Erika Gianelli

Body habitus changes and metabolic alterations in protease inhibitor-naive HIV-1-infected patients treated with two nucleoside reverse transcriptase inhibitors.

&NA; Background: Cross‐sectional and retrospective surveys suggest that nucleoside reverse transcriptase inhibitors (NRTIs) contribute to the metabolic and morphologic alterations observed in patients on antiretroviral therapy (ART). Objectives: To assess the risk of developing body habitus changes (BHCs) and metabolic abnormalities in protease inhibitor (PI)‐naive HIV‐1‐infected patients treated with two NRTIs, and the risk associated with each of these drugs. Design: Prospective cohort study. Patients and Methods: The BHCs occurring in 335 patients treated with two NRTIs were evaluated every 3 months. The laboratory tests included determination of CD4 cell counts and the measurement of HIV RNA, serum glucose, cholesterol, and triglyceride levels. Cox proportional hazard models were used to describe the factors associated with the development of BHCs. Results: During a median exposure of 747.5 days, 46 patients (13.7%) developed BHCs: nine fat accumulation alone, 12 fat loss alone, and 25 combined fat loss and accumulation in different body regions. Fat loss alone occurred after a significantly longer median duration of treatment than the other two forms (p = .004). The risk of developing any BHC was significantly higher in female patients (p < .0001). Fat loss was the prevalent alteration in males. Hypertriglyceridemia was observed in 76 patients (22.7%), hypercholesterolemia in 35 (10.5%), and hyperglycemia in 48 (14.3%). The adjusted risk of developing hypertriglyceridemia was higher in the stavudinetreated patients (p = .04) and in those who had previously received ART (p = .02). The only independent factor associated with the development of hypercholesterolemia was to be ART experienced at baseline (p = .02), whereas age was associated with the development of hyperglycemia (p = .0096). Conclusions: Treatment with NRTIs may be responsible for the same morphologic alterations as those observed in patients treated with PIs. Moreover, altered triglyceride levels are also frequently observed. The different timing of presentation and gender distribution of BHCs suggest that multiple pathogenetic mechanisms are involved.

Prospective observational study of fever in hospitalized returning travelers and migrants from tropical areas, 1997-2001.

BACKGROUND An estimated 50 million people each year from industrialized countries visit tropical areas: 3% to 11% of these travelers report a febrile illness on their return. We conducted a 5-year prospective observational study on the causes of fever in patients admitted to a university teaching hospital after returning from the tropics. METHODS We enrolled in this study all consecutive patients admitted to the Division of Infectious Diseases of the University of Milan, Italy, between January 1997 and December 2001 presenting with fever (oral temperature > or =37.5 degrees C) and a history of travel to a tropical country in the previous 6 months. RESULTS Seven percent (147/2,074) of all hospital admissions in the study period were due to fever in travelers and migrants returning from the tropics. Malaria accounted for 47.6 % of all admissions (70/147), followed by presumed self-limiting viral infections (12%). Pretravel screening and vaccination strategies could have prevented a considerable number of hospitalizations (e.g., hepatitis A and typhoid fever). The most useful investigations were blood examination and PCR for malaria, which gave positive results in 65% of cases in which they were performed. CONCLUSIONS During a 5-year period, the number of patients returning from tropical areas who were admitted with fever to a university hospital in northern Italy remained stable; malaria was the most frequent diagnosis, and should be considered in any febrile patient returning from the tropics. With the exception of hepatitis A and dengue fever infections, in a real-world setting serology is of modest utility and is probably overused.

HIV-infected long-term nonprogressors display a unique correlative pattern between the interleukin-7/interleukin-7 receptor circuit and T-cell homeostasis.

We hypothesized that there may be a correlation between the interleukin‐7 (IL‐7)/IL‐7 receptor (IL‐7R) regulatory system and parameters of T‐cell homeostasis in HIV‐infected long‐term nonprogressors (LTNPs) as compared with patients with disease progression.

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.

Itraconazole Can be Effective in the Treatment of Sporotrichoid Leishmaniasis

J Travel Med 2004; 11:328–330. Leishmaniasis represents a diverse group of diseases caused by protozoan parasites that are transmitted to humans by the bite of phlebotomine sandflies. Three major clinical forms can be recognized,visceral,cutaneous and mucocutaneous, which are widespread in tropical, subtropical and temperate areas.1 Data on the incidence of cutaneous leishmaniasis in travelers are scarce. In fact, constant parameters (time of exposure,kind of travel,burden of outdoor activities, rural or urban setting) are necessary to determine this incidence. Studies performed in defined groups such as military personnel in the Middle East showed an incidence of about 8/1,000 persons.2 Cutaneous leishmaniasis is sometimes associated with sporotrichoid spread. Sporotrichoid leishmaniasis is characterized by the development of subcutaneous, nontender, slightly erythematous nodules, often associated with lymphangitis, that progress, starting from the mother lesion, along dermal and subcutaneous lymphatics. In sporotrichoid cutaneous leishmaniasis, amastigotes may be found in both primary lesions and subcutaneous nodules.3,4 Sporotrichoid spread is more frequently associated with New World cutaneous leishmaniasis,particularly Leishmania braziliensis, although it can be observed also in association with Old World cutaneous leishmaniasis (L. major).5,6 The factors that trigger lymphatic dissemination are unclear.Some data suggest that both antileishmanial treatment and the host immune status could influence the dissemination.7,8 The diagnosis of cutaneous leishmaniasis is often made clinically on the basis of a typical lesion together with a history of exposure.Confirmation can be obtained by the direct detection of amastigotes during histologic examination of the biopsy of the lesion. The identification of Leishmania spp. is done traditionally through isoenzyme analysis and requires parasite culture. PCR is a suitable and quick tool for the diagnosis and identification of the different species.9 In the differential diagnosis of sporotrichoid infections, we have to consider, apart from Leishmania spp., infections caused by Sporotrix schenkii,Mycobacterium spp., Nocardia spp. and Francisella tularensis.