Hospitalization due to adverse drug reactions and drug interactions before and after HAART.

OBJECTIVE: To characterize and compare the rates of adverse drug reactions (ADRs) and interactions on admission in two, one-year periods: pre-highly active antiretroviral therapy (HAART) (phase 1) and post-HAART (phase 2). DESIGN: Retrospective chart review. SETTING: University-affiliated tertiary care centre. POPULATION STUDIED: HIV-positive patients admitted to hospital. MAIN RESULTS: In phase 1, 436 of 517 admissions, and, in phase 2, 323 of 350 admissions were analyzed. Over 92% of patients were male, with a mean age of 38 years. Significant differences (P<0.05) in the mean length of stay (12.08 versus 10.02 days), the CD4 counts (99.25 versus 129.45) and the number of concurrent diseases (4.20 versus 3.63) were found between phase 1 and 2, respectively. The mean number of medications taken (5.52 versus 5.94) and the rates of hospitalization with ADRs (20.4% versus 21.4%) or interactions (2.5% versus 2.16%) were similar between the two phases. Antiretrovirals were more common in ADR admissions post-HAART (21.3% versus 36.2%), while antiparasitics, psychotherapeutics and antineoplastics were more common pre-HAART. Other classes of drugs involved in both phases were sulphonamides, narcotics, ganciclovir, foscarnet, antimycobacterials and antifungals. ADR causality was possible or probable in more than 80% of cases. Over 60% of ADRs were grades 3 to 4, and about 85% were either the main or contributing reason for admission. About 65% of patients had at least partial recovery at the time of discharge. In phases 1 and 2, 8.9% and 2.9% of admissions,respectively, with ADRs were fatal. CONCLUSIONS: Although hospitalizations with ADRs and interactions were similar in both phases, HAART therapy has had a significant impact on the incidence and nature of ADRs at St Michael's Hospital, Wellesley Central Site, Toronto, Ontario.

Evolution of legionnaires' disease in an urban hospital - abstract

Ongoing epidemiological surveillance for nosocomial Legionnaires' Disease (LD) was initiated after control of an initial outbreak involving eight cases at a Nova Scotia Hospital in 1984. All cases of nosocomial pneumonia were screened for LD, and water samples were cultured for Legionella at intervals. No clinical cases of LD were identified until April, 1987, although there were occasional positive cultures from water samples in different areas of the hospital. Subsequently, six to seven cases have been identified over each 12-month period with no more than two cases in any month. The mean age of patients was 67.7 years (range 54 - 83) with a male to female ratio 2.5:1. The mean time of onset of pneumonia after admission was 19.9 days (range 8 - 27) with diagnosis being made in most cases by sputum culture. Risk factors included smoking, immunosuppressive therapy and admission to a specific wing of the hospital. Water samples from the specific wing of the hospital were persistently positive at high levels until certain plumbing revisions were instituted. In contrast to the initial outbreak, these cases represent an endemic level of nosocomial LD related to a specific area of the hospital. Ongoing surveillance is required for detection and control (AU)

High-performance liquid chromatography to assess the effect of serum storage conditions on the detection of hepatitis C virus by the polymerase chain reaction.

The effect of various serum storage conditions on the detection of hepatitis C virus (HCV) by the polymerase chain reaction (PCR) was assessed. 50 microliters aliquots of serum from four HCV PCR positive patients were subjected, in triplicate, to: (a) storage at -20 degrees C for 1, 5, 10 days; (b) storage at room temperature (RT) for 1, 2, 7 days; (c) 1, 3, 5, and 10 successive freeze-thaw cycles; (d) incubation at 37 degrees C, and 56 degrees C for 1, 3, 24 h; and (e) storage in guanidium-thiocyanate extraction buffer at RT, and 4 degrees C for 1, 5, 10 days. PCR products were detected by agarose gel electrophoresis (AGE) and quantitatively by high-performance liquid chromatography (HPLC). Only storage in extraction buffer at RT for 5-10 days and incubation at 56 degrees C for 24 h appeared to result in a loss of > or = 50% of detectable HCV PCR product. Up to 10 successive freeze-thaw cycles, storage at -20 degrees C for up to 10 days or at RT for up to 7 days, storage in extraction buffer at RT for 1 day or at 4 degrees C for up to 10 days, and incubation at 37 degrees C for up to 24 h resulted in minimal PCR signal loss. HPLC was a reproducible method of detecting and quantitating HCV PCR products, and was more sensitive than AGE.

Hepatitis C virus infection in patients infected with the human immunodeficiency virus.

The prevalence and characteristics of hepatitis C virus (HCV) infection in 226 patients who were seropositive for human immunodeficiency virus (HIV) were determined. Antibody to HCV (anti-HCV) was detected by enzyme immunoassay (EIA), and positive results were confirmed by a neutralization EIA or recombinant immunoblot assay. The prevalence of anti-HCV was 8%. Intravenous drug use was the most common risk factor for HCV infection (61.1% of patients), and 52.4% of intravenous drug users were seropositive for anti-HCV (HCV+). Only 16.7% of HCV+ patients had AIDS, as compared with 37.4% of anti-HCV-seronegative (HCV-) patients (P = .04). The prevalence of hepatitis B virus markers in patients with and without anti-HCV was similar. The CD4+ lymphocyte counts were higher for HCV+ patients than for HCV- patients (P = .001), and the prevalence of anti-HCV decreased in parallel with CD4+ counts. Elevated liver function test values were more common for HCV+ patients than for HCV- patients (61.1% vs. 26.0%; P < .01), but abnormalities were usually slight (< 2-fold elevation in values). HCV viremia was detected by the polymerase chain reaction in 88.2% of HCV+ patients. Despite the coexistence of HIV and HCV infection, liver disease appeared to be mild, and HCV infection did not appear to increase the severity of HIV infection. Serological tests for HCV appear to underestimate the prevalence of HCV infection in patients with advanced HIV infection or AIDS.

Ultrastructural evidence for the cellular uptake of rotavirus by endocytosis.

The ultrastructural aspects of rotavirus SA11 infection were studied in MA104 cells, with particular attention directed to the early stages of virus adsorption and penetration. Within the first few minutes postadsorption, rotavirus was seen at the plasma membrane, associated with coated pits and coated vesicles, indicating that SA11 virus is taken into the cell by adsorptive or receptor-mediated endocytosis. Multiple virus particles were seen, beginning at 1 h and continuing throughout infection, in lysosome-like structures. Ultrastructural evidence was obtained to support the hypothesis that rotavirus progeny acquire a temporary envelope by budding into cisternae of the rough endoplasmic reticulum.