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PubMed1993

Combination therapy in experimental invasive aspergillosis.

Combination antifungal therapy was assessed in an immunosuppressed rabbit model of invasive aspergillosis. Treatment with fluconazole, amphotericin B, or a combination of both significantly prolonged survival of animals lethally challenged with Aspergillus fumigatus. High-dose amphotericin B was the most effective therapy for invasive aspergillosis. Although no antagonism was seen when fluconazole was given prophylactically or therapeutically in combination with amphotericin B, combination therapy did not augment the antifungal activity of amphotericin B. Animals given a sublethal challenge of A. fumigatus had lower mortality rates when given amphotericin B, fluconazole as treatment or prophylaxis, or various combination therapies. Only animals treated with flucytosine had mortality rates comparable to those of controls. No antagonism was observed with combinations of fluconazole and amphotericin B, flucytosine and amphotericin B, or fluconazole and flucytosine. These observations provide evidence that fluconazole, flucytosine, and amphotericin B used in various combinations are not antagonistic and may provide some insight into the treatment of invasive aspergillosis in humans.

Amphotericin B↗
PubMed2004

Soluble CD26/30 levels before and after treatment with interferon-alpha and ribavirin combination therapy in a pediatric hepatitis C patient.

Chronic hepatitis C virus (HCV) infection frequently leads to end-stage liver diseases and extrahepatic complications. Combination therapy with interferon-alpha (IFN-alpha) and ribavirin is now recommended as the first-line therapy for patients with chronic hepatitis C in adults. However, the benefit of such combination therapy in children with hepatitis C is still under investigation. We report here on a 6-year-old boy admitted with chronic active hepatitis C infection and treated with interferon-alpha and ribavirin. After treatment for 12 months, his serum showed negative HCV RNA, and normal alanine aminotransferase, and there was a sustained response. The patient's serum soluble CD30 (sCD30) level was higher than that of controls (>100 U/mL vs 46 +/- 11 U/mL) before combination therapy but there was no difference in soluble CD26 (sCD26) [103 ng/mL vs 119 +/- 28 ng/mL]. The sCD30 decreased and sCD26 increased at 6 months (45 U/mL and 188.3 ng/mL, respectively) using combined therapy as well as at 4 months after discontinuing it (33 U/mL and 167.8 ng/mL, respectively) in our patient. The results indicate that combined treatment with IFN-alpha and ribavirin may be used as the first-line treatment for children with chronic hepatitis C. The changes of sCD30 and sCD26 may be helpful in estimating of HCV infection activity.

Child↗
PubMed2001

Combination therapy improves the recovery of the skin barrier function: an experimental model using a contact allergy patch test combined with TEWL measurements.

BACKGROUND: Nickel (Ni) allergic contact dermatitis (ACD) alters the skin barrier. OBJECTIVE: Our aim was to compare the efficacy of combination therapies on ACD, using a topical corticosteroid and a corneotherapy agent (barrier cream), with that of a single therapy with corticosteroids. METHODS: On day 1, 3 Ni test patches were applied on each forearm of 14 Ni-patch-test-positive females. Four contained 5% Ni and 2 physiological saline. Either topical corticosteroid or barrier cream were matched with the combination of both products on 3 of the 4 Ni ACD. The fourth was not treated. Clinical scoring, transepidermal water loss (TEWL) and stratum corneum (SC) capacitance were measured before (day 1) and after (days 4-8) ACD. RESULTS: The combination therapy showed a significant decrease in TEWL values and an increase in SC capacitance. CONCLUSION: Combining a topical corticosteroid with corneotherapy agents prevents the delay in the healing process of skin barrier disruption due to ACD.

Administration, Cutaneous↗
PubMed2004

Combined therapy of enalapril and losartan attenuates histologic progression in immunoglobulin A nephropathy.

