Neurotuberculosis: Control of Steroid-Refractory Paradoxical Inflammatory Reaction With Ruxolitinib.

Paradoxical inflammatory reactions associated with treatment of neurotuberculosis can lead to severe morbidity and mortality and may not be controlled by steroids alone. We report the use of the Janus kinase inhibitor ruxolitinib to treat a steroid-refractory neurotuberculosis paradoxical reaction.

High Rates of Anal High-Grade Squamous Intraepithelial Lesions in HIV-Infected Women Who Do Not Meet Screening Guidelines.

BACKGROUND: Human immunodeficiency virus (HIV)-infected women have a higher burden of anal high-grade squamous intraepithelial lesions (HSIL) and anal cancer (AC) compared with HIV-uninfected women. Guidelines for AC screening in this population are heterogeneous. Here we report outcomes and risk factors for anal HSIL following implementation of universal AC screening offered to all HIV-infected women. METHODS: Data from women who underwent AC screening with anal cytology from April 2009 to July 2014 were analyzed. Routine clinical data included anal and cervical cytology, demographic/behavioral data, and high-resolution anoscopy (HRA) results. We evaluated the association of cytology with HRA results, and predictors of HSIL pathology, and compared rates of HSIL pathology among women meeting screening guidelines to those who did not. RESULTS: Seven hundred forty-five HIV-infected women were screened with anal cytology. Thirty-nine percent had abnormal anal cytology on initial screen and 15% on secondary screen; 208 women underwent HRA following abnormal anal cytology. HSIL was found in 26% and 18% of anal biopsies following initial and secondary screening, respectively. One woman had AC. Cigarette smoking more than doubled HSIL risk. Among women who underwent AC screening despite not meeting existing guideline criteria, 21% and 10%, respectively, were found to have HSIL on biopsy. Neither meeting criteria for screening nor history of receptive anal sex was significantly associated with HSIL. CONCLUSIONS: Anal HSIL is common in HIV-infected women. Substantial numbers of HSIL would have been missed by strictly adhering to existing AC screening guidelines. These results support routine screening of all HIV-infected women regardless of human papillomavirus history or sexual practices.

Direct-acting antiviral-based therapy for chronic hepatitis C virus in HIV-infected patients.

PURPOSE OF REVIEW: The aim of this review was to detail the current therapies and treatments for chronic hepatitis C virus in coinfected patients, focusing on HCV antiviral agents currently used in practice today or scheduled to enter the open market soon. RECENT FINDINGS: Several direct-acting antiviral (DAA) combinations show high sustained virologic response (SVR) rates in HIV/HCV-coinfected patients, which are often close to those observed in HCV-monoinfected patients. Most recommendations regarding treatment stem from trials with coinfected patients. However, data are lacking for some aspects of HCV-treatment in coinfection, so extrapolations must be made from data obtained predominately from monoinfected patients. SUMMARY: HIV/HCV-coinfected patients, who, not too long ago, had inferior outcomes in capturing SVR, now enjoy similar fates as the monoinfected patients. They should thus be prioritized for treatment, since HCV and liver disease have become major causes of morbidity and mortality in this population. However, potential drug-drug interactions between antiretroviral agents and DAAs have to be systematically anticipated before initiating HCV therapy.

Veinte años de investigación sobre HTLV-1 y sus complicaciones médicas en el Perú: perspectivas generales: [revisión] / Twenty years of research on HTLV-1 and its medical complications in Peru: general perspectives: [review]

El virus linfotrópico humano tipo 1 (HTLV-1 [human T-lymphotropic virus]) es un retrovirus con amplia distribución mundial. Pertenece a la familia Retroviridae y a la subfamilia Oncovirinae. Es un virus linfotrópico que compromete principalmente linfocitos CD4. El HTLV-1 está relacionada como agente etiológico de la leucemia/linfoma de células T del adulto (LLTA) y de la mielopatía/paraparesia espástica tropical (M/PPET).

The human T-lymphotropic virus type 1 (HTLV-1 [human T-lymphotropic virus]) is a retrovirus with worldwide distribution. Belongs to the Retroviridae family and subfamily Oncovirinae. It is a lymphotropic virus that mainly involves CD4 lymphocytes. The HTLV-1 is related as the etiologic agent of leukemia / lymphoma, adult T-cell (ATLL) and myelopathy / tropical spastic paraparesis (M / PPET).