Acute promyelocytic leukemia after whole brain irradiation of primary brain lymphomainan HIV-infected patient

The occurrence of acute promyelocytic leukemia (APL) in HIV-infected patients has been reported in only five cases. Due to a very small number of reported HIV/APL patients who have been treated with different therapies with the variable outcome, the prognosis of APL in the setting of the HIV-infection is unclear. Here, we report a case of an HIV-patient who developed APL and upon treatment entered a complete remission. A 25-years old male patient was diagnosed with HIV-infection in 1996, but remained untreated. In 2004, the patient was diagnosed with primary central nervous system lymphoma. We treated the patient with antiretroviral therapy and whole-brain irradiation, resulting in complete remission of the lymphoma. In 2006, prompted by a sudden neutropenia, we carried out a set of diagnostic procedures, revealing APL. Induction therapy consisted of standard treatment with all-trans-retinoic-acid (ATRA) and idarubicin. Subsequent cytological and molecular analysis of bone marrow demonstrated complete hematological and molecular remission. Due to the poor general condition, consolidation treatment with ATRA was given in March and April 2007. The last follow-up 14 months later, showed sustained molecular APL remission. In conclusion, we demonstrated that a complete molecular APL remission in an HIV-patient was achieved by using reduced-intensity treatment

Biological, Epidemiological and Clinical Basis of Understanding Human Immunodeficiency Virus Infection

Human immunodeficiency virus (HIV) causes a chronic infection beginning in most individuals with an acute syndrome followed by an asymptomatic stage and progresses in untreated adults over a median of 10 years to the late stage called AIDS. The virus rapidly and enormously replicates from the initiation of infection. The principal immunodeficiency caused by HIV is depletion in the subset of T lymphocytes referred to as helper T cells. New anti-HIV drugs given in potent combination regimens have demonstrated impressive efficacy by both clinical and laboratory measures, and have provided evidence that drugs can suppress HIV replication and disease manifestations. HIV/AIDS is still uncommon in Croatia. In the period from 1986 to 2000, 171 patients with AIDS have been reported of whom 101 (59%) died. The incidence of AIDS in 2000 was about 4 cases per million inhabitants. Recent testing of injection drug users at a needle exchange program (Help, Split) revealed an HIV incidence of about 1%

Postmarketing research of the efficacy and tolerability of fluconazole and clotrimazole in the treatment of vulvovaginal Candidiasis

U ginekološkim ordinacijama primarne zdravstvene zaštite u Hrvatskoj, u razdoblju od 01.06.2006. do 31.07.2006. godine ispitano je 246 epizoda nekomplicirane vulvovaginalne kandidoze (VVK) u bolesnica dobi od 18 do 45 godina u kojih su simptomi trajali do dva tjedna prije početka liječenja. Pojavi VVK u 83 bolesnice prethodilo je uzimanje antibiotika, mjesečnica ili primjena oralnih kontraceptiva. Ostale bolesnice nisu imale predisponirajuće čimbenike. Seksualni partneri nisu imali balanitis. Bolesnice su liječene prema listi randomizacije klotrimazolom vaginalno – 1×0,2 g kroz 3 dana, odnosno flukonazolom peroralno – 1×150 mg jednokratno. Randomizacijom su određene bolesnice čiji su seksualni partneri primali peroralno flukonazol 1×150 mg jednokratno. Klinička djelotvornost antimikrobnog liječenja nekomplicirane VVK i učestalost pojave ponovnih epizoda VVK nisu se značajno razlikovale s obzirom na vrstu provedenog liječenja i istovremeno liječenje ili neliječenje partnera.Atotal of 246 episodes of uncomplicated vulvovaginal candidiasis (VVC) were examined at gynecological outpatient primary health care departments in the period from June 1, 2006 until July 31, 2006, in patients aged 18 to 45 years in whom the symptoms lasted up to two weeks before treatment. The occurrence of VVC in 83 patients was preceded by antibiotic consumption, menstruation or taking oral contraceptives. Other patients had no predisposing factors. Sexual partners did not experience balanitis. The patients were treated according to the randomization list with either clotrimazole 1×0,2 g vaginally for 3 days or a single dose of fluconazole 1×150 mg perorally. The randomization also determined patients whose sexual partners received a single dose of fluconazole 1×150 mg perorally. Clinical efficacy of antimicrobial treatment of uncomplicated VVC and the frequency of recurring episodes of VVC did not significantly differ with regards to the type of administered treatment or simultaneous treatment or no treatment of sexual partner