BACKGROUND: It has been reported that combined therapy of angiotensin converting enzyme inhibitor and angiotensin receptor blocker significantly decreases proteinuria in immunoglobulin A (IgA) nephropathy. However, histologic alterations following the therapy have not been reported. METHODS: A total of nine Japanese children with severe proteinuric IgA nephropathy who received a prompt immunosuppressive therapy were enrolled the study, four of whom received a combined therapy of angiotensin converting enzyme inhibitor, enalapril and angiotensin receptor blocker, losartan (Group A), while the remaining five did not (Group B). All underwent renal biopsy before and approximately 12 months after the first renal biopsy. RESULTS: At presentation, urine protein excretion and the histologic indices of mean activity index, mean chronicity index and tubulointerstitial scores did not show a statistical difference between the two groups: Group A (2.6 +/- 0.6 g/day; mean activity index, 5.0 +/- 1.0; mean chronicity index, 5.0 +/- 1.0; tubulointerstitial scores, 4.3 +/- 1.0) and Group B (2.2 +/- 0.6 g/day; mean activity index, 4.8 +/- 0.8; mean chronicity index, 4.8 +/- 1.3; tubulointerstitial scores, 3.6 +/- 0.5, respectively). All had normal blood pressure and renal function. Urine protein excretion and the activity index decreased at the second renal biopsy, while the chronicity index and the tubulointerstitial scores slightly increased or remained unchanged. In comparison with Group B, a significant suppression in increasing the chronicity index and the tubulointerstitial scores obtained at the second renal biopsy were observed in Group A [Group A: 4.3 +/- 1.2 and 3.0 +/- 0.0, respectively, vs Group B: 6.0 +/- 0.7 and 4.4 +/- 0.9, respectively (P < 0.05)]. One patient in Group B developed chronic renal insufficiency thereafter. CONCLUSIONS: Although only a small number of patients were examined, these clinical findings suggest that a combined therapy of enalapril and losartan may attenuate histologic progression in at least a proportion of patients with severe proteinuric IgA nephropathy.

Adolescent↗
PubMed2002

Combination therapy for postmenopausal osteoporosis.

A number of agents have been shown to reduce the risk of fractures in patients with postmenopausal osteoporosis. However, the additional benefits of combination therapy as opposed to monotherapy are uncertain. We performed a MEDLINE search and reviewed the published randomized trials of agents used in combination. Combination therapy results in greater gains in bone mineral density than monotherapy and possibly greater effects on bone turnover. However, none of these studies are large enough or of sufficient duration to determine whether a greater reduction in fracture is achieved. Combination therapy has important cost implications and is likely to be associated with an increased prevalence of adverse events, reduced tolerability and a reduction in adherence. Furthermore, over-suppression of bone turnover as a result of combination antiresorptive therapy might have adverse effects on bone strength, particularly with long-term treatment. Thus, the use of combination therapy for treatment of osteoporosis cannot be recommended on the basis of currently available evidence.

Aged↗
PubMed1997

Mutations in the pol gene of human immunodeficiency virus type 1 in infected patients receiving didanosine and hydroxyurea combination therapy.

The pattern of mutations in the reverse transcriptase (RT) of human immunodeficiency virus type 1 (HIV-1) strains that confer resistance to didanosine (ddI) was analyzed in 2 groups of patients receiving either ddI monotherapy or ddI plus hydroxyurea (HU) combination therapy. Twelve patients receiving combination therapy and 8 receiving monotherapy were tested. Combinations of ddI plus HU did not prevent the onset of mutations, which emerged in 50% of the patients in this group compared with 25% of the ddI monotherapy group. In addition, in 1 patient from the combination therapy arm, who had a limited response to the therapy, an unusual pattern of mutations was found: the insertion of 2 amino acids between residues 69 and 70, a region critical for resistance to nucleoside analogs. The higher efficacy of the combination of HU and ddI compared with that of ddI monotherapy cannot be attributed to a delayed or decreased onset of resistance to ddI.

Anti-HIV Agents↗
PubMed1975

Colestipol, clofibrate, cholestyramine and combination therapy in the treatment of familial hyperbetalipoproteinaemia.

