Long-term stabilized immunological-virological parameters of HIV infection in an AIDS presenter followed for 20 years, with irregular or no antiretroviral therapy.

We report the case of an HIV-infected patient who has been followed for 20 years, and despite presenting with AIDS (due to three episodes of cryptococcosis plus one of Pneumocystis jirovecii pneumonia) who during subsequent years missed, refused or took with limited compliance all recommended medications, including combination antiretroviral therapy, and primary and secondary antimicrobial chemoprophylaxis against opportunistic infections. The unexpected clinical and laboratory stabilization of our patient paralleled a progressive increase in his peripheral CD4+ T-lymphocyte count (range 410-825 cells/mL) and a relatively controlled HIV viraemia (5970-44,000 HIV-RNA copies/mL). Such a recovery of sufficient immune competency after experiencing four episodes of severe AIDS-associated opportunistic infections, without reliable antiretroviral and antimicrobial support raises several questions.

A very particular case of long-term non-progressor: nineteen consecutive years of follow-up in the absence of any detectable HIV-1 viraemia.

A case of extremely prolonged non-progression of HIV-1 infection, characterized by 19 consecutive years of persistently undetectable viraemia (or no laboratory markers of HIV replication) is presented and discussed based on recent literature issues regarding virological and immunological outcome of the natural history of HIV-1 infection.

[Pharmaco-economic evaluation of antibiotic therapy in a ward for infections diseases] / Alcune valutazioni di farmacoeconomia sull'antibioticoterapia in un reparto di malattie infettive.

For all hospitalized patients admitted in the first six months of 1999, we recorded the data relative to antibiotic therapy (TA) administered, establishing the period of treatment in days and the dosage, including any variations during the period in question. We calculated the prescribed daily dose (PDD) and were thus able to establish the expense incurred in antibiotic therapy, comparing the real overall cost per product used. For all patients, the discharge diagnosis was reported, and the whole case-study was aggregated into homogeneous groups. PDD was compared with DDD (defined daily doses). The Pareto curve was used to highlight the antibiotics with higher overall cost. Besides cotrimoxazole, ceftriaxone and ciprofloxacin were the antibiotics most frequently prescribed, while ceftriaxone, imipenem-cilastatine and vancomycin were the antibiotics incurring the greatest expense. With reference to the average duration of the treatment cycle, ceftriaxone (9.75 dd) and ciprofloxacin tbl (6.75 dd) were the only antibiotics (in monotherapy) used for less than 10 treatment days. Special attention was paid to analysing the TA costs in treating pneumonia, which accounted for the highest percentage of cases (50 cases). Ceftriaxone, especially pulmonary infections, was the most commonly used drug. In hospitalized subjects treated who show good therapeutic response, we recommend early discharge and continuation of the therapy at home (switch therapy). This strategy will allow the patient to return to his/her family in good time, also thereby reducing hospital management costs.

Cervicofacial and pulmonary actinomycosis associated with non-Hodgkin's lymphoma.

A case of cervicofacial and pulmonary actinomycosis associated with non-Hodgkin's lymphoma (NHL) is reported. The patient underwent antimicrobial treatment and surgical debridement of a palatine lesion. Complete clinical recovery was achieved. The presence of actinomycosis may obscure and delay the diagnosis of NHL.