Discordance in HIV-1 viral loads and antiretroviral drug concentrations comparing semen and blood plasma

Objectives

For individuals not on antiretroviral therapy, the risk of heterosexual transmission of HIV appears negligible when blood plasma (BP) viral loads are <1500 HIV‐1 RNA copies/mL. It is not clear whether this observation can be extrapolated to individuals on highly active antiretroviral therapy (HAART). Because of differential tissue penetration, antiretroviral drug concentrations may be sufficient to maintain an undetectable viral load in the BP yet not achieve adequate levels to suppress HIV in the genital tract. Therefore, we wanted to correlate HIV viral loads and drug concentrations in semen plasma (SP) and BP.

Methods

Thirty‐three men were included. All were on combination antiretroviral therapy with an undetectable BP viral load for at least 1 year. Blood and semen samples were collected within 2 h of each other and tested for HIV RNA by the NucliSens QT (bioMerieux, St Laurent, QC, Canada) method; drug concentrations were determined by liquid chromatography tandem mass spectrometry.

Results

Two of the 33 patients (6.1%) with BP viral loads below detection had time‐matched HIV viral loads in SP ≥700 copies/mL. Both patients were on efavirenz, the SP concentrations of which were ≤10% of the levels in BP and well below the minimal therapeutic drug monitoring target concentration required to suppress HIV.

Conclusions

Because, at least in part, of poor drug penetration into the genital tract, an undetectable HIV viral load in the BP does not guarantee an undetectable viral load in semen. In view of this, caution should be taken in concluding that patients on HAART with suppressed viraemia are sexually non‐infectious.     

炎琥宁与阿奇霉素联合治疗小儿支原体肺炎

目的:探讨炎琥宁辅助治疗小儿支原体肺炎的疗效.方法:将141例临床确诊的支原体肺炎患儿随机分为两组,治疗组71例,应用阿奇霉素加炎琥宁静点.对照组70例,单纯使用阿奇霉素治疗.结果:治疗组有效率96%,对照组有效率87%,两组统计学差异显著(P＜0.05),治疗组疗效优于对照组.结论:炎琥宁辅助治疗小儿支原体肺炎,临床症状消失快,疗效显著,无明显不良反应,值得推广.     

Acute encephalopathy associated with influenza and other viral infections

Acute encephalopathy is the most serious complication of pediatric viral infections, such as influenza and exanthem subitum. It occurs worldwide, but is most prevalent in East Asia, and every year several hundreds of Japanese children are affected by influenza-associated encephalopathy. Mortality has recently declined, but is still high. Many survivors are left with motor and intellectual disabilities, and some with epilepsy. This article reviews various syndromes of acute encephalopathy by classifying them into three major categories. The first group caused by metabolic derangement consists of various inherited metabolic disorders and the classical Reye syndrome. Salicylate is a risk factor of the latter condition. The second group, characterized by a systemic cytokine storm and vasogenic brain edema, includes Reye-like syndrome, hemorrhagic shock and encephalopathy syndrome, and acute necrotizing encephalopathy. Non-steroidal anti-inflammatory drugs, such as diclofenac sodium and mephenamic acid, may aggravate these syndromes. Severe cases are complicated by multiple organ failure and disseminated intravascular coagulation. Mortality is high, although methylprednisolone pulse therapy may be beneficial in some cases. The third group, characterized by localized edema of the cerebral cortex, has recently been termed acute encephalopathy with febrile convulsive status epilepticus, and includes hemiconvulsion-hemiplegia syndrome and acute infantile encephalopathy predominantly affecting the frontal lobes. Theophylline is a risk factor of these syndromes. The pathogenesis is yet to be clarified, but an increasing body of evidence points to excitotoxicity and delayed neuronal death.     

Oral Valganciclovir Is Noninferior to Intravenous Ganciclovir for the Treatment of Cytomegalovirus Disease in Solid Organ Transplant Recipients

Intravenous ganciclovir is the standard treatment for cytomegalovirus disease in solid organ transplant recipients. Oral valganciclovir is a more convenient alternative. In a randomized, international trial, recipients with cytomegalovirus disease were treated with either 900 mg oral valganciclovir or 5 mg/kg i.v. ganciclovir twice daily for 21 days, followed by 900 mg daily valganciclovir for 28 days. A total of 321 patients were evaluated (valganciclovir [n = 164]; i.v. ganciclovir [n = 157]). The success rate of viremia eradication at Day 21 was 45.1% for valganciclovir and 48.4% for ganciclovir (95% CI -14.0% to +8.0%), and at Day 49; 67.1% and 70.1%, respectively (p = NS). Treatment success, as assessed by investigators, was 77.4% versus 80.3% at Day 21 and 85.4% versus 84.1% at Day 49 (p = NS). Baseline viral loads were not different between groups and decreased exponentially with similar half-lives and median time to eradication (21 vs. 19 days, p = 0.076). Side-effects and discontinuations of assigned treatment (18 of 321 patients) were comparable. Oral valganciclovir shows comparable safety and is not inferior to i.v. ganciclovir for treatment of cytomegalovirus disease in organ transplant recipients and provides a simpler treatment strategy, but care should be taken in extrapolating to organ transplant recipients not properly represented in the present study.     