Fifty-seven patients, mean age 26 years, suffering from familial hyperbetalipoproteinaemia (Fredrickson type lla and llb), were treated on a low cholesterol, modified polyunsaturated fat diet for a period of 6-12 weeks prior to the introduction of drug therapy. No significant reduction in the serum levels of total cholesterol, low density lipoprotein (LDL) cholesterol or triglyceride was found. Fifty patients were then treated with colestipol for 6 weeks; total and LDL cholesterol decreased by 23%, but triglyceride levels were unaffected. During the following 6 weeks, placebo was administered, and total and LDL cholesterol returned to pretreatment levels. The patients were then randomly allocated into two groups of 16. The first group continued with clofibrate therapy, while the second group received cholestyramine. In the clofibrate group a reduction in total and LDL cholesterol of the order of 17% was noted, similar to cholestethat achieved in this group on colestipol. Triglyceride levels were 15% lower on clofibrate therapy than on colestipol. In the cholestyramine group, there was a 25% decrease in total and LDL cholesterol, compared with pretreatment levels. This reduction was similar to that found when colestipol was administered. Triglyceride values were significantly raised during cholestyramine therapy. Thirteen patients were then subjected to a 6-week period of combination therapy, either clofibrate or colestipol, or clofibrate and cholestyramine. Total and LDL cholesterol were reduced by 32% on combination therapy compared with 18% on colestipol and 23% on either clofibrate or cholestyramine alone. Furthermore, on combined therapy, triglyceride concentrations fell by 20% when compared with the levels found when colestipol, clofibrate or cholestyramine were administered on their own.

Adolescent↗
PubMed1993

A clomiphene citrate and tamoxifen citrate combination therapy: a novel therapy for ovulation induction.

OBJECTIVE: To assess the efficacy of a clomiphene citrate (CC) and tamoxifen citrate (CC/tamoxifen) combination therapy in ovulation induction by comparing with a CC alone therapy. DESIGN: A randomized cross-over study with CC alone and CC/tamoxifen combination therapies for 20 normoprolactinemic anovulatory women. Randomly selected 10 of the 20 women (group A) underwent a CC alone therapy (100 mg CC during cycle days 5 to 9) for the initial three consecutive treatment cycles and a CC/tamoxifen combination therapy (50 mg CC and 20 mg tamoxifen during cycle days 5 to 9) for the subsequent three consecutive treatment cycles. The remaining 10 (group B) were treated similarly but with the inverse sequence. Ovulation was documented when a high BBT phase persisted for 11 days or more, when midluteal serum P levels exceeded 7 ng/mL (22.3 nmol/L), or when pregnancy ensued. RESULTS: The rates of ovulatory/treated, pregnant/treated, and pregnant/ovulatory cycles were 42 of 56 (75.0%), 3 of 47 (6.4%), and 3 of 35 (8.6%) for CC/tamoxifen, respectively. Those were 25 of 57 (43.9%), 1 of 48 (2.1%), and 1 of 21 (4.8%) for CC, respectively. Clomiphene citrate/tamoxifen was more effective in ovulation induction than CC. All the pregnancies were normal and single. None of the treatments was accompanied by any remarkable side effects. CONCLUSION: Clomiphene citrate/tamoxifen is a novel treatment modality of ovulation induction with high efficacy.

Adult↗
PubMed2003

New developments in type 2 diabetes mellitus: combination therapy with a thiazolidinedione.

