Acute kidney injury KDIGO stage 2 to 3 in HIV-positive patients treated with cART--a case series over 11 years in a cohort of 1,153 patients.

OBJECTIVES: We aimed to explore acute kidney injury (AKI) Kidney Disease Improving Global Guidelines (KDIGO) stage 2 to 3 in a cohort of antiretroviral treated HIV-infected individuals. METHODS: HIV-infected individuals of the Swiss HIV Cohort Study (Basel site), treated with combination antiretroviral therapy (cART) 2002-2013, were included. AKI was defined and classified according to the KDIGO Clinical Practice Guidelines for AKI. Data were prospectively collected and reports of kidney biopsies obtained from records. RESULTS: Among 1,153 cART-treated patients, 13 experienced AKI KDIGO stage 2 to 3 (1 patient stage 2, 12 patients stage 3; median age 46 years; 9 male; median CD4 count 366 cells/µl), corresponding to an incidence rate of AKI of 0.77 (95% confidence interval 0.45-1.33) per 1000 patient-years. Baseline estimated glomerular filtration rate (eGFR) was 87 ml/min (interquartile range 66-100). Ten patients were treated with tenofovir (TDF). Nine patients (69%) had ≥1 cardiovascular risk factor, only two patients had known pre-existing kidney disease. Three patients needed chronic and two temporary dialysis. AKI was associated with TDF therapy in 6 of 13 (46%) patients (mean TDF exposure time before AKI 41 months). Impaired renal function was partially reversible in all patients. In three patients with biopsy-proven pre-existing kidney disease (AA amyloidosis, calcineurin inhibitor-induced nephropathy and minimal change glomerulopathy), TDF potentially added to AKI. CONCLUSIONS: AKI KDIGO stage 2 to 3 demonstrates complex associations at the individual level and can occur without early signs. Although treatment with TDF and presence of cardiovascular risk factors were found frequently, predicting AKI seems very difficult.

Algorithm evolution for drug resistance prediction: comparison of systems for HIV-1 genotyping.

BACKGROUND: Different genotypic HIV resistance algorithms are based on different rules. They may therefore result in different drug-resistance interpretations for the same patient sample. In particular, for early periods of new retroviral inhibitors or classes, sequence interpretation is expected to vary. One would, however, assume that those differences between systems wane with growing experience and that different algorithms yield similar results for well-established drugs. METHODS: To assess the concordance of the Agence Nationale de Recherche sur le SIDA (ANRS), Rega and Stanford-HIVdb algorithms and their evolution over time, we analysed 284 routine samples with the current versions of each algorithm in 2004 and 2013. For 446 recent clinical sequences the differences for actual drugs were analysed. Scoring as 'susceptible' by one algorithm and 'resistant' by a second one defined a discordance. RESULTS: The longitudinal analysis showed similar overall discordances for both time points as well as an evolution over time. The actual analysis demonstrated a higher overall discordance rate, mainly for certain drugs. Most deviations reflected differences between the ANRS and the other two algorithms. CONCLUSIONS: This study demonstrates discordances between three most commonly used interpretation tools even for long-available drugs. It thereby reveals a need for further adjustment and improvement of current interpretation tools and may point at a possibly crucial role of subtype-specific information.

Etravirine: a good option for concomitant use with chemotherapy for Hodgkin's lymphoma.

The treatment of malignancies in HIV patients is challenged by the issue of drug-drug interactions between antiretroviral therapy and antineoplastic agents. While protease inhibitors have been shown to increase the incidence and severity of cancer therapy-related side effects, the impact of other antiretroviral agents on the tolerability and response to chemotherapy is less well documented. We report the successful use of an etravirine-based regimen in a patient treated with BEACOPP chemotherapy for advanced Hodgkin's lymphoma. Etravirine constitutes a valuable option for concomitant use with chemotherapy due to its moderate inducing effect on drug metabolising enzymes.

Propionibacterium acnes prosthetic valve endocarditis with abscess formation: a case report.

BACKGROUND: Endocarditis due to Propionibacterium acnes is a rare disease. Scant data on treatment of these infections is available and is based on case reports only. If the disease is complicated by abscess formation, surgical intervention combined with an antibiotic therapy might improve clinical outcome. In some cases, cardiac surgeons are reluctant to perform surgery, since they consider the intervention as high risk. Therefore, a conservative therapy is required, with little, if any evidence to choose the optimal antibiotic. We report the first case of a successfully treated patient with P. acnes prosthetic valve endocarditis without surgery. CASE PRESENTATION: We report the case of a 29-year-old patient with a prosthetic valve endocarditis and composite graft infection with abscess formation of the left ventricular outflow tract due to P. acnes. Since cardiac surgery was considered as high risk, the patient was treated intravenously with ceftriaxone 2 g qd and rifampin 600 mg bid for 7 weeks and was switched to an oral therapy with levofloxacin 500 mg bid and rifampin 600 mg bid for an additional 6 months. Two sets of blood cultures collected six weeks after completion of treatment remained negative. The patient is considered to be cured based on absence of clinical signs and symptoms, normal laboratory parameters, negative radiology scans and negative blood cultures, determined at site visits over two years after completion of treatment. CONCLUSION: To our knowledge, this is the first successfully managed patient with P. acnes prosthetic valve endocarditis with abscess formation of the left ventricular outflow tract who was treated with antibiotics alone without a surgical intervention. A six month treatment with a rifampin and levofloxacin combination was chosen, based on the excellent activity against stationary-phase and adherent bacteria.

Perfil da mortalidade neonatal em Porto Alegre: revisäo de 715 casos de necrópsias / Profile of the neonatal mortality in Porto Alegre: review of 715 cases of necropsy

Para a programaçäo da assistência e educaçäo médica é fundamental o conhecimento dos tipos e freqüências de patologias que acometem a populaçäo neonatal da nossa regiäo. Com essa finalidade, os autores, revisaram 715 casos de necrópsias realizadas no HCPA, num período de dez anos, 75,2% dos casos eram provenientes de outros hospitais de Porto Alegre e o restante do próprio HCPA. Os resultados obtidos em relaçäo à mortalidade neonatal correspondem aos descritos na literatura, sendo que nos casos provenientes de outros hospitais de Porto Alegre predominaram: prematuridade (48,3%), doenças hematológicas (46,6%), membrana hialina (33,0%), doenças infecciosas (21,9%), sofrimento fetal (21,2%), mal formaçöes (16,2%), outras (9,4%); e no HCPA: prematuridade (62,7%), membrana hialina (38,4%), doenças hematológicas (36,2%), malformaçöes (24,3%), sofrimento fetal (15,9%),doenças infecciosas (13,6%), e outras (11,9%). Tais dados salietam as características terciárias do HCPA. Esses dados podem contribuir para o conhecimento das condiçöes de saúde de recém-nascidos em nosso meio