1/4. Increased prevalence of renal cell carcinoma in patients with HIV infection.Following the observation of the occurrence of renal cell carcinoma (RCC) in a local HIV patient, a retrospective case review was conducted on our local hospital population to determine if the prevalence of RCC in patients with HIV infection was greater than in the non-HIV population. All 66,715 unique adult patient admissions (over 18) to the Medical Center of Central georgia from 1990 through 1994 were reviewed to determine the total number of HIV admissions, the total number of patients with RCC, and the total number of patients with concomitant RCC and HIV infection. The expected prevalence of HIV-positive adults with RCC in this hospital population was then calculated based on local RCC prevalence data using the Poisson equation. Three hundred eight admissions were HIV infected, two of which had concomitant RCC. Forty-eight additional cases of RCC were documented during this time in non-HIV patients. The probability of an adult coming to this institution with RCC is 0.0007. Using this density in the Poisson equation, the probability of observing two cases of RCC in 308 HIV admissions was 0.01873, p < 0.05. The difference between the two proportions equation yielded a z value of 1.121. Data reveal that the prevalence of RCC in our hospital HIV patients is 8.5 times greater than in our non-HIV population, with an average age of occurrence approximately 15 years younger than national statistics.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |
2/4. Acute onset of pancreatitis with concomitant use of tenofovir and didanosine.OBJECTIVE: To report a case of pancreatitis associated with the combined use of didanosine and tenofovir. CASE SUMMARY: A 51-year-old white man with HIV was initiated on antiretroviral therapy with didanosine 250 mg/day, tenofovir 300 mg/day, lamivudine 300 mg/day, stavudine 60 mg/day, and efavirenz 600 mg/day. didanosine was prescribed at a reduced dosage due to the known interaction with tenofovir. Despite this dosage adjustment, the patient developed acute pancreatitis 10 weeks after antiretrovirals were initiated. pancreatitis resolved spontaneously after antiretroviral discontinuation. DISCUSSION: Our report of didanosine-induced pancreatitis secondary to concurrent use with tenofovir is the third reported case that utilized a reduced didanosine dosage. Five previous pancreatitis reports have been described using full-strength didanosine with tenofovir. The exact mechanism of action for this interaction is unknown. Utilizing the Naranjo probability scale to assess causality, a possible adverse drug reaction was determined. CONCLUSIONS: Tenofovir and didanosine may be used cautiously in antiretroviral combination therapy. Reduced didanosine dosage (250 mg) should be used to reduce serum didanosine concentrations and subsequent toxicities. Practitioners should be aware that a significant drug interaction with resulting pancreatitis may occur even when a reduced dosage is prescribed.- - - - - - - - - - ranking = 0.5keywords = probability (Clic here for more details about this article) |
3/4. Breakthrough candida infections in patients receiving voriconazole.OBJECTIVE: To describe 2 instances of breakthrough candida infection in 2 patients on treatment doses of voriconazole. CASE SUMMARIES: A 27-year-old woman with systemic lupus erythematosus was receiving high-dose voriconazole (400 mg twice daily) for central nervous system lesions of unknown origin and developed oral thrush. The patient was receiving concomitant therapy with phenytoin 400 mg/day. The voriconazole dose was increased to 400 mg 3 times daily, and the thrush resolved. A 50-year-old man with HIV infection was receiving enfuvirtide, lamivudine, tenofovir, and efavirenz 600 mg/day, as well as prophylactic trimethoprim/sulfamethoxazole and azithromycin. He was started on voriconazole 200 mg twice daily for pulmonary aspergillosis and developed esophageal candidiasis. The voriconazole dose was increased to 350 mg twice daily, and the thrush eventually resolved. DISCUSSION: Both reactions were probable according to the Naranjo probability scale. Significant drug interactions may have played a role in the development of breakthrough infections in these patients, specifically with phenytoin and efavirenz. Voriconazole is metabolized primarily by CYP2C19, as well as CYP2C9 and CYP3A4. Voriconazole is also known to inhibit these enzymes, and the manufacturer reports an extensive list of drugs that interact with voriconazole. CONCLUSIONS: Although requiring systematic evaluation, there may be a role for voriconazole serum concentration monitoring to ensure therapeutic efficacy when significant drug interactions are suspected.- - - - - - - - - - ranking = 0.5keywords = probability (Clic here for more details about this article) |
4/4. Misdiagnosis of HIV infection by hiv-1 plasma viral load testing: a case series.BACKGROUND: The availability of sensitive assays for plasma HIV viral load and the trend toward earlier and more aggressive treatment of HIV infection has led to the inappropriate use of these assays as primary tools for the diagnosis of acute HIV infection. OBJECTIVE: To describe limitations in the use of plasma viral load testing for the diagnosis of HIV infection. DESIGN: Case series. SETTING: academic medical centers in Providence, rhode island, and Worcester, massachusetts. patients: Three persons in whom HIV infection was falsely diagnosed by plasma viral load testing. MEASUREMENTS: Laboratory measures and clinical outcomes. RESULTS: Two cases of false-positive results obtained by using branched-chain dna plasma viral load assays and one case of a false-positive result obtained by using reverse transcriptase-polymerase chain reaction plasma viral load assay are reported. All three plasma viral load tests yielded positive results with low values (1254 copies/mL, 1574 copies/mL, and 1300 copies/mL). infection with HIV was initially diagnosed in all three patients, but each patient subsequently tested negative by hiv-1 enzyme-linked immunosorbent assay and repeated plasma viral load testing. CONCLUSION: physicians should exercise caution when using plasma viral load assays to detect primary HIV infection, particularly when the pretest probability of infection is low.- - - - - - - - - - ranking = 0.5keywords = probability (Clic here for more details about this article) |