ABSTRACT
In HIV-infected patients, central nervous system (CNS) aspergillosis is rare. Historically, the outcome of such infections has been almost invariably fatal. We report a case involving an AIDS patient with an Aspergillus fumigatus brain abscess who survived for longer than 10 months after surgical drainage and therapy with voriconazole.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Aspergillus fumigatus/isolation & purification , Neuroaspergillosis/diagnosis , Adult , Antifungal Agents/therapeutic use , Brain/pathology , Head/diagnostic imaging , Humans , Male , Neuroaspergillosis/drug therapy , Neuroaspergillosis/surgery , Pyrimidines/therapeutic use , Radiography , Survival , Time Factors , Treatment Outcome , Triazoles/therapeutic use , VoriconazoleABSTRACT
BACKGROUND: Suboptimal improvement in CD4+ T-cell count is not uncommon in HIV-infected patients with suppressed plasma HIV RNA levels, and a decrease in CD4+ T-cell count in patients with suppressed or low-level viraemia has been observed. METHODS: Our objectives were to identify the prevalence of decreasing CD4+ T-cell counts during suppressed or low-level viraemia, to determine the frequency of clinical events during and immediately after such decreases, and to examine for associations with individual variables. A matched case-control study was undertaken using the Duke Infectious Diseases Clinic database (n = 3,949). Cases had at least two consecutive significant decreases in either CD4+ absolute count or CD4+ percentage, while also having plasma HIV RNA levels < 1,000 copies/ml. RESULTS: The prevalence of decreasing CD4+ T-cell counts during suppressed or low-level viraemia was 1.22%. Only three HIV-associated clinical events occurred. The majority of cases had an increase in the CD4+ T-cell count immediately following the study period. The use of either zidovudine or stavudine was weakly associated with decreasing CD4+ T-cell counts in a multivariable analysis, but this association was not present in cases with only a decrease in CD4+ T-cell percentage. CONCLUSIONS: Decreasing CD4+ T-cell counts during suppressed or low-level viraemia are rare, typically transient, and not associated with an increase in HIV-associated clinical events.
Subject(s)
CD4 Lymphocyte Count , CD4-Positive T-Lymphocytes/immunology , HIV Infections/immunology , HIV Infections/virology , HIV/physiology , Viremia , Adult , Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Case-Control Studies , Female , HIV Infections/drug therapy , Humans , Male , RNA, Viral/blood , Stavudine/therapeutic use , Viral Load , Zidovudine/therapeutic useABSTRACT
Virologic relapse after initial virologic suppression remains a concern for patients on antiretroviral therapy (ART). Multiple factors may contribute to virologic relapse, including suboptimal adherence, resistance, and pharmacokinetic issues. The major guidelines for HIV care are in agreement that ART regimen change is indicated in relapse because resistance is identified, but the guidelines are not completely clear on the timing of regimen change. When relapse occurs due to resistance, patients may continue with viremia well below their set points, stable or increasing CD4+ counts, and clinical health for several years. However, delaying a switch in the treatment regimen may lead to the accumulation of resistance which compromises future treatment response. In general, a lower switch threshold is recommended for patients during relapse on first or second line regimens.
Subject(s)
Anti-HIV Agents/administration & dosage , HIV Infections/drug therapy , HIV Infections/virology , HIV-1/physiology , RNA, Viral/blood , Reverse Transcriptase Inhibitors/administration & dosage , Anti-HIV Agents/pharmacokinetics , Anti-HIV Agents/pharmacology , Anti-HIV Agents/therapeutic use , Drug Administration Schedule , Drug Resistance, Viral , Drug Therapy, Combination , HIV-1/drug effects , Humans , Reverse Transcriptase Inhibitors/pharmacokinetics , Reverse Transcriptase Inhibitors/pharmacology , Reverse Transcriptase Inhibitors/therapeutic use , Viral Load , Viremia/drug therapy , Viremia/virologyABSTRACT
The fixed dose combination of abacavir with lamivudine represents a new treatment option for patients infected with HIV. Fixed dose combination abacavir/lamivudine has the convenience of one pill and once-daily dosing. It achieves comparable suppression of plasma HIV RNA with the pill's individual components dosed twice daily and with thymidine analogs combined with lamivudine. The combination is well tolerated, with the potential advantages of less lipoatrophy and fewer metabolic perturbations. However, the abacavir component may cause hypersensitivity reactions, which are reported in up to 8% of patients, and are potentially life threatening. Fixed dose combination abacavir/lamivudine should be considered as a viable treatment option for HIV-infected patients, particularly for those who have otherwise limited nucleoside reverse transcriptase inhibitor choices.
Subject(s)
Anti-HIV Agents/administration & dosage , Dideoxynucleosides/administration & dosage , HIV Infections/drug therapy , HIV-1/drug effects , Lamivudine/administration & dosage , Animals , Anti-HIV Agents/chemistry , Dideoxynucleosides/chemistry , Drug Combinations , HIV Infections/genetics , HIV-1/genetics , Humans , Lamivudine/chemistryABSTRACT
We describe a case of coarctation endarteritis in an adult and review the literature pertaining to this condition. Adult coarctation endarteritis is a rare entity but often represents the initial presentation of coarctation. Diagnosis is critically important given the risk of rupture. Cardiovascular magnetic resonance imaging can be helpful in management.
Subject(s)
Aortic Coarctation/diagnostic imaging , Endarteritis/diagnostic imaging , Magnetic Resonance Imaging , Streptococcal Infections/diagnostic imaging , Adolescent , Adult , Aorta/pathology , Aortic Coarctation/diagnosis , Aortic Coarctation/microbiology , Endarteritis/diagnosis , Endarteritis/microbiology , Female , Humans , Male , Radiography , Streptococcal Infections/diagnosis , Streptococcal Infections/microbiology , Viridans StreptococciABSTRACT
Non-O1 Vibrio cholerae (NOVC) is a rare cause of septicemia in the United States. We report a case of NOVC septicemia and discuss the literature pertaining to this organism. NOVC takes on new significance given that it can be confused with toxigenic V. cholerae, a Centers for Disease Control and Prevention category B bioterrorism agent.