BACKGROUND: Diabetes mellitus (DM) is a serious, chronic metabolic disease affecting approximately 17 million Americans. The microvascular and macrovascular complications of DM are associated with considerable morbidity and mortality. OBJECTIVES: This article reviews the importance of normalizing blood glucose values to reduce the risk of microvascular and macrovascular complications, discusses available treatment options for type 2 DM, and explores the rationale for combination therapy that includes a thiazolidinedione. METHODS: Relevant articles were selected from published reports and conference presentations from the last 10 years on oral agents for monotherapy and combination therapy for type 2 DM. Other sources were identified from the reference lists of selected articles. RESULTS: Choices for the pharmacologic treatment of hyperglycemia in patients with type 2 DM include thiazolidinediones, insulin secretagogues, biguanides, and alpha-glucosidase inhibitors. Each of these drug classes is effective in lowering blood glucose concentrations; however, they have distinctly different mechanisms of action that target various pathophysiologic causes of type 2 DM and have different adverse-event profiles. in addition, several of these agents provide unique benefits unrelated to their hypoglycemic effects. Thiazolidinediones offer the therapeutic benefits of increasing insulin sensitivity and perhaps preserving beta-cell function. Use of a thiazolidinedione from the time type 2 DM is diagnosed improves insulin sensitivity, thereby improving glycemic control and minimizing complications. Over time, however, many patients with type 2 DM are unable to maintain adequate glycemic control (ie, glycosylated hemoglobin [HbA(1c)] <7%) with monotherapy. Combination therapy with agents from different classes may be necessary to achieve blood glucose control through an additive reduction in HbA(1c). The combination of a thiazolidinedione and a biguanide reduces hyperglycemia, hyperinsulinemia, and insulin resistance and improves factors that have been implicated in the pathogenesis of cardiovascular complications. CONCLUSIONS: Patients with type 2 DM who are not able to maintain their HbA(1c). <7% with monotherapy should be considered candidates for combination therapy. Appropriate combination therapy includes treatment with 2 or more agents with different, complementary mechanisms of action. For example, the combination of a thiazolidinedione and a biguanide improves insulin sensitivity and lowers blood glucose through complementary pathways, and therefore produces an additive effect.

Cardiovascular Diseases↗
PubMed2000

[Does combination therapy of chronic viral hepatitis C with interferon-alpha and ribavirin approach financial limits?].

Until April 1999, interferon alpha was the only licensed medication in Germany for chronic hepatitis C virus infection with proven effectiveness. In two large placebo-controlled studies the combination therapy with interferon alpha and ribavirin confirmed a major improvement of the sustained response compared to the treatment with interferon alone. These results led to the approval in Germany of the combination therapy for patients with chronic hepatitis C without prior interferon therapy and for patients who relapse after an initial response to therapy with interferon alone. The expenses for the two drugs of the combination therapy are, however, very high (about 40,000 DM for one year of treatment). Considering the large number of patients with chronic hepatitis C in Germany (about half a million), it is suggested that more detailed recommendations for the indication of the combination therapy should be elaborated by a group of experts. Using data from the published literature it is shown for two subgroups of patients with chronic hepatitis C that a more differentiated indication for the use of the combination therapy is possible and justified and might help to avoid a more dramatic increase of drug expenses without shortcomings for the patients.

Antiviral Agents↗
PubMed2000

Pilot study of combination therapy with ribavirin and interferon alfa for the retreatment of chronic hepatitis B e antibody-positive patients.

Twenty-four patients with chronic hepatitis B virus (HBV), antibody to hepatitis B e antigen (anti-HBe), HBV DNA positivity, and alanine transaminase (ALT) elevation who failed previous interferon alfa (IFN-alpha) therapy were included in a pilot study of combination therapy with ribavirin and IFN-alpha. The patients received daily oral ribavirin (1,000-1,200 mg according to body weight) plus 5 million units (MU) IFN-alpha2b three times a week for 12 months and were followed-up for 12 months. The median viremia level decreased significantly at the end of treatment (1.2 x 10(3) copies/mL) and follow-up (4.0 x 10(2) copies/mL) compared with the baseline (3.0 x 10(6) copies/mL; P <.05). After 12 months, 8 of 24 (33%) patients had cleared HBV DNA and 12 (50%) had normal ALT levels. At the end of the study virological and biochemical response was 50% and 21%, respectively. Thus, virological and biochemical response sustained in 5 of 24 (21%) patients retreated with ribavirin and IFN-alpha; none of them lost hepatitis B surface antigen (HBsAg). Liver histology improved in 2 of 4 sustained responders but in none of the 12 nonresponders with paired biopsies (P =.05). The response was independent of dose and duration of previous treatment, viral load, or the distribution of HBV precore wild-type/mutant variants. However, sustained responders had significantly higher necroinflammation (P =.036) and fibrosis (P =.007) scores. IFN-alpha-related side effects were mild and reversible on discontinuation. In 4 (17%) patients who suffered nausea and diarrhea the ribavirin dosage was reduced by 50% after 1 month of therapy and finally discontinued in all of them. No patient had liver disease decompensation. In summary, combination therapy with ribavirin and IFN-alpha may be efficacious to treat viremic anti-HBe-positive patients with chronic hepatitis B who have failed previous IFN therapy.

