Original Article
Clinical Manifestations of AIDS in the Era of Pneumocystis Prophylaxis
N Engl J Med 1993; 329:1922-1926December 23, 1993
- Abstract
Background
Among patients infected with human immunodeficiency virus type 1 (HIV-1), early and widespread use of prophylactic regimens against Pneumocystis carinii is changing the pattern of illnesses related to the acquired immunodeficiency syndrome (AIDS).
Methods
We conducted a subcohort analysis of 844 men with AIDS (87 percent of whom have since died) from a prospectively followed cohort of 2592 HIV-1-infected homosexual men.
Results
A total of 138 men received prophylaxis before the diagnosis of AIDS, but 39 (28 percent) nevertheless had P. carinii pneumonia at some time. Only four illnesses occurred more frequently in men who received P. carinii prophylaxis before the onset of AIDS: Mycobacterium avium complex disease, which developed in 33.4 percent, as compared with 17.3 percent of the 706 men who did not receive early prophylaxis; wasting syndrome (18.4 percent vs. 6.4 percent); cytomegalovirus disease (44.9 percent vs. 24.8 percent); and esophageal candidiasis (21.3 percent vs. 12.8 percent). Collectively, these four diseases accounted for the initial AIDS-related illness in 42.7 percent of those who received prophylaxis before the onset of AIDS, as compared with 10.7 percent of those who did not. During the three 6-month periods before the diagnosis of AIDS (0 to 6, >6 to 12, and >12 to 18 months), the geometric mean CD4+ cell counts were 48, 87, and 147 per cubic millimeter, respectively, in men who received prophylaxis against P. carinii, as compared with 118, 211, and 279 per cubic millimeter in those who did not.
Conclusions
M. avium complex disease, esophageal candidiasis, wasting syndrome, and cytomegalovirus disease are more common in HIV-infected patients who have received prophylaxis against P. carinii than in those who have not. Prophylaxis may delay the first AIDS illness for 6 to 12 months.
Media in This Article
Figure 1
Frequency of Initial and Subsequent AIDS-Related Illnesses in 138 Men Who Received P. carinii Prophylaxis before the Diagnosis of AIDS and 706 Men Who Did Not.Table 1
Chronologic Changes in the Clinical Manifestations of AIDS and in Therapy and Immune Status before the Diagnosis of AIDS.Article Activity
- Article
Early in the epidemic of the acquired immunodeficiency syndrome (AIDS), Pneumocystis carinii pneumonia occurred in 75 percent of patients with the syndrome1,2. The incidence of P. carinii pneumonia declined after 1988,3-6 however, as the use of primary and secondary prophylaxis against it4-9 (aerosolized pentamidine, trimethoprim-sulfamethoxazole, and dapsone) became common. Unlike antiretroviral therapies,10 these prophylactic regimens are not known to alter replication of human immunodeficiency virus type 1 (HIV-1) or human immune function, nor do they protect against other AIDS-related illnesses, except toxoplasmosis7,8,11. Thus, prophylaxis against P. carinii pneumonia does not directly alter the pathophysiologic processes leading to other AIDS-related illnesses. However, by preventing (or delaying) death from P. carinii pneumonia without stopping the decline in immune function, prophylaxis shifts the clinical manifestations of HIV-1 infection from P. carinii pneumonia to illnesses that occur when immune function is more suppressed.
Clinical investigators need to know which AIDS-related illnesses should now be targeted for diagnosis and further prophylaxis and treatment. Since P. carinii prophylaxis is effective,3-9 priorities should be based on the frequency of diseases that develop in patients receiving this therapy. In this report from the Multicenter AIDS Cohort Study, we describe and quantify AIDS-related illnesses in homosexual men receiving P. carinii prophylaxis. We also compare the CD4+ counts within the six-month period before the onset of the AIDS-defining illness in men who received P. carinii prophylaxis and in those who did not.
Methods
The Multicenter AIDS Cohort Study12 recruited 4954 homosexual men without AIDS from the Baltimore-Washington, D.C., area, Chicago, Los Angeles, and Pittsburgh in 1984 and 1985 and an additional 625 between 1987 and 1991; 2592 of the men were HIV-1-seropositive before 1992. Every six months, each man underwent an evaluation consisting of a physical examination and a CD4+ lymphocyte count. The use of zidovudine and P. carinii prophylaxis (aerosolized pentamidine, trimethoprim-sulfamethoxazole, or dapsone) was ascertained at these visits. For the purpose of this analysis, AIDS and AIDS-related illnesses were defined according to the criteria established by the Centers for Disease Control and Prevention (CDC) in 198713. Illnesses and deaths were continually monitored by means of medical reports and reports by study subjects, with confirmation by a physician or a review of medical records. A subject was considered to have received P. carinii prophylaxis (or zidovudine) before the diagnosis of AIDS if he reported such treatment at any visit before the diagnosis of the initial AIDS-related illness and was considered to have begun prophylaxis after the diagnosis of AIDS if such treatment was first reported after that diagnosis. The AIDS-related illnesses that we documented were P. carinii pneumonia, Kaposi's sarcoma, Mycobacterium avium complex disease, esophageal candidiasis, cytomegalovirus disease, wasting syndrome, lymphoma, cryptosporidiosis, leukoencephalopathy, HIV-1-related dementia, cryptococcal disease, toxoplasmosis, and disseminated herpes simplex, as well as all other illnesses that establish a diagnosis of AIDS, according to the 1987 CDC criteria13.
This analysis is based on 844 men in whom AIDS was diagnosed as of January 7, 1992, and who were followed until April 18, 1993, by which time 87 percent had died.
Descriptive and statistical methods for the analysis of categorical and continuous data (contingency tables, t-tests, linear regressions, and logistic regressions) were programmed with the use of SAS14. Because of skewed data, the logarithmic transformation of CD4+ lymphocyte counts was used, and geometric mean counts (which are close to the medians) are reported here.
Results
Among the 844 subjects with AIDS, 138 (16.4 percent) reported receiving P. carinii prophylaxis and 255 (30.2 percent) reported using zidovudine before the diagnosis of AIDS; only 1 man reported receiving P. carinii prophylaxis but not zidovudine. Of those not receiving P. carinii prophylaxis before the diagnosis of AIDS, 87 (12.3 percent) began primary prophylaxis against P. carinii pneumonia after the diagnosis of an AIDS-defining illness. Table 1Table 1
Chronologic Changes in the Clinical Manifestations of AIDS and in Therapy and Immune Status before the Diagnosis of AIDS. shows the annual changes in the incidence of AIDS, the proportion of cases in which P. carinii pneumonia was the initial AIDS-related illness, the proportion of cases involving prior use of zidovudine and P. carinii prophylaxis, and the mean CD4+ counts within the six months before the diagnosis of AIDS.From 1985 to 1991, the annual number of new cases of AIDS ranged from 92 to 144. The use of zidovudine before the diagnosis of AIDS began in 1987 and increased from 26.1 percent in 1988 to 68.5 percent in 1991. The use of P. carinii prophylaxis before the diagnosis of AIDS began in 1988 and increased from 16.0 percent in 1989 to 43.7 percent in 1990 and 55.4 percent in 1991.
From 1985 to 1988, the mean CD4+ count during the six months before the onset of AIDS ranged from 100 to 129 per cubic millimeter. In 1989, when the use of P. carinii prophylaxis before the diagnosis of AIDS became more common, the mean CD4+ count within the six months before the onset of AIDS began to decline (P<0.001), dropping to a low of 64 per cubic millimeter by 1991. The proportion of AIDS cases diagnosed on the basis of P. carinii pneumonia also started to decline in 1989 (P<0.001), from 47 percent in 1988 to 25 percent in 1991.
