David M. Parenti

George Washington University, Washington, Washington, D.C., United States

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Publications (56)245.17 Total impact

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    ABSTRACT: Background and aims: Coronary artery disease is a growing clinical problem in HIV-infected subjects. The increased risk of coronary events in this population has been linked to low levels of HDL, but the effects of HIV infection and anti-retroviral treatment (ART) on HDL structure and function remain unknown. Here, we aimed to determine the composition and function of HDL particles isolated from ART-naive and ART-positive HIV-infected patients. Methods and results: Proteomic profiling revealed decreased levels of paraoxonase (PON) 1 and PON 3 in HDL from HIV patients relative to HDL from uninfected controls (p < 0.0001), and PON activity of HDL from control group (0.13 ± 0.01 U/μl) was significantly higher than PON activity of HDL from HIV-infected untreated subjects (0.12 ± 0.01 U/μl, p = 0.0035), subjects treated with non-nucleoside reverse transcriptase inhibitor (NNRTI)-based therapy (0.11 ± 0.01 U/μl, p < 0.0001), subjects treated with protease inhibitor (PI)-based therapy with detectable viral load (0.11 ± 0.01 U/μl, p < 0.0001), and PI-treated patients with undetectable viral load (0.12 ± 0.01 U/μl, p = 0.0164). Lipidomic profiling uncovered a negative correlation between CD4 T cell counts and particle sphingomyelin, lyso-phosphatidylcholine and ether-linked phosphatidylserine content in the ART-naive (R(2) = 0.2611, p < 0.05; R(2) = 0.2722, p < 0.05; and R(2) = 0.3977, p < 0.05, respectively) but not treated HIV-infected subjects. Functional analysis demonstrated a negative correlation between cholesterol efflux capacity of HDL and viral load in the ART-naive HIV-infected group (R(2) = 0.26, p = 0.026). Conclusions: Taken together, these results indicate that HIV infection associates with a number of both protein and lipid compositional changes in HDL particles. Moreover, HIV infection affects cholesterol efflux function of HDL, thus contributing to an increased risk of atherosclerosis in this patient population.
    No preview · Article · Aug 2015 · Atherosclerosis
  • Scott W Aesif · David M Parenti · Linda Lesky · John F Keiser
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    ABSTRACT: Context .- Use of reference laboratories for selected laboratory testing (send-out tests) represents a significant source of laboratory costs. As the use of more complex molecular analyses becomes common in the United States, strategies to reduce costs in the clinical laboratory must evolve in order to provide high-value, cost-effective medicine. Objective .- To report a strategy that employs clinical pathology house staff and key hospital clinicians in the effective use of microbiologic send-out testing. Design .- The George Washington University Hospital is a 370-bed academic hospital in Washington, DC. In 2012 all requisitions for microbiologic send-out tests were screened by the clinical pathology house staff prior to final dispensation. Tests with questionable utility were brought to the attention of ordering clinicians through the use of interdisciplinary rounds and direct face-to-face consultation. Results .- Screening resulted in a cancellation rate of 38% of send-out tests, with proportional cost savings. Nucleic acid tests represented most of the tests screened and the largest percentage of cost saved through screening. Following consultation, requested send-out tests were most often canceled because of a lack of clinical indication. Conclusions .- Direct face-to-face consultation with ordering physicians is an effective, interdisciplinary approach to managing the use of send-out testing in the microbiology laboratory.
    No preview · Article · Apr 2014 · Archives of pathology & laboratory medicine
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    ABSTRACT: Tumor necrosis factor alpha (TNF-α) inhibitors are widely used for the treatment of various inflammatory conditions. They are associated with an increased risk for infections. We report a case of herpes simplex virus type 1 (HSV-1) encephalitis in a patient receiving etanercept and review the literature on TNF-α and TNF-α inhibitors, and their importance in the pathophysiology of herpes simplex encephalitis.
