Unmasking tuberculosis-associated immune recons-titution inflammatory syndrome in HIV-1 infection after antiretroviral therapy.

The exaggerated immune response to the subclinical opportunistic microorganisms or their antigens can be found in HIV-1 infected patients after receiving antiretroviral (ARV) therapy. We report a case of unmasking tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) in the HIV-1 infected patient who had no previous history of mycobacterial infection. She had tuberculosis of intestines, peritoneum and mesenteric glands within 2 months of ARV. However, her sputum acid-fast bacilli stain, sputum, blood and cervical lymph node aspiration cultures for mycobacterium were negative. Her CD4 cell count increased of from 46 cells/mL at baseline before receiving ARV to 155 cells/mL at month 6 of ARV. In addition, her plasma pro-inflammatory (IFN-g and TNF-a) and anti-inflammatory (IL-10) cytokine measurement was supported the occurrence of immune restoration reaction. Therefore, the changing in these cytokine profiles may be an important marker of developing unmasking TB-IRIS

Efficacy and safety of zidovudine and zalcitabine combined with a combination of herbs in the treatment of HIV-infected Thai patients.

A randomized double blind placebo controlled trial to determine the efficacy and safety of combined-herbs (SH) given with zidovudine (ZDV) and zalcitabine (ddC) for the treatment of HIV infection in Thai adults was conducted in 3 hospitals in northern Thailand during 2002 to 2003. The eligible subjects were HIV-infected Thai adults who had never received anti-retrovirals, had a Karnofski Performance Score (KPS) of > or = 70, and had no opportunistic infections. The subjects were randomized to receive either a combination of ZDV 200 mg three times per day, ddC 0.75 mg three times per day, and SH 2.5 g three times per day or a combination of ZDV 200 mg three times per day, ddC 0.75 mg three times per day, and placebo 2.5 g three times per day for 24 weeks. The main outcome measures were HIV-RNA, CD4 cells, and blood chemistry profiles prior to the treatment and then every 4 weeks for 24 weeks. The baseline characteristics of 60 evaluable subjects, 40 in the SH group and 20 in the placebo group, were not significantly different. HIV RNA at week 4 and thereafter was significantly decreased from the baseline value in both groups (p<0.001). However, the decline in HIV RNA in the SH group was significantly more than that in the placebo group. The CD4 cells in the SH group at week 12 and thereafter were significantly increased from the baseline value. Serious adverse events in the two groups were not observed. It is concluded that an addition of SH herbs to two nucleoside reverse transcriptase inhibitors has greater antiviral activity than antiretrovirals only. The SH herbs may be an alternative for the third anti-retroviral agent in the triple drug regimen for the treatment of HIV infected patients in countries with limited resources.

Genotype distribution of genital Chlamydia trachomatis in Chiang Mai, Thailand.

Urogenital isolates (N=84) of Chlamydia trachomatis collected from high-risk STD subjects in Chiang Mai and the surrounding areas were investigated for genotype distribution. C. trachomatis genotypes were determined by the PCR-based RFLP technique and confirmed by nucleotide sequencing. By this method, the VD4 DNA of the MOMP gene was amplified and digested separately with 4 restriction endonucleases, AluI, HindIII, DdeI, and EcoRII. The nucleotide sequence was determined by dye terminator cycle sequencing. Eight different C. trachomatis genotypes were identified: genotype D (34.5%), F (21.4%), K (13.1%), H/Ia (8.3%), E (7.1%), B/Ba (7.1%), G (6.0%), and J (2.4%). Genotype D and F were the commonest, accounting for 56% of the C. trachomatis infections. When nucleotides of the VD4-MOMP gene were anlyzed, 43 samples (51.2%) had nucleotide sequences that differed from the prototypes, while 41 (48.8%) were identical. Nucleotide substitution mutation was the major mechanism in these variants; changes in nucleotide sequences usually resulted in amino acid substitution, which could lead to a modification of antigenic determinants and the consequent evasion of immune responses.