ABSTRACT
The current epidemic of H5N1 highly pathogenic avian influenza in Southeast Asia raises serious concerns that genetic reassortment will result in the next influenza pandemic. There have been 164 confirmed cases of human infection with avian influenza since 1996. In 2004 alone, there were 45 cases of human H5N1 in Vietnam and Thailand, with a mortality rate over 70%. In addition to the potential public health hazard, the current zoonotic epidemic has caused severe economic losses. Efforts must be concentrated on early detection of bird outbreaks with aggressive culling, quarantines, and disinfection. To prepare for and prevent increased human cases, it is essential to improve detection methods and stockpile effective antivirals. Novel therapeutic modalities, including short, interfering RNAs and new vaccine strategies that use plasmid-based genetic systems offer promise, should a pandemic occur.
Subject(s)
Influenza A Virus, H5N1 Subtype , Influenza in Birds/diagnosis , Influenza, Human/diagnosis , Animals , Asia, Southeastern/epidemiology , Disease Outbreaks/veterinary , Humans , Influenza in Birds/epidemiology , Influenza in Birds/prevention & control , Influenza in Birds/virology , Influenza, Human/epidemiology , Influenza, Human/therapy , Influenza, Human/virology , PoultryABSTRACT
The current epidemic of H5N1 highly pathogenic avian influenza in Southeast Asia raises serious concerns that genetic reassortment will result in the next influenza pandemic. There have been 164 confirmed cases of human infection with avian influenza since 1996. In 2004, there were 45 cases of human H5N1 in Vietnam and Thailand, with a mortality rate more than 70%. In addition to the potential public health hazard, the current zoonotic epidemic has caused severe economic losses. Efforts must be concentrated on early detection of bird outbreaks with aggressive culling, quarantining, and disinfection. To prepare for and prevent an increase in human cases, it is essential to improve detection methods and stockpile effective antivirals. Novel therapeutic modalities, including short-interfering RNAs and new vaccine strategies that use plasmid-based genetic systems, offer promise should a pandemic occur.
ABSTRACT
Gynecomastia has been reported to occur in HIV-infected patients receiving HAART. A retrospective case-control study was conducted to determine risk factors associated with this condition. Two control patients were randomly chosen for each of 23 case patients identified. An efavirenz-containing regimen was strongly associated with the development of gynecomastia (odds ratio, 20; P < .001). Case patients were not more likely to have lipodystrophy, low testosterone levels, chronic infection with hepatitis B or C virus, or liver dysfunction compared with control patients. None of these factors altered the efavirenz-associated risk when analyzed by multiple logistic regression. Efavirenz appears to be strongly associated with gynecomastia in HIV-infected patients receiving HAART.
Subject(s)
Antiretroviral Therapy, Highly Active/adverse effects , Gynecomastia/etiology , HIV Infections/complications , HIV-1 , Adult , Aged , Alkynes , Analysis of Variance , Antiretroviral Therapy, Highly Active/methods , Benzoxazines , CD4 Lymphocyte Count , Case-Control Studies , Cyclopropanes , Gynecomastia/diagnosis , Gynecomastia/epidemiology , Gynecomastia/metabolism , Gynecomastia/therapy , HIV Infections/drug therapy , HIV-Associated Lipodystrophy Syndrome/epidemiology , HIV-Associated Lipodystrophy Syndrome/etiology , Humans , Logistic Models , Male , Middle Aged , New York City/epidemiology , Oxazines/adverse effects , Risk Factors , Testosterone/blood , Testosterone/deficiency , Time Factors , Treatment OutcomeABSTRACT
Since the first outbreak of hantavirus pulmonary syndrome (HPS) in 1993, understanding of the vast distribution and potential impact of hantaviruses has grown. At least 277 cases of HPS have been documented in the United States. The full clinical spectrum has yet to be elucidated, and one outbreak suggested the possibility of person-to-person transmission. New research has identified the b-3 integrins as cellular receptors for hantaviruses and has determined the pivotal role of the immune system in pathogenesis. Rapid diagnosis has been facilitated by a new immunoblot assay to detect Sin Nombre virus infection. Treatment remains primarily supportive; however, a placebo- controlled trial of ribavirin is ongoing. Extracorporeal membrane oxygenation may be a potential therapy in severe cases; inhaled nitric oxide needs further study. Vaccines developed against hantaviruses associated with hemorrhagic fever and renal syndrome might be effective against HPS-associated strains.
