Association between the Rate of CD4+ T Cell Decrease and the Year of Human Immunodeficiency Virus (HIV) Type 1 Seroconversion among Persons Enrolled in the Swiss HIV Cohort Study

The aim of this study was to investigate the early CD4+ T cell response among human immunodeficiency virus type 1 (HIV-1) seroconverters in relation to their year of seroconversion. Study participants were enrolled in the Swiss HIV Cohort Study between 1985 and 1995 and had not received antiretroviral treatment. The slope of the CD4+ T cell count within 2 years after seroconversion was significantly associated with the year of seroconversion, by sex and by use of injection drugs, when controlling for initial CD4+ cell count. These results show that the loss of CD4+ cells might be associated with the year of seroconversion, suggesting a change in the pathogenesis of HIV across the years. If these results are confirmed, they could have important implications for the pathogenesis of and therapeutic strategies for HIV-1 infectio

Growth-Deficient Mycobacteria in Patients with AIDS: Diagnosis by Analysis of DNA Amplified from Blood or Tissue

Amplification and sequencing of mycobacterial ribosomal RNA genes (16S rDNA) may permit the detection of growth-deficient species (i.e., those exhibiting no growth or those whose growth is delayed for more than 12 weeks). Of blood samples from 26 patients with AIDS and a liver sample from one additional AIDS patient, three samples (two of blood and the one of liver) were positive by polymerase chain reaction only; cultures of these three samples remained negative for more than 12 weeks. Analysis of amplified 16S rDNA from blood revealed a sequence characteristic of Mycobacterium genavense in the first case, in which one of many previous blood cultures had also been positive for M. genavense. The sequences found in the second and third cases were characteristic of Mycobacterium avium. The sample from the second patient was a liver biopsy specimen in which acid-fast bacilli were visualized; the culture of this specimen yielded M. avium after 7 months. The third sample was a blood sample from a patient in whom a relapse of treated M. avium infection was suspected. These results indicate that amplification and sequencing of mycobacterial 16S rDNA may permit early diagnosis and provide a rationale for treatment of infections due to growth-deficient mycobacteri

Severe Leptospirosis with Multiple Organ Failure Successfully Treated by Plasma Exchange and High-Volume Hemofiltration

Background. Leptospirosis is a spirochetal zoonosis with complex clinical features including renal and liver failure. Case report. We report the case of a Swiss fisherman presenting with leptospirosis. After initial improvement, refractory septic shock and severe liver and kidney failure developed. The expected mortality was estimated at 90% with clinical scores. The patient underwent plasma exchanges and high-volume hemofiltration (HVHF) with complete recovery of hepatic and kidney functions. Discussion. Plasma exchanges and HVHF may confer survival benefit on patients with severe leptospirosis, refractory septic shock, and multiple-organ failure

Foscarnet Decreases Human Immunodeficiency Virus RNA

Foscarnet inhibits human immunodeficiency virus (HIV) replication in vitro and decreases p24 antigenemia in patients with cytomegalovirus (CMV) retinitis. To evaluate the effect of foscarnet on HIV replication, HIV RNA was quantitated in 17 patients before and during foscarnet therapy. Fifteen patients had CMV retinitis, 1 had CMV encephalitis, and 1 had intractable zoster. A decrease in HIV RNA was observed in 16 of 17 patients. Before the introduction of foscarnet, mean HIV RNA was 5.82 ± 0.24 log RNA/mL and, after a median of 13 days of therapy, mean HIV RNA was 5.30 ± 0.27 log RNA/mL (P < .001). Among patients with detectable p24 antigen at baseline, a significant decrease was observed (P = .017). This decrease in HIV RNA demonstrates that foscarnet is a potent antiretroviral dru