Comparison of the f-HPV typing™ and Hybrid Capture II® assays for detection of high-risk HPV genotypes in cervical samples.

Human papillomavirus genotyping is being considered in cervical screening programs and for monitoring the effectiveness of HPV vaccination. Both approaches require access to fast, easy and high-throughput technology. The aim of this study was to compare a new commercial assay (f-HPV typing™) with the Hybrid Capture II® (HC2) to detect HPV infection. The F-HPV typing is a multiplex fluorescent PCR method recognizing E6 and E7 regions of 13 high-risk (HR) HPV types, the same set of HR-types targeted HC2 test. A subset of 157 cervical samples was tested with both assays. The percentage of positive HR-HPV DNA samples was 24% (37/155) by HC2 and 33% (49/155) by f-HPV typing. Concordant results were found in 133/155 (overall agreement, 85.8%; Cohen's kappa=0.65). The analytical sensitivity and specificity of f-HPV were 97.6 and 93, respectively. In conclusion, this study shows that the f-HPV assay provides a good alternative to HC2 to detect HPV infection, allowing simple and rapid HPV genotyping and detecting multiple infections.

Human papillomavirus 16 integration and risk factors associated in anal samples of HIV-1 infected men.

BACKGROUND: The integration of HPV-16 DNA into the host genome is considered an important event in the progression of premalignant cervical lesions to cervical cancer. The aim of our study was to assess the prevalence of HPV-16 integration in anal cytologic specimens of HIV-1 infected men and its association with risk factors. PATIENTS METHODS: This cross-sectional study included 269 HIV-infected males. Detection and typing of HPV-infection was done by multiplex PCR, and integration of HPV-16 by real-time PCR. RESULTS: The overall anal HPV-infection prevalence was 78% (209/269), 29% (77/269) for HPV-16 infection, and 9% (25/269) for HPV-16 integration. In HPV-16 infected group, the integration prevalence represented 32% (25/77). The only risk factor associated with HPV-16 integration was the time since HIV diagnosis (OR = 1.2, 95% CI: 1.0-1.3; P = 0.010). The risk factors associated with abnormal cytology results were: HPV infection (OR = 17.8, 95% CI: 6.8-46.6), HPV-16 infection (OR = 4.6, 95% CI: 2.5-8.4), and presence of HPV-16 integrated forms (OR = 11.7, 95% CI: 1.5-93.5). Moreover, in the multivariate analysis, the HPV-16 integration continued representing the most important risk factor (OR = 20, 95% CI: 1.6-226) for anal cytologic abnormalities. CONCLUSION: HPV-16 infection and its integration in anal cells were highly prevalent in HIV-infected men. The assessment of HPV-16 integration rather than HPV-infection could be a good biomarker for predicting anal precancerous lesions in HIV-positive men.

Pneumocystis jirovecii pneumonia in Spanish HIV-infected patients in the combined antiretroviral therapy era: prevalence of dihydropteroate synthase mutations and prognostic factors of mortality.

The incidence of Pneumocystis jirovecii pneumonia (PCP) in HIV-infected patients has decreased thanks to sulfa prophylaxis and combined antiretroviral therapy. The influence of P. jirovecii dihydropteroate synthase (DHPS) gene mutations on survival is controversial and has not been reported in Spain. This prospective multicenter study enrolled 207 HIV-infected patients with PCP from 2000 to 2004. Molecular genotyping was performed on stored specimens. Risk factors for intensive care unit (ICU) admission and mortality were identified using a logistic regression model. Seven patients (3.7%; 95% confidence interval [CI], 1.5-7.5%) had DHPS mutations. Overall mortality was 15% (95% CI, 10-21%), rising to 80% (95% CI, 61-92%) in patients requiring mechanical ventilation. None of the patients with DHPS mutants died, nor did they need ICU admission or mechanical ventilation. PaO(2) <60 mm Hg at admission was a predictor of ICU admission (P = 0.01), and previous antiretroviral therapy predicted non-ICU admission (P = 0.009). PaO(2) <60 mm Hg at admission and ICU admission during the 1st week were predictors of mortality (P = 0.03 and P < 0.001, respectively). The prevalence of DHPS mutants in Spain is low and is not associated with a worse outcome. Severe respiratory failure at admission is the strongest predictor of PCP outcome.

