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The article presents the 2011 guidelines of the British HIV Association for tuberculosis (TB)/HIV coinfection treatment. It says that the guidelines have been created to help physicians in managing TB/HIV coinfection patients in which the guidelines suggests that coinfected patients should be managed by a multidisciplinary team. It explores several diagnostic tests for TB patients such as the tuberculin skin testing in which it the test can identify patients with latent infection.

Study Objective: To determine the effects of various meal compositions and the fasted state on the pharmacokinetics of etravirine, a nonnucleoside reverse transcriptase inhibitor., Design: Phase I, open-label, randomized, repeated single-dose, three-period crossover trial., Setting: Clinical pharmacology unit., Participants: Two parallel panels of 12 human immunodeficiency virus (HIV)-negative, healthy, male volunteers. Twenty volunteers completed the study; three withdrew consent, and one was lost to follow-up. Intervention. Panel 1 received a single dose of etravirine 100 mg after a standard breakfast, in the fasted state, and after a light breakfast (croissant). Panel 2 received the same treatment after a standard breakfast, after an enhanced-fiber breakfast, and after a high-fat breakfast. Each treatment was separated by a washout period of at least 14 days., Measurements and Main Results: For each treatment, full pharmacokinetic profiles of etravirine were determined up to 96 hours after dosing. Pharmacokinetic parameters were determined by noncompartmental methods and analyzed using a linear mixed-effects model for a crossover design. The least-squares mean ratio for the area under the plasma concentration-time curve from time of administration to the last time point with a measurable concentration after dosing (AUClast) was 0.49 (90% confidence interval [CI] 0.39-0.61) for the fasted state compared with dosing after a standard breakfast. When dosing occurred after a light or enhanced-fiber breakfast, the corresponding values were 0.80 (90% CI 0.69-0.94) and 0.75 (90% CI 0.63-0.90), respectively. When administered after a high-fat breakfast the least-squares mean ratio of AUC(last) was 1.09 (0.84-1.41), compared with dosing after a standard breakfast. Adverse events were also assessed. Under all conditions, single doses of etravirine 100 mg were generally safe and well tolerated., Conclusion: Administration of etravirine in a fasted state resulted in 51% lower mean exposure compared with dosing after a standard breakfast. Etravirine should be administered following a meal to improve bioavailability; however, differences in exposure after a standard breakfast versus a high-fat, enhanced-fiber, or light breakfast (croissant) were not considered clinically relevant.

Aims: Maraviroc (UK-427 857), an antagonist of the CCR5 receptor with potent anti-HIV activity, was recently approved for use in treatment-experienced patients infected with CCR5-tropic HIV-1. The aim of this study was to evaluate the effect of selected commonly used antiretroviral therapy (ART) combinations on the pharmacokinetics of a single oral dose of maraviroc 300 mg in HIV-positive subjects compared with historical controls., Methods: In this study, four cohorts of HIV-positive patients (n = 8 each) receiving one of the following combination therapies were recruited: cohort 1--efavirenz + Combivir (lamivudine/zidovudine); cohort 2--efavirenz + didanosine + tenofovir; cohort 3--nevirapine + lamivudine + tenofovir; cohort 4--Kaletra (lopinavir/ritonavir) + stavudine + lamivudine. Subjects continued on their prescribed ART and also received a single oral dose of maraviroc 300 mg. Serial blood samples and urine for determination of maraviroc pharmacokinetics were collected over 12 h postdose. Plasma pharmacokinetic parameters from this study were compared with historical data generated in HIV-positive subjects receiving maraviroc monotherapy in a Phase IIa study., Results: A total of 29 subjects were recruited (eight each in cohorts 1-3, and five in cohort 4). The geometric mean ratios for AUC(12) and C(max) for each treatment group compared with maraviroc monotherapy were: 47% and 67% (cohort 1); 48% and 76% (cohort 2); 101% and 154% (cohort 3); and 265% and 180% (cohort 4), respectively. T(max) was similar in all treatment groups. Mean values for renal clearance ranged from 8.2 l h(-1) (cohort 1) to 13.2 l h(-1) (cohort 4). There were no renal clearance data collected in the comparator study., Conclusions: The results of this study support those previously seen in healthy volunteer studies that showed that efavirenz reduces maraviroc exposure, whereas lopinavir/ritonavir increases maraviroc exposure. These data also suggest that nevirapine does not lead to a clinically significant effect on maraviroc pharmacokinetics.

The acquired immune deficiency syndrome has reached pandemic proportions. Anaesthetists should be aware of the implications of dealing with increasing numbers of both diagnosed and undiagnosed, symptomatic and asymptomatic, human immunodeficiency virus-infected patients in the fields of intensive therapy, operating theatre anaesthesia, obstetrics and pain management. With recent advances, important insights have been gained into the pathogenesis of human immunodeficiency virus. Molecular techniques allow quantification of viral burden, and together with CD4 T-lymphocyte count, prognosis and response to therapy can be evaluated. New drugs and therapeutic regimens have improved prognosis for those who are infected with the virus and vertical transmission of infection from mother to infant can be minimised. Should accidental occupational exposure to the virus occur, a prophylactic regimen of antiretroviral drugs can be administered in an attempt to prevent subsequent human immunodeficiency virus infection.

Opportunistic fungal infections account for a significant amount of morbidity associated with HIV disease. We report here a case of localised oral histoplasmosis without evidence of disseminated disease in a patient who lacked stigmata of HIV disease at the time of initial presentation. The diagnosis is based on histology with special stains, complement fixing antibodies in serum, and culture of the organism from fresh tissues. Activation of subclinical disease following an infection in Uganda may explain the development of these exophytic oral lesions in this British resident.