Metabolic Complications in Korean HIV/AIDS Patients Receiving Highly Active Anti-retroviral Therapy

BACKGROUND: Since the introduction of HAART (Highly Active Anti-Retroviral Therapy), metabolic com- plications have been reported with varying prevalence. We performed a retrospective study to evaluate the incidence and risk factors of metabolic complications arising in Korean HIV/AIDS patients. MATERIALS AND METHODS: 66 HIV positive patients on combination therapy between 1998 June to 2002 June with at least 1 protease inhibitor (PI) or/and Non-nucleoside reverse transcriptase inhibitors (NNRTI) were reviewed. Hyperglycemia was defined as serum glucose >140 mg/dL on 2 or more occasions; diabetes as any random serum glucose >200 mg/dl; hypercholesterolemia as serum cholesterol >240 mg/dL; hypertriglyceridemia as serum triglyceride >200 mg/dL. We used SPSS version 9.0 for statistical analysis. One way ANOVA was used to compare the treatment groups. Multinominal logistic regression analysis was used for risk factor analysis. RESULTS: 66 patients were analyzed and total duration of follow up was 138 patient-years. The incidence of metabolic complication was 20.3%. Incidence of hypertriglyceridemia, hypercholesterolemia, hyperglycemia, and diabetes were 12.3%, 5.8%. 1.4%, 4.3% respectively. On risk factor analysis, factors contributing to the development of metabolic complication were age>35 years (P= 0.020) and baseline serum triglyceride >140 mg/dL (P=0.001). Baseline CD4 count 6 months (P=0.055) were associated with development of metabolic complications with borderline significance. CONCLUSION: The incidence of metabolic complication among Korean HIV/AIDS patients receiving HAART is 20.3%. Older age and high baseline triglyceride were risk factors for development of metabolic complications.

Metabolic Complications in Korean HIV/AIDS Patients Receiving Highly Active Anti-retroviral Therapy

BACKGROUND: Since the introduction of HAART (Highly Active Anti-Retroviral Therapy), metabolic com- plications have been reported with varying prevalence. We performed a retrospective study to evaluate the incidence and risk factors of metabolic complications arising in Korean HIV/AIDS patients. MATERIALS AND METHODS: 66 HIV positive patients on combination therapy between 1998 June to 2002 June with at least 1 protease inhibitor (PI) or/and Non-nucleoside reverse transcriptase inhibitors (NNRTI) were reviewed. Hyperglycemia was defined as serum glucose >140 mg/dL on 2 or more occasions; diabetes as any random serum glucose >200 mg/dl; hypercholesterolemia as serum cholesterol >240 mg/dL; hypertriglyceridemia as serum triglyceride >200 mg/dL. We used SPSS version 9.0 for statistical analysis. One way ANOVA was used to compare the treatment groups. Multinominal logistic regression analysis was used for risk factor analysis. RESULTS: 66 patients were analyzed and total duration of follow up was 138 patient-years. The incidence of metabolic complication was 20.3%. Incidence of hypertriglyceridemia, hypercholesterolemia, hyperglycemia, and diabetes were 12.3%, 5.8%. 1.4%, 4.3% respectively. On risk factor analysis, factors contributing to the development of metabolic complication were age>35 years (P= 0.020) and baseline serum triglyceride >140 mg/dL (P=0.001). Baseline CD4 count 6 months (P=0.055) were associated with development of metabolic complications with borderline significance. CONCLUSION: The incidence of metabolic complication among Korean HIV/AIDS patients receiving HAART is 20.3%. Older age and high baseline triglyceride were risk factors for development of metabolic complications.

