indinavir-sulfate and Acute-Disease

Topics: Acute Disease; Adult; Chronic Disease; Diagnosis, Differential; Follow-Up Studies; HIV Infections; HIV Protease Inhibitors; Humans; Indinavir; Kidney; Male; Nephritis, Interstitial

Clinical and virologic consequences of temporary interruption of HIV therapy are incompletely understood.. To describe a febrile illness that was consistent with the acute HIV syndrome and occurred after interruption of antiretroviral therapy.. Case report.. University clinic.. HIV-infected man.. Plasma viral load, lymphocyte subsets, diagnostic evaluation (including cultures and serologic tests), and analysis of lymph node tissue.. The patient began antiretroviral therapy 3 months after initial HIV exposure and had sustained viral suppression, except during a brief scheduled treatment interruption. One hundred sixty-nine days after resuming therapy, the patient discontinued it again immediately following an influenza vaccination. Eleven days later, he presented with a febrile mononucleosis-like syndrome associated with dramatic shifts in plasma HIV RNA level (<50 to >1 000 000 copies/mL) and CD4 cell count (0.743 x 10(9) cells/L to 0.086 x 10(9) cells/L). Evaluation for alternative causes of fever was unrevealing. Symptoms resolved rapidly with resumption of HIV therapy.. Therapeutic interruption may be associated with profound viral rebound and recurrence of the acute HIV syndrome.

Topics: Acute Disease; Adult; Anti-HIV Agents; CD4 Lymphocyte Count; Chronic Disease; Disease Progression; Drug Therapy, Combination; Fever; HIV; HIV Infections; HIV Protease Inhibitors; Humans; Indinavir; Lamivudine; Male; Recurrence; Reverse Transcriptase Inhibitors; RNA, Viral; Syndrome; Viral Load; Zidovudine

Highly active antiretroviral therapy (HAART) has been shown to have a beneficial effect on several opportunistic and other coinfections of HIV infected individuals. The effect of HAART on HCV coinfections is controversial. We describe the case of a patient, in whom a close temporal relationship between changes in HIV viremia, HCV viremia and ALT levels was observed. Longterm suppression of HIV replication by HAART was associated with a normalization of ALT levels and finally clearance of the HCV infection. Our data suggest that improved immune functions due to reductions of the HIV load led to a better control and finally resolution of the HCV infection in this patient.

Topics: Acute Disease; Adult; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Hepatitis C, Chronic; HIV Infections; HIV Protease Inhibitors; Humans; Indinavir; Male; Nevirapine; Viral Load; Viremia

We report the first case of acute cholecystitis due to indinavir-induced cholelithiasis in a patient infected with human immunodeficiency virus who had been receiving indinavir for 56 months. Infrared spectroscopy demonstrated that the gallstone was composed of indinavir monohydrate (50%), calcium bilirubinate (28%), calcium palmitate (10%), cholesterol (7%), and proteins (5%). The role of high-level chronic unconjugated hyperbilirubinemia coupled with high blood concentrations of indinavir is discussed.

Topics: Acute Disease; Adult; Bilirubin; Cholelithiasis; Cholesterol; HIV Infections; HIV Protease Inhibitors; Humans; Indinavir; Male; Palmitic Acid

Topics: Acute Disease; Adult; Alcoholism; Hepatitis C; HIV Infections; HIV Protease Inhibitors; Humans; Indinavir; Male; Porphyria Cutanea Tarda

The authors describe a case of severe CMV retinitis in a young adult AIDS patient who recovered following first a course of ganciclovir and then HAART. Six months after the initial episode while still under successful HAART, the patient developed an acute episode of retinitis despite a persistent significant improvement in the immunological picture and a very low level of CMV reactivation. The acute episode can be related to an enhanced individual reactivity to minor CMV replication.