    No preview · Article · Nov 2013 · Scandinavian Journal of Infectious Diseases
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    Full-text · Article · Jun 2012 · AIDS (London, England)
  • t Sarpel · John Keiser · David Parenti
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    ABSTRACT: Background: Clostridium difficile-associated diarrhea (CDAD) has been estimated to cost US hospitals $3.2 billion dollars annually. Over the last 10 years there has been increasing incidence of CDAD and severity, particularly infections involving the NAP1 strain of C. difficile. We compare the changes in epidemiology and treatment in CDAD cases identified in 2005 with those in 2010 at the George Washington University Hospital (GWUH). Methods: A retrospective chart review was conducted of hospitalized patients with CDAD diagnosed by positive toxin A/B ELISA assay in 2005 and 2010. Comparisons were made for demographic and clinical data, treatment and in-hospital mortality. Treatment failure was defined as worsening clinical symptoms necessitating a change in therapy. Results: In 2010 there were 109 cases of CDAD vs. 205 in 2005; >80% were healthcare-associated. Demographic and clinical characteristics were similar between 2005 and 2010. There was a statistically significant decrease in the mean number of antibiotic exposures prior to CDAD (2.25 ± 1.88 vs. 3.10± 2.35 p=0.0016) in 2010, predominantly secondary to decreased fluoroquinolone use. There was increased use of oral vancomycin as the initial treatment regimen (33.9% vs. 5.4% p<0.001). Other drugs used for treatment included IV and PO metronidazole, PR vancomycin, rifaximin, and tigecycline. Although there was a trend towards increased treatment failure (23% vs. 32%, p=0.08), there was no statistically significant change in in-hospital or attributable mortality. Age, WBC, and creatinine were predictors of mortality. Conclusion: The incidence of CDAD at the GWUH has decreased when compared to 2005. There has been a decrease in the number of antibiotic exposures, particularly fluoroquinolones. Although oral vancomycin is being used more often as an initial regimen, mortality has remained unchanged. Continued judicious use of antibiotics with early recognition of CDAD remains a priority five years later.
    No preview · Conference Paper · Oct 2011
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    Marc O Siegel · David M Parenti · Gary L Simon
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    ABSTRACT: Atrial-esophageal fistula is a rare but often fatal complication of catheter radiofrequency ablation. Patients occasionally have bacteremia and have been misdiagnosed with endocarditis. Infectious diseases specialists are often consulted and need to be aware of this complication. We report a case of atrial-esophageal fistula after radiofrequency ablation that illustrates the salient features of this illness.
    Full-text · Article · Jul 2010 · Clinical Infectious Diseases
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    ABSTRACT: Multidrug-resistant Acinetobacter baumannii has been recently recognized as a major cause of nosocomial infections. During an outbreak of a multidrug-resistant strain, all isolates of A. baumannii were analyzed by pulsed-field gel electrophoresis, and a retrospective review was conducted to identify risk factors for acquisition. Of the 65 patients, the unique outbreak clone (clone I) was isolated from 43 (group A), whereas 19 different strains were grown from 22 other patients (group B). Clone I was predominantly isolated from pleuropulmonary sources (63%; P < 0.0001). Imipenem resistance was nearly universal in clone I, and amikacin resistance was common. In univariate analysis, admission to the medical/surgical intensive care unit and use of mechanical ventilation and fluoroquinolone antibiotics were associated with clone I. Only admission to the medical/surgical intensive care unit was significant by multivariate analysis. The institution of an infection control program controlled but did not eliminate the outbreak.
    No preview · Article · Jul 2009 · Infectious Disease in Clinical Practice
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    ABSTRACT: Necator americanus Ancylostoma Secreted Protein-2 (Na-ASP-2) is a leading larval-stage hookworm vaccine candidate. Recombinant Na-ASP-2 was expressed in Pichia pastoris and formulated with Alhydrogel. In a phase 1 trial, 36 healthy adults without history of hookworm infection were enrolled into 1 of 3 dose cohorts (n=12 per cohort) and randomized to receive intramuscular injections of either Na-ASP-2 or saline placebo. Nine participants in the first, second and third cohorts were assigned to receive 10, 50 and 100 microg of Na-ASP-2, respectively, on study days 0, 56 and 112, while 3 participants in each cohort received placebo. The most frequent adverse events were mild-to-moderate injection site reactions; in 8 participants these were delayed and occurred up to 10 days after immunization. No serious adverse events occurred. Anti-Na-ASP-2 IgG endpoint titers as determined by ELISA increased from baseline in all vaccine groups and peaked 14 days after the third injection, with geometric mean titers of 1:7066, 1:7611 and 1:11,593 for the 10, 50 and 100 microg doses, respectively, compared to <1:100 for saline controls (p<0.001). Antibody titers remained significantly elevated in all vaccine groups until the end of the study, approximately 8 months after the third vaccination. In vitro stimulation of PBMCs collected from participants with Na-ASP-2 resulted in robust proliferative responses in those who received vaccine, which increased with successive immunizations and remained high in the 50 and 100 microg dose groups through the end of the study. This first trial of a human hookworm vaccine demonstrates that the Na-ASP-2 vaccine is well-tolerated and induces a prolonged immune response in adults not exposed to hookworm, justifying further testing of this vaccine in an endemic area.
