In ARV-naive HIV-1-infected patients, the once-daily lamivudine, tenofovirDF and nevirapine regimen resulted in a high rate of early virological failures. The reasons for the failures remain unclear.

One hundred ninety-six Mycobacterium avium isolates from blood samples recovered from 93 AIDS patients for several months were typed by serotyping, by IS1245 restriction fragment length polymorphism (RFLP) analysis and in some cases RFLP analysis with plasmids pVT2 and pLR7 as probes, and by pulsed-field gel electrophoresis (PFGE). PCR typing of single colonies was also used to detect polyclonal infections. Strains belonged mainly to serotypes 1, 4, and 8. pVT2-and pLR7-related plasmids were detected in strains from 49% of the patients. The IS1245 RFLP and PFGE analyses showed a 96.8% diversity of the M. avium strains from the 93 patients. The vast majority (95.2%) of infections were monoclonal, indicating that recent infection is unlikely, even at an advanced stage of AIDS. For one patient, sequential isolates gave divergent patterns of sensitivity and resistance to clarithromycin, but all were identified as the initial clone. RFLP analysis and PCR typing of single colonies allowed for the detection of three polyclonal infections during the bacteriological follow-up. Among strains from patients whose samples were positive by culture after treatment for 2 to 15 months, 97.4% were the same as the initial strain. In conclusion, relapses and failures were mostly due to the initial strain. These relapses and failures resulted either from the selection of resistant mutants or the reappearance of sensitive strains, suggesting the persistence of nonsterilized tissue reservoirs.

A prospective, placebo controlled double-blind, randomised study comparing oral sparfloxacin 200 mg once daily following a 400 mg loading dose on day 1 with an oral combination of amoxycillin 1 g tid plus ofloxacin 200 mg bid was conducted in 211 hospitalised patients with community-acquired pneumonia. Patients were included in the study if they were aged > 65 years or had failed a previous course of antibacterial therapy. The duration of treatment was 10 days. The overall efficacy rates for the sparfloxacin and amoxycillin plus ofloxacin treatment groups were 91.9% and 81.5%, respectively, in evaluable patients at the end of treatment. Age or prior failure of antibacterial therapy did not affect the overall success rate of sparfloxacin. The safety profile of sparfloxacin was similar to that of the antibacterial combination. This study demonstrated that sparfloxacin given once daily is a suitable therapy for the treatment of community-acquired pneumonia in the elderly or in patients with failure of previous antibiotic therapy.

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ObjectivesData on the durability of antiretroviral regimens over a 3-year period have only rarely been reported. The aim of this study was to evaluate the long-term efficacy and safety of one or two daily doses of nevirapine (NVP), in combination with stavudine (d4T) and didanosine (ddI), in HIV-infected patients. MethodsThis study was a follow-up of the VIR (amune) Grand Ouest (VIRGO) study, a 12-month open-label trial to assess the safety and immunovirological activity of NVP-d4T-ddI combination therapy in antiretroviral-naive HIV-1-infected adults with baseline CD4 counts 200 cells/mL and plasma viral loads 5000 HIV-1 RNA copies/mL. Of the 100 patients included in the study, the 67 patients remaining on the initial triple therapy at the end of the study (1 year) were offered an extra 24 months of follow-up. ResultsOf the 60 patients who extended follow-up, 46 were still being treated with d4T-ddI-NVP at month 36; 91% (39/43) had a plasma viral load o500 copies/mL (data were missing for three patients). CD4 cell counts increased over 36 months. Safety and tolerance were good with no unexpected long-term toxicity. ConclusionAfter 3 years of treatment with NVP-d4T-ddI, nearly half of the patients were still receiving the initial antiretroviral therapy with a sustained and durable immunovirological benefit. Long-term toxicity was mainly related to the nucleoside reverse transcriptase inhibitor components of the regimen.Keywords: long-term efficacy, nevirapine, safety IntroductionHighly active antiretroviral therapy (HAART) has led to a dramatic decline in HIV-related morbidity and mortality. Protease inhibitor (PI)-containing regimens were initially considered the best option because of their demonstrated antiviral potency and immunological benefits. However, despite the efficacy of PI-containing regimens, the use of combination therapy including two nucleoside reverse transcriptase inhibitors (NRTIs) and one PI has been associated with a number of problems. In the short term, PI-related adverse effects, including diarrhoea, nausea and even renal colic, can lead to the discontinuation of treatment [1]. Long-term adverse effects are also a source of concern; these include hyperlipidaemia with hypertriglyceridaemia, resistance to insulin or insulin-dependent diabetes, and fat redistribution syndrome, with a possible increased risk of coronary heart disease [1][2][3][4]. HAART including two NRTIs and one nonnucleoside reverse transcriptase inhibitor (NNRTI) is now considered to be the preferred option by many [5][6][7], because, in addition to providing similar results in terms of virological response and immune restoration, this combination is simpler, more convenient, better tolerated and less toxic than PI-based regimens, especially in the mid-term [8][9][10] 431Assessments of durability of antiretroviral therapy (ART) and long-term safety have seldom been reported [11,12] but are of major importance for better selection of initial therapy. Among the NNRTIs, efavirenz (EFV) has been evaluated over a 3-year peri...