Is Sjögren's syndrome a retroviral disease?

Circumstantial evidence suggests that retroviruses play a role in the pathogenesis of Sjögren's syndrome. Such evidence, derived from studies of patients with Sjögren's syndrome, includes the following: the presence of serum antibodies cross-reactive with retroviral Gag proteins; the occurrence of reverse transcriptase activity in salivary glands; the detection of retroviral antigens, retrovirus-like particles, or novel retroviral sequences in salivary glands; the occurrence of Sjögren's syndrome-like illnesses in patients having confirmed systematic infections with retroviruses such as human immunodeficiency virus-1 (HIV-1) and human T lymphotropic virus type 1; and the beneficial effect of anti-retroviral treatment on the occurrence of HIV-1-associated sicca syndrome. Additional evidence is provided by animal models

Sexually Transmitted Infections in a Cohort of 15,921 Refugees (1926-1940) in the Region of Imathia, Northern Greece

This historical epidemiological study evaluates sexually transmitted infections (STIs) among Greek refugees during the Interwar period in the region of Imathia, Central Macedonia, Greece, as a part of the effort against sexually transmitted infections in Greece (1910-1940). We examined the archives of the Refugee Hospital of Veroia – the capital of the regional unit of Imathia (March 5, 1926 to October 27, 1940). This is a report of previously unpublished primary material comprising a cohort of 15,921 cases, among whom 41 patients were hospitalized on account of syphilis and 19 on account of gonococcal infection. Descriptive statistics were estimated. Primary (n=4), secondary (n=2), tertiary (n=13), congenital (n=7), and not further specified (n=15) cases of syphilis were identified, whereas a variety of differential diagnosis problems arose. Syphilis and gonococcal infection/gonorrhea seemed to affect various social groups, as evidenced by the variety of professions involved. Refugee patients originated from various areas such as Caucasus, Thrace, Constantinople, Bithynia, and Pontus. Lack of information and poor healthcare led to spreading of STIs in Greece. Law 3032/1922 was crucial for the Greek effort against sexually transmitted infection

Sexually Transmitted Infections in a Cohort of 15,921 Refugees (1926-1940) in the Region of Imathia, Northern Greece

This historical epidemiological study evaluates sexually transmitted infections (STIs) among Greek refugees during the Interwar period in the region of Imathia, Central Macedonia, Greece, as a part of the effort against sexually transmitted infections in Greece (1910-1940). We examined the archives of the Refugee Hospital of Veroia – the capital of the regional unit of Imathia (March 5, 1926 to October 27, 1940). This is a report of previously unpublished primary material comprising a cohort of 15,921 cases, among whom 41 patients were hospitalized on account of syphilis and 19 on account of gonococcal infection. Descriptive statistics were estimated. Primary (n=4), secondary (n=2), tertiary (n=13), congenital (n=7), and not further specified (n=15) cases of syphilis were identified, whereas a variety of differential diagnosis problems arose. Syphilis and gonococcal infection/gonorrhea seemed to affect various social groups, as evidenced by the variety of professions involved. Refugee patients originated from various areas such as Caucasus, Thrace, Constantinople, Bithynia, and Pontus. Lack of information and poor healthcare led to spreading of STIs in Greece. Law 3032/1922 was crucial for the Greek effort against sexually transmitted infection

CD4 cell count response to first-line combination ART in HIV-2+patients compared with HIV-1+patients: a multinational, multicohort European study

BACKGROUND: CD4 cell recovery following first-line combination ART (cART) is poorer in HIV-2+ than in HIV-1+ patients. Only large comparisons may allow adjustments for demographic and pretreatment plasma viral load (pVL). METHODS: ART-naive HIV+ adults from two European multicohort collaborations, COHERE (HIV-1 alone) and ACHIeV2e (HIV-2 alone), were included, if they started first-line cART (without NNRTIs or fusion inhibitors) between 1997 and 2011. Patients without at least one CD4 cell count before start of cART, without a pretreatment pVL and with missing a priori-defined covariables were excluded. Evolution of CD4 cell count was studied using adjusted linear mixed models. RESULTS: We included 185 HIV-2+ and 30321 HIV-1+ patients with median age of 46 years (IQR 36–52) and 37 years (IQR 31–44), respectively. Median observed pretreatment CD4 cell counts/mm3 were 203 (95% CI 100–290) in HIV-2+ patients and 223 (95% CI 100–353) in HIV-1+ patients. Mean observed CD4 cell count changes from start of cART to 12 months were +105 (95% CI 77–134) in HIV-2+ patients and +202 (95% CI 199–205) in HIV-1+ patients, an observed difference of 97 cells/mm3 in 1 year. In adjusted analysis, the mean CD4 cell increase was overall 25 CD4 cells/mm3/year lower (95% CI 5–44; P = 0.0127) in HIV-2+ patients compared with HIV-1+ patients. CONCLUSIONS: A poorer CD4 cell increase during first-line cART was observed in HIV-2+ patients, even after adjusting for pretreatment pVL and other potential confounders. Our results underline the need to identify more potent therapeutic regimens or strategies against HIV-2

Invasive Fungal Infections in Patients with Hematological Malignancies: Emergence of Resistant Pathogens and New Antifungal Therapies

Invasive fungal infections caused by drug-resistant organisms are an emerging threat to heavily immunosuppressed patients with hematological malignancies. Modern early antifungal treatment strategies, such as prophylaxis and empirical and preemptive therapy, result in long-term exposure to antifungal agents, which is a major driving force for the development of resistance. The extended use of central venous catheters, the nonlinear pharmacokinetics of certain antifungal agents, neutropenia, other forms of intense immunosuppression, and drug toxicities are other contributing factors. The widespread use of agricultural and industrial fungicides with similar chemical structures and mechanisms of action has resulted in the development of environmental reservoirs for some drug-resistant fungi, especially azole-resistant Aspergillus species, which have been reported from four continents. The majority of resistant strains have the mutation TR34/L98H, a finding suggesting that the source of resistance is the environment. The global emergence of new fungal pathogens with inherent resistance, such as Candida auris, is a new public health threat. The most common mechanism of antifungal drug resistance is the induction of efflux pumps, which decrease intracellular drug concentrations. Overexpression, depletion, and alteration of the drug target are other mechanisms of resistance. Mutations in the ERG11 gene alter the protein structure of C-demethylase, reducing the efficacy of antifungal triazoles. Candida species become echinocandin-resistant by mutations in FKS genes. A shift in the epidemiology of Candida towards resistant non-albicans Candida spp. has emerged among patients with hematological malignancies. There is no definite association between antifungal resistance, as defined by elevated minimum inhibitory concentrations, and clinical outcomes in this population. Detection of genes or mutations conferring resistance with the use of molecular methods may offer better predictive values in certain cases. Treatment options for resistant fungal infections are limited and new drugs with novel mechanisms of actions are needed. Prevention of resistance through antifungal stewardship programs is of paramount importance

Therapy of Mucormycosis

Despite the recent introduction of mold-active agents (posaconazole and isavuconazole), in addition to amphotericin B products, to our armamentarium against mucormycosis, many uncertainties remain for the management of this uncommon opportunistic infection, as there are no data from prospective randomized clinical trials to guide therapy. In this mini-review, we present the current status of treatment options. In view of the heterogeneity of the disease (different types of affected hosts, sites of infection, and infecting Mucorales), mucormycosis management requires an individualized management plan that takes into account the net state of immunosuppression of the host, including comorbidities, certainty of diagnosis, site of infection, and antifungal pharmacological properties