Elizabeth R. Jenny-Avital

Occult Gastrointestinal Kaposi's Sarcoma in an HIV-Infected African Man

A case report is presented of a 33-year-old HIV-positive African-American male who was diagnosed with occult gastrointestinal Kaposis sarcoma (KS). Symptoms, diagnosis, and treatment efforts are detailed. It was hoped that treatment with a triple antiretroviral regimen would resolve his gastrointestinal symptoms, however, the patient experienced adverse effects which were attributed to the antiretroviral treatment. These adverse effects continued even after the treatment ceased; a decision was made to begin minimally active chemotherapy. The patient began improving dramatically after the first treatment. The case history presented suggests that widespread and severe KS does not necessarily indicate a hopeless prognosis, particularly in patients who can experience immune reconstitution as a result of antiretroviral therapy. Newer agents for treating visceral KS, the occurrences of KS in specific populations, and the emergence of KS-associated herpesvirus or human herpesvirus-8 were also discussed.

Report from the 2006 IDSA Meeting

The 2006 meeting of the Infectious Diseases Society of America (IDSA) featured a number of presentations relevant to HIV care, with the most notable focused on community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) and tuberculosis (TB) treatment. Community-Acquired MRSA Characterized as “the convergence of virulence and resistance,” CA-MRSA received much attention at IDSA this year. Resistance to methicillin and other β-lactam drugs in CA-MRSA is mediated by a small mobile genetic element (SCC mec IV) that differs from the element responsible in hospital-acquired MRSA (HA-MRSA). Virulence of MRSA strains is correlated with production of the Panton-Valentine leukocidin (PVL) toxin. Previous studies have shown that CA-MRSA is substantially more likely to result in symptomatic disease among patients who were previously colonized with HA-MRSA than among those who were not. In addition, CA-MRSA strains are more likely to infect patients who were previously colonized with community-acquired methicillin-sensitive S. aureus (MSSA) strains. High …

Sperm Washing for Serodiscordant Couples Who Want a Child

Elizabeth Jenny-Avital, MDA serodiscordant couple from Togo comes to the HIV clinic seeking fertility advice. The man has HIV-1 infection of unknown

A Troublesome Twosome: AIDS and Persistent Bacteremia

Anthony J. Vaccaro, MDThe patient is a 47-year-old white man with a CD4 count of 27 cells/mm3 and a viral load by PCR of 380,000 copies/mL. He has the

GW33908 + RITONAVIR = LESS PI AND RTI RESISTANCE

In the SOLO trial, PI and RTI resistance developed significantly less often with the boosted PI fosamprenavir than with nelfinavir.Efficacy data for

A Positive Epstein-Barr Virus PCR in the CSF in an HIV-Infected Patient: When the Pathogen Does Not Match the Syndrome

Elizabeth R. Jenny-Avital, MDEduard is a 56-year-old man who tested HIV-positive in 1991, after his wife tested positive during pregnancy. His CD4

Can You Be Positive that She's Positive?

A 28-year-old woman is diagnosed as HIV-positive during the first trimester of her first pregnancy. She is originally from Uganda, and moved to the U.S. without a work visa three years earlier. She lives with her husband, and they both have been working various undocumented jobs since arrival. Her physical exam is normal; her CD4 count is 860 cells/mm 3 and her viral load is undetectable (<400 copies/mL) using RT-PCR. A repeat HIV antibody test is again positive (multiple reactive bands on Western blot), and a viral load using bDNA is <75 copies/mL. Her husbands HIV test returns negative. Does this woman have HIV infection? Is there any other way to confirm or refute it? If she is HIV-positive, what are the risks of HIV transmission to her newborn and to her husband? Would you use antiretroviral therapy during this pregnancy? If so, what regimen would you choose and when would you start it? This patient has HIV infection based on repeatedly positive ELISA and Western blot with multiple bands. False-positive HIV-1 testing by ELISA and Western blot are extremely rare but do occur. Because she is from Africa, the possibility of an infection with an uncommon strain of HIV-1 - such as a group O, or a non-clade B group M virus - or with a recombinant virus may explain her undetectable level of HIV-1 by RT-PCR and bDNA. Recombination has been demonstrated between viruses of a different clade, complicating the ability of various tests to detect different strains of HIV-1. Eschelman …

New Considerations for PCP in the Era of Potent Combination Therapy: Sulfa Resistance and Immune Reconstitution

Consuelo S., a 51-year-old Spanish-speaking nonsmoking woman came to our hospitals ER on January 2, 2003, with shortness of breath and cough. She

Failure to Achieve Full Virologic Suppression

Mr. D., a 46-year-old man, was diagnosed HIV positive in the fall 2000. The likely mode of transmission was sex with men. The date of original exposure

Timing Is Everything

Tulula P. made her first visit to our AIDS clinic in January 2000. She tested HIV positive in late 1999 only after she had experienced several episodes