Chiara Scalamogna

Role of PCR in Diagnosis and Prognosis of Visceral Leishmaniasis in Patients Coinfected with Human Immunodeficiency Virus Type 1

ABSTRACT A group of 76 consecutive human immunodeficiency virus (HIV)-positive patients with fever of unknown origin (n = 52) or fever associated with pulmonary diseases was evaluated in order to assess the usefulness of PCR with peripheral blood in the diagnosis and follow-up of visceral leishmaniasis. We identified 10 cases of visceral leishmaniasis among the 52 patients with fever of unknown origin. At the time of diagnosis, all were parasitemic by PCR with peripheral blood. During follow-up, a progressive decline in parasitemia was observed under therapy, and all patients became PCR negative after a median of 5 weeks (range, 6 to 21 weeks). However, in eight of nine patients monitored for a median period of 88 weeks (range, 33 to 110 weeks), visceral leishmaniasis relapsed, with positive results by PCR with peripheral blood reappearing 1 to 2 weeks before the clinical onset of disease. Eight Leishmania infantum and two Leishmania donovani infections were identified by PCR-restriction fragment length polymorphism analysis. PCR with peripheral blood is a reliable method for diagnosis of visceral leishmaniasis in HIV-infected patients. During follow-up, it substantially reduces the need for traditional invasive tests to assess parasitological response, while a positive PCR result is predictive of clinical relapse.

Prevalence and risk determinants of HIV-1 and HIV-2 infections in pregnant women in Bissau

OBJECTIVES To analyse the risk determinants of HIV-1 and HIV-2 infections in pregnant women in Bissau. METHODS Pregnant women attending the antenatal clinics of Bissau between January 2002 and June 2006 were consecutively tested unless they opted out. RESULTS Among 23,869 tested women the overall prevalence of HIV-1 was 5.7%, that of HIV-2 was 2.4%, and these included the 0.7% prevalence of HIV-1 and HIV-2 duals. The main factors associated with the risk of HIV-1 infection were older age, occupation and number of sexual partners. Beafada and Mandinga ethnic groups were at greater risk of presenting HIV-1, and Bijago and Papel at lower risk. The factors associated with the risk of HIV-2 were age, literacy and occupation; the Beafada were at greater risk than the other ethnic groups. CONCLUSIONS The prevalence of HIV-2 infection decreased overtime, whereas that of HIV-1 infection remained substantially stable, but was higher than that observed in previous studies. The rapid decline in the rates of HIV-2 infection suggests that many of the factors that allowed its exponential growth in the past have now been partially removed, and that sexual and vertical transmission have not been sufficient to maintain and extend the epidemic.

KSHV reactivation in post-transplant Kaposi sarcoma

986 VOLUME 9 | NUMBER 8 | AUGUST 2003 NATURE MEDICINE To the editor: In their article on post-transplant Kaposi sarcoma, Barozzi et al.1 elegantly show that in five of the eight Kaposi sarcoma patients investigated, tumor cells infected with Kaposi sarcoma–associated herpesvirus (KSHV) display phenotypic and genotypic features of donor origin. Based on these findings, the authors advocate the use of donor-derived, KSHV-specific T cells for the treatment of post-transplant Kaposi sarcoma. The medical relevance and clinical implications of these findings need to be evaluated in the appropriate context, however. In particular, the seroepidemiological framework underlying the occurrence of post-transplant Kaposi sarcoma in different geographic areas must be considered. We have previously shown that in northern Italy, where the seroprevalence of KSHV among organ donors and recipients is 4% and 6% respectively (C.P. et al., unpublished data), posttransplant Kaposi sarcoma has an incidence of 0.9%, and 90% of those cases occur in patients who were seropositive at the time of transplantation2. Our data are in agreement with other retrospective studies3,4. We can thus infer that KSHV reactivation is the most important pathogenetic event (>80% incidence) underlying postrenal transplant Kaposi sarcoma in the western world. In this regard, it is noteworthy that in the only Kaposi sarcoma patient studied by Barozzi et al. with unequivocal serologic evidence of reactivation, the findings argue against a donor origin of Kaposi sarcoma tumor cells. We therefore advise that baseline serologic testing for KSHV be performed in all transplant donors and recipients to distinguish between viral transmission and reactivation in case of Kaposi sarcoma development. This should allow rational use of investigational immunotherapeutic strategies based on donor-derived, as opposed to recipient-derived, KSHVspecific T cells.

Evidence for Kaposi's sarcoma-associated herpes virus infection in patients with idiopathic pulmonary arterial hypertension: a case series and review of the literature

ABSTRACT Background: The pathogenesis of idiopathic pulmonary arterial hypertension (IPAH) is unknown. Recent molecular and immunohistochemical evidence has demonstrated the presence of Kaposis sarcoma-associated herpes virus (KSHV) at high frequency in lung tissue from patients with IPAH, suggesting a possible role for this virus in the pathogenesis of the disease. Materials and methods: Eighty-seven patients with IPAH (n = 45) or other forms of pulmonary hypertension (n = 42) were prospectively assessed for serologic evidence of KSHV, Epstein–Barr virus (EBV) and human cytomegalovirus (HCMV) infection. Immunofluorescence assays specific for antibodies against latency-associated and lytic antigens of KSHV, as well as commercially available kits that detect antibodies against HCMV and EBV nuclear antigens, were employed. Results: Only one patient with IPAH (2.2%) and one of the patients with other forms of pulmonary hypertension tested seropositive for KSHV. In contrast, 100% and more than 90% of patients with both forms of pulmonary hypertension were positive for EBV and HCMV antibodies, respectively. Conclusions: Italian patients with IPAH do not exhibit serologic evidence of KSHV infection despite a normal ability to mount antibody-mediated responses toward human herpes viruses. KSHV is unlikely to play a role in the pathogenesis of IPAH.