[Use of PCR for TB bacteria on BAL in early diagnosis of tubercular lobitis]. / PCR per BK su BAL nella diagnostica precoce di lobite tubercolare.

In June 2008 a 23-year-old immunocompetent came to our observation, without fever and with an occasional cough for 2 months, who showed two chest X-rays and a CT, performed respectively 60, 40 and 20 days earlier, that pointed to a small lobitis at the right lung base. The patient had already undergone several antibiotic therapies that had not changed the X-graphic framework. On presentation, routine blood tests and cultural examinations of sputum were carried out to detect common germs, fungi and TB bacteria (microscopic observation, cultivation and PCR), and a new antibiotic therapy (piperacillin/tazobactam) was started. Since the radiological picture appeared unchanged after 10 days of therapy and the examinations (microscopic observation and PCR) were negative, bronchoscopy with bacteriological evaluation of BAL was performed, which was positive to Mycobacterium tuberculosis, and then tubercular lobitis was diagnosed. Therefore a specific therapy - rifampin (RMP), isoniazid (INH), etambutol (EMB), pyrazinamid (PZA) - was started and changed after 10 days due to the growth of mycobacteria resistant to INH and EMB on examination of sputum. Consequently, the early use of PCR on BAL allows, in skilled hands, small aspecific lobitis to be diagnosed more rapidly than using cultural examination of sputum.

[Sexual exposure to HIV, sexual behaviour and use of pharmacological post-exposure prophylaxis (PEP)]. / Esposizione sessuale al virus HIV, comportamenti sessuali ed utilizzo della profilassi farmacologica post- esposizione (PEP).

In this study we examined the characteristics of 60 subjects (49 M and 11 F, average age 32.3) out of 195 post-exposure pharmacological prophylaxis (PEP) to HIV, taken in our hospital from 2001 to 2008. The above-mentioned subjects are sexually exposed (or presumably exposed) to HIV. We considered both their sexual intercourse behaviour and protective measures, and sought to infer some trends in sexual behaviour in Italy. All the subjects were monitored until 180 days after exposure, as established by the national guidelines. Only one of the 60 people presented a seroconversion (he dropped out after a 15-day follow-up and after an inadequate 19-day prophylaxis). Another subject, a homosexual male, never previously tested, resulted positive at time 0 both for HIV-Ab and syphilis tests (due to previous risk-sexual exposure), which caused the suspension of the prophylaxis. No HBV, HCV or syphilis seroconversion occurred. Two other homosexual males showed a previously latent positivity to syphilis tests at time 0.

Clinical case of seroconversion for syphilis following a needlestick injury: why not take a prophylaxis?

A 47-year-old woman was pricked accidentally with a needle previously used for a neurosyphilitic man. At day 0 she had no positive laboratory results for the infection, while the source, at day 1, had TPHA positive, but no post-exposure prophylaxis (PEP) against syphilis was prescribed. The subject missed the day 30 follow-up, and underwent our visit at day 90, when she showed no clinical signs, but she seroconverted (VDRL = positive 1/2; TPHA = positive 1/320; FTA-Abs IgG and IgM = present). She started antibiotic therapy, and currently her serological status is VDRL = positive 1/2, TPHA = positive 1/160, FTA-Abs IgM = negative.

Relative prognostic value of self-reported adherence and plasma NNRTI/PI concentrations to predict virological rebound in patients initially responding to HAART.

We studied the predictive value of self-reported adherence and plasma drug concentrations on virological rebound to HAART. Among 238 participants in the AdICoNA study who had viral load < or = 500 copies/ml, 42 (17.6%) experienced virological rebound by 96 weeks. Both self-reported non-adherence and sub-optimal concentration were independently associated with a higher risk of virological rebound.

Depression is a risk factor for suboptimal adherence to highly active antiretroviral therapy.

Affective disorders have been reported as the most common mental health problem in persons with HIV infection. Depression has a significant impact on the quality of life of persons living with HIV and AIDS and is associated with HIV disease progression and mortality, even after controlling for sociodemographic and clinical characteristics and substance abuse. Depression has been also reported as one of the main causes of poor adherence with antiretroviral regimens. However, no published investigation has specifically focused on the relationship between depression and adherence to antiretroviral therapy. Nonetheless, information on the association between depressive symptoms and adherence may be gathered from investigations carried out to explore determinants of adherence with antiretroviral therapy. Findings from available studies show a substantial and consistent relationship between adherence to antiretroviral regimens and depression. Early recognition and proper management of depressive comorbidity could be an effective intervention strategy to improve adherence and may make a difference in the quality of life, social functioning, and disease course of people with HIV.