HIV-1 control after transient antiretroviral treatment initiated in primary infection: role of patient characteristics and effect of therapy

BACKGROUND: The occurrence of viral control after interruption of an antiretroviral treatment (ART) initiated during primary HIV-1 infection (PHI) is rare and the frequency and predictive factors of such a control are unknown. METHODS: Within the French ANRS PRIMO Cohort, 164 patients interrupted ART initiated during PHI. We compared patients whose viral load (VL) remained undetectable (<50 copies/ml) or low (50-500 copies/ml) 1 year after ART interruption to those who evidenced a rapid viral rebound. RESULTS: After ART interruption, VL remained undetectable for a median time of 4.5 years in 14 patients ('post-ART controllers') and low in another 14 patients for a median time of 1.5 years. Post-ART controllers also maintained higher CD4(+) T-cell counts compared to other patients. Female gender, a high CD4(+) T-cell count and low VL during PHI, and a high CD4(+) T-cell count and low HIV DNA levels at interruption, were associated with post-ART HIV control. Treatment characteristics did not differ between controllers and non-controllers. Post-ART controllers had lower specific CD8(+) T-cell frequencies and CD8(+) T-cell activation on ART and after ART interruption than non-controllers. CONCLUSIONS: Few patients maintain very low VL after interruption of treatment initiated during PHI. Early patient characteristics were the main factors of viral control, although early initiation of ART and the effect of ART on reservoir might contribute to control.     

改良义眼座眶内植入术的临床观察

观察改良义眼座植入的临床效果。方法 眼球摘除后，羟基磷灰石义眼座植入肌圆锥内，前半部分以双层自体巩膜覆盖，结膜囊内旋转带孔眼模，常规睑裂缝合。结果 随访2个月－3年，1例球工，经缝合修补后修复，所有病例均义眼活动良好，矫正外形满意。结论 改良义眼座眶内植入术并发症少，疗效满意，比传统术式有更多优点。     

Damage occurs early in systemic vasculitis and is an index of outcome

Because death after acute systemic vasculitis is now uncommon, alternative measures of outcome are required. A significant component of patient morbidity is disease-related damage, which can be quantified by the Vasculitis Damage Index (64 items in 11 organ-based systems). We investigated serially the time-course of damage in 120 patients with systemic vasculitis, to determine the earliest indicators of outcome. High damage scores at 2 years after presentation were characteristic of fatal disease (OR 8.1-12.4). Significant damage occurred within 6 months of presentation, and was a feature of fatal disease. More damage occurred after presentation than after relapse. Lung and multi-system damage were early indicators of poor outcome in severe non-fatal disease. Damage occurs early in systemic vasculitis, and is an indicator of poor outcome. This novel observation, together with evidence of persistent subclinical disease activity and the high frequency of relapse, suggests a need for new treatment strategies. Analogy with the management of acute leukaemia suggests a strategy of early diagnosis and intensive induction of remission, with early escalation of treatment for resistant disease.      

Congenital hemangiopericytoma of the skin

A 5-month-old white boy had a pinhead red spot on his left malleolar region since birth. His mother noted progressive growth and, when he was first examined, the lesion measured 30x25x20 mm in size, had a pyramidal shape, covered by erythematous and smooth skin, with teleangiectasia. The tumor was soft on paipation and movable over the deeper structures (Fig. 1a). X-ray examination revealed no bone abnormalities at that time.
Just before the programmed incisional biopsy, the patient had a febrile episode due to upper respiratory tract viral infection during which the tumor became ulcerated, bleeding and painful (Fig. 1b). As the bleeding was constant the lesion was surgically excised, at which time the whole gelatinous mass was easily detached from the aponeurotic structures (Fig. 1c). The tumor measured 36x31 x30 mm and had a whitish, smooth cut surface crossed by small blood vessels.
Histopathologic examination revealed a tumor mass extending from the mid dermis to the subcutaneous fat and composed of tightly packed fusiform cells in close opposition with lined vascular channels (Fig. 2a). There were atypical areas and mitotic figures were frequently seen. A reticulin preparation showed a dense network surrounding vessels and pericytes. The vessels branched in a staghorn configuration (Fig. 2b). The immunoperoxidase technique with monoclonal antibody anti-Factor VIII was positive in the endothelial cells surrounded by tumor cells (Fig. 2c).
Seven months after surgery the patient returned with a painful subcutaneous mass on the upper third of his left leg that was adherent to the tibial bone. X-ray examination disclosed osteolytic lesions at the tibial base and destruction of the peroneal head (Fig. 3).
The patient was submitted to radiotherapy, amputation of the left lower limb in the middle portion of the thigh and chemotherapy. He is clinically well 3 years after treatment.     

