Optimizing antiretroviral therapy for women living with HIV.

PURPOSE OF REVIEW: This review considers the evidence available to guide clinicians in their choice of optimal antiretroviral therapy (ART) for women with HIV. RECENT FINDINGS: Cohort and clinical trial data indicate that ART is as efficacious in women as men, although women are more likely to discontinue therapy, which compromises effectiveness. For many drugs, women have higher plasma levels than men, although whether this is secondary to differing metabolism in women or because on average women have a lower body mass than men is not clear. For many drugs, women experience more adverse events secondary to ART. Opinion on the use of efavirenz in pregnancy differs between countries. The average age of women with HIV is increasing. Although virological responses to ART are not affected by age, immunological responses may be poorer. Older women with HIV face issues such as neurocognitive impairment, early menopause, osteoporosis and polypharmacy, which will have the potential to impact on their use of ART. SUMMARY: When planning ART regimes with women, clinicians need to be mindful of the woman's social situation and stage in the life course, as well as the scientific data on individual drug effectiveness according to sex.

Delay in the diagnosis of measles complicated by pneumonitis and appendicitis in a returning traveller.

A 40-year-old British man presented to the emergency department for the second time in 10 days following a 2-week holiday in Thailand with malaise, bilateral conjunctivitis and a morbilliform rash. He had previously seen his general practitioner and ophthalmology and was diagnosed with conjunctivitis. We confirmed measles following RNA detection on a mouth swab. Four days after admission he developed abdominal pain and a CT abdomen demonstrated acute appendicitis with large appendicoliths. A perforated appendix was identified intraoperatively. Measles RNA was detected in the resected appendix. Preoperatively he developed hypoxia with right upper lobe changes seen on a CT pulmonary angiogram. Bronchoalveolar lavage performed in theatre isolated measles RNA at high level, consistent with measles pneumonitis. He required ventilatory support in the intensive care unit and was also treated with intravenous antibiotics. He made a complete recovery.

Screening African HIV positive patients for imported parasitic infections.

OBJECTIVES: To assess the results of screening for tropical parasitic infections in HIV patients from Africa, presenting to an infectious diseases unit in the UK. METHODS: A retrospective case note review of patients from Sub-Saharan Africa, newly diagnosed with HIV infection, between March 2001 and November 2007. Data on patient demographics, clinical presentation and laboratory results, including tropical screening tests, were collected. RESULTS: 146 patients had notes available for review. 22 different countries were represented. 84 patients were screened, by serology, for schistosomiasis, strongyloidiasis, filariasis and leishmaniasis. 13/122 (10.7%) patients tested had positive schistosomiasis serology and 2/107 (1.9%) had positive strongyloidiasis serology. No patients had positive Leishmania (n = 108) or filaria (n = 97) serology. 3 of 38 (7.9%) had stool samples that were positive for pathogens. Positive schistosomiasis serology was associated with male sex (61.5% vs 28.4% p < 0.05) and a higher mean eosinophil count (0.46 vs 0.12 cells/microL p < 0.0001). CONCLUSION: Screening HIV patients from Sub-Saharan Africa for schistosomiasis in this population, was positive in over 1 in 10 patients. We would recommend screening for schistosomiasis in these patients. Our results do not support serological screening for leishmaniasis or filarial infection in these patients.