Abdominal miliary tuberculosis in a patient with AIDS: a case report.

We present a 34 year old patient, intravenous drug user, hospitalized with fever, distortion of general status, dry irritating cough, abdominal colicative pains, and we established the diagnosis of HIV infection advanced stage/AIDS; his antecedents revealed (August 2000) abdominal tuberculosis not treated during the last 3 months. He presented a pneumonia with Pneumocystis carinii during hospitalization. Death was due to a colon perforation with secundary peritonitis. Miliary tuberculous lesions in liver, spleen and colon were revealed at necropsy and cytomegalovirus was identified in necrotic samples also.

Efficacy and safety of darunavir (Prezista(®)) with low-dose ritonavir and other antiretroviral medications in subtype F HIV-1 infected, treatment-experienced subjects in Romania: a post-authorization, open-label, one-cohort, non-interventional, prospective study.

INTRODUCTION: The aim of the study was to assess the safety and efficacy of darunavir (Prezista(®)) used in subtype F human immunodeficiency virus - type 1 (HIV-1) infected, antiretroviral therapy (ART)-experienced patients in Romania in routine clinical practice. METHODS: This was a post-authorization, open-label, one-cohort, non-interventional, prospective study conducted at multiple sites in Romania to assess efficacy (CD4 cell count, viral load, and treatment compliance) and safety ([serious] adverse events, clinical laboratory evaluation, and vital signs) of darunavir in combination with low-dose ritonavir (DRV/r) and other antiretroviral (ARV) medications in subtype F HIV-1 infected subjects in naturalistic settings. Seventy-eight subjects were recruited by 9 investigational sites and received 600/100 mg DRV/r twice daily. RESULTS: Treatment with DRV/r administered with other ARV medications resulted in the expected, statistically relevant improvement of CD4 cell count and viral load in subjects eligible for such treatment. In addition, adherence to treatment was high and the treatment-emergent safety profile observed during this study was consistent with the established safety profile of darunavir. CONCLUSION: DRV/r administered in combination with other ARV medications in subtype F HIV-1 infected subjects in naturalistic settings proved to be an effective and safe treatment in Romania. TRIAL REGISTRATION: NCT01253967.

Markers of preclinical vascular disease and left ventricular diastolic dysfunction in patients with HIV infection.

BACKGROUND: HIV infected patients have an increased cardiovascular risk that may be linked not only to the infection itself but also to the metabolic side effects of the antiretroviral therapy. AIM: The aim of our study was to determine markers of aortic arterial stiffness, carotid intima-media thickness (IMT) and parameters of left ventricular diastolic function and to establish the relationship between these vascular and cardiac parameters in HIV infected patients. MATERIAL AND METHOD: In this cross sectional case control study 43 patients with HIV infection and 25 healthy controls, matched for age and sex were enrolled. Aortic pulse wave velocity (PWV) and augmentation index (AIx) using an oscillometric method were measured. Carotid IMT and left ventricular systolic and diastolic function were determined by ultrasonography. Clinical status, laboratory parameters (glucose and lipid metabolism), and markers of disease activity were also recorded. RESULTS: In patients with HIV infection PWV was increased when compared to controls (p=0.02), but there were not significant differences in carotid IMT (p= 0.17). There were no differences for classical risk factors between HIV infected patients and controls with the exception of triglycerides level (p<0.001). HIV infected patients had a significant reduction in E/A ratio when compared to controls (p= 0.03). Significant differences were found for age (p=0.001), PWV (0.002) and carotid IMT (p=0.02) between patients with and without left ventricular diastolic dysfunction (LVDD). In multiple regression analyze only PWV remained correlated with LVDD (OR = 2.90, 95%CI: 1.41-5.97, p=0.004). CONCLUSIONS: In patients with HIV infection, without overt cardiovascular disease, arterial stiffness was increased. This finding is correlated with markers of LVDD. Increased arterial stiffness may be one of the mechanisms implicated in the alteration of left ventricular diastolic function in HIV infected patients.

Arterial stiffness and carotid intima-media thickness in HIV infected patients.

BACKGROUND: Cardiovascular disease is an increasing cause of morbidity and mortality in HIV-infected patients. The increased cardiovascular risk is linked to traditional risk factors for atherosclerosis but also, to HIV infection itself which can damage the arterial wall and the antiretroviral therapy (ART) implicated in metabolic disturbances. The aim of our study was to identify the effects of HIV and ART on carotid artery intima-media thickness (C-IMT) and on arterial stiffness, parameters which are used for the evaluation of cardiovascular risk. PATIENTS AND METHODS: A cross-sectional case-control study of 63 HIV-infected patients (56 exposed to ART, 7 ART naive) and 36 controls matched for age and sex was performed. C-IMT, and arterial stiffness were measured ultrasonographically using an ALOKA ProSound α 10 echo-device. Parameters of arterial stiffness were measured at the common carotid and brachial arteries. RESULTS: HIV-infected patients had a greater C-IMT than controls (p<0.01). There were significant differences regarding arterial stiffness parameters in HIV infected patients compared to controls, and between the groups of patients with different types of ART, especially at the level of carotid artery. Patients with HIV infection had reduced carotid compliance compared to controls (p<0.01). Patients exposed to reverse transcriptase inhibitort (RTI), had increased ß stiffness index (p=0.01) and carotid PWV (p=0.02) and reduced carotid compliance (p<0.01) compared to controls. CONCLUSIONS: HIV infection and ARV treatment is associated with increased C-IMT, and an increase in the arterial stiffness of the large arteries. These vascular modifications are possible causes of increased cardiovascular risk observed in HIV infected patients.