Autoimmune C1 inhibitor deficiency and angioedema.

C1 inhibitor (C1-INH) deficiency results in bouts of mucocutaneous edema and may be inherited (hereditary angioedema) or acquired (acquired angioedema). The syndrome of acquired angioedema, characterized by the adult onset of angioedema and by the lack of evidence of inheritance of the disease, may be associated with lymphoproliferative or other malignant diseases (type I) or with the presence of autoantibodies to C1-INH (type II); this is a rare variant form of C1-INH deficiency with angioedema. We report here a case of acquired C1-INH deficiency with angioedema, hypotension and abdominal discomfort observed in a 71-year-old man in whom complement abnormalities and autoantibodies against C1-INH have been observed and who was classified as having an autoimmune C1-INH deficiency. From the therapeutic point of view after resolution of the acute attacks, high doses of tranexamic acid have been able, at first, to decrease the frequency and the severity of the symptoms, and subsequently to provide a long symptom-free time.

Sexually transmitted diseases and risk of HIV infection.

We have analyzed the association between sexually transmitted diseases (STD) and HIV infection, using data from a cross-sectional survey of subjects attending STD clinics in Northern Italy conducted since 1988. A total of 1,711 subjects (1,259 males, 452 females), who had referred themselves to three STD clinics in Northern Italy for suspected STD or STD treatment, were included for the study. Out of these, 145 subjects (113 males and 32 females) were HIV-positive. A total of 58 HIV-positive and 368 HIV-negative subjects reported a history of STD; the corresponding odds ratio (OR) was 2.3 (95% confidence interval (CI) 1.5-3.6) for subjects reporting a history of STD. Considering various STD in details, the estimated OR was 1.8 (95% CI 0.8-3.8) for a history of gonorrhoea and 1.5 (95% CI 0.8-2.7) of syphilis, and the OR was 1.8 (95% CI 1.0-3.2) and 2.2 (95% CI 1.3-3.8), respectively, for a positive TPHA and VDRL test. The results of the test for HbsAg were available in 50 HIV-positive and 1,028 HIV-negative subjects; the OR of HIV infection in subjects with HbSAg was 3.9 (95% CI 1.7-9.0). Presence of genital ulcers at clinical examination was not significantly associated with the risk of HIV infection (OR yes vs no genital ulcers 1.5, 95% CI 0.6-2.8).

Number of sexual partners, condom use and risk of human immunodeficiency virus infection.

BACKGROUND: To analyse the relation between number of sexual partners, selected sexual habits and the risk of human immunodeficiency virus (HIV) infection. METHODS: We conducted a case-control study nested in a cross-sectional survey conducted among subjects attending sexually transmitted diseases (STD) clinics in Northern Italy. Eligible for the study were 1711 subjects (1259 males, 452 females) who referred themselves for the first time between September 1988 and March 1993 to three STD clinics in Northern Italy for suspected STD or STD treatment. A total of 145 subjects (113 males and 32 females) were HIV positive. RESULTS: In comparison with subjects reporting no or one sexual partner over the 3 years before the interview, the estimated odds ratios (OR) of HIV serum positivity were 1.2 (95% confidence interval [CI]: 0.6-2.3), 0.8 (95% CI: 0.4-1.8) and 0.3 (95% CI: 0.4-2.5) in subjects reporting 2-3, 4-5, and > or = 6 partners, respectively. The results were similar considering separately males and females and in men reporting only homosexual partners. Regular condom use decreased the risk of HIV infection: in comparison with subjects reporting no or occasional use of condoms, the OR of HIV infection was 0.5 (95% CI: 0.4-0.8) for regular users. Considering men only, compared with men with no homosexual intercourse, the OR of HIV infection was 2.3 (95% CI: 1.4-3.9) in those reporting bisexual intercourse and 2.2 (95% CI: 1.2-4.2) in men reporting only homosexual intercourse (among homosexuals). There was no relation between HIV infection risk and receptive anal sex. CONCLUSIONS: The risk of HIV infection does not increase linearly with the number of sexual partners in this population. This is reasonable, as the prevalence of HIV infection in this population is essentially determined by drug use. Caution is needed in the interpretation of these results since the analysis of role of number of sexual partners in male intravenous drug users is impaired by low statistical power.

