Roberto Zerboni

A controlled study of inhaled pentamidine for primary prevention of Pneumocystis carinii pneumonia

BACKGROUND Current recommendations for prophylaxis of Pneumocystis carinii pneumonia (PCP) are based on data from patients who have had at least one episode of PCP (secondary prevention). We designed a study to determine the efficacy and side effects of inhaled pentamidine in the primary prevention of PCP. METHODS Two hundred twenty-three patients sero-positive for human immunodeficiency virus (HIV) who had the acquired immunodeficiency syndrome (AIDS) but not PCP, who had advanced AIDS-related complex, or who had less than 0.2 x 10(9) CD4-positive lymphocytes per liter received either 300 mg of pentamidine isethionate or 300 mg of sodium isethionate every 28 days by inhaler. The proportion of patients surviving without PCP was analyzed with the log-rank test as a function of time spent in the trial, according to the intention to treat with either placebo or pentamidine. RESULTS The third of five planned interim analyses showed a significant difference in the occurrence of PCP, with 8 cases in pentamidine group and 23 in the placebo group (nominal P value = 0.0021). There were no deaths within 60 days of the diagnosis of PCP and no significant differences in survival between groups. Approximately 53 inhalations were needed to prevent one episode of pneumonia. Thirty-eight of 114 patients given pentamidine (33 percent) and 7 of 109 given placebo (6 percent) had moderate-to-severe coughing during inhalations (two-tailed P less than 0.00001), which caused 4 patients given pentamidine (3.5 percent) to discontinue taking it. CONCLUSIONS A dose of 300 mg of aerosolized pentamidine given every four weeks was well tolerated and 60 to 70 percent effective in preventing a first episode of PCP in patients with HIV infection.

Oral hairy leukoplakia.

Oral hairy leukoplakia was first described in homosexual men infected with the human immunodeficiency virus. It is thought to be caused by infection with both the Epstein-Barr virus and human papillomavirus. We report 59 cases of oral hairy leukoplakia. The disease was diagnosed in patients in all risk groups and was categorized in all classes of the Walter Reed classification without significant differences in prevalence. Epstein-Barr virus could be demonstrated in all tissue samples examined; human papillomavirus was found in only a few specimens. In our series oral hairy leukoplakia had a chronic course, although temporary spontaneous healing occurred in some cases. Its appearance was a poor prognostic sign because acquired immunodeficiency syndrome developed in a significant proportion of patients within a few months of onset.

Mucocutaneous manifestations in patients infected with human immunodeficiency virus

The mucocutaneous manifestations observed in 516 patients infected with human immunodeficiency virus attending an outpatient clinic for acquired immunodeficiency syndrome in Milan, Italy, from July 1985 to March 1987 are listed, and the clinicopathologic aspects of these disorders are reported. The prognostic significance of some human immunodeficiency virus-associated dermatoses is also discussed.

Incidence of Kaposi's sarcoma and HHV-8 seroprevalence among homosexual men with known dates of HIV seroconversion

ObjectivesTo evaluate temporal trends of Kaposis sarcoma (KS) and of the KS-related human herpesvirus (HHV-8) among homosexual men who seroconverted for HIV between 1984 and 1997. MethodsThe study participants were 387 homosexual men. Changes over a period of time were assessed by estimating KS incidence rates per 1000 person–years for the periods 1984–1989, 1990–1992, 1993–1995, and 1996–1997. The proportional incidence of KS as the AIDS-defining disease for the same periods was also calculated. To evaluate a cohort effect of calendar period, Kaplan–Meier curves were used to estimate the risk of KS by period of HIV seroconversion [i.e. before 1990 (median year of seroconversion) versus later]. Relative hazards for the four periods were estimated using competitive-risks models. We also estimated HHV-8 seroprevalence over the study period. ResultsForty-eight participants developed KS. Between 1984 and 1995, the incidence rate of KS per 1000 person–years increased from 3.9 to 32.8, whereas the proportional incidence decreased from 33.3 to 24.3%. The risk of developing KS after HIV seroconversion did not change when comparing the seroconversion periods (i.e. before 1990 versus later). HHV-8 seroprevalence also remained stable. The rates of KS and the relative hazards dramatically decreased after 1995. ConclusionsAlthough KS incidence rates increased up to 1995, the proportional incidence decreased, due to the higher increase in rates of other AIDS-defining diseases. The finding that the risk of developing KS after HIV seroconversion remained stable over time is consistent with the stable trend of HHV-8 seroprevalence. The dramatic decrease in KS incidence rates after 1995 coincides with combined antiretroviral therapy.