Frequency of HIV-1 Viral Load Monitoring of Patients Initially Successfully Treated with Combination Antiretroviral Therapy

BACKGROUND: Although considered an essential tool for monitoring the effect of combination antiretroviral treatment (CART), HIV-1 RNA (viral load, VL) testing is greatly influenced by cost and availability of resources. ----- OBJECTIVES: To examine whether HIV infected patients who were initially successfully treated with CART have less frequent monitoring of VL over time and whether CART failure and other HIV-disease and sociodemographic characteristics are associated with less frequent VL testing. ----- METHODS: The study included patients who started CART in the period 1999-2004, were older than 18 years, CART naive, had two consecutive viral load measurements of <400 copies/ml after 5 months of treatment and had continuous CART during the first 15 months. The time between two consecutive visits (days) was the outcome and associated factors were assessed using linear mixed models. ----- RESULTS: We analyzed a total of 128 patients with 1683 visits through December 2009. CART failure was observed in 31 (24%) patients. When adjusted for the follow-up time, the mean interval between two consecutive VL tests taken in patients before CART failure (155.2 days) was almost identical to the interval taken in patients who did not fail CART (155.3 days). On multivariable analysis, we found that the adjusted estimated time between visits was 150.9 days before 2003 and 177.6 in 2008/2009. A longer time between visits was observed in seafarers compared to non-seafarers; the mean difference was 30.7 days (95% CI, 14.0 to 47.4; p<0.001); and in individuals who lived more than 160 kilometers from the HIV treatment center (mean difference, 16 days, p=0.010). ----- CONCLUSIONS: Less frequent monitoring of VL became common in recent years and was not associated with failure. We identified seafarers as a population with special needs for CART monitoring and delivery

A Cross‐Sectional Assessment of Frailty, Falls and Perceptions of Ageing in People Living with HIV Using an mHealth Platform

Objective: To evaluate frailty, falls and perceptions of ageing among clinically stable individuals with HIV, engaged with remote healthcare delivered via a novel smartphone application. Methods: This was a multi-centre European cross-sectional, questionnaire-based sub-study of EmERGE participants. Frailty was assessed using the five-item FRAIL scale. Present criteria were summed and categorized as follows: 0, robust; 1-2, pre-frail; 3-5, frail. Falls history and EQ-5D-5L quality of life measure were completed. Participants were asked their felt age and personal satisfaction with ageing. Results: A total of 1373 participated, with a mean age of 45 (± 9.8) years. Frailty was uncommon at 2%; 12.4% fell in the previous year, 58.8% of these recurrently. Mood symptoms and pain were prevalent, at 43.3% and 31.8%, respectively. Ageing satisfaction was high at 76.4%, with 74.6% feeling younger than their chronological age; the mean felt age was 39.3 years. In multivariable analysis, mood symptoms and pain were positively associated with frailty, falls and ageing dissatisfaction. An increase in pain severity and mood symptoms were respectively associated with 34% and 63% increased odds of pre-frailty/frailty. An increment in pain symptoms was associated with a 71% increase in odds of falling. Pain was associated with ageing poorly, as were mood symptoms, with odds of dissatisfaction increasing by 34% per increment in severity. Conclusions: Although uncommon, frailty, falls and ageing dissatisfaction were seen in a younger cohort with medically stable HIV infection using a remote care model, promoting screening as advocated by European guidelines. These were more common in those with pain or mood symptoms, which should be proactively managed in clinical care and explored further in future research.info:eu-repo/semantics/publishedVersio

