Necrotizing granulomatous vasculitis in advanced HIV infection.

We describe the first case of granulomatous necrotizing vasculitis not restricted to the central nervous system in an HIV-infected patient. No mycobacteria or drugs potentially associated with granuloma formation were involved in this patient, suggesting that the cause of this vasculitis was probably autoimmune. The development of granulomatous vascular inflammation in this patient with less than 200 CD4 cells/microl might have been due to immune overactivation. After starting potent antiretroviral therapy a profound immune deactivation was observed and the vasculitis did not relapse.

[Prevalence of Bartonella spp. seropositivity in human immunodeficiency virus-infected and non infected intravenous drug abusers]. / Prevalencia de seropositividad para Bartonella spp. en pacientes adictos a drogas por vía parenteral infectados y no infectados por el virus de la inmunodeficiencia humana.

BACKGROUND: Serology is an useful tool in the diagnosis of Bartonella spp. infections in human immunodeficiency virus (HIV) seronegative patients. The value of this technique in HIV co-infected individuals is unknown. The aim of this study was to assess the prevalence of Bartonella spp. seropositivity among intravenous drugs abusers (IDA), both HIV-infected and non-infected. PATIENTS AND METHOD: A retrospective seroepidemiological study was carried out among 241 IDA. One hundred and forty-seven of them were infected with HIV type 1. The titer of serum IgG antibodies against Bartonella spp. were determined. RESULTS: Thirty-three (14%) individuals were seropositive for Bartonella spp. Nineteen (13%) seropositive cases were found among HIV carriers and 14 (15%) among HIV uninfected people. No relationship between Bartonella spp. seropositivity and the CD4+ cell counts was found when HIV infected patients were analyzed. CONCLUSIONS: We have found a similar prevalence of Bartonella spp. seropositivity in HIV-infected and non HIV-infected IDA.

Prevalencia de seropositividad para Bartonella spp. en pacientes adictos a drogas por vía parenteral infectados y no infectados por el virus de la inmunodeficiencia humana / Prevalence of Bartonella spp. seropositivity in human immunodeficiency virus-infected and non infected intravenous drug abusers

FUNDAMENTO: La serología es útil en el diagnóstico de la infección por Bartonella spp. en pacientes inmunocompetentes. Se desconoce su rendimiento en individuos coinfectados por ambos microorganismos. Nuestro objetivo fue conocer la prevalencia de anticuerpos frente a Bartonella spp. en pacientes adictos a drogas por vía parenteral (ADVP), infectados y no infectados por el virus de la inmunodeficiencia humana (VIH). PACIENTES Y MÉTODO: Realizamos un análisis seroepidemiológico retrospectivo en 241 pacientes ADVP, de los cuales 147 estaban infectados por el VIH. En todos los pacientes se determinó la presencia de anticuerpos IgG frente a Bartonella spp. RESULTADOS: Treinta y tres (14 per cent) individuos fueron seropositivos para Bartonella spp., 19 (13 per cent) en el grupo infectado por el VIH, y 14 (15 per cent) en los no coinfectados. No hubo relación entre la seropositividad para Bartonella spp. y el recuento de células CD4+ en los pacientes coinfectados por el VIH.CONCLUSIONES: Hemos encontrado una prevalencia de seropositividad frente a Bartonella spp. similar en ADVP infectados y no infectados por el VIH (AU)

[Effect of highly active antiretroviral therapy on the clinical onset of AIDS defined by clinical episodes]. / Efecto del tratamiento antirretroviral de gran actividad sobre la forma de presentación del sida definido por episodios clínicos.

