No abstract

Diffuse fusiform intracranial aneurysms have been reported in children with human immunodeficiency virus (HIV) for over 2 decades, but have only recently been reported in adults with HIV. Although these aneurysms have important clinical implications, their etiology and optimal therapy are unknown. We present a systematic review of diffuse intracranial fusiform aneurysmal vasculopathy in patients who are HIV-positive. We conducted a comprehensive literature search for relevant case reports and reviews published before February 2009. Patients were included if they had HIV infection and radiographic imaging consistent with fusiform aneurysmal vasculopathy. We identify 11 published adult cases of intracranial fusiform aneurysmal vasculopathy and describe 1 unpublished case from our own institution. Available data regarding clinical presentation, characteristic imaging findings, and treatment of this complex syndrome are reviewed. Adults with HIV-associated intracranial aneurysmal vasculopathy typically are significantly immunosuppressed and present with gross neurologic dysfunction. Characteristic radiographic findings include diffuse cerebral fusiform aneurysms with hemorrhage or infarct. Treatment of any active infection followed by the initiation of antiretroviral therapy and corticosteroids may be a reasonable approach in this complex syndrome.

Introduction One of the most serious known adverse effects of feminizing cross-sex hormone therapy (CSHT) is venous thromboembolism (VTE); however, no study has assessed the incidence of VTE from the hormone therapies used in the United States because previous publications on this topic have originated in Europe. CSHT in the United States typically includes estradiol with the antiandrogen spironolactone, whereas in Europe estradiol is prescribed with the progestin cyproterone acetate. Aim To estimate the incidence of VTE from the standard feminizing CSHTs used in the United States. Methods A retrospective chart review of transgender women who had been prescribed oral estradiol at a District of Columbia community health center was performed. Main Outcome Measure The primary outcomes of interest were deep vein thrombosis or pulmonary emboli. Results From January 1, 2008 through March 31, 2016, 676 transgender women received oral estradiol-based CSHT for a total of 1,286 years of hormone treatment and a mean of 1.9 years of CSHT per patient. Only one individual, or 0.15% of the population, sustained a VTE, for an incidence of 7.8 events per 10,000 person-years. Conclusion There was a low incidence of VTE in this population of transgender women receiving oral estradiol.

Background Novel treatment strategies to slow the continued emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae are urgently needed. A molecular assay that predicts in vitro ciprofloxacin susceptibility is now available but has not been systematically studied in human infections. Methods Using a genotypic polymerase chain reaction assay to determine the status of the N. gonorrhoeae gyrase subunit A serine 91 codon, we conducted a multisite prospective clinical study of the efficacy of a single oral dose of ciprofloxacin 500 mg in patients with culture-positive gonorrhea. Follow-up specimens for culture were collected to determine microbiological cure 5–10 days post-treatment. Results Of the 106 subjects possessing culture-positive infections with wild-type gyrA serine N. gonorrhoeae genotype, the efficacy of single-dose oral ciprofloxacin treatment in the per-protocol population was 100% (95% 1-sided confidence interval, 97.5–100%). Conclusions Resistance-guided treatment of N. gonorrhoeae infections with single-dose oral ciprofloxacin was highly efficacious. The widespread introduction and scale-up of gyrA serine 91 genotyping in N. gonorrhoeae infections could have substantial medical and public health benefits in settings where the majority of gonococcal infections are ciprofloxacin susceptible. Clinical Trials Registration NCT02961751.

Background HIV/HCV co-infected patients are known to have lower sustained viral response (SVR) rates than HCV mono-infected patients. However, the role of CD4+ T-cell counts on viral kinetics and outcome is not fully understood. Methods HCV-RNA kinetics (bDNA v3, LD=615 IU/ml) was analyzed in 32 HIV/HCV co-infected persons treated with Pegylated interferon-α2b (1.5 μg/kg weekly) and ribavirin (1–1.2 g daily) for 48 weeks and compared with results obtained from 12 HCV monoinfected patients treated with the same regimen. Results Baseline CD4+ T cell counts ≥450cells/mm3 were significantly (P<0.002) associated with SVR in co-infected genotype 1 patients. First phase decline was significantly lower among patients with low as compared to high CD4 counts (P<0.03) and among co-infected compared to mono-infected patients (P<0.002). Second phase decline slope showed a similar trend for co-infected patients. Conclusions Low baseline CD4+ T cell count is associated with slower HCV viral kinetics and worse response to treatment among HIV co-infected patients, suggesting HCV treatment response depends on immune status. HCV genotype 1 co-infected patients have slower first phase viral kinetics than HCV mono-infected patients. First-phase viral decline (>1.0 log) and second-phase viral decline slope (>0.3 log/week) are excellent predictors of SVR for co-infected patients.