1/43. Antiviral treatment for human immunodeficiency virus patients co-infected with hepatitis b virus: combined effect for both infections, an obtainable goal?A large percentage of human immunodeficiency virus (HIV) patients have serological evidence of a past or present hepatitis b virus infection (HBV). Long-term survival is increasing for HIV patients because of highly active antiretroviral therapy. Therefore, the chronic hepatitis B infection may become an important determinant of disease outcome in these co-infected patients. We describe two HIV/HBV co-infected patients who were treated with extended antiviral therapy, initially indicated for the HIV infection. lamivudine, a suppressor of viral replication in both infections, was one of these antiviral drugs. One patient showed a severe rebound of the HBV after withdrawal of lamivudine, the other patient developed a mutant hepatitis b virus after 18 months of treatment. This mutation was exclusively induced by lamivudine. These patients show that, with improved HIV-related survival, the HBV infection should be monitored carefully, thereby enabling the physician to interfere with therapy when necessary.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/43. Human bites and the risk of human immunodeficiency virus transmission.The risk of human immunodeficiency virus (HIV) transmission following a bite injury is important to many groups of people. The first are those who are likely to be bitten as an occupational risk, such as police officers and institutional staff. Another group are represented by the victims and perpetrators of crimes involving biting, both in attack and defense situations. The possibility of these bites transmitting a potentially fatal disease is of interest to the physicians who treat such patients and the legal system which may have to deal with the repercussions of such a transmission. Bite injuries represent 1% of all emergency department admissions in the united states, and human bites are the third most common following those of dogs and cats. The worldwide epidemic of HIV and acquired immunodeficiency syndrome (AIDS) continues, with >5 million new cases last year and affecting 1 in 100 sexually active adults. A review of the literature concerning human bites, HIV and AIDS, HIV in saliva, and case examples was performed to examine the current opinion regarding the transmission of HIV via this route. A bite from an HIV-seropositive individual that breaks the skin or is associated with a previous injury carries a risk of infection for the bitten individual.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/43. Common head and neck manifestations of AIDS.head and neck manifestations of acquired immunodeficiency syndrome (AIDS) can involve the skin, ear, upper aerodigestive tract, and neck. Several head and neck manifestations of AIDS may be the only initial sign of this disease process and therefore primary-care physicians and otolaryngologists must be able to recognize and understand the management of these lesions. Cystic enlargement of the parotid gland and Kaposi's sarcoma are increasingly being encountered in the head and neck exam of HIV-infected patients. An example of each of these disease processes is presented with full discussion about the various treatment methods.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/43. Lactic acidosis and hepatic steatosis associated with use of stavudine: report of four cases.BACKGROUND: An association between use of zidovudine and didanosine and a rare but life-threatening syndrome of hepatic steatosis, lactic acidosis, and myopathy has been reported. OBJECTIVE: To describe the syndrome of hepatic steatosis, lactic acidosis, and myopathy in four patients taking stavudine. DESIGN: Case series. SETTING: A community hospital in washington, D.C., and National Institutes of health Clinical Center, Bethesda, maryland. patients: Two men and two women with hiv-1 infection who were taking stavudine presented with lactic acidosis and elevated levels of aminotransferases. All patients required intensive care. MEASUREMENTS: Levels of lactic acid, alanine aminotransferase, aspartate aminotransferase, amylase, and lipase; computed tomography of the abdomen; liver biopsy (two patients); and muscle biopsy (two patients). RESULTS: Histologic findings consistent with mitochondrial injury confirmed the diagnosis of hepatic or muscle abnormality. CONCLUSION: Because hepatic steatosis may be life-threatening, physicians should consider it as a possible cause of elevated hepatic aminotransferase levels among patients taking stavudine.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/43. thromboembolism associated with HIV infection: a case report and review of the literature.The array of the clinicopathologic spectrum related to HIV infection continues to increase and present new challenges to physicians caring for HIV-infected patients. Recent literature is encumbered with reports of various abnormalities consistent with a hypercoagulable state leading to thromboembolic complications. The coexistence of HIV/AIDS-related illnesses, such as malignancies, opportunistic infections, or autoimmune diseases, as well as drug therapy, may also predispose HIV-infected patients to thromboembolic disease. A case report of a 39-year-old man with Kaposi sarcoma who developed pulmonary embolism is presented, along with a review of the literature.