Venous thrombotic events (VTEs) may occur at higher rates among HIV patients; some studies suggest that HAART may increase the risk for these potentially life-threatening events. We performed a retrospective study among HIV patients to evaluate the incidence and risk factors for VTEs during the HAART era. A literature review was performed examining VTEs in the pre-and post HAART eras. Seventeen (3.7%) of 465 HIV patients experienced a VTE. The overall incidence rate of deep VTEs among HIV positive persons was 377 cases/100,000 person-years, a four-fold higher rate compared to age-matched males in the general population. The median age at VTE was 36 years (range 27-68). Patients with a thrombosis compared to those without had significantly lower current CD4 (153 vs. 520 cells/mm 3 , p<0.001) and nadir (76 vs. 276 cells/mm 3 , p<0.001) CD4 counts, higher viral loads (3.6 vs. 1.7 log 10 copies/ml, p=0.003), and more likely to have a diagnosis of AIDS (76% vs. 32%, p<0.001); there were no differences in demographics, hyperlipidemia, current use of HAART, the duration of HAART or PI exposure. A review of the literature noted 129 VTE cases; mean age was 40 years, mean CD4 count was 181 cells/mm 3 , the majority of patients were not receiving HAART, and the most common risk factor was an ongoing infection. Thrombotic events are occurring among HIV patients despite their relatively young ages. Advanced HIV disease is a risk factor for development of thromboses, possibly due to an increased inflammatory state or the presence of concurrent comorbidities such as infections. HAART or PI therapy does not appear to play a significant role in the occurrence of VTEs.

Community-associated MRSA (CA-MRSA) infections are well described among the general population, but little is known regarding the incidence of and predictors for recurrent CA-MRSA infections among HIV-infected persons. We retrospectively evaluated HIV-infected patients seen at the Naval Medical Center San Diego from January 1, 2000 to June 30, 2007 for wound culture-proven MRSA infections defined as community-associated based on CDC criteria. Data on skin/soft tissue infections (SSTIs) following an initial CA-MRSA infection were collected by review of medical records and culture results. Patients with or without recurrent infections were compared for predictors of recurrence using multivariate logistic regression models. Thirty-one (6.8%) of 458 HIV patients had wound culture-proven CA-MRSA SSTIs for an incidence rate of 12.3 infections/1,000 person-years. Those who developed a MRSA infection had a mean age of 40 years, 97% were male, and 58% were Caucasian, 23% were Hispanic, 16% were African American, and 3% were other; demographics were similar to the overall study population. Fourteen (41%) HIV patients with an initial MRSA infection had recurrent SSTIs; of these, seven (21%) had culture-confirmed recurrent CA-MRSA. The median time between infection recurrences was four months (range one to 20 months). Suppressed HIV-1 RNA levels of <1000 copies/ml (OR 0.14, p=0.03) was associated with a lower rate of SSTI recurrence. In summary, HIV-infected persons have a high incidence of CA-MRSA skin/soft tissue infections and a high rate of recurrence. HIV control is associated with a reduced risk of recurrent skin/soft tissue infections.

Summary Syphilis is an important public health issue which continues to occur at high rates among HIV-infected patients. Although abnormal liver function tests are common among HIV-infected persons, the incidence of syphilitic hepatitis in this population is currently unknown. We present two cases of syphilitic hepatitis and performed a retrospective study to determine the incidence of hepatitis during early syphilis infections among HIV-infected persons. Our study showed that syphilitic hepatitis is common occurring in 38% (12/32) of HIV-positive patients with early stages of syphilis infection. Most cases occurred during secondary syphilis with the most common finding being a maculopapular rash. Syphilis should be included in the differential diagnosis of HIV patients presenting with liver test abnormalities, rash and/or sexual risk factors.

Background Limited studies have suggested increased incidence rates and unusual clinical presentations of appendicitis among HIV‐infected patients during the pre‐highly active antiretroviral therapy (HAART) era. Data in the HAART era are sparse, and no study has evaluated potential HIV‐related risk factors for the development of appendicitis. Methods We retrospectively studied 449 HIV‐infected patients receiving care at a US Naval hospital involving 4750 person‐years (PY) of follow‐up. We also evaluated the rates of appendicitis among HIV‐negative persons at our medical facility. We compared demographics, HIV‐specific data, and HAART use in HIV‐infected patients with and without appendicitis. Results Sixteen (3.6%) of 449 patients developed appendicitis after HIV seroconversion. The incidence rate was 337 cases/100 000 PY, more than fourfold higher than among HIV‐negative persons. Eighty‐eight per cent of cases among HIV‐infected patients had an elevated white blood count at presentation, 39% were complicated, and 64% required hospitalization. HIV‐infected patients with appendicitis compared with those who did not develop appendicitis were less likely to be receiving HAART (25 vs. 71%, P<0.001), had higher viral loads (3.5 vs. 1.7 log10 HIV‐1 RNA copies/mL, P=0.005), and were younger (median age of 30 vs. 41 years, P<0.002). In the multivariate model, receipt of HAART remained protective [odds ratio (OR) 0.21, P=0.012] for appendicitis, while younger age was positively associated (OR 1.08, P=0.048) with appendicitis. Conclusion Acute appendicitis occurs at higher incidence rates among HIV‐infected patients compared with the general population. Our study demonstrates that the lack of HAART may be a risk factor for appendicitis among HIV‐infected patients; further studies are needed.