Studio caso-controllo sui fattori di rischio delle infezioni micotiche nei pazienti sottoposti a trapianto ortotopico di fegato (OLT) da donatore cadavere e da donatore vivente.

La sopravvivenza e la qualità della vita dei pazienti sottoposti a trapianto di organo solido è notevolmente migliorata grazie a innovative tecniche chirurgiche, a nuove terapie immunosoppressive e a un miglior controllo delle complicanze infettive. Nonostante ciò l'incidenza delle infezioni micotiche profonde nei pazienti sottoposti a OLT, rimane più alta rispetto ad altri tipi di trapianto di organo solido, e determina una mortalità ad esse correlata tutt'ora rilevante. Non è noto se i pazienti sottoposti a trapianto da donatore vivente abbiano un'incidenza minore di infezioni micotiche rispetto a quelli sottoposti da donatore cadavere

Antiretroviral genotyping resistance in plasma RNA and whole blood DNA in HIV-1 infected patients failing HAART

The extent to which HIV-1 proviral DNA mutations cause clinically relevant antiretroviral resistance is still controversial. Paired plasma HIV-1 RNA and whole blood DNA were compared in patients failing HAART to investigate if the additional knowledge of archived mutations could improve the selection of potentially active drugs. Seventy-three HIV-1-infected patients with first/second HAART failure were studied before starting a new regimen based on RNA genotyping. Follow-up data after a 12-week therapy were available. DNA genotyping was retrospectively performed on stored whole blood samples and mutational profiles were compared to those from RNA. The mean number of IAS pol mutations was significantly higher in RNA (4.45 +/- 2.76) than in DNA (2.88 +/- 2.47) (P or=1 mutation revealed by DNA genotyping alone, probably affecting therapy success in 2/16. However, neither RNA/DNA discordance nor detection of isolated DNA mutations were statistically associated with outcome. In conclusion, plasma RNA remains the elective choice for HIV genotyping in patients with therapy failure, even if the detection of proviral resistance-associated mutations, not simultaneously found in RNA, is a frequent event. Therefore, in some cases DNA plus RNA genotyping might assist in choosing more accurately subsequent antiretroviral regimen