Risk of high-level viraemia in HIV-infected patients on successful antiretroviral treatment for more than 6 months.

OBJECTIVES: According to the Swiss Federal Commission for HIV/AIDS, HIV-infected patients on successful antiretroviral treatment have a negligible risk of transmitting HIV sexually. We estimated the risk that patients considered to have an undetectable viral load (VL) are actually viraemic. METHODS: A Danish, population-based nationwide cohort study of HIV-infected patients with VL <51 HIV-1 RNA copies/mL for more than 6 months was carried out for the study period 2000-2008. The observation time was calculated from 6 months after the first VL <51 copies/mL to the last measurement of VL or the first VL >50 copies/mL. The time at risk of transmitting HIV sexually was calculated as 50% of the time from the last VL <51 copies/mL to the subsequent VL if it was >1000 copies/mL. The outcome was the time at risk of transmitting HIV sexually divided by the observation time. RESULTS: We identified 2680 study subjects contributing 9347.7 years of observation time and 56.4 years of risk of transmitting HIV (VL>1000 copies/mL). In 0.6% [95% confidence interval (CI) 0.5-0.8%] of the overall observation time the patients had VL >1000 copies/mL. In the first 6 months this risk was substantially higher (7.9%; 95% CI 4.5-11.0%), but thereafter decreased and was almost negligible after 5 years (0.03%; 95% CI 0.0-0.2%). The risk was higher in injecting drug users, but otherwise did not differ between subgroups of patients. CONCLUSION: The risk of viraemia and therefore the risk of transmitting HIV sexually are high in the first 12 months of successful antiretroviral treatment, but thereafter are low.

Antibody response against Mycobacterium avium complex in cystic fibrosis patients measured by a novel IgG ELISA test.

BACKGROUND: Early signs of Mycobacterium avium complex pulmonary disease can be missed in patients with cystic fibrosis due to subclinical infection or delays in mycobacterial culture. The aim of this study was to determine the diagnostic accuracy of a novel enzyme linked immunosorbent assay for immunoglobulin G against Mycobacterium avium complex, which could help stratify patients according to risk. METHODS: A retrospective cross sectional analysis of serum samples from the Copenhagen Cystic Fibrosis Center was performed. Corresponding clinical data were reviewed and patients with cystic fibrosis were assigned to one of four groups based on their mycobacterial culture results. In addition, anti-Mycobacterium avium complex immunoglobulin G levels were measured longitudinally before and after first positive culture in the period 1984-2015. RESULTS: Three-hundred and five patients with cystic fibrosis were included with a median of five nontuberculous mycobacterial cultures. Four individuals had Mycobacterium avium complex pulmonary disease at the time of cross sectional testing and their median antibody level was 22-fold higher than patients with no history of infection (1820 vs. 80 IgG units; p < 0.001). Test sensitivity was 100% (95% CI 40-100) and specificity 77% (95% CI 72-81). Longitudinal kinetics showed rising antibodies prior to first positive culture suggesting diagnostic delay. CONCLUSIONS: Antibody screening for Mycobacterium avium complex may be used as a supplement to culture. Although confirmation in a larger cohort is needed, our findings suggest that stratifying a cystic fibrosis population into high- and low-risk groups based on antibody levels may help clinicians identify patients in need of more frequent culture.

First report of lung transplantation in a patient with active pulmonary Mycobacterium simiae infection.

Mycobacterium simiae is a slow-growing mycobacteria that in rare cases can cause chronic pulmonary infection. We report the first case of lung transplantation in a patient with active M simiae infection at the time of transplantation. A 56-year-old immunocompetent nonsmoking woman underwent bilateral lung transplantation for end-stage idiopathic bronchiectasis and chronic M simiae infection. The disease proved manageable on a regimen of clarithromycin, moxifloxacin, and cotrimoxazole with a successful outcome 1-year posttransplantation. There is increasing evidence that nontuberculous mycobacterium infection should no longer be an absolute contraindication for lung transplantation.

