We describe 7 cases of renal tubular injury in HIV-infected patients receiving an antiretroviral regimen containing tenofovir. Our patients (5 women and 2 men) developed renal tubular dysfunction, with hypophosphatemia, normoglycemic glycosuria, proteinuria, and decrease of creatinine clearance. The first biologic signs of renal toxicity were observed after duration of tenofovir treatment from 5 weeks to 16 months, and they resolved less than 4 months after discontinuation of tenofovir. Six patients had a low body weight (<60 kg). Five patients received low doses of ritonavir, and 1 received didanosine. In 5 patients, the signs resolved with the discontinuation of only the tenofovir. A renal biopsy performed in 1 patient was consistent with tubulointerstitial injury. Proximal tubulopathy appears to be a rare adverse effect of long-term tenofovir therapy. In patients with low weight or mild preexisting renal impairment, regular monitoring of tubulopathy markers could lead to early detection of this dysfunction.

The Sensio study objectives were to assess the outcome of neuropsychiatric adverse reactions (NPAR) that develop after initiation of efavirenz (EFV) therapy, to ascertain the late NPAR after a 3-month treatment period, to evaluate the impact of NPAR on patients' quality of life (QoL) in a real-life population. MethodsDuring a 6-month period, consecutive HIV-infected adult outpatients receiving an ongoing EFV therapy for at least 3 months were asked to ®ll in a speci®cally designed self-administered questionnaire addressing sleep disturbances, behavioural changes, mood disturbances, anxiety, cognitive disorders, hallucinations, dizziness and the general impact on patients' QoL. ResultsA total of 174 questionnaires were analyzed. The main late emergent NPAR were sleep disorders: abnormal dreams 24.7%, nocturnal waking 19.6%, trouble falling asleep 17.8%; cognitive disorders: memory disorders 23.0%, impaired concentration 18.9%; anxiety 15.5%; mood disorders: sadness 19.3%, suicidal ideations 9.2%. Global neuropsychic discomfort was moderate to severe in 23% of patients after a 3-month treatment period. ConclusionNPAR occur mainly during the ®rst month of EFV therapy but often persist thereafter. A signi®cant percentage of patients reported suicidal ideations at the time of the study. Our results suggest the need for routine screening for NPAR among patients receiving EFV therapy and better management. IntroductionNeuropsychiatric adverse reactions (NPAR) commonly occur within the ®rst days following initiation of treatment with efavirenz (EFV) and resolve in 2±4 weeks of EFV use [1]. NPAR have been reported in about 50% of the patients treated with this drug in clinical trials. Central nervous system disturbances range from dizziness to hallucinations, including frequent nightmares, unusual dreams and insomnia. Symptoms are usually mild to moderate [2]. The Sensio study was focused on the NPAR self-reported by HIV-positive patients with an ongoing antiretroviral regimen including EFV in real-life conditions. The objectives were to assess the outcome of NPAR that develop after initiation of EFV therapy, to ascertain the late adverse reactions of EFV after a 3-month treatment period, and to evaluate the NPAR impact on patients' quality of life (QoL). Patients and methodsDuring a 6-month period, in three HIV outpatient units, all consecutive HIV-infected adults receiving an ongoing EFV therapy for at least 3 months were concerned by the Sensio study. Capacity to understand and answer a questionnaire in the French language was required. Patients meeting these inclusion criteria were asked by investigators to complete [7]. First, patients had to report their current antiretroviral treatment and the date of EFV initiation. Then, patients assessed their own psychological and physical status by completing the following items: sleep disturbances (trouble falling asleep, nocturnal waking, early morning waking, nightmares, perturbed dreams, day-time drowsiness, fatigue) behavioural changes (euphoria, irritability, tobacco ...

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log 10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV—CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences—is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.

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Early lung cancer diagnosis with CT in HIV-infected smokers was feasible, safe, and yielded a significant number of cancers. Lung cancer screening of HIV-infected smokers with an important history of immunodeficiency revealed a substantial number of cancers at younger ages than the targeted range in the general population.