Table 2Table 2
CD4+ Counts before the Diagnosis of AIDS in Men Who Received P. carinii Prophylaxis and Men Who Did Not. shows that in all periods before the diagnosis of AIDS, the mean CD4+ count was significantly lower in the 138 men who reported receiving P. carinii prophylaxis before the diagnosis of AIDS than in the 706 who did not (P<0.001 for all comparisons). During the six months before the diagnosis of AIDS, the mean CD4+ count was 48 per cubic millimeter in the men who received P. carinii prophylaxis (interquartile range, 24 to 97). Among the men who did not receive prophylaxis, the mean count during the 6 months before the diagnosis of AIDS was 118 per cubic millimeter, a value that lay between the means observed for two earlier 6-month periods (>6 to 12 months and >12 to 18 months) before the diagnosis of AIDS in the men receiving P. carinii prophylaxis (87 and 147 per cubic millimeter, respectively). These results suggest that, as compared with the group of men who did not receive prophylaxis, the group of men who did contracted the first AIDS-related illness after 6 to 12 months' additional loss of CD4+ cells.Figure 1Figure 1
Frequency of Initial and Subsequent AIDS-Related Illnesses in 138 Men Who Received P. carinii Prophylaxis before the Diagnosis of AIDS and 706 Men Who Did Not. shows the frequencies of AIDS-related illnesses in the 138 men who received P. carinii prophylaxis before the diagnosis of AIDS and in the 706 who did not.Among the 706 men who did not receive prior P. carinii prophylaxis, 327 (46.3 percent) contracted P. carinii pneumonia as the initial AIDS-related illness. Among these 327, 214 did not receive secondary P. carinii prophylaxis and have died. Almost 50 percent (103) of these 214 men did not report another AIDS-related illness before death. Of the 138 men who reported receiving P. carinii prophylaxis before the onset of AIDS, 14.5 percent nonetheless contracted P. carinii pneumonia as the initial AIDS-related illness.
Four diseases were significantly more common as initial AIDS-related illnesses among the men who received prior P. carinii prophylaxis: M. avium complex disease (in 13.0 percent of those who received prophylaxis vs. 1.8 percent of those who did not, P<0.001), wasting syndrome (10.9 vs. 0.8 percent, P<0.001), cytomegalovirus disease (9.4 vs. 3.1 percent, P = 0.004), and esophageal candidiasis (9.4 vs. 5.0 percent, P = 0.04). These four illnesses collectively constituted 42.7 percent of initial AIDS-related illnesses in those who received prior P. carinii prophylaxis, as compared with 10.7 percent in those who did not receive prior prophylaxis. This difference of 32 percentage points is close to the previously noted figure of 31.8 percentage points (from 46.3 percent to 14.5 percent) for the decline in the incidence of P. carinii pneumonia as an initial AIDS-related illness among men who received P. carinii prophylaxis.
The sum of the shaded and unshaded portions of each bar in Figure 1 represents the cumulative occurrence of the illness in question as either the initial or a later AIDS-related condition. Only 12 percent of the men who did not receive prior prophylaxis and 14 percent of those who did were living at the time of analysis and hence were at risk for contracting additional illnesses. Furthermore, because at least 15 months had passed since the diagnosis of AIDS, many of these survivors were likely to die soon. Thus, the cumulative occurrence of each illness shown in Figure 1 should only slightly underestimate the total probability that the illness would have occurred before death from AIDS.
Of the men who did not receive P. carinii prophylaxis before the diagnosis of AIDS, 87 (12.3 percent) began primary P. carinii prophylaxis after the AIDS-defining illness had developed. If we had excluded these men from the analysis, the remaining group would, by artifact alone, probably have had fewer subsequent AIDS-related illnesses. Those who died soon after the development of the initial AIDS-related disease had less time to begin P. carinii prophylaxis or to contract subsequent AIDS-related illnesses. Nevertheless, a comparison of the cumulative occurrence of AIDS-related illnesses in subjects who received prophylaxis before the diagnosis of AIDS and those who did not produces a conservative bias. It is more difficult to detect differences that can be attributed to P. carinii prophylaxis with this comparison than it would be with a comparison of pure groups.
Although 39 (28.3 percent) of the men who received prophylaxis before the diagnosis of AIDS nevertheless contracted P. carinii pneumonia at some point, this proportion was much smaller (P<0.001) than the 61.3 percent of those with no prior prophylaxis (including those who received prophylaxis after but not before the diagnosis of AIDS) who contracted P. carinii pneumonia at some point. The nine illnesses (Figure 1) that did not differ statistically between the two groups with respect to their occurrence as the AIDS-defining illness also did not differ with respect to their occurrence at any time.
In contrast, for each disease that occurred significantly more often as the initial AIDS-related illness in the men who received P. carinii prophylaxis before the diagnosis of AIDS, the difference was even larger when any occurrence of the disease was considered. Individually, the frequencies of any occurrence of the disease in the men with prior prophylaxis as compared with those without were as follows: 44.9 percent and 24.8 percent, respectively, for cytomegalovirus disease (P<0.001); 33.4 percent and 17.3 percent for M. avium complex disease (P<0.001); 21.3 percent and 12.8 percent for esophageal candidiasis (P<0.01); and 18.4 percent and 6.4 percent for wasting syndrome (P<0.001). Men who received P. carinii prophylaxis before the diagnosis of AIDS had a 74.6 percent chance of contracting at least one of these four illnesses.
Discussion
Although our results confirm other reports that prophylaxis against P. carinii pneumonia is effective,3-9 P. carinii pneumonia was the initial AIDS-related illness in 14.5 percent of the men who received prophylaxis and was eventually seen in at least 28.3 percent of those who received prophylaxis before the development of AIDS. This suggests that more effective long-term protection against P. carinii pneumonia is needed and that the failure of current prophylactic regimens warrants investigation.
Pentamidine was used by 78 percent of the men in our study who received prophylaxis, making it impossible to compare the various prophylactic regimens here. Other researchers have reported that P. carinii pneumonia occurred less frequently in patients using trimethoprim-sulfamethoxazole than in those using pentamidine,7 but a similar advantage was not observed with dapsone8.
Comparisons of CD4+ counts before the diagnosis of AIDS (Table 2) provide an estimate of the net time by which prophylaxis delays the onset of the initial AIDS-related illness. These comparisons suggest that by preventing P. carinii pneumonia, prophylaxis delays the first AIDS-related illness by 6 to 12 months.
We examined whether the results in Table 2 might in part reflect a selection bias, because P. carinii prophylaxis is not recommended until the CD4+ count is below 200 per cubic millimeter,9 and thus the men who contracted AIDS-related illnesses when their CD4+ counts were above this level did not have the chance to use prophylaxis. The mean CD4+ count in the six months before the diagnosis of AIDS for those who did not receive prophylaxis was 118 per cubic millimeter, which was similar to the overall mean CD4+ count (114 per cubic millimeter) in the corresponding six-month period before prophylaxis was recommended (1985 to 1988), suggesting that the selection bias was not strong.
In our study, only four diseases occurred more often in the men who received P. carinii prophylaxis before the diagnosis of AIDS than in the men who did not: M. avium complex disease, wasting syndrome, cytomegalovirus disease, and esophageal candidiasis. Why did the nine other AIDS-related illnesses not occur more frequently in the men whose lives were extended at a lower level of immune function by P. carinii prophylaxis? The prevention of P. carinii pneumonia should not greatly increase the frequency of illnesses that occur at levels of immune function higher than the level at which P. carinii pneumonia occurs. At least two of the nine illnesses, Kaposi's sarcoma and herpes simplex, generally occur at earlier stages of immunosuppression than does P. carinii pneumonia15,16. Other diseases, such as toxoplasmosis, that did not increase in frequency among the men who received prediagnosis prophylaxis are caused by infections that were not common in the study population,17 and such diseases thus remained unlikely to develop, even in the men whose lives were extended by P. carinii prophylaxis.
