[Prevalence of HLA-B*57:01 allele in HIV-infected patients in a university hospital in Tehran]

Abacavir is an anti-retroviral medication used to treat HIV infected/AIDS patients and its efficacy has been proven in randomized clinical trials. The most significant adverse reaction associated with abacavir is the acute hypersensitivity phenomenon which manifests in many forms and in severe cases could result in death. Hypersensitivity reaction to abacavir has been closely linked to the presence of HLA-B*57:01 allele. Avoidance of abacavir initiation in allele-positive patients is the most effective strategy in preventing possible severe hypersensitivity reactions. Previous epidemiologic studies have made great strides toward delineating HLA-B*57:01 allele frequency in different regions of the World and the available results indicate significant discrepancy between geographical regions. Despite these efforts, no study to date has determined the allele frequency among Iranian HIV-positive patients. The aim of the present study was to determine the proportion of allele-positive patients among a group of Iranian HIV-infected patients. Between September 2012 and February 2013, 122 HIV-positive patients were selected among patients referred to Imam Khomeini Hospital's Consultation center for high risk behaviors using the convenience sampling method. Sampling scheme was designed in a manner to include equal number of infected patients with and without clinical Acquired Immunodeficiency Syndrome [AIDS]. Patient data was collected using available records and a blood sample for DNA analysis was also obtained. Presence of HLA-B*57:01 allele was determined using the Polymerase Chain Reaction- Sequence Specific Method [PCR-SSP]. Seventy three patients [59.8%] were male. Co-infection with hepatitis B and C was observed in 1.7% and 40.7% of the patients, respectively. History of addiction and anti-retroviral therapy was positive in 50.0% and 60.7% of the patients, respectively. Overall, three patients were allele-positive which corresponds to a frequency of 2.46% [95% CI: 0.005-7.30]. No association between presence of allele and investigated variables were identified. Frequency of HLA-B*57: 01 allele among a group of Iranian HIV-infected patients is estimated to be 2.5%. This rate is comparable to those reported in other Middle-Eastern countries, yet is relatively lower than reports generated from South-Eastern Asia, Europe, and the United States. Future studies with larger sample sizes are needed to corroborate these findings

Disseminated tuberculosis in an AIDS/HIV-infected patient

Disseminated tuberculosis [TB] is commonly seen in HIV-infected patients and is major cause of death in these patients. In HIV-infected patients disseminated tuberculosis is frequently undiagnosed or misdiagnosed. In this article we report a case of disseminated TB in a HIV-infected patient with a relatively long history of fever and other complaints without definite diagnosis. Diagnosis of disseminated TB was confirmed by bone marrow biopsy and polymerase chain reaction analysis [PCR] of the ascitic fluid. With anti-TB treatment signs and symptoms improved.

Subtenon carboplatin in the management of intraocular retinoblastoma

To evaluate the efficacy of subtenon carboplatin as an adjuvant to systemic chemotherapy in the management of intraocular retinoblastoma. This study was conducted as a randomized, double-masked clinical trial. A diagnosis of intraocular retinoblastoma was made based on clinical examination, ultrasonography and orbital CT-scanning. The greatest basal dimension of the tumors was estimated in disc diameter [DD] by indirect ophthalmoscopy. Tumor thickness was determined by ultrasonography. Each eye was assigned to one of 10 blocks based on tumor stage [Reese-Ellseworth classification] and randomly received systemic chemotherapy alone [control group] or systemic chemotherapy plus 20mg subtenon carboplatin [case group]. Indirect laser photocoagulation or cryotherapy was performed as additional treatment. The study included 35 tumors in 17 eyes of 14 patients [19 tumors in 8 eyes of the control group and 16 tumors in 9 eyes of the case group]. There was 57.22% and 61.73% decrease in tumor thickness in the control and case groups, respectively [P=0.12]. The decrease in greatest basal tumor dimension in the control group [47.32%] was not significantly different from that in the case group [38.80%]. One eye [12.5%] in the control group and 3 eyes [33.3%] in the case group were enucleated. Adjuvant subtenon carboplatin does not seem to increase the efficacy of systemic chemotherapy in the treatment of intraocular retinoblastoma