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Biomedical subjects

M A Conant

Publications and source records attributed to M A Conant.

At least 19 recordsLinked to original sources
PubMed1992

Maintenance of CD4+ cells by thymopentin in asymptomatic HIV-infected subjects: results of a double-blind, placebo-controlled study.

OBJECTIVE: To assess the efficacy and safety of thymopentin in HIV-infected patients who had not yet developed AIDS. DESIGN: Patients were stratified into asymptomatic or symptomatic groups and randomized to receive either thymopentin (50 mg) or placebo, subcutaneously, double-blind for 24 or 52 weeks, three times a week. SETTING: Patients were enrolled at three sites (two hospital clinics and one private practice). PATIENTS: Of 91 HIV-seropositive patients (52 asymptomatic and 39 symptomatic) from whom HIV could be isolated from peripheral blood, 45 were enrolled for 24 weeks and 46 for 52 weeks of double-blind evaluation. MAIN OUTCOME MEASURES: Virological, immunological and clinical evaluations were performed before and during treatment. RESULTS: Thymopentin-treated asymptomatic patients had more CD4+ cells, as demonstrated by a greater area under the percentage CD4+ cells curve (P = 0.03) and a shorter median time to a 20% increase in percentage of CD4+ cells (P = 0.04) in the first 24 weeks, with similar trends in the 52-week study. By 24 weeks no asymptomatic thymopentin-treated and two placebo-treated patients (9.1%, Kaplan-Meier estimate) had progressed to constitutional symptoms (P = 0.12; two-tailed Wilcoxon-Gehan test), with only one further progression in a placebo-treated patient in the subset followed for 52 weeks. Symptomatic patients receiving thymopentin or placebo were similar in both CD4+ cell levels and disease progression (two progressions to AIDS in each group). No serious adverse effects attributable to thymopentin were observed. CONCLUSIONS: These results, if confirmed, indicate that thymopentin, by maintaining CD4+ cells, could slow or arrest immune decline and consequent disease progression at the asymptomatic stage of HIV infection.

Amino Acid Sequence↗
PubMed1990

Human immunodeficiency virus-associated psoriasis, psoriatic arthritis, and Reiter's syndrome: a disease continuum?

The presence of peripheral arthritis and HLA-A, B, C, DR, and DQ antigens was evaluated prospectively in 18 Caucasian men with human immunodeficiency virus-associated psoriasis. An asymmetric polyarthritis occurred in 32% of the patients and correlated with the presence of HLA-B27. Extensive clinical overlap between psoriatic arthritis, psoriasis, and Reiter's syndrome was noted. No significant excess of the HLA antigens previously found to be associated with psoriasis was seen, which suggests that human immunodeficiency virus-associated psoriasis per se may instead constitute another form of spondylarthropathy that is more closely related to Reiter's syndrome.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Efficacy of desciclovir in the treatment of Epstein-Barr virus infection in oral hairy leukoplakia.

The efficacy of desciclovir, an analog of acyclovir, in eliminating lesions of oral hairy leukoplakia (HL) and suppressing Epstein-Barr virus (EBV) infection was evaluated in a double-blind, placebo-controlled study of 14 patients. Patients were randomized to receive either the active drug, 250 mg three times a day for 14 days, or placebo. In all eight patients receiving desciclovir, lesions of HL were either completely resolved or significantly reduced during the treatment period, whereas lesions in patients receiving placebo showed no change. The histological features of HL were significantly diminished in patients on desciclovir, and cytochemical, in situ hybridization, and ultrastructural studies showed that EBV infection was eliminated or dramatically reduced in the desciclovir group only. Four patients on desciclovir reported side effects, but none required withdrawal from the study. The reappearance of HL in all eight subjects on desciclovir within 1-4 months after therapy was discontinued suggests the need for additional study.

Acyclovir↗
PubMed1989

Targeting AIDS prevention and treatment toward HIV-1-infected persons. The concept of early intervention.

We propose establishing private and public outpatient facilities where persons with human immunodeficiency virus, type 1 (HIV-1), infection can receive state-of-the-art clinical and behavioral follow-up, treatment, and assistance. The possible advantages of enrolling HIV-1-positive persons into long-term follow-up are early treatment of clinical conditions and resulting gains in life quality and life expectancy, decreased transmission of HIV-1 to uninfected persons, more efficient use of scarce patient-care resources, and improved estimates of the total number of HIV-infected persons. The possible disadvantages of such a program are adverse psychological reactions to knowledge of HIV-1 infection, adverse societal actions against infected persons, and, finally, the economic cost of the program. These facilities, with the proper expertise and safeguards of confidentiality and trust, could prolong and improve the lives of infected persons while preventing infection of others.

