Administration of 908 BID resulted in a potent and sustained antiretroviral response, notably in ART-naive patients with advanced HIV disease. GW433908 was generally well tolerated and provides a convenient dosing option without food or fluid restrictions.
SummaryCandida auris is an emerging multidrug-resistant (MDR) fungus associated with invasive infections and high mortality. This report describes 9 patients from whom C. auris was isolated at a hospital in Panama City, Panama, the first such cases in Central America, and highlights the challenges of accurate identification and methods for susceptibility testing.
K E Y W O R D Sacurate, Candida auris, diagnose, susceptibility
To compare the lipid and metabolic effects, efficacy, and safety of twice-daily regimens of Trizivir s (abacavir 300 mg/lamivudine 150 mg/zidovudine 300 mg triple nucleoside tablet; TZV), Combivir s (lamivudine 150 mg/zidovudine 300 mg combination tablet; COM) 1 nelfinavir (NFV), and stavudine (d4 T) 1 lamivudine (3TC) 1 NFV.
Study designAn international, phase 4, open-label, parallel-group, 34-centre study was conducted in 254 nondiabetic, antiretroviral-naive, HIV-infected out-patients with an HIV-1 RNA level of 41000 HIV-1 RNA copies/mL and 200 000 copies/mL and a CD4 cell count of 450 cells/mL.
MethodsPatients were randomized 1 : 1 : 1 to TZV twice daily (n 5 85), COM/NFV 1250 mg twice daily (n 5 88), or d4T 40 mg 1 3TC 150 mg 1 NFV 1250 mg twice daily (n 5 81) for 96 weeks. Treatments were compared using analysis of covariance (ANCOVA) with regard to changes from baseline in fasting lipids in the total population and in sex and ethnic subgroups. The proportions of patients achieving HIV-1 RNA o50 and o400 copies/mL were compared using a 95% confidence interval (CI) on the difference between proportions.
ResultsThe study population was diverse (50% female, 40% black and 37% Hispanic). Mean baseline lowdensity lipoprotein (LDL) cholesterol was 99 mg/dL, HIV-1 RNA was 4.43 log 10 copies/mL and CD4 cell count was 355 cells/mL. At week 96, fasting LDL cholesterol changed minimally in the TZV group [least square mean (LSM) change from baseline, À 8 mg/dL], but increased with d4T/3TC/NFV and COM/NFV ( 1 29 and 1 19 mg/dL, respectively; Po0.001 versus TZV). Week 96 LDL-cholesterol levels were significantly lower in the TZV group than in the other two treatment groups in women and men and lower than in the d4T/3TC/NFV group in Hispanic and black patients. In black patients, the week-96 LSM change from baseline in LDL cholesterol was significantly less with TZV than with d4T/3TC/NFV ( 1 1 vs 1 39 mg/dL; P 5 0.003). Total cholesterol4200 mg/dL occurred in a smaller proportion of patients receiving TZV (30%) compared with COM/NFV (50%) or d4T/3TC/NFV (60%; P 5 0.005 vs TZV). High-density lipoprotein (HDL) cholesterol did not change markedly with any treatment. Although triglycerides increased, they changed least in women and Hispanic patients receiving TZV. Virological and CD4 responses to the treatments were similar in the total population and in the subgroups. Diarrhoea was reported more often in the NFV arms and nausea in the ZDV arms.
85
ConclusionsOver 96 weeks, TZV twice daily has significantly less effect on LDL cholesterol than COM/NFV or d4T/3TC/NFV twice daily, especially in women and black patients, and is associated with similar virological and CD4 responses.
The first molecular epidemiology study of human immunodeficiency virus type 1 (HIV-1) in Panama has been performed with plasma samples from 66 AIDS patients infected by different transmission routes and obtained from distinct locations. All samples were amplified by RT-PCR and sequenced in gag (p17) and env (C2-C4) genes. Phylogenetic analyses revealed that 64 (97%) of the samples belong to subtype B. We also identified the presence of two CRF, one CRF12_BF and one CRF02_AG. The most notable feature of the subtype B epidemic in Panama was the large genetic distance among isolates with a mean of 15.2% but reaching up to 31.3 % in env, indicating an epidemic with a long period of evolution.
Melioidosis is an infection caused by Burkholderia pseudomallei. Most cases occur in Southeast Asia and northern Australia; <100 cases have been reported in the Americas. We conducted a retrospective study and identified 12 melioidosis cases in Panama during 2007–2017, suggesting possible endemicity and increased need for surveillance.
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