5% Imiquimod cream for external anogenital warts in HIV-infected patients under HAART therapy

The efficacy of imiquimod in the treatment of external genital warts in HIV positive subjects was compared to a group of patients with normal immune function. Imiquimod 5% cream was applied by patients three times a week until resolution for a maximum of 16 weeks. Assessment for response and the occurrence of side effects was performed every four weeks. Thirty-one per cent of 75 HIV positive patients achieved a complete clearance, a partial response was obtained in 24% of subjects while in 45% we observed no clinical response. In the control group a total clearance was obtained in 62% of subjects, a partial response in 24% and no response in 14%. Recurrences occurred in 4/23 HIV patients and 2/31 immunocompetent patients within three months of follow-up. Side effects were minor to moderate. We conclude that imiquimod 5% cream has an acceptable efficacy and safety on HIV patients.

Incidence of Kaposi's sarcoma and HHV-8 seroprevalence among homosexual men with known dates of HIV seroconversion. Italian Seroconversion Study

OBJECTIVES

To evaluate temporal trends of Kaposi's sarcoma (KS) and of the KS-related human herpesvirus (HHV-8) among homosexual men who seroconverted for HIV between 1984 and 1997.

METHODS

The study participants were 387 homosexual men. Changes over a period of time were assessed by estimating KS incidence rates per 1000 person-years for the periods 1984-1989, 1990-1992, 1993-1995, and 1996-1997. The proportional incidence of KS as the AIDS-defining disease for the same periods was also calculated. To evaluate a cohort effect of calendar period, Kaplan-Meier curves were used to estimate the risk of KS by period of HIV seroconversion [i.e. before 1990 (median year of seroconversion) versus later]. Relative hazards for the four periods were estimated using competitive-risks models. We also estimated HHV-8 seroprevalence over the study period.

RESULTS

Forty-eight participants developed KS. Between 1984 and 1995, the incidence rate of KS per 1000 person-years increased from 3.9 to 32.8, whereas the proportional incidence decreased from 33.3 to 24.3%. The risk of developing KS after HIV seroconversion did not change when comparing the seroconversion periods (i.e. before 1990 versus later). HHV-8 seroprevalence also remained stable. The rates of KS and the relative hazards dramatically decreased after 1995.

CONCLUSIONS

Although KS incidence rates increased up to 1995, the proportional incidence decreased, due to the higher increase in rates of other AIDS-defining diseases. The finding that the risk of developing KS after HIV seroconversion remained stable over time is consistent with the stable trend of HHV-8 seroprevalence. The dramatic decrease in KS incidence rates after 1995 coincides with combined antiretroviral therapy.

Human herpesvirus 8 seropositivity and risk of Kaposi's sarcoma and other acquired immunodeficiency syndrome-related diseases

BACKGROUND

The incidence of Kaposi's sarcoma (KS) is increased severalfold in individuals infected with human immunodeficiency virus-1 (HIV). Human herpesvirus 8 (HHV8) has also been implicated in KS. We investigated several factors that may determine the onset of KS, particularly HHV8 infection in individuals after becoming seropositive for HIV.

METHODS

We studied 366 individuals belonging to different HIV-exposure categories (i.e., homosexual activity, intravenous drug use, and heterosexual contact) for whom a negative HIV serologic test and then a positive HIV serologic test were available within a 2-year period. HHV8 antibody testing was performed by use of an immunofluorescence assay on the first serum sample available after the first positive HIV test. Actuarial rates of progression of KS and of other acquired immunodeficiency syndrome (AIDS)-defining diseases were estimated by use of time-to-event statistical methods. All statistical tests were two-sided.

RESULTS

Twenty-one of the 366 study participants developed AIDS-related KS, and 83 developed AIDS without KS. One hundred forty (38.3%) participants had detectable anti-HHV8 antibodies. The actuarial progression rate to KS among persons co-infected with HIV/HHV8 was nearly 30% by 10 years after HIV seroconversion. Increasing HHV8 antibody titers increased the risk of developing KS (for seronegative versus highest titer [1:125 serum dilution], adjusted relative hazard [RH] = 51.82; 95% confidence interval [CI] = 6.08-441.33) but not of other AIDS-defining diseases (adjusted RH = 1.14; 95% CI = 0.72-1.80). HHV8-seropositive homosexual men compared with HHV8-seropositive participants from other HIV-exposure categories showed an increased risk of KS that approached statistical significance (adjusted RH = 6.93; 95% CI = 0.88-54.84).

CONCLUSIONS

Approximately one third of individuals co-infected with HIV/HHV8 developed KS within 10 years after HIV seroconversion. Progression to KS increased with time after HIV seroconversion. Higher antibody titers to HHV8 appear to be related to faster progression to KS but not to other AIDS-defining diseases.

