indinavir-sulfate and Cytomegalovirus-Infections

Topics: Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cytomegalovirus Infections; Drug Therapy, Combination; Female; Foscarnet; HIV-1; Humans; Indinavir; Kidney; Kidney Function Tests; Male; Retrospective Studies

The clearance of cytomegalovirus viraemia in HIV-1-infected patients may partly result from the inhibition of cytomegalovirus protease by HIV-1 protease inhibitors contained in highly active antiretroviral therapy. We used a computational method to calculate the binding affinity of six HIV-1 protease inhibitors to cytomegalovirus protease based on its X-ray crystallography structure. The calculations showed that amprenavir and indinavir occupy the substrate-binding site of the cytomegalovirus protease with high affinity, and may be implicated in alleviating cytomegalovirus infection.

Topics: AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Binding Sites; Carbamates; Crystallography, X-Ray; Cytomegalovirus; Cytomegalovirus Infections; Furans; HIV Infections; HIV Protease Inhibitors; HIV-1; Humans; Indinavir; Molecular Structure; Peptide Hydrolases; Sulfonamides

To analyse the characteristics of opportunistic infections in patients receiving highly active antiretroviral treatment (HAART).. A retrospective study performed in seven hospitals, included all patients starting treatment by ritonavir or indinavir between 26 March and 31 December 1996. Patients were evaluated for the development of AIDS-defining events. Clinical evaluation, plasma HIV-1 RNA quantification, CD4 cell count were recorded at baseline and at the onset of the event.. Four hundred and eighty-six patients were included: 44.2% had a CD4 cell count below 50 x 10(6) cells/l. Fifty clinical events were recorded in 46 patients with a mean follow-up of 6.1 months, of which 34 events (68%) were observed during the first 2 months of HAART. Eighteen of these occurred despite a reduction of viral load by at least 1.5 log10) and a 100% increase of the CD4 cell count compared with that at the onset of the event, corresponding to 11 cytomegalovirus infections, five mycobacterial infections, one case of cryptococcosis, and one case of Varicella-Zoster virus-related acute retinal necrosis. Among the 16 events observed after the second month, six occurred despite a marked biological improvement, corresponding to a recurrence in five of six patients who had stopped their maintenance therapy. Events were one cytomegalovirus infection, two mycobacterial infections, one episode of oesophageal candidiasis and one cryptococcal meningitis.. In patients at high risk of developing an opportunistic infection prior to the institution of a HAART regimen, prophylaxis should not be discontinued during the first 2 months of treatment, and maintenance therapy should be carried on despite a significant increase in the CD4 cell count.

Topics: AIDS-Related Opportunistic Infections; Anti-HIV Agents; Candidiasis; CD4 Lymphocyte Count; Cryptococcosis; Cytomegalovirus Infections; Disease Progression; Drug Therapy, Combination; HIV Infections; HIV Protease Inhibitors; HIV-1; Hospitals, University; Humans; Indinavir; Mycobacterium Infections; Pneumonia, Pneumocystis; Retrospective Studies; Ritonavir; RNA, Viral; Toxoplasmosis, Cerebral; Viral Load

To quantify the inflammatory reaction that can be seen in HIV-infected patients with cytomegalovirus (CMV) retinitis after the introduction of an HIV protease inhibitor and correlate it with ocular findings and systemic HIV parameters.. Report of a patient with CMV retinitis systematically followed by slit-lamp examination, funduscopy, fundus photographs and laser flare photometry before and after introduction of an HIV protease inhibitor.. Manifest granulomatous panuveitis developed 2 months after the introduction of the protease inhibitor indinavir (CD4 rise from 2 to 64 CD4/mm3) and coincided with cicatrization of the CMV retinitis in the absence of efficient anti-CMV therapy.. Occurrence of uveitis in patients with CMV retinitis following the introduction of HIV protease inhibitors may be a factor indicating a good ocular prognosis, possibly pointing to the presence of the anti-CMV repertoire in the reconstituting CD4 cell population.

Topics: Adult; CD4 Lymphocyte Count; Cicatrix; Cytomegalovirus Infections; HIV Protease Inhibitors; Humans; Indinavir; Male; Prognosis; Retinitis; Treatment Outcome; Uveitis