The ASSURE study: HIV-1 suppression is maintained with bone and renal biomarker improvement 48 weeks after ritonavir discontinuation and randomized switch to abacavir/lamivudine + atazanavir.

OBJECTIVES: HIV treatment guidelines endorse switching or simplification of antiretroviral therapy in therapy-experienced patients with suppressed viraemia; ritonavir discontinuation may also enhance tolerability and reduce long-term adverse events (AEs). This open-label, multicentre, noninferiority study enrolled HIV-1-infected, treatment-experienced adults with confirmed HIV-1 RNA ≤ 75 HIV-1 RNA copies/mL currently receiving tenofovir/emtricitabine + atazanavir/ritonavir (TDF/FTC + ATV/r) for ≥ 6 months with no reported history of virological failure. METHODS: Participants were randomized 1:2 to continue current treatment or switch to abacavir/lamivudine + atazanavir (ABC/3TC + ATV). Endpoints included the proportion of participants with HIV-1 RNA < 50 copies/mL by time to loss of virological response (TLOVR), AEs, fasting lipids, and inflammatory, coagulation, bone and renal biomarkers. RESULTS: After 48 weeks, 76% (152 of 199) of ABC/3TC + ATV-treated and 79% (77 of 97) of TDF/FTC + ATV/r-treated participants had HIV-1 RNA < 50 copies/mL (TLOVR; P = 0.564). Other efficacy analyses yielded similar results. Rates of new grade 2-4 AEs were 45% in both groups, but an excess of hyperbilirubinaemia made the rate of treatment-emergent grade 3-4 laboratory abnormalities higher with TDF/FTC + ATV/r (36%) compared with ABC/3TC + ATV (19%). Most fasting lipid levels remained stable over time; high-density lipoprotein (HDL) cholesterol increased modestly in ABC/3TC + ATV-treated participants. Bone and renal biomarkers improved significantly between baseline and week 48 in participants taking ABC/3TC + ATV and were stable in participants taking TDF/FTC + ATV/r. No significant changes occurred in any inflammatory or coagulation biomarker within or between treatment groups. CONCLUSIONS: The ABC/3TC + ATV treatment-switch group had similar viral suppression rates up to 48 weeks to the TDF/FTC + ATV/r comparator group, with lower rates of moderate- to high-grade hyperbilirubinaemia and improvements in bone and renal biomarkers.

Tropical pyomyositis: delineation by gray scale ultrasound.

This report describes a case of tropical pyomyositis in a 25-year-old man in which gray scale ultrasound played a critical role in the diagnosis and management. A review of relevant literature is provided, and a recommended approach to the diagnosis of this disease is given.

Safety and efficacy of teicoplanin for bone and joint infections: results of a community-based trial.

To evaluate the efficacy and safety of teicoplanin in the treatment of gram-positive bone and joint infections, parenteral teicoplanin was used once daily in an average dose of 10.1 mg/kg (range 6 to 12 mg/kg) after loading to treat patients with acute or chronic osteomyelitis and septic arthritis. From the 66 patients who met criteria for initial enrollment, 60 gram-positive isolates were recovered from bone and joint fluid, and each was sensitive to teicoplanin at < or = 2 micrograms/mL (median 0.25 microgram/mL). Teicoplanin was more active in vitro against these isolates than either vancomycin or oxacillin. Among the 43 patients in whom microbiologic efficacy could be assessed, the initial pathogen was eradicated in 37 (86%). Clinically, 45 patients infected with staphylococci (including oxacillin-susceptible and oxacillin-resistant Staphylococcus aureus and coagulase-negative staphylococci) met predetermined criteria for completed adequate therapy. Of these, 39 (87%) responded favorably and became free of all signs of infection; 6 (13%) failed to respond or suffered relapse. Overall, 36 patients completed teicoplanin therapy at home. Adverse reactions necessitated discontinuance of therapy in 12 patients and included fever, rash, hepatic function test abnormalities, and renal insufficiency. We found teicoplanin to be effective and generally well tolerated for treatment of bone and joint infections by gram-positive organisms in a community setting.

