C. Dupont

Long-term efficacy on Kaposi's sarcoma of highly active antiretroviral therapy in a cohort of Hiv-positive patients

ObjectiveTo assess the efficacy of highly active antiretroviral treatment (HAART) on AIDS–Kaposis sarcoma (KS). DesignProspective cohort of patients followed for 24 months. SettingFour referral hospitals of the West Paris metropolitan area. Patients/interventionThirty-nine AIDS–KS patients, 42 ± 9 years old, who began HAART (HIV-protease inhibitor and two nucleoside analogues) between March and December 1996, were enrolled. One was lost to follow-up at month 12. Main outcome measuresKS response, using criteria of the AIDS clinical trials group (ACTG), CD4 cell counts, and plasma HIV-RNA, assessed every 6 months. ACTG TIS staging of KS. ResultsEighteen patients had T1 KS and 21 T0 KS. One patient died from KS at month 6. KS improved progressively, with complete and partial response rates of 46% and 28% at month 24, respectively. Only six patients were still receiving systemic KS therapy at month 24. Complete response was observed in 10 of the 19 patients without systemic KS therapy at inclusion. Patients with complete response at month 24 had higher CD4 cell counts than others (465 ± 343 versus 185 ± 167 × 106/l;P  < 0.01), but the proportion of patients with HIV-1 RNA < 500 copies/ml was not significantly different. An increase in CD4 cell counts from inclusion to month 12 of > 150 × 106/l [odds ratio (OR), 13.4; 95% confidence interval (CI), 2–82] and T0 KS at inclusion: [OR, 7; 95% CI, 1.1–42] were predictive of complete response at month 24. ConclusionsHAART appears to have prolonged efficacy on AIDS–KS, even without specific KS therapy, and this effect appears to be linked to the restoration of immune function.

Maraviroc Intensification in HIV-1 Infected Patients with Persistant Low-levelViremia

HIV-1 persistent low-level-viremia under 500 copies RNA/ml (PLV) is associated with an increased risk of virological progression and resistance. We performed a study on 18 HIV-1 treated patients who received ARV treatment intensification with maraviroc (MVC) because of PLV during the 6 last months or more. During the 12 months following intensification, CD4 T-cells increased by an average of 104/mm3. Percentage of patients with a plasmatic viral load under 50 copies/ml increased regularly since intensification to reach 71% after 12 months of follow-up. MVC intensification could improve virological and immunological responses in case of PLV.

Unusual presentation of a tuberculous peritonitis in a patient with concomitant AIDS and liver cirrhosis

We report a case of tuberculous peritonitis in a patient with concomitant HIV infection and liver cirrhosis. A 50-year-old man with viral B and delta liver cirrhosis and AIDS was diagnosed with spontaneous Escherichia coli peritonitis and successfully treated with beta-lactamins. Three months later, ascites reappeared and Mycobacterium tuberculosis was identified in peritoneal fluid cultures. The triple antituberculosis regimen was adjusted to his level of liver failure but the patient died of hepatic encephalopathy. Concomitant HIV infection and liver cirrhosis favour tuberculous peritonitis but they also make its diagnosis extremely difficult. Considering the poor prognosis of this infection when untreated, tuberculous peritonitis should be systematically suspected in such patients.