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The human immunodeficiency virus (HIV, the virus that causes AIDS) attacks and destroys the immune system, making individuals with AIDS very susceptible to other types of infection. Mycobacterium avium (M. avium) is a common bacterial cause of lung infection in patients with AIDS. Once M. avium infects the lungs it can spread (disseminate) to other parts of the body and cause M. avium complex infection (MAC). Many studies have reported that MAC reduces the survival time of patients with AIDS, but the validity of these studies has been challenged. In an attempt to gain a better understanding of the role that MAC plays in altering the survival time of AIDS patients, the medical records were reviewed of 137 AIDS patients attending the San Francisco General Hospital between 1983 and 1986. Thirty-four of the patients were diagnosed with lung infections caused by M. avium. In 22 of the 34 cases, the infection had spread to other parts of the body. When the infection spread to other parts of the body, the survival time of the patient was indeed shortened. It is concluded that a lung infection with M. avium predicts the development of disseminated MAC, and disseminated MAC reduces the survival time of patients with AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

AIDS is caused by infection with the human immunodeficiency virus (HIV). The virus attacks and destroys the immune system, resulting in immunodeficiency or decreased ability to fight infection. People who develop AIDS are more susceptible to opportunistic infections which do not usually affect individuals with normal immune function. Eye infection due to cytomegalovirus (CMV) is common in patients with AIDS. CMV retinitis (inflammation of the retina) is estimated to occur in 6 to 40 percent of this patient population. At present, foscarnet and ganciclovir are the only drugs that have been shown to be effective in treating CMV retinitis. However, foscarnet is not commercially available in the United States, and prolonged treatment with ganciclovir has been reported to cause neutropenia (abnormally low number of white blood cells known as neutrophils). Acyclovir is an antiviral drug that has been used to treat infections with herpes simplex virus and Epstein-Barr virus. This drug has also been shown to be beneficial in treating transplant patients who develop CMV infections. A study was performed to determine if high doses of intravenously administered acyclovir could be effective in treating CMV retinitis in AIDS patients. Twelve men with AIDS and CMV retinitis were treated with ganciclovir for 12 to 14 days. Following this treatment, the patients received daily treatments with acyclovir and zidovudine (AZT). For half the patients retinitis did not progress during 32 days or more of acyclovir and AZT treatment. During the study period, 10 patients who were evaluated did not develop CMV retinitis in the uninfected eye. In a previous study, retinitis spread from one eye to the other in 60 percent of the patients. These findings indicate that, in patients with AIDS, acyclovir may be beneficial for delaying the progression of CMV retinitis and preventing the spread of retinitis to the unaffected eye. (Consumer Summary produced by Reliance Medical Information, Inc.)

The human immunodeficiency virus (HIV) is the causative agent of AIDS. This virus attacks and destroys cells in the immune system, the body's natural defense system for fighting infection. The resulting immunodeficiency makes patients with AIDS susceptible to life-threatening infections. The bacteria Streptococcus pneumoniae is a common cause of pneumonia in patients with HIV infection. Pneumococcal vaccines have been given to patients with AIDS in an attempt to prevent pneumonia, but have produced mixed results. For a vaccine to work, the immune system must make substances (antibodies) that will destroy the invading microorganism. However, it is difficult for immunodeficient patients with AIDS to produce antibodies. Zidovudine (also known as AZT) has been shown to prolong the lives of patients with AIDS. This drug gives the immune system a boost by temporarily increasing the number of immune cells. Consequently, it was suggested that prior AZT treatment might improve the effectiveness of the pneumonia vaccine in this patient population. To test this notion, 38 patients with HIV infection were studied. Twenty-four of the patients, who had AIDS or AIDS-related complex (ARC), were treated with zidovudine for an average of 18 weeks. Eight patients with AIDS/ARC and six asymptomatic patients with HIV infection did not receive AZT. Vaccines were administered to all 38 patients and blood samples were taken to measure the amount of antibody that was produced in response to the vaccine. Following vaccination, the AIDS/ARC patients who received AZT had higher levels of specific antibody in the blood than those who were not treated. The patients with asymptomatic HIV infection had similar amounts of antibody, compared with AZT-treated AIDS/ARC patients. The authors recommend that pneumococcal vaccine should be given early in the course of HIV infection. Patients who have developed AIDS should be treated with AZT for four weeks prior to receiving the vaccine. (Consumer Summary produced by Reliance Medical Information, Inc.)