PIP: It remains to be clearly established how multiple sex partners affect the risk of HIV infection. Northern Italy is a region where the prevalence of HIV infection is high mainly among IV drug users. The authors conducted a case-control study nested in a cross-sectional survey among subjects attending three STD clinics in Bergamo, Brescia, and Verona with the goal of analyzing the relationship between the number of sex partners, selected sex practices, and the risk of HIV infection. The study population was comprised of 1259 males and 452 females who referred themselves for the first time between September 1988 and March 1993 to the clinics for suspected STD or STD treatment. The men were of median age 30 years in the range of 16-70, while the women were of median age 28 years in the range of 16-61. 113 males and 32 females were HIV-seropositive. In comparison with subjects reporting no or one sex partner over the three years before the interview, the estimated odds ratio (OR) of HIV serum positivity were 1.2, 0.8, and 0.3 in subjects reporting 2-3, 4-5, and 6 or more partners, respectively. The risk of HIV infection therefore does not increase linearly with the number of sex partners in this population. These results were similar considering separately males and females and among the 91 men reporting only homosexual partners. 165 men reported themselves as being bisexual. Regular condom use decreased the risk of HIV infection such that the OR of HIV infection was 0.5 for regular users compared to subjects who reported no or occasional use of condoms. Considering men only, compared with men with no homosexual intercourse, the OR of HIV infection was 2.3 among those reporting bisexual intercourse and 2.2 among men reporting only homosexual intercourse. There was no relation between HIV infection risk and receptive anal sex. IV drug use was strongly associated with HIV-seropositivity, while a history of STD was more frequently reported by HIV-positive subjects than by HIV-negative subjects.

Risk factors for HIV infection in adults attending sexually transmitted disease clinics in Italy.

We assessed prevalence and risk factors for human immunodeficiency virus (HIV) infection in 637 patients (506 men, 131 women; median age 30 years, range 17-64) attending between September 1988 and July 1989 for the first time two sexually transmitted disease (STD) clinics in Northern Italy, for suspected or STD treatment. A total of 44 subjects (6.9%, 95% confidence interval, (Cl): 4.9-8.9) were seropositive for HIV antibodies. The prevalence of HIV infection decreased with age, from 9% in patients aged 24 years or less to 3% in those aged 45 years or more (chi 21 trend 4.97, p less than 0.05). Women tended to have a lower prevalence of infection than men (5.3% versus 7.3%) but this was not statistically significant. Compared with men reporting no homosexual intercourse, HIV infection risk was about 50% higher in those reporting bisexual intercourse (age- and sex-adjusted odds ratio (OR) 1.5,95% Cl: 0.6-3.6) and about fourfold in those reporting only homosexual intercourse (OR 3.8, 95% Cl: 1.7-8.5). No clear trend in risk was observed with number of sexual partners both in men and in women. Intravenous drug users had an increased risk of HIV infection; compared with non-users, the OR was 5.6 (95% Cl: 3.0-10.5) in users, and the point estimates increased with frequency of use, from 3.3 (95% Cl: 0.8-11.5) in occasional users to 6.4 (95% Cl: 3.2-12.8) in regular users. The risk of HIV infection was 2.2 (95% Cl: 1.1-4.3) in patients reporting a history of STD, and 1.6 (95% Cl: 0.8-3.3) in those reporting syphilis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pigmentation abnormalities in the course of topical immunotherapy of alopecia areata]. / Anomalie pigmentaire in corso di immunoterapia topica per l'alopecia areata.

Pigmentation troubles have been associated in the past years with contact dermatitis and patch-testing. Contact allergy and increase of pigmentation has been associated with Tinopal; on the other hand contact allergy and depigmentation have been associated with many substances such as DNCB, squaric acid dibutylester (SADBE), carbyne, alstroemeria. Leukoderma can also be produced by irritant compound such as phenols, catechols and mercaptoamines. During 1978 and 1984 we have treated 132 patients suffering from alopecia areata with DNCB or SADBE: 51 patients have been treated by DNCB and 81 by SADBE. During the treatment 10 patients developed a leukoderma vitiligo-like localized to the areas of topical application of the allergens and to the flare-up site; one patient had an increase of pigmentation. Lesions vitiligo-like appeared 10-15 weeks after the onset of treatment. Among the patients who developed leukoderma, 4 had a personal history of vitiligo. The possible pathogenetic mechanisms are discussed.