The use of complementary and alternative medicine by persons with HIV infection in Europe.

Between June 1996-September 1997 and December 1998-December 1999, two surveys using an anonymous questionnaire were carried out in Europe among persons living with HIV infection. The questionnaire included questions on use of antiretrovirals, complementary or alternative medicines. Vitamins/minerals were taken by 528 (58%) of the 1996-97 participants, compared to 326 (63%) of the 1998-99 participants (P =0.06). Homeopathy was taken by respectively 176 (21%) and 55 (14%) (P =0.003) participants and herbal products respectively by 213 (25%) and 77 (20%) (P =0.06). In multiple regression analysis a longer time since HIV diagnosis, having a higher education level and having a lower CD(+) lymphocyte count were associated with the use of homeopathy. A longer time since HIV diagnosis and a more advanced stage of the disease were associated with the use of herbal products. The study shows that despite the availability of highly active antiretroviral therapy many people with HIV infection still take complementary and alternative medicine.

Two imported cases of Penicillium marneffei infection in Belgium.

Two imported cases of Penicillium marneffei infection in Belgium are reported. Both patients are Thai women co-infected with HIV. P. marneffei infection should be suspected in immunocompromised patients originating or travelling from South-East Asia with unexplained fever (> 38 degrees C), weight loss, a generalised lymphadenopathy, hepatomegaly, splenomegaly, skin lesions, cough and anaemia. Diagnosis is made by culture and/or histopathological examination. Mild to moderate infections are treated with itraconazole 400 mg/day as first choice. Amphotericin B parenteral therapy may be required for seriously ill patients. Maintenance therapy with itraconazole 200 mg/day is necessary to prevent relapses.

CD8+ cells and not CD4+ T cells are hyporesponsive to CD28- and CD40L-mediated activation in HIV-infected subjects.

T cell dysfunction in HIV-infected subjects could be the consequence of altered sensitivity of CD4+ or CD8+ T cells to various costimulatory signals. Therefore, we studied proliferation and cytokine production in highly purified CD8+ and CD4+ T cells from HIV-infected and HIV- subjects, induced by co-activation via cell-bound CD80, CD86 and CD40 or by allo-activation. Regardless of the nature of the first and the costimulatory signal, CD8+ T cells from patients proliferated consistently less than controls, while responses from CD4+ T cells were similar in patients and controls. This phenomenon was observed after ligation of CD28 combined with anti-CD3 or phorbol myristate acetate (PMA), but also after allogeneic stimulation and after activation by CD40 and anti-CD3. Anti-CD3 combined with CD80 or CD86 induced a mixed Th1/Th2-type cytokine profile in both CD4+ and CD8+ T cells from controls, whereas anti-CD3 plus CD40 induced only low levels of Th2-type cytokines and no interferon-gamma (IFN-gamma) in CD4+ T cells. Compared with controls, CD4+ T cells from patients produced slightly lower levels of IL-10 but equal amounts of IFN-gamma, IL-4 and IL-5, while CD8+ T cells from patients produced less of all cytokines tested. In conclusion, responses of purified CD4+ T cells from HIV+ subjects to various costimulatory pathways are relatively intact, whereas CD8+ T cells are hyporesponsive at the level of proliferation and cytokine production. A generalized intrinsic CD8+ T cell failure might contribute to viral and neoplastic complications of HIV infection.