Adult↗
PubMedDate not supplied

Combination therapy with interferon alpha and beta to chronic hepatitis C.

To increase the sustained response (SR) rate in chronic hepatitis C (CHC), we tried a combination therapy with interferon (IFN) alpha and beta. Fifty patients were grouped into 4 groups: group 1H (n=9), HCV serotype 1 and high HCV-RNA titer (over 6 log copies/ml); group 1L (n=11), HCV serotype 1 and low HCV-RNA titer (less than 6 log copies/ml); group 2H (n=23), HCV serotype 2 and high HCV-RNA titer; group 2L (n=7), HCV serotype 2 and low HCV-RNA titer. They were given a total dose of 768 MIU which included natural IFN beta (6 MIU) once daily for 28 consecutive days and then natural IFNalpha (10 MIU) three times a week for 20 weeks. Forty-nine patients with CHC receiving IFN alpha at total dose of 480 MIU served as single therapy group. In combination group, SR rate was achieved in 62%, 44% in 1H, 45% in 1L, 70% in 2H, and 86% in 2L, respectively. In single group, SR rate was achieved in 45, 14, 58, 60, and 82%, respectively. There was no significant difference for SR rate between combination group and single group. However, in patients with HCV-RNA titer between 6-7 log copies/ml of 1H group, SR rate in combination group (67%, 4/6) was significantly higher than that of single group (18%, 3/17) (p<0.05). These data suggest the usefulness of combination therapy with IFN alpha and beta in CHC with serotype 1 having moderately high HCV-RNA titer.

Adult↗
PubMed2004

Narrowband UVB and cream psoralen-UVA combination therapy for plaque-type psoriasis.

BACKGROUND: Psoralen-UVA (PUVA) and narrowband UVB (311-nm) therapy are considered to be first-line phototherapies for patients with moderate to severe psoriasis. To reduce side effects as a result of systemic resorption of psoralens, topical PUVA therapies have been developed and proven to be effective in the treatment of psoriasis. OBJECTIVE: We sought to evaluate the combination therapy of narrowband UVB plus cream PUVA on selected psoriatic plaques compared with narrowband UVB or cream PUVA alone. METHODS: A total of 30 patients (Psoriasis Area and Severity Index score of 8-15) were included in the randomized study. The combination therapy consisting of narrowband UVB whole-body irradiation followed by cream PUVA therapy for selected psoriatic plaques was evaluated in 10 patients with chronic plaque-stage psoriasis. For comparison, the therapeutic efficacy, number of treatments, and cumulative UV doses until remission (Psoriasis Area and Severity Index score < 4) of cream PUVA therapy or narrowband UVB alone was determined in 10 patients, respectively. RESULTS: Both monotherapies induced clearance of psoriatic lesions in all patients within 5 to 7 weeks. Mean number of treatments for cream PUVA was 24 +/- 5; for narrowband UVB was 21 +/- 3. The mean cumulative UVA dose was 45.0 +/- 16.3 J/cm(2) and the mean cumulative UVB dose was 17.1 +/- 4.1 J/cm(2). Combination therapy resulted in complete clearance of lesions in all patients after 3 to 4 weeks. Mean number of treatment was 14 +/- 2, mean cumulative UVA dose was 18.7 +/- 4.7 J/cm(2), and mean cumulative UVB dose was 8.2 +/- 3.3 J/cm(2). The number of treatments (P <.001, analysis of variance), UVA dose (P <.001, t test), and UVB dose (P <.001, t test) were significantly reduced compared with both monotherapies. CONCLUSIONS: Our results indicate that a combination therapy of narrowband UVB plus cream PUVA appears to have a significantly higher efficacy compared with either monotherapy. The cumulative UV doses were significantly lower in the combination therapy. We conclude that cream PUVA can be used in addition to narrowband UVB for areas that tend to clear less quickly than the rest of the body.