Human immunodeficiency virus infection and intestinal tuberculosis: a case report

Opisujemo tridesetdvogodišnjeg bolesnika zaraženog HIV-om koji se razbolio pet mjeseci prije prijema u Kliniku s progresivnim mršavljenjem, febrilitetom i dijarejom. Zadnja 4 dana prije prijama osjetio je jače bolove u trbuhu. U času prijama u bolnicu bio je afebrilan, orijentiran, usporen, blijed, afoničan, klonuo, kahektičan i nepokretan. Abdomen je bio mekan, difuzno lagano osjetljiv na palpaciju. Opće stanje je bilo teže poremećeno. Na rendgenogramu pluća bila su obostrano prisutna inhomogena zasjenjenja. Postupno se razvijao akutni abdomen te je bolesnik operiran, nađeno je više perforacija na tankom i debelom crijevu, uz sterkoralni peritonitis. Učinjena je resekcija dijela terminalnog ileuma, desna hemikolektomija, ileotransverzalna terminoterminalna anastomoza i jejunostomija. Patohistološkom pretragom nađena je granulomatozna upala s kazeoznom nekrozom u stijenci tankog i debelog crijeva. Bolesnik je imao 11 limfocita CD4+ u mikrolitru krvi, te HIV-1 viremiju određenu metodom PCR od 1 480 000 kopija u mililitru plazme. Liječen je uspješno antituberkuloticima i kombinacijom antibiotika uz antiretrovirusno liječenje i parenteralnu i enteralnu alimentaciju. Privremena jejunostoma zatvorena je 3 mjeseca po prvoj operaciji, a 8 mjeseci potom bolesnik ima uobičajenu tjelesnu težinu (ukupno je dobio 35 kg). PCR HIV1 RNK je tada bila nedektabilna, a apsolutni broj limfocita CD4+ iznosio je 163/μL plazme.We present a case of a thirty-two-year-old HIV infected patient who presented with a 5 months history of weight loss, fever and diarrhea. Four days before admission he started to experience abdominal pain. On admission to the hospital the patient had no fever was pale, cachectic and immobile. The abdomen was diffusely tender on palpation. His general condition was poor. Achest X-ray upon the admission showed bilateral inhomogenous infiltrations. The patient developed clear signs of acute abdomen. Surgery was performed and multiple perforations of the small and large intestine were found together with a stercoral peritonitis. The terminal ileum was partially removed, a right hemicolectomy with a terminoterminal ileotransversal anastomosis and a jejunostomy were performed. Patohistological examination of the intestine revealed granulomatous inflammation of the small and large intestine areas of caseous necrosis. The CD4 lymphocyte count was 11 per microliter and the plasma HIV viral load measured by PCR showed 1 480 000 copies per milliliter. The patient was successfully treated with antituberculous drugs and other antimicrobials together with antiretrovirals. Parenteral and enteral alimentation was also given. The temporary jejunostomy was closed three months after the first operation. Eight months after the operation the patients regained his normal body weight (weight gain: 35 kg). HIV1 RNA was at that time undetectable and his CD4+ lymphocyte count was 163/μL