Nontuberculous mycobacterial disease is not a contraindication to lung transplantation in patients with cystic fibrosis: a retrospective analysis in a Danish patient population.

Whether nontuberculous mycobacterial (NTM) disease is a contraindication to lung transplantation remains controversial. We conducted a nationwide study to evaluate the clinical importance of NTM infection among lung transplant patients with cystic fibrosis (CF) in Denmark and to determine if NTM infection poses a contraindication to lung transplantation. All CF patients with current or prior NTM who had undergone lung transplantation were identified. Out of 52 lung transplant patients with CF 9 (17%) had NTM disease. Five patients had known infection at the time of transplantation. Two of these died of non-NTM-related causes whereas two developed deep Mycobacterium abscessus wound infections and one was transiently culture negative until M abscessus was reactivated. One patient was subsequently cured; the other two remained on therapy with good performance status. The study supports the contention that CF patients with prior or active NTM can undergo lung transplantation although postoperative complications can be expected.

Pediatric pulmonary CT-scanning. Anaesthesia-induced changes.

Forty three lung scans, obtained in 29 anaesthetized children, were evaluated and compared with 85 scans performed in 52 sedated children. Confluent high absorptive areas in the lower parts of the lungs were found in 35 (81%) of the scans performed in children under general anaesthesia but such areas were not found in the scans performed under sedation.--For general anaesthesia, halothane-N2O-O2 was used in all but one patient. The radiological changes are presumably due to a fall in functional residual capacity with consequent airway closure.--It is important not to misinterpret these anaesthesia-induced pulmonary changes which may obscure or mimic true pathological lesions, such as parenchymal and pleural metastases.

Concentrations of thiopentone in mature breast milk and colostrum following an induction dose.

In two groups of eight patients, concentrations of thiopentone in mature breast milk and colostrum following anaesthesia induction with 5.4 and 5.0 mg kg-1 b.w. (mean), respectively, were measured in the first 36 h postoperatively. Blood concentrations were measured simultaneously. The maximal concentrations were: in mature breast milk, 3.4 +/- 0.68 mumol l-1 (mean +/- s.e. mean) (0.090 mg 100 ml-1), and in colostrum, 1.3 +/- 0.5 mumol l-1 (0.034 mg 100 ml-1). The milk/plasma ratio was less than 1.0 in both groups. The above concentrations may be regarded as negligible and therefore non-toxic for the nursing infant.

Moderate hypotensive anaesthesia for reduction of blood loss during total hip replacement.

Thirty-two consecutive patients scheduled for total hip replacement were randomly allocated to receive either neurolept anaesthesia or halothane anaesthesia. In the halothane group, systolic blood pressure was reduced to 10.69-13.33 kPa in normotensive patients, and to 13.33-16.0 kPa in hypertensive patients by adjusting the inspired halothane concentration and using supplementary fentanyl when necessary. In the neurolept group, no attempt was made to reduce blood pressure below the level achieved with adequate anaesthetic doses of fentanyl and droperidol. The average peroperative blood loss in the halothane group was 809 ml (range 250-1700 ml); this was significantly lower than in the neurolept anaesthesia group in which an average blood loss of 1909 ml (range 600-4900 ml) occurred. Moderate hypotensive halothane anaesthesia is recommended as an anaesthetic technique for total hip replacement.

The cardiovascular effects of pancuronium during halothane and cyclopropane anaesthesia.

The effect of pancuronium 0.1 mg/kg i.v. on heart rate (HR) and mean arterial blood pressure were investigated in two groups of eight patients, each receiving inhalational anaesthesia with either halothane or cyclopropane. A more pronounced effect on HR in the cyclopropane group with a mean increase of 104% occurred. The mean increase in the halothane group was 54%. There was a statistically significant difference (P less than 0.05) between the HR increases The vagolytic effect of pancuronium and the influence of halothane and cyclopropane on the autonomic nervous system are discussed.