Treatment of malignant hypertension with an angiotensin converting enzyme inhibitor.

Malignant hypertension developed in an 18-year-old man whose primary hypertension had been diagnosed by chance. Standing blood pressure was 290/170 mmHg. Tests of renal function revealed high blood urea nitrogen and creatinine levels and low levels of both effective renal plasma flow and the glomerular filtration rate. Plasma renin activity and levels of angiotensin II and aldosterone were greatly elevated. Severe concentric left ventricular hypertrophy was noted. The patient received standard antihypertensive treatment with furosemide, propranolol, nifedipine, and prazosin, but his blood pressure did not decrease and there was no improvement in the clinical or biochemical measures. The patient was then given 20 mg of enalapril daily for one year. The inhibition of angiotensin converting enzyme immediately reduced blood pressure. Angiotensin II and aldosterone levels became normal, kidney function and hemodynamics improved, and echocardiograms revealed that the left ventricular hypertrophy had regressed. The results confirm the pathogenetic role of angiotensin II in the development of the malignant phase of hypertension.

[A case of AIDS-related complex (ARC/LAS) in a health worker]. / Considerazioni su un caso di sindrome correlata alla AIDS (ARC/LAS) in una operatrice sanitaria.

A case of ARC/LAS syndrome in a student nurse accidentally pricked by an infected needle is reported. This case-report is published to encourage the recognition of hospital staff.

Human immunodeficiency virus seroprevalence and condom use among female sex workers in Italy.

BACKGROUND AND OBJECTIVES: In two different studies, we evaluated the human immunodeficiency virus (HIV) seroprevalence rate and the condom use in a group of female sex workers working in Italy. STUDY DESIGN: In the first study we collected data on HIV serologic testing of female sex workers; in the second study, we evaluated the use of condoms and high-risk sexual practices by sex workers with their clients and nonpaying partners. RESULTS: Overall, 131 of 802 (16%) were HIV positive: 36 of 558 (6%) professional sex workers and 95 of 244 (39%) sex workers who used intravenous drugs. There was a significant increase of seroprevalence among professional sex workers between 1988 to 1990 and 1991 to 1995 (2% versus 11%, P < or = 0.001), whereas among the sex workers who used intravenous drugs, the increase was not significant (37% versus 40%, P = 0.70). Similarly, the HIV seroprevalence in the Italian professional sex workers is constant in the two periods of time (2% versus 1%). In the second study, 97 of 102 (95%) sex workers reported regular condom use with clients, whereas 63% of sex workers reported they never used them with nonpaying partners. Fourteen sex workers reported having nonpaying partners who used intravenous drugs and 6 reported having nonpaying bisexual partners; 8 of these 20 partners were HIV positive. CONCLUSION: The results of the first study showed a significant increase of seroprevalence among professional sex workers, whereas the high seroprevalence among sex workers who used intravenous drugs was constant. The results of the second study showed that sex workers may be at higher risk for HIV infection through noncommercial sexual intercourses.

PIP: HIV seroprevalence and condom use among female sex workers (FSWs) in Italy were investigated in two studies, with particular emphasis on trends before and after 1990--the year of arrival for most immigrant FSWs. The first study enrolled 802 FSWs (176 foreigners) presenting to sexually transmitted disease and HIV clinics in 14 cities in northern Italy in 1988-95. Overall, 131 women (16%) tested HIV-positive; 36 of these women were professional FSWs (6% of 558) and 95 were from the subgroup of FSWs who used intravenous (IV) drugs (39% of 244). HIV seroprevalence among professional FSWs increased significantly between 1988-90 (2%) and 1991-95 (11%); the corresponding increase among drug-injecting FSWs (37% to 40%) was not significant. The increase in HIV in the professional subgroup was caused by the influence of immigrant FSWs; seroprevalence in Italian-born FSWs remained constant in both time periods (2% and 1%, respectively). The second study investigated the condom use patterns of 102 FSWs from 9 Italian cities. 97 FSWs (96%) reported always using a condom with clients, but only 6 (5%) used condoms consistently with nonpaying partners. 14 FSWs had nonpaying partners who used IV drugs and 6 reported nonpaying bisexual partners; 8 of these 20 men were reportedly HIV-infected. Of the 75 sex workers who reported being tested for HIV, 4 (5%)--all of whom were IV drug users--were HIV-positive. These findings indicate that FSWs who use IV drugs or are from foreign countries represent high-risk subgroups. They further suggest that professional FSWs may be at higher risk for HIV infection through noncommercial than commercial sexual encounters.

Failure of stavudine-lamivudine combination therapy in antiretroviral-naive patients with AZT-like HIV-1 resistance mutations.

To analyze the clinical relevance of AZT resistance mutations in AZT-naive patients, 56 HIV-1 seropositive patients treated for 18 months with stavudine/lamivudine (27 patients) or AZT/lamivudine (29 patients) were studied. AZT-like resistance mutations were found in 13 out of 29 (44%) patients treated with AZT/lamivudine and in 11 out of 27 (40%) patients treated with stavudine/lamivudine. No stavudine or multi-drug resistance mutations were detected. After 26 months of treatment more than 60% of patients showed a virological failure. Among 10 patients failing treatment with stavudine/lamivudine, 9 had AZT-like resistance mutations. The phenotypic test, performed on HIV-1 strains isolated from six of these nine patients, showed a resistance to AZT in five isolates and to stavudine in two isolates. The genotypic pattern of the latter two isolates showed the combined mutations M184V plus R211K and L214F. AZT-like resistance mutations in AZT-naive patients seem to correlate with a virological failure during long-term stavudine therapy.