Detrimental effects of continued illicit drug use on the treatment of HIV-1 infection.

OBJECTIVE: To identify the effects of substance abuse status (active, former, and never) on utilization of highly active antiretroviral therapy (HAART), medication adherence, and virologic and immunologic responses to therapy. DESIGN: Prospective cohort study of 764 HIV-1-infected patients who attended an urban HIV clinic and participated in a standardized interview. MAIN OUTCOME MEASURES: Past utilization of HAART, self-reported nonadherence with antiretroviral therapy, and changes in HIV-1 RNA level and CD4+ lymphocyte count relative to prior peak and nadir, respectively. RESULTS: Forty-four percent of active drug users failed to utilize HAART compared with 22% of former drug users and 18% of non-drug users (p <.001 for both comparisons). Among participants who were taking antiretroviral therapy when interviewed, active drug users were more likely to report medication nonadherence (34% vs. 24% of nonusers and 17% of former users), had a smaller median reduction in HIV-1 RNA from baseline (0.8 log10 copies/ml vs. 1.7 in nonusers and 1.6 in former users), and had smaller median increases in CD4+ lymphocyte count from baseline (65 cells/mm3 vs. 116 in nonusers and 122 in former users) (p <.05 for all comparisons with active users). CONCLUSIONS: Active drug use was strongly associated with underutilization of HAART, nonadherence, and inferior virologic and immunologic responses to therapy, whereas former drug users and non-drug users were similar in all outcomes. Effective strategies are needed that integrate HIV-1 and substance abuse treatments.

To take or not to take that mound of medicine.

AIDS: Patient adherence to dosing schedules is critically important for the long-term success of antiviral therapy, but a question remains regarding how much adherence is enough for therapy to be successful. Aggressive therapy is hard to maintain, and results of a study measuring patient adherence were reported. Results demonstrate the clear association between adherence and viral suppression, although it is noted that even highly adherent patients can suffer virologic failure. Factors associated with non-adherence include depression and race. Predicting which patients are most likely to be adherent remains difficult, but adherence may improve if more effective interventions are developed.^ieng

Primary invasive cutaneous Microsporum canis infections in immunocompromised patients.

Two cases of primary invasive cutaneous infections caused by the zoophilic dermatophytic species Microsporum canis are presented. The first case occurred in a liver transplant recipient who was receiving immunosuppressive therapy. Multiple erythematous papules were seen on both legs, and a biopsy revealed invasive fungal hyphae. The second case was diagnosed in a human immunodeficiency virus-positive individual with a CD4 lymphocyte count of 81 mm3. Raised red nodules were seen on her scalp and face. Histopathology was consistent with bacillary angiomatosis, and in addition, invasive septate hyphae were observed. The two strains recovered from the biopsy specimens from both individuals had colony morphologies consistent with that of M. canis, but it was difficult to induce production of macroconidia. These cases serve to increase the awareness of this unusual infection, reinforce the need for cultures, and raise some interesting questions about the potential virulence of this dermatophyte species.

Human EBV-transformed lymphocytes of patients with Schistosoma japonicum infection secrete idiotypically related immunoregulatory antibodies.

Lymphocytes derived from the peripheral blood of individuals infected with Schistosoma japonica were transformed in vitro with Ebstein-Barr virus (EBV). Serological characterization of antibody molecules revealed both antigen reactive (idiotypic) and anti-idiotypic transformants. One idiotypic EBV transformant, LO2C2, describes a major cross-reactive idiotype associated with anti-antigen binding molecules. Other antibody populations expressing idiotypic cross-reactivity were derived from separate individuals showing shared idiotypy in S. japonicum field study populations in the Republic of Philippines. Both idiotypic and anti-idiotypic molecules suppressed parasite antigen-driven blastogenesis of heterologous human peripheral blood lymphocytes. The data show a serologically related immunoregulatory immune network in patients in the Republic of the Philippines which is serologically distinct from idiotypy expressed in other selected S. japonicum endemic areas in the Far East.