Efficiency of the EmERGE Pathway of Care in Five European HIV Centres

Objective: We aimed to calculate the efficiency of the EmERGE Pathway of Care in five European HIV clinics, developed and implemented for medically stable people living with HIV. Methods: Participants were followed up for 1 year before and after implementation of EmERGE, between April 2016 and October 2019. Micro-costing studies were performed in the outpatient services of the clinics. Unit costs for outpatient services were calculated in national currencies and converted to US$2018 OECD purchasing parity prices to enable between clinic comparisons in terms of outcomes and costs. Unit costs were linked to the mean use of services for medically stable people living with HIV, before and after implementation of EmERGE. Primary outcome measures were CD4 count and viral load; secondary outcomes were patient activation (PAM13) and quality of life (PROQOL-HIV). Out-of-pocket expenditure data were collected. Results: There were 2251 participants: 87-93$ purchasing parity prices. Primary and secondary outcome measures of participants did not change during the study. Conclusions: EmERGE is acceptable and provided cost savings in different socio-economic settings. Antiretroviral drug costs remain the main cost drivers in medically stable people living with HIV. While antiretroviral drug prices in local currencies did not differ that much between countries, conversion to US$ purchasing parity prices revealed antiretroviral drugs were more expensive in the least wealthy countries. This needs to be taken into consideration when countries negotiate drug prices with pharmaceutical vendors. Greater efficiencies can be anticipated by extending the use of the EmERGE Pathway to people with complex HIV infection or other chronic diseases. Extending such use should be systematically monitored, implementation should be evaluated and funding should be provided to monitor and evaluate future changes in service provision.info:eu-repo/semantics/publishedVersio

Thoracic empyema with scarlatiniform rash and acral desquamation: a case report

A 5 year old girl with thoracic empyema developed a scarlatiniform rash and acral desquamation. Cultures from blood, throat, and pleural fluid all grew Streptococcus pyogenes, a common etiologic agent of pediatric thoracic empyema. The presence of a scarlatiniform rash and acral desquamation in children with a thoracic empyema may help identify the causative organism

Prevalence and Outcomes for Heavily Treatment-Experienced (HTE) Individuals Living with Human Immunodeficiency Virus in a European Cohort

BACKGROUND: Although antiretroviral treatments have improved survival of persons living with HIV, their long-term use may limit available drug options. We estimated the prevalence of heavily treatment-experienced (HTE) status and the potential clinical consequences of becoming HTE. SETTING: EuroSIDA, a European multicentre prospective cohort study. METHODS: A composite definition for HTE was developed, based on estimates of antiretroviral resistance and prior exposure to specific antiretroviral regimens. Risks of progressing to clinical outcomes were assessed by Poisson regression, comparing every HTE individual with three randomly-selected controls who never became HTE. RESULTS: Of 15,570 individuals under follow-up in 2010-2016, 1617 (10.4%, 95% CI 9.9-10.9%) were classified as HTE. 1093 individuals became HTE during prospective follow-up (HTE incidence rate 1.76, CI 1.66-1.87 per 100 person-years of follow-up). The number of HTE individuals was highest in West/Central Europe (636/4019 persons, 15.7%) and lowest in East Europe (26/2279 persons, 1.1%). Although most HTE individuals maintained controlled viral loads (<400 copies/ml), many had low CD4 counts (≤350 cells/µl). After controlling for age, immunological parameters and pre-existing comorbidities, HTE status was not associated with the risk of new AIDS (adjusted incidence rate ratio, aIRR 1.44, CI 0.86-2.40, p = 0.16) or non-AIDS clinical events (aIRR 0.96, CI 0.74-1.25, p = 0.77). CONCLUSIONS: HTE prevalence increased with time. After adjusting for key confounding factors, there was no evidence for an increased risk of new AIDS or non-AIDS clinical events in HTE. Additional therapeutic options and effective management of comorbidities remain important to reduce clinical complications in HTE individuals

Криостимуляция околораневых и раневых тканей в лечении длительно не заживающих ран и язв конечностей

Представлен опыт применения разработанного автором метода криостимуляции околораневых и раневых тканей, его сочетания с атравматическим адгезивным растяжением тканей у больных с длительно не заживающими ранами и язвами конечностей. Определены критерии его безопасного применения и эффекты влияния на ткани. Получены положительные результаты в восстановлении опорных и других тканей конечностей.The experience of application of the original method of cryostimulation of wound tissue and its combination with atraumatic adhesive stretching of the tissue in patients with persisting wounds and ulcers of the extremities is presented. The criteria of its safe use and effects of influence on the tissue were determined. Positive results in restoration of supporting and other tissue of the extremities were obtained