Background It is becoming increasingly clear that, during successful highly active antiretroviral therapy (HAART), a proportion of treated patients develop opportunistic infections (OIs), referred to in this setting as immune restoration disease (IRD). We examined the risk of developing IRD in HAART‐treated HIV‐infected patients. Methods A retrospective study of a cohort including all 389 patients treated with HAART between 1 January 1998 and 31 May 2004 in our HIV unit was performed to evaluate the occurrence of and risk factors for IRD during HAART. Baseline and follow‐up values of CD4 T‐cell counts and plasma viral loads (pVLs) were compared to assess the success of HAART. Results During successful HAART (significant increase in CD4 T‐cell counts and decrease in pVL), at least one IRD episode occurred in 65 patients (16.7%). The median time to IRD was 4.6 months (range 2–12 months). IRDs included dermatomal herpes zoster (26 patients), pulmonary tuberculosis (four patients), tuberculous exudative pericarditis (two patients), tuberculous lymphadenitis (two patients), cerebral toxoplasmosis (one patient), progressive multifocal leucoencephalopathy (PML) (one patient), inflamed molluscum (one patient), inflamed Candidaalbicans angular cheilitis (three patients), genital herpes simplex (two patients), tinea corporis (two patients), cytomegalovirus (CMV) retinitis (two patients), CMV vitritis (one patient) and hepatitis B (three patients) or C (fifteen patients). A baseline CD4 T‐cell count below 100 cells/μL was shown to be the single predictor [odds ratio (OR) 2.5, 95% confidence interval (CI) 0.9–6.4] of IRD, while a CD4 T‐cell count increase to >400 cells/μL, but not undetectable pVL, was a negative predictor of IRD (OR 0.3, 95% CI 0.1–0.8). Conclusions To avoid IRD in advanced patients, HAART should be initiated before the CD4 T‐cell count falls below 100 cells/μL.

We describe the first reported outbreak of West Nile virus (WNV) infection in humans in Serbia in August to October 2012 and examine the association of various variables with encephalitis and fatal outcome. Enzyme-linked immunosorbent assay (ELISA) was used for detection of WNV-specific IgM and IgG antibodies in sera and cerebrospinal fluid. A total of 58 patients (mean age: 61 years; standard deviation: 15) were analysed: 44 were from Belgrade and its suburbs; 52 had neuroinvasive disease, of whom 8 had meningitis, while 44 had encephalitis. Acute flaccid paralysis developed in 13 of the patients with encephalitis. Age over 60 years and immunosuppression (including diabetes) were independently associated with the development of encephalitis in a multivariate analysis: odds ratio (OR): 44.8 (95% confidence interval (CI): 4.93-408.59); p=0.001 (age over 60 years); OR: 10.76 (95% CI: 1.06-109.65); p=0.045 (immunosuppression including diabetes). Respiratory failure requiring mechanical ventilation developed in 13 patients with encephalitis. A total of 35 patients had completely recovered by the time they were discharged; nine patients died. The presence of acute flaccid paralysis, consciousness impairment, respiratory failure and immunosuppression (without diabetes) were found to be associated with death in hospital in a univariate analysis (p<0.001, p=0.007, p<0.001 and p=0.010, respectively).

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BackgroundMucocutaneous manifestations such as oral candidiasis (OC) and seborrheic dermatitis (SD) are very common HIV-related opportunistic events and are usually initial markers of immunodeficiency. AimThe purpose of this study was to evaluate the efficacy of highly active antiretroviral therapy (HAART) in the regression of HIV-associated OC and SD. MethodsIn a prospective study, 120 HIV-infected patients with OC and SD were divided into two groups: HAART-treated patients (group 1, n 5 76) and non-HAART-treated patients (group 2, n 5 44). Non-HAART-treated patients were given antimicrobial therapy. Study subjects were matched for sex, age, risk, and stage of HIV infection. The results were analysed by w 2 test and the Kaplan-Meier method. ResultsAt baseline, OC was evident in 59 (77.7%) of the HAART-treated patients and in 34 (77.3%) of the non-HAART-treated patients, while SD was present in 19 (25.0%) of the HAART-treated patients and in 17 (38.6%) of the non-HAART-treated patients. After a median follow-up period of 22 months, regression of OC and SD occurred in 49 (83.1%) and 16 (84.2%) of the HAART-treated patients, respectively. In the control group, regression of OC and SD occurred in only five (14.7%) and seven (41.2%) patients, respectively, during the same period. ConclusionsHAART showed greater efficacy than standard antimicrobial therapy for the treatment of OC and SD in HIV-infected patients. Oral candidiasis is the most common oral feature of opportunistic fungal infection, occurring in 90% patients during the course of HIV disease, and is an important criterion in most clinical staging systems for HIV infection [4,7]. SD is a common skin condition among HIV-infected persons, with a prevalence of 7-50%, and is also closely related to the stage of HIV infection [6,8].The introduction of highly active antiretroviral therapy (HAART) has resulted in a dramatic decline in the incidence of opportunistic infections. HAART has led to reductions in disease progression and mortality [5,[9][10][11][12][13].The aim of the study was to evaluate the efficacy of HAART regarding the regression of HIV-associated OC and SD. A total of 120 HIV-infected patients (53 women and 67 men; ages ranging from 9 to 67 years) with mucocutaneous manifestations were divided into two groups: 76 patients treated with HAART (59 OC and 19 SD) and 44 non-HAART-treated patients (34 OC and 17 SD; control group) treated with antimicrobial therapy.Diagnoses of OC and SD were based on clinical manifestations (Figs 1 and 2) and confirmed using smears taken from lesions and examined by potassium hydroxide preparation for Candida albicans, plus fungal cultures to identify the causitive organism, and for Pityrosporum ovale, at the beginning of the study and during the follow-up period.The HAART regimen consisted of one protease inhibitor (saquinavir, nelfinavir, ritonavir or indinavir) and two reverse transcriptase inhibitors (zidovudine, didanosine, stavudine, lamivudine or abacavir). The HAART-treated patients did not receive standard derm...