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The infection of muscle is an infrequent condition. We report on a patient with a juvenile form of dermatomyositis who developed infectious myositis caused by Streptococcus pyogenes. The inflammatory myopathy probably favoured the colonization of muscle during a bacteremia related to the skin lesions. The main forms of streptococcal myositis, which can currently be differentiated by means of imaging techniques, are discussed in addition to its treatment and prognosis.

The most prevalent adverse event was diarrhoea in the SQV cohort (11%) and hypertrigliceridaemia in the FPV cohort (4%). Only four patients (2%) withdrew their treatment due to an adverse event. One patient (0.5%) with baseline mild renal impairment (GFR: 63 mL/min) withdrew his treatment due to a grade 1 GFR decrease. Conclusion In this cohort, concomitant use of TDF with SQV or FPV was associated with good tolerability and an adequate rate of viral effectiveness, suggesting these combinations are suitable as rescue therapy in highly treatment-experienced patients. from Ninth International Congress on Drug Therapy in HIV Infection Glasgow, UK. 9–13 November 2008

Purpose of the study Antiretroviral (ARV) toxicity, especially of nucleoside-analogues, together with HIV-infection have both been demonstrated to induce mitochondrial DNA (mtDNA) depletion and mitochondrial dysfunction. The contribution of each mechanism (either HIV or ARV) to the observed mitochondrial damage present in HIV-infected patients on highly active ARV treatment (HAART) is difficult to elucidate. HIV-induced mitochondrial lesion has been studied in HIV-infected but non-HAART-treated individuals, but ARV-related mitochondrial damage has been poorly explored in non-infected subjects. The aim of the present study is to assess in vivo mitochondrial toxicity of HAART without HIV-infection effects.

Fifty-five episodes of central nervous system (CNS) toxoplasmosis developing in 43 of the 329 AIDS cases seen at our institution were diagnosed during a 34-month period and were prospectively studied. Acute episodes were treated with a pyrimethamine/sulfadiazine (P/S) combination for a mean of 21 days. Because of a previously known major allergy to sulfonamides, three episodes were treated with clindamycin instead of sulphadiazine. In those patients who accepted maintenance therapy, a combination of P/S or pyrimethamine and clindamycin (P/C) was administered 2 days per week. Thirty-six patients (83.7%) survived the first episode. Four of these 36 were lost to further study. Six of the 12 (50%) who decided not to undergo maintenance therapy relapsed (mean follow-up: 12 months). Fourteen patients were given P/S and none relapsed while they were on maintenance therapy (mean follow-up: 10.3 months). Six patients received an intermittent maintenance treatment with P/C and one relapsed 2 months after starting the maintenance therapy (mean follow-up: 13.7 months). We conclude that an intermittent (2 days per week) maintenance treatment for CNS toxoplasmosis with P/S was effective in preventing relapses, although prospective randomized studies remain to be done.

Accepted 15 February 1995 A 67-year-old woman was admitted because of a progressive impairment in her visual fields during the last six days, together with bilateral fronto-orbicular cephalea, particularly in the morning. In 1980 she had been diagnosed as suffering from diabetes insipidus. For this, she received chlorpropamide and clofibrate, and then inhaled desmopresine. A radiological study performed in 1986 because ofpain in the left knee confirmed the existence ofan osteolytic image at this level, together with lytic images in both iliac crests and the left scapula. Skin hyperpigmented lesions with thickening of the epidermis were detected in both legs, and the biopsy ofone of these lesions also showed a typical histological pattern of histiocytosis. Treatment with etoposide and prednisolone was given, but had to be discontinued because of side-effects. Physical examination showed red-violet skin lesions in the inferior right extremity. Ophthalmological examination showed a reduction ofthe visual fields and a bilateral papilledema. The rest of the examination was normal. A cranial magnetic resonance scan was performed (figures 1 and 2).