The human immunodeficiency virus (HIV) is the agent that causes AIDS. The HIV attacks and destroys the immune system (the body's natural defense system for fighting infection). Therefore, patients with AIDS have a greater risk of developing life-threatening infections. Infections that frequently affect patients with immunodeficiency are known as opportunistic infections. One of the most common opportunistic infections in AIDS patients is pneumonia caused by Pneumocystis carinii; it is estimated to occur in 80 percent of all AIDS patients. Drugs such as trimethoprim/sulfamethoxazole and pentamidine are effective in treating Pneumocystis carinii pneumonia, but they may cause adverse side effects. New drugs that are effective, safe and inexpensive are needed. Another common infection in patients with AIDS is tuberculosis caused by Mycobacterium avium. This type of infection is resistant to many forms of drug treatment that are available, and new therapies are needed. The most common type of central nervous system infection in AIDS patients is toxoplasmic encephalitis (TE). It is characterized by inflammation in the brain and is caused by Toxoplasma gondii. Drugs used to treat TE include pyrimethamine and sulfadiazine. These drugs are effective in treating the infection, but are toxic to the patient. Fungal infections frequently occur in patients with AIDS. Infection with Candida albicans accounts for almost 40 percent of all infections affecting AIDS patients. While C. albicans frequently causes nonlife-threatening infection in patients with normal immune function, it causes meningitis (inflammation of the brain and spinal cord) and endocarditis (inflammation in the heart) in patients with immunodeficiency. Amphotericin B is the standard drug used for treatment, but its toxicity limits its use. It is apparent that there are many different types of opportunistic infections that can occur in patients with AIDS and that newer, safer, and more effective drugs are needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection with the human immunodeficiency virus (HIV), which causes AIDS, may be complicated by infection with Mycobacterium avium-intracellulare complex (MAC). This microorganism is present in soil, water, house dust, and plants, and does not usually infect humans. MAC infection may develop when the microorganism has the opportunity to invade tissues, and in people who live in the southeastern United States, where MAC is prevalent. However, MAC infection is usually not persistent due to nonspecific resistance and specific immune mechanisms. Persistent MAC disease occurs under conditions of weakened immunity, such as AIDS. MAC infection in AIDS patients is characterized by the aggregation of bacteria-infected macrophages (a type of defense cell) in various tissues. The factors that influence the infectivity of MAC and the mechanisms for resistance against MAC infections were assessed. Monocytes (a type of white blood cell) of normal subjects were effective in killing a large proportion of MAC, whereas macrophages were less effective against MAC infection. The bactericidal effect of monocytes, or ability of monocytes to kill bacteria, was prevented by interferon-gamma (IFN-gamma), a protein with immune functions. MAC-infected cells exposed to IFN-gamma had higher levels of bacteria than those not treated with IFN-gamma. This suggests that IFN-gamma may activate the growth of MAC within the monocytes. However, IFN-gamma did not enhance MAC survival and growth in macrophages. IFN alpha/A2 had similar effects as IFN-gamma. These findings suggest that the ability of monocytes to kill mycobacteria is controlled by IFN. (Consumer Summary produced by Reliance Medical Information, Inc.)

Salmonella bacteremia or septicemia is infection of the blood with the bacteria Salmonella. The development of this infection is a sign of impaired immunity in patients who have human immunodeficiency virus (HIV), which causes AIDS. The incidence of Salmonella bacteremia before and after the HIV epidemic, and risk factors for recurrent nontyphoidal Salmonella septicemia (RSS) were assessed. Data were obtained from a national laboratory-based Salmonella and AIDS surveillance system. The incidence (number of new cases) of Salmonella infection increased from 2.8 percent between 1978 and 1982 to 14.2 percent between 1983 and 1987 among 25- to 49-year-old men residing in states with a high prevalence of AIDS. The incidence of infection with Salmonella enteritidis and typhimurium have particularly increased. RSS developed in 0.48 percent of adolescents and adults diagnosed with AIDS between September 1987 and March 1990. The risk of RSS was increased among residents of the Northeast, intravenous drug users, blacks, and Hispanics. Hence, the risk of RSS in persons with AIDS is influenced by geographic distribution of Salmonella, patient characteristics, and infective ability of the Salmonella strain. (Consumer Summary produced by Reliance Medical Information, Inc.)

