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Biomedical subjects

D I Abrams

Publications and source records attributed to D I Abrams.

At least 55 records · Page 3Linked to original sources
PubMed1990

The relationship between Kaposi's sarcoma and intestinal parasites among homosexual males in the United States.

An interesting temporal relationship exists between the emergence of the epidemic of intestinal parasites in the homosexual male population and the subsequent appearance of Kaposi's sarcoma. Existent models suggest possible links between chronic parasitosis, viral infection, and the emergence of malignant disease. Patients with AIDS-related conditions have been demonstrated to have a high rate of asymptomatic amebiasis. Possible links between intestinal parasites and the development of Kaposi's sarcoma in human immunodeficiency virus-infected patients are explored.

Acquired Immunodeficiency Syndrome↗
PubMed1989

AIDS-associated non-Hodgkin's lymphoma in San Francisco.

The characteristics of acquired immunodeficiency syndrome-associated non-Hodgkin's lymphoma in 84 patients diagnosed and treated at San Francisco General Hospital are presented herein. While the majority were high-grade B-cell lymphomas, one cutaneous T-cell and one peripheral T-cell lymphoma were observed. In addition, three other tumors were suspicious for T-cell lymphoma. Sixty-seven percent of patients had stage IV disease, often at unusual sites. Epstein-Barr virus DNA sequences were identified in only five of 15 tumors by dot-blot analysis. Patients were treated with a variety of standard chemotherapeutic regimens, with radiation therapy alone, or with a novel chemotherapy protocol (COMET-A). No significant differences in complete response rates were observed. The most important predictor of survival was the total number of CD4-positive lymphocytes. Other predictors of survival included history of a diagnosis of acquired immunodeficiency syndrome, Karnofsky performance score, and the presence of extranodal disease. Survival was shorter among patients who received higher doses of cyclophosphamide (greater than 1 g/m2), including those treated with the COMET-A regimen. Implications for therapeutic decision making are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Oral dextran sulfate (UA001) in the treatment of the acquired immunodeficiency syndrome (AIDS) and AIDS-related complex.

STUDY OBJECTIVE: To evaluate the tolerance and safety of oral dextran sulfate (UA001), a potent in-vitro inhibitor of human immunodeficiency virus (HIV) in patients with the acquired immunodeficiency syndrome (AIDS) and AIDS-related complex. DESIGN: Unblinded, dose-escalation 8-week trial. SETTING: An AIDS outpatient clinic of a university-affiliated municipal hospital. PATIENTS: Thirty-four patients with stage III or IV HIV infection were enrolled. Five patients in six different dosage cohorts completed the study. The population was predominantly homosexual men with persistent generalized lymphadenopathy (stage III). INTERVENTIONS: Oral dextran sulfate was given three times daily in total daily doses of 900 to 5400 mg for 8 weeks. Patients were monitored for tolerance and toxicity. Immunologic and virologic values were also followed. MEASUREMENTS AND MAIN RESULTS: Oral dextran sulfate was given without significant side effects. The commonest minor subjective complications were mental hyperexcitability and gastrointestinal complaints. The most frequent laboratory abnormalities were leukopenia and hepatic transaminase elevations. Eleven patients required dose reductions, and therapy was stopped in 4 because of toxicities. The CD4 lymphocyte numbers did not change appreciably. No decline in beta-2 microglobulin levels occurred. The HIV antigen levels were unchanged from baseline. No assay for dextran sulfate plasma levels has yet proven successful. CONCLUSIONS: Oral dextran sulfate appears to be well tolerated. No evidence of systemic absorption of the parent compound is available. However, in view of the promising in vitro effects and acceptable toxicity, oral dextran sulfate as a potential antiretroviral agent continues to be studied.

AIDS-Related Complex↗
PubMed1989

Serum beta 2-microglobulin decreases in patients with AIDS or ARC treated with azidothymidine.