    Full-text · Article · May 2008 · Vaccine
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    ABSTRACT: Background: Clostridium difficile associated diarrhea (CDAD) has increased in incidence and can lead to substantial morbidity and mortality. Recently fluoroquinolones (FQs) have been implicated in the predisposition to CDAD. Methods: A retrospective review was conducted of a sample of hospitalized patients (PTS) with CDAD diagnosed by positive toxin A/B ELISA in 2005. Demographic and clinical data, and exposure to CL and FQs (ciprofloxacin (CIP)/moxifloxacin) < 90 days prior to admission was collected. Treatment failure was defined as worsening clinical symptoms with a change in therapy. Annual hospital purchasing trends for CL and FQs were also examined. Results: 40 PTS with CDAD had a mean age of 59.8 ± 19.8 years; 60% were female. 82.5% of CDAD cases were health care-associated; 17.5% community acquired. The mean number of antibiotics received prior to CDAD was 2.8; 55% received FQs, 17.5% CL. Other underlying conditions were malignancy 27.5%, diabetes 27.5%, HIV 17.5%, surgery 32.5%, proton pump inhibitor/H2 antagonist use 42.5%. The time to toxin assay positivity was ≤ 7 days after admission in 75%. 2 PTS had megacolon, and 1 required surgery. Attributable mortality was 7.5%. Treatment information was available for 33 PTS: 25% failed to respond to initial therapy, and this was significantly associated with higher mortality (p=0.001), and prior CIP exposure (p=0.01). From 2003-2005, hospital purchases for CL increased by 118%, and FQs 33%, of which 73% was CIP. Conclusion: The emergence of bacterial resistance and greater emphasis on outpatient treatment of infections have led to increased utilization of CL and FQs, which may be partially responsible for increases in CDAD. Prior CIP usage had a significant association with CDAD treatment failure. The prudent and judicious use of CIP and CL is warranted.
    No preview · Conference Paper · Oct 2006
  • Pinzone · M L Fox · M K Sastry · D M Parenti · G L Simon
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    ABSTRACT: Leptin, the protein product of the obese gene (ob), is secreted by adipocytes. Circulating leptin levels correlate with fat mass in humans, including individuals infected with HIV. Leptin serves as an adipostatic hormone, a permissive factor for reproduction and a modulator of immune function. Leptin is a cytokine, and has been demonstrated to enhance CD4 cell proliferation and IL-2 secretion from CD4 cells in vitro. The role of leptin in HIV-positive patients treated with highly active antiretroviral therapy (HAART) has not been well defined. We haveevaluated leptin levels in HIV-infected individualsduringthe early phase of HAART. We measured plasma leptin levels in 15 antiretroviral-naive HIV positive patients at baseline and after 1 and 4 weeks of HAART. After the first week of therapy, mean leptin level and CD4 count were increased compared to baseline, 6.0 vs 7.2 ng/ml (p = 0.004) and 377 vs 432 cells/ul (p = 0.014), respectively. In contrast, mean body mass index (BMI) remained unchanged 27.0 vs 26.8 kg/m2 (p < 0.08). After four weeks of therapy, leptin and BMI values were unchanged compared to baseline, 6.0 vs 5.9 (p < 0.4) and 27.0 vs 26.9 (p < 0.5), respectively, whereas CD4 count continued to increase to 491 cells/ul (p < 0.012 compared to baseline). These data demonstrate an early transient increase in plasma leptin levels in HIV positive patients initiated on HAART, despite a lack of change in BMI. It is unclear if the transient increase in leptin is related to its role as a cytokine, a metabolic regulator, or reproductive factor.
