Archive for October 25, 2012

Non-cirrhotic portal hypertension in human immunodeficiency virus-infected patients: a new challenge in antiretroviral therapy era.

Open AIDS J. 2011 V.5  P.59-61.

Alvarez Díaz H, Mariño Callejo A, García Rodríguez JF.

Source

Infectious Diseases Unit, Department of Internal Medicine, Hospital Arquitecto Marcide-Profesor Novoa Santos, Ferrol, A Coruña, Spain.

Abstract

Non-cirrhotic portal hypertension (NCPH) has been recently reported as a liver disease in Human Immunodeficiency Virus (HIV)-infected patients under antiretroviral therapy (ART). Combination of non-exclusive mechanisms has been described: primary endothelial damage of terminal portal veins induced by HIV or immunologic disorders, mitochondrial toxicity by didanosine and prothrombotic state. It is characterized by heterogeneous liver histological findings, frequently identified as nodular regenerative hyperplasia and clinical manifestations of portal hypertension with well-preserved liver function. We describe herein two HIV-infected patients with clinical picture suggestive of NCPH. Besides the case reports, we briefly address questions to apply to patient care in clinical practice.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134955/pdf/TOAIDJ-5-59.pdf

 

October 25, 2012 at 2:13 pm

Anticoagulant therapy for nodular regenerative hyperplasia in a HIV-infected patient.

BMC Gastroenterol. 2010 Jan 18;10:6.

Bihl F, Janssens F, Boehlen F, Rubbia-Brandt L, Hadengue A, Spahr L.

Source

Department of Gastroenterology and Hepatology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 1211, Switzerland. F.bihl@mac.com

Abstract

BACKGROUND:

Nodular regenerative hyperplasia (NRH) has been recently recognized as an emergent cause of liver disease in HIV-infected patients. NRH may cause non-cirrhotic portal hypertension with potentially severe consequences such as refractory ascites, variceal bleeding and hypersplenism. Obliteration of the small intrahepatic portal veins in association with prothrombotic disorders linked to HIV infection itself or anti-retroviral therapy seem to be the causes of NRH and thus the term HIV-associated obliterative portopathy has been proposed.

CASE PRESENTATION:

Here we describe a case of a HIV-infected patient with biopsy-proven NRH and listed for liver transplantation (LT) because of refractory ascites and repeated upper gastrointestinal bleedings. A transjugular intrahepatic portosystemic shunt was placed as a bridge to LT and did not improve liver function. However, anticoagulant therapy with low-molecular-weight heparin (LMWH) was associated with rapid improvement in the liver condition and allowed to avoid LT in this patient.

CONCLUSIONS:

Thus, this case underscores the relation between thrombophilia and HIV-associated NRH and emphasizes anticoagulant therapy as possible treatment.

PDF

http://www.biomedcentral.com/content/pdf/1471-230X-10-6.pdf

October 25, 2012 at 2:11 pm

Antiretroviral prophylaxis for HIV prevention in heterosexual men and women.

N Engl J Med. 2012 Aug 2 V.367 N.5  P.399-410.

Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, Tappero JW, Bukusi EA, Cohen CR, Katabira E, Ronald A, Tumwesigye E, Were E, Fife KH, Kiarie J, Farquhar C, John-Stewart G, Kakia A, Odoyo J, Mucunguzi A, Nakku-Joloba E, Twesigye R, Ngure K, Apaka C, Tamooh H, Gabona F, Mujugira A, Panteleeff D, Thomas KK, Kidoguchi L, Krows M, Revall J, Morrison S, Haugen H, Emmanuel-Ogier M, Ondrejcek L, Coombs RW, Frenkel L, Hendrix C, Bumpus NN, Bangsberg D, Haberer JE, Stevens WS, Lingappa JR, Celum C; Partners PrEP Study Team.

Collaborators (504)

Source

Department of Global Health, University of Washington, Seattle, WA 98104, USA. jbaeten@uw.edu

 

Abstract

BACKGROUND:

Antiretroviral preexposure prophylaxis is a promising approach for preventing human immunodeficiency virus type 1 (HIV-1) infection in heterosexual populations.

METHODS:

We conducted a randomized trial of oral antiretroviral therapy for use as preexposure prophylaxis among HIV-1-serodiscordant heterosexual couples from Kenya and Uganda. The HIV-1-seronegative partner in each couple was randomly assigned to one of three study regimens–once-daily tenofovir (TDF), combination tenofovir-emtricitabine (TDF-FTC), or matching placebo–and followed monthly for up to 36 months. At enrollment, the HIV-1-seropositive partners were not eligible for antiretroviral therapy, according to national guidelines. All couples received standard HIV-1 treatment and prevention services.

RESULTS:

We enrolled 4758 couples, of whom 4747 were followed: 1584 randomly assigned to TDF, 1579 to TDF-FTC, and 1584 to placebo. For 62% of the couples followed, the HIV-1-seronegative partner was male. Among HIV-1-seropositive participants, the median CD4 count was 495 cells per cubic millimeter (interquartile range, 375 to 662). A total of 82 HIV-1 infections occurred in seronegative participants during the study, 17 in the TDF group (incidence, 0.65 per 100 person-years), 13 in the TDF-FTC group (incidence, 0.50 per 100 person-years), and 52 in the placebo group (incidence, 1.99 per 100 person-years), indicating a relative reduction of 67% in the incidence of HIV-1 with TDF (95% confidence interval [CI], 44 to 81; P<0.001) and of 75% with TDF-FTC (95% CI, 55 to 87; P<0.001). Protective effects of TDF-FTC and TDF alone against HIV-1 were not significantly different (P=0.23), and both study medications significantly reduced the HIV-1 incidence among both men and women. The rate of serious adverse events was similar across the study groups. Eight participants receiving active treatment were found to have been infected with HIV-1 at baseline, and among these eight, antiretroviral resistance developed in two during the study.

CONCLUSIONS:

Oral TDF and TDF-FTC both protect against HIV-1 infection in heterosexual men and women. (Funded by the Bill and Melinda Gates Foundation; Partners PrEP ClinicalTrials.gov number, NCT00557245.).

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1108524

Comment in

EDITORIAL COMMENTARY

Preexposure prophylaxis for HIV–where do we go from here? [N Engl J Med. 2012]

http://www.nejm.org/doi/pdf/10.1056/NEJMe1207438

October 25, 2012 at 2:10 pm

Practice guidelines for the diagnosis and management of skin and soft-tissue infections.

Clin Infect Dis. 2005 Nov 15 V.41 N.10 P.1373-406.

Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan EL, Montoya JG, Wade JC; Infectious Diseases Society of America.

Source

Infectious Diseases Section, Veterans Affairs Medical Center, Boise, Idaho 83702, USA. dlsteven@mindspring.com

Soft-tissue infections are common, generally of mild to modest severity, and are easily treated with a variety of agents. An etiologic diagnosis of simple cellulitis is frequently difficult and generally unnecessary for patients with mild signs and symptoms of illness. Clinical assessment of the severity of infection is crucial, and several classification schemes and algorithms have been proposed to guide the clinician [1]. However, most clinical assessments have been developed from either retrospective studies or from an author’s own “clinical experience,” illustrating the need for prospective studies with defined measurements of severity coupled to management issues and outcomes …

PDF

http://cid.oxfordjournals.org/content/41/10/1373.full.pdf+html

Update – Errata

http://cid.oxfordjournals.org/content/41/12/1830.1.full.pdf+html

 

October 25, 2012 at 2:07 pm


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