Prevalence of sensitization to Alternaria in allergic patients in Italy

BACKGROUND

The actual prevalence of sensitization to Alternaria is not known, partly due to the unreliability of diagnostic extracts.

OBJECTIVE

To assess skin positivity to extracts of Alternaria in a wide population of Italian patients suffering from respiratory symptoms using a biologically standardized extract.

METHODS

A total of 2942 patients were skin prick tested with Alternaria, and a panel of common inhalant allergens. Blood samples for specific IgE quantitation were taken both from patients positive and from patients negative (control group) to Alternaria extract.

RESULTS

Three hundred six patients (10.4%, ranging from 1.8% in Turin to 29.3% in Cagliari) were positive to Alternaria; 37 were sensitized to only this mold, while the remaining 269 were sensitized to at least one other allergen. Of the Alternaria-positive patients, 79.7% suffered from rhinitis and 53.3% from asthma, either alone or associated with other symptoms.

CONCLUSIONS

We suggest that, at least in Italy and in countries with similar climatic and environmental situations, standardized Alternaria extract should be included in the panel commonly used in investigating the allergen responsible in patients suffering from respiratory allergy.

Skin manifestations caused by pigeon ticks (Argas reflexus)

Three adult patients (one woman and two men) presented with polymorphous skin manifestations caused by pigeon ticks (Argas reflexus). These manifestations were characterized by wheals with a central hemorrhagic point in the first patient, crusted-ulcerative lesions in the second, and pustular lesions in the third patient. We observed specific IgE against a somatic extract (antigen A) and the saliva (antigen B) of A. reflexus in two patients.

Fine structural specificity differences of trimethoprim allergenic determinants

BACKGROUND

Adverse reactions, including immediate hypersensitivity, to the widely used antibacterial agent trimethoprim occur quite frequently. In recent years some progress has been made in developing an immunoassay to aid diagnosis of type 1 allergic reactions to trimethoprim and to define the basis of IgE antibody recognition of the drug.

OBJECTIVES

The molecular basis of IgE binding to trimethoprim was examined more closely with a view to defining the fine structural recognition differences between patient's sera. Utilization of such information may lead to immunoassays that are more specific and sensitive and of greater diagnostic value.

METHODS

Immunoassays for specific IgE antibodies and quantitative hapten inhibition studies with trimethoprim and selected structural analogues were employed, together with sera from eight subjects clearly defined clinically as allergic to trimethoprim.

RESULTS

Three different allergenic determinant structures have been identified on the trimethoprim molecule. Identification of the 3,4-dimethoxybenzyl group as a determinant was achieved on the basis of inhibitory activities of diaveridine, 3,4-dimethoxyphenylethylamine, 3,4-dimethoxybenzoic acid and 3,4,5-trimethoxycinnamic acid. Evidence that the opposite end of the trimethoprim molecule was not being recognized was obtained from results with some pyrimidine derivatives, each of which showed no activity. Identification of the second determinant, the 2,4-diamino-5-(3',4'-dimethoxybenzyl) pyrimidine group, rested mainly on the superior inhibitory potency of diaveridine, which differs from trimethoprim by just one methoxy group. With sera from some trimethoprim-allergic subjects, only trimethoprim was active, suggesting that the entire molecule was a third IgE-binding determinant structure.

CONCLUSION

As with other drug allergenic determinants defined so far, heterogeneity of trimethoprim IgE-binding determinants exists, and fine structural differences between determinants may be as small as a single methoxy group. Identification of the 2,4-diamino-5-(3',4'-dimethoxybenzyl) pyrimidine group as an allergenic determinant increases the number of known trimethoprim determinants to three, and suggests that the number and heterogeneity of determinants will be a reflection of the number of allergic subjects studied.

Lichen myxoedematosus in a patient with AIDS

We report a patient with acquired immunodeficiency syndrome (AIDS) who developed a widespread papular eruption due to deposition of mucin in the dermis. Paraproteinaemia was demonstrated. Lichen myxoedematosus type 2 was diagnosed. This is the third case of this rare disorder reported in a human immunodeficiency virus (HIV)-seropositive subject.

Epidemic HIV-related Kaposi's sarcoma: a retrospective analysis and validation of TIS staging. GICAT. Gruppo Italiano Collaborativo AIDS e Tumori

BACKGROUND

We wished to assess the clinical value in terms of treatment choice and establishment of the prognosis of the ACTG classification modified (TNM-TIS) according to the recent guidelines of CDC for the classification of the HIV infection in patients with HIV-related epidemic Kaposi's sarcoma (EKS).