    No preview · Article · Mar 2005 · Journal of endocrinological investigation
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    ABSTRACT: A recent resurgence of primary and secondary syphilis has been observed in certain population groups, particularly among persons infected with human immunodeficiency virus (HIV). Liver involvement is an infrequently recognized complication of early syphilis, with no previous reports among HIV-infected patients. We describe 7 cases of syphilitic hepatitis in HIV-positive individuals and review the literature. At our institutions, all patients presented with a rash consistent with secondary syphilis. Each case was characterized by a conspicuous increase in serum alkaline phosphatase level (mean level +/- standard deviation, 905 +/- 523.6 IU/L) and milder elevations in serum transaminase levels. The mean CD4+ absolute T cell count was 317 cells/mm3, and the median rapid plasma reagin (RPR) titer was 1 : 128. There was a significant correlation between higher CD4+ cell counts and the RPR titers (R=0.93; P=.002). Symptomatic resolution and biochemical improvement, particularly a significant decrease in serum alkaline phosphatase levels (P=.02), occurred following antibiotic therapy. Hepatic dysfunction is not uncommon in HIV-infected persons and is attributable to multiple causes. In the appropriate clinical setting, syphilitic hepatitis is an easily diagnosed and reversible etiology of liver dysfunction. The recognition of this entity will prevent unnecessary evaluation of abnormal liver enzyme levels in HIV-positive patients.
    Full-text · Article · Dec 2004 · Clinical Infectious Diseases
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    ABSTRACT: Background: The occurrence of herpes zoster infection after initiation of HAART has been well described and is presumed to be due to the phenomenon of immune reconstitution. However, this infection also occurs in patients who are not receiving antiretroviral therapy. We sought to better understand the occurrence of HZ relative to the use of HAART. Methods: A retrospective chart review was conducted of HIV-infected patients with HZ seen in the Infectious Diseases clinics at the GWUMC and the VAMC between January 1997 and March 2004. Charts were assessed for antiretroviral use, CD4, CD8 and HIV RNA at the time of their zoster occurrence. Case patients were matched 1:2 with HIV-infected control patients seen at the VAMC clinic at the same time as the case HZ occurrence. The patients were divided into four groups based on their antiretroviral use: recent initiation of HAART, recent interruption of HAART, those stable on HAART > 6 mos, and those being monitored off all antiretroviral agents > 6 mos. Results: 69 patients with HZ infections were identified in the 7-year period and compared with 138 control patients by independent samples t-tests, Chi-square, univariate and multivariate logistic regression analyses. Mean CD4 count (285 cells/ml vs. 385 cells/ml, p=0.004) and nadir CD4 count (174.9 cells/ml vs. 238.9 cells/ml, p=0.018) were significantly lower, and HIV RNA was significantly higher (53,883 cp/ml vs. 25,336 cp/ml, p=0.07) in the HZ case patients. There was no significant difference in CD8 values. After adjusting for CD4 and HIV RNA, patients with HZ were more likely to have newly initiated therapy (OR 3.8, p=0.0008) or to have been off therapy (OR 2.3, p= 0.059). Patients with HZ were less likely to be receiving stable antiretroviral therapy (OR 0.2, p< 0.0001). Conclusions: HIV-infected patients with HZ were more immunocompromised as assessed by CD4 at the time of HZ, nadir CD4, and HIV RNA levels. The current and stable use of antiretroviral medications was associated with a lower occurrence of HZ infection. The groups with the highest occurrence of HZ were those off antiretroviral medications and those newly initiating HAART therapy.
    No preview · Conference Paper · Oct 2004
  • David Parenti · Gary Simon · John Keiser · Joseph Gross
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    ABSTRACT: Background: Acinetobacter baumanii is a common cause of nosocomial infection and has been responsible for several reported hospital outbreaks. In 2003, there was a substantial increase in the number of A. baumanii isolates at GWUMC. Many isolates shared a similar, multi-drug resistant antibiogram. Analysis of A. baumanii isolates was undertaken in order to determine risk factors for acquisition of this organism. Methods: 35 consecutive patients were identified from whom A. baumanii was isolated. The strains were sent for DNA fingerprinting by pulsed field gel electrophoresis (PFGE). Clinical and laboratory information were collected by retrospective chart review. Results: The isolates from 35 patients were sent for analysis, and 33 of these patients had charts available for review. 21 patients (Group A) had strains that were identical by PFGE; the remaining 14 patients (Group B) had isolates that were represented by 10 PFGE patterns. Patients in Group A tended to be slightly older than in Group B (median age 58 v. 51, p=NS). There were no differences in gender between the two groups. Isolates from Group A were usually sensitive to amikacin, but resistant to most other antibiotics, whereas Group B isolates had a broader susceptibility pattern. Patients in Group A were more often in the medical/surgical intensive care units (ICU) than patients in Group B (90% v. 46%, p=.01), and were more likely to have been placed on mechanical ventilation (95% v. 60%, p=.03). Between Group A and Group B there was no significant difference in mortality (30% v. 23%), in number of patients infected rather than colonized (45% v. 54%) or in antibiotic usage. Conclusion: This outbreak of multi-drug resistant A. baumanii was associated with admission to either of our two medical/surgical ICUs and with the use of mechanical ventilation. The factors contributing to nosocomial transmission have not been fully elucidated, but there may be a common source that is unique to these two wards, and this source may be associated with mechanical ventilation.
