Pulmonary Kaposi sarcoma in the era of highly active antiretroviral therapy.

OBJECTIVE: Since the introduction of highly active antiretroviral therapy (HAART) there has been a dramatic reduction in the incidence of Kaposi sarcoma (KS) and an improvement in survival. We wished to examine whether the outcome in pulmonary KS (pKS) has also altered. METHODS: In a single-institution cohort of 1140 HIV-positive patients with KS, 305 patients were diagnosed in the HAART era (1996-2004). We examined the clinicopathological features and outcomes of these patients, of whom 25 had pKS and 280 did not. RESULTS: Patients with pKS had lower CD4 cell counts at the time of KS diagnosis (Mann-Whitney U-test P=0.005). The incidence of pKS was higher in African patients than in non-African patients in this sample (Fisher's test, P=0.001). There were no significant differences in age, gender, plasma HIV-1 viral load or prior HAART treatment at the time of KS diagnosis. Five-year overall survival in the pKS group was 49% [95% confidence interval (CI) 26-73%] as compared with 82% (95% CI 76-87%) for the non-pKS group (log rank, P<0.0001). CONCLUSION: PKS remains an ominous diagnosis in the era of HAART, with a median survival of just 1.6 years.

Immune reconstitution inflammatory syndrome associated with Kaposi's sarcoma.

PURPOSE: A proportion of patients with HIV infection who subsequently receive highly active antiretroviral therapy (HAART) exhibit a deterioration in their clinical status, despite control of virologic and immunologic parameters. This clinical response, known as the immune reconstitution inflammatory syndrome (IRIS), occurs secondary to an immune response against previously diagnosed pathogens. PATIENTS AND METHODS: From our cohort of 5,832 patients treated in the HAART era, we identified 150 therapy-naive patients with a first presentation of Kaposi's sarcoma (KS). Their clinicopathologic features and progress were recorded prospectively. RESULTS: After commencing HAART, ten patients (6.6%) developed progressive KS, which we identify as IRIS-associated KS. In a comparison of these individuals with those whose KS did not progress, we found that IRIS-KS occurred in patients with higher CD4 counts (P = .03), KS-associated edema (P = .01), and therapy with both protease inhibitors and non-nucleosides together (P = .03). Time to treatment failure was similar for both groups, although the CD4 count declined more rapidly at first, in those patients with IRIS-associated KS. Despite this initial decline, in our clinical experience HAART could be successfully continued in those with IRIS-associated KS. CONCLUSION: We have identified IRIS-KS in a cohort of HIV patients with KS who start HAART.

Nucleotide sequence of coliphage HK620 and the evolution of lambdoid phages.

HK620 is a temperate lambdoid bacteriophage that adsorbs to the O-antigen of its host, Escherichia coli H. The genome of a temperature-sensitive clear-plaque mutant consists of 38,297 nucleotides in which we recognize 60 open reading frames (orfs). Eighteen of these lie in a region of the genome that we call the virion structure domain. The other 42 orfs lie in what we call the metabolic domain. Virions of HK620 resemble those of phage P22. The virion structural orfs encode three kinds of putative proteins relative to the virion proteins of P22: (1) those that are nearly (about 90 %) identical; (2) those that are weakly (about 30 %) identical; and (3) those composed of nearly and weakly identical segments. We hypothesize that these composite proteins form bridges between the virion proteins of the other two kinds. Three of the putative virion proteins that are only weakly identical to P22 proteins are 71, 60 and 79 % identical to proteins encoded by the phage APSE-1, whose virions also resemble those of P22. Because the hosts of APSE-1 and HK620 have been separated from each other by an estimated 200 My, we propose using the amino acid differences that have accumulated in these proteins to estimate a biological clock for temperate lambdoid phages. The putative transcriptional regulatory gene circuitry of HK620 seems to resemble that of phage lambda. Integration, on the other hand, resembles that of satellite phage P4 in that the attP sequence lies between the leftward promoter and int rather than downstream of int. Comparing the metabolic domains of several lambdoid phage genomes reveals seven short conserved sequences roughly defining boundaries of functional modules. We propose that these boundary sequences are foci of genetic recombination that serve to assort the modules and make the metabolic domain highly mosaic genetically.

General transducing phages like Salmonella phage P22 isolated using a smooth strain of Escherichia coli as host.

A smooth colony strain, resistant to phages lambda and P22, was isolated from sewage and identified as Escherichia coli (strain H). Four temperate phages plaquing on strain H were isolated from sewage. The archetype, HK620, does not plaque on strains C and K12 of E. coli nor on the LT2 strain of Salmonella enterica. Bacterial mutants resistant to a clear plaque mutant of HK620 produce rough colonies. Some are also galactose-negative, a few are histidine auxotrophs, and most show sensitivity to lambda. HK620 can transduce a wide variety of auxotrophic mutants of E. coli H to prototrophy. It can recombine with lambda but its virions resemble those of P22.