BACKGROUND: The frequency of opportunistic infections and the mortality of HIV-infected patients have changed notably since the widespread use of highly active antiretroviral therapy. Accordingly, the spectrum of first AIDS-defining conditions may have changed too. The aim of the present study was to analyze whether there have been changes in the clinical presentation of AIDS after the extensive use of highly active antiretroviral therapy. PATIENTS AND METHOD: We performed an analysis of the presentation forms of AIDS in 190 patients with a prospective follow-up who developed this disease between April 1989 and December 2000. We compared the first AIDS-defining conditions occurring until December 1996 with those occurring after January 1997. RESULTS: Visceral leishmaniasis was the first AIDS-defining condition in 18 patients (14.2%) during the first period, whereas it was the AIDS-onset disease in two cases (3.1%) during the second period (P = 0.01). Tuberculosis was the first diagnosis in 63 patients (50%) in the first period and in 26 cases (40.6%) in the second period (P = 0.22). The frequency of other first AIDS-defining disorders remained unchanged along the whole study time. CONCLUSION: With regard to the clinical onset of AIDS, there has been a significant reduction in the frequency of visceral leishmaniasis as the first AIDS-defining disorder after the introduction of highly active antiretroviral therapy. Tuberculosis continues to be the more frequent clinical debut condition of AIDS.

Efecto del tratamiento antirretroviral de gran actividad sobre la forma de presentación del sida definido por episodios clínicos / Effect of highly active antiretroviral therapy on the clinical onset of AIDS defined by clinical episodes

FUNDAMENTO: El tratamiento antirretroviral de gran actividad (TARGA) ha modificado notablemente la frecuencia de infecciones oportunistas y la mortalidad de los pacientes con infección por el virus de la inmunodeficiencia humana, por lo que podría haber cambiado la forma de presentación del sida definido por episodios clínicos. El objetivo de este trabajo fue analizar si se han producido cambios en la forma de presentación del sida clínico en nuestra área después del uso generalizado del TARGA. PACIENTES Y MÉTODO: Se realizó un análisis de la forma de presentación del sida en 190 pacientes, seguidos prospectivamente, que desarrollaron esta enfermedad entre abril de 1989 y diciembre de 2000, comparando las enfermedades con las que se presentaron en los casos ocurridos antes de final de diciembre de 1996 y a partir de enero de 1997. RESULTADOS: La leishmaniasis visceral fue el primer episodio diagnóstico de sida en 18 pacientes (14,2 per cent) en el primer período y en dos (3,1 per cent) en el segundo (p = 0,01). Su frecuencia fue menor tanto en los pacientes seguidos en una unidad especializada como en los no seguidos previamente. La tuberculosis fue el primer diagnóstico en 63 pacientes (50 per cent) en el primer período y en 26 (40,6 per cent) en el segundo (p = 0,22). No hubo diferencias en la frecuencia del resto de las enfermedades diagnósticas de sida en uno y otro período. CONCLUSIONES: Tras la introducción del TARGA, la forma de presentación del sida en nuestra área sólo se ha modificado por una reducción en la frecuencia de leishmaniasis visceral como primer episodio diagnóstico. La tuberculosis continúa siendo la forma más común de inicio clínico del sida (AU)

Transient rebounds of low-level viraemia among HIV-infected patients under HAART are not associated with virological or immunological failure.

OBJECTIVE: To analyse whether blips are associated with a higher risk of virological or immunological failure than persistent undetectable viraemia (UND) among HIV-infected patients receiving HAART. DESIGN: Retrospective cohort study. SUBJECTS: Patients with blips or UND were selected from a prospective cohort of 330 patients under HAART for over 48 weeks. Blips were defined as detectable viraemia up to a maximum of 1000 copies/ml preceded by two consecutive visits and followed by one visit showing undetectable viraemia. Patients were included according to the following criteria: i) Blip group: patients that showed transient relapses of viraemia; ii) UND group: patients who had achieved UND on HAART before 24 weeks of therapy and that sustained viral suppression for four consecutive visits. MAIN OUTCOME MEASURES: Virological and immunological failure. RESULTS: Thirty seven (11%) and 65 (20%) patients showed blips and persistent UND, respectively. Virological failure was observed in three (8.1%) patients in the blip group and 11 (16.9%) patients in the UND group (P=0.25). The time to virological failure was shorter in the UND group (P=0.12). The rates of virological failure and the time to virological failure were similar between both groups after excluding patients with compliance <95%. The time to immunological failure was also similar in both groups (P=0.5). In a Cox model, only the use of saquinavir hard gel-based regimens was independently associated with the time to virological and immunological failure. CONCLUSION: Patients under HAART with transient low-level viraemia are not at an increased risk of developing virological or immunological failure.