Treatment of Early Syphilis Fantry, L; Tramont, E C
The New England journal of medicine,
12/1997, Letnik:
337, Številka:
23
Journal Article
Recenzirano
To the Editor:
Rolfs and coworkers (July 31 issue)
1
convincingly demonstrated that
Treponema pallidum
invades the central nervous system in at least one fourth of persons with early syphilis ...regardless of their status with respect to human immunodeficiency virus (HIV) infection. In addition, they adequately demonstrated that serologically defined treatment failure did not reflect early clinically defined treatment failure. Their study did not, however, address the long-term neurologic sequelae, which usually take from 15 to 25 years to occur.
2
The purpose of using a treatment regimen such as amoxicillin and probenecid is not to increase the likelihood that acute symptoms . . .
A cohort of human immunodeficiency virus (HIV)-infected (n = 253) and uninfected (n = 658) women was prospectively studied to assess the relationship between venereal warts and HIV status, adjusting ...for self-reported and biologic measures of sexual risk behavior. Participants were assessed every 6 months for venereal warts and other sexually transmitted diseases, self-reported sexual behavior, and CD4 cell counts. The incidence of venereal warts was significantly increased in HIV-infected women (8.2 vs. 0.8/100 person-years of follow-up). This difference remained after adjusting for measures of high-risk sexual behavior and was observed in women at all levels of immune function, including those with ⩾500/mm3 CD4 cells. The increased risk of venereal warts in HIV infection can occur relatively early in HIV disease and appears chiefly attributable to a higher risk of progression from subclinical to clinical human papillomavirus (HPV) disease rather than to a higher risk of HPV acquisition.
Background Individuals with HIV infection exhibit high cytomegalovirus (CMV) IgG levels, but there are few data regarding the association of hepatitis C virus (HCV) with the immune response against ...CMV. Methods Associations of HCV with CMV seropositivity and CMV IgG levels were studied in 635 HIV-infected women, 187 of whom were HCV-seropositive, with adjustment in multivariable models for age, race/ethnicity, and HIV disease characteristics. Eighty one percent of the women reported receipt of highly active antiretroviral therapy (HAART) prior to or at CMV testing. Results In adjusted models women with chronic HCV had higher CMV IgG levels than those without HCV RNA ( beta = 2.86, 95% CI:0.89 - 4.83; P = 0.004). The association of HCV RNA with CMV IgG differed by age (Pinteraction = 0.0007), with a strong association observed among women in the low and middle age tertiles ( less than or equal to 45.3 years of age; beta = 6.21, 95% CI:3.30 - 9.11, P<0.0001) but not among women in the high age tertile. CMV IgG levels were not associated with non-invasive measures of liver disease, APRI and FIB-4, or with HCV RNA level and adjustment for Epstein-Barr virus (EBV) IgG levels did not affect the association between HCV and CMV. Conclusions CMV IgG levels are higher in HCV/HIV co-infected women than in HIV mono-infected women. Further research on the association of HCV with CMV IgG is indicated because prior studies have found CMV IgG to be associated with morbidity and mortality in the general population and subclinical carotid artery disease in HIV-infected patients.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
BACKGROUND: Neutropenia is well described in individuals infected with human immunodeficiency virus (HIV) and occurs in approximately 10% to 50% of cases. Neither the effect of highly active ...antiretroviral therapy (HAART) on neutrophil counts nor the significance of neutropenia in terms of survival has previously been evaluated. METHODS: The prevalence of neutropenia among 1729 HIV-infected women, followed up as part of the Women's Interagency HIV Study, was evaluated. The CD4 lymphocyte counts, HIV-1 RNA levels, and complete blood cell counts, including absolute neutrophil counts, were obtained at 6-month intervals. RESULTS: Neutropenia was common among HIV-infected women; at baseline, 44% had neutrophil counts less than 2000/μL, whereas 7% had counts less than 1000/μL. During 7.5 years of follow-up, neutrophil counts less than 2000/μL occurred on at least 1 occasion in 79%, whereas absolute neutrophil counts less than 1000/μL were documented in 31%. Worsening HIV disease parameters, such as lower CD4 cell counts (P<.001) and higher HIV-1 RNA levels (P<.001), were associated with development of neutropenia. Resolution of neutropenia was associated with higher CD4 cell counts (P<.001) and use of HAART (P=.007). We found that HAART, without zidovudine, was associated with protection against development of neutropenia. On multivariate analysis, neutropenia was not found to be associated with decreased survival among HIV-infected women. CONCLUSIONS: Worsening HIV disease parameters are associated with neutropenia in HIV-infected women. Treatment with HAART, without zidovudine in the regimen, protects against development of neutropenia, whereas HAART use and higher CD4 cell counts are associated with resolution of neutropenia. Neutropenia is not associated with decreased survival in HIV-infected women.Arch Intern Med. 2006;166:405-410-->
OBJECTIVE: Our goal was to determine types of inpatient admissions among human immunodeficiency virus-infected women both before and after the human immunodeficiency virus diagnosis, so that we might ...outline opportunities for intervention.
