of systemic chemotherapy. Our objective was to determine the relative risk of opportunistic infection and the relative change in immunologic function in a cohort of patients who had HIV-associated non-Hodgkin's lymphoma(NHL) and who were treated with combination chemotherapy compared with a matched cohort of control subjects who had advanced HIV infection but no signs of NHL. We performed a case-control study in which the clinical course of each patient with HIV-associated NHL (N = 43; case subjects) treated with infusional cyclophosphamide, doxorubicin, and etoposide (CDE) was compared with that of two patients with HIV infection but without lymphoma that were matched for CD4 count and prior opportunistic infection (N = 86; control subjects). Univariate and multivariate analyses were performed to determine whether any of a number of confounding factors (e.g. age, sex, CD4 count, prior opportunistic infection, and prior antiretroviral therapy) could have influenced the risk of developing a first infectious event(defined as opportunistic infection or non-lymphoma death). In the multivariate analysis, being a case subject (RR 2.1, 95% CI = 1.2, 3.6;P <.01), having a low CD4 count (RR 2.1, 95% CI = 1.2, 3.9;P <.05), and being female (RR 3.0, 95% CI = 1.8, 5.6; P <.001) were the only characteristics associated with an increased risk of a first event. In the univariate analysis, other factors associated with an increased risk included prior Pneumocystis carinii pneumonia, any prior opportunistic infection, and prior antiretroviral therapy. When the mean CD4 lymphocyte count at one year was compared with baseline, there was a significantly greater decrease in the CD4 count among case subjects than among control subjects (mean decrease 99/uL ∟+ SD 138/uL| versus 29/uL∟+ SD 100/uL; P = .03). Treatment of HIV-associated NHL patients with a nonsteroid containing chemotherapy regimen was associated with a significant and sustained reduction in the CD4 lymphocyte count and a two-fold increase in the risk of developing opportunistic infection. Oncologists and other physicians who treat patients with HIV-associated NHL should be familiar with the prophylaxis, recognition, and management of opportunistic infection. In addition, there is a need to identify effective strategies for the amelioration of chemotherapy-induced immunosuppression in this population.

Opportunistic infection and immunologic function in patients with human immunodeficiency virus-associated non-Hodgkin's lymphoma treated with chemotherapy.

The incidence of systemic non-Hodgkin's lymphoma (NHL) is higher in the population infected with human immunodeficiency virus (HIV) than in the uninfected population. Standard treatment for this cancer involves the administration of systemic chemotherapy. Our objective was to determine the relative risk (RR) of opportunistic infection and the relative change in immunologic function in a cohort of patients who had HIV-associated NHL and who were treated with combination chemotherapy and to compare them with those in a matched cohort of control subjects who had advanced HIV infection but no signs of NHL. We performed a case-control study in which the clinical course of each patient with HIV-associated NHL (n = 43; case subjects) treated with infusional cyclophosphamide, doxorubicin, and etoposide was compared with that of two patients with HIV infection but without lymphoma who were matched for CD4 lymphocyte count and prior opportunistic infection (n = 86; control subjects). The patients' medical records were reviewed for all information related to acquired immunodeficiency syndrome (AIDS)-defining opportunistic infections, survival, cause of death, and lymphocyte subset analyses. Univariate and multivariate analyses were performed to determine whether any of a number of confounding factors (e.g., age, sex, CD4 count, prior opportunistic infection, and prior antiretroviral therapy) could have influenced the risk of developing a first infectious event (defined as opportunistic infection or nonlymphoma death). All P values resulted from two-sided statistical tests. In the univariate analysis, a significantly greater risk for a first event was associated with being a case subject (RR = 1.8; 95% confidence intervals [CI] = 1.1-3.0; P < .05), having a low CD4 count (< 100/microL) (RR = 3.1; 95% CI = 1.8-5.4; P < .0001), being female (RR = 1.7; 95% CI = 1.1-3.3; P < .05), having prior Pneumocystis carinii pneumonia (RR = 3.5; 95% CI = 1.9-6.3; P < .0001), having any prior opportunistic infection (RR = 3.6; 95% CI = 2.1-6.4; P < .0001), and having prior antiretroviral therapy (RR = 1.9; 95% CI = 1.1-3.3; P < .05). In the multivariate analysis, however, being a case subject (RR = 2.1; 95% CI = 1.2-3.6; P < .01), having a low CD4 count (RR = 2.1; 95% CI = 1.2-3.9; P < .05), and being female (RR = 3.0; 95% CI = 1.8-5.6; P < .001) were the only characteristics associated with an increased risk of a first event. When the mean CD4 lymphocyte count at approximately 1 year was compared with that at baseline, there was a significantly greater decrease in the CD4 count among case subjects than among control subjects (mean decrease +/- standard deviation [SD] = 99/microL +/- 138/microL versus 29/microL +/- 100/microL; P = .03). Treatment of patients who have HIV-associated NHL with a non-steroid-containing chemotherapy regimen was associated with a significant and sustained reduction in the CD4 lymphocyte count and a twofold increase in the risk of developing opportunistic infection. Oncologists and other physicians who treat patients with HIV-associated NHL should be familiar with the prophylaxis, recognition, and management of opportunistic infection. In addition, there is a need to identify effective strategies for the amelioration of chemotherapy-induced immunosuppression in this population.

Management of malignancy in HIV infection.

The prevalence of HIV-related malignant disease is increasing, probably due to more effective management of opportunistic infection. The most frequent tumours are Kaposi's sarcoma, systemic non-Hodgkin's lymphoma and primary central nervous system lymphoma. Management of these conditions must take into account host indicators of immunosuppression and prognostic outcome in order to minimise treatment associated complications.

Azithromycin in the management of opportunistic infections

Azithromycin in the management of opportunistic infections

Management Of Opportunistic Infections In Patients With HIV Infection: Update

From the Division of Infectious diseases, The Johns Hopkins Medical Institutions, Baltimore, Maryland

HIV-mediated B-lymphocyte activation and lymphomagenesis

Non-Hodgkin's (1ii)lymphoma is an AIDS-defining event in a significant percent of U.S. patients infected with the human immunodeficiency virus (HIV). Advances in anti-retroviral treatment and management of opportunistic infection have been accompanied by an increase in the incidence of these lymphomas. In the immunocompromised state of patients late in the course of HIV infection, these lymphomas represent a complication of HIV infection that is associated with an extremely poor prognosis. Currently, there is little understanding of the pathogenesis of HIV-associated lymphomas, which are nearly exclusively of B-cell origin. Experimental data do not support HIV infection in these lymphomas. While some lymphomas show evidence of EBV infection, the majority do not. Polyclonal B-cell hyperactivity during the early phases of HIV infection argues that chronic B-cell stimulation may be the major process predisposing B-cells in the HIV-infected individual to malignant transformation. The mechanism of this stimulation of normal B cells and its relationship to AIDS-associated lymphomas remain poorly understood. In this review, we will summarize current information on HIV-associated B lymphoma and then discuss our views on the association and regulation of HIV-related hyperactivity on the pathogenesis of this lymphoma.