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In order to evaluate the occurrence of hepatotoxicity in patients treated with antiretroviral therapy (ART) who switch protease inhibitor (PI), and the role of viral hepatitis in its development, we performed a retrospective study on 182 HIV patients treated with ART for 24 months. The presence of hepatitis viruses and alanine transaminase levels were evaluated. Hepatotoxicity developed in a low number of subjects without co-infection, but was significantly higher in co-infected patients (14/51 versus 62/131, P = 0.01). Ritonavir was associated with higher rates of severe hepatotoxicity in the co-infected group. Patients presenting any problems related to ART, including the development of hepatotoxicity, continued therapy by switching PI. The occurrence of hepatotoxicity with second/third choice PIs, including ritonavir, remained stable. Our results suggest that switching PI does not increase the occurrence of drug-related liver toxicity.

To evaluate the occurrence of hepatotoxicity in patients during antiretroviral therapy (ART) that contains protease inhibitors and the role of hepatitis viruses in its development, we performed a retrospective study including 1325 HIV-infected patients treated with ART for at least 6 months. Presence or absence of hepatitis viruses, alanine aminotransferase (ALT), total bilirubin, CD4 cell count, and plasma HIV RNA levels were evaluated. Hepatotoxicity developed in a few study subjects without coinfection, whereas it was significantly higher in coinfected patients. Univariate logistic regression analysis showed that viral hepatitis coinfections are independent risk factors for hepatotoxicity. After 6 months of treatment, ritonavir was associated with higher rates of severe hepatotoxicity in the coinfected group; in fact, ritonavir seems to be the most strongly hepatotoxic agent among coinfected patients. After 12 months of therapy, hepatotoxicity occurred more frequently in patients with hepatitis C virus who did not respond to antiretroviral therapy (ART), whereas patients who did respond to ART showed decreased ALT levels. Hepatotoxicity is not exclusively an effect of drug toxicity, and the presence of hepatitis coinfection is an independent risk factor. Moreover, chronic hepatotoxicity mainly occurs in patients who did not respond to therapy. Conversely, patients who did respond to ART seemed to show improvement of chronic liver infection.

This paper reviews the complications that arose after 68 276 percutaneous liver biopsies performed from 1973 to 1983. The complications are analyzed in relation to the underlying liver disease and to the type of needle used. Death was infrequent (9/100 000); it was always due to haemoperitoneum and occurred only in patients with malignant diseases or cirrhosis. Complications were less frequent in AVH (44/100 000) than in other liver diseases (from 125 to 278/100 000). Death, serious haemorrhagic complications, pneumothorax and biliary peritonitis were more frequent after biopsy with the Trucut needle than after biopsy with Menghini's needle (3/1000 against 1/1000). Sixty-one percent of complications were discovered within two hours of biopsy and 96% within one day. The data indicate a post biopsy observation period of at least 24 hours. The day-case procedure should be reserved for patients not presenting liver tumour or cirrhosis.

Pneumococcal serotyping by quellung reaction has been performed in five Italian areas on 267 strains, isolated from throat swab, sputum, blood, liquor, etc. 37 serotypes have been identified. The most frequent types resulted 19, 6, 3, 20, 9, 4 (in 50% of total samples), with no difference from those detected in other European countries. The proportion of type 19 was the highest among all age group, in four out of five different areas and in bacteremic pneumonia and meningitis. 36 strains were isolated from infection sites among which type 19 resulted more frequent than in isolates from throat swab and sputum (27.7% versus 16.1%). Pneumococcal serotyping should be routinely done in the light of forthcoming use of polysaccharide vaccine.

To estimate the antibacterial activity of sub-MIC concentrations of Erythromycin and Miocamycin in the mucosal surfaces, we studied the adhesivity of Gram-positive pathogenic strains (S. pyogenes, S. aureus) towards oral and urinary epithelial cells. Erythromycin strongly inhibits the adhesivity of Staphylococci to oral cells (50% of inhibition) and to a lesser extent the adhesivity of Streptococci (21%), while Miocamycin reduced the adhesivity of Staphylococci by about 16%. In some cases, an increase in the adhesivity on urinary cells was found mainly for Miocamycin. Therefore Erythromycin, at sub-MIC concentrations, is able to induce a marked reduction in the adhesivity of Staphylococci and Streptococci; this may interfere with the invasivity and subsequent pathogenicity of these bacteria. As far as phagocytosis is concerned, one strain of enterotoxic coagulase + S. aureus bearing A-protein on its surface but lacking the capsule was taken into consideration. The presence of A-protein induces resistance to phagocytosis and opsonization by normal serum. The addition of antibiotics which inhibit protein biosynthesis, such as Clindamycin, Miocamycin and Erythromycin, increases either uptake of this strain or intracellular killing. In particular Clindamycin and Erythromycin, at sub-MIC concentrations, are able to affect the interaction of Staphylococcus with phagocytic cells.