Renal dysfunction by baseline CD4 cell count in a cohort of adults starting antiretroviral treatment regardless of CD4 count in the HIV Prevention Trials Network 071 [HPTN 071; Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART)] study in South Africa.

OBJECTIVES: Renal dysfunction is a significant cause of morbidity and mortality among HIV-positive individuals. This study evaluated renal dysfunction in a cohort of adults who started antiretroviral treatment (ART) regardless of CD4 count at three Department of Health (DOH) clinics included in the HIV Prevention Trials Network 071 (HPTN 071) Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART) trial. METHODS: A retrospective cohort analysis of routine data for HIV-positive individuals starting ART between January 2014 and November 2015 was completed. Incident renal dysfunction was defined as an estimated glomerular filtration rate (eEGFR) < 60 mL/min after ART initiation among individuals with a baseline (pre-ART) eGFR ≥ 60 mL/min. RESULTS: Overall, 2423 individuals, with a median baseline CD4 count of 328 cells/µL [interquartile range (IQR) 195-468 cells/µL], were included in the analysis. Forty-seven individuals had a baseline eGFR < 60 mL/min. Among 1634 nonpregnant individuals started on a tenofovir-containing ART regimen and with a baseline eGFR ≥ 60 mL/min, 27 developed an eGFR < 60 mL/min on ART. Regression analysis showed lower odds of baseline eGFR < 60 mL/min at baseline CD4 counts of > 500 cells/µL [adjusted odds ratio (aOR) 0.29; 95% confidence interval (CI) 0.11-0.80], 351-500 cells/µL (aOR 0.22; 95% CI 0.08-0.59) and 201-350 (aOR 0.48; 95% CI: 0.24-0.97) compared with baseline CD4 counts < 200 cells/µL. CONCLUSIONS: This study showed low rates of renal dysfunction at baseline and on ART, with lower rates of baseline renal dysfunction among individuals with baseline CD4 counts > 200 cells/µL. Strategies that use baseline characteristics, such as age, to identify individuals at high risk of renal dysfunction on ART for enhanced eGFR monitoring may be effective and should be the subject of future research.

Sonography of the knee, a pictorial review.

The use of ultrasound for evaluation of the knee is increasing. Although it cannot replace magnetic resonance imaging (MRI), which has been the modality of choice in conjunction with plain radiographs, ultrasound does have certain advantages in knee diagnosis. For example, in South Africa the cost of an ultrasound examination is approximately 10% of the cost of an MRI scan. Ultrasound is a very cost-effective alternative for imaging of the knee, providing the indications, advantages, and limitations are understood. Probably the greatest advantage of ultrasound, however, is for the detailed evaluation of the soft tissues within and surrounding the knee. These include ligamentous, tendinous, fibrous, fatty, synovial, and neurovascular structures. These tissues can be assessed for size, continuity, anatomic orientation, and echogenecity; furthermore, they can be readily compared contralaterally. Evaluation of intra-articular elements such as the menisci, cruciate ligaments, and articular cartilage is limited mainly by inaccessibility, which results from the small acoustic windows obtainable in most patients. This liberally illustrated article reviews ultrasound of the knee, including anatomy, ultrasound technique, and pathologic findings.

Fluoroacetate-metabolizing pseudomonad isolated from Dichapetalum cymosum.

A pseudomonad was isolated from the fluoroacetate-producing plant Dichapetalum cymosum (Hook) Engl. and identified as Pseudomonas cepacia. We established that this isolate was capable of growing in fluoroacetate-enriched solutions without any reduction in growth rate. Our isolate of P. cepacia was capable of defluorinating 2.69 mg of fluoroacetate per 10(9) cells per h. Fluoroacetate was degraded to CO2 at a rate of 23.53 ng/10(9) cells per h.