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Biomedical subjects

C B Wofsy

Publications and source records attributed to C B Wofsy.

At least 19 recordsLinked to original sources
PubMed1991

Foscarnet therapy in five patients with AIDS and acyclovir-resistant varicella-zoster virus infection.

OBJECTIVE: To determine whether foscarnet has potential efficacy in the treatment of acyclovir-resistant mucocutaneous varicella-zoster infection in patients with the acquired immunodeficiency syndrome (AIDS). DESIGN: Open-label study. SETTING: Three university medical centers. PATIENTS: Five patients with AIDS who were infected with thymidine-kinase-deficient or -altered strains of varicella-zoster virus. INTERVENTION: Foscarnet, 40 mg/kg body weight every 8 hours in 1-hour infusions for 10 or more days. MAIN RESULTS: Four patients had healing in response to foscarnet therapy, and each of four tested patients became culture negative for virus during foscarnet therapy. Results of fluorescent antigen testing remained positive during therapy in two patients; one of these patients had concomitant clinical failure but the other patient healed fully. One patient had complete healing despite the emergence of resistance to foscarnet in serial specimens obtained during foscarnet therapy. CONCLUSION: Foscarnet is a potentially effective and tolerable antiviral agent for patients with acyclovir-resistant, varicella-zoster virus infection; however, the optimal dosage and duration of therapy require further study, as does the relation between clinical findings and in-vitro susceptibility results.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Oral therapy for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A controlled trial of trimethoprim-sulfamethoxazole versus trimethoprim-dapsone.

BACKGROUND: Antimicrobial drugs that can be taken orally are needed for the treatment of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome (AIDS). Preliminary data indicate that dapsone with trimethoprim may be an effective alternative to trimethoprim-sulfamethoxazole, which is frequently toxic. METHODS: In a double-blind trial, 60 patients with AIDS and mild-to-moderately-severe first episodes of P. carinii pneumonia (partial pressure of oxygen in arterial blood, greater than 60 mm Hg while breathing room air) were randomly assigned to 21 days of treatment with either trimethoprim-sulfamethoxazole (20 and 100 mg per kilogram of body weight per day, respectively) or trimethoprim-dapsone (20 mg per kilogram per day and 100 mg per day). RESULTS: The orally administered treatment failed because of progressive pneumonitis in 3 of the 30 patients assigned to trimethoprim-sulfamethoxazole and in 2 of the 30 assigned to trimethoprim-dapsone (P greater than 0.3). Major toxic effects required a switch to intravenous pentamidine for 17 patients (57 percent) in the trimethoprim-sulfamethoxazole group, as compared with 9 (30 percent) in the trimethoprim-dapsone group (P less than 0.025). With trimethoprim-sulfamethoxazole, there were more instances of severe chemical hepatitis (six, as compared with one in the trimethoprim-dapsone group) and marked neutropenia (five vs. one). Intolerable rash (three in each treatment group) and severe nausea and vomiting (two in each group) occurred with equal frequency with both drug combinations. Methemoglobinemia occurred in most of the patients treated with trimethoprim-dapsone, but it was asymptomatic and the level exceeded 20 percent in only one patient. Mild hyperkalemia (serum potassium level, 5.1 to 6.1 mmol per liter) also occurred in 53 percent of the patients treated with trimethoprim-dapsone. CONCLUSIONS: In patients with AIDS, oral therapy with trimethoprim-sulfamethoxazole and with trimethoprim-dapsone are equally effective for mild-to-moderate first episodes of P. carinii pneumonia, but with trimethoprim-dapsone there are fewer serious adverse reactions than with trimethoprim-sulfamethoxazole.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Dapsone, trimethoprim, and sulfamethoxazole plasma levels during treatment of Pneumocystis pneumonia in patients with the acquired immunodeficiency syndrome (AIDS). Evidence of drug interactions.