Chronic hypertrophic acyclovir-resistant genital herpes treated with topical cidofovir and with topical foscarnet at recurrence in an HIV-positive man.

JEADV 2006, 20, 868–902

Atypical Early Syphilis in an HIV-Infected Homosexual Male

A homosexual male, seropositive to HIV and with previously documented syphilitic infections, developed a slowly growing nodule on his left wrist (possibly a chancre) followed, after 2 months, by a few scattered, large papular lesions. Serological evidence of active syphilis was obtained and treponema were identified in the initial lesion by means of immunofluorescent staining. Treatment with both aqueous crystalline penicillin G and benzathine penicillin G healed the lesions. This represents a further case of an atypical presentation of early syphilis in an immunocompromised host.

Three-year neuropsychological follow-up in a selected group of HIV-infected homosexual/bisexual men

ObjectiveTo evaluate changes in cognition in a selected group of asymptomatic homosexual/bisexual men over a 3-year period. Patients and methodsSixty HIV-infected (Centers for Disease Control stage II) subjects and 60 controls (individually matched for age and years in education) were administered neuropsychological tests evaluating attention, language, memory, logic and visuo-motor abilities. None of the patients had a history of alcohol or drug abuse, and all received the baseline cognitive evaluation within 18–24 months of seroconversion. ResultsThe HIV-infected subjects differed from controls in only one of the six memory tests (P< 0.01). Follow-up evaluation after 18 and 36 months (available for 51 and 36 subjects, respectively) demonstrated a significant deterioration in visuo-motor ability (P< 0.01) only in subjects who had progressed to AIDS, without signs or symptoms of central nervous system involvement. ConclusionsThe data suggest that cognitive alterations in asymptomatic stages of HIV infection are in most subjects minor and do not develop. Percentage rates of CD4 lymphocyte decline appear to be significantly related to deterioration in visuo-motor abilities.

Prevalence and determinants of herpes simplex virus type 2 infection in a cohort of HIV-positive individuals in Italy.

Background Herpes simplex virus type 2 (HSV-2) infections may be a risk factor for the transmission of HIV. Data on the prevalence of HSV-2 infection among HIV-positive individuals are scarce. Goal The goal was to study the seroprevalence of and risk factors for HSV-2 infection among a cohort of Italian HIV-positive individuals. Study Design This was a cross-sectional study. HSV-2 serologic testing was performed for individuals with known date of HIV seroconversion, on the serum specimen obtained on the date closest to the estimated date of seroconversion. Antibodies to HSV-2 (anti-HSV-2) were detected by a gG2-specific ELISA. Results A total of 380 HIV-positive individuals were tested for anti-HSV-2; 126 (33.2%) of them were positive. Older age at HIV seroconversion and homosexuality were significantly associated with HSV-2 infection in the multivariate analysis. Conclusions These data stress the need for including anti-HSV-2 testing and therapy in the management of HIV positivity, especially for reducing the risk of transmission of HIV through herpetic lesions.

Local and systemic allergic contact dermatitis due to dental alloys

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Lichen myxoedematosus in a patient with AIDS

We report a patient with acquired immunodeficiency syndrome (AIDS) who developed a widespread popular eruption due to deposition of muein in the dermis. Paraproteinaemia was demonstrated. Lichen myxoedematosus type 2 was diagnosed. This is the third case of this rare disorder reported in a human immunodeficiency virus (HIV)‐seropositive subject.