Abnormally elevated serum beta 2-microglobulin has been associated with progression of human immunodeficiency virus (HIV) disease and could reflect in vivo HIV activity. We prospectively studied the effect of azidothymidine therapy on serum beta 2-microglobulin concentration in 41 patients with AIDS or AIDS-related complex. Median beta 2-microglobulin concentration decreased from 4.02 mg/L before therapy to 3.73 mg/L at week 24 of therapy (P = .016). Individual changes in beta 2-microglobulin during azidothymidine therapy correlated with changes in serum HIV p24 antigen (Spearman, r = .42, P = .007). Also, in a randomized placebo-controlled study, median beta 2-microglobulin concentration decreased after 16 w of therapy in 5 azidothymidine-treated patients compared with levels in 7 placebo-treated controls (P = .05). Serum beta 2-microglobulin appears to be a sensitive marker for in vivo antiretroviral drug activity and may be a better marker than serum p24 antigen for early intervention trials involving antiretroviral agents.

AIDS-Related Complex↗
PubMed1989

Intralesional recombinant tumor necrosis factor-alpha for AIDS-associated Kaposi's sarcoma: a randomized, double-blind trial.

The effect of recombinant tumor necrosis factor-alpha (rTNF), injected directly into the tumor, was evaluated in a Phase I/II study of 27 patients with AIDS-associated Kaposi's sarcoma (KS). The maximally tolerated intralesional dose was less than 100 micrograms/m2 and the recommended intralesional dose was 25 micrograms/m2. In a double-blind, randomized, placebo-controlled study, rTNF reduced the cross-sectional area of 15 of 16 (94%) of the injected KS lesions and caused complete disappearance of 3 of 16 (19%) lesions. Only injected lesions showed a response. Rigors and fever were common dose-dependent side effects and were attenuated by meperidine. There were no changes in human immunodeficiency virus (HIV) activity as determined by serum p24 antigen levels. While biologically active, the systemic toxicity of rTNF as well as the lack of distant antitumor effects in noninjected lesions limits its clinical usefulness under the conditions employed in this trial.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Peripheral neuropathy associated with acquired immunodeficiency syndrome. Prevalence and clinical features from a population-based survey.

We prospectively studied 40 hospitalized patients who had well-established diagnoses of acquired immunodeficiency syndrome. Patients with confounding risk factors for neuropathy were excluded; none of the study patients had known vitamin deficiency, alcoholism, or any metabolic, drug, or toxic factor. Clinical and electrophysiologic evidence of a distal symmetric polyneuropathy was found in 35% (13/37) of the patients. Symptoms and signs of neuropathy were usually mild, and painful dysesthesias were uncommon. Amplitude reduction of sural nerve action potentials distinguished all patients with from those without clinical neuropathy. Results of other electrophysiologic studies of sural, peroneal, and median nerves were typically normal. These results provide evidence of distal axonal degeneration. Neuropathy occurred only in patients with systemic illness longer than five months' duration. When compared with patients without neuropathy, these patients had more severe weight loss and a higher incidence of clinical dementia. Follow-up evaluation showed no evidence of clinical progression over a six-month period. The pathogenesis of this common distal axonal polyneuropathy is unknown and warrants further investigation.

Acquired Immunodeficiency Syndrome↗
PubMed1988

The pre-AIDS syndromes. Asymptomatic carriers, thrombocytopenic purpura, persistent generalized lymphadenopathy, and AIDS-related complex.

With the passage of time and the refinement of laboratory techniques, the ability to recognize disease related to human immunodeficiency virus infection has improved. Currently, a number of clinical conditions can be identified as "pre-AIDS" syndromes. These include the syndrome of persistent generalized lymphadenopathy, immune thrombocytopenic purpura, the wasting syndrome, and certain predominantly neurologic presentations. All are characterized by the presence of human immunodeficiency virus infection, symptomatic illness, and a tendency to progress to a diagnosis of full-blown AIDS that appears to be ever increasing with the passage of time.

AIDS-Related Complex↗
PubMed1987

Lack of response to suramin in patients with AIDS and AIDS-related complex.