Preventing or delaying death from P. carinii pneumonia should selectively increase the frequency of illnesses that result from common conditions and occur at lower levels of immune function than does P. carinii pneumonia. Three of the four illnesses that increased in frequency after P. carinii prophylaxis result from organisms that are common in humans (cytomegalovirus and candida) or in the environment (M. avium complex). The fourth illness, wasting syndrome, may be due to physiologic abnormalities directly caused by immune deregulation and cytokine production18. All four illnesses occur at a lower level of immune function than does P. carinii pneumonia16.
Interpretation of the results of our study is limited by its design as a natural-history study. Care must be taken to separate treatment effects from other, possibly unrelated, chronologic changes. The associations we reported persisted when pre-1987 data were excluded from the analysis. This was true even for HIV-1-related dementia and wasting syndrome, which were added to the CDC list of AIDS-defining conditions in 198713. Because of the extensive medical and neurologic follow-up of this cohort, occurrences of wasting syndrome and dementia before 1987 could be identified from medical records, although there was probably some underreporting.
In our study, all medications were prescribed by the patients' physicians or provided as part of an experimental protocol. The use of prediagnosis P. carinii prophylaxis was not strongly associated with demographic characteristics (unpublished data). As indicated earlier, there was only a small selection effect resulting from the practice of not recommending prophylaxis until the CD4+ count dropped below 200 per cubic millimeter. However, prophylaxis was rarely prescribed without the concurrent use of zidovudine. Bone marrow suppression from zidovudine19,20 could conceivably alter the immune system in ways that change the susceptibility to AIDS-related illnesses. However, Table 1 shows that the shifts in AIDS-related illnesses and CD4+ counts before diagnosis occurred not after the increase in the use of zidovudine but after the subsequent increase in the use of prediagnosis P. carinii prophylaxis. Some associations were observed between zidovudine use before the diagnosis of AIDS and both AIDS-related illnesses and CD4+ counts in the men who did not receive prior P. carinii prophylaxis (data not shown). The magnitude of these associations was small, however, and they may in fact be explained by a confounding effect of unreported P. carinii prophylaxis.
Although we believe that the findings of our study can be applied to other groups, such generalizations must be made cautiously. Our study may need to be replicated in populations with other risk factors or with other highly endemic background infections, such as M. tuberculosis.
Clinicians monitoring CD4+ counts in patients should consider that although these counts vary from person to person, among homosexual men receiving P. carinii prophylaxis the initial AIDS-related illness may tend to develop when the CD4+ count is about 50 per cubic millimeter. Furthermore, although Kaposi's sarcoma and P. carinii pneumonia cannot be ignored, patients receiving P. carinii prophylaxis should also be monitored for M. avium complex disease, cytomegalovirus disease, wasting syndrome, and esophageal candidiasis. As forms of prophylaxis and treatment for other AIDS-related diseases continue to be developed and tested,7,8,11,21,22 priority should be placed on these last four illnesses. Prophylactic and therapeutic regimens should be evaluated not only for their efficacy against the target illness but also for the resulting delay in the first clinical manifestation of AIDS and the extension of life.
Prophylaxis against P. carinii infection, which was previously the predominant cause of AIDS-related illness and death,2 may delay the onset of the first AIDS-related illness by 6 to 12 months. But further prophylaxis against any other AIDS-related illness will probably not be as effective, since no single illness predominates among patients receiving P. carinii prophylaxis. No illness is responsible for more than 20 percent of AIDS diagnoses, and each of six illnesses has an 18 to 45 percent chance of occurring at some point. Although it might be possible to provide prophylaxis or treatment for several illnesses at the same time, the number of regimens a patient can tolerate simultaneously may be limited.
Clearly, specific additional treatments will be advantageous when patients receiving P. carinii prophylaxis contract other illnesses. In our study, however, the 50 men receiving pre-AIDS prophylaxis for whom data were available in the six months before death had a geometric mean CD4+ count of only 15 per cubic millimeter. With CD4+ counts that are already so low, it may not be realistic to expect prophylaxis and treatment against additional AIDS-related illnesses to extend life substantially.
Supported by grants (N01-AI-72634, N01-AI-72676, N01-AI-32535, N01-AI-72631, and N01-AI-72632) from the National Institutes of Health.
We are indebted to Edith Muth and Judy Konig for assistance in the preparation of the manuscript.
Source Information
From the Departments of Epidemiology and Biostatistics, School of Hygiene and Public Health, Johns Hopkins University, Baltimore (D.R.H., A.J.S., H.B.); the Division of Infectious Diseases, Northwestern University Medical School, Evanston, Ill. (J.P.); the School of Public Health, UCLA, Los Angeles (R.D.); the Graduate School of Public Health, University of Pittsburgh, Pittsburgh (R.A.); and the National Institute of Allergy and Infectious Diseases, Bethesda, Md. (R.A.K.).
Address reprint requests to Dr. Hoover at Johns Hopkins University, 624 N. Broadway, Suite 784, Baltimore, MD 21205.
Participating centers and investigators are listed in the Appendix.
Appendix
The Multicenter AIDS Cohort Study includes the following centers and investigators, in addition to the authors: Johns Hopkins University, Baltimore (J. Palenicek, H. Armenian, H. Farzadegan, N. Graham, J. Margolick, and J. McArthur); Howard Brown Memorial Clinic-Northwestern University, Chicago (J. Chmiel, B. Cohen, M. O'Gorman, D. Variakojis, J. Wesch, and S. Wolinsky); UCLA, Los Angeles (B. Visscher, D. Besley, I. Chen, J. Dudley, J. Fahey, J. Giorgi, M. Lee, O. Martinez-Maza, E. Miller, P. Nishanian, J. Taylor, and J. Zack); University of Pittsburgh, Pittsburgh (C. Rinaldo, L. Kingsley, J. Becker, P. Gupta, and M. Ho); Data Coordinating Center: Johns Hopkins School of Hygiene and Public Health, Baltimore (A. Munoz, L. Epstein, N. Galai, L. Jacobson, A. Kirby, C. Meinert, K. Nelson, S. Piantadosi, and S. Su); the National Institute of Allergy and Infectious Diseases, Bethesda, Md. (L. Schrager, S. Vermund, and M. VanRaden); and the National Cancer Institute, Bethesda, Md. (D. Seminara).
