Recurrence of progressive multifocal leukoencephalopathy despite immune recovery in two HIV seropositive individuals

We present two cases of recurrent progressive multifocal leukoencephalopathy (PML) in patients with long standing virally suppressed human immunodeficiency virus (HIV) and normal CD4+ T cell count who were taking stable regimens of highly active antiretroviral therapy (HAART). This has significant implications for other patients with a past history of PML, not just those with HIV but also those on medications such as natalizumab or fumarates.     

Social and lifestyle characteristics and burden of ill-health associated with self-reported hearing and vision impairments in older men in the British community: a cross-sectional study

BackgroundSensory impairment is common in older adults and we need to understand more about its association with other health conditions. We explored sensory impairment in relation to demographic, lifestyle factors, and health conditions in older men.MethodsIn a cross-sectional study, 3981 men aged 63–85 years (82% of participants recruited to the British Regional Heart Study cohort in 1978–80 and still alive in 2003) were selected from general practices in 24 British towns. Data on hearing aid use and ability to follow television at a volume others find acceptable allowed for four categories of hearing: can hear (n=2851), can hear with an aid (n=482), cannot hear and no aid (n=424), and cannot hear despite an aid (n=168). Vision impairment was defined as not being able to recognise a friend across a road (n=124). Logistic regression was used to investigate associations of hearing impairment and vision impairment with self-reported doctor-diagnosed coronary heart disease, disability (difficulty taking the stairs, difficulty keeping balance), social interaction (attending few social activities), and quality of life (experiencing pain, feeling anxious or depressed).Findings1074 men (27%) reported hearing impairment and 124 (3%) reported vision impairment. Compared with those reporting no hearing problem, hearing impairment was associated with disability, poor social interaction, and poor quality of life. Poor quality of life remained significant after having adjusted for social class, smoking, obesity, and physical activity. Only men who could not hear despite having a hearing aid were more likely to report coronary heart disease (age-adjusted odds ratio 1·89, 95% CI 1·36–2·63) and falls (1·62, 1·05–2·48). Vision impairment was associated with symptoms of coronary heart disease including chest pain (1·58, 1·07–2·40) and breathlessness (2·06, 1·38–3·06), but not with diagnosed coronary heart disease (1·39, 0·93–2·07). Vision impairment was also significantly associated with falls, poor quality of life, poor social interaction, and disability, which remained significant after adjusting for social class, smoking, obesity, and physical activity. Men with a sensory impairment were more likely to be physically inactive, obese (hearing impairment only), and in a manual social class.InterpretationOlder men with hearing impairment and vision impairment have a high risk of disability, poor health, and poor social interaction. Policy efforts for early detection and treatment of sensory impairment could be crucial for independent living in old age.FundingThe British Regional Heart Study is funded by the British Heart Foundation. AEML is funded by the National Institute for Health Research School for Public Health Research. SER is funded by a UK Medical Research Council Fellowship.     

Translational benefits of gene therapy to date

Gene therapy is now a reality with a number of early phase clinical trials having been completed and several currently in progress. In spite of some early setbacks substantial progress has been made with treatment of several different diseases using a variety of delivery vectors and transgenes. Indeed for some diseases gene therapy is now the treatment of choice, in particular the inherited immune deficiencies. Treatment of ocular diseases and cancer are also showing great promise. Immune responses and insertional mutagenesis still pose problems but refinement of delivery systems and an increased understanding of oncogene activation should ensure that more successful protocols will emerge in the near future. Continuous progress suggests that a wider range of diseases can be treated with gene therapy in the future.