Objectives:Dolutegravir (DTG) has been studied in three trials in HIV treatment-naive participants, showing noninferiority compared with raltegravir (RAL), and superiority compared with efavirenz and ritonavir-boosted darunavir. We explored factors that predicted treatment success, the consistency of observed treatment differences across subgroups and the impact of NRTI backbone on treatment outcome.Design:Retrospective exploratory analyses of data from three large, randomized, international comparative trials: SPRING-2, SINGLE, and FLAMINGO.Methods:We examined the efficacy of DTG in HIV-infected participants with respect to relevant demographic and HIV-1-related baseline characteristics using the primary efficacy endpoint from the studies (FDA snapshot) and secondary endpoints that examine specific elements of treatment response. Regression models were used to analyze pooled data from all three studies.Results:Snapshot response was affected by age, hepatitis co-infection, HIV risk factor, baseline CD4+ cell count, and HIV-1 RNA and by third agent. Differences between DTG and other third agents were generally consistent across these subgroups. There was no evidence of a difference in snapshot response between abacavir/lamivudine (ABC/3TC) and tenofovir/emtricitabine (TDF/FTC) overall [ABC/3TC 86%, TDF/FTC 85%, difference 1.1%, confidence interval (CI) −1.8, 4.0 percentage points, P = 0.61] or at high viral loads (difference −2.5, 95% CI −8.9, 3.8 percentage points, P = 0.42).Conclusions:DTG is a once-daily, unboosted integrase inhibitor that is effective in combination with either ABC/3TC or TDF/FTC for first-line antiretroviral therapy in HIV-positive individuals with a variety of baseline characteristics.

Fifteen tularaemia cases were identified after a holiday spent at a converted mill in the Vendee region in France, between 9 and 12 August 2004. The mill was visited, and descriptive, retrospective cohort and environmental investigations were conducted. The 39 people who had stayed at the mill between 24 July and 11 August were asked about symptoms, exposure to food and animals, and leisure activities. A case was defined as a person with evidence of fever and a positive serology (seroconversion or significant rise in antibody titre, or a single titre) = 40. Culture for Francisella tularensis and polymerase chain reaction (PCR) diagnosis was carried out for drinking water, firewood, and domestic animals at the mill. Fifteen cases of tularaemia (38%) were confirmed. Twelve of the cases (80%) had the pulmonary form. None of the patients was admitted to hospital. There was a strong association between infection and participation in a dinner at the mill on 4 August (p<10-8). One of the three dogs present in the dining room was serologically positive for F. tularensis. Results of analysis of environmental samples were negative. These investigations confirmed the occurrence of a cluster of 15 tularaemia cases, in patients who were infected on the evening of 4 August, in a mill in Vend¨¦e, an endemic area for tularaemia. The investigations highlight the existence of nonspecific and benign pulmonary forms of the illness in France. The pulmonary form of infection in the human cases and the positive serology of the dog suggest contamination by inhalation of contaminated particles from the dog¡¯s fur disseminated by the dog shaking itself.

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Neisseria elongata subsp. nitroreducens, an usual commensal of the nasopharynx, can cause serious infections, usually endocarditis. A case of Neisseria elongata endocarditis complicating mitral valve prolapse in a patient allergic to penicillin is reported. Cure was obtained with a combination of ceftriaxone and gentamicin, there being no requirement for surgery during the acute phase of the disease.