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November 2008
Vol. 18 No. 11
Patient Care and Science
In the IDSA Journals

Effect of Combination Antiretroviral Therapy on CD4 T Cell Count

Treatment options for HIV infection have evolved from nonboosted protease inhibitors (PIs) to nonnucleoside reverse-transcriptase inhibitors and boosted PI-based regimens, but the impact on immunologic recovery has remained uncertain. In a retrospective cohort study, the authors found that all three treatment strategies resulted in a similar recovery of the CD4 T cell count. (Khanna et al., Clin Infect Dis. 2008;47:1093-1101.)  

Combination Therapy or Monotherapy for Prosthetic Joint Infection?

Despite medical and surgical advances, the optimal treatment of prosthetic joint infections (PJI) remains a challenge, and the outcome remains poorly defined. In a retrospective cohort study, researchers analyzed data for all patients with enterococcal PJI over a 30-year period at a single institution. The outcomes of patients treated with a combination of vancomycin or β-lactam with an aminoglycoside were not significantly different from those of patients treated with monotherapy. (Helou et al., Clin Infect Dis. 2008;47:903-909.)  

Hospital Staffing and Health Care-associated Infections

In a review of studies of the relationship between nurse staffing variables and a patient's risk of developing a health care–associated infection, a significant correlation was found in 45 percent of the studies. The use of nonpermanent staff was associated with increased rates of hospital-associated infection. Float nurses and other temporary staff members may lack specific training, familiarity with procedures, and the relationships necessary for clear communication. (Stone et al., Clin Infect Dis. 2008;47:937-944.)

Bacteria Were Main Killers in Spanish Flu

Secondary bacterial pneumonia caused the vast majority of deaths in the 1918-19 influenza pandemic, according to a re-examination of autopsy samples and data. Pandemic influenza planning must target these infections as well as the primary viral infections, conclude the authors. (Morens et al., Journ Infect Dis. 2008;198:962-970; editorial commentary by McCullers, Journ Infect Dis. 2008;198:945-947.)

CXCR4 Emergence as Predictor of AIDS?

Emergence of CXCR4-utilizing HIV (X4) appears to contribute to T cell decline and progression to AIDS. A study of 67 HIV-infected patients found X4 tropism was more common in those who progressed to AIDS within 11 years of seroconversion and among those who experienced a decline in total T cell populations, compared to those who did not. Emergence of X4 viruses was seen at a median CD4 T cell count  of 475/µL in these patients, and occurred nearly a year before any T cell decline was noted. (Shepherd et al., J Infect Dis. 2008;198:1104-1112; editorial commentary by Burger and Hoover, J Infect Dis. 2008;198:1095-1097.)

HSV Reactivations Frequent but Brief

Asymptomatic reactivations of herpes simplex virus (HSV) 1 and 2 infection are more frequent, but briefer than previously thought, and are cleared rapidly. This study of 25 patients infected with HSV-2 and 18 HSV-1 patients observed an average rate of 18 reactivations per year, 81 percent of which were asymptomatic, and half of which lasted less than 12 hours. Rapid clearance strongly suggests involvement of the peripheral mucosal immune system. (Mark et al., J Infect Dis. 2008;198:1141-1149; editorial commentary by Mertz, J Infect Dis. 2008;198:1098-1100.)

For More in the Literature...

The IDSA Journal Club features brief summaries of key infectious diseases studies in the previous month’s major journals chosen by the IDSA Literature Review Panel. The Journal Club will return in the next issue of IDSA News.

In each issue of Clinical Infectious Diseases (CID), the “In This Issue” section highlights several important studies from that journal. (Click for November 1 or November 15.) For a review of other recent research in the infectious diseases literature, see “In the Literature,” by Stanley Deresinski, MD, in each issue of CID:

November 1:

  • Candida Endocarditis
  • Histoplasmosis and HIV Infection
  • Neutropenic Enterocolitis and Other Causes of Abdominal Pain in Neutropenic Patients
  • Herpes Simplex Suppression and HIV Infection

November 15:

  • Staphylococcus lugdunensis
  • Dental Bacteremia
  • The Right Time for Surgical Antibiotic Prophylaxis

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