Administration, Topical↗
PubMed2005

[Combined therapy for stage IIIa non-small cell lung cancer].

OBJECTIVE: To evaluate the long-term outcome of combined therapy for stage IIIa non-small cell lung cancer (NSCLC). METHODS: Eight and twelve patients with stage IIIa NSCLC, 662 males and 150 females, aged 58.6 (24-79), underwent surgical resection, 326 of which received pre- and postoperative chemotherapy and/or radiotherapy, and 486 of which received surgery alone. The patients were classified according to the TNM staging, and the specimens of resected cancer were examined pathologically. The clinical data of these patients were analyzed. RESULTS: The overall 5-year survival rate was 16.4%. The 5-year survival rate of the combined therapy group was 23.5%, significantly higher than that of the surgical resection alone group (P < 0.01). The 5-year survival rate was 27.6% for the squamous cell carcinoma (SCC), and 23.5% for adenocarcinoma (AC) in the combined therapy group; and was 115.2% for SCC and 9.9% for AC in the surgical resection alone group (all P < 0.01). CONCLUSION: The curative effectiveness of combined therapy is significantly better than surgical resection alone for stage IIIa NSCLC. However, The combination should be based on the TNM staging and pathological type.

Adenocarcinoma↗
PubMed2000

Ketorolac versus prednisolone versus combination therapy in the treatment of acute pseudophakic cystoid macular edema.

OBJECTIVE: To evaluate the efficacy of ketorolac tromethamine 0.5% ophthalmic solution, prednisolone acetate 1.0% ophthalmic solution, and ketorolac and prednisolone combination therapy in the treatment of acute, visually significant, cystoid macular edema (CME) occurring after cataract extraction surgery. DESIGN: Randomized, double-masked, prospective trial. PARTICIPANTS: Twenty-eight patients who had undergone cataract extraction and in whom clinical CME developed within 21 to 90 days after cataract surgery. METHODS: Patients were randomized to topical therapy with ketorolac (group K), prednisolone (group P), or ketorolac and prednisolone combination therapy (group C) four times daily. Treatment was continued until CME resolved or for 3 months, whichever occurred first. Treatment was then tapered over 3 weeks. Examinations were monthly and included Snellen visual acuity, contrast sensitivity, Amsler grid, slit-lamp examination, dilated fundus examination, and fluorescein angiography. RESULTS: Twenty-six of 28 patients completed the study. Patients were enrolled an average of 48 days after surgery. The average improvements in Snellen visual acuity were as follows: 1.6 lines in group K, 1.1 lines in group P, and 3.8 lines in group C. This reached statistical significance for all visits when group C was compared with group P, and for visits 4 and 5 when group C was compared with group K. Group C reached a mean change of two lines or more by visit 2; at no time did either group K or P reach a mean two-line improvement. At no time was a significant difference detected between group K and P with regard to visual acuity or change from baseline. A two-line or more improvement in Snellen acuity was achieved in 16 of 26 patients (61%). Analysis by group revealed four of eight patients (50%) in group P, six of nine patients (67%) in group K, and eight of nine patients (89%) in group C who had achieved a two-line or more improvement. In patients who did improve two lines or more, improvement occurred an average of 2.75 months after initiating therapy in group P, 1.43 months in group K, and 1.33 months in group C. Improvements in contrast sensitivity and leakage on fluorescein angiography tended to mirror improvements in Snellen acuity. CONCLUSIONS: Treatment of acute, visually significant pseudophakic CME with ketorolac and prednisolone combination therapy appears to offer benefits over monotherapy with either agent alone. Patients were more likely to experience recovery of two lines or more of visual acuity. Patients treated with combination therapy or ketorolac monotherapy responded more quickly than did patients treated with prednisolone alone.

Acute Disease↗
PubMed1986

[Combination therapy (hypervolemia, Fluosol-DA 20%, hypertension) in the treatment of symptomatic vasospasm].