- References
References
1
Pneumocystis pneumonia -- Los AngelesMMWR Morb Mortal Wkly Rep 1981;30:250-252
Medline2
Hay JW ,Osmond DH ,Jacobson MA . Projecting the medical costs of AIDS and ARC in the United States. J Acquir Immune Defic Syndr 1988;1:466-485
Web of Science | Medline3
Graham NMH ,Zeger SL ,Park LP , et al. Effect of zidovudine and Pneumocystis carinii pneumonia prophylaxis on progression of HIV-1 infection to AIDS: the Multicenter AIDS Cohort Study. Lancet 1991;338:265-269
CrossRef | Web of Science | Medline4
Munoz A ,Schrager LK ,Bacellar H , et al. Trends in the incidence of outcomes defining acquired immunodeficiency syndrome (AIDS) in the Multicenter AIDS Cohort Study: 1985-1991. Am J Epidemiol 1993;137:423-438
Web of Science | Medline5
Leoung GS ,Feigal DW Jr ,Montgomery AB , et al. Aerosolized pentamidine for prophylaxis against Pneumocystis carinii pneumonia: the San Francisco Community Prophylaxis Trial. N Engl J Med 1990;323:769-775
Full Text | Web of Science | Medline6
Hirschel B ,Lazzarin A ,Chopard P , et al. A controlled study of inhaled pentamidine for primary prevention of Pneumocystis carinii pneumonia. N Engl J Med 1991;324:1079-1083
Full Text | Web of Science | Medline7
Schneider MME ,Hoepelman AIM ,Eeftinck Schattenkerk JKM , et al. A controlled trial of aerosolized pentamidine or trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection. N Engl J Med 1992;327:1836-1841
Full Text | Web of Science | Medline8
Girard P-M ,Landman R ,Gaudebout C , et al. Dapsone-pyrimethamine compared with aerosolized pentamidine as primary prophylaxis against Pneumocystis carinii pneumonia and toxoplasmosis in HIV infection. N Engl J Med 1993;328:1514-1520
Full Text | Web of Science | Medline9
Guidelines for prophylaxis against Pneumocystis carinii pneumonia for persons infected with human immunodeficiency virus 10
National Institute of Allergy and Infectious Diseases 11
Carr A ,Tindall B ,Brew BJ , et al. Low-dose trimethoprim-sulfamethoxazole prophylaxis for toxoplasmic encephalitis in patients with AIDS. Ann Intern Med 1992;117:106-111
Web of Science | Medline12
Kaslow RA ,Ostrow DG ,Detels R ,Phair JP ,Polk BF ,Rinaldo CR Jr . The Multicenter AIDS Cohort Study: rationale, organization, and selected characteristics of the participants. Am J Epidemiol 1987;126:310-318
Web of Science | Medline13
Update: acquired immunodeficiency syndrome -- United States
Medline14
SAS user's guide: statistics, version 6.3. Cary, N.C.: SAS Institute, 1991.
15
Beral V . Epidemiology of Kaposi's sarcoma. Cancer Surv 1991;10:5-22[Erratum, Cancer Surv 1992;12:following 225.]
Medline16
Crowe SM ,Carlin JB ,Stewart KI ,Lucas CR ,Hoy JF . Predictive value of CD4 lymphocyte numbers for the development of opportunistic infections and malignancies in HIV-infected persons. J Acquir Immune Defic Syndr 1991;4:770-776
Web of Science | Medline17
Israelski DM ,Chmiel JS ,Poggensee L ,Phair JP ,Remington JS . Prevalence of Toxoplasma infection in a cohort of homosexual men at risk of AIDS and toxoplasmic encephalitis. J Acquir Immune Defic Syndr 1993;6:414-418
Web of Science | Medline18
Grunfeld C ,Feingold KR . Metabolic disturbances and wasting in the acquired immunodeficiency syndrome. N Engl J Med 1992;327:329-337
Full Text | Web of Science | Medline19
Richman DD ,Fischl MA ,Grieco MH , et al. The toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex: a double-blind, placebo-controlled trial. N Engl J Med 1987;317:192-197
Full Text | Web of Science | Medline20
Clerici M ,Landay AL ,Kessler HA , et al. Reconstitution of long term T-helper cell function after zidovudine therapy in human immunodeficiency virus-infected patients. J Infect Dis 1992;166:723-730
CrossRef | Web of Science | Medline21
Studies of Ocular Complications of AIDS Research Group, AIDS Clinical Trials Group
Full Text | Web of Science | Medline22
Benson CA ,Ellner JJ . Mycobacterium avium complex infection and AIDS: advances in theory and practice. Clin Infect Dis 1993;17:7-20
CrossRef | Web of Science | Medline
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CrossRef20
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CrossRef22
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CrossRef23
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CrossRef24
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CrossRef25
Véronique Bortolotti, Anne Buvé. (2002) Prophylaxis of opportunistic infections in HIV-infected adults in sub-Saharan Africa: opportunities and obstacles. AIDS 16:10, 1309-1317
CrossRef26
Dylan Slotar, Patricio Escalante, Brenda E Jones. (2002) Pulmonary manifestations of HIV/AIDS in the tropics. Clinics in Chest Medicine 23:2, 355-367
CrossRef27
Jean T. Santamauro, Rashmi Nisha Aurora, Diane E. Stover. (2002) Pneumocystis carinii pneumonia in patients with and without HIV infection. Comprehensive Therapy 28:2, 96-108
CrossRef28
Martin, Daniel F., Sierra-Madero, Juan, Walmsley, Sharon, Wolitz, Richard A., Macey, Katherine, Georgiou, Panos, Robinson, Charles A., Stempien, Mary Jean, . (2002) A Controlled Trial of Valganciclovir as Induction Therapy for Cytomegalovirus Retinitis. New England Journal of Medicine 346:15, 1119-1126
Full Text29
Douglas A. Jabs, Adele M. Kaplan Gilpin, Yuan-I Min, Alejo Erice, John H. Kempen, Thomas C. Quinn. (2002) HIV and cytomegalovirus viral load and clinical outcomes in AIDS and cytomegalovirus retinitis patients: Monoclonal Antibody Cytomegalovirus Retinitis Trial. AIDS 16:6, 877-887
CrossRef30
Hansjakob Furrer, Phil Chan, Rainer Weber, Matthias Egger, The Swiss HIV Cohort Study. (2001) Increased risk of wasting syndrome in HIV-infected travellers: prospective multicentre study. Transactions of the Royal Society of Tropical Medicine and Hygiene 95:5, 484-486
CrossRef31
Pierre Reusser. (2001) Oral valganciclovir: a new option for treatment of cytomegalovirus infection and disease in immunocompromised hosts. Expert Opinion on Investigational Drugs 10:9, 1745-1753
CrossRef32
Priscilla S. A. Sarinas, Rajinder K. Chitkara, Ware G. Kuschner, Jon C. Kosek. (2001) Endobronchial Pneumocystis carinii Pneumonia. Journal of Bronchology 8:3, 197-199
CrossRef33
Natividad Benito, Ana Rañó, Asunción Moreno, Julià González, Montserrat Luna, Carlos Agustí, Cristina Danés, Tomás Pumarola, José María Miró, Antoni Torres, José María Gatell. (2001) Pulmonary Infiltrates in HIV-Infected Patients in the Highly Active Antiretroviral Therapy Era in Spain. Journal of Acquired Immune Deficiency Syndromes 27:1, 35-43
CrossRef34