STUDY OBJECTIVE: To examine the interaction between dapsone and trimethoprim in patients with the acquired immunodeficiency syndrome (AIDS). DESIGN: Measurement of drug levels as part of an open study of dapsone alone and randomized, double-blind comparison of trimethoprim-dapsone with trimethoprim-sulfamethoxazole in treating Pneumocystis carinii pneumonia in patients with AIDS. SETTING: County hospital and AIDS clinic. PATIENTS: Eighteen patients treated with dapsone alone, 30 with trimethoprim-dapsone, and 30 with trimethoprim-sulfamethoxazole. INTERVENTION: Dapsone, 100 mg/d; trimethoprim, 20 mg/kg body weight per day, and sulfamethoxazole, 100 mg/kg.d; administered for 21 days. MEASUREMENTS AND MAIN RESULTS: Concentrations of dapsone were 40% higher in patients treated with trimethoprim-dapsone than in those treated with dapsone alone (2.1 compared with 1.5 micrograms/mL; P less than 0.05). Trimethoprimdapsone-treated patients had fewer treatment failures but more side effects and treatment terminations due to toxicity than those treated with dapsone alone. The concentration of trimethoprim was 48.4% higher in patients treated with trimethoprim-dapsone than in those treated with trimethoprim-sulfamethoxazole, (18.4 compared with 12.4 micrograms/mL; P less than 0.05). Discontinuation of therapy due to toxicity was commoner in the trimethoprim-sulfamethoxazole group (57% compared with 30%). CONCLUSIONS: A bidirectional drug interaction exists between dapsone and trimethoprim, resulting in higher concentrations of each in the presence of the other.

Acetylation↗
PubMed1988

Prevention of HIV transmission.

With screening of the blood supply and effective heat and chemical treatment of blood product derivatives, the overwhelming majority of newly acquired adult HIV infections will result from consensual acts, through the exchange of blood or sexual secretions. Societal relaxation about discussion of sex, death, homosexuality, drugs, and abortion is essential to prevent further deaths. Careful partner selection, use of condoms in conjunction with nonoxynol-9 (a viricidal spermicide), and selected confidential HIV antibody testing could help decrease the number of infected persons. Efforts directed toward IV drug users to decrease initiation of drugs, make drug treatment more accessible, provide simple techniques for cleaning needles such as a quick rinsing with bleach and water, and emphasizing the risks of sharing needles could decrease the exponential rise of HIV infection in IV drug users. A substantial percentage of women infected with both HIV and hepatitis B are unaware of their infection. Information, counseling, and antibody testing of men and women prenatally with informed options could reduce infection in children. Health care providers must work through their own valid issues of fear and possible discomfort with various lifestyles to function effectively in the health professions.

Acquired Immunodeficiency Syndrome↗
PubMed1988

AIDS care: providing care for the HIV infected.

To meet the needs of human immunodeficiency virus (HIV) infected individuals, innovative approaches to health care delivery have been developed that could affect the entire worldwide medical care system. Innovations include dedicated inpatient and outpatient AIDS treatment and research units, extensive community service organizations, active volunteers, hospices, visiting nurses, AIDS information hot lines, confidential testing sites, outpatient infusion centers, integration of research and clinical care, and new roles for health professionals including AIDS as an unofficial medical subspecialty. Patient care has replaced medical care, and nurture and technology must coexist when a cure cannot be assured. Physicians expecting choice in patients they care for must accept HIV; staggering health care costs, a sorely taxed public care system, fear of infection or medical inadequacy, declining nursing school enrollment, decreased interest in primary care medical specialties, a dwindling supply of community volunteers, and sparse extended care facilities hamper our efforts to provide for AIDS patients. However, the abundance of vacant hospital beds, the social and scientific challenge of AIDS care and research, employment opportunities, and a new generation of health care professionals accepting AIDS as part of the challenge of medicine all offer hope for change. In AIDS, we have the opportunity to strike an alliance between the art of healing and the advanced technology of modern medicine. In doing so, we will all face our own mortality.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Women and the acquired immunodeficiency syndrome. An interview.