Combination therapy of (1) hypervolemia with albumin (1 g/kg/day), (2) artificial blood substitute (Fluosol-DA 20%, 10 ml/kg/day) and (3) induced hypertension was performed for the treatment of symptomatic vasospasm. Outcome was compared between thus treated patients (Treated group) and those without specific treatment (Non-treated group) in (1) 30 patients presenting with vasospasm who were planned to undergo delayed operation (Delayed operation group), (2) 23 patients undergoing early operation whose subarachnoid hemorrhage (DAH) was in group 2 according to Fisher's classification (Fisher Group-2) and (3) 25 patients undergoing early operation whose SAH was in group 3 (Fisher Group-3). In delayed operation group, the combination therapy improves the outcome to some extent resulting in increase of "Excellent" and "Good" patient from the rate of 25% to 35% (Table 1). Vasospasm appears at a low rate of 26% as well as in mild degree in Fisher Group-2 regardless of the treatment, which contributes to the satisfactory result observed in this group (Table 2). The outcome of the treated group in Fisher Group-3 is proved to be fairly good with "Excellent" and "Good" patient rate of 70% (Table 3), which seems largely to be attributed to the prophylactic effect of hypervolemia on vasospasm (Table 4). From these results, the combination therapy is considered to be performed with relatively small load on cardiovascular system compared with conventional hypervolemia-hypertension therapy.

Albumins↗
PubMedDate not supplied

HIV and combination therapy: meeting the challenge of a new era.

With the advent of combination therapy in the treatment of human immunodeficiency virus (HIV) infection, there has been a vast reduction in the number of people admitted to AIDS units as inpatients, and a marked improvement in the quality of life for people infected with HIV. Combination therapy comprises the combined administration of various powerful antiviral drugs to prevent CD4 cell destruction and minimize the chance of a rapidly replicating virus becoming resistant. This article presents an overview of the basic elements of this therapy, discussing some of the challenges that are a corollary of this new era. In particular, the implications of an extended period of survival and wellness for a group of people previously thought to be the victims of a strictly acute condition are addressed. These implications relate to therapeutic, psychological, employment, social and sexual issues. Finally, the issues facing carers (both lay and professional) are discussed.

Anti-HIV Agents↗
PubMed1998

Combination therapy with GH and cyproterone acetate does not improve final height in boys with non-GH-deficient short stature.

BACKGROUND AND OBJECTIVE: Recently, we reported that GH therapy without gonadal suppression (GS) decreased the final height of boys with non-GH-deficient short stature by decreasing the height standard deviation score (SDS) for bone age (BA) during puberty. Combination therapy with GH and GS has been reported to suppress bone maturation and improve final height in some cases. We evaluated the effects of combination therapy with GH and GS using cyproterone acetate on the final height of boys with non-GH-deficient short stature. PATIENTS: Fifty nine boys with non-GH deficient short stature were observed retrospectively until they reached their final height. The boys were divided into 3 groups: Group A consisted of 26 boys who were not treated with GH, group B consisted of 13 boys who were treated with GH alone, and group C consisted of 20 boys who were treated with combination therapy with GH and GS using cyproterone acetate. At the start of observation, the height SDS for BA and projected height were matched among these three groups. RESULTS: The mean +/- SDS of the final height for groups A, B, and C were 162.7 +/- 5.3 cm, 155.4 +/- 4.9 cm, and 161.9 +/- 3.2 cm, respectively. GH therapy did not affect the height SDS for BA during the prepubertal period. GH therapy without GS decreased the height SDS for BA during puberty in group B. Combination therapy with GH and cyproterone acetate increased the height SDS for BA between 12 and 14 years BA in group C. However, after GS therapy was discontinued at 14 years BA, the height SDS for BA gradually decreased and eventually reached the same value as that in group A. CONCLUSIONS: GH therapy during the prepubertal period did not improve the final height of boys with non-GH-deficient short stature. GH therapy without GS decreased pubertal height gain, resulting in reduced final height. Combination therapy with GH and GS using cyproterone acetate decelerated the bone maturation during puberty which might be accelerated by GH therapy, but did not improve the final height which might have been attained without treatment.

Androgen Antagonists↗