ABSTRACT
With the objective of analyzing the efficacy of directly observed treatment (DOT) of HIV infection in the management of severely immunodepressed patients, this method was examined in individuals cared for in two social welfare facilities for HIV-infected persons and compared to self-administered therapy in outpatients. Forty-seven patients with registered HIV infection, stage C, were assigned to DOT for 9 months, the majority of whom had previously received antiretroviral therapy. A group of 51 HIV-infected outpatients, who attended day clinics attached to the reference hospitals, served as a comparison group. Together with increases in weight (9.2+/-7.5 kg) and Karnofsky scores (16.9+/-12.2) in the DOT group, a significant improvement of surrogate markers, such as CD4+ T-cell counts (increase in DOT group, 113.4+/-151.0 cells/microl; control group, -2.8+/-114.1 cells/microl; P<0.001) and HIV load (decrease in DOT group, -1.7+/-2.3 log10 copies/ml; control group, -0.4+/-1.5 log10 copies/ml; P<0.01) was detected in the DOT group. Morbidity and mortality were similar in both groups. The results indicate that such welfare facilities provide a useful framework not only for social objectives but also for healthcare purposes.
Subject(s)
Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Directly Observed Therapy , HIV Infections/drug therapy , Patient Compliance , Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/mortality , Adult , Ambulatory Care , Case-Control Studies , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Follow-Up Studies , HIV Infections/diagnosis , HIV Infections/mortality , Home Care Services , Humans , Male , Probability , Reference Values , Risk Assessment , Severity of Illness Index , Social Welfare , Spain , Survival Analysis , Treatment Outcome , Viral LoadABSTRACT
Tuberculosis constitutes a public health problem that has become more serious in the past couple of years primarily due to the pandemic of human immunodeficiency virus (HIV). This study analyzes the evolutionary, clinical, and epidemiological characteristics of the extrapulmonary and disseminated forms of tuberculosis (TBD/E) in AIDS patients diagnosed in the province of Cádiz. Data for 103 patients who manifested both diseases were gathered prospectively. The prevalence of TBD/E was 30 percent among patients with AIDS. The primary risk factor was addiction to parenteral drugs (91 percent). Seventy-five percent of the patients were diagnosed with disseminated forms of the illness and 25 percent with extrapulmonary forms. The organs affected tended to be lymphatic ganglions and the lungs. Worthy of note is the lateness in seeking medical attention (45.6 +/- 4.5 days; range: 4-240 days). We conclude that tuberculosis constitutes a common pathology with an appreciable mortality in AIDs patients. Disseminated forms of tuberculosis predominate and may adopt a wide range of clinical manifestations. The lateness with which patients seek medical attention is a fact worth emphasizing.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Tuberculosis/complications , Acquired Immunodeficiency Syndrome/mortality , Adult , Cause of Death , Female , Follow-Up Studies , Humans , Male , Prospective Studies , Spain , Survival Rate , Tuberculosis/epidemiologyABSTRACT
BACKGROUND: Bacteremia by Corynebacterium jeikeium is generally described in patients with a bone marrow transplantation and/or neutropenia. In 1991, the first case of bacteremia by C. jeikeium was described in a patient with AIDS and neutropenia. The aim of this study was to describe 2 cases of bacteremia by C. jeikeium in patients with AIDS without neutropenia. To the authors' knowledge, this presentation has not been described previously. METHODS: The bacteremia episode was related with a central venous catheter in both patients. The first patient was diagnosed of tuberculous lymphadenitis and cerebral toxoplasmosis and the second patient of disseminated tuberculosis. Both receive specific treatment for these diseases. Zidovudine was not administered. The bacteremia resolved in both cases after withdrawal of the catheter and antibiotic treatment with vancomycin. CONCLUSIONS: Bacteremia by Corynebacterium jeikeium should be considered in the differential diagnosis of febrile patients with AIDS and vascular catheters, even if granulocytopenia is not present. The isolation of C. jeikeium from blood in AIDS patients, particularly neutropenic patients, should be carefully evaluated by microbiologists and clinicians prior to discard it as a "contaminant".
