Oral Ganciclovir for the Prevention of Cytomegalovirus Disease in Persons with AIDS

Spector, Stephen A.; McKinley, George; Lalezari, Jacob; Samo, Tobias; Andruczk, Robert; Follansbee, Stephen; Sparti, Paula D.; Havlir, Diane V.; Simpson, Gail; Buhles, William; Wong, Rodney; Stempien, Mary Jean

doi:10.1056/nejm199606063342302

Cited by 288 publications

(104 citation statements)

References 32 publications

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“…First, exposure to this virus is almost universal in the HIVϩ population (18), and it thus serves as a good general model of an Ag-specific response. Second, CMV also happens to be the most common cause of life-threatening viral infection in AIDS (affecting up to 40% of such patients with either retinitis or other tissue manifestations; 17,18), and delineation of the fate of CMV responsive T cells might lead to a better understanding of the factors responsible for the onset of opportunistic infection.…”

Section: Discussionmentioning

confidence: 99%

Determination of antigen-specific memory/effector CD4+ T cell frequencies by flow cytometry: evidence for a novel, antigen-specific homeostatic mechanism in HIV-associated immunodeficiency.

Waldrop¹,

Pitcher²,

Peterson³

et al. 1997

J. Clin. Invest.

518

340

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The highly regulated secretion of effector cytokines by CD4 ϩ T cells plays a critical role in immune protection against pathogens such as cytomegalovirus. Here, we directly compare the frequency and functional characteristics of cytomegalovirus-specific CD4 ϩ memory/effector T cells in normal and HIV ϩ subjects using a novel, highly efficient multiparameter flow cytometric assay that detects the rapid intracellular accumulation of cytokine(s) after short-term (6 h) in vitro antigen stimulation. Responses in this assay correlate precisely with independent measures of sensitization history (e.g., seroreactivity), and allow the simultaneous assessment of multiple cytokines in single effector T cells. Healthy HIV Ϫ individuals manifested an average of 0.71, 0.72, 0.38, and 0.06% CD4 ϩ T cells responding to cytomegalovirus with ␥ -IFN, TNF-␣ , IL-2, and IL-4 production, respectively, with the simultaneous production of ␥ -IFN, TNF-␣ , and IL-2 being the most common effector phenotype. Significantly, overall cytomegalovirus-specific CD4 ϩ effector frequencies were markedly higher among 40% of HIV ϩ subjects (2.7-8.0%), and demonstrated a predominately polarized ␥ -IFN ϩ /TNF-␣ϩ /IL-2 Ϫ /IL-4 Ϫ phenotype. In contrast, CD4 ϩ effector frequencies for heterologous, nonubiquitous viruses such as the mumps virus were low or absent in the HIV ϩ group. These data suggest the existence of homeostatic mechanisms in HIV disease that selectively preserve memory T cell populations reactive with ubiquitous pathogens such as cytomegalovirus-likely at the expense of T cell memory to more sporadically encountered infectious agents. ( J. Clin. Invest. 1997. 99:1739-1750.)

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Section: Discussionmentioning

confidence: 99%

Determination of antigen-specific memory/effector CD4+ T cell frequencies by flow cytometry: evidence for a novel, antigen-specific homeostatic mechanism in HIV-associated immunodeficiency.

Waldrop¹,

Pitcher²,

Peterson³

et al. 1997

J. Clin. Invest.

518

340

View full text Add to dashboard Cite

show abstract

“…Randomized placebo-controlled studies of oral ganciclovir for primary prophylaxis have demonstrated a reduction in the incidence of retinal and gastrointestinal involvement. In one study, 80 the incidence of CMV disease at 1 year was 14% in the treated group compared to 26% in the placebo group. The number of patients developing gastrointestinal CMV was low in both groups.…”

Section: Cytomegalovirusmentioning

confidence: 96%

“…These lesions can present at the time of seroconversion, 170 although typically occur when immunode®ciency is severe; the median CD4 count in these patients is <50/mm 3 . 80 Several studies have identi®ed HIV-infected in¯ammatory cells in the ulcer base of these lesions, suggesting an aetiological role for HIV. 171,172 However, HIV has not been identi®ed in oesophageal squamous mucosa but rather in in¯am-matory cells, and has been found in HIV-infected patients with oesophageal diseases other than IEU.…”

Section: Idiopathic Oesophageal Ulcermentioning

confidence: 99%

The therapy of gastrointestinal infections associated with the acquired immunodeficiency syndrome

Wilcox

Mönkemüller

1997

Aliment Pharmacol Ther

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Although there have been dramatic strides in the therapy of human immunodeficiency virus infection over the last few years, the number of infected people world‐wide is tremendous and, at least in developing countries, continues to expand. Complications which involve the gastrointestinal tract are common in these patients, because the gut is a major site for involvement by opportunistic infections and neoplasms in patients with the acquired immunodeficiency syndrome. It is important to recognize the clinical spectrum of gastrointestinal diseases, as well as the appropriate and most cost‐effective diagnostic strategies, as therapies for a number of these disorders are both widely available and highly effective. This review summarizes the major gastrointestinal infections which are seen in patients with the acquired immunodeficiency syndrome, and their treatment.

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“…[11] Early detection is very important in treating opportunistic infections and there are many drugs to improve the survival of such patients. [12] …”

Section: Detection Of Opportunistic Dna Viral Infections By Multiplexmentioning

confidence: 99%

Detection of Opportunistic Dna Viral Infections by Multiplex PCR Among Hiv Infected Individuals Receiving Care at a Tertiary Care Hospital in South India

Sachithanandham

Ramamurthy

Kannangai

et al. 2009

Indian Journal of Medical Microbiology

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Oral Ganciclovir for the Prevention of Cytomegalovirus Disease in Persons with AIDS

Abstract: In persons with advanced AIDS, phophylactic oral ganciclovir significantly reduces the risk of CMV disease.

Cited by 288 publications

References 32 publications

Determination of antigen-specific memory/effector CD4+ T cell frequencies by flow cytometry: evidence for a novel, antigen-specific homeostatic mechanism in HIV-associated immunodeficiency.

Determination of antigen-specific memory/effector CD4+ T cell frequencies by flow cytometry: evidence for a novel, antigen-specific homeostatic mechanism in HIV-associated immunodeficiency.

The therapy of gastrointestinal infections associated with the acquired immunodeficiency syndrome

Detection of Opportunistic Dna Viral Infections by Multiplex PCR Among Hiv Infected Individuals Receiving Care at a Tertiary Care Hospital in South India

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