Forty-one homosexual men with the acquired immune deficiency syndrome (AIDS) or AIDS-related complex were treated with 0.5, 1.0, or 1.5 g of suramin weekly for up to six months. In no patient was evidence of symptomatic improvement or regression of Kaposi's sarcoma shown. Opportunistic infections developed in 16 patients during therapy. Only six patients (15 percent) became human immunodeficiency virus (HIV) culture-negative during treatment, despite documentation of adequate serum suramin levels. All but one of these six have had disease progression. Decreases in the numbers of total T4 cells with time were observed in both AIDS and AIDS-related complex subgroups. Toxicity was significant and consisted of fatigue, fever, and hepatic and renal dysfunction, all of which were observed most frequently with the 1.0 or 1.5 g dosages. Fatal hepatic failure developed in two patients, and adrenal insufficiency was documented in eight patients. Suramin is a toxic agent that shows no virologic, immunologic, or clinical benefit in patients with HIV-related disease.

AIDS-Related Complex↗
PubMed1987

Immunodeficiency-associated thrombocytopenic purpura (IDTP). Response to splenectomy.

Immunodeficiency-associated thrombocytopenic purpura (IDTP) is a feature of the acquired immunodeficiency syndrome--related complex. Current therapeutic modalities for IDTP include splenectomy and the administration of corticosteroids or other agents. Empiric treatment of IDTP has been analogous to that for immunologic thrombocytopenic purpura (ITP). The present report reviews 15 patients who underwent splenectomy for IDTP, demonstrates the successful use of surgical therapy, and defines our indications for splenectomy in the treatment of this disorder. Thirteen of 15 patients had initially failed to respond to steroid therapy. Fourteen patients (93%) initially responded to splenectomy, with platelet counts increasing to 150 X 10(9)/L (150,000/mm3) or greater. A continuing complete response was achieved in nine patients (60%) following splenectomy. After postsurgical adjunctive therapy, durable remission was achieved in 73% (11/15) of the patients. Complications occurred in three patients, and there were no deaths. The mean follow-up was 12.4 months. Splenectomy may be performed in the treatment of IDTP with acceptable morbidity and likelihood of response.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Relation of oral hairy leukoplakia to infection with the human immunodeficiency virus and the risk of developing AIDS.

We investigated the relation of oral hairy leukoplakia (HL) to human immunodeficiency virus (HIV) infection and to the presence or development of AIDS. All 155 patients with HL seen in our clinic were immunosuppressed homosexual men. Of 101 serum samples obtained from patients in this group who did not have AIDS, 100 showed antibodies to HIV. HIV was recovered from peripheral blood mononuclear cells of 22 of 28 patients tested. Most serum samples examined by immunoblot assay reacted with the viral envelope and gag gene precursors gp160 and p55. Of the 155 patients, 12 had AIDS at the time of diagnosis, and the syndrome developed in an additional 43 patients in one to 31 months. Survival analysis showed that the probability of AIDS developing in patients with HL was 48% by 16 months and 83% by 31 months. We conclude that oral HL is highly predictive of the development of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1987

AIDS update--1987.

Human immunodeficiency virus (HIV) infection produces a spectrum of clinical syndromes, progressing in severity from asymptomatic infection through the life-threatening diseases of the acquired immunodeficiency syndrome (AIDS). Current knowledge about the epidemiology, virology, and clinical manifestations of HIV infection and AIDS are reviewed.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Alpha interferon therapy of AIDS-associated Kaposi's sarcoma.

