Archive for October, 2011

Thirty Years of HIV and AIDS: Future Challenges and Opportunities

Annals of Internal Medicine June 7, 2011 V.154 N.11 P.766-771

Carl W. Dieffenbach, PhD; and Anthony S. Fauci, MD

From the National Institute of Allergy and Infectious Diseases, Bethesda, Maryland.

Abstract

As the third decade since AIDS was first recognized comes to an end, extraordinary advances have occurred in the understanding, treatment, and prevention of HIV infection and AIDS. As a result of these successes, it is now time to focus on future challenges.Paramountamong these is reaching the goal of truly controlling and ultimately ending the HIV and AIDS pandemic.

To that end, AIDS researchers and public health personnel worldwide are aggressively pursuing 3 key areas of scientific research. Given the availability of highly effective therapeutic regimens for HIV infection, the first challenge is efficiently identifying a maximum number of HIV-infected persons through voluntary HIV testing and initiating antiretroviral therapy (ART). Second, scientists are trying to develop a cure for HIV infection, which would alleviate the need for lifelong ART. Finally, preventing new cases of HIV infection, which currently number approximately 2.6 million per year globally, is critical to any attempt to end this pandemic. This article addresses each of these challenges and provides directions for the future.

abstract

http://www.annals.org/content/154/11/766.abstract

PDF

http://www.annals.org/content/154/11/766.full.pdf+html

October 31, 2011 at 6:22 pm Leave a comment

Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model.

Lancet 2009 V.373 N.9657 P.48-57

Granick RM, Gilks Cf, Dye C et al.

a Department of HIV/AIDS, WHO, Geneva, Switzerland

b Stop TB Department, WHO, Geneva, Switzerland

 Correspondence to: Reuben Granich, Antiretroviral Treatment and HIV Care Unit, Department of HIV/AIDS, WHO, Avenue Appia 20, CH-1211, Geneva 27, Switzerland

Summary

Background

Roughly 3 million people worldwide were receiving antiretroviral therapy (ART) at the end of 2007, but an estimated 6·7 million were still in need of treatment and a further 2·7 million became infected with HIV in 2007. Prevention efforts might reduce HIV incidence but are unlikely to eliminate this disease. We investigated a theoretical strategy of universal voluntary HIV testing and immediate treatment with ART, and examined the conditions under which the HIV epidemic could be driven towards elimination.

Methods

We used mathematical models to explore the effect on the case reproduction number (stochastic model) and long-term dynamics of the HIV epidemic (deterministic transmission model) of testing all people in our test-case community (aged 15 years and older) for HIV every year and starting people on ART immediately after they are diagnosed HIV positive. We used data fromSouth Africaas the test case for a generalised epidemic, and assumed that all HIV transmission was heterosexual.

Findings

The studied strategy could greatly accelerate the transition from the present endemic phase, in which most adults living with HIV are not receiving ART, to an elimination phase, in which most are on ART, within 5 years. It could reduce HIV incidence and mortality to less than one case per 1000 people per year by 2016, or within 10 years of full implementation of the strategy, and reduce the prevalence of HIV to less than 1% within 50 years. We estimate that in 2032, the yearly cost of the present strategy and the theoretical strategy would both be US$1·7 billion; however, after this time, the cost of the present strategy would continue to increase whereas that of the theoretical strategy would decrease.

Interpretation

Universal voluntary HIV testing and immediate ART, combined with present prevention approaches, could have a major effect on severe generalised HIV/AIDS epidemics. This approach merits further mathematical modelling, research, and broad consultation.

Funding

None.

abstract

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61697-9/abstract

October 31, 2011 at 12:29 pm Leave a comment

Leptospirosis: Presentación de una infección fulminante y revisión de la literatura

Rev Chil Infect 2005 V.22  N.1  P.93-97

M. Cecilia Abuauad A, Guido Osorio S, Juan L. Rojas P y Lorena Pino V.

Hospital Barros Luco Trudeau, Santiago, Chile

Servicio de Gastroenterología (MCAA)

Servicio de Medicina (GOS, LPV)

Universidad de Santiago, Santiago, Chile

Unidad de Anatomía Patológica (JLRP)

Resumen

Entre las nuevas y re-emergentes enfermedades infecciosas que amenazan a la humanidad, y como resultado de este caso clínico, se hace una revisión bibliográfica acerca de leptospirosis insistiendo en la necesidad de tenerla in mente en el diagnóstico diferencial de un cuadro febril con ictericia.