AIDS Serodiagnosis↗
PubMed1989

Patient-applied podofilox for treatment of genital warts.

In a double-blind trial, 0.5% podofilox (podophyllotoxin) or placebo was applied by patients to their own genital warts in up to four treatment cycles. At some time during the study, 25 of the 56 podofilox treated patients and none of the 53 placebo group were completely wart-free. At the end of the treatment, 73.6% of the original warts in podofilox treated patients were gone compared with only 8.3% of those in the placebo group (mean percentage of total original wart area was reduced by 82.3% compared with 4.2%). 82% of the treated warts in the podofilox group and 13% in the placebo group had resolved at 6 weeks. Recurrence was observed in 34% of the previously resolved warts. Consistent with this rate of recurrence, new warts developed in a third of the subjects in each group at sites remote from the treatment site. There were no systemic adverse reactions, although transient inflammation, erosion, pain, and burning were common.

Administration, Topical↗
PubMed1989

Disseminated ecthymatous herpes varicella-zoster virus infection in patients with acquired immunodeficiency syndrome.

Herpesvirus infections are among the most common and debilitating opportunistic infections in patients with acquired immunodeficiency syndrome (AIDS), and they may have atypical clinical features. We describe the cases of three patients with AIDS in whom atypical persistent ulcerative skin lesions developed as a result of varicella-zoster virus infection. Two patients had disseminated infection without a vesicular stage; one patient had underlying asteatotic eczema. All responded well to acyclovir. One patient was treated with azidothymidine, and typical dermatomal herpes zoster subsequently developed. The profound loss of helper T cell function in AIDS may lead to multiple abnormalities in local immune response to cutaneous herpesvirus infections and may be responsible for the atypical morphology and a prolonged course.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Analysis of human KS biopsies and cloned cell lines for cytomegalovirus, HIV-1, and other selected DNA virus sequences.

Investigation into a possible role of several human viruses, including human cytomegalovirus (HCMV), human immunodeficiency virus (HIV-1), hepatitis B virus (HBV), human herpesvirus 6 (HHV6), and Epstein-Barr virus (EBV) in the pathogenesis of Kaposi's sarcoma (KS) has resulted in the lack of an association of these viruses in KS biopsy and cloned KS cell line specimens. Since nearly all patients with KS, including those with HIV-associated KS, have a high incidence of HCMV infection, HCMV has been proposed to be etiologically associated with KS. Moreover, our previous studies showed the retention of HCMV morphological transforming region II (mtrII) in both transformed and tumor-derived cell lines. As a result, we focused on the nucleic acid hybridization analysis of both KS biopsies from AIDS patients as well as cloned KS endothelial cell lines for HCMV mtrII sequences. We also analyzed KS biopsy and KS cloned cell line specimens for HIV-1, HBV, HHV6, and EBV sequences, since these viruses have also been implicated in the etiology of KS. In one set of experiments, Southern blot analysis revealed the presence of HCMV mtrII sequences in two of six KS biopsies; in other experiments, HBV sequences were found in one of seven KS biopsies. No hybridization in any biopsy tissue was detected for HIV-1 DNA sequences. The analysis of six independently derived cloned KS cell lines was next studied. All these lines were negative for hybridization to the HCMV mtrII transforming fragment as well as to subgenomic fragments of HHV6 and EBV.(ABSTRACT TRUNCATED AT 250 WORDS)

Blotting, Southern↗
PubMed1988

Episodic twice-daily treatment for recurrent genital herpes.

A new dosage regimen of orally administered acyclovir, 800 mg twice daily for five days, for the treatment of recurrent genital herpes was compared with the standard dosage of 200 mg given five times per day. A double-blind study of 157 patients was used to evaluate the safety and efficacy of both regimens. The new regimen was well tolerated, more convenient, and as effective as the standard dosage. In male patients, the new regimen may be more effective than the standard regimen of 200 mg given five times per day to treat lesions that are already present.

Acyclovir↗
PubMed1988

Prophylactic and suppressive treatment with acyclovir and the management of herpes in patients with acquired immunodeficiency syndrome.