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/43. stevens-johnson syndrome caused by the antiretroviral drug nevirapine.nevirapine is a non-nucleoside reverse transcriptase inhibitor widely used in combination with other antiretroviral agents for the treatment of HIV infection. Severe rash, including the stevens-johnson syndrome (SJS), is the major toxicity of nevirapine and is described in the package labeling with a prominent, boxed warning. Though physicians treating large populations of patients with HIV are well aware of this complication, only one other report of nevirapine-associated SJS has been documented in the dermatology literature. We describe 2 cases of SJS related to nevirapine use and review the literature on this newly recognized association.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/43. Serious adverse events attributed to nevirapine regimens for postexposure prophylaxis after HIV exposures--worldwide, 1997-2000.In September 2000, two instances of life-threatening hepatotoxicity were reported in health-care workers taking nevirapine (NVP) for postexposure prophylaxis (PEP) after occupational human immunodeficiency virus (HIV) exposure. In one case, a 43-year-old female health-care worker required liver transplantation after developing fulminant hepatitis and end-stage hepatic failure while taking NVP, zidovudine, and lamivudine as PEP following a needlestick injury (1). In the second case, a 38-year-old male physician was hospitalized with life-threatening fulminant hepatitis while taking NVP, zidovudine, and lamivudine as PEP following a mucous membrane exposure. To characterize NVP-associated PEP toxicity, CDC and the food and Drug Administration (FDA) reviewed MedWatch reports of serious adverse events in persons taking NVP for PEP received by FDA (Figure 1). This report summarizes the results of that analysis and indicates that healthy persons taking abbreviated 4-week NVP regimens for PEP are at risk for serious adverse events. Clinicians should use recommended PEP guidelines and dosing instructions to reduce the risk for serious adverse events.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/43. Non-Hodgkin's lymphoma in a patient with human immunodeficiency virus.A 38-year-old woman with human immunodeficiency virus who was recently diagnosed with gastric ulcer presented to the hospital with nausea and vomiting of 1 month's duration. work-up of patient led to a diagnosis of diffuse, large B-cell non-Hodgkin's lymphoma. The patient underwent six cycles of chemotherapy, and repeated endoscopy and biopsy failed to reveal malignancy. She remains in remission 23 months posttreatment. Management of patients with human immunodeficiency virus and concurrent malignancy remains a challenge. The primary care physician plays a central role by collaborating with infectious disease and oncologist specialists to formulate a management plan.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/43. Illustrations and implications of current models of HIV health service provision in rural areas.Despite recent evidence of faster than average increases in HIV/AIDS cases in rural areas across the U.S., there is still a generally poor understanding of successful models of rural HIV/AIDS health-care delivery. Past research in rural kentucky suggested several barriers to care resulting in most rural HIV-positive patients traveling from rural to urban areas for care. patients sought urban areas for care for reasons including patient confidentiality, a perceived lack of expertise on the part of rural physicians in caring for HIV-positive patients, and outright referral from rural to urban areas. Case histories are used to illustrate a variety of models of care used by rural HIV-positive patients. These include splitting and sharing care between rural primary care physicians and urban medical specialists, as well as patients receiving all their care in urban areas. Implications of these models for quality of care are discussed.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
10/43. telephone medical care of patients with HIV/AIDS.It has been reported that primary care physicians make 27% of their patient contacts by telephone. With the knowledge that more than 90% of the population has access to a telephone, it is reasonable to propose that the telephone might be employed in a more structured and organized manner for improved, cost-effective medical care. In the current study, two diverse practices (multiphysician and university-affiliated HIV/AIDS clinic, private practice specializing in HIV/AIDS care), both of which used the telephone as having a central role in patient management, were critically observed and reported through three case reports. The results indicate that personnel other than the primary physician provider, such as the triage nurse, may handle a large percentage of calls and successfully manage numerous psychologic and health care issues for the patient, referring, when necessary, appropriate medical inquiries to the physician. It is recommended that physicians take the time to construct sound protocols for clinic personnel to manage patient inquiries by telephone.- - - - - - - - - - ranking = 5keywords = physician (Clic here for more details about this article) |
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