Archive for September 6, 2008

Etravirine (TMC125)

Etravirine (TMC125)

Etravirine, also known as Intelence or TMC125, is a type of medicine called a non-nucleoside reverse transcriptase inhibitor (NNRTI). NNRTIs work by blocking reverse transcriptase, a protein that HIV needs to make more copies of itself.


September 6, 2008 at 1:28 pm Leave a comment



Maraviroc, also known as Selzentry, is a type of medicine called an entry inhibitor. Entry inhibitors work by blocking HIV from entering human cells.


September 6, 2008 at 1:27 pm Leave a comment



Raltegravir, also known as Isentress and MK-0518, is a type of medicine called an integrase inhibitor. Integrase inhibitors work by blocking integrase, a protein that HIV needs to insert its viral genetic material into the genetic material of an infected cell.


September 6, 2008 at 1:26 pm Leave a comment

Early mortality in patients with community-acquired pneumonia: causes and risk factors

European Respiratory Journal  1 Sept 2008  V.32  N.3  p.733-739

C. Garcia-Vidal1, N. Fernández-Sabé1, J. Carratalà1, V. Díaz1, R. Verdaguer2, J. Dorca3, F. Manresa3 and F. Gudiol1

1 Infectious Disease, 2 Microbiology, and 3 Respiratory Medicine Services, Institute of Biomedical Investigation of Bellvitge (IDIBELL) – Hospital University of Bellvitge, University of Barcelona, L’Hospitalet, Barcelona, Spain.

The first 48 h of evolution of patients with community-acquired pneumonia (CAP) are critical. The aim of the present study was to determine the frequency, causes and factors associated with early mortality in CAP.

Nonimmunocompromised adults hospitalised with CAP were prospectively observed from 1995 to 2005. Early deaths, defined as death due to any cause 48 h after admission, were compared with all patients who survived >48 h. Furthermore, early deaths were compared with late deaths (patients who died >48 h) and with survivors.

Of 2,457 patients, 57 (2.3%) died 48 h after admission. Overall mortality was 7.7%. The main causes of early mortality were respiratory failure and septic shock/multiorgan failure. Independent factors associated with early deaths were increased age, altered mental status at presentation, multilobar pneumonia, shock at admission, pneumococcal bacteraemia and discordant empiric antibiotic therapy.

Currently, early mortality is relatively low and is caused by pneumonia-related factors. It occurs mainly among the elderly and in patients presenting with altered mental status, multilobar pneumonia and septic shock. Pneumococcal bacteraemia and discordant antibiotic therapy, mainly due to lack of coverage against Pseudomonas aeruginosa are also significant risk factors.


September 6, 2008 at 1:24 pm Leave a comment

Usefulness of consecutive C-reactive protein measurements in follow-up of severe community-acquired pneumonia

European Respiratory Journal  1 Sept 2008  V.32  N.3  p.726-732

A. H. W. Bruns1, J. J. Oosterheert1, E. Hak2,3 and A. I. M. Hoepelman1,4

1 Division of Medicine, Dept of Internal Medicine and Infectious Diseases, 2 Julius Center for Health Sciences and Primary Care, 3 Paediatric Immunology, Wilhelmina Children’s Hospital, and 4 Eijkman-Winkler Institute for Microbiology, Infectious Diseases and Inflammation, University Medical Center Utrecht, Utrecht, The Netherlands.

Despite the introduction of new inflammatory markers, C-reactive protein (CRP) remains commonly used in patients hospitalised with severe infections. However, evidence on the usefulness of consecutive CRP measurements is still unclear. The clinical relevance of consecutive CRP measurements was studied in follow-up of antibiotic treatment in patients with severe community-acquired pneumonia (CAP).

In a prospective multicentre trial, CRP levels were measured on admission, and on days 3 and 7. Patients were followed clinically for 28 days.

Aetiology could be determined in 137 (47.4%) out of the 289 patients included. In 122 (38.8%) patients, initial antibiotic therapy was appropriate. A decline of <60% in CRP levels in 3 days and a decline of <90% in CRP levels in 7 days were both associated with an increased risk of having recieved inapproriate empiric antibiotic treatment (day 0–3, odds ratio (OR) 6.98, 95% confidence interval (CI) 1.56–31.33 and day 0–7, OR 3.74, 95% CI 1.12–13.77).

In conclusion, consecutive C-reactive protein measurements are useful in the first week in follow-up of antibiotic treatment for severe community-acquired pneumonia when taking the causative microorganism and use of steroids into account. A delayed normalisation of C-reactive protein levels is associated with a higher risk of having received inappropriate antibiotic treatment.


September 6, 2008 at 1:23 pm Leave a comment

The association between HIV and antituberculosis drug resistance

European Respiratory Journal  1 Sept 2008  V.32  N.3  p.718-725

C. E. French1, J. R. Glynn2, M. E. Kruijshaar1, I. C. Ditah3, V. Delpech4 and I. Abubakar1

1 Tuberculosis Section, Respiratory Diseases Dept, and 4 HIV and AIDS Reporting Section, HIV and STI Dept, Health Protection Agency Centre for Infections, 2 Infectious Diseases Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, and 3 University of East Anglia, Norwich, UK.

In the UK, HIV is considered to be a risk factor for antituberculosis drug resistance. Evidence of the association is, however, inconclusive and there are few population-level data. The present study investigated the association in England and Wales during the period 1999–2005.

National tuberculosis surveillance data for adults were matched to HIV/AIDS reports. Unmatched cases were assumed to be HIV-negative. Separate analyses were conducted on new tuberculosis cases and those with a previous diagnosis. Logistic regression was used for univariable and multivariable analyses.

There were 1,657 previously diagnosed cases (80 HIV-positive) and 18,130 new cases (1,156 HIV-positive). Isoniazid resistance was found in 8.1% of previously diagnosed cases and 6.6% of new cases, and multidrug resistance in 2.8% and 0.7%, respectively. There was no evidence of an association between HIV and antituberculosis drug resistance among previously diagnosed cases. Among new cases, there was no overall association between HIV and isoniazid or multidrug resistance after adjusting for confounding factors. White HIV-positive patients were more likely to have multidrug resistance, but numbers were small.

In contrast to some previous studies, this large, up-to-date study provides little evidence that HIV co-infected tuberculosis patients in England and Wales are at increased risk of firstline antituberculosis drug resistance.


September 6, 2008 at 1:21 pm Leave a comment


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