The attachment sites of T5-host range temperate coliphages.

The attachment sites of 13 temperate coliphages were determined. Specialized transduction of proAB mutants was shown by eight isolates and of a his mutant by another two. Two isolates were concluded to integrate at atthtt and the integration site of one isolate remained undetermined.

Lambdoid coliphages conferring a novel pattern of phage sensitivity on Escherichia coli K12.

Seven temperate coliphages recovered from naturally occurring lysogenic strains of Escherichia coli were found to lyse E. coli C but not K12. Four of these C-specific phages produced mutants (hrk) able to grow on K cells. The K cells harbouring HK253hrk and HK183hrk were converted so that they could adsorb and be lysed by three other non-mutant C-specific phages. HK253, HK183 and two other phages were shown to recombine with phage lambda.

Temperate coliphage HK253: attachment site and restricted transduction of proAB mutants of Escherichia coli K-12.

Temperate coliphage HK253 integrates near the proAB locus on the Escherichia coli K-12 chromosome. It can bring about specialized transduction of proAB and phoE mutants of E. coli, but it is incapable of general transduction. One of the proline-transducing particles was found to be nondefective.

Assignment of two new host range types to the P2 family of temperate coliphages.

Six non-inducible coliphages which grow on Escherichia coli C but not on K12 (C-specific) were shown to be antigenically related to P2. All six were shown to be P4 helpers and some of them could also recombine with P2.

Lambdoid coliphage HK139 integrates between his and supD.

Phage HK139 is UV inducible and lambda homoimmune and has the host range of phi80. It can recombine with lambda as well as with phi80, and in the prophage form it is found integrated between the loci his and supD.

Accessory replicons of species of Salmonella and Shigella.

Shigella and Salmonella strains isolated from clinical samples were examined. Out of 42 Shigella strains tested, 17 (40%) were found to be colicinogenic and another 3 were lysogenic. All three lysogens yielded a phage antigenically homologous to coliphage P2. Out of 30 strains tested, only 1 was found to be resistant to both neomycin and sulfamethoxazole. Out of 48 strains of Salmonella tested for drug resistance, only 2 showed multiple drug resistance. In contrast to Shigella isolates, the Salmonella isolates were infrequently (approximately 5%) bacteriocinogenic. The frequency of lysogeny in Salmonella strains was found to be 6% when tested on Salmonella typhimurium LT2, but by using a set of five indicators belonging to species Salmonella potsdam, Salmonella mbadanka, Salmonella dublin, Salmonella london, and Salmonella wandsworth, 50% of the strains were shown to be lysogenic. Salmonella phages related to P22 were recoverable from Salmonella saintpaul, Salmonella indiana, and Salmonella heidelberg. Some isolates of S. typhimurium yielded a temperature-sensitive and P22-heterologous phage which was found to be a more efficient transducer of bacterial genetic markers than P22. EcoRI-generated fragments of the DNA of some phages permitted the establishment of a clonal descent for some of the wild-type lysogenic bacterial strains. This last observation points out the potential usefulness of prophages as epidemiological markers.

Restriction fragment analysis for differentiation of indistinguishable temperate coliphages.

DNA of lambda and seven related phages was digested with restriction endonuclease, EcoRI. Seven different fragment patterns were observed, only two of the eight phages showing identical profiles. Restriction enzyme fragment analysis is thus shown to be a sensitive tool for the differentiation of biologically indistinguishable phages.

Incidence of lysogeny, colicinogeny, and drug resistance in enterobacteria isolated from sewage and from rectum of humans and some domesticated species.

Enterobacteria were isolated by streaking swabs of sewage and rectal swabs from human volunteers from domesticated animals. Thirty strains of human origin were identified as Escherichia coli. Out of 1,367 rectal isolates of animal origin, 21% were lysogenic (phi+), 29% were colicinogenic (col+), and 7% were col+ phi+. Out of 85 rectal samples more than 60% harbored variable numbers of col+ or phi+ bacteria. Lysogens harboring homoimmune prophages were detectable in six out of eight human subjects in sequential samples taken at weekly intervals. Chickens in Hong Kong are fed on antibiotic-containing feeds; the avian isolates contained the highest frequency (98%) of drug-resistant bacteria, whereas only 39% of the bovine and 61% of the human isolates were drug resistant. Transmissible drug resistance was demonstrable in sewage isolates and those from animal sources; the highest frequency (58%) of resistance donors was shown by the avian isolates, and the lowest (9%) was shown by the bovine isolates. Unselected marker analysis has shown that a vast majority of multiply resistant donors of diverse origins are able to transmit multiple resistance.