Management of HIV/hepatitis C virus-coinfected patient non-responders to hepatitis C virus antiviral therapy and relapsers.

PURPOSE OF REVIEW: To examine recent developments in the management of HIV/hepatitis C virus-coinfected patients who relapsed or who responded poorly to initial therapy, with particular emphasis on peginterferon plus ribavirin. RECENT FINDINGS: End-stage liver disease is the first cause of non-AIDS-related mortality in patients on antiretroviral therapy. A pool analysis of recent studies suggested that only 33% of HIV/hepatitis C virus-coinfected patients will achieve sustained virological response with peginterferon plus ribavirin. A substudy of the APRICOT trial shows that this strategy will benefit liver histology even in non-responding patients. The management of side effects is important and, according to a recent study, erythropoietin can improve clinical outcomes of hepatitis C virus therapy, although no direct association between response and the control of haematological toxicity was demonstrated. Patients who did not clear hepatitis C virus RNA with a slow virological response to previous courses of peginterferon and ribavirin might benefit from prolonging therapy to up to 72 weeks. SUMMARY: Re-treatment strategies in non-responders to previous interferon-based therapies and relapsers should consider the previous virological response profile and ensure that treatment-related toxicity is controlled to avoid dose reductions or premature treatment interruptions. Further studies are needed to optimize therapeutic regimens.

Enfermedad de Hodgkin en pacientes con infección por el virus de la inmunodeficiencia humana. Estudio de 15 casos / Hodgkin's disease in patients infected by the human immunodeficiency virus. Study of fifteen cases

Fundamento: Aunque la enfermedad de Hodgkin (EH) no se considera como una entidad definitoria de sida, en los pacientes infectados por el VIH presenta unas características clínicas y biológicas diferenciadas. Pacientes y métodos: Estudio de las características clinicopatológicas y analíticas, de la presencia del virus de Epstein-Barr (VEB) (reacción en cadena de la polimerasa) y del pronóstico en 15 pacientes con EH e infección por el VIH diagnosticados en un solo centro durante un período de 10 años. Resultados: Trece enfermos presentaban signos B; en 10 había afección extraganglionar y 12 presentaban una EH avanzada. Los tipos histológicos más frecuentes fueron la celularidad mixta (6) y la depleción linfocítica (6). La media (DE) de linfocitos CD4 fue 0,10 (0,08) * 109/l. Se evidenció la presencia del VEB en la biopsia ganglionar en 3 de 4 pacientes analizados. Hubo respuesta completa al tratamiento en 7 de 14 pacientes (50 por ciento), la mediana de supervivencia global fue de 26 meses y la probabilidad de supervivencia libre de evento a los 2 años fue del 60 por ciento. Conclusiones: La EH en los pacientes con infección por el VIH se presenta en estadios avanzados, subtipos histológicos desfavorables, frecuente afección extraganglionar y presencia de signos B. El pronóstico es malo, lo cual se debe, sobre todo, a una baja tasa de respuesta al tratamiento (AU)

Background: In spite of not being considered as an AIDS defining illnes, Hodgkin's disease (HD) has specific clinical and biological features in HIV-infected patients. Patients and methods: Study of clinicopathologic and analytic characteristics, Epstein-Barr virus (EBV) detection (polymerase chain reaction), and prognosis in 15 patients with HD and HIV infection. Results: Thirteen patients had B symptoms, 10 extranodal involvement and 12 advanced HD. The most frequent histologic subtypes were mixed cellularity (6) and lymphocyte depletion (6). The mean (SD) of CD4 lymphocytes was 0.10 (0.08) * 109/l. The presence of EBV in lymph node biopsy was demonstrated in 3 out of 4 patients investigated. Complete remission (CR) was achieved in 7 out of 14 treated cases (50%), the median overall survival was 26 months and the 2 year event-free survival probability was 60%. Conclussions: In HIV-infected patients, HD presents in advanced stages, unfavourable histologic subtypes, frequent extranodal involvement and B symptoms. The prognosis is poor, mainly because of a low CR rate (AU)