Residual Human Immunodeficiency Virus (HIV) Type 1 RNA and DNA in Lymph Nodes and HIV RNA in Genital Secretions and in Cerebrospinal Fluid after Suppression of Viremia for 2 Years

Residual viral replication persists in a significant proportion of human immunodeficiency virus (HIV)-infected patients receiving potent antiretroviral therapy. To determine the source of this virus, levels of HIV RNA and DNA from lymphoid tissues and levels of viral RNA in serum, cerebrospinal fluid (CSF), and genital secretions in 28 patients treated for ⩽2.5 years with indinavir, zidovudine, and lamivudine were examined. Both HIV RNA and DNA remained detectable in all lymph nodes. In contrast, HIV RNA was not detected in 20 of 23 genital secretions or in any of 13 CSF samples after 2 years of treatment. HIV envelope sequence data from plasma and lymph nodes from 4 patients demonstrated sequence divergence, which suggests varying degrees of residual viral replication in 3 and absence in 1 patient. In patients receiving potent antiretroviral therapy, the greatest virus burden may continue to be in lymphoid tissues rather than in central nervous system or genitourinary compartment

Residual Human Immunodeficiency Virus (HIV) Type 1 RNA and DNA in Lymph Nodes and HIV RNA in Genital Secretions and in Cerebrospinal Fluid after Suppression of Viremia for 2 Years

Residual viral replication persists in a significant proportion of human immunodeficiency virus (HIV)-infected patients receiving potent antiretroviral therapy. To determine the source of this virus, levels of HIV RNA and DNA from lymphoid tissues and levels of viral RNA in serum, cerebrospinal fluid (CSF), and genital secretions in 28 patients treated for ⩽2.5 years with indinavir, zidovudine, and lamivudine were examined. Both HIV RNA and DNA remained detectable in all lymph nodes. In contrast, HIV RNA was not detected in 20 of 23 genital secretions or in any of 13 CSF samples after 2 years of treatment. HIV envelope sequence data from plasma and lymph nodes from 4 patients demonstrated sequence divergence, which suggests varying degrees of residual viral replication in 3 and absence in 1 patient. In patients receiving potent antiretroviral therapy, the greatest virus burden may continue to be in lymphoid tissues rather than in central nervous system or genitourinary compartment

Does robotic-assisted transabdominal preperitoneal (R-TAPP) hernia repair facilitate contralateral investigation and repair without compromising patient morbidity?

Inguinal hernia repair (IHR) is performed through either an open or minimally invasive approach (MIS). MIS allows for exploration and potential repair of an occult contralateral hernia. The aim of this study is to evaluate complications associated with intraoperative contralateral exploration and repair through robotic-assisted (da Vinci) IHR. 652 robotic-assisted inguinal hernia procedures were uniformly and retrospectively collected from seven surgeons. Incidental contralateral findings were evaluated and populations with and without contralateral findings were compared in terms of demographics, operative characteristics and complications. This case series includes the earliest cases in each surgeon\u27s robotic-assisted IHR experience. Seventy-one percent (71%) of patients presented with a unilateral hernia. Intraoperative/incidental contralateral ( occult ) hernias were found in 12.3% of patients with a unilateral diagnosis. For patients with and without contralateral findings, there were no significant differences in demographics and baseline health characteristics. Perioperative morbidity was statistically similar between groups: intraoperative complications (0 vs 0.5%, p = 1.000), postoperative complications prior to discharge (0 vs 3.2%, p = 0.38) and from discharge through 30 days (5.3 vs 4.0%, p = 0.72), as well as readmissions and reoperations related to the repair within 30 days. Differences in setting of care, length of stay, rate of blood transfusions, concomitant procedures and conversions were nonsignificant. Mean operative time was longer in patients with a contralateral hernia by 19 min (p \u3c 0.0001). Intraoperative contralateral exploration and subsequent repair during robotic-assisted IHR does not compromise perioperative patient morbidity. These study results support the increasing evidence for repair of contralateral, incidentally discovered inguinal hernias.Clinicaltrials.Gov ID number: NCT02684448