68例社区获得性肺炎病原及临床特征分析

目的　 68例外周血白细胞正常或降低的社区获得性肺炎 (CAP)病原及临床特点分析。方法　检测CAP患者呼吸道及血液标本的常见病原体 ,并分析其临床特点。结果　军团菌属占 2 2 .1 % (1 5/ 68) ,肺炎支原体占 1 1 .8% (8/ 68) ,病毒占 1 6 .2 % (1 1 / 68) ,其中甲型流感病毒 2例、乙型流感病毒 5例 ,副流感病毒 1例 ,腺病毒 1例 ,艾滋病病毒 2例。细菌占 2 .9% (2 / 68) ,有 47.1 % (32 / 68)不能明确病原体 ,混合感染率为 8.8% (6/ 68)。病毒性肺炎、军团菌肺炎及肺炎支原体肺炎的临床症状、体征、外周血白细胞、胸部影像均无特异性 ,其鉴别需靠病原学检查。结论　外周血白细胞正常或降低的CAP病因主要为非典型病原体和病毒 ,对此类CAP的经验治疗应首选大环内酯类抗生素或抗病毒药物。     

94例有肺外并发症的儿童肺炎支原体肺炎临床分析

目的探讨肺炎支原体肺炎（myeoplasma pneumoniae pneumonia，MPP）临床、肺外并发症和诊治。方法对94例确诊为MPP患儿进行回顾性分析。结果发病多集中在学龄前及学龄儿童，3～10岁55例（58．4％），发热69例（73．4％），持续性咳嗽80例（85．1％），多数肺部可闻及干啰音，胸片呈斑点状阴影41例，呈阶段性肺炎26例，呈间质性损害16例，表现肺门影增浓11例，大多患者（84．0％）外周血白细胞总数正常，血红蛋白低于正常值29例，全部病例均有肺外并发症，72例静脉使用红霉素，后改阿奇霉素口服治疗，47例痊愈。结论MPP好发学龄前及学龄儿童，其肺外并发症常见，红霉素、阿奇霉素序贯治疗安全、疗效满意。     

Acute viral myocarditis A death associated with anaesthesia

The death of a 35-year-old woman in the immediate postoperative period as a result of undiagnosed acute viral myocarditis is described. The presentation, diagnosis and course of the disease is discussed. It is recommended that wider use to be made of routine electrocardiographs as a screening test.     

57例小儿肺炎患者T淋巴细胞亚群及NK细胞观察

为了检测肺炎患儿的免疫功能,用 APAAP 法对57例反复患支气管肺炎的患儿进行 T 淋巴细胞亚群及 NK 细胞检测,结果 CD_3~+53.20±7.64%(对照组:62.50±9.65%),CD_4~+34.2±4.36%(对照组:38.64±4.05%),CD_8~+32.50±6.39%(对照组:26.70±4.23%)。CD_4~+/CD_8~+比值1.05±0.14(对照组:1.45±0.11),NK 细胞8.30±2.40%(对照组:6.44±3.37%)。结果证明,患儿 T 细胞亚群与对照组比较差异有显著(P<0.01),NK 细胞差异无显著性(P>0.05)。     

转人GM—CSF基因人膀胱癌细胞株的建立及体外生物学特性

经逆转录病毒载体将人GM-CSF基因导入人膀胱癌细胞株BIU-87细胞中,建立了转基因细胞株BIU/GM。经流式细胞仪行细胞DNA周期分析表明GM-CSF基因的导人及表达对BIU-87细胞的增长无影响。免疫荧光测定发现转GM-CSF基因及表达不能促进BIU-87细胞表面HLA-ABC、DR、DQ抗原的表达。转基因瘤细胞株经6000rad X射线照射灭活后,丧失增殖能力,逐步死亡,但能维持一定水平的GM-CSF分泌活性达两周以上。从而为制备灭活的转基因瘤苗提供了初步经验。