Subject(s)
AIDS-Related Opportunistic Infections/microbiology , Bacteremia/microbiology , Corynebacterium Infections/complications , Corynebacterium/isolation & purification , HIV-1 , AIDS-Related Opportunistic Infections/blood , Adult , Bacteremia/complications , Catheterization, Central Venous/adverse effects , Corynebacterium/classification , Corynebacterium/drug effects , Corynebacterium Infections/microbiology , Humans , Leukocyte Count , Male , NeutrophilsABSTRACT
BACKGROUND: Given the progressive increase in infectious endocarditis (IE) in intravenous drug addicts (IVDA) in the province of Cadiz the present study was designed with the aim of studying the epidemiologic and clinical characteristics of this disease in our environment. METHODS: One hundred fifty episodes of IE occurring in 133 IVDA admitted to 6 hospitals in the province of Cadiz were studied in an open, multicentric study with a protocol of gathering of common data. Well known diagnostic criteria were used for this process and a univariant technique was employed in the analysis of prognostic factors. RESULTS: Fifty-three percent of the episodes occurred in the county of Campo de Gibraltar and 32% in the area of the Bay of Cadiz. The increase of the disease has been progressive since 1984 and marked over the last two years. All the patients presented fever, abnormal chest radiography in 90% and the process was produced by Staphylococcus aureus in 88%. Echography was abnormal in 85% of the episodes and vegetation was identified in 75%. The IE was located as right in 90%, mixed in 5% and left in 5%. Surgical treatment was required in 4 patients. Mortality was of 9%. Mixed or left location (p = 0.00003) and the development of the respiratory distress syndrome of the adult (p = 0.00001) were significantly associated with greater mortality. CONCLUSIONS: Infectious endocarditis in intravenous drug addicts maintains a well defined pattern of clinical expressivity and presents identifiable factors of prognostic influence. The increase in its prevalence in the province of Cadiz is probably due to a parallel increase in the addiction to intravenous heroin in this area.
Subject(s)
Endocarditis, Bacterial/epidemiology , Heroin Dependence/epidemiology , Substance Abuse, Intravenous/epidemiology , Adolescent , Adult , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/etiology , Endocarditis, Bacterial/microbiology , Endocarditis, Bacterial/therapy , Female , Heroin Dependence/complications , Humans , Male , Prognosis , Retrospective Studies , Spain/epidemiology , Substance Abuse, Intravenous/complicationsABSTRACT
BACKGROUND: The epidemiological characteristics, clinical manifestations and survival were analyzed in 269 patients with acquired immunodeficiency syndrome (AIDS) diagnosed in the province of Cadiz up to June 1970. METHODS: A multicenter protocol study including the 7 hospitals attending practically all of the population of the area of Cadiz was carried out. The diagnosis of AIDS was performed according to the 1987 CDC criteria. The Kaplan and Meier actuarial method was used for the survival study. RESULTS: The prevalence was of 10 cases in 1986, 37 in 1987, 61 in 1988, 121 in 1989 and 40 during the first 5 months of 1990. Males dominated (84%) and mean age was of 28.6 years. The predominant risk factor was parenteral drug abuse (84%) with signs of social unacceptance (unemployment 70% and with prison records 68%). Thirty eight percent of the patients were no longer drug addicts at the time of diagnosis. The number of cases of women who acquired the disease through heterosexual transmission has increased over the last 2 years (13 cases). Opportunistic infections made up 93% of the diagnostic criteria with esophageal candidiasis (EC) (45%) and extrapulmonary tuberculosis (ET) (34%) being the most frequent. The probability of survival was 14% at 35 months. When ET was the exclusive diagnostic criteria, survival was higher (30% vs 9%) and the mean of T4 lymphocytes in this group was higher (228 vs 154), all being statistically significant. CONCLUSIONS: AIDS is a serious, progressive problem of the Public Health Department in the province of Cadiz and predominantly affects parenteral drug addicts with a percentage higher than other Spanish series in socially unaccepted people. The increase in the cases of women with AIDS from heterosexual transmission is worrisome. EC and ET are the most verified diagnostic criteria. The prognosis of AIDS remains bad at short term, with survival being greater in those patients with ET as the exclusive criteria due to lesser cellular immunodeficiency.
Subject(s)
Acquired Immunodeficiency Syndrome/epidemiology , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/mortality , Actuarial Analysis , Adolescent , Adult , Age Factors , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Sex Factors , Spain/epidemiologyABSTRACT
We retrospectively analyze the untoward effects due to cotrimoxazole (CMX) when this drug was used as initial therapy in 37 Spanish AIDS patients with Pneumocystis carinii pneumonia (PCP). A total of 46% of patients developed an adverse reaction, that was considered severe in 24.3% of cases, and prompted to stop CMX therapy in 10.8% of patients. The most frequent untoward effects were low white blood cells count (29.7%), skin rash (16.2%) and low platelet count (13.5%). The overall compliance and absence of undesirable effects to CMX seen in our patients, together with the well established clinical efficacy of this drug, allow us to recommend the use of CMX as initial therapy for Spanish AIDS patients with PCP.
