COINFECTIONS
Understanding and Managing Community-Acquired Methicillin-Resistant Staphylococcus Aureus Among HIV-Infected Persons
Methicillin resistant Staphylococcus aureus (MRSA) has been recognized as an important pathogen in nosocomial settings for many years. More recently, serious methicillin resistant S aureus infections from the community have been described in children in Minnesota and North Dakota who have died from these infections in 1997, 1998 and 1999 (Herold, 1998; MMWR, 1999). The children were noted to have matching strains of bacteria despite having no epidemiologic links and no hospital exposure. Since these initial reports, several groups have reported outbreaks of MRSA infections occurring outside of healthcare facilities, involving athletes, military personnel, and inmates in correctional facilities (Lindenmayer, 1998; MMWR, 2003a,b; Pan, 2003; Zinderman, 2004; Kazakova, 2005; Nguyen, 2005; Aiello, 2006) leading to the term community-acquired MRSA (CA-MRSA). CA-MRSA outbreaks in men who have sex with men (MSM) have been recently reported in several US cities, possibly associated with methamphetamine use and risky sexual behavior (Lee, 2005). This review summarizes the current knowledge of the epidemiology, clinical manifestations, diagnosis, and management of CA-MRSA infections with an emphasis on the HIV patient.
Virology And Clinical Management of Hepatitis B And HIV Coinfection
Due to shared modes of transmission, coinfection with hepatitis B virus (HBV) and HIV is common. With a reduction in AIDS-related deaths due to highly active antiretroviral therapy (HAART), liver disease has emerged as an important cause of death in patients with HBV-HIV coinfection.
Diagnosis and Treatment of HPV-Related Squamous Intraepithelial Neoplasia
Human papillomavirus (HPV) is the most prevalent sexually transmitted infection. It is more common than herpes and chlamydia and it has been estimated that more than 75% of sexually active adolescents and adults between the ages of 15 and 49 will acquire at least one type of HPV infection. The infection is practically guaranteed in people with more than five sex partners in their lifetime.
Screening and Treatment of Anal Intraepithelial Neoplasia to Prevent Anal Cancer: Where do we stand?
The preceding article by Dr. Stephen Goldstone nicely outlines the issues around anal human papillomavirus (HPV) infection, anal intraepithelial neoplasia (AIN), and anal cancer. The article highlights several areas in which we are sure of the facts: 1) anal HPV infection is very common among men who have sex with men (MSM); 2) the prevalence and incidence of the putative anal cancer precursor, high-grade squamous intraepithelial lesions (HSIL) are very high among MSM; 3) the annual incidence of anal cancer among MSM is unacceptably high; 4) each of the above is more common among HIV-positive MSM than HIV-negative MSM; and 5) combination antiretroviral therapy has little, if any, impact on HSIL, portending the possibility-with some data supporting this suggestion-that the incidence of anal cancer among HIV-positive men on antiretroviral therapy will continue to rise in the future. Taken together, these observations would suggest that we should be mounting all-out campaigns to educate people around these issues and immediately implement screening and treatment programs to prevent anal cancer, modeled after the highly successful programs to prevent cervical cancer.
TB and HIV Coinfection: Current Trends, Diagnosis and Treatment Update
The impact that HIV has on the pathogenesis of tuberculosis (TB) is clear. It is one of the most important risk factors associated with an increased risk of latent TB infection (LTBI) progressing to active TB disease. HIV-infected people have an annual risk of 5% to 15% of developing active TB once infected (Rieder, 1999). TB is the most common opportunistic infection in people living with HIV worldwide. It is also the most common cause of death in HIV-positive adults living in developing countries, despite being a preventable and treatable disease (Corbett, 2003).
Ulcerating STDs and HIV: A Cause for Concern
Sexually transmitted infections (STIs) are among the most common infectious diseases in the United States today. More than 20 STIs have now been identified, and they affect more than 13 million men and women in this country each year.
Pathogenesis and Treatment of Human Immunodeficiency Virus and Chronic Hepatitis C Virus infection
The hepatitis C virus (HCV) is a single-stranded, enveloped virus of the Flaviviridae family, identified in 1989. Usually, HCV persists as a chronic infection, potentially leading to cirrhosis, liver failure, and hepatocellular carcinoma (HCC) if untreated. In the United States and Europe, liver disease secondary to HCV is the leading indication for liver transplantation.
