HIV-associated Isospora belli infection: incidence and risk factors in the French Hospital Database on HIV.

OBJECTIVE: To determine the incidence of Isospora belli infection in HIV-infected patients in France, and to study risk factors. METHODS: The French Hospital Database on HIV (FHDH) is a prospective cohort study that collects demographic, clinical and therapeutic data on patients managed in 62 hospitals. We reviewed all cases of I. belli infection recorded between 1992 and 2003. We compared the incidence in 1992-1994 [before the use of dual therapy and combination antiretroviral therapy (cART)] and in 1997-2003 (when use of cART was widespread), after stratification for CD4 cell count (< 50, 50-99, 100-199 and > 200 cells/microL). RESULTS: A total of 164 patients had I. belli infection either at enrollment (n=71) or during follow up (n=93). During the study period, I. belli infection tended to occur less frequently during follow up, and to be diagnosed mainly at database enrollment. The incidence of I. belli infection during follow up fell by 79% [relative hazard (RH) 0.21; 95% confidence interval (CI) 0.13-0.33] in the cART period compared with the pre-cART period; no such change was noted among patients with CD4 cell counts below 50 cells/microL. In multivariable analysis, the risk of I. belli infection was significantly higher among patients from sub-Saharan Africa (RH 4.3; 95% CI 2.6-7.3). After adjustment for CD4 cell count, patients receiving cotrimoxazole prophylaxis were found to be at a lower risk of I. belli infection (RH 0.3; 95% CI 0.2-0.6). CONCLUSIONS: In France, I. belli infection among HIV-infected patients is now mainly seen in patients from sub-Saharan Africa, who present at an advanced stage.

[Metastatic cancer of the prostate in a young 40 year-old HIV-infected male patient]. / Cancer de prostate métastatique chez un jeune adulte de 40 ans infecté par le VIH.

INTRODUCTION: Cancer of the prostate in HIV-infected patients has rarely been reported in the literature. OBSERVATION: A 40 year-old man presented with an adenocarcinoma of the prostate and bone and glandular metastases. The patient exhibited HIV seropositivity stage B1, the immune-virology of which was well controlled by antiretroviral tritherapy. COMMENTS: The relationship between cancer and HIV has been established for certain cancers such as Hodgkin's disease, non-Hodgkin malignant lymphoma, Kaposi's sarcoma and invasive cancers of the uterine neck in women. The significant increase in some cancers in patients infected by HIV (lung, penis, soft tissue, lips, seminoma) suggests the potential association with immunodepression unless it corresponds to a risk induced by antiretroviral treatments in the long term.

[Metastatic cancer of the prostate in a 40-year-old HIV-infected male patient]. / Cancer de prostate métastatique chez un jeune adulte de 40 ans infecté par le VIH.

INTRODUCTION: Cancer of the prostate in HIV-infected patients has rarely been reported in the literature. OBSERVATION: A 40-year-old man presented with an adenocarcinoma of the prostate and bone and glandular metastases. The patient exhibited HIV seropositivity stage B1, the immune-virology of which was well controlled by antiretroviral tritherapy. COMMENTS: The relationship between cancer and HIV has been established for certain cancers such as Hodgkin's disease, non-Hodgkin malignant lymphoma, Kaposi's sarcoma and invasive cancers of the uterine neck in women. The significant increase in some cancers in patients infected by HIV (lung, penis, soft tissue, lips, seminoma) suggests the potential association with immunodepression unless it corresponds to a risk induced by antiretroviral treatments in the long term.

Osteomalacia cured by surgery.

Oncogenic osteomalacia is an uncommon syndrome characterized by bone pain, proximal muscle weakness, hypophosphatemia, hyperphosphaturia, and a low concentration of 1,25-dihydroxyvitamin D. This syndrome is induced by a tumor, usually benign, of mesenchymal origin and resolves after its excision. We report a case of an oncogenic osteomalacia caused by a small mesenchymal tumor of the tendon sheath of the foot, a localized form of tenosynovial giant cell tumor.

[Pulmonary mucormycosis: benefit of aerosol amphotericin B?]. / Mucormycose pulmonaire: intérêt des aérosols d'amphotéricine B?

Mucormycosis is an opportunistic fungal infection usually observed in diabetic or neutropenic patients. Prognosis is serious with a high rate of mortality. Intravenous amphotericin B is the gold standard treatment. The main side effect is renal failure. Liposomal amphotericin B (AmBisome(R)) is not nephrotoxic and can be proposed as an alternative treatment although its cost is high. We report a case of mucormycosis in a diabetic woman who developed renal failure after intravenous amphotericin B treatment. AmBisome(R) could not be used for long-term treatment due to its high case. The patient was given nebulized amphotericin B and achieved recovery. This kind of treatment may provide a useful alternative to intravenous amphotericin B.