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In the continued absence of a cure for AIDS, or even the remote prospect of one, the clinician's goal is to keep the patient as healthy as possible for as [...]

Many HIV-infected people enrolled in clinical trials of zidovudine (ZDV) may be using a variety of other drugs concurrently. Researchers studied 2,801 HIV-infected people participating in clinical trials of ZDV to assess use of non-ZDV drugs. Results revealed that more than 85% of patients reported using non-ZDV medications during the clinical trials. A total of 43,311 uses of drugs other than zidovudine were reported. More patients with advanced HIV-infection used non-ZDV medications than patients with earlier stages of the disease. AIDS patients reported using an average of 7.1 different drugs per month. Patients with AIDS-related complex, or ARC, used an average of 3.1 drugs per month and patients with no symptoms used an average of 2.7 drugs per month. The most commonly used drugs among all patient groups were anti-infectives, analgesics or antipyretics, and vitamins. In general, patient characteristics other than disease progression did not affect use of non-ZDV drugs.

The number of women enrolled in large HIV clinical trials appears to have decreased between 1987 and 1990 due to demographic and geographic factors. Of 11,909 participants in AIDS Clinical Trials Group studies, only 801 (6.7%) were women. White women comprised 48.5% of women enrolled in the trials. However, the proportion of nonwhite women rose from 45.4% to 53.1% between 1987 and 1990. Women in the studies were less likely to have used intravenous drugs than women with AIDS in the total US population, 22.6% compared to 51%. More women enrolled in studies that included patients without symptoms of HIV infection than in studies limited only to patients with HIV symptoms. More women also participated in trials studying prevention methods than in those evaluating therapies. Geographic regions that have a greater percentage of women with AIDS showed larger numbers of female study participants. Research efforts headed by women enrolled more than twice as many female subjects as studies led by men.

Pneumocystis carinii pneumonia (PCP) is a common opportunistic infection in patients who are infected with human immunodeficiency virus (HIV), the agent that causes AIDS. PCP is associated with high morbidity (illness) and mortality, but it does not often occur before an HIV-infected individual's immune system is depressed to a certain level, usually when the CD4 lymphocyte counts drop below 200/mm3. There are treatments available that can prevent the development of PCP, and it has been recommended that all HIV-infected individuals begin such treatment when their CD4 counts drop below 200/mm3. The number of people requiring this treatment in the near future could be well over one million. The possible costs to the health care system could be enormous. A treatment that combines safety, effectiveness, and cost efficiency is required. This study examined these factors for three possible PCP-preventive treatments: aerosolized pentamidine, trimethoprim-sulfamethoxazole, and dapsone. A study model was made for comparing life expectancy, costs, side effects, and other factors of each treatment and of no treatment for patients who reached the threshold of immune suppression. Data were gathered from two previous studies. Results showed that life expectancy would increase 18 percent, from 3.2 years to about 3.77 years, in those who were treated with any of the three methods. Treatment costs per person per year were estimated to be $440 for dapsone, $700 for trimethoprim, and $1,680 for pentamidine. When increases in life expectancy were compared with costs, dapsone was the most cost effective. This was so even when other factors such as toxicity, compliance, and the lower number of pentamidine side effects were considered. These results indicate that initial therapy with dapsone or trimethoprim is warranted to prevent PCP in patients with CD4 counts below the established limit, unless side effects require a shift to pentamidine. Treatment would be effective, while approximately $100 million per year would be saved. (Consumer Summary produced by Reliance Medical Information, Inc.)

• Two cases of facial erysipelas in immunologically altered hosts are reported herein. The unusual presentation with absence of erythema in the skin lesion is emphasized. Atypical fever patterns were also noted. In one patient, the facial lesion followed the onset of fever by 48 hours, and, in the other, the facial swelling preceded the fever. Various aspects of the patient's altered host status are discussed in light of the atypical clinical presentation. Recognition of facial erysipelas as a potential source of group A β-hemolytic streptococcemia in immunealtered hosts is important to ensure rapid and appropriate therapeutic intervention.(Arch Dermatol 117:47-49, 1981)