Hvordan kan HIV-infeksjon eradikeres?

Kun en person, den såkalte Berlinpasienten, har blitt fullstendig kurert for HIV. Dette var et resultat av at pasienten mottok to allogene stamcelletransplantasjoner med CCR5-delta32-mutasjon. Da pasienter med allogen stamcelletransplantasjon, uten muterte celler, ikke oppnådde eradikering, tyder mye på at svaret ligger i CCR5-delta32-mutasjonen. Det jobbes med å danne pluripotente stamceller med CCR5-delta32-mutasjon, ved hjelp av genmanipulasjon. Tanken er dermed å kunne gjennomføre autologe stamcelletransplantasjon med de muterte cellene. Med dette vil man unngå ulemper ved allogen stamcelletransplantasjon, som graft versus host disease, immunsuppresjon og problemer med å finne matchende donor. Det forskes samtidig på muligheten for å aktivere hvilende CD4-T-celler, som utgjør størsteparten av HIV-reservoiret, slik at HAART kan eradikere viruset fullstendig. Dog er det fortsatt mye som er ukjent vedrørende reservoiret av latente virus. Kartlegging av HIV-reservoiret er under arbeid

Preventing chylous ascites after right hemicolectomy with D3 extended mesenterectomy

Abstract Background We aim to find the incidence of chylous ascites in patients undergoing D3 extended mesenterectomy and evaluate if a routine fat-reduced diet (FRD) has a prophylactic effect. Methods Data from 138 patients included in a D3 extended mesenterectomy trial were collected prospectively. Surgical drains and biochemical testing of drain fluid were used to find the incidence of chylous ascites among the first 39 patients, and a prophylactic fat-reduced diet was then implemented in the next 99 patients as a prophylactic measure. Results In the first 39 patients, we found that 16 (41.0%) developed chylous ascites. After the fat-reduced diet was implemented, 1 (1.0%) of 99 patients developed chylous ascites. Drain discharge was 150 vs. 80 mL daily, respectively, and a regression analysis shows the average leakage in the group with fat-reduced diet was 105 mL/day less than in the patients with no dietary restrictions ( p  < 0.001). There were no significant differences in the rate of other complications (Fisher exact test, one-tailed p  = 0.8845), and although there was a tendency to a shorter hospital stay when given a fat-reduced diet (7.3 ± 5.4 vs. 8.9 ± 4.9 days), the difference was not significant ( p  = 0.19). Conclusions Chylous ascites is a very common postoperative occurrence after right colectomy with extended D3 mesenterectomy and may be prevented using a routine fat-reduced diet