In HIV-1-infected patients with virological suppression, abacavir/lamivudine did not meet the noninferiority outcome for treatment efficacy compared with tenofovir/emtricitabine.

Switching to ATV/r in virologically suppressed patients who were receiving a LPV/r-containing highly active antiretroviral therapy provided comparable (noninferior) efficacy and a safety profile with improved lipid parameters [ISRCTN24813210].

IntroductionThe use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals.Materials and MethodsA set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed.ResultsNone of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR-145 correlated with nadir CD4+ T cell count.DiscussionNo associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection.

Case report A 23 year old male heroin addict was admitted to hospital with chills, malaise, right pleuritic chest pain, and fever. On physical examination blood pressure was 120/70 mm Hg, pulse 100 beats/min, respiratory rate 20/min, and temperature 38 8°C. The conjunctivae and the optical fundi were normal. There was no jugular venous distension. Fine rales were heard over the right lung base. Cardiac examination showed a normal sized heart. The first heart sound was normal and the second sound was split physiologically. Neither the liver nor the spleen was palpable. There were no petechiae, splinter haemorrhages, or Osler nodes. The haemoglobin concentration was 128 g/l and the white cell count was 15 8 x 109/l with a shift to the left. Staphylococcus aureus was given in six consecutive blood cultures. A chest x ray film showed right nodular densities consistent with septic pulmonary emboli. An electrocardiogram showed sinus tachycardia. The M mode and cross sectional echocardiograms showed evidence of a highly mobile mass (3-0 cm long and with a maximum diameter of 1-5 cm) that was globular and pedunculated and attached to the eustachian valve (figs 1 and 2). The other cardiac valves were normal.Staphylococcal endocarditis affecting the eustachian valve was diagnosed and the patient was treated with oxacillin and gentamicin for 6 weeks. The pleuritic chest pain present on admission disappeared by the fifth hospital day. The fever, leucocytosis, and the radiographic signs of lung disease resolved. A repeat cross sectional echocardiographic study before discharge again showed the vegetation, which seemed to be smaller. On re-evaluation five months later, the patient was symptom free; the vegetation persisted at the same site but was smaller than before. DiscussionThe eustachian valve or valve of the inferior vena cava is a normal remnant of the right valve of the sinus venosus. In the embryo this valve directs blood from the inferior vena cava into the left atrium through the foramen ovale.' Its 340

Gastrointestinal involvement is reported in approximately 50% to 93% of patients with human immunodeficiency virus. It is frequently the result of coinfection with several microorganisms. Selective Leishmania intestinal involvement presents with atypical symptoms for visceral leishmaniasis, and may appear as a relapse or as the first manifestation of the disease. The authors present a patient with acquired immune deficiency syndrome who has a history of treated leishmaniasis and gastrointestinal infection by showed Mycobacterium avium intracellulare (MAI). After the new onset of abdominal pain, an intestinal biopsy showed the presence of both MAI and Leishmania in duodenum. Intestinal infection by Leishmania must be included in the differential diagnosis in patients with a previous history of leishmaniasis or travel to an endemic area.