Federica Faggian

Recreational substance use and tolerance of efavirenz in HIV-1 infected patients

Abstract During the past few years, efavirenz has been increasingly used in the treatment of HIV1 infection. Its main side effect is a syndrome of central nervous system stimulation occurring in 40–50% of adults in the first few weeks of therapy which might be observed at increased frequency in subjects concurrently using recreational substances. We therefore conducted a single center, retrospective study in 134 patients treated with efavirenz and found no significant differences in CNS side effects or discontinuation rates between recreational substance (cocaine, ecstasy, cannabis) users and non-users. Although our study is limited, the results support the idea that efavirenz can be safely prescribed to patients using recreational substances.

Painful Neuropathy Vasculitis in 2 Patients with Long-Standing Human Immunodeficiency Virus-1 Infection

We describe 2 most unusual cases of distal symmetrical painful polyneuropathy in patients with long-standing HIV-1 infection well controlled by HAART. Sural nerve biopsies revealed vasculitis in both cases and steroid therapy led to resolution of symptoms not influenced by analgesics and anti-inflammatory drugs. These unusual cases outline the importance of nerve biopsies in order to reach a diagnosis.

Hyperacute unilateral gonococcal endophthalmitis in an HIV-infected man without genital infection.

Purpose To demonstrate the necessity of obtaining an accurate history from patients presenting abnormal evolution of ophthalmologic diseases. Methods A 42-year-old patient, denying any previous ocular or systemic morbidity, presented with an unusual severe and hyperacute gonococcal endophthalmitis with corneal abscess but no concurrent genitourinary infection. Only after a further interview did the patient reveal his human immunodeficiency virus status and a previous diagnosis of acquired immunodeficiency syndrome. Results Adequate topical and intravenous antibiotic treatment and surgery led to salvage of the eye. Conclusions An accurate history should be obtained by patients with an abnormal course of an ophthalmologic disease, focusing on immunologic deficiencies that can cause extremely serious ophthalmologic complications with ensuing risk of visual impairment or ocular loss (bulbar enucleation).

Is there a role for TNF-alpha in HIV1-associated lipodystrophy?

Sir, Christeff and coauthors, in their recent study, have demonstrated an association between increased serum interferon alpha and lipodystrophy (LD) in HIV1-infected subjects [1]. In the same study these authors failed to show significant differences in tumour necrosis factor alpha (TNFα ) serum levels between HIV1-positive individuals with and without lipodystrophy, although the levels of this latter cytokine were significantly higher in HIV-infected subjects than in normal people. These latter data support the hypothesis (put forward by the same French group) that antiretroviral therapy, including protease inhibitors, dysregulates the homeostasis of TNFα synthesis through reduced apoptosis of TNFα producing CD8+ CD28– T cells, and thus contributes to the development of HIV-associated lipodystrophy syndrome [2]. We report our experience in a group of 20 HIV1-infected asymptomatic individuals (15 men, age range 27–60 years, mean age 40, three previously untreated, 10 with lipodystrophy diagnosed according to a previously published clinical score) [3] on a HAART regimen, including one protease inhibitor (PI) in whom CD4, CD8 and CD8+ CD28– T cells, plasma HIV1-RNA, serum TNFα and lipid (triglycerides, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol) concentrations were determined. These 20 individuals were selected from a cohort of 97 patients on the same HAART regimen on the basis of the similarities of the parameters considered later in this Letter between the two subgroups (with and without lipodystrophy). Twenty HIV1-negative healthy blood donors acted as controls. Table 1 summarizes the individuals’ data (values are given as means ± SD; significant statistical correlations [ P < 0·05] between the parameters examined within each group of subjects were determined by Student’s t -test). Duration of HAART was comparable in both subgroups (mean 61 ± 24·6 months in the LD-positive patients vs. 56 ± 18·8 months in the LD-negative patients). The mean numbers of CD4, CD8 and CD8+ CD28– T lymphocytes were also similar. HIV1 RNA levels (Chiron bDNA assay) were less than the lower limit of detection (50 copies mL − 1 ) in all but four individuals, with no significant differences between the two groups. The LD-positive subjects showed a marked increase in serum levels of triglycerides (mean 4·9 ± 3·53 vs. 1·2 ± 0·45; P < 0·0039), while levels of HDL and LDL cholesterol were comparable. Serum TNFα levels (Quantikine; R & D Systems, Minneapolis, MN) were reduced in the HIV1-infected subjects in respect of healthy, uninfected controls; the reduction was statistically significant in the LD-negative patients compared with the healthy controls ( P < 0·05), whereas no significant differences were observed between the two groups of infected individuals. Our results are therefore in sharp contrast with those of Christeff and coworkers [1]. First, we were unable to confirm a significant increase in CD8 T cells in LD-positive individuals [1–3]; second, we failed to find an increase in the number of CD8+ CD28– T cells (responsible for 80– 90% of TNFα production) [2] in LD-positive subjects; finally, we did not observe a positive correlation between the absolute numbers of these latter CD8 T-cell subpopulations and an increased serum triglycerides concentration (correlation coefficient 0·05068 in the LD-positive and 0·3822 in the LD-negative patients, P = 0·51). Although found in a limited population of HIV1-infected subjects, our results raise doubts on the proposed role of TNFα in the pathophysiologic mechanisms leading to lipodystrophy.

Histoplasmosis in two human immunodeficiency virus-positive immigrants to Italy : Clinical features and management in the highly active antiretroviral therapy era

We report two cases of histoplasmosis occurring in human immunodeficiency virus-positive patients who immigrated to Italy, and focus our attention on the clinical features and therapeutic aspects, with particular emphasis on secondary prophylaxis. The patients had comparable human immunodeficiency virus baseline parameters, but had a completely different compliance over therapeutic regimens. The two patients were followed in two different city hospitals of our region, Padua and Verona, and the diagnosis was made on the basis of instrumental, histologic, and microbiologic findings. One of them was treated with corticosteroids because of nephrotic syndrome.

Early detection of lung cancer in high-risk patients with HIV-1 infection.

50.0000, Tukey test indicating Mae Hong Son and Other had signi® cantly fewer customers per day (Table 2). Correlation analysis indicated a signi® cant positive correlation of r= 0.5500 between mean number of condoms used per day and the mean number of customers per day. Both condoms per day and customers per day were signi® cantly negatively correlated with the age of the FSW, 70.5780 and 70.4200 respectively, P-value 50.000. Overall mean proportion of condom use was 51% and the ethnic breakdown included: foreign Asian averaged 52%, Western averaged 46%, and local Thai men averaged 27% (F= 0.390,008, Pvalue 50.0000, Turkey test, Thai men signi® cantly lower condom use.