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Diarrhoea and weight loss are found in more than 50% of patients with the acquired immunodeficiency syndrome (AIDS). In some patients the symptoms can be very severe, leading to death even in the absence of opportunistic infections. In 30% of these patients, enteric pathogens cannot be identified, and approximately only half of the identifiable aetiologic agents of diarrhoea in patients infected with the human immunodeficiency virus (HIV) were treatable with antibiotics. Immunoglobulins from bovine colostrum (Lactobin, Biotest, Dreieich, FRG) contain high titers of antibodies against a wide range of bacterial, viral and protozoal pathogens as well as against various bacterial toxins. Lactobin (LIG) is quite resistant to 24-h incubation with gastric juice. In a multi-center pilot study 37 immunodeficiency patients with chronic diarrhoea [29 HIV-infected patients, 2 patients with common variable immunodeficiency (CVID), one unidentified immunodeficiency, five patients with graft versus host disease (GvHD) following bone marrow transplantation] were treated with oral LIG (10 g/day for 10 days). Good therapeutic effects were observed. Out of 31 treatment periods in 29 HIV-infected patients 21 gave good results leading to transient (10 days) or long-lasting (more than 4 weeks) normalisation of the stool frequency. The mean daily stool frequency decreased from 7.4 to 2.2 at the end of the treatment. Eight HIV-infected patients showed no response. The diarrhoea recurred in 12 patients within 4 weeks (32.4%), while 19 patients were free of diarrhoea for at least 4 weeks (51.3%). In 5 patients intestinal cryptosporidiosis disappeared following oral LIG treatment. LIG treatment was also beneficial in 4 out of 5 GvHD patients.(ABSTRACT TRUNCATED AT 250 WORDS)

From 01. 01. 1988 to June 1990, a total of 275 patients with AIDS had been examined in our ophthalmological out-patient clinic. The clinical diagnosis of a cytomegalovirus (CMV) retinitis was recorded in 56 of these patients (= 20.1%). The initial therapy, as usual, took the form of infusions of the virustatic drug ganciclovir at an induction dose of 10 mg/kg body weight per day (3 weeks), with a maintenance dose of 3.5-5 mg/kg body weight per day (5 days per week) thereafter. During maintenance therapy recurrences were observed in 15 cases and herpes simplex retinitis in 3, with progressive retinal destruction. Therefore we began treatment with trisodium phosphonoformate (Foscavir) at a dosage of 60 mg/kg body weight per day (3 weeks), continuing with maintenance therapy at 90 mg/kg body weight per day (7 days a week). After the induction dose 14 patients showed subjective improvement and satisfactory cicatrization of the retinal lesions. We monitored the retina by a standardized method and 50 wide-angle retinal photographs. One case of acute retinal necrosis (ARN) did not show any response to foscavir therapy. Typical side-effects of therapy with trisodium phosphonoformate were seldom seen: adverse events included renal dysfunction, neutropoenia, and asymptomatic hypocalcaemia. We conclude that trisodium phosphonoformate is an effective and well-tolerated agent for the treatment and prevention of relapse of CMW retinitis and can be used as an alternative ganciclovir.

Standard therapy of pneumocystis carinii pneumonia with cotrimoxazole and intravenous pentamidine second line therapy both have a response rate of 75 to 90%. As severe side effects, myelotoxicity and skin reaction have been observed which may occur from treatment day 7 on. In order to prevent such side effects as well as reduce hospitalization times, an open, randomized pilot study was designed. Object of this study was the comparison of efficacy and safety of two different treatment schemes: standard therapy versus sequential treatment. Twelve patients were treated according to study design: five patients with cotrimoxazole only, and seven patients with sequential therapy consisting of cotrimoxazole followed by pentamidine aerosol. All patients were treated for 21 days. Four out of five patients with cotrimoxazole, and two out of seven patients with sequential therapy, were successfully treated and had no pneumocystis carinii pneumonia relapses within four weeks after termination of treatment. Each group had one treatment failure. Four patients under sequential treatment were not evaluable. - In spite of the rather unfavourable preliminary results, the study should be continued. However, patients with secondary opportunistic infections respectively other severe diseases should not be included into the study.

In an open prospective study in the AIDS Outpatient Department of the Frankfurt University Clinic the efficacy of pentamidine aerosol at a dosage of 200 mg every 14 days in the primary and secondary prophylaxis of pneumocystis carinii pneumonia was tested. The incidence of pneumocystis carinii pneumonia was reduced by more than 75% in the group of patients receiving pentamidine additionally by inhalation as compared with a historical cohort given azidothymidine alone. The results of the study suggest that a CD4-positive cell count of less than 50/microliters with a concomitant secondary lung infection promotes the development of pneumocystis carinii pneumonia. There was no correlation between the incidence of pneumocystis carinii pneumonia and the number of previous disease episodes. No systemic toxicity of pentamidine aerosol was established.

The case of an AIDS patient with visceral leishmaniasis diagnosed by bone marrow and liver biopsy is reported. Despite the infrequent association between HIV infection and leishmaniasis pathologists and clinicians alike should be alerted to the possibility of leishmaniasis occurring as yet another opportunistic infection in the setting of HIV-induced immunodeficiency.