Disposition of zidovudine in obese pregnant women with human immunodeficiency virus type 1 infection

Resuscitation of the morbidly obese patient

Obesity is a major health care problem in the United States. The body mass index (BMI) is the standard measure of obesity. A BMI >25 kg/m2 is defined as overweight and obesity as a BMI > 30 kg/m2. Recent surveys indicate that 54% of adults, or roughly 97 million people, are overweight. Given the incidence of obesity in the general population, it is likely that EM physicians will be involved in the emergency care of critically ill or injured obese patients. The objective of this article is to present the clinical problems associated with the resuscitation of the critically ill or injured obese patient and their potential solutions.

Prevalence and predictive value of overweight in an urban HIV care clinic

OBJECTIVE

To determine the prevalence and predictive value of overweight in an urban HIV clinic.

METHODS

Medical records of all new adult, nonpregnant registrants in 1996 in an urban HIV clinic with at least one height and weight measurement were reviewed. Body mass index (BMI) at clinic enrollment was calculated, and prevalence of overweight was thus determined. The subsequent clinical course of the overweight group was compared with that of a randomly selected group of gender-stratified non-overweight patients.

RESULTS

At baseline, 12.6% of men and 32.5% of women were overweight. Female gender and lack of AIDS diagnosis were independently associated with overweight. More than one half of women and 19.6% of men were overweight at some point during the study. Providers were more likely to properly acknowledge underweight than overweight. Among patients without AIDS, there was a trend toward slower disease progression and lower viral load in overweight patients, despite similar baseline CD4+ lymphocyte counts and similar time to initiation of highly active antiretroviral therapy. In multivariate proportional hazards analyses, lower baseline BMI and falling BMI during follow-up were independently predictive of progression to AIDS.

CONCLUSIONS

Overweight was a common and underrecognized finding, particularly among women. Overweight patients may progress more slowly to AIDS than non-overweight patients.

Zidovudine

Zidovudine was the first agent approved for treatment of HIV disease, and since its widespread availability in 1987, the pharmacokinetic disposition and clinical effects of ZDV have been extensively evaluated. In addition to its utility as a component of a multidrug combination regimen for the treatment of adult and pediatric HIV-1 infection, it is the only agent approved by the FDA for the prevention of mother-to-child HIV-1 transmission. The effectiveness of ZDV for the prevention of mother-to-child HIV-1 transmission has been demonstrated in several studies. The optimal time during gestation to initiate ZDV therapy and the relative importance of the intrapartum and newborn components is the focus of both current interventional and observational studies. Until more information is available from these trials, the combined maternal/newborn ZDV regimen studied in ACTG 076 remains the recommended treatment regimen of choice in the United States.