Mycobacterium avium (M. avium) is a bacteria that causes a lung disease that is similar to tuberculosis. It is one of the most common types of bacterial infection in patients with AIDS, and it has been reported to cause death in some of these patients. It is estimated that 18 to 27 percent of the patients infected with the human immunodeficiency virus (HIV, which causes AIDS) are also infected with M. avium. Studies that have examined AIDS patients after they have died have reported that almost 50 percent of the patients had infections due to M. avium. This infection can spread to many different parts of the body including the liver, kidneys, spleen, bone marrow, lymph glands, stomach, intestines, muscles and brain. The most common symptoms of infection are fever, sweating, loss of appetite, weight loss and weakness. Infection with M. avium is diagnosed by testing blood samples for the presence of the bacteria. To determine if the infection is spreading throughout the body, tissue samples are taken from the lymph nodes, bone marrow and liver for further examination. Antibiotic drugs used to treat infections caused by M. avium include isoniazid, clofazimine, ciprofloxacin, ethambutol, amikacin, rifabutin and rifampin. It is common practice to treat infected patients with three or more of these drugs simultaneously because none of the drugs is effective when given alone. A recent study reported improvement in 19 of 20 AIDS patients with M. avium infections who were treated with a combination of amikacin, ciprofloxacin, ethambutol, rifampin, and clofazimine. The use of more than one drug reduces the required dose of each drug, minimizes the severity of side effects, and reduces the chance that the bacteria will become resistant to (not killed by) the drugs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Syphilis is a sexually-transmitted disease that is caused by infection with the microorganism known as Treponema pallidum. The first symptoms usually appear within 30 days and include fever and chancroid skin lesions, or ulcers, on the genital organs. During the early stages of disease, the infection can be treated with penicillin. In rare cases, syphilis can reappear and, in the later stages of disease, can spread to the central nervous system. This condition is called neurosyphilis. It can damage the brain and cause loss of memory and the inability to think clearly. Neurosyphilis was very rare in the United States until recently when it began to occur in patients with AIDS. Infection with the human immunodeficiency virus (HIV) causes AIDS. This virus attacks the immune system (the body's natural defense system for fighting infection) and increases the risk for developing life-threatening infections. There have been many reports of neurosyphilis in patients with AIDS; meningitis (inflammation of the brain and spinal cord membranes), nerve abnormalities and strokes have resulted. One study reported that approximately half of the AIDS patients who developed neurosyphilis had been treated with penicillin during the early stages of syphilis. This indicates that penicillin is not effective in preventing neurosyphilis in all patients with AIDS. New methods of preventing and treating neurosyphilis are needed for AIDS patients who develop syphilis. (Consumer Summary produced by Reliance Medical Information, Inc.)