BackgroundSimplified antiretroviral regimens are needed to improve patient adherence and quality of life. The purpose of this study was to evaluate the efficacy and safety of a once-daily regimen consisting of didanosine (ddI), lamivudine (3TC) and nevirapine (NVP) for adult antiretroviral-naive patients with HIV-1 infection.MethodsThis was a prospective, one-arm, multicentre pilot study. Daily drug dosage was 250 or 400 mg didanosine, 300 mg lamivudine and 400 mg nevirapine. The primary outcome measure was the percentage of patients with a plasma HIV-RNA level ResultsSeventy patients were enrolled in the study. At baseline, mean plasma HIV-1 RNA was 5.10 log10copies/ml, and mean CD4 cell count was 262 cells/μl. At month 12, 67% (95% CI: 56–78) of patients maintained a viral load of 100 cells/μl than in those with a poorer immunological status at baseline, although the number of patients with CD4 counts ConclusionA once-daily combination of ddI, 3TC and NVP seems to be an effective, safe and easy-to-take regimen in antiretroviral-naive patients, at least in those who do not have severe immunodepression at baseline.

Background: Induction-maintenance strategies were associated with a low response rate. We compared the virological response with two different induction regimens with trizivir plus efavirenz or lopinavir/ritonavir. Methods: A randomized, multicentre, open-label clinical trial with 209 antiretroviralnaive HIV-infected patients assigned to trizivir plus either efavirenz or lopinavir/ ritonavir during 24–36 weeks. Patients reaching undetectable plasma viral loads during induction entered a 48-week maintenance on trizivir alone. The primary endpoint was the proportion of patients without treatment failure at 72 weeks using an intent to treat (ITT) analysis (switching equals failure). Results: Patients were randomly assigned (efavirenz 104; lopinavir/ritonavir 105), and 114 (55%) entered the maintenance phase (efavirenz 54; lopinavir/ritonavir 60). Baseline characteristics were balanced between groups. The response rate at 72 weeks was 31 and 43% (ITT analysis, P ¼ 0.076) and 63 and 75% (on-treatment analysis, P ¼ 0.172) in the efavirenz and lopinavir/ritonavir arms, respectively. Virological failure occurred in 27 patients: six during induction (efavirenz, three; lopinavir/ritonavir, three; P ¼ 1.0) and 21 during maintenance (efavirenz, 14; lopinavir/ritonavir, seven; P ¼ 0.057). Thirty-four patients in the efavirenz arm switched treatment because of adverse events compared with 25 in the lopinavir/ritonavir arm (P ¼ 0.17). Conclusion: Trizivir plus either efavirenz or lopinavir/ritonavir followed by maintenance with trizivir achieved a low but similar response at 72 weeks, with a high incidence of adverse events leading to drug discontinuation during the induction phase in both arms. The study showed a trend towards an increased virological failure rate in the efavirenz arm during the maintenance phase. 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins AIDS 2008, 22:377–384

To assess the effectiveness of a simplified therapy for very nonadherent patients who had previously failed with HAART.We performed a prospective open-label study of antiretroviral-experienced patients. Dosing schedule comprised (co-formulated) zidovudine, lamivudine, and abacavir bid. Eligible patients had to have plasma HIV RNA5000 copies/mL, previous therapy, and very poor adherence to the medication regimen.Eighty-five patients were included (mean viral load, 4.4 log/mL; mean CD4, 240 cells/mL; IDUs, 78%; methadone maintenance program, 42%; AIDS, 28%). Number of previous therapies: one, 53%; two, 28%; three or more, 19%. In the intent-to-treat analysis at 1 year, 38 patients (44.7%) achieved viral load below 500 copies/mL. Adherence greater than 90% of prescribed drugs was reported in 49% of patients, adverse events were reported in 17.6%, mortality in 6%, and lost to follow-up in 26%. The factors associated with virologic failure were nonadherence (odds ratio [OR], 4.4; 95% CI 1.5-12.3), baseline CD4 cell count200 cells/mL (OR, 3.4; 95% CI 1.3-8.9; p =.01), and more than one previous treatment (OR, 2.7; 95% CI 1.1-6.9).Regarding previously very nonadherent patients, this simplified combination therapy containing three NRTIs obtained satisfactory results in ART-experienced patients. However, more aggressive interventions to enhance adherence are needed to improve results.