Host range, immunity and antigenic properties of lambdoid coliphage HK97.

Temperate coliphage HK97 was isolated from pig dung. Although HK97 is antigenically unrelated to coliphage lambda, it has similar morphology, host range and immunity properties, and can recombine with it.

Temperate coliphages: classification and correlation with habitats.

Temperate coliphages were recovered from sewage, mammalian feces, and lysogenic strains of Escherichia coli. A total of 32 phages of independent origin were divided into six groups by applying the criteria of host range, antigenic homology, and the ultraviolet inducibility of the prophage. The demonstration of genetic interactions in some cases has confirmed the classification scheme. Nine phages were assigned to the P2 family and 19 to the lambda family. The remaining four isolates may represent some novel phylogenetic types. Phages recovered from the lysogenic strains of E. coli were all found to be P2 related, whereas a majority of the phages recovered as cell-free plaque-forming units were assignable to the lambda family. It is proposed that the biological attributes of the phages belonging to the two principal families are reflected in the distribution patterns observed. The virions of phage HK256 show multiple tail fibers and may thus represent a "new" virion form among the temperate coliphages.

Coliphage HK243: biological and physicochemical characteristics.

Coliphage HK243 can form plaques on Escherichia coli C and K-12, but not B. The plaques are 1-2 mm in diameter and are opaque areas which clear upon exposure to chloroform vapor. During one-step growth, the eclipse and the latent periods are 20 and 30 min, respectively. Phage-infected cells continue to produce cell-free plaque-forming units for as long as 80 min after the end of the latent period, although at high multiplicities of infection (MOI) most cells lyse. No lysogenic bacteria have been found among survivors, so HK243 is considered a virulent phage. Some of the cells surviving a high MOI challenge are maltose negative and resistant to both HK243 and coliphage lambda. This fact has made possible the isolation of lambda-resistant mutants of lambda-lysogens. However, no serological cross-reaction between the phages lambda and HK243 has been detected. Genetic data involving three essential loci and a locus controlling plaque morphology suggest a circular linkage map. The virions are tadpole-shaped with an icosahedral head 68 nm long which is attached to a flexible tail 131 nm long. The phage has a linear, duplex DNA genome of molecular weight approximately 44 x 10(6) and a base composition of 33% adenine, 31% thymine, 16% guanine, and 20% cytosine.

Temperate coliphage HK022. Clear plaque mutants and preliminary vegetative map.

Wild type phage HK022 was mutagenized by N-methyl-N'-nitro-N-nitrosoguanidine to induce clear plaque mutants. A total of 225 clear plaque mutants were isolated and 198 of these were assignable to one or the other of two complementation groups of the corresponding cistrons which have been designated as cI and cII, respectively. Approximately 25% of the c mutants were found to be temperature-sensitive (cts); producing turbid plaques at 32 C and clear plaques at 38 C and above. From complementation tests involving cI and cII mutants, bacteria lysogenic for cII prophage were frequently obtained. Double lysogens harboring a CI and a cII prophage were infrequently found and single lysogens harboring only a cI prophage have not been recovered. Bacterial lysogens harboring a prophage carrying a cts mutation in the cI cistron were readily obtainable. However, such lysogens show a lethal phenotype at 40 C and above, although they appear to be fully viable at 32 C. It is shown that by incubation of lysogens harboring a cts mutant of the cI cistron at 42 C, it is possible to isolate cryptic lysogens which are non-immune but harbor at least one of the phage sus+ alleles. Genetic data involving cI, cII, and two complementing sus mutants of essential genes are presented. From these data the following vegetative map is deduced: sus4--cII-cI-sus3.

Studies on bacteriophage distribution: virulent and temperate bacteriophage content of mammalian feces.

Freshly voided samples of the feces of cows, pigs, and humans were analyzed for the enumeration of cell-free plaque-forming units (PFU) of coliphages and Salmonella phages. Coliphage PFU counts per gram (wet weight) of feces were found to range from less than 10(1) to greater than 10(7). Salmonella phages were found in three out of five porcine samples, but none were found in the four bovine samples analyzed. Virulent coliphages related to the phiX174/S13 serological group showed some "habitat preference" in that the S13 type of phages was found only in pig feces, whereas the phiX174 type of phages was found only in cow dung. Temperate coliphages were detectable in a majority of samples of both human and porcine origin but were infrequently found in bovine samples. About 80% of the temperate coliphages of fecal origin have been found to be serologically related to phage HK022 (Dhillon and Dhillon, 1973), and all are efficiently inducible by ultraviolet light irradiation. However, considerable diversity with the group was found when the prophage immunity pattern of 10 randomly selected isolates was examined.