Antiretroviral therapy alters lipid metabolism in HIV-infected patients. However, interpreting the impact of HIV infection on lipid metabolism is difficult because of various associated factors, including antiretroviral drugs and demographic characteristics. A few studies have associated HIV infection with lipid metabolism in antiretroviral-naïve HIV-infected patients. Because there were no data in this regard from Japan, the present study examined the impact of HIV infection, as well as demographic and clinical features, on lipid metabolism in antiretroviral-naïve HIV-infected patients in Japan. We performed a cross-sectional study to examine the impact of HIV disease, demographic and clinical characteristics on lipid metabolism among 168 HIV-infected Japanese men who were antiretroviral naïve and who did not have hemophilia, including patients who took medication for dyslipidemia. The mean age of the patients was 45.7 years; 0.6% of the patients took medication to dyslipidemia. The mean CD4 lymphocyte count was 289/μL, the mean baseline log10 HIV viral load was 4.2 HIV-1 RNA copies/mL, and 22% of the patients had a history of AIDS-defining events. A higher HDL-C concentration was associated with a higher CD4 lymphocyte count (p = 0.043). Also, a higher LDL-C concentration was associated with a higher CD4 lymphocyte count (p = 0.003). Infection with HIV was associated with dyslipidemia in antiretroviral-naïve patients. More advanced HIV disease was associated with less favorable lipid homeostatic profiles. These results are similar to findings from other countries.

In this study, we compared Ma Huang Tang (maoto), a traditional Japanese medicine (Kampo), with antiviral drugs to evaluate their respective and combined effect on the duration of fever and other subjective symptoms of influenza. Forty-five patients enrolled in this randomized control trial had positive type A influenza on rapid influenza antigen test, provided written consent, and sought treatment at Juntendo University Hospital between November 2008 and March 2009. Using a computer-gen- erated list, patients were randomly assigned to one of the four intervention groups: 1): maoto (TJ-27), 9 subjects; 2): Tamiflu (oseltamivir), 13 subjects; 3): Relenza (zanamivir), 6 subjects; and 4): maoto/oseltamivir combination, 9 subjects. Six outcome measures were evaluated, including fever, myalgia, headache, arthralgia, fatigue, and cough. Statistical differences were determined by the Bonferroni-adjusted t-test for multiple comparisons. Our results showed that there were no significant differences among the four groups in the time-course profile of fever and the number of days until fever resolution since treatment was initiated. In addition, no significant intergroup differences were detected in the number of days until resolution of myalgia, headache, fatigue, and cough. However, the maoto group reported a more rapid improvement in joint pain than the oseltamivir group (P = 0.01). In conclusion, maoto showed comparable efficacy as antiviral medications in reducing fever and influenza symptoms. As serious concerns over the indiscriminate use, adverse reactions, and resistance to current antiviral drugs continue to grow, maoto may serve as an elegant option for the treatment of influenza

Poor dentition and/or dental infection due to insufficient oral care are presumed to be risk factors for infective endocarditis (IE). We present a case of endocarditis caused by Granulicatella adiacens and Sjögren’s syndrome (SS) with oral complications diagnosed simultaneously.A 67-year-old woman was admitted to our hospital with fever, general fatigue, arthralgia, and back pain. She was diagnosed with primary SS according to the criteria of the American-European Consensus Group. Transthoracic echocardiography carried out to examine her persistent fever revealed vegetation formation (14 × 5 mm) on the aortic valve and her blood cultures were positive for G. adiacens. According to modified Duke’s criteria, she was also diagnosed with IE. She underwent aortic valve replacement and was administered ampicillin with gentamicin for 6 weeks following surgery.G. adiacens, which is formerly known as one of the nutritionally variant streptococci, is found as part of the normal microbiota of the oral cavity. The patient had chronic periodontitis associated with SS that likely predisposed to G. adiacens bacteremia and subsequent seeding of the aortic valve. Patients with SS may be at risk of IE because of the increased risk of bacteremia from oral complications such as dental caries or periodontal disease.An association between SS and IE has not yet been reported. Our case indicates that SS may be the underlying pathology in patients with IE due to an oral bacterium.

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We performed a cross-sectional study that included 100 HIV-infected Japanese men without hemophilia to examine the influence of smoking on HIV infection. History of smoking was obtained using a questionnaire. The percentage of current smokers was 40 % and was the highest (50 %) among men in their forties. The mean Brinkman index (BI, number of cigarettes smoked per day multiplied by years of smoking) was 450. The percentage of patients with a BI ≥600 was significantly higher in patients with an AIDS-defining event than in those without an AIDS-defining event. A BI ≥600 was associated with an AIDS-defining event. Reducing smoking appears to be critical to enhancing disease management efforts in Japanese men with HIV.