Natividad Benito, Ana Rañó, Asunción Moreno, Julià González, Montserrat Luna, Carlos Agustí, Cristina Danés, Tomás Pumarola, José María Miró, Antoni Torres, José María Gatell. (2001) Pulmonary Infiltrates in HIV-Infected Patients in the Highly Active Antiretroviral Therapy Era in Spain. JAIDS Journal of Acquired Immune Deficiency Syndromes 27:1, 35-43
CrossRef35
De Smith, J Bell, M Johnson, M Youle, B Gazzard, S Tchamouroff, G Frechette, W Schlech, S Miller, D Spencer, W Seifert, M Peeters, K De Beule. (2001) A randomized, double-blind, placebo-controlled study of itraconazole capsules for the prevention of deep fungal infections in immunodeficient patients with HIV infection. HIV Medicine 2:2, 78-83
CrossRef36
S. Chariyalertsak, T. Sirisanthana, O. Saengwonloey, K. E. Nelson. (2001) Clinical Presentation and Risk Behaviors of Patients with Acquired Immunodeficiency Syndrome in Thailand, 1994-1998: Regional Variation and Temporal Trends. Clinical Infectious Diseases 32:6, 955-962
CrossRef37
Andrew L. Rosenberg, Michael G. Seneff, Lyna Atiyeh, Randall Wagner, Leody Bojanowski, Jack E Zimmerman. (2001) The importance of bacterial sepsis in intensive care unit patients with acquired immunodeficiency syndrome: Implications for future care in the age of increasing antiretroviral resistance. Critical Care Medicine 29:3, 548-556
CrossRef38
Gregory J. Dore, Yueming Li, Ann McDonald, John M. Kaldor. (2001) Spectrum of AIDS-Defining Illnesses in Australia, 1992 to 1998: Influence of Country/Region of Birth. JAIDS Journal of Acquired Immune Deficiency Syndromes 26:3, 283-290
CrossRef39
Gregory J. Dore, Yueming Li, Ann McDonald, John M. Kaldor. (2001) Spectrum of AIDS-Defining Illnesses in Australia, 1992 to 1998: Influence of Country/Region of Birth. Journal of Acquired Immune Deficiency Syndromes283-290
CrossRef40
Julio Collazos, Jose Mayo, Eduardo Martinez. (2001) The Evolving Mode of Presentation of HIV-Infected Patients to Health Services of Northern Spain: 1985 through December 1999. AIDS Patient Care and STDs 15:2, 67-71
CrossRef41
Stephen Kravcik. (2001) Pharmacology and clinical experience with saquinavir. Expert Opinion on Pharmacotherapy 2:2, 303-315
CrossRef42
Marco Terreni, Pierangela Villani. (2001) New anti-Mycobacterium agents: recent advances in patent literature. Expert Opinion on Therapeutic Patents 11:2, 261-268
CrossRef43
A Villasís-Keever. (2001) Clinical Manifestations and Survival Trends During the First 12 Years of the AIDS Epidemic in Mexico. Archives of Medical Research 32:1, 62-65
CrossRef44
John H. Kempen, Kevin D. Frick, Douglas A. Jabs. (2001) Incremental Cost Effectiveness of Prophylaxis for Cytomegalovirus Disease in Patients with AIDS. PharmacoEconomics 19:12, 1199-1208
CrossRef45
Todd A. Lee, Sean D. Sullivan, David L. Veenstra, Scott D. Ramsey, Patrick J.K. Steger, Raffaele Malinverni, Andreas M. Pleil, Todd Williamson. (2001) Economic Evaluation of Systemic Treatments for Cytomegalovirus Retinitis in Patients with AIDS. PharmacoEconomics 19:Parts 1 and 2, 535-550
CrossRef46
Akemi NISHIMOTO, Ken NARITA, Shinobu OHMOTO, Yoshie TAKAHASHI, Satoshi YOSHIZUMI, Toshihiko YOSHIDA, Noriyuki KADO, Eichi OKEZAKI, Hideo KATO. (2001) Studies on Macrolide Antibiotics I. Synthesis and Antibacterial Activity of Erythromycin A 9-O-Substituted Oxime Ether Derivatives against Mycobacterium avium Complex.. CHEMICAL & PHARMACEUTICAL BULLETIN 49:9, 1120-1127
CrossRef47
Woraphot Tantisiriwat, William G. Powderly. (2000) PROPHYLAXIS OF OPPORTUNISTIC INFECTIONS. Infectious Disease Clinics of North America 14:4, 929-944
CrossRef48
Chien-Ching Hung, Mao-Yuan Chen, Szu-Min Hsieh, Wang-Hwei Sheng, Shan-Chwen Chang. (2000) Clinical Spectrum, Morbidity, and Mortality of Acquired Immunodeficiency Syndrome in Taiwan: A 5-Year Prospective Study. JAIDS Journal of Acquired Immune Deficiency Syndromes 24:4, 378-385
CrossRef49
Chien-Ching Hung, Mao-Yuan Chen, Szu-Min Hsieh, Wang-Hwei Sheng, Shan-Chwen Chang. (2000) Clinical Spectrum, Morbidity, and Mortality of Acquired Immunodeficiency Syndrome in Taiwan: A 5-Year Prospective Study. Journal of Acquired Immune Deficiency Syndromes 24:4, 378-385
CrossRef50
Hansjakob Furrer, Amalio Telenti, Marco Rossi, Bruno Ledergerber. (2000) Discontinuing or withholding primary prophylaxis against Mycobacterium avium in patients on successful antiretroviral combination therapy. The Swiss HIV Cohort Study. AIDS 14:10, 1409-1412
CrossRef51
Douglas Ormrod, Lesley J. Scott, Caroline M. Perry. (2000) Valaciclovir. Drugs 59:4, 839-863
CrossRef52
Vonda F Hoffman, Daniel J Skiest. (2000) Therapeutic developments in cytomegalovirus retinitis. Expert Opinion on Investigational Drugs 9:2, 207-220
CrossRef53
Michael Zegans, Bryan Marsh, R. Christopher Walton. (2000) Cytomegalovirus Retinitis in the Era of Highly Active Antiretroviral Therapy. International Ophthalmology Clinics 40:2, 127-135
CrossRef54
Robert H. Lyles, Alice M. Tang, Ellen Smit, John W. Mellors, Joseph B. Margolick, Barbara R. Visscher, John P. Phair, Neil M. H. Graham. (1999) Virologic, Immunologic, and Immune Activation Markers as Predictors of HIV-Associated Weight Loss Prior to AIDS. JAIDS Journal of Acquired Immune Deficiency Syndromes 22:4, 386
CrossRef55
Robert H. Lyles, Alice M. Tang, Ellen Smit, John W. Mellors, Joseph B. Margolick, Barbara R. Visscher, John P. Phair, Neil M. H. Graham. (1999) Virologic, Immunologic, and Immune Activation Markers as Predictors of HIV-Associated Weight Loss Prior to AIDS. Journal of Acquired Immune Deficiency Syndromes 22:4, 386
CrossRef56
Martin J. Wiselka, Karl G. Nicholson, Stephen Rowley, Kim Bibby. (1999) Cytomegalovirus viraemia has poor predictive value for the development of cytomegalovirus disease in patients with advanced HIV-infection. Journal of Infection 39:3, 187-192
CrossRef57
Anne C Moorman, Scott D Holmberg, Steven I Marlowe, Jennifer C Von Bargen, Bienvenido G Yangco, Frank J Palella, Douglas J Ward, Mark O Loveless, Jack Fuhrer, Patrick Joseph, William A Alexander, Diane J Aschman. (1999) Changing Conditions and Treatments in a Dynamic Cohort of Ambulatory HIV Patients. Annals of Epidemiology 9:6, 349-357
CrossRef58
Gregory J. Dore, Patricia K. Correll, Yueming Li, John M. Kaldor, David A. Cooper, Bruce J. Brew. (1999) Changes to AIDS dementia complex in the era of highly active antiretroviral therapy. AIDS 13:10, 1249-1253
CrossRef59
Christine A. Wanke. (1999) Epidemiological and clinical aspects of the metabolic complications of HIV infection The fat redistribution syndrome. AIDS 13:11, 1287-1293
CrossRef60
