ABSTRACT
OBJECTIVES: Transmitted HIV-1 drug resistance (TDR) can reduce the efficacy of first-line antiretroviral therapy. PATIENTS AND METHODS: A retrospective analysis was performed to assess the prevalence and correlates of TDR in Italy over time. TDR was defined as the presence of at least one of the mutations present in the surveillance drug resistance mutation (SDRM) list. RESULTS: Among 1690 antiretroviral therapy-naive patients, the most frequent HIV subtypes were B (78.8%), CRF02_AG (5.6%) and C (3.6%). Overall, TDR was 15%. TDR was 17.3% in subtype B and 7.0% in non-B carriers (P < 0.001). TDR showed a slight, although not significant, decline (from 16.3% in 1996-2001 to 13.4% in 2006-07, P = 0.15); TDR declined for nucleoside reverse transcriptase inhibitors (from 13.1% to 8.2%, P = 0.003) but remained stable for protease inhibitors (from 3.7% to 2.5%, P = 0.12) and non-nucleoside reverse transcriptase inhibitors (from 3.7% to 5.8%). TDR to any drug was stable in B subtype and showed a decline trend in non-B. In multivariable analysis, F1 subtype or any non-B subtype, compared with B subtype, and higher HIV RNA were independent predictors of reduced odds of TDR. CONCLUSIONS: Prevalence of TDR to nucleoside reverse transcriptase inhibitors seems to have declined in Italy over time. Increased prevalence of non-B subtypes partially justifies this phenomenon.
Subject(s)
Drug Resistance, Viral , HIV Infections/epidemiology , HIV Infections/virology , HIV-1/classification , HIV-1/drug effects , Adult , Amino Acid Substitution , Anti-HIV Agents/pharmacology , Female , Genotype , HIV Infections/transmission , HIV Protease Inhibitors/pharmacology , HIV-1/genetics , HIV-1/isolation & purification , Humans , Italy/epidemiology , Male , Mutation, Missense , Prevalence , RNA, Viral/genetics , Retrospective Studies , Reverse Transcriptase Inhibitors/pharmacologySubject(s)
Antiretroviral Therapy, Highly Active , CD4-Positive T-Lymphocytes/immunology , Drug Resistance, Viral , HIV Infections/drug therapy , HIV Infections/immunology , RNA, Viral/analysis , Viremia/drug therapy , Viremia/immunology , Adult , CD4-Positive T-Lymphocytes/drug effects , Drug Administration Schedule , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , RNA, Viral/drug effects , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
Little is known about factors involved in virological response to treatment changes guided by genotyping in patients whose highly active antiretroviral therapy (HAART) fails. A 12-month observational study was conducted of 45 patients infected with human immunodeficiency virus (HIV)-1, who underwent a new genotype-guided HAART regimen following virological treatment failure. Logistic regression models were used to define factors predictive of virological response to genotype-assisted treatment switches. Virological response was defined as achievement of a level of plasma HIV-1 RNA <1000 copies/mL at the end of the follow-up. Drug-resistance mutations were detected at baseline in 30 patients (66.7%). A sustained virological response to new treatment occurred in 13 (43.3%) of these, as opposed to 11 (73.3%) of the 15 patients harboring drug-susceptible virus at baseline (P=.07). In multivariate logistic regression analysis, the number of drug classes where there was resistance at baseline was the only independent predictor of virological failure (P=.0313). Lack of virological response to genotype-guided treatment changes is primarily due to complex baseline resistance patterns. Benefits of antiretroviral resistance testing may be seriously limited by the lack of subsequent treatment options for heavily pretreated patients.
Subject(s)
Acquired Immunodeficiency Syndrome/drug therapy , Antiretroviral Therapy, Highly Active/methods , HIV-1/genetics , Mutation , Adult , Analysis of Variance , Drug Resistance, Microbial/genetics , Female , Follow-Up Studies , Genotype , HIV-1/isolation & purification , Humans , Logistic Models , Male , Middle Aged , Risk Factors , Treatment FailureABSTRACT
The role of Toscana (TOS) virus in producing encephalitis without meningitis is uncertain. We studied 2 cases of TOS virus encephalitis without meningitis by means of nested polymerase chain reaction assay and DNA sequencing. Findings confirm that TOS virus may directly cause encephalitis and suggest the usefulness of DNA sequencing in investigating relationships between TOS virus molecular patterns and the spectrum of neurological involvement.
Subject(s)
Encephalitis, Viral/virology , Phlebotomus Fever/virology , Adult , Antibodies, Viral/blood , Antibodies, Viral/cerebrospinal fluid , DNA, Viral/analysis , Encephalitis, Viral/immunology , Encephalitis, Viral/physiopathology , Humans , Male , Meningitis , Middle Aged , Phlebotomus Fever/immunology , Phlebotomus Fever/physiopathology , Phlebovirus/genetics , Phlebovirus/immunology , Phlebovirus/isolation & purification , SerotypingABSTRACT
A case of non-fatal encephalitis in a 21-y-old immunocompetent woman is described. High titre serum antibodies against Mycoplasma pneumoniae were found. In addition, Mycoplasma pneumoniae DNA was detected in the cerebrospinal fluid by polymerase chain reaction. Neuroimaging findings by magnetic resonance and computed tomographic scanning of the brain, and laboratory investigations, including a search for serum antibodies to gangliosides, did not support an immune-mediated mechanism. No other pathogens were found. These results strongly suggest that the encephalitis was caused directly by Mycoplasma pneumoniae invasion of the central nervous system. They also indicate that such pathogenetic mechanism may sometimes be sufficient to explain neurological manifestations occurring during the course of Mycoplasma pneumoniae infection. The consequences for therapy are discussed.
Subject(s)
DNA, Bacterial/cerebrospinal fluid , Encephalitis/etiology , Mycoplasma pneumoniae/isolation & purification , Pneumonia, Mycoplasma/complications , Adult , Anti-Bacterial Agents/therapeutic use , Antibodies, Bacterial/blood , Clarithromycin/therapeutic use , Encephalitis/drug therapy , Female , Humans , Magnetic Resonance Imaging , Mycoplasma pneumoniae/pathogenicity , Tomography, X-Ray ComputedABSTRACT
An imported case of intestinal schistosomiasis in AIDS is analysed by the relationships between immune response, diagnostic methods, pathogenetic mechanisms. The inconclusiveness of negative results from both serology and stool parasitology is remarked whereas the efficacy of associated histological, histochemical and immunohistochemical methods is emphasized in order to get better data on aetiological diagnosis and on cell types and size of reactive granulomas. In the case studied, negative serology, absent fecal egg excretion and uneffective granulomatous response with scarcity of T and B lymphocytes have been documented by means of the above methods.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Proctocolitis/etiology , Schistosomiasis mansoni/diagnosis , Adult , Humans , Immunohistochemistry , Male , Proctocolitis/diagnosis , Proctocolitis/pathology , Schistosomiasis mansoni/pathologyABSTRACT
Microbial isolates from 60 diarrheic AIDS patients hospitalized to the Infectious Disease Division of Careggi hospital (Florence) are described. Clinical, microbiological and diagnostic features of each case are discussed with emphasis to some rare or underestimated entities in Europe: Campylobacter laridis bacteremia, Whipple-like disease by atypical Mycobacteria, Schistosoma mansoni proctocolitis. Results regarding newly AIDS-related microorganisms are also stressed.
