Paolo Costigliola

Man-to-woman sexual transmission of HIV: longitudinal study of 343 steady partners of infected men.

To study incidence and risk factors of heterosexually transmitted HIV infection, we followed a cohort of 343 seronegative women, stable, monogamous partners of infected men whose only risk of acquiring HIV was sexual exposure to the infected partner. Nineteen seroconversions occurred in 529.6 person years (py) of observation, yielding an incidence rate of 3.6 per 100 py. The incidence rate was 7.2 per 100 py among women who did not always use or never used condoms and 1.1 among those who always used them [relative risk (RR) 6.6, 95% confidence interval (CI) 1.9-21.9]. Anal sex was associated with a risk increase in only those women not always using condoms (RR 1.4, 95% CI 0.4-4.8). No seroconversions were observed among 22 women using oral contraceptives. One of the women using intrauterine devices seroconverted. In couples who did not always use condoms, seroconversions occurred more frequently in partners of men with symptomatic diseases, with a low CD4+ cell number (< 400 per mm3) or with a detectable p24 antigen. In couples not always using condoms and where the man had a low CD4+ cell count, the joint presence of blood viral antigens and AIDS symptoms conditioned a fivefold increased risk of seroconversion of the woman (RR 5.4, CI 1.4-20.3). At multivariate analysis, women with longer relationships (> or = 1 year) showed a lower risk of seroconversion (RR 0.3, CI 0.1-0.8), and those partners of men positive for p24 antigen in serum had an increased risk of seroconversion (RR = 4.0, CI 0.1-0.8).

Cutaneous cryptococcosis and AIDS

The incidence of cryptococcosis in patients with the acquired immunodefficiency syndrome (AIDS) ranges from 1.9% to 9.0%. 1 The infection usually has central nervous system and /or pulmonary involvement but may progress to widespread visceral invasion by cryptococci. Cutaneous localization of the infection is rare and usually appears in the late stages of a disseminated cryptococcal disease

Systemic fungemia and hepatic localizations of Fusarium solani in a liver transplanted patient: An emerging fungal agent

The incidence of invasive fungal infection is increasing especially in the field of transplantation, affecting as many as 50% of bone marrow transplant (BMT) patients with neutropenia and 5‐20% of solid‐organ transplant (SOT) recipients. Fusarium species are soil saprophytes and plant pathogens. They may cause superficial mycoses or important opportunistic infections in patients with bone marrow suppression and neutropenia, they have been rarely described in solid organ recipients, and up to now there have been no reports of such infection in isolated liver transplanted patients. We describe a case of disseminated Fusarium solani infection with hepatic localization in a liver transplanted patient that resolved with the administration of amphotericin B. Our observation confirms that Fusarium spp. are emerging pathogens that may most frequently affect not only BMT patients and patients with hematological malignancies, but also SOT patients. They may cause both localized and disseminated infection. In conclusion, Fusarium spp. etiology should be considered in the context of infectious diseases following liver transplantation. Liver Transpl 12:1711–1714, 2006.

Anti-hepatitis C virus antibodies amongst Italian homo-bisexual males

The authors report on an anti-hepatitis C virus antibody (HCV Ab) prevalence (6.9%) in 622 homo-bisexual males from Northern Italy, voluntarily attending an HIV and STDs screening program in the period 1984–89. The anti-HCV antibody prevalence shows a significant correlation with: i) presence of serological markers for HBV (O.R. = 3.12; 95% C.I. =1.53–6.52) and HIV (O.R. = 12.09; C.I. = 6.52–22.52) infection; ii) a stable relationship with an anti-HCV antibody positive partner (O.R. = 7.79; 95% C.I. = 2.50–23.90); iii) more than twenty different male partners per year (O.R. = 2.55; 95% C.I. =1.17–5.66). These data demonstrate the existence of a sexual transmission of HCV among homosexuals. This route might contribute in maintaining endemic levels of HCV infection in the homo-bisexual population and it might represent an important way of spreading the virus in the general population too.

Detection of circulating p24 antigen-positive CD4+ cells during HIV infection by flow cytometry.

ObjectivesTo determine the amount of circulating CD4+ cells positive for intracellular p24 antigen during HIV infection, and to correlate the results with clinical, virological and therapeutic parameters. MethodsData were obtained from 24 anti-HIV-negative subjects (controls) and 47 anti-HIV-positive patients classified according to clinical diagnosis, serum p24-antigen assay results, and antiretroviral treatment with zidovudine, using a modified flow cytometric assay for the detection of intracellular HIV p24 antigen (p24-FCA) in circulating CD4+ lymphocytes. ResultsThe proportion of CD4+ lymphocytes positive for p24-FCA correlated well with HIV infection (1.685 ± 1.902 versus 0.160 ± 0.152 in controls; P<0.001) and clinical progression [Centers for Disease Control (CDC) stage II: 1.310 ± 1.187; CDC stage III 1.145 ± 1.442; CDC stage IVA/C2: 2.335 ± 2.112; CDC stage IVC1: 2.066 ± 2.420]. The percentage of CD4+ cells positive for HIV p24-FCA was inversely correlated with an absolute peripheral blood CD4+ lymphocyte count (Spearmans rank correlation = –0.324; P<0.05). However, there was no statistically significant difference between patients in presence (n = 27; 1.938 ± 2.095) or absence (n = 20; 1.343 ± 1.594) of serum p24 Ag. The variable linked most strongly to the detection of intracellular p24 in anti-HIV-positive patients was zidovudine treatment: the proportion of p24-FCA-positive CD4+ lymphocytes was significantly lower (0.825 ± 0.910) in the treated patients (n = 25) than in the untreated patients (n = 22; 2.662 ± 2.248; P<0.001). ConclusionsOur results suggest that CD4+ p24 Ag-FCA is a rapid and easy test for the identification of the proportion of CD4+ lymphocytes with intracellular p24 Ag, and that it could be more appropriate than serum p24 Ag assay in evaluating disease progression and efficacy of antiretroviral treatment.