Shabbar Jaffar, Koya Ariyoshi, Peggy Frith, Yuka Okouchi, Sehu Sabally, Tunde Ajewole, Robin Bailey, Pak Lee, Tumani Corrah, Gordon Johnson, Hannah Faal, Hilton Whittle. (1999) Retinal manifestations of HIV-1 and HIV-2 infections among hospital patients in The Gambia, West Africa. Tropical Medicine and International Health 4:7, 487-492
CrossRef61
Irene Kuo, Narsing A. Rao. (1999) Ocular disease in AIDS. Springer Seminars in Immunopathology 21:2, 161-177
CrossRef62
Daniel J. Skiest. (1999) Cytomegalovirus Retinitis in the Era of Highly Active Antiretroviral Therapy (HAART). The American Journal of the Medical Sciences 317:5, 318
CrossRef63
Furrer, Hansjakob, Egger, Matthias, Opravil, Milos, Bernasconi, Enos, Hirschel, Bernard, Battegay, Manuel, Telenti, Amalio, Vernazza, Pietro L., Rickenbach, Martin, Flepp, Markus, Malinverni, Raffaele, . (1999) Discontinuation of Primary Prophylaxis against Pneumocystis carinii Pneumonia in HIV-1–Infected Adults Treated with Combination Antiretroviral Therapy. New England Journal of Medicine 340:17, 1301-1306
Full Text64
Martin, Daniel F., Kuppermann, Baruch D., Wolitz, Richard A., Palestine, Alan G., Li, Hong, Robinson, Charles A., the Roche Ganciclovir Study Group. (1999) Oral Ganciclovir for Patients with Cytomegalovirus Retinitis Treated with a Ganciclovir Implant. New England Journal of Medicine 340:14, 1063-1070
Full Text65
Vincent C. Emery, Mark C. Atkins, E. Frances Bowen, Duncan A. Clark, Margaret A. Johnson, I. Michael Kidd, James E. McLaughlin, Andrew N. Phillips, Padraig M. Strappe, Paul D. Griffiths. (1999) Interactions between ?-herpesviruses and human immunodeficiency virus in vivo: Evidence for increased human immunodeficiency viral load in the presence of human herpesvirus 6. Journal of Medical Virology 57:3, 278-282
CrossRef66
Suhail Raoof, Mark J. Rosen, Faroque A. Khan. (1999) ROLE OF BRONCHOSCOPY IN AIDS. Clinics in Chest Medicine 20:1, 63-76
CrossRef67
Janet L Davis, Homayoun Tabandeh, William J Feuer, Seema Kumbhat, Daniel B Roth, Nauman A Chaudhry. (1999) Effect of potent antiretroviral therapy on recurrent cytomegalovirus retinitis treated with the ganciclovir implant. American Journal of Ophthalmology 127:3, 283-287
CrossRef68
Margriet ME Schneider, Jan CC Borleffs, Ronald P Stolk, Christian AJJ Jaspers, Andy IM Hoepelman. (1999) Discontinuation of prophylaxis for Pneumocystis carinii pneumonia in HIV-1-infected patients treated with highly active antiretroviral therapy. The Lancet 353:9148, 201-203
CrossRef69
Sharon L. Walmsley, Shideh Khorasheh, Joel Singer, Ognjenka Djurdjev. (1998) A Randomized Trial of N-Acetylcysteine for Prevention of Trimethoprim-Sulfamethoxazole Hypersensitivity Reactions in Pneumocystis carinii Pneumonia Prophylaxis (CTN 057). Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 19:5, 498-505
CrossRef70
CONSTANCE R. UPHOLD, M. FRAN SMITH, BRADLEY S. BENDER. (1998) Failure of a Prospective Trial to Detect Cytomegalovirus Retinitis after Initiation of Highly Active Antiretroviral Therapy. AIDS Patient Care and STDs 12:12, 907-912
CrossRef71
Franck Carbonnel, Caroline Maslo, Laurent Beaugerie, Fabrice Carrat, Edith Wirbel, Christian Aussel, Jean Gérard Gobert, Pierre Marie Girard, Jean Pierre Gendre, Jacques Cosnes, Willy Rozenbaum. (1998) Effect of indinavir on HIV-related wasting. AIDS 12:14, 1777-1784
CrossRef72
Douglas A Jabs, Cheryl Enger, J.P Dunn, Michael Forman, Larry Hubbard. (1998) Cytomegalovirus retinitis and viral resistance: 3. Culture results. American Journal of Ophthalmology 126:4, 543-549
CrossRef73
Peter J McCluskey, Rajiv Shah, Patrick Versace. (1998) Outcomes of cytomegalovirus retinitis following the use of ganciclovir implants. Australian and New Zealand Journal of Ophthalmology 26:3, 207-210
CrossRef74
Ahmed M. Bayoumi, Donald A. Redelmeier. (1998) Preventing Mycobacterium avium complex in patients who are using protease inhibitors. AIDS 12:12, 1503-1512
CrossRef75
William G Hodge, Stuart R Seiff, Todd P Margolis. (1998) Ocular opportunistic infection incidences among patients who are HIV positive compared to patients who are HIV negative11The authors have no financial or proprietary interest in any good or service mentioned in this article.22Performed at the San Francisco General Hospital of the University of California, San Francisco, California.. Ophthalmology 105:5, 895-900
CrossRef76
David A. Wheeler, Cynthia L. Gibert, Cynthia A. Launer, Norma Muurahainen, Richard A. Elion, Donald I. Abrams, Glenn E. Bartsch. (1998) Weight Loss as a Predictor of Survival and Disease Progression in HIV Infection. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 18:1, 80-85
CrossRef77
YVONNE A. MALDONADO, ROSARIO G. ARANETA, ADAM L. HERSH. (1998) Pneumocystis carinii pneumonia prophylaxis and early clinical manifestations of severe perinatal human immunodeficiency virus type 1 infection. The Pediatric Infectious Disease Journal 17:5, 398-402
CrossRef78
Judd E. Shellito, Ruxandra Olariu. (1998) Alcohol Decreases T-Lymphocyte Migration into Lung Tissue in Response to Pneumocystis carinii and Depletes T-Lymphocyte Numbers in the Spleens of Mice. Alcoholism: Clinical and Experimental Research 22:3, 658-663
CrossRef79
Vadim Pliner, Jeremy Weedon, Pauline A. Thomas, Richard W. Steketee, Elaine J. Abrams, Genevieve Lambert, Barbara Greenberg, Mahrukh Bamji, Donald M. Thea, Pamela B. Matheson. (1998) Incubation period of HIV-1 in perinatally infected children. AIDS 12:7, 759-766
CrossRef80
Jacob P. Lalezari, Gary N. Holland, Françoise Kramer, George F. McKinley, Carol A. Kemper, David V. Ives, Robert Nelson, W. David Hardy, Baruch D. Kuppermann, Donald W. Northfelt, Michael Youle, Margaret Johnson, Richard Alan Lewis, David V. Weinberg, Gary L. Simon, Richard A. Wolitz, April E. Ruby, Robert J. Stagg, Howard S. Jaffe. (1998) Randomized, Controlled Study of the Safety and Efficacy of Intravenous Cidofovir for the Treatment of Relapsing Cytomegalovirus Retinitis in Patients With AIDS. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 17:4, 339-344
CrossRef81
John C. Walsh, Colin D. Jones, Eric A. Barnes, Brian G. Gazzard, Suzanne M. Mitchell. (1998) Increasing survival in AIDS patients with cytomegalovirus retinitis treated with combination antiretroviral therapy including HIV protease inhibitors. AIDS 12:6, 613-618
CrossRef82
Hartwig Klinker, Peter Langmann, Michael Zilly, Ernst Richter. (1998) Drug monitoring during the treatment of AIDS-associated Pneumocystis carinii pneumonia with trimethoprim-sulfamethoxazole. Journal of Clinical Pharmacy and Therapeutics 23:2, 149-154
CrossRef83