FULL TEXT

http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0716-10182005000100012

PDF

http://www.scielo.cl/pdf/rci/v22n1/art12.pdf

October 28, 2011 at 5:51 pm Leave a comment

Factors influencing the normalization of CD4+ T-cell count, percentage and CD4+/CD8+ T-cell ratio in HIV-infected patients on long-term suppressive antiretroviral therapy

Clinical Microbiology and Infection Aug 2011

C. Torti1, M. Prosperi2, D. Motta1, S. Digiambenedetto2, F. Maggiolo3, G. Paraninfo4, D. Ripamonti3, G. Cologni3, M. Fabbiani2, S. L. Caputo5, L. Sighinolfi6, N. Ladisa7, I.

1 Institute of Infectious and Tropical Diseases, University of Brescia, Brescia

2 Catholic University of Sacred Heart, Rome

3 Ospedali Riuniti, Bergamo

4 Spedali Civili di Brescia, Brescia

5 S. Maria Annunziata Hospital, Florence

6 S. Anna Hospital, Ferrara

7 Policlinico di Bari, Bari, Italy

8 Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA

*Correspondence: Corresponding author: C. Torti, Clinica di Malattie Infettive e Tropicali, Piazzale Spedali Civili, 1, 25123 Brescia, Italy E-mail: torti@med.unibs.it

Abstract

We evaluated factors associated with normalization of the absolute CD4+ T-cell counts, per cent CD4+ T cells and CD4+/CD8+ T-cell ratio. A multicentre observational study was carried out in patients with sustained HIV-RNA <50 copies/mL. Outcomes were: CD4-count >500/mm3 and multiple T-cell marker recovery (MTMR), defined as CD4+ T cells >500/mm3plus%CD4 T cells >29%plus CD4+/CD8+ T-cell ratio >1. Kaplan–Meier survival analysis and Cox regression analyses to predict odds for achieving outcomes were performed. Three hundred and fifty-two patients were included and followed-up for a median of 4.1 (IQR 2.1–5.9) years, 270 (76.7%) achieving a CD4+ T-cell count >500 cells/mm3 and 197 (56%) achieving MTMR. Using three separate Cox models for both outcomes we demonstrated that independent predictors were: both absolute CD4+ and CD8+ T-cell counts, %CD4+ T cells, a higher CD4+/CD8+ T-cell ratio, and age. A likelihood-ratio test showed significant improvements in fitness for the prediction of either CD4+ >500/mm3 or MTMR by multivariable analysis when the other immune markers at baseline, besides the absolute CD4+ count alone, were considered. In addition to baseline absolute CD4+ T-cell counts, pretreatment %CD4+ T cells and the CD4+/CD8+ T-cell ratio influence recovery of T-cell markers, and their consideration should influence the decision to start antiretroviral therapy. However, owing to the small sample size, further studies are needed to confirm these results in relation to clinical endpoints.

abstract

http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2011.03650.x/abstract

October 28, 2011 at 5:49 pm Leave a comment

Clinical Characteristics of Bacteremia Due to Extended-Spectrum β-Lactamase (ESBL)-Producing Enterobacteriaceae in the Era of CTX-M and KPC-type β-Lactamases

Clinical Microbiology and Infection Aug 2011

Zubair A. Qureshi1, David L. Paterson1,2, Anton Y. Peleg3,4, Jennifer M. Adams-Haduch1, Kathleen A. Shutt1, Diana L. Pakstis1, Emilia Sordillo5,6, Bruce Polsky5,6, Gabriel Sandkovsky5