Alpha interferon has been the most widely studied biologic response modifier for the treatment of Kaposi's sarcoma (KS) associated with acquired immune deficiency syndrome (AIDS). At San Francisco General Hospital's AIDS Clinic, three sequential trials of recombinant interferon alfa-2b (Intron A) were conducted between August 1982 and April 1984. In the first study, ten patients with early KS were randomized to receive either low-dose (1 MU/m2) subcutaneous (SC) or high-dose (50 MU/m2) intravenous (IV) treatment 5 days per week, every other week, for eight weeks. A perceived advantage of the latter regimen led to a subsequent trial in which 20 subjects received high-dose IV therapy. A 32% objective response rate was achieved, despite the fact that these patients had less favorable disease status and more constitutional symptoms than those in the first trial and had also experienced previous opportunistic infections (Ols). A final 8-week investigation evaluated the use of 30 MU/m2 three times per week in 30 subjects. Drug-related toxicity seemed more pronounced with this regimen, but overall objective responses were identical to those seen in the high-dose IV study. None of the trials produced evidence of immune reconstitution on laboratory evaluation. The patients were not protected from developing AIDS-related OI either during or following interferon therapy, although OI was diagnosed less frequently in responders, who also displayed a distinct survival advantage over those with progressive disease. These trends remained evident when the data from the three studies were pooled with those from three parallel trials conducted at the University of California, Los Angeles (UCLA). Studies evaluating the combined use of alpha interferon and chemotherapeutic agents known to be active against AIDS-related KS (such as VP-16 and vinblastine) have thus far failed to demonstrate a synergistic antitumor effect, while toxicity has increased. In light of in vitro evidence that alpha interferon suppresses the AIDS retrovirus and has clinical efficacy in KS comparable to that of cytotoxic agents, additional investigations, focusing on maximizing therapeutic potential, are warranted.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Lupus anticoagulant in the acquired immunodeficiency syndrome.

Prolongation of partial thromboplastin time was noted in patients with acquired immunodeficiency syndrome (AIDS) who were admitted to the hospital for diagnosis of opportunistic infection. As biopsy procedures were often indicated, detailed investigation of the abnormal coagulation study was performed in four patients. Results confirmed the presence of a lupus anticoagulant. Partial thromboplastin times of 34 consecutive subsequent patients hospitalized with the diagnosis of AIDS-associated opportunistic infection were recorded; prolongation was noted in 24 of these. None of these 38 patients exhibited clinical evidence of bleeding. One patient had a confirmed thrombotic episode. Prolonged partial thromboplastin time is a common finding in hospitalized patients with AIDS and opportunistic infection. If no clinical history of unusual bleeding is noted, the lupus anticoagulant should be suspected. Many patients with AIDS require invasive procedures for disease management; the lupus anticoagulant, an in vitro phenomenon, should not prevent these studies.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Lymphadenopathy related to the acquired immunodeficiency syndrome in homosexual men.

Persistent generalized lymphadenopathy is a nonspecific physical finding common in AIDS and AIDS-related disorders. A subset of patients with a benign course and normal laboratory evaluation are at low risk for developing full-blown AIDS. Simple clinical and laboratory findings may predict progression from lymphadenopathy syndrome to more malignant manifestations of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Routine care and psychosocial support of the patient with the acquired immunodeficiency syndrome.

Due to the magnitude of the AIDS epidemic in San Francisco, centralization of services has been essential for providing maximal patient care and support, and allowing for efficient performance of clinical investigation. While other locales with fewer numbers of documented cases may not have the need for such extensive organization, lessons can be adopted from the San Francisco experience. It is never an easy task to provide routine medical care and psychosocial support for a young patient with an ultimately fatal illness. Close cooperation of the medical establishment and the community at large, with governmental assistance and support, facilitates this difficult undertaking.

Acquired Immunodeficiency Syndrome↗
PubMed1986

AIDS-related lymphomas: evaluation by abdominal CT.

Recent evidence indicates that individuals with acquired immunodeficiency syndrome (AIDS) or those at high risk for AIDS have an increased occurrence of lymphoma. AIDS-related lymphomas (ARLs) often present with an advanced stage of disease and highly malignant histologic subtypes. This study reviewed the abdominal computed tomographic (CT) findings in 29 patients with ARL, including ten with Hodgkin disease (HD) and 19 with non-Hodgkin lymphoma (NHL). Focal splenic and hepatic involvement was more common in both AIDS-related HD (10%) and NHL (26%) than reported in the non-AIDS population. In addition, mesenteric lymphadenopathy was demonstrated in 20% of patients with AIDS-related HD, compared with less than 5% in non-AIDS patients. In this series, patients with NHL had pelvic nodal masses in 37%, bowel involvement in 26%, and renal lesions in 11%. The authors conclude that ARLs are highly aggressive neoplasms that often present with atypical features compared with lymphomas in other patients. Potential problems in the CT interpretation of ARL for homosexual men are discussed.

Acquired Immunodeficiency Syndrome↗