Archive for July 1, 2014

Management of HIV Infection in Patients With Cancer Receiving Chemotherapy

Clinical Infectious Diseases July 1, 2014 V.59 N.1 P.106-114

Kenneth H. Mayer, Section Editor

Harrys A. Torres and Victor Mulanovich

Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston

Correspondence: Harrys A. Torres, MD, FACP, Department of Infectious Diseases, Infection Control and Employee Health, Unit 1460, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (htorres@mdanderson.org).

Abstract

The optimal antiretroviral therapy (ART) regimen for human immunodeficiency virus (HIV)–infected patients with cancer remains unknown, as clinical trials are lacking and published data are insufficient to guide recommendations.

When concomitant use of chemotherapy and ART is anticipated, overlap of toxic effects and drug–drug interactions between chemotherapy and ART may alter the optimal choice of ART.

Prospective studies are urgently needed to further define the toxic effects of combined chemotherapy and ART in HIV-positive cancer patients. Such studies should aid the development of guidelines for treatment of this population.

For now, clinicians should individualize decisions regarding treatment of HIV according to clinical and laboratory findings, cancer treatment plan (chemotherapy, radiotherapy, or surgery), liver or renal disease, potential adverse drug effects (eg, rash, gastrointestinal intolerance, bone marrow suppression), and patient preference.

This review focuses on what infectious disease specialists need to know to select the most appropriate ART regimens for patients receiving chemotherapy.

PDF

http://cid.oxfordjournals.org/content/59/1/106.full.pdf+html

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July 1, 2014 at 5:30 pm

Middle East Respiratory Syndrome Coronavirus: A Case-Control Study of Hospitalized Patients

Clinical Infectious Diseases July 15, 2014 V.59 N.2 P.160-165

Jaffar A. Al-Tawfiq1,2, Kareem Hinedi1, Jihad Ghandour1, Hanan Khairalla1, Samir Musleh1, Alaa Ujayli1, and Ziad A. Memish3,4

1Medical Department, Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia

2Indiana University School of Medicine, Indianapolis

3World Health Organization Collaborating Center for Mass Gathering Medicine, Saudi Arabian Ministry of Health

4Al-Faisal University, Riyadh, Saudi Arabia

Correspondence: Jaffar A. Al-Tawfiq, MD, FACP, FCCP, MIDSA, PO Box 76, Rm A-428-2, Bldg 61, Dhahran Health Center, Saudi Aramco, Dhahran 31311, Saudi Arabia (jaffar.tawfiq@aramco.com; jaltawfi@yahoo.com).

Background.

There is a paucity of data regarding the differentiating characteristics of patients with laboratory-confirmed and those negative for Middle East respiratory syndrome coronavirus (MERS-CoV).

Methods

This is a hospital-based case-control study comparing MERS-CoV–positive patients (cases) with MERS-CoV–negative controls.

Results

A total of 17 case patients and 82 controls with a mean age of 60.7 years and 57 years, respectively (P = .553), were included. No statistical differences were observed in relation to sex, the presence of a fever or cough, and the presence of a single or multilobar infiltrate on chest radiography. The case patients were more likely to be overweight than the control group (mean body mass index, 32 vs 27.8; P = .035), to have diabetes mellitus (87% vs 47%; odds ratio [OR], 7.24; P = .015), and to have end-stage renal disease (33% vs 7%; OR, 7; P = .012). At the time of admission, tachypnea (27% vs 60%; OR, 0.24; P = .031) and respiratory distress (15% vs 51%; OR, 0.15; P = .012) were less frequent among case patients. MERS-CoV patients were more likely to have a normal white blood cell count than the control group (82% vs 52%; OR, 4.33; P = .029). Admission chest radiography with interstitial infiltrates was more frequent in case patients than in controls (67% vs 20%; OR, 8.13; P = .001). Case patients were more likely to be admitted to the intensive care unit (53% vs 20%; OR, 4.65; P = .025) and to have a high mortality rate (76% vs 15%; OR, 18.96; P < .001).

Conclusions

Few clinical predictors could enhance the ability to predict which patients with pneumonia would have MERS-CoV. However, further prospective analysis and matched case-control studies may shed light on other predictors of infection.

PDF

http://cid.oxfordjournals.org/content/59/2/160.full.pdf+html

July 1, 2014 at 5:26 pm


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