AZT Plus Methotrexate in HIV-Related Non-Hodgkin's Lymphomas

AZT is a thymidine analogue useful in the treatment of AIDS. It has been demonstrated that this compound can possess a significant antineoplastic activity when combined with de novo thymidylate synthesis inhibitors, such as 5-fluorouracil (5FU) and methotrexate (MTX). Here we report a review of our data concerning the efficacy and tolerance of the combination AZT + MTX in HIV-related non Hodgkins lymphomas (NHL). Twenty-nine patients were treated, at weekly intervals, with three (patient 1 to 10) or six (patient 11 to 29) consecutive courses of MTX 1g/m2 and increasing doses of oral AZT (2, 4 and 6g/m2) with leucovorin rescue. Of 26 evaluable patients, a total (complete + partial) response rate of 77% was obtained. The median complete response duration was 16.8 months. There was one therapy-related death due to septic shock. Grade III-IV neutropenia was observed after 19% of the courses, but was prevented by G-CSF administration in 82/119 courses. Grade III-IV anemia was observed after 9% of the courses. In conclusion, the combination AZT + MTX was effective and well tolerated in our series of HIV-related NHL patients.

Abdominal lymphadenopathy detected by ultrasonography in HIV-1 infection: prevalence and significance.

By using abdominal ultrasonography (UlS), deep nodes were detected in 41 of 85 (48%) HIV-1 positive subjects, most of them heroin addicts, but in none of 85 healthy HIV-negative controls. Computerized tomography, performed in 10 cases of lymphadenopathy, invariably confirmed the UlS findings. Prevalence [asymptomatic carriers: 8/15 (53%); PGL patients: 8/18 (44%); ARC: 13/27 (48%); AIDS: 12/25 (48%)], number, size, and site of deep nodes were comparable among the different CDC groups. No correlation was found between abdominal and superficial lymphadenopathy. Median serum concentrations of gammaglobulins (g/dl) and IgG (mg/dl) were higher in patients with than without deep nodes (2.25 vs 1.87 and 2540 vs 1900, respectively) (p < 0.01) as well as in cases with than without superficial nodes (2.15 vs 1.80 and 2340 vs 1941, respectively) (p < 0.05). Abdominal lymphadenopathy occurred during all stages of HIV infection even in asymptomatic carriers: this should be considered in the differential diagnosis of UlS-detected deep nodes. Enlargement of either deep or superficial nodes seems to reflect a state of polyclonal B cell activation.

Vertical transmission of human immunodeficiency virus type 1 : prognostic value of IgA antibody to HIV-1 polypeptides during pregnancy

In a retrospective study of 31 pregnant women infected with human immunodeficiency virus type 1 (HIV-1), nine (29%) infants presented unequivocal signs of HIV-1 infection (persistent p24 antigenemia and/or positive virus isolation). All serum samples obtained from the others, during pregnancy and on delivery, were studied for specific antibody (IgA) production by immunoblotting analysis to establish a possible link between the presence of a defined antibody class and mother-to-child viral transmission. The majority (16 of 22) of HIV-1-seropositive mothers who delivered uninfected children showed IgA antibody to low-molecular-weight HIV-1 polypeptides during pregnancy. Among those who delivered infected babies, only one showed a weak IgA reactivity to HIV-1 during pregnancy. Thus, our results suggest that immunoblotting study of IgA may be a diagnostic adjunct to predict the risk of mother-to-child HIV-1 transmission.

Need for Kidney Transplantation in HIV-positive Individuals: Results of a Survey in Italy

It is well known that HIV+individuals can be affected by end-stage renal diseases (ESRD). Despite the availability of new effective antiretroviral therapies, HIV-infected people are generally excluded from kidney transplantation, the treatment of choice for ESRD. A small number of transplantations have been performed, with encouraging data in terms of graft and patient survival. To evaluate the need of kidney transplant for HIV+individuals, we designed a multicentre study which enabled the simulation of a virtual transplant waiting list for those on dialytic treatment. In 38 participating infectious disease units, 16 HIV+patients were selected for renal replacement treatment/dialytic treatment, and they were enrolled. Clinical data were collected in order to apply general exclusion criteria and evaluate HIV clinical status. Clinical data confirmed inclusion of 7/16 patients. After application of CD4+count and HIV viraemia for further selection, the number of subjects was significantly reduced. Six patients had CD4+count greater than 200/cmm (2/6 with undetectable HIV viraemia). Only 3 patients had CD4+higher than 350/cmm (1/3 with undetectable HIV viraemia). Our data represent the first evaluation of the need and eligibility for kidney transplantation for HIV+subjects with ESRD. Application of HIV infection related parameters as selection criteria has a great strength in reducing the waiting list of HIV+subjects suitable for kidney transplant and could be carefully considered when planning inclusion/exclusion criteria for experimental purposes.