ABSTRACT
HIV-HCV-HBV-coinfected patients were assessed to characterize the viral interactions in the setting of HIV coinfection and in the HAART era. All positive anti-HCV antibody and HBs antigen-positive HIV-infected patients were identified at five HIV clinics. Antihepatitis delta (HDV) antibody, serum HIV RNA, HCV RNA, and HBV DNA quantification and genotype determinations were performed. Out of 67 patients identified 47 (70%) were receiving anti-HBV therapy. HCV RNA and HBV DNA were detectable in 52.5% and 37% of patients, respectively. All possible patterns were found, regardless of anti-HBV therapy. HDV coinfection was associated with undetectable HCV RNA [RR 9.52 (95% CI 1.85-49.01); p = 0.007]. Independent factors predicting undetectable HBV DNA lacked HBeAg [RR 13.94 (95% CI 3.05-63.72); p = 0.001] and use of anti-HBV therapy [RR 11.42 (95% CI 2.43-53.54); p = 0.002]. Replication and genotypes of HCV or HBV had no impact on the replication of the other virus. In conclusion, in this cohort of triple infection (HBV/HCV/HIV) various viral patterns were identified. Spontaneous HCV clearance was frequent, and it was independently associated with HDV coinfection. In the absence of HBV therapy, HBV most often actively replicates. HBV/HCV replication or genotypes were not related to the replication of the other virus.
Subject(s)
HIV Infections/drug therapy , HIV Infections/epidemiology , HIV/physiology , Hepatitis B/epidemiology , Hepatitis C/epidemiology , Adult , Anti-Retroviral Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Antiviral Agents/therapeutic use , Comorbidity , Cross-Sectional Studies , DNA, Viral/analysis , DNA, Viral/genetics , Female , HIV Infections/virology , Hepacivirus/classification , Hepacivirus/isolation & purification , Hepacivirus/physiology , Hepatitis B/blood , Hepatitis B/drug therapy , Hepatitis B/virology , Hepatitis B Surface Antigens/blood , Hepatitis B virus/classification , Hepatitis B virus/isolation & purification , Hepatitis B virus/physiology , Hepatitis C/blood , Hepatitis C Antibodies/blood , Hepatitis D/epidemiology , Hepatitis Delta Virus/genetics , Hepatitis Delta Virus/isolation & purification , Humans , Italy/epidemiology , Male , Mexico/epidemiology , Middle Aged , North Carolina/epidemiology , RNA, Viral/analysis , Retrospective Studies , Risk Factors , Spain/epidemiology , Virus ReplicationABSTRACT
Toxic epidermal necrolysis (TEN) is a severe cutaneous reaction that most commonly is related to drug exposure and that clinically can be confused with other bullous dermatoses, particularly staphylococcal scalded skin syndrome (SSSS) and erythema multiforme major (the Stevens-Johnson syndrome). We report the first case, to our knowledge, of TEN associated with ethambutol hydrochloride administration. Toxic epidermal necrolysis can be partially differentiated from other bullous dermatoses by history and clinical presentation. Microbiological results (eg, the isolation of Staphylococcus aureus in SSSS) and immunological studies (eg, the demonstration of immune complexes in the Stevens-Johnson syndrome) may aid in differentiation, but ultimately the diagnosis depends on histopathological examination of involved skin.