The human immunodeficiency virus (HIV) attacks and destroys cells of the immune system, called CD4+ T lymphocytes, and drastically reduces the body's ability to fight infection. In the advanced stages of AIDS, HIV causes damage to the central nervous system that results in loss of brain function, called AIDS dementia. Previous studies have shown that patients with AIDS dementia have higher than normal levels of a protein called beta2-microglobulin in their cerebrospinal fluid (CSF, the fluid that surrounds the brain and spinal cord), and it has been suggested that the severity of the dementia is related to the levels of this protein. Also, it has been shown that patients with AIDS have very low levels of CD4+ T lymphocytes in their blood. To determine the relationship between beta2-microglobulin, CD4+ cells, and the severity of AIDS, blood and CSF samples from 163 adults with HIV infection but no neurological symptoms were analyzed. The patients with the highest levels of beta2-microglobulin in their CSF and blood had the lowest numbers of CD4+ cells. The results of this study indicate that high levels of beta2-microglobulin and low numbers of CD4+ cells may be useful for predicting the onset and severity of nervous system damage in patients with AIDS. If this proves to be the case, then the effects of antiviral drugs on beta2-microglobulin levels should be investigated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patients who are infected with the human immunodeficiency virus (HIV), the agent that causes AIDS, are at risk of developing infections, such as Pneumocystis carinii pneumonia, that do not generally affect people with normal immune function. Most patients with AIDS will experience a bout with Pneumocystis carinii pneumonia which, if left untreated, is invariably fatal. Current drugs of choice do not effectively eliminate this parasite, and episodes of pneumonitis frequently recur, suggesting the need for more effective and long-lasting therapy. A new hydroxynaphthoquinone known as compound 566C80 has demonstrated antiprotozoal activity in experimental animals with murine P. carinii pneumonia; in doses of 100 milligrams per kilogram of body weight per day, 566C80 was fully effective in the prevention and treatment of the disease. Phase 1 multidose studies were conducted in five cohorts of four male patients with AIDS to assess dose levels and ascertain the safety and pharmacokinetics of the drug in humans. Participants had not received medical treatment for P. carinii pneumonia in the previous four weeks, and satisfied other experimental parameters. Daily doses of 100, 250, 750, l,500 and 3,000 milligrams of 566C80 were administered to the 5 cohorts, respectively, for 12 or 21 days, after they ate a standard breakfast. A sixth cohort received another dosage regimen to characterize the pharmacokinetic properties of the new compound. The drug was well tolerated up to the maximum dosage in the trial. No significant abnormal clinical findings were attributed to the new compound. Administration of 566C80 with food enhanced its absorption and produced higher blood levels of the drug. The action of this agent suggests that the parasite was killed rather than inhibited; this is an added advantage in the treatment of immunocompromised patients. The apparent successful application of this new class of compounds provides a new category of potentially effective antiprotozoal drugs and offers hope for an effective treatment for P. carinii pneumonitis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Resistance to the antiviral drug ganciclovir has been reported in a small number of AIDS patients with cytomegalovirus (CMV) infections. Drug resistance was based on the patients' clinical responses to therapy. Ganciclovir has been used to treat more than 10,000 patients with CMV infections. A prospective study of 72 patients with AIDS and CMV retinitis (that is, infection of the retina due to CMV) was conducted to assess the prevalence of ganciclovir resistance. All of the patients tested positive for CMV in baseline urine cultures. In pretreatment studies, no ganciclovir-resistant strains were isolated from 31 randomly selected cases. However, ganciclovir-resistant strains of CMV were found in approximately 8 percent of the patients who received treatment for three or more months. Patients with AIDS who receive ganciclovir for CMV infections and experience persistent or advancing CMV disease should be reevaluated; alternative drug therapy should be considered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pneumonia is a common cause of death among patients with human immunodeficiency virus (HIV). Early detection and treatment of pneumonia in these AIDS patients has improved the fatality rate. Corticosteroid treatment, when started early and used in combination with antimicrobial agents, slows the deterioration of pulmonary function in AIDS patients with pneumonia. However, if steroid therapy is initiated after pulmonary deterioration has begun, then there is no clinical benefit. In May 1990, the National Institute of Allergy and Infectious Diseases sponsored an international panel for the development of corticosteroid therapy in the treatment of pneumocystis pneumonia in AIDS patients. The panel concluded that corticosteroid therapy should be used in AIDS patients at risk for respiratory failure. (Consumer Summary produced by Reliance Medical Information, Inc.)

