Mark Kelly

Efavirenz and chronic neuropsychiatric symptoms: a cross-sectional case control study

The aim of the study was to investigate symptoms of long‐term central nervous system (CNS) toxicity in HIV‐positive patients treated with efavirenz (EFV).

Antimalarial activity of sera from subjects taking HIV protease inhibitors

Synergy between HIV and malaria is being increasingly recognized. We examined the antimalarial activity of sera from subjects receiving chloroquine, no drugs or HAART. Sera from subjects taking ritonavir-boosted saquinavir or lopinavir significantly inhibited parasite growth (median of 55 and 69% inhibition, respectively). These results indicate that patients on protease inhibitors may be afforded some protection from malaria. The clinical relevance of these observations will require confirmation in controlled studies in malaria-endemic regions.

A preliminary study to determine the effect of an infusion of cryopreserved autologous lymphocytes on immunocompetence and viral load in HIV-infected patients

Therapeutic measures aimed at boosting the immunity of HIV-infected patients are a critical component of strategies for effective therapy of HIV and AIDS. To improve immunocompetence in patients with progressive disease, autologous lymphocytes that were collected and cryopreserved earlier in the course of HIV-infection were reinfused. None of the 12 patients receiving cell infusions experienced any adverse effects. Improvements in immunologic parameters (CD4+ counts, CD8+ counts, or both; HIV-specific cytotoxic T-lymphocyte (CTL) activity; or viral load) were seen in seven patients. Restoration of the CD4+ count to the level recorded at the time of cell harvest was achieved in two patients with less advanced disease. Plasma HIV RNA was reduced by >0.5 logs in two of the four patients tested. These preliminary results suggest that cellular immunotherapy using cryopreserved autologous lymphocytes has the potential to improve some measures of immunity in patients with HIV/AIDS and warrants further investigation.

Acute hepatitis B virus infection despite previous immunization in the context of recent HIV-1 infection.

Fig. 1. Schematic of case. Week 0 represents date of HIV diagnosis; hepatitis B virus (HBV) was diagnosed at week 12. Limits of detection of HIV RNA are: upper limit 5.0 log10 copies/ml and lower limit 1.7 log10 copies/ml. Limits of detection of HBV DNA are: upper limit 5.2 log10 copies/ml and lower limit 2.0 log10 copies/ml. Aspartate aminotransferase (AST) is measured in U/l and CD4 10/l. NT, tested. 3TC, lamivudine; ADV, adefovir; FAM, famcoclovir; LPV/r, ritonavir-boosted lopinavir; TDF, tenofovir. Landrum et al. [1] report high rates of hepatitis B virus (HBV) infection in patients immunized against HBV after HIV infection in a large military cohort. They found that, in fully vaccinated patients, a hepatitis B surface antibody (HBsAb) titre of 10 IU/l or greater was possibly associated with a reduced but ongoing risk of HBV infection compared with those with a HBsAb titre less than 10 IU/l. They did not report the median HBsAb titre in the group that developed HBV infection and it is therefore unclear whether there is a threshold of postvaccination HBsAb titre that reduces the risk of subsequent HBV infection. Also, the authors could not assess whether vaccine escape could be an explanation for postvaccination HBV infection, most commonly as a result of mutations with loss of the ‘a’ determinant of HBV surface antigen (HBsAg) [2–5]. We report a case of acute HBV infection in the context of recent HIV-1 infection despite previous immunization and high HBsAb titres.