    No preview · Conference Paper · Oct 2004
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    ABSTRACT: HIV-infected patients who continue to have unprotected sex are at risk of contracting syphilis. One of the less frequently recognized manifestations of secondary syphilis is hepatitis. Since 2001, five HIV-infected patients with syphilitic hepatitis have been identified. Rash was the most frequently noted physical finding and was seen in all 5 patients. Jaundice, fever and abdominal pain were each noted in 2 patients. The most prominent laboratory abnormality was a marked elevation in alkaline phosphatase; milder elevations in liver transaminases were also noted. Three of the patients were receiving HAART at the time of syphilis diagnosis. The mean laboratory data at presentation is represented below: Hepatic involvement is not uncommon in patients with HIV infection and secondary syphilis. The relatively high CD4 count seen in these patients raises the possibility that the clinical manifestations of syphilitic hepatitis is due, in part, to the host immune response to this organism.
    No preview · Conference Paper · Oct 2003
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    ABSTRACT: To assess efficacy, safety, and adherence with compact quadruple therapy comprising one lamivudine 150-mg/zidovudine 300-mg tablet (COM) twice daily + one abacavir (ABC) 300-mg tablet twice daily + three efavirenz (EFV) 200-mg capsules at bedtime for 24 weeks, followed by one lamivudine 150-mg/zidovudine 300-mg/ABC 300-mg triple nucleoside tablet (TZV) twice daily + three EFV 200-mg capsules at bedtime for 24 weeks. A pilot 48-week, prospective, open-label trial in which 38 antiretroviral-naïve HIV-infected adults (baseline median HIV-1 RNA 5.1 log(10) copies/mL, CD4+ cell count 285/microL) received the above treatment and were monitored regularly with respect to plasma HIV-1 RNA levels, CD4+ cell counts, T-cell receptor excision circles (TRECs), adherence, and adverse events. At Week 48, intent-to-treat, switch-included analysis showed plasma HIV-1 RNA levels <400 copies/mL in 100% (29/29) of patients and <50 copies/mL in 93% (27/29); 59% of patients who achieved <50 copies/mL had <3 copies/mL (16/27). Similar virologic suppression was observed in patients with baseline HIV-1 RNA above or below 100000 copies/mL. HIV-1 RNA and CD4+ cell counts changed from baseline by a median of -3.4 log(10) copies/mL and +172 cells/microL, respectively. One virologic failure occurred at Week 16. Median TRECs/100000 peripheral blood lymphocytes increased 6-fold between baseline and Week 48. Median adherence rates were consistently 100% by self-report and 94% by pill count. Grade 2-4 treatment-related adverse events included dreams (16%), nausea (13%), decreased white cells (8%), dizziness (8%), sleep disorders (8%), and malaise and fatigue (8%). A suspected ABC hypersensitivity reaction occurred in 8% (3/38) of patients. COM/ABC/EFV or TZV/EFV produced potent, durable virologic suppression and immunologic benefits, was associated with high adherence rates, and was generally well tolerated.
    No preview · Article · Jul 2003 · HIV Clinical Trials
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    ABSTRACT: Plasma lipid and lipoprotein levels were measured at baseline and after 8 weeks of highly active antiretroviral therapy among patients receiving delavirdine with or without a protease inhibitor (PI). In patients receiving nucleoside reverse transcriptase inhibitors (NRTI) plus delavirdine, there was a statistically significant increase in cholesterol and HDL levels, whereas those receiving NRTI plus a PI had no significant change in their HDL levels. When delavirdine was combined with a PI, there was a more dramatic increase in both cholesterol and HDL concentrations.
    No preview · Article · Oct 2002 · AIDS
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    ABSTRACT: Plasma lipid and lipoprotein levels were measured at baseline and after 8 weeks of highly active antiretroviral therapy among patients receiving delavirdine with or without a protease inhibitor (PI). In patients receiving nucleoside reverse transcriptase inhibitors (NRTI) plus delavirdine, there was a statistically significant increase in cholesterol and HDL levels, whereas those receiving NRTI plus a PI had no significant change in their HDL levels. When delavirdine was combined with a PI, there was a more dramatic increase in both cholesterol and HDL concentrations.
