ABSTRACT
The effect of protease inhibitors (PIs) on the outcome of AIDS-associated cytomegalovirus (CMV) colitis is unknown. The aim of this study was to determine the impact of PIs on the recurrence of CMV disease and long-term survival in a large cohort of acquired immunodeficiency syndrome (AIDS) patients with CMV colitis. We reviewed the medical records of 252 AIDS patients who were diagnosed with CMV colitis by colonoscopy between January 1992 and January 1997 at Bellevue Hospital (New York, NY, U.S.A.). Follow-up data were obtained from chart review and direct telephone contact. A complete response to ganciclovir and/or foscarnet therapy was seen in 87.0% of the patients. Recurrence of CMV colitis occurred in 53.1% of patients and was significantly less common in those who received maintenance therapy (36.1% vs. 56.7%; p = 0.03) and in those who were treated with PIs (22.8% vs. 71.9%; p < 0.001). During follow-up. 69.3% of patients died. Multivariate analysis using Cox regression showed that mortality was increased in patients with recurrent CMV colitis (relative risk [RR] of death, 1.7: 95% CI, 1.1-2.6; p = 0.02) and comorbid disease (RR, 1.5: 95% CI, 1.1-2.2; p = 0.02), and decreased in those who were treated with PIs (RR, 0.42; 95% CI, 0.3-0.7; p = 0.001). The median survival was 71 weeks and was significantly longer in patients who were treated with PIs than in those who did not receive these potent anti-retroviral medications (99 vs. 51 weeks; p < 0.001). PIs significantly improve the outcome of AIDS-associated CMV colitis.
Subject(s)
AIDS-Related Opportunistic Infections/drug therapy , Antiviral Agents/therapeutic use , Colitis/drug therapy , Cytomegalovirus Infections/drug therapy , Foscarnet/therapeutic use , Ganciclovir/therapeutic use , HIV Protease Inhibitors/therapeutic use , AIDS-Related Opportunistic Infections/mortality , Adult , Cohort Studies , Colitis/mortality , Colitis/virology , Cytomegalovirus Infections/mortality , Female , Follow-Up Studies , Humans , Male , Proportional Hazards Models , Recurrence , Survival Rate , Time Factors , Treatment OutcomeABSTRACT
Large-scale process simulation was used to reconstruct the geologic evolution during the past 600,000 years of an alluvial fan in northern California. In order to reproduce the sedimentary record, the simulation accounted for the dynamics of river flooding, sedimentation, subsidence, land movement that resulted from faulting, and sea level changes. Paleoclimatic trends induced fluctuations in stream flows and dominated the development of the sedimentary deposits. The process simulation approach serves as a quantitative means to explore the genesis of sedimentary architecture and its link to past climatic conditions and fault motion.