During 1 year of continuous suppressive therapy for frequent recurrent genital herpes, about 44% of patients taking 400 mg acyclovir twice a day had no recurrences and 4% of patients taking placebo had no recurrences (i.e., fewer patients taking acyclovir had recurrences, and when they did there were fewer recurrences). Toxicity of continuous suppressive acyclovir treatment appears to be minimal, and viral resistance developing to the drug during use of suppressive therapy has not been a problem, although it does occur. Patients with acquired immunodeficiency syndrome with recurrent herpes may be given 400 mg acyclovir five times a day for 5 days or until the eruption clears and then 400 mg three times a day for 1 or 2 months followed by 400 mg twice a day thereafter. Herpes zoster of immunocompromised patients, including patients with acquired immunodeficiency syndrome, may be treated with 800 mg oral acyclovir five or six times a day for 5 to 10 days depending on the response, and they may derive additional benefit from concomitant topical acyclovir.

Acquired Immunodeficiency Syndrome↗
PubMed1988

HIV disease prevention and treatment. A model for local planning.

Since first reported in 1981, about a fourth of all cases of the acquired immunodeficiency syndrome in the United States have occurred in California. In response to the human immunodeficiency virus (HIV) epidemic, California has developed a five-point strategy consisting of epidemiologic surveillance; prevention education; the provision of medical treatment and supportive services; research; and continuous planning, evaluation, and coordination of programs. Given the size and tremendous environmental and cultural diversity of California, as well as the variable local impact of HIV disease local jurisdictions need to develop HIV disease prevention and treatment plans specifically tailored to the circumstances of their communities. At a minimum, these plans should include central participatory planning, epidemiologic surveillance, HIV antibody testing and prevention education programs, provision for medical treatment and social support services, and coordination of financing mechanisms. We present a model for such plans.

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↗
PubMed1986

Oral acyclovir for episodic treatment of recurrent genital herpes. Efficacy and safety.

This multicenter double-blind study of 157 patients was designed to evaluate the safety and efficacy of a new dosage regimen of oral acyclovir (800 mg twice a day for 5 days) for the treatment of recurrent genital herpes. The new regimen was compared with the standard dosage of 200 mg given five times a day to patients treated for three consecutive episodes (one episode with physician-initiated therapy and two with patient-initiated therapy) and followed up for three untreated episodes. The new regimen was well tolerated and effective. In male patients it may be more effective than the standard regimen of 200 mg given five times a day to treat vesicles that are already present.

Acyclovir↗
PubMed1986

Oral findings in people with or at high risk for AIDS: a study of 375 homosexual males.

A total of 375 homosexual males were studied to assess the dental findings, life-style, and risk factors during a 4-year period. At baseline, 136 of the patients were diagnosed as having AIDS, 116 were considered at risk for AIDS, and 123 were considered healthy. In a mean follow-up time of 23 months, nine of the patients at risk for AIDS and five of the patients considered healthy were diagnosed as having AIDS. Kaposi's sarcoma was the most common oral neoplasm, and candidiasis was the most frequent oral infection. Hairy leukoplakia was found in 28% of the patients, and periodontal disease was found in 17% of the patients. Carriers of the AIDS virus may not be identified easily and control measures in the dental office must be followed.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Replication of Epstein-Barr virus within the epithelial cells of oral "hairy" leukoplakia, an AIDS-associated lesion.

We conducted a study to identify the viruses in tissue specimens of oral "hairy" leukoplakia, a lesion that is found in immunosuppressed male homosexuals and that is associated with the subsequent development of the acquired immunodeficiency syndrome. When stained for papillomavirus core antigen, 49 of 67 biopsy specimens (73 per cent) yielded positive results in epithelial-cell nuclei. Electron microscopy showed papillomavirus-like particles in all of 25 specimens, and the herpes-type virus described in a previous report was seen in 23 of the 25 specimens. Three specimens had both types of particle in the same individual epithelial cells. Immunofluorescence for herpes simplex virus, varicella-zoster virus, and cytomegalovirus gave negative results in all cases, but 19 of 20 specimens showed intense nuclear staining in epithelial cells for the viral capsid antigen of Epstein-Barr virus (EBV). DNA hybridization using EBV probes in Southern blots demonstrated EBV DNA in all of 13 specimens and found 200 or more viral DNA molecules per cellular genome in 11 of the 13. The whole EBV genome was also demonstrated in the specimens and found to be in linear virion form. We conclude that EBV replicates within the epithelial cells in hairy leukoplakia.

Acquired Immunodeficiency Syndrome↗