Hepatitis B or hepatitis C virus infection is a risk factor for severe hepatic cytolysis after initiation of a protease inhibitor-containing antiretroviral regimen in human immunodeficiency virus-infected patients. The APROCO Study Group.

In a cohort of 1,047 human immunodeficiency virus type 1-infected patients started on protease inhibitors (PIs), the incidence of severe hepatic cytolysis (alanine aminotransferase concentration five times or more above the upper limit of the normal level >/= 5N) was 5% patient-years after a mean follow-up of 5 months. Only positivity for hepatitis C virus antibodies (hazard ratio [HR], 7. 95; P < 10(-3)) or hepatitis B virus surface antigen (HR, 6.67; P < 10(-3)) was associated with severe cytolysis. Before starting patients on PIs, assessment of liver enzyme levels and viral coinfections is necessary.

Five versus ten days treatment of streptococcal pharyngotonsillitis: a randomized controlled trial comparing cefpodoxime proxetil and phenoxymethyl penicillin.

A total of 220 adults and children > 10 years old (mean 29.5 +/- 11.7 years) with pharyngitis/tonsillitis were randomized to receive either cefpodoxime proxetil 100 mg bid for 5 days (n = 113) or phenoxymethyl penicillin, 600 mg tid for 10 days (n = 107). At the end of treatment of the 166 evaluable patients, a satisfactory clinical response was obtained in 85/88 (96.6%) patients treated with cefpodoxime proxetil and in 75/78 (96.1%) treated with phenoxymethyl penicillin. Group A beta-hemolytic streptococci (GABHS) eradication was similar in both groups: 79/82 (96.3%) patients in the cefpodoxime proxetil group and 64/68 (94.1%) patients in the phenoxymethyl penicillin group. At follow-up (20-30 days after the end of treatment) the GABHS eradication persisted in 67/72 (93.1%) patients treated with cefpodoxime proxetil and in 56/61 (91.8%) patients treated with phenoxymethyl penicillin. Significantly better compliance (p < 0.01) was noticed with the cefpodoxime proxetil regimen compared with the phenoxymethyl penicillin regimen, with only 2/110 (2%) poorly compliant patients in the cefpodoxime proxetil group vs 17/104 (16%) in the phenoxymethyl penicillin group. Thus, the shorter duration of therapy, in conjunction with demonstrated clinical and bacteriological efficacy that is equivalent to standard therapy, makes cefpodoxime proxetil an acceptable alternative for the treatment of GABHS pharyngitis/tonsillitis.

Acyclovir pharmacokinetics in plasmapheresis.

During experimental treatment of human immunodeficiency virus (HIV-1) infection using high doses of acyclovir (ACV) (600 mg IV every 8 h), cyclosporin, and several courses of plasmapheresis (PE) (60 ml/kg), ACV pharmacokinetics in three patients have been measured. The results with or without PE were not significantly different: half-time of elimination 3 vs. 2.3 h, volume of distribution 1.8 vs. 1.14 liter/kg, and total clearance 404 vs. 314 ml/min. The clearance and the fraction of elimination due to PE were 5.27 ml/min and 2.5%, respectively. These findings suggest that supplemental doses of ACV are not needed when plasmapheresis is performed.

[Meningeal diffusion of cefpirome in adults]. / Diffusion méningée du cefpirome chez l'adulte.

Cefpirome is a new aminothiazolyl cephalosporin with a low protein binding, a long half-life of elimination and a wide antibacterial spectrum including pseudomonas and staphylococcus. We studied its diffusion into the cerebrospinal fluid (CSF). Cefpirome, 2 g, was administered intravenously over 3 min. Nineteen patients, aged 12-75 y (mean +/- SD = 40 +/- 20) were studied: 13 had meningitis (septic = 6; chronic = 2; viral = 4). Seric and CSF samples were assayed by the high pressure liquid chromatography (HPLC) procedure. Results at 1, 3, 6, 9 and 12 hours after the infusion were (mean +/- SD) 62.44 +/- 19.8 mg/l, 26.51 +/- 3.7 mg/l, 10.19 +/- 3.3 mg/l, 3.99 +/- 2.3 mg/l, 2 +/- 1.72 mg/l in the serum and 1.1 +/- 1 mg/l, 2.6 +/- 1.8 mg/l, 2.83 +/- 1.7 mg/l, 1.92 +/- 1 mg/l, 1.83 +/- 0.36 mg/l in CSF of bacterial meningitidis respectively. The half-life of elimination were 2.45 h and 9.8 h in the blood and CSF respectively. The area under the curve CSF/serum ratio was 28%. We conclude that cefpirome concentrations in the CSF were above the minimal inhibitory concentrations of almost all the bacteria causing meningitis.

[A simplified method of vaccination against rabies after exposure]. / Schéma simplifié pour la vaccination antirabique après exposition.

Vaccination against rabies after exposure to the risk of contamination is currently performed according to the WHO recommendations: 6 injections in 6 visits. We have studied the serological effectiveness of a simplified method using the human diploid-cell rabies vaccine: the vaccine is injected subcutaneously at the rate of 2 doses on day 0, then one dose on day 7 and one dose on day 21. Fifty subjects were vaccinated, and antiglycoprotein antibodies were assayed in serum by the immunoenzymatic technique (EU/ml). Seroconversion with titres above 0.5 EU/ml was observed in all subjects. The antibody titres were 0.127 +/- 1.57, 11.31 +/- 8.87, 10.2 +/- 7.55, and the numbers of subjects with protective titres were 0/50, 11/50, 46/47 and 36/37 on days 0, 7, 21 and 90 respectively. No undesirable side-effect was recorded. The good results obtained with this 2+1+1 vaccination schedule (4 injections in 3 visits) suggest that the recommended method of post-exposure vaccination could be replaced by this simplified method.

Altered peripheral nerve conduction in HIV-patients.

An electrophysiological study on peripheral nerves conduction was performed on HIV-seropositive patients without neurological signs on clinical examination. Eight of the 28 patients (28%) had an infraclinical neuropathy, which was myelinic or axonal and rather distal than proximal. The mechanism of these involvements is not known, but their early existence could justify an early treatment even for asymptomatic patients.