Impact of HIV infection on sustained virological response to treatment against hepatitis C virus with pegylated interferon plus ribavirin.

It is commonly accepted that human immunodeficiency (HIV) coinfection negatively impacts on the rates of sustained virological response (SVR) to therapy with pegylated interferon plus ribavirin (PR). However, this hypothesis is derived from comparing different studies. The aim of this study was to determine the impact of HIV coinfection on SVR to PR in one single population. In a multicentric, prospective study conducted between 2000 and 2013, all previously naïve hepatitis C virus (HCV)-infected patients who started PR in five Spanish hospitals were analyzed. SVR was evaluated 24 weeks after the scheduled end of therapy. Of the 1046 patients included in this study, 413 (39%) were coinfected with HIV. Three hundred and forty-one (54%) HCV-monoinfected versus 174 (42%) HIV/HCV-coinfected patients achieved SVR (p < 0.001). The corresponding figures for undetectable HCV RNA at treatment week 4 were 86/181 (47%) versus 59/197 (30%), p < 0.001. SVR was observed in 149 (69%) HCV genotype 2/3-monoinfected subjects versus 91 (68%) HIV/HCV genotype 2/3-coinfected subjects (p = 0.785). In the HCV genotype 1/4-infected population, 188 (46%) monoinfected patients versus 82 (30%) with HIV coinfection (p < 0.001) achieved SVR. In this subgroup, absence of HIV coinfection was independently associated with higher SVR [adjusted odds ratio (95% confidence interval): 2.127 (1.135-3.988); p = 0.019] in a multivariate analysis adjusted for age, sex, baseline HCV RNA load, IL28B genotype, fibrosis stage, and type of pegylated interferon. HIV coinfection impacts on the rates of SVR to PR only in HCV genotype 1/4-infected patients, while it has no effect on SVR in the HCV genotype 2/3-infected subpopulation.

Euroforgen-NoE collaborative exercise on LRmix to demonstrate standardization of the interpretation of complex DNA profiles.

There has been very little work published on the variation of reporting practices of mixtures between laboratories, but it has been previously demonstrated that there is little consistency. This is because there is no current uniformity of practice, so different laboratories will operate using different rules. The interpretation of mixtures is not solely a matter of using some software to provide 'an answer'. An assessment of a case will usually begin with a consideration of the circumstances of a crime. Assumptions made about the numbers of contributors follow from an examination of the electropherogram(s)--and these may differ between the prosecution and the defence hypotheses. There may be a necessity to evaluate several sets of hypotheses for any given case if the circumstances are uncertain. Once the hypotheses are formulated, the mathematical analysis is complex and can only be accomplished by the use of specialist software. In order to obtain meaningful results, it is essential that scientists are trained, not only in the use of the software, but also in the methodology to understand the likelihood ratio concept that is used. The Euroforgen-NoE initiative has developed a training course that utilizes the LRmix program to carry out the calculations. This software encompasses the recommendations of the ISFG DNA commissions on mixture interpretation and is able to interpret samples that may come from two or more contributors and may also be partial profiles. Recently, eighteen different laboratories were trained in the methodology. Afterwards they were asked to independently analyze two different cases with partial mixture DNA evidence and to write a statement court-report. We show that by introducing a structured training programme, it is possible to demonstrate, for the first time, that a high degree of standardization, leading to uniformity of results can be achieved by participating laboratories.

[Infection due to Rhodococcus equi in HIV infected patients: four cases]. / Infección por Rhodococcus equi en pacientes infectados por virus de la inmunodeficiencia humana: descripción de cuatro casos.

INTRODUCTION: Incidence of Rhodococcus equi (R. equi) infection is increasing parallel to a greater prevalence of immunosupressed patients. This study aims to describe clinico-epidemiological characteristics of R. equi infections in a single hospital. METHODS: Retrospective, observational study that includes any patient diagnosed of R. equi infection during the 1999-2007 period. Clinical and epidemiological characteristics were recorded. RESULTS: Four patients were diagnosed of R. equi infection, with a mean age of 37.75+/-9.94 years old. All of them were male, infected with human immunodeficiency virus, and showed severe immunosuppression (mean CD4+ lymphocyte count of 83+/-55.2 cells/microl). Respiratory symptoms and cavitary pulmonary lesions were constantly present. R. equi was always cultured in blood and respiratory secretions. CONCLUSIONS: R. equi infection is a rare disease that occurs predominantly in HIV infected patients, severely immunosuppressed patients and almost always causes cavitary pneumonia.

Infección por Rhodococcus equi en pacientes infectados por virus de la inmunodeficiencia humana: descripción de cuatro casos / Infection due to Rhodococcus equi in HIV infected patients: four cases

IntroducciónLa incidencia de la infección por Rhodococcus equi está incrementándose en paralelo con la mayor prevalencia de pacientes inmunodeprimidos. Este estudio se propone conocer las características clínico-epidemiológicas de las infecciones por R. equi en un único centro.MétodosEstudio retrospectivo, de observación, que incluye a todos los pacientes diagnosticados de infección por R. equi en el período 1999–2007. Se registraron características clínicas y epidemiológicas generales.ResultadosSe diagnosticó a cuatro pacientes de infección por R. equi, de 37,75±9,94 años de edad, todos ellos varones infectados por el virus de la inmunodeficiencia humana (VIH), con inmunosupresión importante (contaje medio de linfocitos CD4+: 83±55,2 células/μl). Todos los pacientes tenían sintomatología respiratoria y mostraban lesiones pulmonares radiológicas cavitadas. Se aisló R. equi tanto en sangre como en muestras respiratorias.ConclusionesLa infección por R. equi es poco frecuente, incide sobre todo en pacientes con infección por VIH muy inmunodeprimidos y cursa casi siempre como neumonía cavitada(AU)

