Hepatitis C virus co-infection and sexual risk behaviour are associated with a high homocysteine serum level in HIV-infected patients.

BACKGROUND AND AIMS: A better understanding of the relationship of homocysteine with cardiovascular risk factors is needed. The objectives of this study were to assess the serum level of homocysteine in HIV-infected patients and to analyse the possible association of increased levels of the amino acid with cardiovascular risk factors, demographic and clinical characteristics of participants. METHODS: Cross-sectional study carried out as a supplementary task to the usual controls necessary in HIV-infected patients in the outpatient clinic of the Hospital General of Castellon, Spain. For two consecutive visits the demographic, clinical and HIV-related characteristics and blood analyses result…

Interleukin 2 treatment in HIV-1 infection

Presentation and outcome of infective endocarditis in Spain: a retrospective study

Summary Objective To analyze cases of infective endocarditis in patients who attended the Hospital General de Castellon, Spain, between 1999 and 2004. Methods This was a retrospective study. Demographic and clinical characteristics were assessed, variation in presentation over time was analyzed, and factors influencing outcome were determined. Results A total of 54 cases in 48 patients were included; 33 (61%) were in men. The median patient age was 62 years. Infective endocarditis occurred on a native valve in 36 cases (67%), a mechanical prosthetic valve in 12 (22%), and a pacemaker in six (11%). The mitral valve was the most commonly affected site. Transthoracic and/or transesophageal ech…

Interobserver discrepancy in liver fibrosis using transient elastography

Summary.  Transient elastography is a useful method to assess liver fibrosis, but uncertainties still exist regarding reliability and reproducibility of the technique. We aimed to improve knowledge on interobserver variability with the procedure and tried to find factors associated with such variability. This was a cross-sectional study to compare the results of transient elastography performed by two different operators, one test made just after the other. We assessed both results with correlation tests and with repeated parametric or nonparametric tests, as needed. We also carried out a multivariate analysis to find factors associated with discrepancy in the results obtained by the two op…

Dermopatía y neuropatía periférica

Varon de 70 anos, de nacionalidad espanola, residente en una zona rural de Venezuela desde los 21 anos de edad. Entre sus antecedentes destacan hepatitis, hipertension y tabaquismo. Ingresa por presentar desde hace varias semanas lesiones cutaneas por todo el cuerpo, que van aumentado progresivamente de tamano. Tambien refiere sensacion de obstruccion nasal, y disminucion de la sensibilidad en las zonas donde tiene lesiones cutaneas y en las partes distales de los cuatro miembros. A la exploracion se halla con buen estado general y constantes vitales normales. Presenta placas eritematosas ligeramente sobreelevadas de hasta 8 cm de diametro por todo el cuerpo (figs. 1A a C). Tiene disminuida…

Epistaxis and systemic disease

Abstract We report the case of a 77-year-old man who presented nasal obstruction sensation and epistaxis. Otorhinolaryngologic examination revealed occupation of the left nasal passage and the left maxillary sinus by an inflammatory tumour, the biopsy results of which were inconclusive. While diagnostic tests were being carried out, the patient presented a severe systemic condition consisting mainly of anemia, acute renal failure, and cavitated diffuse bilateral lung infiltrates. In the light of the results of anti-neutrophilic cytoplasmic antibodies and renal biopsy, Wegener's granulomatosis was diagnosed and treatment for the disease was instituted, with a favourable response. Finally, cl…

Adverse drug reactions to antiretroviral medication

Antiretroviral therapy has greatly improved prognosis of HIV infection, with a dramatic reduction of morbidity and mortality worldwide. Nevertheless, the condition is still a common cause of death in many underdeveloped countries, where effective treatment is not always unavailable. More than 20 drugs active against HIV are commercially available, which belong to one of four groups: nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, and fusion/entry inhibitors. In the near future new drugs are expected, including those of a novel group, the integrase inhibitors. To avoid viral resistance, combinations of the drugs must always b…

Pandemic H1N1 influenza-associated myocarditis in a patient with Castleman's disease.

We report on a patient with longstanding multicentric Castleman’s disease, hyaline-vascular type, who presented with nearly-fatal myocarditis associated with a 2009 pandemic H1N1 influenza virus infection. This is the first case of such an association described in the literature.