STUDY DESIGN: A total of 292 human immunodeficiency virus-infected women were interviewed about the reproductive history and prior hospitalizations. A reproductive health hospitalization was defined as either an obstetric admission or a gynecologic admission. Other admissions were categorized as either human immunodeficiency virus related, possibly human immunodeficiency virus related, or not human immunodeficiency virus related. Assignments were made independently by two human immunodeficiency virus specialists. If there was a conflict, a third reviewer was used.
RESULTS: In the 10 years before study entry 44.4% of women had at least one obstetric admission, 30.4% had at least one gynecologic admission, 3.1% had at least one human immunodeficiency virus-related admission, 18.1% had at least one admission that was possibly human immunodeficiency virus related, and 13.3% had at least one admission that was not human immunodeficiency virus related. Overall, 226 (77%) women had been admitted to the hospital; of these, 201 (69%) had been admitted for reproductive health reasons. Similar patterns were seen in the year before diagnosis and the time after diagnosis. Reproductive health admissions were more common among women who were younger, who used drugs, and who had higher CD4
+ cell counts.
CONCLUSION: Women with human immunodeficiency virus infection are often admitted to hospitals for reproductive health reasons before and after the human immunodeficiency virus status is known. Clinicians providing reproductive health care must be actively engaged in efforts to reduce the heterosexual and perinatal transmission of human immunodeficiency virus, to identify human immunodeficiency virus-infected women early in the course of the disease, and to provide ongoing care to human immunodeficiency virus-infected women. (Am J Obstet Gynecol 1998;178:166-70.)
We sought to determine whether the standard diagnostic methods for vaginitis behave similarly among HIV-infected and at-risk seronegative women.
We performed pairwise comparisons over time ...(1994-2003) for the different diagnostic methods for bacterial vaginosis (BV) (Nugent score and Amsel criteria), vulvovaginal candidiasis (potassium hydroxide smear and Pap smear), and trichomoniasis (culture, wet mount, and Pap smear) among HIV-infected and at-risk HIV seronegative women in the Women's Interagency HIV Study cohort. We stratified subjects by HIV status and among the HIV-infected women by CD4+ cell count strata.
For BV and trichomoniasis, kappa statistics comparing clinical diagnostic methods to laboratory-based methods improved after the first year. Significant differences in overall kappa statistics between HIV-infected and at-risk HIV-seronegative women were found only for vulvovaginal candidiasis where potassium hydroxide smear and Pap smear findings were more tightly correlated among HIV-infected women than among at-risk HIV-seronegative women; among these HIV-infected women, concordance was highest at lower CD4 cell counts. No significant differences in kappa statistics were found for the diagnostic methods of BV or trichomoniasis neither by HIV status nor CD4 cell count strata.
The standard diagnostic tests for BV, vulvovaginal candidiasis, and trichomoniasis behave similarly in HIV-infected and at-risk seronegative women. Training and experience are critical for the accurate performance of the diagnostic methods that require clinician interpretation.
Featuring the trusted, practical format of the CURRENT series, this authoritative, quick-access guide delivers a top-to-bottom overview of STDs commonly encountered in clinical practice. The book ...begins with an insightful introduction to the field that emphasizes the patient-doctor relationship, and then explores clinical problems with STDs in terms of diagnostic, management, and treatment considerations.
The use of antiretroviral agents to treat patients infected with HIV has become increasingly complex. Obstetricians caring for the pregnant woman infected with HIV must, no less than the HIV ...specialist, be familiar with the various medications now available. This article profiles each of the antiretroviral agents currently available, with a focus on issues relevant to the pregnant patient. Strategies for treating the nonpregnant patient and considerations for the use of these strategies in pregnancy also are discussed. Additional information about prophylaxis for common opportunistic infections is included.
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