Human T-lymphotropic Virus Co-infections in Adults Infected With Human Immunodeficiency Virus.

INTRODUCTION: Human T-lymphotropic virus type 1 or 2 (HTLV-1/2) co-infection in patients infected with the human immunodeficiency virus (HIV) can lead to increased morbidity. Because HTLV-1/2 shares a similar transmission route with HIV, HTLV-1/2 infection may be more prevalent in HIV-infected individuals. However, rates of HTLV-1/2 co-infection among HIV-infected individuals have not been studied recently in the United States. MATERIALS AND METHODS: We conducted a cross-sectional study using serum from 292 HIV-infected subjects from one clinic in Virginia. Serum samples were tested for co-infection with HTLV-1/2 by commercial ELISA; positive results were then confirmed via western blot, which also differentiated between HTLV-1 and -2. RESULTS: Seven (2.4%) of the subjects were co-infected with HTLV-2. One subject (among the seven co-infected with HTLV-2) was co-infected with HTLV-1 (0.3%). The only demographic factor significantly associated with HTLV-2 infection was history of intravenous drug abuse (p=0.002). CONCLUSIONS: While our results are limited to a single city, our low rates of co-infection do not support routine screening for HTLV-1/2 co-infection among HIV-infected individuals in the United States.

Effects of Well-Controlled HIV Infection on Complement Activation and Function.

INTRODUCTION: Uncontrolled HIV infection is known to activate the complement system, leading to an increase in chronic inflammation. Whether or not this activation of complement persists and contributes to chronic inflammation in subjects with HIV infection that is well controlled through use of antiretroviral therapy has not been studied. METHODS: We conducted an observational, cross-sectional study using sera from 305 adults with well-controlled HIV infection and 30 healthy controls. Sera was tested for markers of complement activation (C3a and C5a levels), complement function (CH50 assay), and immunoglobulin levels (IgG1-IgG4) as IgG can activate complement. We evaluated the association of well-controlled HIV infection with C3a, C5a, CH50, IgG1-IgG4, and total IgG levels using both univariate and multivariate analyses, controlling for factors such as age, sex, race, comorbidities (including hepatitis C coinfection), smoking status, and statin use. RESULTS: Well-controlled HIV infection was associated with a 54% increase in complement activation as measured by C3a levels compared with healthy controls (P < 0.0001). Hepatitis C coinfection was associated with a further 52% increase in complement activation, as measured by C3a levels, over HIV alone (P = 0.003). CONCLUSION: These results suggest that complement activation may contribute to a proinflammatory state even in well-controlled HIV infection. Furthermore, hepatitis C virus coinfection may be even more proinflammatory, in complement activation, compared with HIV infection alone.

Community circulation patterns of oral polio vaccine serotypes 1, 2, and 3 after Mexican national immunization weeks.

BACKGROUND: With wild poliovirus nearing eradication, preventing circulating vaccine-derived poliovirus (cVDPV) by understanding oral polio vaccine (OPV) community circulation is increasingly important. Mexico, where OPV is given only during biannual national immunization weeks (NIWs) but where children receive inactivated polio vaccine (IPV) as part of their primary regimen, provides a natural setting to study OPV community circulation. METHODS: In total, 216 children and household contacts in Veracruz, Mexico, were enrolled, and monthly stool samples and questionnaires collected for 1 year; 2501 stool samples underwent RNA extraction, reverse transcription, and real-time polymerase chain reaction (PCR) to detect OPV serotypes 1, 2, and 3. RESULTS: OPV was detected up to 7 months after an NIW, but not at 8 months. In total, 35% of samples collected from children vaccinated the prior month, but only 4% of other samples, contained OPV. Although each serotype was detected in similar proportions among OPV strains shed as a result of direct vaccination, 87% of OPV acquired through community spread was serotype 2 (P < .0001). CONCLUSIONS: Serotype 2 circulates longer and is transmitted more readily than serotypes 1 or 3 after NIWs in a Mexican community primarily vaccinated with IPV. This may be part of the reason why most isolated cVDPV has been serotype 2.

The differential diagnosis of hypoglycorrhachia in adult patients.

OBJECTIVES: Hypoglycorrhachia, a low glucose level in the cerebrospinal fluid (CSF), can suggest bacterial, fungal or tuberculous meningitis. When tests for these common infectious etiologies are negative, many clinicians are unsure of which diagnoses to consider, resulting in delayed treatment. The authors analyzed the diagnoses associated with hypoglycorrhachia to determine their relative frequencies at our institution and summarized all the diagnoses associated with hypoglycorrhachia in the literature. METHODS: Retrospective analysis of adults with hypoglycorrhachia at a tertiary care teaching hospital over a 5-year period. Inclusion criteria included CSF glucose <40 mg/dL and age 18 years or older. Exclusion criteria included CSF/serum glucose ≥0.6. RESULTS: Eighty-nine unique hypoglycorrhachia episodes were identified. The most common etiologies among all episodes of hypoglycorrhachia were bacterial meningitis (24%), fungal meningitis (15%), stroke/bleed (13%), malignancy (11%), viral meningitis (6%), neurosarcoidosis (4%), neurosyphilis (4%) and cerebral toxoplasmosis (3%). The most common etiology was fungal meningitis (38%) among HIV-infected patients and bacterial meningitis (62%) among neurosurgery patients. However, in patients without HIV or neurosurgical history, noninfectious etiologies (stroke/bleed, 24%; malignancy, 22%) were most common. CONCLUSIONS: Many diagnoses, both infectious and noninfectious, lead to hypoglycorrhachia and must be considered in the differential diagnosis.