Detectable cerebrospinal fluid JCV DNA in late-presenting HIV-positive patients: beyond progressive multifocal leukoencephalopathy?

In the absence of effective prophylaxis and treatment, therapeutic options in HIV-positive patients with progressive multifocal leukoencephalopathy (PML) are limited to antiretroviral therapy: nevertheless, outcome is poor. We conducted a retrospective study (2009-2015) describing the outcome of 25 HIV-positive patients with detectable cerebrospinal fluid JC virus DNA: 14 had a probable PML while the others had evidence of other inflammatory central nervous system (CNS) affecting disorders. In the former group, 6-month mortality was 45.5% vs 21.4 in the latter one: survival was higher than previously described but no predictor of poor outcome was identified. Two patients treated with 5HT2-inhibitors survived. The contributing role of JCV replication in other CNS-affecting disorders needs to be assessed as well as the benefits of 5HT2-inhibitors in HIV-positive patients with proven PML.

Sequential therapy with entecavir and PEG-INF in patients affected by chronic hepatitis B and high levels of HBV-DNA with non-D genotypes.

Complete eradication of hepatitis B virus (HBV) is rarely achieved. Treatment options include currently available nucleos(t)ide analogues and pegylated interferon. The aim of our exploratory study was to assess the effectiveness of sequential therapy for chronic hepatitis B (CHB) vs the current standard of care. We evaluated an association with entecavir and pegylated interferon alfa-2a (PEG-IFN) in 20 patients with hepatitis B, high HBV viremia and genotypes A, B, C and E. Patients received entecavir alone for 12 weeks, then entecavir and PEG-IFN for 12 weeks, lastly PEG-IFN alone for 36 weeks. The results were compared with 20 patients (control group) treated in the past with 48 weeks of PEG-IFN monotherapy. Our results show that complete sustained virological response (SVR) and partial SVR were, respectively, 60% and 80% in the study group and 10% and 30% in the control group; anti-HBe seroconversion rate were 76.9% vs 15%, and anti-HBs seroconversion were 20% vs 0%, respectively. We found a correlation among different genotypes and virological and serological outcomes - genotype C has a better virological response, while genotype A had a better serological response, and E genotype had a poor response. These results show that a sequential approach is a promising strategy of treatment in patients with CHB and high viremia in comparison with PEG-IFN monotherapy. The E genotype seems to have the worse rate of response and requires other treatment strategies.

Amino acid changes in the attachment G glycoprotein of human respiratory syncytial viruses (subgroup A) isolated in Italy over several epidemics (1997-2006).

The human respiratory syncytial virus (HRSV) is the most important cause of admission to hospital for acute lower respiratory tract infections in infants and young children worldwide. Only few studies have investigated the molecular evolution of HRSV, and none has been conduct ed in Italy. The genetic diversity of the G glycoprotein of 59 subgroup A strains obtained from two clinical centers located in Northern and Central Italy was studied, during seven nonconsecutive epidemic seasons (1997-2006). The nucleotide sequences encompassing 624 bp, at the carboxy terminus of the G glycoprotein gene, were compared to sequences representative of previously defined HRSV genotypes. Phylogenetic analysis indicated that most Italian group A isolates clustered into two different lineages (GA2 and GA5), whereas only few isolates grouped into the other known lineages. Eight positively selected sites were found and it was predicted that serine and threonine of positively selected sites 117 and 262 (respectively) are O-glycosilated. The presence of multiple identical sequences in three lineages (GA1, GA5, and BE/A1) suggests that certain strains are predominant in a given epidemic season. Although most of the sites of the G glycoprotein gene of HRSV-A strains seem invariable because of strong purifying selection, some evolutionary "hot spots" may be present. Since the G glycoprotein is a major target (together with the F glycoprotein) of the HRSV humoral immune response, it is important to provide information about its genetic heterogeneity in order to address better both therapeutic and vaccine strategy.