As of January 1990, the World Health Organization received reports of 203,599 persons with AIDS. These cases, from 154 countries, emphasize the global nature of this epidemic. As the human host with human immunodeficiency virus (HIV) infection loses his/her defenses, organisms that are normally under control cause complicating (opportunistic) infections. The renewed virulence of these organisms ultimately leads to conditions that define AIDS, such as Pneumocystis carinii pneumonia, tuberculosis, cytomegalovirus and herpesviruses. Patients diagnosed with these opportunistic infections are often subsequently diagnosed with AIDS. The authors addressed this problem by assessing the potential risk of AIDS and the clinical manifestations consistent with patients' countries of origin. In Africa, most AIDS cases are reported from the central, southern and eastern part of the continent. Another epicenter is located in West Africa. In South America, 77 percent of all cases are reported from Brazil, Haiti, Mexico and the Dominican Republic. By comparison, Asia reported only 464 cases of AIDS, and Japan reported about 100 cases. Because of the nature of AIDS, substantial underreporting is likely. Three major patterns of incidence are described. In the pattern I region, including the US, western Europe, and Australia, HIV transmission occurs predominantly through intravenous drug abuse and homosexual contact. In Latin America, also part of this region, homosexual contact is the usual mode of transmission. In the pattern II region, including sub-Saharan Africa and the Caribbean, heterosexual transmission of HIV predominates. In the pattern III region, including Asia, eastern Europe, the Middle East and North Africa, the pattern of HIV transmission is yet to be discerned. AIDS precipitates exacerbations of pre-existing, but latent or controlled pathogens. The patterns of these diseases are described according to the African, Latin American, and Haitian patterns. The uncommon opportunistic infections that a particular population of AIDS patients develops will reflect the lifetime exposure of those individuals. Consequently, these infections will vary according to the patients' countries of origin. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patients with AIDS have compromised immune systems and are at greater risk for the development of opportunistic infections. Fungal infections that are common among AIDS patients include candidiasis (lesions in the skin or mouth), disseminated histoplasmosis (a form of pneumonia), and cryptococcal meningitis (inflammation of the membranes surrounding the brain and spinal cord). Fungal infections among patients with AIDS and the azole group of antifungal agents are reviewed. Cryptococcus neoformans (carried and transmitted by pigeon fecal matter) is the most common and life-threatening fungal infection in AIDS patients. Infection with Cryptococcus neoformans usually results in meningitis. The standard therapy for cryptococcal meningitis involves treatment with amphotericin B alone or in combination with flucytosine. Ketoconazole and miconazole do not readily penetrate into the cerebrospinal fluid (CSF) and thus are not very effective in treating meningitis. Recently, fluconazole was approved by the Food and Drug Administration (FDA) for the treatment of cryptococcal meningitis. In drug trial studies, fluconazole was effective in converting positive CSF cultures (cultures with cryptococcal meningitis) to negative cultures in 33 of 46 patients tested. In a larger drug study, fluconazole was found to be as effective as amphotericin B in converting positive CSF cultures to negative cultures. Itraconazole is a new drug, not yet approved by the FDA, that is currently undergoing preliminary trials for the treatment of cryptococcal meningitis. In AIDS patients with disseminated histoplasmosis, amphotericin B is one of the best available therapeutic agents; in one study, treatment with amphotericin B resulted in clinical improvement in 90 percent of patients. Ketoconazole and clotrimazole have been used successfully in the treatment of Candida infections in patients with AIDS. Preliminary studies with fluconazole indicate that it may also be useful in treating Candida infections. (Consumer Summary produced by Reliance Medical Information, Inc.)

Human immunodeficiency virus (HIV) is the causative agent of AIDS. Individuals with HIV infection have suppressed immune systems and are at greater risk for developing opportunistic infections. Herpes simplex virus (HSV) is a common infection among patients with HIV, and acyclovir is the usual treatment for HSV infection in these patients. For acyclovir to work, it must be activated by an enzyme called thymidine kinase (TK), which is present in the virus. However, some mutant strains of HSV lack the TK enzyme, and thus are not killed by acyclovir. These strains of HSV are called acyclovir-resistant. Acyclovir-resistant HSV type 2 (HSV-2) was isolated from a 24-year-old female patient with AIDS. The patient had no prior history of intravenous drug use, blood transfusions or herpes genitalis (genital herpes). She was treated with acyclovir, intermittently, for five months. During the initial stages of acyclovir therapy the genital lesions responded to the treatment, but did not heal completely. When HSV-2 was isolated from the patient and grown in culture, the combination of acyclovir and interferon reduced viral replication by greater than 97 percent. However, when administered to the patient, the combination of acyclovir and interferon only resulted in partial clinical improvement. Intravenous treatment with foscarnet for 10 to 12 days controlled severe ulceration of the lesions, but clinical improvement only lasted for 6 months. When HSV-2 infection recurred, the HSV-2 was resistant to both acyclovir and foscarnet. (Consumer Summary produced by Reliance Medical Information, Inc.)

