Foscarnet Decreases Human Immunodeficiency Virus RNA

Foscarnet inhibits human immunodeficiency virus (HIV) replication in vitro and decreases p24 antigenemia in patients with cytomegalovirus (CMV) retinitis. To evaluate the effect of foscarnet on HIV replication, HIV RNA was quantitated in 17 patients before and during foscarnet therapy. Fifteen patients had CMV retinitis, 1 had CMV encephalitis, and 1 had intractable zoster. A decrease in HIV RNA was observed in 16 of 17 patients. Before the introduction of foscarnet, mean HIV RNA was 5.82 ± 0.24 log RNA/mL and, after a median of 13 days of therapy, mean HIV RNA was 5.30 ± 0.27 log RNA/mL (P < .001). Among patients with detectable p24 antigen at baseline, a significant decrease was observed (P = .017). This decrease in HIV RNA demonstrates that foscarnet is a potent antiretroviral dru

Cytomegalovirus Retinitis: Decreased Risk of Bilaterality with Increased Use of Systemic Treatment

Cytomegalovirus (CMV) retinitis may be treated systemically or intravitreally. We reviewed retrospectively patients with CMV retinitis, in order to determine whether systemic treatment was associated with less spread of CMV retinitis from one eye to the other. Of 222 cases, 92 patients had bilateral disease at onset of CMV retinitis, leaving 130 for analysis. Bilaterality occurred in 10 patients during 12,687 days of systemic treatment and in 34 during 14,791 days without systemic treatment (odds ratio [OR] = 2.92; confidence interval [CI], 1.44-5.90). Patients who had received systemic treatment for <50% of the follow-up period had a greater risk of bilaterality (OR = 3.7; CI, 2.79-4.54) than did the more intensively treated patients. CD4 cell levels also contributed to increased risk, but multivariate analysis showed that CD4 cell counts and treatment intensity were independent risk factors. CMV retinitis was more likely to become bilateral in patients who received less intravenous therapy. Local treatment can complete but does not replace systemically administered therap

Once-Weekly Administration of Dapsone/Pyrimethamine vs. Aerosolized Pentamidine as Combined Prophylaxis for Pneumocystis carinii Pneumonia and Toxoplasmic Encephalitis in Human Immunodeficiency Virus-Infected Patients

To evaluate combined prophylaxis for Pneumocystis carinii pneumonia (PCP) and toxoplasmic encephalitis, 533 patients with symptomatic human immunodeficiency virus infection and/or CD4 lymphocyte counts of <200/µL were randomized to receive dapsone/pyrimethamine (200/75 mg once weekly) or aerosolized pentamidine (300 mg every 4 weeks). The median CD4 lymphocyte count was 110/µL; 47.5% were seropositive for toxoplasma antibodies. The median duration of follow-up was 483 days. In the intent-to-treat analysis, 12 cases of PCP and 14 of toxoplasmic encephalitis occurred in the dapsone/pyrimethamine group and 13 and 20 cases, respectively, in the aerosolized pentamidine group (adjusted relative risk for toxoplasmosis, 0.56; P = .10). However, only two of the 14 cases of toxoplasmic encephalitis in the dapsone/pyrimethamine group developed during actual treatment. The mortality among the two groups was similar. Dapsone/pyrimethamine was not tolerated by 30% of participants. A subanalysis of 240 matched, tolerant patients yielded a relative risk for toxoplasmosis of 0.21 (P = .014), a result favoring the use of dapsone/pyrimethamine. Dapsone/pyrimethamine was as effective as aerosolized pentamidine as prophylaxis for PCP and significantly reduced the incidence of toxoplasmic encephalitis among those participants who tolerated i

Qualité des soins ambulatoires : opinion des patients infectés par le VIH

Ce travail décrit une étude, qui a visé à évaluer la performance d'un questionnaire de satisfaction en développement, destiné à mesurer l'opinion de patients infectés par le VIH suivis ambulatoirement. 1. Problématique. 1.1. La qualité des soins, une définition. 1.2. L'opinion des patients : comment la mesurer ? Le questionnaire, les questionnaires existants, le focus groups, description de la technique. 2. Patients et méthodes. 2.1. Critères d'inclusion et d'exclusion. 2.2. Les envois et les rappels. 2.3. Stabilité test-retest. 2.4. Le recrutement. 3. Résultats. 3.1. Acceptabilité du questionnaire : participation. 3.2. Représentativité de l'échantillon. 3.3. Scores par dimension. 3. 4. Evaluation de la validité du questionnaire, convergence des items par dimension et cohérence interne. 3.5. Les questions issues du questionnaire SF-36. 4. Discussion. 4.1. Coping et méthodes alternatives. 4.2. Impact sur les service d'une enquête sur la qualité des soins. 5.1. Le questionnaire de satisfaction élaboré. 5.2. Les différents questionnaires des Hospices : patients hospitalisés et ambulatoires. 5.3. Formulaire d'information de l'enquête par questionnaire. 5.4. Formulaire de consentement à l'enquête. 5.5. Lettre d'accompagnement du questionnaire. 5.6. Profil socio-démographique et résultats complets par item

Foscarnet Decreases Human Immunodeficiency Virus RNA

Foscarnet inhibits human immunodeficiency virus (HIV) replication in vitro and decreases p24 antigenemia in patients with cytomegalovirus (CMV) retinitis. To evaluate the effect of foscarnet on HIV replication, HIV RNA was quantitated in 17 patients before and during foscarnet therapy. Fifteen patients had CMV retinitis, 1 had CMV encephalitis, and 1 had intractable zoster. A decrease in HIV RNA was observed in 16 of 17 patients. Before the introduction of foscarnet, mean HIV RNA was 5.82 ± 0.24 log RNA/mL and, after a median of 13 days of therapy, mean HIV RNA was 5.30 ± 0.27 log RNA/mL (P < .001). Among patients with detectable p24 antigen at baseline, a significant decrease was observed (P = .017). This decrease in HIV RNA demonstrates that foscarnet is a potent antiretroviral drug

Telebiometrie und telefonische Kurzschulungen bei arterieller Hypertonie

Disease Management Programme (DMPs), die Telebiomonitoring des Blutdrucks (Messung der Blutdruckwerte zu Hause und Übermittlung an ein telemedizinisches Zentrum) sowie Patientenschulungen über das Telefon umfassen, können die hausärztliche Betreuung von schwer einstellbaren Patienten ergänzen. Diese Evaluation untersucht, inwieweit solche DMPs bei der hausärztlichen Einstellung des Blutdrucks helfen können

Influenza surveillance using data from a telemedicine centre.

OBJECTIVES: This study aimed at investigating whether data from medical teleconsultations may contribute to influenza surveillance. METHODS: International Classification of Primary Care 2nd Edition (ICPC-2) codes were used to analyse the proportion of teleconsultations due to influenza-related symptoms. Results were compared with the weekly Swiss Sentinel reports. RESULTS: When using the ICPC-2 code for fever we could reproduce the seasonal influenza peaks of the winter seasons 07/08, 08/09 and 09/10 as depicted by the Sentinel data. For the pandemic influenza 09/10, we detected a much higher first peak in summer 2009 which correlated with a potential underreporting in the Sentinel system. CONCLUSIONS: ICPC-2 data from medical teleconsultations allows influenza surveillance in real time and correlates very well with the Swiss Sentinel system