Potential drug-drug interactions between antiretroviral drugs and comedications, including dietary supplements, among people living with HIV: A clinical survey.

OBJECTIVE: Age-related comorbidities, polypharmacy and thereby the risk of potential drug-drug interactions (PDDIs) among people living with HIV (PLWH) have increased over the years. We estimated the prevalence of comedications, including dietary supplements, and evaluated PDDIs among PLWH receiving antiretroviral therapy (ART) in Denmark in an outpatient setting. METHODS: Information on prescription medication, over-the-counter medication and dietary supplements was obtained from adult PLWH receiving ART attending two outpatient clinics in Denmark. The PDDIs were identified using the University of Liverpool's drug interaction database. Associations between PDDIs and relevant variables were compared using logistic regression models. RESULTS: A total of 337 PLWH receiving ART with a median age of 53 years (interquartile range: 45-61) were included; 77% were male and 96% had a HIV-RNA viral load < 50 copies/mL. Twenty-six per cent of participants received five or more comedications and 56% consumed dietary supplements. Co-administration of drugs requiring dose adjustment or monitoring was identified in the medication lists of 52% of participants, and 4.5% were on drugs that should not be co-administered. Male sex [odds ratio (OR) = 1.9, 95% confidence interval (CI): 1.0-3.4], being on a protease inhibitor (OR = 4.3, 95% CI: 1.9-9.7), receiving five or more comedications (OR = 3.3, 95% CI: 1.5-7.2), taking over-the-counter medications (OR = 1.9, 95% CI: 1.1-3.3) and dietary supplements (OR = 2.0, 95% CI: 1.2-3.3) were independent predictors of PDDIs. CONCLUSION: Potential drug-drug interactions were common among our study population Our study confirms that polypharmacy and being on a protease inhibitor-based regimen increase the risk of PDDIs considerably and highlights the importance of questioning PLWH about dietary supplement intake.

Chronic appendicitis: two case reports.

BACKGROUND: Chronic appendicitis is a condition unfamiliar to many physicians and is often referred to as a controversial diagnosis. This can give rise to diagnostic delay. CASE PRESENTATION: We present two cases of chronic appendicitis: a Caucasian female aged 21 years and a Caucasian male aged 34 years. The patients had different clinical presentations, which led the initial investigations in very different directions-tropical infectious disease and possible malignancy, respectively. In both cases, radiological imaging was the key investigation leading to the final surprising diagnosis. CONCLUSION: With these two case stories, we wish to draw attention to chronic appendicitis as a possible differential diagnosis in younger patients with chronic or recurrent abdominal pain, particularly if the pain is located in the lower abdomen and is accompanied by fever.

18F-FDG PET/CT Findings in a Patient with Chikungunya Virus Infection.

We present a case demonstrating the diagnostic work-up and follow-up of a patient with Chikungunya infection. An 18F-FDG PET/CT performed four weeks after debut of symptoms revealed pathological 18F-FDG uptake in enlarged lymph nodes on both side of the diaphragm, and inflammation of both shoulder and hip joints. Lymphoma and infection were the main differential diagnoses. Follow-up 18F-FDG PET/CT scan in the patient performed 14 weeks after the abnormal scan, revealed almost complete resolution of the metabolically active disease. This case is to our knowledge the first to demonstrate sequential 18F-FDG PET/CT scan results in a patient with Chikungunya virus infection.

A comparison of interferon-γ and IP-10 for the diagnosis of tuberculosis.

OBJECTIVE: Interferon-γ and IP-10 release assays are diagnostic tests for tuberculosis infection. We have compared the accuracy of IP-10 and QuantiFERON-TB Gold In-tube [QFT-IT] in Tanzanian children suspected of having active tuberculosis (TB). METHODS: Hospitalized Tanzanian children with symptoms of TB were tested with the QFT-IT and IP-10 tests and retrospectively classified into diagnostic groups. Adults with confirmed TB were assessed in parallel. RESULTS: A total of 203 children were included. The median age was 3.0 years (interquartile range: 1.2-7.0), 38% were HIV infected, 36% were aged <2 years, and 58% had a low weight-for-age. IP-10 and QFT-IT test performance was comparable but sensitivity was low: 33% (1 of 3) in children with confirmed TB and 29% (8 of 28) in children with probable TB. Rates of indeterminate responders were high: 29% (59 of 203) for IP-10 and 26% (53 of 203) for QFT-IT. Age <2 years was associated with indeterminate test outcome for both IP-10 (adjusted odds ratio [aOR]: 2.2; P = .02) and QFT-IT (aOR: 2.4; P = .01). TB exposure was associated with positive IP-10 test outcome (aOR: 3.6; P = .01) but not with positive QFT-IT outcome (aOR 1.4; P = .52). In 102 adults, test sensitivity was 80% for both tests (P = .248). CONCLUSIONS: Although IP-10 and QFT-IT performed well in Tanzanian adults, the tests exhibited an equally poor performance in diagnosing active TB in children. Test performance was especially compromised in young children. Neither test can be recommended for use in hospitalized children in high-burden settings.

[New diagnostic test for tuberculosis]. / Ny test til diagnostik af tuberkulose.

The performance of two commercially-available Interferon Gamma Release Assays, QuantiFERON-TB-Gold and T-SPOT-TB, is reviewed. The tests can indirectly detect M. tuberculosis infection based on T-cell recognition of specific proteins which are not present in the BCG vaccine M. avium, or most other environmental mycobacteria.The sensitivity (76-88%) of the IGRAs is not optimal for a diagnostic test for active tuberculosis. However, the specificity is high (92-97%), and the IGRAs may play an important role in the investigation for active tuberculosis and screening for latent tuberculosis infection in BCG vaccinated populations and immunosuppressed patients.

[Measles in two children and one adult--outbreak of measles genotype B3]. / Maeslinger hos to børn og en voksen--udbrud med maeslingevirus genotype B3.

Measles virus genotype B3 was isolated from patients during a measles outbreak in Copenhagen starting January 2006. Here we describe three cases: two children aged 9 and 22 months, respectively, and a 29-year-old man. All three patients were hospitalised. Several doctors examined both the children before the diagnosis of measles was established. The patients were not vaccinated against measles. They had not been abroad within the last three weeks. Genotype B3 is endemic in West and Central Africa. The genotype B3 detected in these cases was different from the B3 seen in recent outbreaks in Europe.