The Danish PEP Registry: Experience with the use of post-exposure prophylaxis following blood exposure to HIV from 1999-2012.

BACKGROUND: The risk of occupational exposures to blood cannot be eliminated completely and access to post-exposure prophylaxis (PEP) to prevent HIV transmission is important. However, PEP administration has been associated with frequent adverse effects, low compliance and difficulties to ensure a proper risk assessment. This nationwide study describes 14 years of experience with the use of PEP following blood exposure in Denmark. METHODS: A descriptive study of all PEP cases following non-sexual exposure to HIV in Denmark from 1999-2012. RESULTS: A total of 411 cases of PEP were described. There was a mean of 29.4 cases/year, increasing from 23 cases in 1999 to 49 cases in 2005 and then decreasing to 16 cases in 2012. Overall 67.2% of source patients were known to be HIV-positive at the time of PEP initiation, with no significant change over time. The median time to initiation of PEP was 2.5 h (0.15-28.5) following occupational exposure. Adverse effects were reported by 50.9% with no significant difference according to PEP regimen. In 85.1% of cases with available data, either a full course of PEP was completed or PEP was stopped because the source was tested HIV-negative. Only 6.6% stopped PEP early due to adverse effects. CONCLUSIONS: PEP in Denmark is generally prescribed according to the guidelines and the annual number of cases has declined since 2005. Adverse effects were common regardless of PEP regimens used and new drug regimens should be considered.

Effect of fish oil (n-3 polyunsaturated fatty acids) on plasma lipids, lipoproteins and inflammatory markers in HIV-infected patients treated with antiretroviral therapy: a randomized, double-blind, placebo-controlled study.

Patients on antiretroviral therapy are reported to have an increased risk of cardiovascular disease. We aimed to investigate the effect of n-3 polyunsaturated fatty acids (n-3 PUFAs) on plasma lipids, lipoproteins and inflammatory markers in HIV-infected patients treated with antiretroviral therapy. We randomized 51 patients in a placebo-controlled, double-blind trial to receive either 2 capsules of Omacor twice daily or 2 capsules of placebo. Compliance was measured by determining levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in neutrophils. Plasma triglycerides were reduced in the n-3 PUFA group by 0.14 mmol/l after 12 weeks of treatment (n=26), while plasma triglycerides increased by 0.36 mmol/l in the control group (n=25). The difference between groups was significant, p=0.03. No significant effect of treatment was found for total cholesterol, high-density lipoprotein (HDL) or low-density lipoprotein (LDL) cholesterol or apolipoproteins. There was a significant increase in leukotriene B5 (LTB5) and LTB5/LTB4 ratio in the n-3 PUFA group compared to the control group. Baseline values for intercellular adhesion molecule-1 (ICAM), vascular cell adhesion molecule-1 (VCAM) and highly sensitive C-reactive protein (hsCRP) were comparable at baseline, and the intervention did not change these parameters significantly. The present study showed that treatment with n-3 PUFA slightly decreased plasma triglycerides and induced anti-inflammatory effects by increasing formation of anti-inflammatory LTB5.

High levels of chronic immune activation in the T-cell compartments of patients coinfected with hepatitis C virus and human immunodeficiency virus type 1 and on highly active antiretroviral therapy are reverted by alpha interferon and ribavirin treatment.

Chronic immune activation is a driver of human immunodeficiency virus type 1 (HIV-1) disease progression. Here, we describe that subjects with chronic hepatitis C virus (HCV)/HIV-1 coinfection display sharply elevated immune activation as determined by CD38 expression in T cells. This occurs, despite effective antiretroviral therapy, in both CD8 and CD4 T cells and is more pronounced than in the appropriate monoinfected control groups. Interestingly, the suppression of HCV by pegylated alpha interferon and ribavirin treatment reduces activation. High HCV loads and elevated levels of chronic immune activation may contribute to the high rates of viral disease progression observed in HCV/HIV-1-coinfected patients.