Acute Hepatitis C Infection in HIV-Infected Men—an Emerging Epidemic
Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are two of the most prevalent persistent viral infections worldwide. Given their shared routes of transmission it is not surprising that HCV/HIV coinfection is relatively common. Globally, approximately 25% of patients with HIV are also infected with HCV (WHO, 2005). While the precise impact of HCV infection on the natural history of HIV infection is still controversial, uncontrolled HIV infection enhances the pathogenicity of HCV, leading to an increased morbidity and mortality in these patients...
Treatment of HCV in HIV and HCV Coinfection: What are the New Questions?
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Management of HIV/HCV Coinfection: An Update
According to Dr. Ray Chung, hepatitis C virus (HCV) and HIV coinfection is a tale of two viruses that can viewed through two different prisms. To hepatologists, including Dr. Chung, the scope of the problem is typically viewed through the HCV prism, in which HIV infection is a reality for roughly one-tenth of all HCV cases in the United States. For clinicians involved in primary care, the view through the HIV prism casts a more startling picture. Among all HIV-positive individuals in this country, HCV coinfection can be documented in approximately one-third of them.
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Herpes Group Viruses and HIV Infection
The name herpes comes from the greek herpein—“to creep.” Members of the Herpesviridae family have been identified in a variety of animals and they all share certain features, including an ability to establish latency following primary infection, as well as a potential to reactivate and cause further disease. Herpesviruses have large genomes and contain approximately 35 virion genes—all of which encode a number of enzymes involved in nucleic acid metabolism, DNA syntheses, and protein processing—making them a complex group of viruses. The Herpesviruses are widely separated in terms of genomic sequence and proteins, but all are similar in terms of virion structure and genomic organization.
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Coinfection with HIV and HBV: Diagnosis and Therapy
It has been estimated that 400 million people worldwide have chronic hepatitis B virus (HBV) infection. In the United States alone, an estimated 1.25 million people—0.35% of the U.S. population—have chronic HBV, defined as patients with a positive hepatitis B surface antigen (HBsAg) serology for more than six months. “Rates are higher when you single out health-care workers, dialysis patients, oncology patients, intravenous drug users, multiply transfused patients, and individuals with multiple sex partners,” Dr. Marion Peters said in kicking off her second PRN lecture focusing on HIV and HBV coinfection. “Rates of chronic HBV are highest in immigrants from high-endemic areas, such as Southeast Asia. There are parts of China and Korea where the incidence is as high as 14%.”
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Diagnosis and Management of HPV-Associated Anogenital Dysplasia in HIV-Infected Men and Women
Antiretroviral therapy continues to have a positive impact on both the incidence and prevalence of many AIDS-related diseases. At the same time, the life-extending benefits of antiretroviral therapy have paved the way for infections with long latency periods to fulfill their pathogenic potential and fulminate into life-threatening complications. A prime example of this is human papillomavirus (HPV) and its sinister sequelae: squamous intraepithelial lesions and invasive cervical or anal carcinoma.
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When Two Infections Are Better Than One: The Exceptional Role of GB Virus-C (GBV-C) in HIV Disease
When it comes to HIV and hepatitis virus coinfections, the pages of The PRN Notebook have been filled with numerous reports highlighting the distressing prevalence and negative consequences of both hepatitis B virus (HBV) and hepatitis C virus (HCV) in HIV-infected individuals. However, it does not appear that all coinfections are harmful. In fact, some may be associated with a significant survival advantage-a theory that has many HIV experts both perplexed and excited.
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Bioterrorism and Smallpox Vaccination: Experience and Considerations
Smallpox, which is believed to have originated over 3,000 years ago in India or Egypt, is one of the most devastating diseases known to humanity. For centuries, repeated smallpox epidemics swept across continents, decimating populations in their wake. The disease, for which no effective treatment was ever developed, killed as many as 30% of those infected. Between 65% and 80% of survivors were marked with deep-pitted pockmarks, most prominent on the face. Blindness was another complication. In 18th century Europe, a third of all reported cases of blindness were because of smallpox.
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