Prevalence of genotypic and phenotypic resistance to anti-retroviral drugs in a cohort of therapy-naïve HIV-1 infected US military personnel.

OBJECTIVE: While transmission of drug-resistant HIV-1 has been reported, estimates of prevalence of resistance in drug-naïve populations are incomplete. We investigated the prevalence of genotypic mutations and phenotypic antiretroviral resistance in a cohort of HIV-1 infected U.S. military personnel prior to the institution of antiretroviral therapy. DESIGN: Cross-sectional cohort study. METHODS: Plasma was obtained from 114 recently HIV-1 infected subjects enrolled in an epidemiological study. Genotypic resistance was determined by consensus sequencing of a PCR product from the HIV-1 pol gene. Sequences were interpreted by a phenotypic-genotypic correlative database. Resistance phenotypes were determined by a recombinant virus cell culture assay. RESULTS: Genotypic mutations and phenotypic resistance were found at a higher than expected frequency. Resistance to non-nucleoside reverse transcriptase inhibitors was most common, with a prevalence of 15% of 95 subjects by genotype and 26% of 91 subjects by phenotype. Genotypic and phenotypic resistance respectively were found in 4% and 8% of subjects for nucleoside reverse transcriptase inhibitors and in 10% and 1% for protease inhibitors. One subject harbored virus with resistance to all three drug classes. CONCLUSIONS: A substantial frequency of resistance to antiretroviral drugs was identified in a therapy-naïve U.S. cohort. In most cases, the genotypic and phenotypic assays yielded similar results, although the genotypic assay could detect some protease inhibitor resistance-associated mutations in the absence of phenotypic resistance. These data suggest the need for optimization of treatment guidelines based on current estimates of the prevalence of drug resistance in HIV-1 seroconverters.

Accuracy of oral specimen testing for human immunodeficiency virus.

Antibodies to human immunodeficiency virus (HIV) can be detected in oral fluid with great accuracy, due to technical advances in both the collection of oral samples and assays. Reported sensitivities of 97.2-100% and specificities of 97.7-100% compare well with those of serum-based assays and qualify oral fluid for the screening and diagnosis of HIV infection in both high- and low-risk populations. In addition, oral fluid offers several advantages over serum as a testing medium for HIV, including greater safety, ease of collection, and patient acceptability.

A modified ELISA and western blot accurately determine anti-human immunodeficiency virus type 1 antibodies in oral fluids obtained with a special collecting device.

Serum and saliva from 195 known human immunodeficiency virus (HIV)-seropositive patients and 198 military personnel undergoing annual HIV serologic testing were evaluated in a prospective, blinded fashion for anti-HIV-1 antibodies. Oral specimens, collected with a device designed to concentrate oral mucosal transudate from whole saliva, were tested by a modified ELISA and by Western blot. Serum was tested in a standard manner. All 195 HIV-1-seropositive subjects had detectable anti-HIV-1 antibodies in their saliva by ELISA; 190 saliva samples were positive by Western blot and 5 were indeterminate. None of the 198 military personnel were positive by ELISA of serum or oral fluid. The sensitivity, specificity, and positive and negative predictive values for ELISA of saliva were each 100%. The serologic testing of oral mucosal transudate appears to be a simple, safe, sensitive, and specific method for detecting anti-HIV-1 antibodies.

Progressive pulmonary cryptococcosis in a patient who is immunocompetent.

Pulmonary cryptococcal disease can have variable clinical and roentgenographic presentations. Symptoms and radiographic abnormalities can resolve prior to therapy, even in a patient who is immunocompromised. Antifungal therapy is generally not recommended for a patient who is immunocompetent with nonprogressive, nondisseminated pulmonary cryptococcosis. We present a case of pulmonary cryptococcosis that progressed despite fluconazole therapy in a patient who was immunocompetent. This appears to be the second reported case of a discrete endobronchial cryptococcoma.

Antibacterial prophylaxis.

Bacteremias of dental origin have been implicated as sources of infection in specific cardiac conditions, diabetes, neutropenia, kidney disease, splenectomy, and patients with prosthetic joints. This article reviews the relative risks of dental bacteremias in these patients, discusses the merits of various regimens, and presents current prophylactic antibiotic recommendations.

Rhodococcus equi infection in the patient with AIDS: literature review and report of an unusual case.

Rhodococcus equi is an aerobic, intracellular, gram-positive rod-coccus that is partially acid fast. The organism is primarily a pathogen in animals and has only rarely been seen in immunocompromised humans. Its most common manifestation is a slowly progressive pneumonia that may cavitate. Infections are thought to be acquired via respiratory exposure to animals or soil. R. equi infections are difficult to treat, usually requiring prolonged administration of parenteral antibiotics and often necessitating surgical drainage. A case of cavitary pneumonia and recurrent bacteremia with R. equi in a patient with AIDS is reported, and the current literature on R. equi infections in humans is reviewed.

Immediate and delayed reactions to cosmetic ingredients.

The purpose of this study was to investigate the incidence and etiology of cutaneous reactions caused by cosmetics, with an emphasis on perfume sensitivity. 19 control subjects and 31 patch test clinic patients (16 with a history of adverse cosmetic reactions) were examined for sensitivity by history, open and patch testing using the North American Contact Dermatitis Group (NACDG) fragrance screening series and 11 other common allergens found in cosmetics. Contact urticaria was very frequent to certain chemicals; however, patients with a history of cosmetic sensitivity were not found to have a significant increase in positive reactions when compared to controls or patients with eczematous skin. 12 subjects had positive patch test reactions, most of which were not clinically relevant. 3 patients with a history of cosmetic sensitivity had positive reactions, only 1 of which was in the fragrance screening series (cinnamic alcohol). There were 6 reactions in patients with eczematous skin, 4 of which were to preservatives. 3 controls had positive reactions, each to thimerosal. A history of cosmetic sensitivity was not confirmed by open and closed skin testing in our subjects.