Objective To assess the efficacy and safety of an extended treatment period in HIV/hepatitis C virus (HCV)-coinfected patients without early virological response (EVR). Methods Patients received pegylated interferon (peg-INF)-α2a 180 μg/week plus ribavirin 800 mg/d for 12 weeks. Patients achieving EVR at week 12 continued under therapy for an additional 12 or 36 weeks depending on genotype. Patients without EVR were randomized to complete the standard treatment or treatment lasting 72 weeks (extension arm). Results One hundred and ten patients were included (mean age 38.7 years, mean weight 68 kg, 74% males, 74% on highly active antiretroviral therapy, mean CD4+ T-cell count 564 cells/mm3). Fifty-one patients harboured genotype 1, 44 genotype 2/3, and 15 genotype 4. Fifty-three had an HCV load >800,000 IU/ml. Premature interruptions occurred in 32.7%. EVR was achieved in 63.6% (51% in genotype 1, 88.6% in genotype 2/3, 33.3% in genotype 4). End-of-treatment response was 52.7% (47.2% in genotype 1, 68.2% in genotype 2/3, 26.7% in genotype 4). Sustained virological response (SVR) was achieved in 41.8% (37.3% in genotype 1, 54.6% in genotype 2/3, 20% in genotype 4). Only one patient allocated to the extended arm achieved SVR. The rate of drop-outs in the extension arm was 68%. The negative predictive value of EVR was 97.5%. Conclusions This study shows no benefit of extending therapy in patients without EVR at week 12. Measures to improve adherence to HCV antiviral therapy should be considered when new approaches based on extended periods of treatment are investigated.

ObjectiveTo assess the efficacy and safety of a once-daily antiretroviral regimen in HAART-experienced subjects with long-lasting viral suppression.MethodsOne-hundred-and-sixty-nine patients with chronically suppressed viral load (limit of detection ResultsAt week 48, the proportion of patients with viral suppression in the QD and in the BID Group, respectively, was 97 vs 100% in the per-protocol analysis ( P=0.497), and 76 vs 86% for the intention-to-treat analysis ( P=0.176). Nevertheless, CD4 count decreased in the QD Group, with a mean decline of 95 cells/mm3(95% CI: 45–145). Twelve subjects in the QD Group (14%) discontinued treatment due to adverse events, mainly nevirapine-related hepatitis (6%). No significant differences regarding the rate of acute pancreatitis or peripheral neuropathy were observed between both groups. A significant improvement in the lipid profile was only seen in the QD Group. High levels of adherence were observed in both groups during follow-up, as well as a good quality of life. At week 48, a reduction in effort to take medication ( P≤0.001) and an increment in the satisfaction with the treatment ( PConclusionTreatment simplification to a once-daily antiretroviral regimen based on didanosine, tenofovir and nevirapine may be a valid approach in HIV-infected subjects with long-lasting viral suppression. Combination of standard doses of didanosine and tenofovir may have contributed to the CD4 cell decline observed with this QD regimen.

ss Open Acce Poster presentation Risk factors for end-stage liver disease among HIV and hepatitis C virus co-infected patients in the Spanish VACH Cohort R Teira*1, P Geijo2, J Cosin3, A Munoz-Sanz4, P Viciana5, I Suarez-Lozano6, J Lopez-Aldeguer7, E Pedrol8, F Vidal9, T Sanchez10, F Lozano11, A Terron12, A Vergara13, MJ Galindo14, P Domingo15, E Ribera16, B Roca17, ML GarciaAlcalde18, M Garrido19 and P Munoz-Sanchez20