Evolving perspectives on HIV-associated lipodystrophy syndrome: moving from lipodystrophy to non-infectious HIV co-morbidities.

This article will provide insight into the evolving perspectives on HIV-related lipodystrophy syndrome: recent changes in epidemiology, a shifting focus from individual component assessment towards a more comprehensive risk evaluation for organ dysfunction and disease, the impact of patient-related outcomes in heath-related quality of life and the integration of this syndrome into a wider scenario of a premature ageing process in HIV-infected people will be discussed. The time has come to proceed beyond lipodystrophy studies based on blood concentrations of lipids and glucose and body fat evaluation. Surrogate markers of organ disease associated with lipodystrophy better identify patients vulnerable to non-infectious co-morbidities (NICMs) rather than statistical risk algorithms. In this evolving perspective NICMs take the place of lipodystrophy in the description of the clinical spectrum of HIV disease and allow integration of this syndrome into the wider scenario of a premature ageing process in HIV-infected people. Management of NICMs needs to be considered as part of a multi-disciplinary holistic approach that accommodates the increasing number of factors influencing non-infectious HIV-related outcomes

First-time use of bevacizumab for metastatic hepatocellular carcinoma in a HIV/HBV coinfected patient. A case report

A case of a HIV-1 infected patient with history of chronic hepatitis B and chronic alcohol use without cirrhosis, who presented with aggressive hepatocellular carcinoma (HCC) with multiple metastasis is presented. Systemic chemotherapy combined with use of bevacizumab (anti-VEGF monoclonal antibody) was without effect and the patient succumbed to his disease within weeks. Relatively recent data indicate that HCC may be extremely aggressive in HIV/HBV or HIV/HCV coinfected patients with younger age at presentation, shorter evolution time, a more advanced stage at presentation with higher rates of extrahepatic-extranodal metastases and, finally, a reduced survival rate as compared with HIV-negative patients. To our knowledge, this is the first report in the English literature of bevacizumab use for metastatic hepatocellular carcinoma in HIV infected patients

Primary Staphylococcus aureus urinary tract infection: The role of undetected hematogenous seeding of the urinary tract

Staphylococcus aureus (SA) bacteriuria may accompany SA bacteremia, but primary SA urinary tract infection (UTI) may also occur. Our clinical observation of SA UTIs following intravenous catheter-related phlebitis lead us to review hematogenous and ascending route-related risk factors in patients with primary SA UTIs. The charts from all patients with SA UTIs over a 1.5-year period were reviewed for concurrent or recent hospitalization, intravenous catheterization, and for known UTI risk factors. Patients with concurrent SA bacteremia were excluded. Patients with Escherichia coli UTIs during the same period were included as controls. Twenty cases of primary SA UTI were compared with 43 E. coli UTI cases and they did not differ in age, diabetes mellitus, prostatic hypertrophy, previous UTI, or other urinary tract (UT) abnormality. However, cases were more likely than controls to have had recent or concurrent hospitalization, UT catheterization, and history of recent phlebitis. In multivariate analysis, UT catheterization and recent hospitalization retained significant association with SA UTI. Similar results were shown for the methicillin-resistant SA UTI subgroup. Even though UT catheterization is the main predisposing factor for primary SA UTI, some cases may be mediated through unrecognized preceding bacteremia related to intravascular device exposure or other healthcare-related factors. © 2010 Springer-Verlag

Risk factors for tracheobronchial acquisition of resistant gram-negative bacterial pathogens in mechanically ventilated ICU patients

The aim of this study was to identify risk factors for tracheobronchial acquisition with the most commonresistant Gram-negative bacteria in the intensive care unit (ICU) during the first week after intubation and mechanical ventilation. Tracheobronchial and oropharyngeal cultures were obtained at admission, after 48 hours, and after 7 days of mechanical ventilation. Patient characteristics, interventions, and antibiotic usage were recorded. Among 71 eligible patients with two negative bronchial cultures for resistant Gramnegative bacteria (at admission and within 48 hours), 41 (58%) acquired bronchial resistant Gram-negative bacteria by day 7. Acquisition strongly correlated with presence of the same pathogens in the oropharynx: Acinetobacter baumannii [odds ratio (OR)520.2, 95% confidence interval (CI): 5.5–73.6], Klebsiella pneumoniae (OR58.0, 95% CI: 1.9–33.6), and Pseudomonas aeruginosa (OR527, 95%: CI 2.7–273). Bronchial acquisition with resistant K. pneumoniae also was associated with chronic liver disease (OR53.9, 95% CI: 1.0–15.3), treatment with aminoglycosides (OR54.9, 95% CI: 1.4–18.2), tigecycline (OR54.9, 95% CI: 1.4–18.2), and linezolid (OR53.9, 95% CI: 1.1–15.0). In multivariate analysis, treatment with tigecycline and chronic liver disease were independently associated with bronchial resistant K. pneumoniae acquisition. Our results show a high incidence of tracheobronchial acquisition with resistant Gramnegative microorganisms in the bronchial tree of newly intubated patients. Oropharynx colonization with the same pathogens and specific antibiotics use were independent risk factors. © 2015 Edizioni Scientifiche per l’Informazione su Farmaci e Terapia