SPECIAL EDITOR'S NOTE: Constance B. Wofsy, MD, is Co-Director of AIDS Activities at San Francisco General Hospital and Medical Center, as well as Associate Clinical Professor of Medicine at the University of California, San Francisco; Assistant Chief, Infectious Diseases, San Francisco General Hospital; and Principal Investigator, Project AWARE (Association for Women's AIDS Research and Education). Although she was not able to contribute an article for WOMEN AND MEDICINE on this very important subject, she kindly agreed to an interview. Both physicians and nonphysicians were asked what questions they had about the acquired immunodeficiency syndrome (AIDS) and the human immunodeficiency virus (HIV) in women.

Acquired Immunodeficiency Syndrome↗
PubMed1988

AIDS.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Treatment of patients with acquired immunodeficiency syndrome and associated manifestations.

Treatment of AIDS is multidisciplinary and often involves input from a number of medical subspecialties. Treatment of opportunistic infections and malignancies in AIDS is largely palliative in that these treatments do not reverse the underlying immunodeficiency. Investigational approaches to the treatment of this syndrome with immunomodulators and antiviral agents are currently being investigated with the hope that these agents, either alone or in combination, will be active against this devastating disease.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Therapy of acquired immune deficiency syndrome with recombinant interleukin-2.

Recombinant human interleukin-2 (rIL-2) was administered to 87 patients with the acquired immune deficiency syndrome (AIDS) to test the hypothesis that this lymphokine would correct the underlying qualitative and quantitative deficiency in cellular immunity. Patients were divided into two groups by the presence or absence of Kaposi's sarcoma and subjects within each of these groups received intravenous rIL-2 three times weekly for eight weeks. Subjects received one of several doses which ranged from 1,000 to 2,000,000 units per square meter body surface area. Toxicity at high doses consisted of flu-like symptoms and hypotension at highest doses. Partial objective tumor regression was observed in three patients with Kaposi's sarcoma. Seventeen patients had progression of disease (new opportunistic infection or increase in Kaposi's sarcoma) during therapy. No improvement in immunologic status was observed. This study does not suggest a role for single-agent rIL-2 therapy of established AIDS but its use in less symptomatic persons or in conjunction with antiretroviral agents such as azidothymidine should be investigated.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Isolation of AIDS-associated retrovirus from genital secretions of women with antibodies to the virus.

The AIDS-associated retrovirus (ARV) was isolated from vaginal and/or cervical secretions from 4 out of 8 women whose sera contained antibodies to the virus. The quantity of virus recovered initially was so low that identification of ARV was accomplished only after passage of the isolates to cultured mitogen-stimulated normal human peripheral blood mononuclear cells. The results indicate that the vaginal canal under certain conditions could be a source of transmission of ARV.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Use of a specific and sensitive assay to determine pentamidine pharmacokinetics in patients with AIDS.

The first-dose pharmacokinetics of pentamidine were studied in patients with AIDS. Pentamidine isethionate (4 mg/kg) was administered intramuscularly or intravenously to two groups of six patients each. Serial plasma and urine concentrations were measured by high-performance liquid chromatography, which is accurate and precise (sensitivity limits, 2.29 ng/ml in plasma and 229 ng/ml in urine). The mean peak concentrations in plasma after intramuscular and intravenous administration were 209 ng/ml and 612 ng/ml, respectively. Plasma concentrations, which declined biexponentially, were detectable throughout the 24-hr dosing interval and fell to less than 25 ng/ml after 8 hr. The mean plasma clearance, elimination half-life, apparent volume of distribution, and apparent volume at steady state for intramuscularly treated patients were 305 liters/hr, 9.36 hr, 924 liters, and 2,724 liters, respectively; these parameters for intravenously treated patients were 248 liters/hr, 6.40 hr, 140 liters, and 821 liters, respectively. Renal clearance of pentamidine was 5.0% of the plasma clearance for intramuscularly treated patients and 2.5% for intravenously treated patients. We found significant differences in the pharmacokinetic parameters between intramuscularly and intravenously treated patients.

Acquired Immunodeficiency Syndrome↗