Impact of timing of antiretroviral therapy initiation on survival of cervical squamous intraepithelial lesions: a cohort analysis from South Africa.

To determine factors that influence excision treatment outcome and recurrence of cervical squamous intraepithelial lesions (SIL) in women living with HIV infection, we analysed 1848 women who underwent excision treatment of cervical SIL at Tygerberg Hospital, Cape Town, South Africa. We compared treatment failure defined as presence of cervical intraepithelial neoplasia (CIN) I (presence of CIN I or higher at first follow-up after excision treatment) and post-excision recurrence of lesions (at one year or later) between women of HIV-positive, -negative or unknown status and examined factors associated with excision treatment outcome and recurrence. HIV-infected women experienced higher treatment failure than uninfected women (53.8% versus 26.9%, P < 0.001). At treatment failure, more HIV-infected women had low-grade squamous intraepithelial lesion (LSIL) compared with uninfected women (64.9% versus 37.3%, P < 0.001). Treatment failure did not differ with the type of excision used in HIV-infected women. HIV-infected women were more likely to experience recurrence of lesions after excision treatment than uninfected women (hazard ratio 1.95, 95% confidence interval [CI] 1.59-2.39; P < 0.001). Antiretroviral therapy (ART) initiated before excision biopsy had a strong protective effect against recurrence (hazard ratio 0.70, 95% CI 0.55-0.89; P = 0.006). Our data suggest that women with cervical SIL initiated on ART earlier may be expected to have better long-term excision treatment outcome. Close follow-up should be maintained after cervical excision treatment, especially in a setting of high HIV prevalence.

Successful treatment of Acanthamoeba rhinosinusitis in a patient with AIDS.

Acanthamoeba infection is a rare, difficult-to-treat, and often fatal, opportunistic parasitic infection in immunocompromised hosts, such as patients infected with HIV. We describe an aggressive nasal and sinus infection by Acanthamoeba spp. in a person with AIDS. The resolution of this Acanthamoeba infection was secondary to a multidisciplinary treatment approach involving a combination of surgery as well as high-dose amphotericin B plus 5-fluorocytosine. In the era of the HIV/AIDS pandemic, the present report underscores the need for early identification and prompt aggressive treatment to ensure successful management of this rare but potentially fatal opportunistic infection.

Diagnostic yield of peripheral lymph node needle-core biopsies in HIV-infected adults with suspected smear-negative tuberculosis.

Significant lymphadenopathy in human immunodeficiency virus (HIV) infected adults in developing countries is usually caused by tuberculosis. We studied the safety and diagnostic yield of needle-core biopsies, under local anaesthetic, of enlarged lymph nodes in 26 HIV-infected adults presenting with suspected tuberculosis who were sputum smear-negative. Biopsy samples were sent for histology and mycobacterial culture. Induced sputum, urine and blood were also sent for mycobacterial culture. The procedure was well tolerated. A definitive diagnosis was made on initial needle-core biopsy in 22 subjects (85%) and in two of three subjects who underwent a second needle-core biopsy. Tuberculosis was the final diagnosis in 24 subjects (92%).

Septic arthritis caused by Haemophilus influenzae associated with endocarditis.

Septic arthritis with Haemophilus influenzae is infrequent in adults and often associated with an extra-articular septic focus. We report the case of a septic arthritis caused by H. influenzae in an elderly (89-year-old) female patient in whom an transoesophageal echocardiogram showed an aortic valve endocarditis.

Chronic dissection of the thoracic aorta in a patient with tuberculous pleuro-pericarditis.

We describe a case of chronic dissection of thoracic aorta presumed to be due to tuberculosis from pleuro-pericarditis foci and who was cured by antituberculous therapy and surgery. With the recent increase of tuberculosis cases, tuberculous aortitis might become less rare and the clinicians should suspect this diagnosis in subjects with aortic dissection and history of tuberculosis.