Rapid Diagnosis of HCMV Diseases by pp65 Antigenemia Assay: Comparison of pp65 Antigenemia with Polymerase Chain Reaction

BACKGROUND: The present study was performed to evaluate clinical usefulness of pp65 antigenemia assay (pp65 Ag), plasma polymerase chain reaction (P-PCR) and peripheral blood mononuclear cell PCR (PBMC-PCR) in patients with cytomegalovirus (CMV) diseases. METHODS: Sixty samples from 41 patients admitted in Seoul National University Hospital from Sep, 2001 through Feb, 2002 were evaluated. Twenty-eight patients who had symptoms and signs of CMV disease and 13 patients who were asymptomatic were tested for CMV infection. Among 60 samples, 59 samples were tested for pp65 Ag by Clonab CMV kit (Biotest, Dreieich, Germany). Fifty-six samples were tested for P-PCR and PBMC-PCR, respectively. RESULTS: Fifteen (25%) out of 59 samples showed positive by pp65 Ag, 16 (29%) and 24 (43%) out of 56 samples showed positive by P-PCR and PBMC-PCR, respectively. The concordance rate of pp65 Ag and P-PCR in the same blood sample was 82%. CMV disease was diagnosed in 15 (37%) patients. The sensitivities of pp65 Ag, P-PCR and PBMC-PCR were 60, 53 and 80%, respectively, and in specificities were 96, 92, 88%, respectively. Of the 15 patients with CMV diseases, 4 patients who underwent allogenic bone marrow transplantation showed positive results by all the three assays, and the number of pp65 positive cells in these patients was high (3-30/4X10(5)). Eight out of the 15 patients with CMV diseases had CMV gastroenteritis. Four of them showed positive by pp65 Ag(the number of pp65 positive cells : 1-3/4X10(5)) and 2 patients showed positive by P-PCR. CONCLUSION: The senstivity of PBMC-PCR was high and the specificity was relatively low. It is quite likely PBMC-PCR was not able to distinguish CMV reactivation from latent infection. The sensitivity and specificity of pp65 Ag were similar to those of P-PCR. CMV pp65 positive cells could be quantitated by pp65 Ag.

Rapid Diagnosis of HCMV Diseases by pp65 Antigenemia Assay: Comparison of pp65 Antigenemia with Polymerase Chain Reaction

BACKGROUND: The present study was performed to evaluate clinical usefulness of pp65 antigenemia assay (pp65 Ag), plasma polymerase chain reaction (P-PCR) and peripheral blood mononuclear cell PCR (PBMC-PCR) in patients with cytomegalovirus (CMV) diseases. METHODS: Sixty samples from 41 patients admitted in Seoul National University Hospital from Sep, 2001 through Feb, 2002 were evaluated. Twenty-eight patients who had symptoms and signs of CMV disease and 13 patients who were asymptomatic were tested for CMV infection. Among 60 samples, 59 samples were tested for pp65 Ag by Clonab CMV kit (Biotest, Dreieich, Germany). Fifty-six samples were tested for P-PCR and PBMC-PCR, respectively. RESULTS: Fifteen (25%) out of 59 samples showed positive by pp65 Ag, 16 (29%) and 24 (43%) out of 56 samples showed positive by P-PCR and PBMC-PCR, respectively. The concordance rate of pp65 Ag and P-PCR in the same blood sample was 82%. CMV disease was diagnosed in 15 (37%) patients. The sensitivities of pp65 Ag, P-PCR and PBMC-PCR were 60, 53 and 80%, respectively, and in specificities were 96, 92, 88%, respectively. Of the 15 patients with CMV diseases, 4 patients who underwent allogenic bone marrow transplantation showed positive results by all the three assays, and the number of pp65 positive cells in these patients was high (3-30/4X10(5)). Eight out of the 15 patients with CMV diseases had CMV gastroenteritis. Four of them showed positive by pp65 Ag(the number of pp65 positive cells : 1-3/4X10(5)) and 2 patients showed positive by P-PCR. CONCLUSION: The senstivity of PBMC-PCR was high and the specificity was relatively low. It is quite likely PBMC-PCR was not able to distinguish CMV reactivation from latent infection. The sensitivity and specificity of pp65 Ag were similar to those of P-PCR. CMV pp65 positive cells could be quantitated by pp65 Ag.

