Martin Egger

Retinal microangiopathy in human immunodeficiency virus infection is related to higher human immunodeficiency virus-1 load in plasma

PURPOSEnTo evaluate the prevalence of retinal microangiopathy in human immunodeficiency virus (HIV)-1-infected patients and its association with virologic, immunologic, and sociodemographic parameters.nnnDESIGNnSingle-center cross-sectional study.nnnPARTICIPANTSnOne hundred eighty-eight HIV-1-positive individuals from a single outpatient clinic.nnnMETHODSnHuman immunodeficiency virus-positive patients were screened for signs of HIV-associated retinal angiopathy. Plasma HIV-1 RNA and CD4-positive cell counts were monitored within 3 months of the ophthalmologic assessment. The absence or presence of angiopathy or of opportunistic viral retinitis was then correlated to data respecting CD4-positive cell count, plasma viral load of HIV-1, and sociodemographic parameters.nnnMAIN OUTCOME MEASURESnAssociation between CD4-positive cell count, HIV-1 plasma viral load, sociodemographic parameters, and the manifestation of retinal microangiopathy.nnnRESULTSnAt the baseline consultation, 130 (69%) patients exhibited no retinal pathologic features, 45 (24%) manifested retinal angiopathy, and 13 (7%) had opportunistic viral retinitis. In univariate analysis, retinal angiopathy was associated with lower CD4-positive cell count and higher HIV-1 plasma viral load. In a multivariate logistic model, the presence of retinal microangiopathy was associated with higher age (P = 0.02) and higher viral load of HIV-1 (P < 0.005), but not with lower CD4 cell counts (P > 0.05).nnnCONCLUSIONSnHuman immunodeficiency virus-associated retinal microangiopathy is likely a multifactorial condition. Its presence is associated with higher age and higher replication of HIV-1 as measured by plasma HIV-1 RNA levels. In contrast to opportunistic infectious retinitis, the degree of immunodeficiency does not seem to be independently correlated with retinal angiopathy.

Low Incidence of Community-Acquired Pneumonia among Human Immunodeficiency Virus-Infected Patients after Interruption of Pneumocystis carinii Pneumonia Prophylaxis

We compared the incidence of bacterial pneumonia among 336 patients who discontinued trimethoprim-sulfamethoxazole (TMP-SMX) as prophylaxis against Pneumocystis carinii pneumonia (PCP) with that among 75 patients who fulfilled the criteria for discontinuation but continued receiving prophylaxis. The difference in the overall incidence rates for the 2 groups (1.2 events per 100 person-years) was not statistically significant. Discontinuation of TMP-SMX prophylaxis against PCP is not associated with a significant increase in the incidence of bacterial pneumonia among patients with a sustained CD4 cell count increase to >200 cells/microL.

Infections aiguës des voies urinaires, partie 2: les IVU à l’hôpital et en établissement médico-social

A l’hopital, des cas complexes d’IVU sont parfois traites car les germes sont plus souvent antibioresistants. La patiente tire profit d’une bonne collaboration du medecin de famille avec l’infectiologue, l’urologue et le gynecologue.

Infections aiguës des voies urinaires, partie1: les IVU dans la pratique

Les cystites aigues sont nettement plus frequentes chez les femmes que chez les hommes. En cas de diagnostic clinique evident, un test par bandelette urinaire positif n’apporte pas d’informations supplementaires; a l’inverse, jusqu’a 30% des femmes souffrant d’une infection des voies urinaires ont un test par bandelette negatif.