Topics: Acute Disease; Adult; AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Antiviral Agents; CD4 Lymphocyte Count; Cidofovir; Cytomegalovirus Retinitis; Cytosine; Drug Therapy, Combination; Ganciclovir; HIV Infections; Humans; Indinavir; Lamivudine; Male; Organophosphonates; Organophosphorus Compounds; Zidovudine

T-cell responses were evaluated prospectively in 41 patients with acute human immunodeficiency virus type 1 (HIV-1) infection (30 untreated and 11 receiving zidovudine, lamivudine, and indinavir) and in 38 uninfected adults. By 6-12 months, treated patients had significantly greater median Candida and tetanus lymphoproliferative responses (stimulation index [SI], 76 and 55, respectively) than did untreated patients (SI, 7 and 6, P=.02 and.001, respectively), and the responses of treated patients surpassed those of uninfected adults (SI, 19 and 32, P= .002 and .101, respectively). Unlike the patients in the untreated group, the patients in the treated group mounted a 6-fold increased HIV-1 p24 response (SI increase, 1.0 to 5.7, P= .01) within 3 months. HIV-1-specific cytotoxicity remained detectable in most treated patients. Thus, combination therapy administered within 3-4 months of infection was associated with improved T-cell memory responses that were distinct from those of untreated patients. The amplified HIV-1-specific T-cell responses may help maintain cytotoxic activities.

Topics: Acute Disease; Adult; Anti-HIV Agents; Candida; CD4 Lymphocyte Count; Chronic Disease; Cytokines; Cytotoxicity, Immunologic; Drug Therapy, Combination; Female; HIV Antigens; HIV Infections; HIV-1; Humans; Indinavir; Lamivudine; Lymphocyte Activation; Male; Middle Aged; Prospective Studies; T-Lymphocytes; Tetanus Toxoid; Viral Load; Zidovudine

Major T-cell receptor beta chain variable region (TCRBV) repertoire perturbations are temporally associated with the down-regulation of viremia during primary human immunodeficiency virus (HIV) infection and with oligoclonal expansion and clonal exhaustion of HIV-specific cytotoxic T lymphocytes (CTLs). To determine whether initiation of antiretroviral therapy (ART) or highly active antiretroviral therapy (HAART) during primary infection influences the dynamics of T-cell-mediated immune responses, the TCRBV repertoire was analyzed by semiquantitative polymerase chain reaction in serial blood samples obtained from 11 untreated and 11 ART-treated patients. Repertoire variations were evaluated longitudinally. Stabilization of the TCRBV repertoire was more consistently observed in treated as compared with untreated patients. Furthermore, the extent and the rapidity of stabilization were significantly different in treated versus untreated patients. TCRBV repertoire stabilization was positively correlated with the slope of HIV viremia in the treated group, suggesting an association between repertoire stabilization and virologic response to treatment. To test whether stabilization was associated with variations in the clonal complexity of T-cell populations, T-cell receptor (TCR) heteroduplex mobility shift assays (HMAs) were performed on sequential samples from 4 HAART-treated subjects. Densitometric analysis of HMA profiles showed a reduction in the number of TCR clonotypes in most TCRBV families and a significant decrease in the total number of clonotypes following 7 months of HAART. Furthermore, a biphasic decline in HIV-specific but not heterologous CTL clones was observed. This indicates that ART leads to a global reduction of CD8(+) T-cell oligoclonality and significantly modulates the mobilization of HIV-specific CTL during primary infection. (Blood. 2000;95:1743-1751)

Topics: Acute Disease; Anti-HIV Agents; Clone Cells; Didanosine; Drug Administration Schedule; Drug Therapy, Combination; Gene Rearrangement, beta-Chain T-Cell Antigen Receptor; HIV Infections; HIV Protease Inhibitors; HIV Reverse Transcriptase; HIV-1; Humans; Indinavir; Lamivudine; Lymphocyte Activation; Polymerase Chain Reaction; RNA-Directed DNA Polymerase; Saquinavir; T-Lymphocytes, Cytotoxic; Viremia; Zidovudine

Topics: Acute Disease; Adult; Anti-HIV Agents; HIV Infections; HIV Protease Inhibitors; Humans; Indinavir; Male; Porphyrias

Topics: Acute Disease; Adult; Anti-HIV Agents; HIV Infections; HIV Protease Inhibitors; Humans; Indinavir; Male; Respiratory Insufficiency

Topics: Acute Disease; Administration, Oral; Adult; HIV Infections; HIV Protease Inhibitors; HIV-1; Humans; Indinavir; Male; Thrombocytopenia