A phase III study of recombinant human interferon gamma to prevent opportunistic infections in advanced HIV disease.

The efficacy and safety of recombinant human interferon gamma (rIFN-gamma) in the reduction of opportunistic disease in patients with advanced HIV-1 infection are assessed. A 12-month double-blind, placebo-controlled, multicenter, Phase III trial of rIFN-gamma in HIV-positive patients with CD4 < 100 x 10(9)/liter on stable antiretroviral therapy. Eighty-four patients were allocated treatment on a 1:1 basis to rIFN-gamma or placebo. Patients received rIFN-gamma 0.05 mg/m(2) or 0.9% saline subcutaneously three times weekly for 48 weeks (optional extension to 18 months). The primary end point was the incidence of opportunist infections (CDC categories B/C). Secondary end points included mortality, immunological, and virological parameters. Patients on placebo had a mean of 3.45 opportunist infections (OIs) in the first 48 weeks. Patients treated with rIFN-gamma had a mean of 1.71 OIs (p = 0.04). However, the model showed overdispersion and the inclusion of a dispersion factor raised the p value to 0.13. rIFN-gamma appeared to have a particular effect on the incidence of Candida, herpes simplex, and cytomegalovirus infections. Three-year survival in the rIFN-gamma arm was 28% compared to 18% in the placebo group (not significant). rIFN-gamma-associated side-effects of headache, fatigue, rigors, influenza-like symptoms, depression, myalgia, and granulocytopenia were reversible. There was no evidence for HIV activation. Although not significant, the trend towards decreased opportunistic infections and increased survival warrants consideration of further trials of rIFN-gamma. The study gives additional information on the safety profile of this cytokine.

Chlamydia trachomatis detection--is it doctor dependent?

The accuracy of tests for chlamydia depends, among other things, upon the quality of the clinical specimen. Most chlamydia tests do not allow comment on specimen quality. It has been shown that examination of Papanicolaou stains or Diff-Quik stains of endocervical secretions can be used to assess the quality of endocervical sampling. This study has found that by analysing surrogate markers, such as the rates of inadequate cervical cytology and chlamydia detection rates in patients not identified as chlamydia contacts, it is possible to identify doctors performing less well in cervical sampling without the need for extra tests.

Blood-borne virus infection: the occupational risks.

Healthcare workers who are in contact with patients and/or clinical material are at continuous risk of acquiring blood-borne viral infections, in particular, infection with hepatitis B virus, hepatitis C virus and the human immunodeficiency virus (HIV). Prevention of occupational exposure is dependent on education. Prevention strategies include immunization, exposure avoidance by the use of universal precautions at all times, and post-exposure advice and prophylaxis. This article will review the risks to healthcare workers associated with exposure to hepatitis B, hepatitis C, and HIV. It will discuss post-exposure management in the United Kingdom (UK) and briefly outline the risks to patients from infected healthcare workers.

'Get it on' in the millennium.

Over the Christmas and New Year period the Health Education Authority launched a sexual health promotion campaign aimed at increasing the awareness of and reducing the incidence of sexually transmitted infections (STIs) and unwanted pregnancy. We undertook a study to assess the effect of this campaign locally in 2 genitourinary medicine (GUM) clinics. From our study we concluded the following: (1) Although rarely performed, it is possible to assess the effectiveness of health promotion campaigns. (2) Genitourinary medicine clinics provide a good forum for the assessment of such campaigns. (3) The information obtained from such assessments can be valuable for effective targeting of future campaigns.