Human immunodeficiency virus (HIV) attacks and weakens the immune system, thereby increasing host susceptibility to opportunistic infection. The later stages of HIV infection are often accompanied by pneumonia. Recent reports have indicated that tuberculosis may be related to HIV infection. HIV-positive intravenous drug users in New York city were reported to have an increased incidence of tuberculosis. In order to examine the relationship between tuberculosis and HIV, blood samples from patients diagnosed with tuberculosis were screened for the presence HIV antibodies. The study group was selected from 128 diagnosed cases of tuberculosis reported at the San Francisco Department of Public Health Tuberculosis Clinic between July 1986 and May 1988. Out of the 128 patients diagnosed with tuberculosis, 60 agreed to participate in the study. The mean time between tuberculosis diagnosis and HIV testing was three months. Twenty-eight percent of the tuberculosis patients participating in the study had antibodies to HIV. Ten percent of the 68 patients diagnosed with tuberculosis who did not participate in the study were diagnosed as having AIDS. Therefore, out of all the diagnosed cases of tuberculosis, 19 percent had antibodies to HIV. Tuberculosis was the first opportunistic infection to occur in 88 percent of those diagnosed as HIV-positive. The were no clinical or pathological differences in the tuberculosis diagnosed in the HIV-positive and the HIV-negative patients. Risk factors associated with HIV included homosexual behavior and intravenous drug use. It is concluded that tuberculosis is an important early opportunistic infection occurring in HIV patients. It is recommended that patients with tuberculosis be tested for HIV, especially those living in areas were HIV infection is prevalent. (Consumer Summary produced by Reliance Medical Information, Inc.)

Human immunodeficiency virus (HIV) is the causative agent of acquired immune deficiency syndrome (AIDS). Patients with AIDS have suppressed immune systems and are thus prone to opportunistic infections, such as by Mycobacterium avium-intracellulare complex (MAC). Symptoms of MAC infection include sweats, fever, lethargy, cough, abdominal pain and headache. Since MAC is resistant to many different antibacterial agents, drug treatment protocols have been redesigned to include a multiple drug approach. Rifabutin and clofazimine are commonly used and are effective in treating certain strains of MAC. A quadruple drug therapy program for the treatment of AIDS patients with MAC was initiated at the Fairfield Infectious Diseases Hospital in Melbourne, Australia. The treatment regimen included isoniazid, ethambutol, clofazimine and rifabutin. Blood samples were analyzed for the presence of Mycobacterium. Prior to drug treatment, all of the patients had reduced numbers of T-lymphocytes (cells that stimulate antibody production) in their blood, indicating that patients were immunodeficient. In 22 out of 25 patients, the Mycobacterium infection disappeared and did not return during a four-week follow-up period. In 16 out of 25 patients, the infection disappeared and did not return for up to 72 weeks. MAC isolated from blood samples was resistant to clofazimine, isoniazid and ethambutol when these drug were tested individually. Sixteen of 24 MAC samples isolated from blood were resistant to rifabutin. It is concluded that the quadruple drug treatment protocol used in this study appears to be effective in clearing mycobacteremia and in alleviating the symptoms associated with infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pneumocystis carinii (Pc) pneumonia occurs in more than 80 percent of AIDS cases, and is one of the primary causes of death in patients with AIDS. The current therapy for Pc pneumonia consists of trimethoprim-sulfamethoxazole (T-S) or pentamidine isethionate (P-I), and produces significantly adverse side effects in as many as 80 percent of patients. Nonetheless, Pc pneumonia mortality ranges between 40 and 60 percent of cases. Trimetrexate (TX) is a new agent with promising effects. Its mode of action is the same as T-S, but it is 1,500 times more effective in binding to dihydrofolate reductase of pneumocystis. The addition of leucovorin (5-formyl tetrahydrofolate; LV) protects the patient's cells from the cytotoxic effects of TX. Used together, TX-LV should be a significant adjunct to the current formulary of AIDS patients with Pc pneumonia. A group of 54 AIDS patients with Pc pneumonia were enrolled in a dosage evaluation trial with TX-LV. Varying dosage schedules and combinations were administered, and the side effects, particularly hematologic (blood-related) in nature, were assessed. A full treatment course consisted of 21 full doses of TX. Therapeutically effective combination doses were achieved at 45 milligrams per square meter per day of TX and 80 milligrams per square meter per day of LV. Further control studies are recommended to compare the safety and effectiveness of these drugs with other medications used to treat Pc pneumonia. (Consumer Summary produced by Reliance Medical Information, Inc.)