IntroductionIncidence of Rhodococcus equi (R. equi) infection is increasing parallel to a greater prevalence of immunosupressed patients. This study aims to describe clinico-epidemiological characteristics of R. equi infections in a single hospital.MethodsRetrospective, observational study that includes any patient diagnosed of R. equi infection during the 1999–2007 period. Clinical and epidemiological characteristics were recorded.ResultsFour patients were diagnosed of R. equi infection, with a mean age of 37,75±9,94 years old. All of them were male, infected with human immunodeficiency virus, and showed severe immunosuppression (mean CD4+ lymphocyte count of 83±55,2 cells/μl). Respiratory symptoms and cavitary pulmonary lesions were constantly present. R. equi was always cultured in blood and respiratory secretions.ConclusionsR. equi infection is a rare disease that occurs predominantly in HIV infected patients, severely immunosuppressed patients and almost always causes cavitary pneumonia(AU)

Otitis media y bacteriemia / Otitis media and bacteremia

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[Polyarteritis nodosa associated with hepatitis C virus]. / Panarteritis nodosa asociada al virus de la hepatitis C.

BACKGROUND: To study the seroprevalence of hepatitis C virus in a cohort of six patients with a diagnosis of polyarteritis nodosa (PAN). METHODS: There have been included six patients with a diagnosis of PAN, carrying out a serodiagnosis of hepatitis B virus (VHB) and C (VHC) this last one by means of the following methods: ELISA, RIBA-II and PCR. RESULTS: These cases (50%) showed exclusive positivity to VHC by means of the three ways of diagnosis, two cases showed positivity to VHB (33.3%), one case (16.6%) showed positivity to both virus (VHB and (VHC) and one case didn't show positivity virus. CONCLUSIONS: It is probable a ethipatogenic relation between hepatitis C virus and polyarteritis nodosa, our sample doesn't show any difference from that written in the literature. The positive rheumatoid factors can give false positive for VHC by means of the technique ELISA because of this it is necessary to confirm the positive by means of the techniques RIBA-II and PCR.

[Pancreatic disease in patients with HIV treated with didanosine (DDI)]. / Afectación pancreática en pacientes VIH tratados con didanosina (DDI).

Pancreatic involvement has been studied in 70 HIV infected patients, in diverse stages, that were treated with didanosine (ddI), both as monotherapy or associated to zidovudine; 38% of patients presented adverse reaction that obliged to withdraw the medication: pancreatitis (4%), hyperamylasemia (21%) and abdominal pain and/or diarrhea (12%). The possible causes in presentation of adverse effects were evaluated: route of infection, stage of HIV infection, use of pentamidine or trimethoprim-sulfamethoxazole for preventing Pneumocystis carinii pneumonia, administration of ddI in monotherapy or in combined form with zidovudine, time of treatment and level of CD4 lymphocytes. The outcome of adverse effects is related significantly only with the most advanced stage of HIV infection.

[Liver involvement in Q fever and Mediterranean boutonneuse fever. Comparative study]. / Afectación hepática en la fiebre Q y la fiebre botonosa del Mediterráneo. Estudio comparativo.

Rickettsia spp. infections produce hepatic damage with transaminases elevation and biological signs of cholostasis. Classical biochemical tests of hepatic function were analyzed and compared in 8 patients with Q Fever (QF) and 7 with Boutonneuse Mediterranean Fever (BMF). Liver enlargement was detected in 75% of the QF group of patients as compared with the 57% of the BMF group. Transaminases were raised in 75% of the patients of the QF group and in 85, 7% of the BMF patients. Only one patient in the QF group showed manifest clinical jaundice. Statistically significant differences were found between the values of AST, ALT, alkaline phosphatase and GGT, which were higher in the QF group. Liver involvement is more important in patients with QF than in FBM. There is a large percentage of clinically silent involvement in both diseases. Liver function tests should be carried out in infections by Rickettsia spp.

[Biliary drainage in the diagnosis of acute idiopathic pancreatitis]. / El sondaje biliar en el diagnóstico de las pancreatitis agudas idiopáticas.

The identification of a casual agent in the so-called "idiopatic acute pancreatitis" is of great interest in relationship with the prognosis and the election of correct therapy. We have performed a duodenal drainage for the microscopic study of the bile, looking for cholesterol crystals and bilirrubinate's in a group of 19 patients with idiopatic acute pancreatitis. The results have been compared with a control group composed by 45 assymptomatic individuals. In the patients group drainage results were abnormal in 11 cases (57.9%) vs. 11.2% in the control group (difference statistically significant). In 4 of the 11 cases, a cholecystectomy was performed showing biliary pathology. Patients at follow-up were assymptomatic. Duodenal drainage is an easy method without risks that must be used always in idiopatic acute pancreatitis. It allows the diagnosis of microlithiasis and may help in the therapeutic indication of cholecystectomy.

[Calcification of auricular cartilages in a patient with adrenal insufficiency: presentation of a case and review of the literature]. / Calcificación de los cartílagos auriculares en un paciente con insuficiencia suprarrenal: aportación de un caso y revisión de la literatura.

Suprarenal insufficiency is the systemic disease more frequent associated to auricular cartilage calcification. Physiopathologic mechanism of this phenomenon remain without elucidate, several hypothesis have been postulated. We introduce one patient male attached of Addison's disease with external ear bilateral calcification. We review 20 case related in literature, postulating that low levels of cortisone, established in acute or chronic form, can cause a maintained or transitory hypercalcemia, calcium deposit in predisposed physically-chemically tissue: deficient peripheral vascularization and susceptibility to external aggression like traumatisms or cold.