Clinical Manifestations and Treatment Outcome of Invasive Aspergillosis / 감염

BACKGROUND: The incidence of invasive aspergillosis has been increasing as the number of severe immunocompromised hosts has increased. We reviewed representative cases of invasive aspergillosis to describe clinical manifestations and treatment outcome. METHODS: We identified 40 cases of invasive aspergillosis on the ground of pathologic and radiologic findings from January 1991 to December 2000 and reviewed medical records and laboratory data. RESULTS: Forty cases of invasive aspergillosis included 28 'definite' cases and 12 'probable' cases. Major involved organs of invasive aspergillosis were lung (n=23, 57.5%), sinus (n=11, 27.5%), brain (n=3, 7.5%), spine (n=1, 2.5%), skull (n=1, 2.5%), and small bowel (n=1, 2.5%). Underlying diseases and risk factors were hematologic malignancies (n=21, 52.5%), high-dose steroid treatment (n=8, 20%), post-transplantation of solid organ (n=2, 5%), and ectopic ACTH syndrome (n=1, 2.5%). Immunocompetent hosts including DM patients were 8 cases (20%) and their major involved sites were sinus (n=4) and brain (n=2). Crude mortality rate of total invasive aspergillosis after 3 months and 12 months were 30% and 47.5%, respectively. 3-month and 12-month mortality rate for pulmonary aspergillosis (n=23) were 39%, 61% and those for extrapulmonary aspergillosis (n=17) were 18 %, 29%. Patients with hematologic malignancy (n=21) were in 33%, 57%, other immunocompromised hosts (n=11) were in 45%, 45%, and immunocompetent hosts (n=8) were in 0%, 25%. Patients with aggravated underlying diseases and sustained risk factors (n=20) were in 60%, 70% and patients with improved underlying diseases and no risk factor (n=20) were in 0%, 20%. CONCLUSION: Invasive aspergillosis mainly developed in severe immunocompromised hosts, but invasive sinus aspergillosis and cerebral aspergillosis occasionally developed in apparently immunocompetent hosts. The degree of immunosuppression and severity of underlying diseases affected the treatment outcome of invasive aspergillosis.

The Effects of Initial Empirical Antibiotics Regimens on the Outcomes of Staphylococcus aureus Bacteremia / 감염

BACKGROUND: Because of the concern for the emergence of resistance, the prudent use of vancomycin is essential. However, it is uncertain whether the initial delay in the effective treatment of Staphylococcus aureus bacteremia adversely affects the outcome. We performed this study to determine the outcome of an initial delay in the use of antistaphylococcal antibiotics for Staphylococcus aureus bacteremia (SAB). METHODS: We conducted a retrospective cohort study of 238 with SAB at a tertiary care hospital. Empirical antibiotics treatment was considered ineffective if the isolated strain was not susceptible, in vitro, to antibiotics given during the first 48 hours. The outcome was measured as SAB-related mortality within 8 weeks from the SAB. RESULTS: The mortality for the patients with ineffective empirical regimen (50/117, 42.7%) showed a trend toward being higher than that with effective empirical regimen (38/121, 31.4%), but it did not reach the statistical significance (OR 1.63 95% CI 0.96~2.77, P=0.07). However, in the subgroups of end-stage renal disease ineffective empirical antibiotics adversely affected the outcomes (OR 5.42, 95% CI 1.25~23.49, P=0.02) On multivariate logistic regression analysis, adjusted OR of ineffective empirical regimen for SAB-related mortality was 2.03 (95% CI 1.08~3.82, P=0.03). CONCLUSION: Our findings suggest that an initial delay in the use of antistaphylococcal antibiotics for the first 2 days might adversely affect the outcome when treating SAB, especially in the patients with end-stage renal disease.

A case of Sweet's syndrome with pulmonary involvement / 대한내과학회지

Sweet's syndrome is a rare disorder presenting with painful erythematous plaques or nodules of the skin with fever, leukocytosis, arthralgia and conjunctivitis.Sweet's syndrome occurs in association with malignant tumors in 10~20% of cases. Eighty five percent of the malignant tumors are hematologic malignancies, acute myelogenous leukemia being most common. Sweet's syndrome occurring in a patient with solid tumor is rare and pulmonary involvement of Sweet's syndrome occurring in a patient with a solid tumor has not been reported in world literature so far. We report a case of Sweet's syndrome presenting with pulmonary nodules in a patient with hepatocellular carcinoma.