One clinic's experience with carbon fiber orthoses in neuromuscular disease

Introduction: The purpose of this study was to summarize our experience with off‐the‐shelf anterior shell carbon fiber ankle–foot orthoses (CFAFOs) prescribed to adult neuromuscular patients in an outpatient clinic. Methods: We studied ambulatory patients who were seen in Muscular Dystrophy Association or amyotrophic lateral sclerosis clinics between 2011 and 2014 and prescribed anterior shell CFAFOs. Charts were reviewed with attention to diagnosis, satisfaction with use, and reasons for acceptance or rejection. We included individuals who were currently using AFOs and those being prescribed AFOs for the first time. We were especially interested in reasons for acceptance or rejection of the orthosis. Results: Two hundred eighty‐three charts were reviewed. Of these, 109 of 123 (89%) patients were satisfied or extremely satisfied with the anterior shell CFAFOs, including 38 who had previously used other styles. Conclusion: Anterior shell CFAFOs should be considered for most neuromuscular patients with distal leg weakness. Muscle Nerve 55 : 202–205, 2017     

Prevalence of transfusion-transmitted Chagas disease among multitransfused patients in Brazil

Background

Prevalence and risk factors for Chlamydia trachomatis infection among young men in Switzerland is still unknown. The objective of the present study was to assess prevalence and risk factors for C. trachomatis infection in young Swiss men.

Methods

517 young Swiss men were enrolled in this cross-sectional study during their compulsory military recruitment. Participants completed a questionnaire and gave urine samples which were screened for C. trachomatis DNA by PCR. Genotyping of positive samples was done by amplification and sequencing the ompA gene.

Results

The prevalence of chlamydial infection among young Swiss male was 1.2% (95% confidence interval [95%CI], 0.4–2.5%). C. trachomatis infection was only identified among the 306 men having multiple sexual partner. Although frequent, neither unprotected sex (absence of condom use), nor alcohol and drug abuse were associated with chlamydial infection. Men living in cities were more frequently infected (2.9%, 95%CI 0.8–7.4%) than men living in rural areas (0.5%, 95%CI 0.1–1.9%, p = 0.046). Moreover, naturalised Swiss citizens were more often positive (4.9%, 95%CI 1.3–12.5%) than native-born Swiss men (0.5%, 95%CI 0.1–1.7%, p = 0.003).

Conclusion

In comparison with other countries, the prevalence of chlamydial infection in men is extremely low in Switzerland, despite a significant prevalence of risky sexual behaviour. C. trachomatis infection was especially prevalent in men with multiple sexual partners. Further research is required (i) to define which subgroup of the general population should be routinely screened, and (ii) to test whether such a targeted screening strategy will be effective to reduce the prevalence of chlamydial infection among this population.     

Daily cannabis and reduced risk of steatosis in human immunodeficiency virus and hepatitis C virus‐co‐infected patients (ANRS CO13‐HEPAVIH)

Liver steatosis is common in human immunodeficiency virus (HIV)‐hepatitis C virus (HCV)‐co‐infected patients. Some recent studies have found that cannabis use is negatively associated with insulin resistance in the general population and in HIV‐HCV‐co‐infected patients. Given the causal link between insulin resistance and steatosis, we hypothesized that cannabis use has a positive impact on steatosis. Therefore, we aimed to study whether cannabis use in this population was associated with a reduced risk of steatosis, measured by ultrasound examination. ANRS CO13‐HEPAVIH is a French nationwide multicentre cohort of HIV‐HCV‐co‐infected patients. Medical and socio‐behavioural data from clinical follow‐up visits and annual self‐administered questionnaires were prospectively collected. A cross‐sectional analysis was conducted using data from the first visit where both ultrasound examination data for steatosis (positive or negative diagnosis) and data on cannabis use were available. A logistic regression model was used to evaluate the association between cannabis use and steatosis. Among study sample patients (n = 838), 40.1% had steatosis. Fourteen per cent reported daily cannabis use, 11.7% regular use and 74.7% no use or occasional use (“never or sometimes”). Daily cannabis use was independently associated with a reduced prevalence of steatosis (adjusted odds ratio [95% CI] = 0.64 [0.42;0.99]; P = .046), after adjusting for body mass index, hazardous alcohol consumption and current or lifetime use of lamivudine/zidovudine. Daily cannabis use may be a protective factor against steatosis in HIV‐HCV‐co‐infected patients. These findings confirm the need for a clinical evaluation of cannabis‐based pharmacotherapies in this population. Eudract.ema.europa.eu number, DGS050367.