Treatments for Immune deficiency conditions
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- 0.062% (7,916) of hospital consultant episodes were for immunodeficiency with predominantly antibody defects in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 100% of hospital consultant episodes for immunodeficiency with predominantly antibody defects required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 52% of hospital consultant episodes for immunodeficiency with predominantly antibody defects were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 48% of hospital consultant episodes for immunodeficiency with predominantly antibody defects were for women in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 3% of hospital consultant episodes for immunodeficiency with predominantly antibody defects required emergency hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
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Severe combined immunodeficiency disease:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment aims to restore the immune response and prevent infection. Histocompatible bone marrow transplantation is the only satisfactory treatment available to correct immunodeficiency. Because bone marrow cells must be human leukocyte antigen and mixed leukocyte culture matched, the most common donors are histocompatible siblings. However, because bone marrow transplant can produce a potentially fatal graft-versus-host (GVH) reaction, newer methods of bone marrow transplant that eliminate GVH reaction (such as lectin separation and the use of monoclonal antibodies) are being evaluated.
Fetal thymus and liver transplants have achieved limited success. Immune globulin administration may also play a role in treatment. Some SCID infants have received long-term protection by being isolated in a completely sterile environment. However, this approach isn’t effective if the infant already has had recurring infections.
Gene therapy is being used to treat ADA deficiency.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Common variable immunodeficiency:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment and care of patients with common variable immunodeficiency are essentially the same as for those with X-linked hypogammaglobulinemia.
Injection of immune globulin (usually weekly to monthly) helps maintain the immune response. Because these injections are painful, give them deep into a large muscle mass, such as the gluteal or thigh muscles, and massage well. If the dosage is more than 1.5 ml, divide the dose and inject it into more than one site; for frequent injections, rotate the injection sites. Because immune globulin is composed primarily of IgG, the patient may also need fresh frozen plasma infusions to provide IgA and IgM.
Antibiotics are the mainstay for combating infection. Regular X-rays and pulmonary function studies help monitor lung infection; chest physiotherapy may be ordered to forestall or help clear such infection.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Acquired immunodeficiency syndrome:
Treatment
(Professional Guide to Diseases (Eighth Edition))
There is no cure for either HIV or AIDS. However, significant advances have been made to help patients control signs and symptoms and impair disease progression. Because HIV can become resistant to any drug, health care professionals use combination treatments and multiple drug regimens to suppress the virus. Patients on medication remain infectious.
An effective method of treatment is highly active antiretroviral therapy (HAART). HAART aims to reduce the number of HIV particles in the blood as measured by viral load, thus increasing T-cell counts and improving the immunologic system’s functioning. A regular and vigilant medication regimen is critical or resistance will develop because HIV strains mutate and can become resistant to HAART relatively easily.
The nucleoside analogues (sometimes called reverse transcriptase inhibitors) have been the mainstay of AIDS therapy in recent years. These drugs interfere with viral reverse transcriptase, which impairs HIV’s ability to turn its ribonucleic acid into deoxyribonucleic acid for insertion into the host cell.
Antiretroviral therapy typically begins when the patient’s CD4+ T-cell count drops to less than 500/µl or when the patient develops an opportunistic infection. Most clinicians recommend starting the patient on a combination of these drugs in an attempt to gain the maximum benefit and to inhibit the production of resistant mutant strains of HIV. The drug combinations and dosages are then altered, depending on the patient’s response.
Increasingly, physicians are basing changes in therapy on the patient’s viral load rather than on his CD4+ T-cell count. Because the CD4+ count is influenced by the total white blood cell count, changes in the CD4+ count may have nothing to do with changes in the patient’s HIV status. Many physicians suggest that patients on antiretroviral therapy have their viral load checked every 3 months.
The increasing use of protease inhibitors (PIs) has greatly increased the life expectancy of patients with AIDS. These drugs block the enzyme protease, which HIV needs to produce virions, the viral particles that spread the virus to other cells. The use of PIs dramatically reduces viral load — sometimes to undetectable levels — while producing a corresponding increase in the CD4+ T-cell count and, because they act at a different site than nucleoside analogues, the PIs don’t produce additional adverse effects when added to a patient’s regimen.