ABSTRACT

A multicenter, case-control study was conducted to assess risk factors and patient outcomes from bacteremia due to Enterobacteriaceae producing extended-spectrum β-lactamases (ESBL) and Klebsiella pneumoniae carbapenemases (KPCs). One hundred five and 20 patients with bacteremia due to ESBL and KPC-producing organisms were matched to controls that had bacteremia with non-ESBL/KPC-producing organisms, respectively. Independent risk factors for ESBL production included admission from a nursing home (odds ratio [OR], 4.64; 95% confidence interval [CI], 2.64-8.16), chronic renal failure (OR, 2.09; 95% CI, 1.11-3.92), the presence of a gastrostomy tube (OR, 3.36; 95% CI, 1.38-8.18), length of hospital stay before infection (OR, 1.02; 95% CI, 1.01-1.03), transplant recipients (OR, 2.48; 95% CI, 1.24-4.95) and receipt of antibiotics with Gram-negative activity in the preceding 30 days (OR, 1.76; 95% CI, 1.00-3.08). 28-day crude mortality rates for patients infected with ESBL or KPC-producing organisms and controls were 29.1% (34/117) and 19.5% (53/272), respectively (OR 1.70; 95% CI 1.04-2.80). On multivariate analysis, inadequate empiric therapy (OR, 2.26; 95% CI, 1.18-4.34), onset of bacteremia while in ICU (OR, 2.74; 95% CI, 1.47-5.11), Apache II score (OR, 1.17; 95% CI, 1.12-1.23), and malignancy (OR, 2.66; 95% CI, 1.31-5.41) were independent risk factors for mortality. CTX-M was the most common ESBL type in E. coli, whereas SHV predominated in Klebsiella spp. and Enterobacter spp.

abstract

http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2011.03658.x/abstract

October 28, 2011 at 5:47 pm Leave a comment

Emergence of Carbapenem-resistant Enterobacteriaceae in Austria, 2001-2010

Clinical Microbiology and Infection Aug 2011

Gernot Zarfel1, Martin Hoenigl2, Benjamin Würstl3, Eva Leitner1, Helmut J. F. Salzer2, Thomas Valentin2, Josefa Posch1, Robert Krause2, Andrea J. Grisold1,*

Abstract:

We report the emergence of carbapenem-resistant Enterobacteriaceae inAustria. Over a ten- year-period carbapenem-resistant Enterobacteriaceae were isolated from 13 hospitalized patients with the first isolation in the year 2005 and a remarkable increase of involved patients in 2010. Carbapenem-resistant Enterobacteriaceae comprise 8 Klebsiella pneumoniae, 4 Klebsiella oxytoca and one Escherichia coli isolate. Detected carbapenemases belonged to the metallo-ß-lactamases NDM-1, VIM and IMP and to serin-ß-lactamases KPC.

abstract

http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2011.03659.x/abstract

October 28, 2011 at 5:45 pm Leave a comment

Chorioamnionitis: from pathogenesis to treatment

Clinical Microbiology and Infection Sept 2011

REVIEW

M. J. Czikk1, F. P. McCarthy2, K. E. Murphy1

1 Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada

2 Anu Research Centre, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland

*Correspondence: Corresponding author: M. J. Czikk, Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, c/o Dr Kellie E Murphy, 700 University Avenue, Room 3278, Toronto, ON M5G 1Z5, Canada E-mail:mczikk@mtsinai.on.ca

Abstract

Chorioamnionitis refers to inflammation of the amniochorionic membrane, and is a significant cause of maternal and neonatal morbidity. Chorioamnionitis most often occurs as a result of ascending infection, and is commonly associated with premature rupture of the membranes. Chorioamnionitis is generally the result of a polymicrobial infection, with Ureaplasma urealyticum, Mycoplasma hominis and Gram-negative anaerobes being frequent causative organisms. The mainstay of treatment includes antimicrobial agents, antipyretics, expedition of delivery and supportive care. Further research is required to identify mechanistic pathways and early biomarkers that accurately predict women at higher risk of adverse maternal and neonatal outcomes, and that can thus lead to the development of additional treatment and prevention strategies.

Abstract

http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2011.03574.x/abstract

October 28, 2011 at 5:44 pm Leave a comment

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