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Indinavir plasma concentrations were highly variable among patients receiving the same dosage. Patients with an undetectable plasma HIV RNA level who were protease inhibitor naive had statistically higher indinavir concentrations and slower oral clearance than the group with detectable HIV RNA. Relationships between indinavir concentrations and anti-HIV effect provide a basis for quantifying the pharmacologic contribution to the heterogeneity in therapeutic response.

Penile, cervical, and vulvovaginal samples from 50 couples attending a sexually transmitted disease clinic and perianal samples from women only were tested for human papillomavirus (HPV) DNA by dot filter hybridization (DFH) and polymerase chain reaction (PCR). Only 18% of women and 4% of men were HPV-positive by DFH, but 72% of women and 63% of men were HPV-positive by PCR. HPV type-specific concordance between partners was more common than predicted by chance (P = .01) and was associated with detection of HPV DNA by DFH in either partner. Thus, genital HPV infection in this population is common in both men and women, and the HPV type-specific concordance in sex partners is consistent with sexual transmission. Higher levels of genital or perianal HPV, as reflected by detection of HPV DNA with the less-sensitive DFH method, may promote sexual transmission.

We recently saw two unusual manifestations of Haemophilus influenzae infection in adults in the Seattle area: fulminant sepsis in an otherwise-healthy man and three episodes of bacteremia in a woman with chronic liver disease. We retrospectively identified 79 bacteremic and 40 non-bacteremic cases of invasive H. influenzae infection developing in patients > or = 9 years of age between 1 January 1980 and 31 December 1990. The most common clinical presentations among patients with bacteremia included pneumonia (52%), septicemia (27%), meningitis (8%), gynecologic infection (5%), and epiglottitis (5%). Underlying illnesses were common in these patients, and overall mortality was 35.5%. Factors associated with mortality included underlying neurological disease, polymicrobial bacteremia, and advanced age. The clinical presentations of the 40 patients without bacteremia included soft-tissue abscesses (45%), lung abscesses (18%), peritonitis (13%), meningitis (8%), gynecologic infection (8%), epididymitis (5%), mastoiditis (3%), and osteomyelitis (3%). Thus H. influenzae disease has a variety of presentations and is associated with significant mortality in older children and adults. Further study is required to determine whether widespread administration of H. influenzae type b conjugate vaccine to infants will alter the development of subsequent disease in later life.

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