HIV Infection and Infertility

Human immunodeficiency virus (HIV) infection has become a chronic and manageable disease since the availability of combination antiretroviral therapy (cART). Persons living with HIV are living longer with better quality of life. Given that worldwide many HIV-infected individuals are in the reproductive age, fertility and reproductive desire have emerged as clinically important issues among this population. Biological changes caused by HIV, including systemic illnesses, stress, and weight loss, may affect the function of reproductive organs and result in infertility. Newly diagnosed HIV infection may cause psychological trauma and decrease in sexual drive and sexual activity. Several HIV/acquired immune deficiency syndrome (AIDS)-related comorbidities have been reported to be associated with infertility. These include orchitis, acute epididymitis, and pelvic inflammatory disease caused by opportunistic pathogens and coinfections with sexually transmitted infections (STIs) acquired through a similar route of transmission as HIV. The common STIs caused by Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Treponema pallidum, herpes simplex virus-2, and Trichomonas vaginalis can damage the reproductive system and cause infertility. Hypogonadism especially in men with AIDS is one of the important endocrine disorders that causes infertility. Although cART provides significant benefits in reducing morbidity and mortality among HIV-infected persons, some antiretroviral drugs, including nucleoside reverse transcriptase inhibitors, are toxic to cellular mitochondria and may affect the mitochondrial biogenesis of sperm and oocytes. HIV-infected individuals may have limited access to reproductive care given the severity of their disease, cost of care, stigmatization, and lack of specific HIV infection/infertility knowledge among their providers

Intrathecal colistin for drug-resistant Acinetobacter baumannii central nervous system infection: a case series and systematic review

AbstractTreatment limitations exist for drug-resistant Acinetobacter baumannii central nervous system (CNS) infection. We conducted a retrospective study and systematic literature review to identify patients with drug-resistant A. baumannii CNS infection who received primary or adjunct intrathecal or intraventricular (IT/IVT) colistin. In a case series of seven Thai patients and 17 patients identified in the literature, clinical and microbiological cure rates with IT/IVT colistin therapy were 83% and 92%, respectively. Three patients (13%) developed chemical ventriculitis and one (4%) experienced treatment-associated seizures. Death was associated with delayed IT/IVT colistin therapy compared to survival (mean time from diagnosis to IT/IVT colistin, 7 vs. 2 days; p 0.01). The only independent predictor of mortality was the severity of illness (APACHE II score > 19, adjusted odds ratio 49.5; 95% CI 1.7–1428.6; p 0.02). This case series suggests that administration of primary or adjunctive IT/IVT colistin therapy was effective for drug-resistant A. baumannii CNS infection