Antiviral therapy includes the use of multiple combined drug therapies that suppress the replication of the HIV virus in the body. After antiviral therapy is initiated, treatment should be aggressive. Initially, highly active antiviral therapy, consisting of a triple drug therapy regimen — a PI and two non-nucleoside reverse transcriptase inhibitors — is recommended. In addition to these primary treatments, anti-infectives are used to combat opportunistic infections (some are used prophylactically to help patients resist opportunistic infections), and antineoplastic drugs are used to fight associated neoplasms. Supportive treatments help maintain nutritional status and relieve pain and other distressing physical and psychological symptoms.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Severe combined immunodeficiency disease:
Treatment
(Handbook of Diseases)
Restoring immune response and preventing infection are the first goals of treatment. Histocompatible bone marrow transplant is the only satisfactory treatment available to correct immunodeficiency.
Because bone marrow cells must be matched according to human leukocyte antigen and mixed leukocyte culture, the most common donors are histocompatible siblings. But bone marrow transplant can produce a potentially fatal graft-versus-host (GVH) reaction, so newer methods of bone marrow transplant that eliminate GVH reaction (such as lectin separation and the use of monoclonal antibodies) are being evaluated.
Fetal thymus and liver transplants have achieved limited success. Administration of immune globulin may also play a role in treatment. Some SCID infants have received long-term protection by being isolated in a completely sterile environment. However, this approach isn’t effective if the infant already has had recurring infections.
Gene therapy is being used for ADA deficiency.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Common variable immunodeficiency:
Treatment
(Handbook of Diseases)
Patients with common variable immunodeficiency need essentially the same treatment as patients with X-linked hypogammaglobulinemia.
I.V. immune globulin (usually weekly to monthly) helps maintain immune response. Because immune globulin is made up primarily of IgG, the patient may also need fresh frozen plasma infusions to provide IgA and IgM.
Antibiotics are the mainstay for combating infection. Regular X-rays and pulmonary function studies help monitor infection in the lungs; chest physiotherapy may forestall or help clear such infection.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Human immunodeficiency virus infection:
Treatment
(Handbook of Diseases)
No cure has yet been found for the disorder; however, primary therapy for HIV infection includes three different types of antiretroviral agents:
❑ protease inhibitors (PIs), such as ritonavir, indinavir, nelfinavir, and saquinavir
❑ nucleoside reverse transcriptase inhibitors (NRTIs), such as zidovudine, didanosine, zalcitabine, lamivudine, and stavudine
❑ nonnucleoside reverse transcriptase inhibitors (NNRTIs), such as nevirapine and delavirdine.
These agents, used in various combinations, are designed to inhibit HIV viral replication. Other potential therapies include immunomodulatory agents designed to boost the weakened immune system and anti-infective and antineoplastic agents to combat opportunistic infections and associated cancers; some are used prophylactically to help patients resist opportunistic infections.
Current treatment protocols combine three agents in an effort to gain the maximum benefit with the fewest adverse reactions. Such regimens include one PI and are considered the most effective treatment. Many variations and drug interactions are under study. Combination therapy helps inhibit the production of resistant, mutant strains. Supportive treatments help maintain nutritional status and relieve pain and other distressing physical and psychological symptoms.
Many pathogens respond to anti-infective drugs but tend to recur after treatment ends. For this reason, most patients need continuous anti-infective treatment, presumably for life or until the drug is no longer tolerated or effective.
UNDER STUDY: Once-daily dosing with antiretroviral drugs, such as didanosine, efavirenz, lamivudine, and tenofovir, to increase treatment adherence to drug-resistant variants of HIV is under investigation. A combination of amprenavir, a protease inhibitor, boosted with ritonavir has been approved, and other new antiretroviral drugs are currently in development for new dosing schedules.
Zidovudine
Treatment with zidovudine has proven effective in slowing the progression of HIV infection, decreasing opportunistic infections, and prolonging survival. However, it commonly produces serious adverse reactions and toxicities. The drug is typically combined with other agents (such as lamivudine) but has also been used as a single agent for pregnant HIV-positive women.
The current recommendation is to take 100 mg every 4 hours for a total daily dose of 600 mg, or 500 mg if the patient doesn’t want to interrupt sleep. Other NRTIs, such as didanosine and zalcitabine, may also be used in combination regimens for patients who can’t tolerate or no longer respond to zidovudine.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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