Carol L. Brosgart, Thomas A. Louis, David W. Hillman, Charles P. Craig, Beverly Alston, Evelyn Fisher, Donald I. Abrams, Roberta L. Luskin-Hawk, James H. Sampson, Douglas J. Ward, Melanie A. Thompson, Ramon A. Torres. (1998) A randomized, placebo-controlled trial of the safety and efficacy of oral ganciclovir for prophylaxis of cytomegalovirus disease in HIV-infected individuals. AIDS 12:3, 269-277
CrossRef84
F. Saillour, N. Bernard, L. Dequae-Merchadou, C. Marimoutou, V. Journot, F. Dabis. (1998) Predictive Factors of Occurrence of Cytomegalovirus Disease and Impact on Survival in the Aquitaine Cohort in France, 1985 to 1994. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 17:2, 171-178
CrossRef85
Daniel J. Walker, Steven R. Meshnick. (1998) Drug resistance in Pneumocystis carinii: an emerging problem. Drug Resistance Updates 1:3, 201-204
CrossRef86
Richard E. Chaisson, Joel E. Gallant, Jeanne C. Keruly, Richard D. Moore. (1998) Impact of opportunistic disease on survival in patients with HIV infection. AIDS 12:1, 29-33
CrossRef87
C DECKER, H MASUR. (1998) PNEUMONIA IN AIDS PATIENTS IN THE CRITICAL CARE UNIT. Critical Care Clinics 14:1, 135-157
CrossRef88
H Reinhard Brodt, Bernd S. Kamps, Peter Gute, Bernhard Knupp, Shlomo Staszewski, Eilke B. Helm. (1997) Changing incidence of AIDS-defining illnesses in the era of antiretroviral combination therapy. AIDS 11:14, 1731-1738
CrossRef89
JULIE S YOUNG. (1997) HIV and Medical Nutrition Therapy. Journal of the American Dietetic Association 97:10, S161-S166
CrossRef90
Richard D. Moore, Richard E. Chaisson. (1997) Cost-Utility Analysis of Prophylactic Treatment With Oral Ganciclovir for Cytomegalovirus Retinitis. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 16:1, 15-21
CrossRef91
Gregory J. Dore, Jennifer F. Hoy, Simon A. Mallal, Yueming Li, Anne M. Mijch, Martyn A. French, David A. Cooper, John M. Kaldor. (1997) Trends in Incidence of AIDS Illnesses in Australia From 1983 to 1994: The Australian AIDS Cohort. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 16:1, 39-43
CrossRef92
PATRICK HASLETT, MARGARET HEMPSTEAD, CYNTHIA SEIDMAN, JOLANTA DIAKUN, DACIA VASQUEZ, VICTORIA H. FREEDMAN, GILLA KAPLAN. (1997) The Metabolic and Immunologic Effects of Short-Term Thalidomide Treatment of Patients Infected with the Human Immunodeficiency Virus. AIDS Research and Human Retroviruses 13:12, 1047-1054
CrossRef93
Wood, Alastair J.J., , Jacobson, Mark A., . (1997) Treatment of Cytomegalovirus Retinitis in Patients with the Acquired Immunodeficiency Syndrome. New England Journal of Medicine 337:2, 105-114
Full Text94
M COWAN, J SHELHAMER, S LEVINE. (1997) ACUTE RESPIRATORY FAILURE IN THE HIV-SEROPOSITIVE PATIENT. Critical Care Clinics 13:3, 523-552
CrossRef95
C. Mussini, N. Mongiardo, G. Manicardi, F. Trenti, A. Alessandri, F. Paolillo, A. Catania, M. Portolani, M. Pecorari, V. Borghi, G. Ficarra, A. Cossarizza, B. Rienzo. (1997) Relevance of clinical and laboratory findings in the diagnosis of cytomegalovirus encephalitis in patients with AIDS. European Journal of Clinical Microbiology & Infectious Diseases 16:6, 437-444
CrossRef96
Kathleen Mulligan, Viva W. Tai, Morris Schambelan. (1997) Cross-Sectional and Longitudinal Evaluation of Body Composition in Men With HIV Infection. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 15:1, 43-48
CrossRef97
Sophie Pueyo, L. Rachid Salmi, Geneviève Chêne, Catherine Leport, Philippe Morlat, Laurence Dequae, Valérie Grégoire, Richard Hafner, Jean-Louis Vildé, Benjamin J. Luft, Jean Aubertin. (1997) Survival After AIDS-Defining Events in Patients With<200 Lymphocytes CD4+ × 106/L Who Are Toxoplasmosis Antibody Positive. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 14:5, 459-464
CrossRef98
Audrey L. French, Debra A. Benator, Fred M. Gordin. (1997) NONTUBERCULOUS MYCOBACTERIAL INFECTIONS. Medical Clinics of North America 81:2, 361-379
CrossRef99
Richard E. Chaisson, Philip Keiser, Mark Pierce, W Jeffrey Fessel, Joel Ruskin, Christopher Lahart, Constance A. Benson, Kysa Meek, Nancy Siepman, J Carl Craft. (1997) Clarithromycin and ethambutol with or without clofazimine for the treatment of bacteremic. AIDS 11:3, 311-317
CrossRef100
Winston Cavert. (1997) VIRAL INFECTIONS IN HUMAN IMMUNODEFICIENCY VIRUS DISEASE. Medical Clinics of North America 81:2, 411-426
CrossRef101
Antonella dʼArminio Monforte, Franco Mainini, Letizia Testa, Luca Vago, Livia Balotta, Manuela Nebuloni, Spinello Antinori, Teresa Bini, Mauro Moroni. (1997) Predictors of cytomegalovirus disease, natural history and autopsy findings in a cohort of patients with AIDS. AIDS 11:4, 517-524
CrossRef102
Jean T. Santamauro, Diane E. Stover. (1997) PNEUMOCYSTIS CARINII PNEUMONIA. Medical Clinics of North America 81:2, 299-318
CrossRef103
W. David Hardy. (1997) Management Strategies for Patients With Cytomegalovirus Retinitis. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 14, S7-S12
CrossRef104
M. Opravil. (1997) Epidemiological and clinical aspects of mycobacterial infections. Infection 25:1, 56-59
CrossRef105
Cheryl Enger, Douglas A. Jabs, James P. Dunn, Michael S. Forman, Neil M. Bressler, Joseph B. Margolick, Patricia Charache. (1997) Viral resistance and CMV retinitis: design and methods of a prospective study. Ophthalmic Epidemiology 4:1, 41-48
CrossRef106
Jacob P. Lalezari. (1997) Cidofovir. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 14, S22-S26
CrossRef107
J. Randall Curtis, Kimberley A. Marquis. (1997) Care for the Patient with AIDS in the ICU: Outcomes and Ethics. Clinical Nurse Specialist 11:1, 31-38
CrossRef108
Stewart J. Levine. (1996) PNEUMOCYSTIS CARINII. Clinics in Chest Medicine 17:4, 665-695
CrossRef109
Mark J. Rosen. (1996) OVERVIEW OF PULMONARY COMPLICATIONS. Clinics in Chest Medicine 17:4, 621-631
CrossRef110
C.Mel Wilcox, Linda Rabeneck, Scott Friedman. (1996) AGA technical review: Malnutrition and cachexia, chronic diarrhea, and hepatobiliary disease in patients with human immunodeficiency virus infection. Gastroenterology 111:6, 1724-1752
CrossRef111
Daniel P. Chin, Philip C. Hopewell. (1996) MYCOBACTERIAL COMPLICATIONS OF HIV INFECTION. Clinics in Chest Medicine 17:4, 697-711
CrossRef112
Graeme J. Moyle. (1996) Occurrence of Lymphomas during ddC or ddC/Zidovudine Combination Therapy in Persons Infected with HIV Type 1. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 13:5, 464
CrossRef113
Christine A. Wanke, Douglas Pleskow, Paola C. Degirolami, Barbara B. Lambl, Kimberly Merkel, Salim Akrabawi. (1996) A medium chain triglyceride-based diet in patients with HIV and chronic diarrhea reduces diarrhea and malabsorption: A prospective, controlled trial. Nutrition 12:11-12, 766-771