Impact of body weight on virological and immunological responses to efavirenz-containing regimens in HIV-infected, treatment-naive adults

Objective: The prevalence of overweight and obesity is increasing among HIV-infected patients. Whether standard antiretroviral drug dosage is adequate in heavy individuals remains unresolved. We assessed the virological and immunological responses to initial efavirenz (EFV)-containing regimens in heavy compared to normal-weight HIV-infected patients. Design: Observational European cohort collaboration study. Methods: Eligible patients were antiretroviral-naive with documented weight prior to EFV start and follow-up viral loads after treatment initiation. Cox regression analyses evaluated the association between weight and time to first undetectable viral load ( 50 copies/ml) after initial s…

Relationship Between Homocysteine Serum Level and Other Blood Analyses Parameters in HIV-infected Patients

Castleman's disease presenting as fever of unknown origin: diagnostic value of fluorodeoxyglucose-positron emission tomography/computed tomography.

Abstract: Castleman's disease is an uncommon lymphoproliferative disorder that can present in both nodal and extranodal sites. The cause is unknown, but a disordered immunoregulation, which results in the excessive proliferation of B lymphocytes and plasma cells in lymphoid organs, plays a central role in the development of the condition. Three distinct histologic types (hyaline vascular, plasma cell, and mixed), and 2 anatomical variants (localized and multicentric) have been described. Clinical presentation generally consists of enlargement of lymph nodes or other tissues, fever, asthenia, weight loss, and other general symptoms, associated with nonspecific blood analysis abnormalities, s…

[Pharmacogenomics of antiretrovirals].

HIV infection is a serious but treatable disease, yet current treatment is limited by development of resistance and high rates of adverse drug reactions. Antiretroviral therapy is especially suitable for pharmacogenomic investigation as both drug exposure and treatment response can be reliably measured. Increasing knowledge about genes implicated in pharmacokinetics, mode of action, efficacy, and toxicity of drugs has already provided relevant results for clinical practice, for example: The strong association of the abacavir hypersensitivity reaction with HLA-B*5701 permits testing patients for the allele, and if present avoiding the drug and therefore preventing the reaction. Persons with …

Epistaxis y enfermedad sistémica

Resumen Varon de 77 anos que comenzo con un cuadro de sensacion de obstruccion nasal y epistaxis. Los examenes otorrinolaringologicos mostraron una ocupacion de la fosa nasal y el seno maxilar izquierdos por una tumoracion inflamatoria, cuya biopsia no resulto diagnostica. Mientras se estudiaban dichos sintomas, el paciente presento un grave cuadro sistemico, fundamentalmente anemia, insuficiencia renal aguda e infiltrados alveolointersticiales bilaterales pulmonares cavitados. Con base en la positividad de los anticuerpos anticitoplasma de neutrofilo y el resultado de la biopsia renal, se establecio el diagnostico de granulomatosis de Wegener y se inicio su tratamiento, con buena respuesta…

A dendritic cell tumor in an HIV-infected patient: case report

Borreliosis de Lyme

La borreliosis de Lyme es una zoonosis transmitida por garrapatas y producida por la espiroqueta Borrelia burgdorferi. Existen casos de esta infeccion al menos desde principios del siglo xx, sin embargo sudescripcion completa no se realizo hasta 1982. Clinicamente se caracteriza por una afeccion cutanea caracteristica, el eritema migratorio, y por una variada sintomatologia sistemica, que evoluciona en fases, durante meses o anos. El diagnostico suele realizarse mediante serologia, y responde bien a diversos antibioticos, especialmente si se administran en las primeras fases de la enfermedad.

Nocardia brain abscess

Within subject variability of HDL-cholesterol in HIV-infected patients

Background and objective: Within-subject variability of cardiovascular risk factors may influence the development of cardiovascular disease. We aimed to improve knowledge on HDL-cholesterol variability and its clinical significance in HIV-infected patients, a population at high risk of cardiovascular disease.Methods: This was a cohort study to quantify the variability of HDL-cholesterol between two consecutive visits and to determine factors associated with such variability, in a group of HIV-infected patients.Results: A total of 307 patients were included, mean ± standard deviation of their age was 45.1 ± 8.5 years, and 225 of them (73.3%) were male. The absolute difference (after squaring…

Typhlitis as a complication of influenza in a patient with advanced HIV infection.

The authors report the case of an HIV-infected patient who presented with typhlitis as a complication of typical influenza. To the best of their knowledge, this is the first case reported in the literature with such an association of clinical conditions.