RA patients are at risk for subclinical atherosclerosis despite absence of traditional CV risk co morbidities and active disease was the independent factor associated with it.

Introduction:The introduction of highly active antiretroviral therapy (HAART), in 1996, has resulted in marked reductions in the rate of illness and death, due to HIV infection. The HAART has transformed HIV infection into a manageable chronic disease. However, although many regimens lower plasma viral load, to below the limit of detection, in most patients, maintaining viral load suppression remains challenging, because of adverse effects and toxicity in the long term, which can lead to non-adherence, virologic failure and drug resistance. Although rare, lactic acidosis often develops fatal complications, as reported in several human immunodeficiency virus infected patients treated with nucleoside reverse transcriptase inhibitors (NRTIs). The purpose of this paper is to report a case of tenofovir induced lactic acidosis and review the literature.Case Presentation:A 52-year-old Malay gentleman, with hepatitis C virus and HIV infection was admitted to the intensive care unit for severe lactic acidosis, with concurrent Escherichia coli bacteremia with multiorgan dysfunction. The patient was started on highly active antiretroviral therapy, which included tenofovir, 5 weeks before presentation. Antimicrobial therapy, continuous veno-venous hemofiltration, and other supportive treatments were instituted. However, the patient eventually succumbed to his illness.Conclusions:It is essential for clinicians to be able to recognize the signs and symptoms of lactic acidosis in NRTIs treated HIV patients, as an early diagnosis is important to institute treatment.

Non-tuberculous mycobacteria (NTM) are recognized as an important cause of human diseases and infections. It is commonly known to cause infections of the skin, soft tissue infections, and pulmonary infection as well as bacteraemia. We report a challenging case of severe mycobacterium abscessus bacteraemia in a pregnant lady with active systemic lupus erythematous (SLE). A comprehensive literature review of NTM infection among SLE patients was also performed, and pooled analysis of the reported cases, including our case, was done to determine the clinical characteristics and factors associated with poor outcome of NTM infection.

BackgroundRheumatoid Arthritis (RA) patients are at risk of cardiovascular disease (CVD) and carotid intima media thickness (cIMT) is an excellent marker of subclinical atherosclerosis. However, cIMT and the CVD biomarkers among RA patients with low disease activity and remission are not well studied.ObjectivesTo assess the carotid intima media thickness (cIMT) in RA patients who were in low disease activity state and lacking concomitant co-morbidities potentially influencing cIMT. This study was also aimed to determine the correlation between serum IL-17 with cIMT.MethodsRheumatoid Arthritis patients who were in low disease activity or remission (DAS28<3.2) from Rheumatology Clinic, National University of Malaysia Medical Centre were recruited. Patients with traditional CVD risk factors were excluded. Carotid ultrasound was performed in RA patients and their age and gender-matched healthy controls to determine the cIMT thickness. Serum IL-17 was measured using ELISA method.ResultsA total of 76 patients were screened and 22 RA patients who were in low disease activity or remission were included. Patients with RA had significantly higher median cIMT, 0.53 (IQR0.13) mm compared to controls, 0.47 (IQR 0.14) mm, p=0.01. In RA patients, the cIMT had significant positive correlation with age (rs=0.84, p=0.00), systolic BP (rs=0.45, p=0.04), waist circumference (rs=0.43, p=0.04), total cholesterol (rs=0.54, p=0.01), BMI (rs=0.45, p=0.04) and serum IL-17 (rs=0.45, p=0.03) but negative correlation with total HDL (rs=-0.43, p=0.05).ConclusionsPatients with RA had significantly higher cIMT as compared to healthy controls despite minimal disease activity and lack of traditional CV risk factors, suggesting that the vascular injury due to previous inflammation may not be reversible. Serum IL-17 was also found to be correlated significantly with cIMT, suggesting that it may play a role in atherogenesis among RA patients.Referencesvan Sijl AM et al, Carotid intima media thickness in rheumatoid arthritis as compared to control subjects: a meta-analysis. Semin Arthritis Rheum. 2011;40(5):389–97Targonska-Stepniak B et al. The relationship between carotid intima media thickness and the activity of rheumatoid arthritis. J Clin Rheumatol. 2011;17(5):249–55Disclosure of InterestNone declared