    No preview · Article · Sep 2002 · AIDS
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    ABSTRACT: To survey the evolution over the past decade of attitudes and practices of obstetricians in maternal-fetal medicine fellowship programs regarding the management of human immunodeficiency virus (HIV)-infected pregnant women. Directors of all 65 approved maternal-fetal medicine training programs were sent questionnaires, responses to which were to reflect the consensus among members of their faculties. Programs were stratified based upon the number of HIV-infected pregnant patients cared for in the previous year. Responses reflect experience with over 1000 infected pregnant women per year, nearly one-quarter with advanced disease. Combination antiretroviral therapy was prescribed by all respondents, universally in the 2nd and 3rd trimesters. A three-drug regimen (often containing a protease inhibitor) was used more often by those who treated at least 20 HIV-infected pregnant patients per year than by those programs seeing a lower number of patients (80 vs 59%). Despite the known and unknown risks of the use of antiretrovirals during pregnancy, only half of all responding programs report adverse events to the Antiretroviral Pregnancy Registry; reporting was more common among the institutions seeing a higher number of patients (61 vs 45%). Seventy-eight percent of higher volume programs enroll their patients in clinical studies, usually multicenter, versus 35% of lower volume programs. Care for HIV+ pregnant women has dramatically changed over the past decade. Antiretroviral therapy is now universally prescribed by physicians involved in maternal-fetal medicine training programs. Given limited experience with these agents in the setting of pregnancy, it is essential for maternal-fetal medicine practitioners to actively report on adverse events and participate in clinical trials.
    Full-text · Article · Feb 2001 · Infectious Diseases in Obstetrics and Gynecology
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    ABSTRACT: Comparison of stavudine (d4T), didanosine (ddI) and indinavir (IDV) with zidovudine (ZDV), lamivudine (3TC) and IDV in HIV-1 infected patients. Randomized, open-label. Fourteen HIV Clinical Research Centers. Two-hundred and five patients with less than 4 weeks antiretroviral treatment, naive to 3TC and protease inhibitors and with CD4 cell counts > or = 200 x 10(6)/l and plasma HIV-1 RNA levels > or = 10,000 copies/ml. Stavudine 40 mg and ddI 200 mg twice daily plus IDV 800 mg every 8 h compared with ZDV 200 mg every 8 h or 300 mg twice daily, 3TC 150 mg twice daily plus IDV. The proportion of patients with plasma HIV-1 RNA levels < 500 copies/ml and < or = 50 copies/ml and changes in CD4 cell counts were compared. In an analysis of the primary endpoint, 61% of patients on d4T + ddI + IDV and 45% of patients on ZDV + 3TC + IDV had all HIV-1 RNA values obtained between weeks 40 and 48 < 500 copies/ml [95% confidence interval (CI) for the difference between proportions, 1.7-30.3%; P = 0.038]. In an intent-to-treat analysis, the percentage of all patients randomized with all HIV-1 RNA levels < 500 copies/ml between 40 and 48 weeks were 53% for the d4T + ddI + IDV arm and 41% for the ZDV + 3TC + IDV arm (95% CI, -1.4% to 25.7%; P = 0.068). At 48 weeks 41% and 35% were < or = 50 copies/ml for the stavudine- and ZDV-containing arms respectively (P > 0.2). The median time-weighted average increases in CD4 cells count over 48 weeks were 150 x 10(6)/l cells for the d4T arm and 106 x 10(6)/l cells for the ZDV arm (P= 0.001). The occurrence of serious adverse events was not significantly different between arms. The combination of stavudine, ddl and IDV resulted in potent antiretroviral effects over a 48-week period, comparable or superior to zidovudine, 3TC and IDV supporting the use of stavudine, ddI and a protease inhibitor as an initial antiretroviral treatment.
    No preview · Article · Jul 2000 · AIDS
  • Kara Ammerman · David A. Schessel · Gary L. Simon · David M. Parenti

    No preview · Article · Feb 2000 · Infectious Disease in Clinical Practice

Publication Stats

1k Citations
245.17 Total Impact Points

Institutions

  • 1986-2015
    • George Washington University
      • • Department of Medicine
      • • Department of Microbiology, Immunology, and Tropical Medicine
      • • Division of Infectious Diseases
      • • Department of Ophthalmology
      Washington, Washington, D.C., United States
  • 1995
    • University of Pittsburgh
      • Department of Medicine
      Pittsburgh, Pennsylvania, United States
  • 1993
    • Washington DC VA Medical Center
      Washington, Washington, D.C., United States