Late occurrence of pleural and peritoneal effusion due to Mycobacterium tuberculosis infection (TB) in a patient with posttransplantation recurrent HCV chronic hepatitis: safety of peginterferon and ribavirin treatment after recovery of TB:- a case report.

The late occurrence of a large and often long-lasting effusion in the pleural and peritoneal cavities after liver transplantation is an uncommon and poorly understood complication. Even rarer (<1%) is the incidence of Mycobacterium tuberculosis (MT) in Western world series. Herein we have described a case of massive pleural effusion and ascites due to MT occurring 22 months after liver transplantation for hepatitis C virus (HCV) cirrhosis. The infection was successfully treated with no hepatotoxicity or rejection, so that it was possible to start antiviral treatment with peginterferon and ribavirin for recurrent HCV without reactivation of MT infection.

Adherence to combination antiretroviral treatment in children.

PURPOSE: To assess the level of nonadherence to combination antiretroviral therapy of HIV-infected children and to identify the main problems faced by caregivers when giving medicines to children. METHOD: A questionnaire was administered to the caregivers of HIV-infected children who were under combination antiretroviral treatment and were followed at our institution. RESULTS: We evaluated 44 children (mean age, 9.4 years); 13 were treated with a two-drug regimen, 30 with a three-drug regimen, and 1 with a four-drug regimen. Each child received a mean of 8.1 pills and/or syrup doses. In 54.5% of treatments, food restrictions were necessary. The mother was the main person giving medicines to the child (56.8%). A complete written schedule of the child's treatment was present in 50% of families. About 20.5% and 31.8% of children had missed at least one dose of antiretroviral drugs in the last 3 days before assessment and since last visit (1-2 months earlier), respectively. Main problems reported by caregivers were: (a) too many medicines/ pills (34%); (b) difficulty in swallowing pills (29.5%); (c) taking medicines at school or out of home (27.3%); (d) child resisting/refusing therapy/spitting out (25%); and (e) food interactions (22.7%). CONCLUSION: The observed high level of nonadherence was similar to what was reported by other pediatric studies. Specific interventions aimed at improving compliance in pediatric patients were identified: improvement of anti-HIV drug formulations, better counselling for children and their families, and tailoring of antiretroviral treatment. However, caution is necessary in generalizing our results due to the small sample size and to the heterogeneity of the cohort.