The virus that causes AIDS attacks and destroys cells in the immune system, the body's natural defense system for fighting infection. This explains why patients with AIDS are so susceptible to infections. Cytomegalovirus (CMV) retinitis (inflammation of the retina) is a type of eye infection that is estimated to occur in five percent of patients with AIDS. Ganciclovir has been reported to be effective in treating CMV retinitis in 81 to 97 percent of the AIDS patients. However, many patients suffer a relapse within eight weeks and others develop neutropenia (abnormally low number of white blood cells) as a result of ganciclovir treatment. Foscarnet is another antiviral drug that may be useful for treating CMV retinitis, but it is toxic to the kidneys; it is estimated to cause kidney damage in 20 to 50 percent of patients. In addition, foscarnet can cause anemia (abnormally low number of red blood cells), muscle twitching and nausea. However, foscarnet may be useful for treating AIDS patients who already have advanced stage kidney disease and can not be treated with ganciclovir. This article describes the case of a 32-year-old black man with AIDS who developed kidney failure. As a result, the patient was dependent on hemodialysis. Two years after beginning dialysis treatment he developed CMV retinitis. The retinitis stabilized during 14 weeks of foscarnet therapy. However, the patient developed several other AIDS-related complications during that period and died. The authors suggest that foscarnet may be a useful alternative for treating CMV retinitis in AIDS patients who are receiving hemodialysis. (Consumer Summary produced by Reliance Medical Information, Inc.)

The human immunodeficiency virus (HIV) is the viral agent that causes AIDS. This virus destroys the immune system (the body's natural defense system for fighting infection) and sharply diminishes the abilities of HIV-infected patients to fight infection. Consequently, these patients are more susceptible to other types of infections. Infection with cytomegalovirus (CMV) frequently occurs in patients with AIDS, and it is the most common cause of blindness in these patients. CMV causes inflammation inside of the eye (retinitis), damaging the portion of the eye that is sensitive to light (the retina). Ganciclovir is the drug that is used to treat retinitis in AIDS patients. However, some types of CMV are resistant to (not killed by) this drug. The authors describe the cases of two AIDS patients with retinitis who did not respond to treatment with ganciclovir. Both patients were being treated with zidovudine (AZT) for AIDS. They developed CMV retinitis one year and two years, respectively, after AIDS was diagnosed. They were treated with ganciclovir, but the retinitis continued to become worse in both cases. When the patients were treated with foscarnet (another antiviral drug), retinitis stabilized. However, 12 and 25 weeks, respectively, after treatment with foscarnet, the retinitis started to worsen. These findings suggest that foscarnet may be beneficial in treating AIDS patients with CMV retinitis that does not respond to treatment with ganciclovir. (Consumer Summary produced by Reliance Medical Information, Inc.)

Mycobacterium avium-intracellulare (MAI) used to be a relatively rare form of pneumonia in the United States. It was mainly associated with chronic lung disease. With the development of acquired immunodeficiency syndrome (AIDS), MAI infections have become more common. MAI is now recognized as the most common cause of systemic bacterial infection in AIDS patients in the United States. The prevalence of MAI infection varies from one geographic region to another. The occurrence of MAI infection does not appear to be related to gender, age, race or sexual preference. Symptoms of MAI infection include loss of appetite, weight loss, weakness, fever, diarrhea and abdominal pain. Blood cultures are the common method for diagnosing MAI, since blood samples of patients with MAI have large amounts of bacteria. To better understand the geographic influences of MAI infection, the prevalence of MAI was determined in AIDS patients living in Uganda. Blood samples from 50 severely ill Ugandan AIDS patients were analyzed for the presence of MAI. Blood samples were analyzed at the national reference laboratory for mycobacteria. All 50 blood samples were negative for MAI. These findings indicate that MAI infection is not common in AIDS patients in Uganda. (Consumer Summary produced by Reliance Medical Information, Inc.)