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Biomedical subjects

J D Rich

Publications and source records attributed to J D Rich.

At least 55 records · Page 3Linked to original sources
PubMed1998

Interpretation of indeterminate HIV serology results in an incarcerated population.

The objective of this study was to evaluate the significance of indeterminate HIV test results in the prison setting. No specific information or guidelines are currently available to direct counseling of incarcerated persons with an indeterminate HIV test. A medical chart review was conducted on all incarcerated inmates at the Rhode Island State Prison who received indeterminate HIV test results between the inception of mandatory testing in 1990 and October 1996. Thirty-five inmates had an indeterminate HIV Western blot (WB) result, and 31 had follow-up HIV testing. Twenty-three of 31 (74%) of the prisoners with follow-up HIV tests seroconverted (95% confidence interval, 55%-88%). Drug/alcohol use, including crack cocaine and injection drug use, was strongly associated with seroconversion (p < 0.01, odds ratio [OR] = 11.8, relative risk [RR] = 2.04). Injection drug use was also significantly associated with seroconversion (p = 0.03, OR = 9.3, RR = 1.56). This is the highest rate of seroconversion ever reported for persons with indeterminate WB test results. Indeterminate test results need to be interpreted differently in the prison setting than in the community. Prison inmates with indeterminate HIV serology should be counseled that in all likelihood they are HIV-infected, and confirmatory viral load testing should be conducted immediately.

Adult↗
PubMed1998

Pulmonary aspergillosis and invasive disease in AIDS: review of 342 cases.

Aspergillosis is an infrequent but commonly fatal infection among HIV-infected individuals. We review 342 cases of pulmonary Aspergillus infection that have been reported among HIV-infected patients, with a focus on invasive disease. Invasive pulmonary aspergillosis usually occurs among patients with <50 CD4 cells/mm3. Major predisposing conditions include neutropenia and steroid treatment. Fever, cough, and dyspnea are each present in >60% of the cases. BAL is often suggestive, but biopsy specimens are necessary for definite diagnosis. Amphotericin B is the mainstay of treatment and mortality is > 80%. Avoiding neutropenia and judicious use of steroids may be helpful in prevention. Aggressive diagnostic approach, early initiation of treatment, adequate dosing of antifungals, and close follow-up may improve the currently dismal prognosis.

AIDS-Related Opportunistic Infections↗
PubMed1997

Trimethoprim/sulfamethoxazole incremental dose regimen in human immunodeficiency virus-infected persons.

BACKGROUND: The mechanism of tolerance to incremental doses of trimethoprim-sulfamethoxazole given to human immunodeficiency virus-infected persons who have had a prior intolerance to this agent has not been studied. OBJECTIVE: We prospectively evaluated a regimen of incremental doses of oral trimethoprim-sulfamethoxazole in human immunodeficiency virus-infected persons who had a prior trimethoprim-sulfamethoxazole-induced fever and nonexfoliative skin rash to investigate the mechanism by which it permits tolerance. METHODS: Oral trimethoprim (0.00004 mg)/sulfamethoxazole (0.00002 mg) was given to 22 human immunodeficiency virus-infected persons on day 1 and gradually increased over eight days to 1 double strength (DS) tablet/day in an outpatient setting. At study entry, skin tests and IgG antibodies to sulfa were performed; the latter was repeated at study week 4. RESULTS: Nineteen patients tolerated trimethoprim/sulfamethoxazole at the completion of the 8-day protocol (86% effective). Moderate toxicities occurred in eight persons during the desensitization protocol; five of these were able to continue trimethoprim/sulfamethoxazole with adjunctive prednisone. Skin tests to sulfa antigen were negative in all persons. Eleven patients at study entry had antibodies to sulfamethoxazole; IgG antibodies appeared at week 4 in 8 of the 11 patients who initially had no antibody detected. CONCLUSIONS: The mechanism of tolerance to the incremental doses of trimethoprim/sulfamethoxazole given to previously intolerant human immunodeficiency virus-infected persons is not due to desensitization and remains undetermined.

Administration, Oral↗
PubMed1996

Dapsone penetrates cerebrospinal fluid during Pneumocystis carinii pneumonia prophylaxis.

Dapsone has been proposed as a prophylactic agent for both Pneumocystis carinii pneumonia (PCP) and reactivation cerebral toxoplasmosis. To determine whether dapsone penetrates the central nervous system, cerebrospinal fluid (CSF) and serum samples were drawn from patients taking dapsone for PCP prophylaxis. These samples were quantitatively assayed using high-performance liquid chromatography. Five AIDS patients and one cardiac transplant patient had CSF assayed for dapsone. Only one had evidence of CSF inflammation, resulting from a paraspinal abscess. Doses ranged from 50 mg 3 days/week to 100 mg/day, and levels were 0.30-1.61 mu g/ml, which are in the range of inhibition of Toxoplasma gondii tachyzoites. This is the first report to demonstrate that dapsone enters the CSF, and supports preliminary clinical evidence that dapsone may have protective activity against cerebral toxoplasmosis when used for PCP prophylaxis.

Adult↗