Small artery structure is an independent predictor of cardiovascular events in essential hypertension.

OBJECTIVE: Structural abnormality of resistance arteries is a characteristic pathophysiological phenomenon in essential hypertension and can be assessed in vitro as an increase in the media: lumen ratio (M: L) of isolated small arteries. We have investigated whether M: L is a risk predictor in uncomplicated essential hypertensive patients. Recently, high M: L was demonstrated as a prognostic marker in patients at high cardiovascular risk, including normotensive type 2 diabetic patients. Since diabetes is associated with pressure-independent changes in M: L, the relevance of this finding to essential hypertension has been uncertain. METHODS: We conducted a follow-up survey of 159 essential hypertensive patients, who had previously been submitted to a M: L evaluation while participating in a clinical trial. They composed a homogeneous moderate-risk group, with no concomitant diseases, and represented 1661 years of follow-up. RESULTS: Thirty patients suffered a documented predefined cardiovascular event during follow-up. Increased relative risk (RR) was associated with M: L >or= 0.083 (mean level of the hypertensive cohort), RR = 2.34 [95% confidence interval (CI) 1.11-4.95], and with M: L >or= 0.098 (mean level of a normotensive control group + 2SD), RR = 2.49 (95% CI 1.21-5.11). Both results remained significant (RR = 2.19, 95% CI 1.04-4.64, and RR = 2.20, 95% CI 1.06-4.56, respectively) when adjusted for Heart Score level (10-year mortality risk-estimate, integrating age, gender, systolic blood pressure, cholesterol and smoking). CONCLUSION: Abnormal resistance artery structure independently predicts cardiovascular events in essential hypertensive patients at moderate risk.

[Candidemia in the hospitals in the Aarhus County, Denmark, 1993-2002]. / Candidaemier på Arhus Amts hospitaler 1993-2002.

INTRODUCTION: During recent years a rise in the occurrence of candidaemia has been reported in the USA as well as in Europe, and especially in intensive care units (ICUs). The aim of this study was to describe the frequency of candidaemia and related Candida infections in the hospitals of Aarhus County, Denmark, from 1993 to 2002, and to assess possible causal factors, among these the consumption of antimicrobial agents. MATERIALS AND METHODS: The material included blood cultures carried out at the Department of Clinical Microbiology, Aarhus University Hospital (AUH), during the study period, plus Candida-positive cultures from other normally sterile sites from patients with candidaemia. Microbiological findings were compiled from our laboratory information system, MADS. Information regarding the use of antimicrobial agents in the hospitals of Aarhus County was obtained from the University Hospital pharmacy and the Danish Medicines Agency Web site. RESULTS: During the study period the fraction of positive blood cultures was constant, while the fraction of positive cultures yielding Candida species increased from 1.8% to 3.4%, with an especially marked increase among patients in AUH. An increase in the proportion of Candida non-albicans species compared to C. albicans was noted, and it was also noted that the consumption of antimicrobial agents had risen markedly during the period. DISCUSSION: The present study adds to the assumption of a causal relationship between candidaemia and the use of antimicrobials and foreign bodies.

[Atherosclerosis and Chlamydia pneumoniae]. / Aterosklerose og Chlamydia pneumoniae.

Chlamydia pneumoniae could be associated with the risk of developing atherosclerosis and an increased risk of thromboembolic complications. However, the evidence of an association seems to be declining and there is no evidence of causality. The effect of antibiotic treatment in cardiovascular disease has been explored in epidemiologic studies and in randomised controlled trials. Data suggest a protective but short-lasting effect of macrolide antibiotics on cardiovascular disease. The effect could be the result of anti-bacterial as well as anti-inflammatory properties. Ongoing larger and longer lasting treatment trials could provide better measures of the effects of antibiotic treatment, although they will not clarify the role of C. pneumoniae. Currently, there is no indication for treating cardiovascular disease with antibiotics.