losartan-potassium and Opportunistic-Infections

Fever during neutropenia may be a symptom of severe life threatening infection, which must be treated immediately with antibiotics. If signs of infection persist, therapy must be modified. Diagnostic measures should not delay treatment. If the risk of febrile neutropenia after chemotherapy is ≥ 20%, then prophylactic therapy with G-CSF is standard of care. After protocols with a risk of febrile neutropenia of 10-20%, G-CSF is necessary, in patients older than 65 years or with severe comorbidity, open wounds, reduced general condition. Anemia in cancer patients must be diagnosed carefully, even preoperatively. Transfusions of red blood cells are indicated in Hb levels below 7-8 g/dl. Erythropoiesis stimulating agents (ESA) are recommended after chemotherapy only when hemoglobin levels are below 11 g/dl. The Hb-level must not be increased above 12 g/dl. Anemia with functional iron deficiency (transferrin saturation < 20%) should be treated with intravenous iron, as oral iron is ineffective being not absorbed. Therapy of pain must follow diagnostic and treatment standards. Nausea or emesis following chemotherapy can be classified as minimal, low, moderate and high. The antiemetic prophylaxis should be escalated accordingly. In chemotherapy with low emetogenic potential steroids are sufficient, in the moderate level 5-HT3 receptor antagonists (setrons) are added, and in the highest level Aprepitant as third drug.

Topics: Anemia; Anti-Bacterial Agents; Antineoplastic Agents; Diarrhea; Erythropoietin; Granulocyte Colony-Stimulating Factor; Humans; Nausea; Neutropenia; Opportunistic Infections; Otorhinolaryngologic Neoplasms; Pain Management; Palliative Care; Pneumonia; Vomiting

Topics: Antineoplastic Agents; Erythropoietin; Hematologic Neoplasms; Hematopoietic Stem Cell Transplantation; Humans; Opportunistic Infections; Survival Analysis; Transplantation Conditioning; Transplantation, Homologous; Treatment Outcome

Topics: Adolescent; Blood Transfusion; Drug Resistance; Erythema Infectiosum; Erythropoietin; Hematinics; Humans; Immunocompromised Host; Immunoglobulins, Intravenous; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Male; Nephritis, Hereditary; Opportunistic Infections; Red-Cell Aplasia, Pure; Treatment Outcome

Topics: Aged; Anemia; Antibodies; Chronic Disease; Cyclophosphamide; Darbepoetin alfa; Erythropoietin; Fatal Outcome; Hematinics; Humans; Immunosuppressive Agents; Kidney Diseases; Male; Opportunistic Infections; Prednisolone; Red-Cell Aplasia, Pure

Twenty-two patients with acquired immunodeficiency syndrome (AIDS) or severe AIDS-related complex and multilineage hematopoietic defects were treated with recombinant granulocyte colony-stimulating factor (G-CSF) and erythropoietin (EPO) in a phase I/II trial. All patients were neutropenic and anemic after withdrawal of all bone marrow-suppressive drugs. Daily, G-CSF was subcutaneously self-administered until an absolute neutrophil count (ANC) greater than 6,000/microL was achieved and maintained for 2 weeks. Subcutaneous EPO was added to the regimen and the dose increased until an increase of 15 g/L of hemoglobin was observed. Groups of patients were administered increasing doses of zidovudine to determine their tolerance. G-CSF and EPO therapy was continued with dose modification to maintain an ANC greater than 1,500/microL and hemoglobin greater than 100 g/L. The dose of zidovudine was not altered. All 22 patients responded to G-CSF with a mean 10-fold increase in neutrophils occurring in less than 2 weeks. Significant increases in CD4 and CD8 cell number, lymphocyte proliferative response, and bone marrow cellularity were seen. EPO therapy increased hemoglobin in all 20 evaluable patients within 8 weeks. Sixteen patients received 1,000 mg and four patients received 1,500 mg of zidovudine per day. The reinstitution of zidovudine resulted in a decline in reticulocytes and hemoglobin and the reappearance of transfusion requirements in eight of the 20 patients, six of whom had the study medications stopped. No patient had the study medications stopped because of neutropenia or thrombocytopenia. Toxicities were mild and did not require dose modifications. Limiting dilution plasma and lymphocyte co-cultures for HIV as well as serum p24 antigen levels did not change significantly during G-CSF or combined G-CSF and EPO therapy. HIV p24 antigen decreased significantly with zidovudine therapy. Opportunistic infections occurred in 14 patients but were successfully treated with myelosuppressive antimicrobial agents, including ganciclovir, without the development of neutropenia. These results suggest that combined therapy with G-CSF and EPO may improve the neutropenia and anemia of AIDS. Combined therapy may allow the resumption of full-dose zidovudine in most patients intolerant of the hematologic effects of zidovudine without apparent alteration of HIV expression or the efficacy of zidovudine.

Topics: Acquired Immunodeficiency Syndrome; Blood Cell Count; Cell Survival; Dose-Response Relationship, Drug; Drug Evaluation; Drug Therapy, Combination; Erythropoietin; Ganciclovir; Gene Products, gag; Granulocyte Colony-Stimulating Factor; Hemoglobins; HIV; HIV Core Protein p24; Humans; Injections, Subcutaneous; Neutropenia; Opportunistic Infections; Recombinant Proteins; Viral Core Proteins; Virus Replication; Zidovudine

The ability of peripheral-blood hematopoietic progenitor cells from AIDS patients and normal controls to respond to erythropoietin (Epo) was assessed for burst-forming units-erythroid (BFU-E). BFU-E colony formation from AIDS patients' peripheral blood responded to a wide range of Epo concentrations (0.5-4 U) in a similar manner as erythroid progenitors obtained from normal peripheral blood. The optimum dose response of BFU-E to Epo was 2 U which resulted in generation of 71 +/- 4 BFU-E in AIDS patients (n = 10), as compared to 77 +/- 5 BFU-E in normal donors (n = 3). The optimum concentration range of hemin enhancement of erythroid progenitor BFU-E was 10-50 microM. In all instances, Epo was essential for BFU-E growth. Inclusion of hemin at a concentration of 10 microM in AIDS patients' peripheral-blood erythroid progenitor cells resulted in enhancement of BFU-E by 136-215%. Similarly, inclusion of hemin (10-100 microM) in normal bone marrow erythroid progenitor cell cultures resulted in enhancement of BFU-E. Inclusion of an equivalent amount of iron or tin protoporphyrin to progenitors cells from AIDS patients' peripheral blood had no effect on the number of colonies observed. On the other hand, inclusion of another heme analogue, zinc protoporphyrin, in AIDS or normal cultures resulted in a 50% suppression of BFU-E colony formation. These results demonstrate that peripheral-blood mononuclear cells from AIDS patients retain the capacity to generate erythroid precursors such as BFU-E in the presence of Epo, and that hemin has a specific enhancement effect on growth of BFU-E colony formation obtained from peripheral blood or bone marrow cells.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Complex; Cells, Cultured; Colony-Forming Units Assay; Dose-Response Relationship, Drug; Drug Synergism; Erythroid Precursor Cells; Erythropoietin; Hemin; HIV Infections; Humans; Middle Aged; Opportunistic Infections; Protoporphyrins; Reference Values

Topics: Adult; Ambulatory Care; Catheters, Indwelling; Combined Modality Therapy; Erythropoietin; Female; HIV Infections; Humans; Male; Opportunistic Infections; Physician's Role; Terminal Care; Zidovudine