CrossRef114
Andrew N. Phillips, Adriano Lazzarin, Juan Gonzales-Lahoz, Nathan Clumeck, M.P. Glauser, R. Proenca, D. Banhegyi, Court Pedersen, Jens D. Lundgren, Anne M. Johnson. (1996) Factors associated with the CD4+ lymphocyte count at diagnosis of acquired immunodeficiency syndrome. Journal of Clinical Epidemiology 49:11, 1253-1258
CrossRef115
Sheri A. Keitz, Lori A. Bastian, Charles L. Bennett, Eugene Z. Oddone, Jack A. DeHovitz, Robert A. Weinstein. (1996) AIDS-relatedPneumocystis carinii pneumonia in older patients. Journal of General Internal Medicine 11:10, 591-596
CrossRef116
Ashley Watson, Matthew H. Samore, Christine A. Wanke. (1996) Diarrhea and quality of life in ambulatory HIV-infected patients. Digestive Diseases and Sciences 41:9, 1794-1800
CrossRef117
D. S. Stein, N. M. H. Graham. (1996) Interaction of Herpes Viruses with HIV: Can Antiherpes Drugs Prolong Survival Among AIDS Patients?. Reviews in Medical Virology 6:3, 163-172
CrossRef118
Stephen Kravcik, Baldwin W. Toye, Kathryn Fyke, Nanci Hawley-Foss, Diane Fillion, Joseph A. Yurack, D. William Cameron. (1996) Impact of Mycobacterium avium Complex Prophylaxis on the Incidence of Mycobacterial Infections and Transfusion-Requiring Anemia in an HIV-Positive Population. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 13:1, 27-32
CrossRef119
Ronnie D. Horner, Charles L. Bennett, Chad Achenbach, Daniel Rodriguez, John Adams, Stuart C. Gilman, Susan E. Cohn, Gordon M. Dickinson, Jack A. DeHovitz, Robert A. Weinstein. (1996) Predictors of Resource Utilization for Hospitalized Patients with Pneumocystis carinii Pneumonia (PCP): A Summary of Effects From the Multi-city Study of Quality of PCP Care. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 12:4, 379-385
CrossRef120
Georg Plum, Martina Brenden, Paulo Santos, Evelyn Schwarz, Ulrich Wahnschaffe, Gottfried Mauff, Gerhard Pulverer. (1996) Serum Antibody Reactivity to Recombinant mig and Whole Cell Antigens in Mycobacterium avium Infection. Zentralblatt für Bakteriologie 284:2-3, 348-360
CrossRef121
Sean D. Sullivan, Essy Mozaffari, Eric S. Johnson, Richard Wolitz, Stephen E. Follansbee. (1996) An economic evaluation of oral compared with intravenous ganciclovir for maintenance treatment of newly diagnosed for maintenance treatment of newly diagnosed cytomegalovirus retinitis in AIDS patients. Clinical Therapeutics 18:3, 546-558
CrossRef122
Kitahata, Mari M., Koepsell, Thomas D., Deyo, Richard A., Maxwell, Clare L., Dodge, Wayne T., Wagner, Edward H., . (1996) Physicians' Experience with the Acquired Immunodeficiency Syndrome as a Factor in Patients' Survival. New England Journal of Medicine 334:11, 701-707
Full Text123
G.P. Rizzardi, A. Lazzarin, M. Musicco, D. Frigerio, M. Maillard, M. Lucchini, M. Moroni. (1996) Risks and benefits of aerosolized pentamidine and cotrimoxazole in primary prophylaxis of Pneumocystis carinii pneumonia in HIV-1-infected patients: a two-year Italian multicentric randomized controlled trial. Journal of Infection 32:2, 123-131
CrossRef124
Margaret Sullivan, Judith Feinberg, John G. Bartlett. (1996) FEVER IN PATIENTS WITH HIV INFECTION. Infectious Disease Clinics of North America 10:1, 149-165
CrossRef125
Vivian Y. Kim, Jay S. Duker. (1996) Ocular Manifestations of Human Immunodeficiency Virus. Seminars in Ophthalmology 11:1, 93-106
CrossRef126
Douglas A. Jabs. (1996) Design of clinical trials for drug combinations: cytomegalovirus retinitis — foscarnet and ganciclovir. The CMV retinitis retreatment trial. Antiviral Research 29:1, 69-71
CrossRef127
Giuseppe Pagani, Pietro Borgna, Claudio Piersimoni, Domenico Nista, Marco Terreni, Massimo Pregnolato. (1996) In Vitro Anti-Mycobacterium avium Activity ofN-(2-Hydroxyethyl)-1,2-benzisothiazol-3(2H)-one and -thione Carbamic Esters. Archiv der Pharmazie 329:8-9, 421-425
CrossRef128
E.F. Bowen, M. Atkins, P.D. Griffiths, V.C. Emery, S. Madge, M.A. Johnson, P. Wilson. (1995) Natural history of untreated cytomegalovirus retinitis. The Lancet 346:8991-8992, 1671-1673
CrossRef129
Georgeann McGuinness, David P Naidich. (1995) Bronchiectasis: CT/clinical correlations. Seminars in Ultrasound, CT, and MRI 16:5, 395-419
CrossRef130
Holland, Gary N., Tufail, Adnan, . (1995) New Therapies for Cytomegalovirus Retinitis. New England Journal of Medicine 333:10, 658-659
Full Text131
Baldassano, Vincent, Dunn, James P., Feinberg, Judith, Jabs, Douglas A., . (1995) Cytomegalovirus Retinitis and Low CD4+ T-Lymphocyte Counts. New England Journal of Medicine 333:10, 670-670
Full Text132
Gian Paolo Rizzardi, Adriano Lazzarin, Massimo Musicco, Daniela Frigerio, Myriam Maillard, Maurizio Lucchini, Mauro Moroni. (1995) Better efficacy of twice-monthly than monthly aerosolised pentamidine for secondary prophylaxis of Pneumocystis carinii pneumonia in patients with AIDS. An Italian multicentric randomised controlled trial. Journal of Infection 31:2, 99-105
CrossRef133
Camilla S. Graham, Brevick G. Graham, John A. Bartlett, Alison E. Heald, Susan S. Schiffman. (1995) Taste and smell losses in HIV infected patients. Physiology & Behavior 58:2, 287-293
CrossRef134
J. Randall Curtis, Douglas S. Paauw, Marjorie D. Wenrich, Jan D. Carline, Paul G. Ramsey. (1995) Ability of primary care physicians to diagnose and managePneumocystis carinii pneumonia. Journal of General Internal Medicine 10:7, 395-399
CrossRef135
Robert S. Root-Bernstein. (1995) Five myths about AIDS that have misdirected research and treatment. Genetica 95:1-3, 111-132
CrossRef136
Mark A. Jacobson. (1995) Current Management of Cytomegalovirus Disease in Patients with AIDS. Aids Patient Care 9:1, 10-17
CrossRef137
Donald R. Hoover, Alvaro Muñtoz, Yanhua He, Jeremy M. G. Taylor, Lawrence Kingsley, Joan S. Chmiel, Alfred Saah. (1994) The effectiveness of interventions on incubation of AIDS as measured by secular increases within a population. Statistics in Medicine 13:19-20, 2127-2139
CrossRef138
JOHN P. PHAIR. (1994) Variations in the Natural History of HIV Infection. AIDS Research and Human Retroviruses 10:8, 883-885
CrossRef139
MARK A. JACOBSON. (1994) Current Management of Cytomegalovirus Disease in Patients with AIDS. AIDS Research and Human Retroviruses 10:8, 917-923
CrossRef140
Juraj Sprung, Denis L. Bourke, Colin F. Mackenzie, Padmini Thomas. (1994) Chronic methemoglobinemia: Improving hemoglobin saturation monitoring during anesthesia. Journal of Clinical Monitoring 10:4, 267-269
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