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With the advent of protease inhibitors, the treatment of persons infected with the human immunodeficiency virus (HIV) has resulted in lower levels of the virus in the blood. The first of these protease inhibitors was saquinavir, which inhibits the HIV protease enzyme responsible for post-translational processing of Gag and Gag-Po1 poly protein precursors into their functional products. Studies have suggested that ketoconazole, given in combination with saquinavir, increases the bioavailability of saquinavir. This study compared the HIV viral load in patients treated with saquinavir alone and in combination with ketoconazole. Results showed that while all patients who received saquinavir exhibited a positive response, patients who also received ketoconazole had a greater drop in viral load levels. In addition, a greater number of patients had undetectable viral levels after 3 months on the ketoconazole/saquinavir regimen. These results indicate that the combination of saquinavir/ketoconazole for the treatment of HIV requires further study.

Cryptosporidium enteritis (CE) in patients with acquired immunodeficiency syndrome (AIDS) can be a life-threatening opportunistic infection. A retrospective review of 471 charts of patients with AIDS in our clinic, prior to the availability of clarithromycin for the treatment of Mycobacterium avium complex (MAC), revealed that seven patients with CD4 counts < 25/mm3 developed CE. The median survival period from diagnosis to death in these patients was 10.6 days. The incidence of CE in patients with CD4 counts < 50/mm3 treated with clarithromycin prophylaxis for MAC was compared with patients not receiving clarithromycin prophylaxis. Of 136 patients with AIDS, 63 received clarithromycin 500 mg twice daily, and 73 patients not treated with clarithromycin represented the control group. None of the patients who received clarithromycin developed CE compared with four patients who developed CE in the control group. All four patients in the control group who developed CE had CD4 counts < 25/mm3. All patients who received clarithromycin remained stool negative for Cryptosporidium. In a subsequent 2-year follow-up of an additional 217 AIDS patients with CD4 counts < 50/mm3 receiving clarithromycin 500 mg twice daily as MAC prophylaxis, no patient developed CE. These results provide strong evidence supporting the use of clarithromycin as prophylaxis against cryptosporidium enteritis in patients with AIDS.

One hundred individuals confirmed to be infected with the human immunodeficiency virus (HIV), volunteered to participate in a pilot study comparing clinical status and enteric parasite burden with race, age, CD4 levels, risk factors and sexual practice. The prevalence of enteric parasites was 55 (55%) for Giardia lamblia, 6 (6%) for Cryptosporidium, 10 (10%) for Isospora belli and 3 (3%) for Entamoeba histolytica. There was no associations between demographic variables and the presence of parasites. The presence of giardia was significantly associated with anal-penile sex (P = .017), with an odds ratio of 2.9. A logistic regression model was used to explain the presence of any parasite by a number of sexual practices. The only practice found to be significant was anal-penile sex, which substantially increased the likelihood of the presence of the parasites. In this regression, 38.5% of pairs were concordant and 12.2% were discordant. These findings differed from surveys conducted in similar populations. The significance of this will be discussed in the context of medical service provision to this and similar populations.

Thirty-five human immunodeficiency virus (HIV)-positive patients were followed over a 2-year period. All agreed to abstain from sexual intercourse. This group had a low level of recurring infections. A comparison study of sexually active HIV males is underway.

Twenty-one patients who presented to three sexually transmitted disease (STD) clinics in the south area of Los Angeles County were diagnosed to have anorectal or pharyngeal gonorrhea and gave a history of hypersensitivity of penicillin. Treatment with doxycycline, 300 mg initially, followed by 200 mg daily for six days was successful in all cases. None was found to have penicillinase producing gonorrhea (PPNG).

Over 950 patients in the southeast region and south area of Los Angeles County were treated with cefotaxime and the effectiveness of its treatment is reported herein.