PATIENTS

We retrospectively studied 296 HIV-positive individuals with EKS. Patients were initially classified according to the NYU system and then reclassified according to the TNM-TIS proposal which considers three major parameters: T, anatomical extent of the lesion; I, immune system status; S, HIV-related systemic illness.

METHODS

Survival analyses according to patient characteristics and the different TNM-TIS classification stages were performed; curves were compared using the Kaplan-Meyer method, and predictive factors for survival using the Cox model.

RESULTS

Of the parameters considered in the TNM-TIS staging system, the T variable was not predictive of survival. Conversely, I and S variables revealed predictive value in the survival analyses, when considered separately and together.

CONCLUSIONS

The extent of cutaneous or mucosal lesions of Kaposi's sarcoma did not correlate with prognosis. However, both CD4+ cell count and history of systemic illness were predictive of survival. Indicators of HIV infection must be included in the clinical evaluation of EKS patients and taken into account when choosing optimal treatment.

Three-year neuropsychological follow-up in a selected group of HIV-infected homosexual/bisexual men

OBJECTIVE

To evaluate changes in cognition in a selected group of asymptomatic homosexual/bisexual men over a 3-year period.

PATIENTS AND METHODS

Sixty HIV-infected (Centers for Disease Control stage II) subjects and 60 controls (individually matched for age and years in education) were administered neuropsychological tests evaluating attention, language, memory, logic and visuo-motor abilities. None of the patients had a history of alcohol or drug abuse, and all received the baseline cognitive evaluation within 18-24 months of seroconversion.

RESULTS

The HIV-infected subjects differed from controls in only one of the six memory tests (P < 0.01). Follow-up evaluation after 18 and 36 months (available for 51 and 36 subjects, respectively) demonstrated a significant deterioration in visuo-motor ability (P < 0.01) only in subjects who had progressed to AIDS, without signs or symptoms of central nervous system involvement.

CONCLUSIONS

The data suggest that cognitive alterations in asymptomatic stages of HIV infection are in most subjects minor and do not develop. Percentage rates of CD4 lymphocyte decline appear to be significantly related to deterioration in visuo-motor abilities.

Olive (Olea europea) and privet (Ligustrum vulgare) pollen allergens. Identification and cross-reactivity with grass pollen proteins

Protein blotting studies showed that three olive pollen components with mol. wts approximately 18-19, 20 and 40 kD can be considered to be major allergens. For privet pollen, the highest recognition frequencies were for allergens of mol. wts approximately 20, approximately 19, approximately 40 and approximately 70 kD. When results with the 62 subjects examined were separated into groups corresponding to their geographical locations, viz. Italy, France and Australia, subjects sensitized to olive, but not other pollens (some Italian subjects), were found to show higher frequencies of recognition of major olive allergens than subjects sensitized to olive pollen via cross-reacting allergens from unrelated pollen sources (the Australian and French subjects). Blotting, adsorption and elution and inhibition studies clearly demonstrated allergenic cross-reactivity (that is, antigenic cross-reactivity detected by IgE antibodies) between olive, privet, ryegrass (Lolium perenne) and couch grass (Bermuda grass: Cynodon dactylon) pollen components. As with our previous findings with birch pollen, we conclude that the presence of pollen-reactive IgE antibodies may not necessarily be a true reflection of the sensitizing pollen species.

Non-pathogenic entamoeba histolytica in Italian HIV-infected homosexuals

A cohort of 51 homosexuals who were either HIV-positive or had AIDS was followed prospectively with parasitologic stool examination and in vitro culture in order to determine the incidence of E. histolytica infection. Amoebic isolates were further characterized by electrophoretic isoenzyme study. Five subjects (9.8%) were found to be infected with E. histolytica. None of the amoebic isolates were found to be pathogenic by isoenzyme analysis.

[Interdigital pilonidal sinus in barbers]

Three cases of barber's hair sinus of the hand are presented. The lesion is produced by the penetration of extraneous short hairs into the interdigital spaces of the hand. The hairs produce an inflammatory reaction and foreign body granuloma. The clinical picture is usually benign but can be complicated by repeated infection which may require surgery. The structure of the lesions varies from epithelial-lined tract, cyst with surrounding foreign body reaction, to fibrotic cicatricial tissue. The exact reasons for the lesion are not known, but several theories are offered. It is, however, clear that since the 1970's Italian barbers have changed their methods of cutting hair, using their hands more than the customary instruments, i.e., combs, brushes, etc. The authors discuss the occupational problems due to the complications of disabling lesions.