Invasive infection due to Apophysomyces elegans in immunocompetent hosts.

A previously well 59-year-old man developed necrotizing, invasive cellulitis and subsequent osteomyelitis at what was judged to be the site of a bite or sting. The pathogen isolated was Apophysomyces elegans. Eventually, in addition to treatment with intravenous amphotericin B, en bloc resection was required for cure. Only six previous cases of A. elegans infection have been reported in the literature. The lack of underlying disease in six of the total of seven cases contrasts with the usual findings for other zygomycoses. This article describes all seven reported cases as well as the characteristics of this unique fungal pathogen.

Comparison of single-dose tetracycline hydrochloride to conventional therapy of urinary tract infections.

Sixty-two women with signs and symptoms compatible with lower urinary tract infections were randomized to receive single-dose tetracycline (2 g), multi-dose tetracycline (500 mg four times per day for 10 days), or single-dose amoxicillin (3 g). Urine cultures were obtained upon entry into the study and on days 4, 14, and 28 after therapy. Single-dose tetracycline cured 12 of 16 (75%) of women with documented urinary tract infections, compared with 15 of 16 (94%) in the multi-dose tetracycline group and 7 of 13 (54%) receiving single-dose amoxicillin. Mild nausea in 3 of 20 patients (15%) was the only complication in the single-dose tetracycline group. Two grams of single-dose tetracycline is as effective as other reported regimens regardless of the susceptibility of the initial pathogen and has minimal toxicity.

Epidemiology of human rabies post-exposure prophylaxis at the US Naval Facility, Subic Bay, Philippines.

Data collected during 1984 from an active animal rabies surveillance system and human rabies post-exposure prophylaxis program at the US Naval Hospital, Subic Bay Naval Facility, Philippines revealed that potential rabies exposure, most commonly from dog bites or scratches, was reported for 311 US military and civilian personnel and four Filipino employees working on the facility. Seventy-nine persons (25 per cent) required complete post-exposure prophylaxis. Brain tissue from two captured dogs implicated in attacks was subsequently found to be positive for rabies antigen on fluorescent antibody testing.

Oral atovaquone compared with intravenous pentamidine for Pneumocystis carinii pneumonia in patients with AIDS. Atovaquone Study Group.

OBJECTIVE: To test the hypothesis that the therapeutic success rate of oral atovaquone is not worse than that of intravenous pentamidine in the primary treatment of mild and moderate Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome and to detect differences in the toxicity rates of the two treatments. DESIGN: Patients were randomly assigned to receive 21 days of open-label therapy with either atovaquone, 750 mg orally with meals three times daily, or intravenous pentamidine, 3 to 4 mg per kg body weight once daily. SETTING: Multicenter study including university and community treatment facilities. PATIENTS: Patients with human immunodeficiency virus infection and clinical presentations consistent with mild or moderate P. carinii pneumonia were eligible. For efficacy and safety analyses, patients with histologically confirmed P. carinii pneumonia were emphasized. MEASUREMENTS: Patients were monitored by clinical and laboratory evaluations for therapeutic efficacy and adverse events during the acute treatment phase and for 8 weeks after therapy was discontinued. RESULTS: As initial therapy for a histologically confirmed episode of P. carinii pneumonia, 56 patients received atovaquone and 53 received pentamidine. More patients were successfully treated with atovaquone (57%) than with pentamidine (40%), a difference of 17% (95% CI, -3% to 38%; P = 0.085), but more patients failed to respond to atovaquone (29%) than to pentamidine (17%), a difference of 12% (CI, -6% to 29%; P = 0.18). Discontinuation of original therapy because of treatment-limiting adverse events was more frequent in the pentamidine group (36%) than in the atovaquone group (4%) (difference, -32%; CI, -48% to -17%; P < 0.001). Nine patients in each treatment group died during the study. CONCLUSIONS: Oral atovaquone and intravenous pentamidine have similar rates for successful treatment of mild and moderate P. carinii pneumonia, but atovaquone has significantly fewer treatment-limiting adverse events.