Risk of AIDS in HIV seroconverters: a comparison between intravenous drug users and homosexual males

A multicentre cohort study was conducted in Italy to estimate the risk of developing AIDS in 261 intravenous drug users and 89 homosexual males for whom the seroconversion period was known. Four years after HIV seroconversion, AIDS incidence, estimated by Kaplan-Meier survival technique, was 13.8% for intravenous drug users and 16.2% for homosexual males; the difference was not statistically significant. These findings suggest that four years after seroconversion the risk of developing AIDS in HIV seropositive intravenous drug users is no higher than that of subjects who acquired HIV infection through sexual contact.

Oral hairy leukoplakia

Oral hairy leukoplakia was first described in homosexual men infected with the human immunodeficiency virus. It is thought to be caused by infection with both the Epstein-Barr virus and human papillomavirus. We report 59 cases of oral hairy leukoplakia. The disease was diagnosed in patients in all risk groups and was categorized in all classes of the Walter Reed classification without significant differences in prevalence. Epstein-Barr virus could be demonstrated in all tissue samples examined; human papillomavirus was found in only a few specimens. In our series oral hairy leukoplakia had a chronic course, although temporary spontaneous healing occurred in some cases. Its appearance was a poor prognostic sign because acquired immunodeficiency syndrome developed in a significant proportion of patients within a few months of onset.

Occupational contact psoriasis

Occupational psoriasis accounts for about 1.2% of all cutaneous pathologic conditions due to work. It is especially important for subjects with slight signs of psoriasis, since patients already suffering from clear illness spontaneously avoid traumatic activities. Our interest was directed to cutaneous symptoms, signs for identifying subjects predisposed to traumatic dermatitis, also useful in vocational guidance. The necessity of official acknowledgement of such work-related dermatological pathologies is suggested.

Mucocutaneous manifestations in patients infected with human immunodeficiency virus

The mucocutaneous manifestations observed in 516 patients infected with human immunodeficiency virus attending an outpatient clinic for acquired immunodeficiency syndrome in Milan, Italy, from July 1985 to March 1987 are listed, and the clinicopathologic aspects of these disorders are reported. The prognostic significance of some human immunodeficiency virus-associated dermatoses is also discussed.

Atypical early syphilis in an hiv-infected homosexual male

A homosexual male, seropositive to HIV and with previously documented syphilitic infections, developed a slowly growing nodule on his left wrist (possibly a chancre) followed, after 2 months, by a few scattered, large papular lesions. Serological evidence of active syphilis was obtained and treponema were identified in the initial lesion by means of immunofluorescent staining. Treatment with both aqueous crystalline penicillin G and benzathine penicillin G healed the lesions. This represents a further case of an atypical presentation of early syphilis in an immunocompromised host.

[Dermatopathies in the domestic worker: the Lombard experience]

In order to identify the etiopathogenesis of cutaneous diseases in housewives, a questionnaire was made, and the gathered data are here described. 1,824 people have answered this questionnaire: 1,007 have reported lesions with a suspicious immunological pathogenesis. The commercial products which were reported as a cause of the dermatitis have been 834. In a group of 142 housewives (86 with allergic contact dermatitis and 56 with irritative contact dermatitis), the allergic sensitizations to the chemicals in the detergents were tested. 21% of the cases had positive cutaneous reactions for nickel salts and 8.4% for chromium salts. The analysis in atomic absorption method of these metals in 34 commercial products has shown their presence in almost all the samples. Hypothesis are formulated to find the source of these polluting substances. The aims and the methods of a investigation carried out on 1.800 housewives, who are going to be controlled in order to estimate the prevalence, the clinical kinds and the etiopathogenesis of dermatitis related to house work, are described. The study will be carried out at the Occupational Health Institute "Clinica del Lavoro L. Devoto" of Milan and at the Dermatological Departments of the Universities of Bari and Florence.

[Determination of urinary estriol in pregnancy. I. Comparison of the gas-chromatographic and colorimetric methods]

The gas-chromatographic method is confronted with the amply used colorimetric method in the determination of the urinary oestriol. The two methods give practically the some results, even so the gas-chromatographic is to be preferred for its specificity, for salvaging accuracy, and for the possibility to receive hormonal profiles with only one determination.

[Determination of urinary estriol in pregnancy. II. Normal levels with the gas-chromatographic method]

We carried the values of the oestrioluria received examining n o 755 samples of urine of women with normal pregnancies using the gas-chromatographic method. The gas-chromatographic method makes possible a "fascia" of normal values superimposable to those received from others AA. with the colorimetric method in the first months of pregnancy, where we have a major tendency to the dispersion of the values in the last months of pregnancy.