Objectives Despite the rise of methicillin‐resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) among HIV‐infected persons during the era of highly active antiretroviral therapy (HAART), the precise relationship between these two infections has not been fully elucidated. Therefore, we provide a comprehensive, literature‐based review of MRSA infections among HIV‐infected persons. Methods A systematic search of MEDLINE using the search terms “HIV” and “MRSA” identified references published during the HAART era (January 1996 to January 2011). Relevant articles on MRSA in the general population were also reviewed for comparison. Results The most common type of MRSA infection among HIV‐infected persons is SSTI caused by USA300, Panton‐Valentine leukocidin (PVL)‐positive strains. HIV‐infected persons have an increased risk for both initial MRSA infections and recurrent infections compared with the general population. Risk factors for MRSA infections in this population include immunosuppression, comorbid conditions and certain lifestyle behaviours such as high‐risk sexual behaviours and illicit drug use. Further research is needed on the optimal treatment and prevention strategies for MRSA infections among HIV‐infected persons. Conclusions HIV‐infected persons have a propensity for MRSA SSTI and a high rate of recurrent disease. The reasons for the elevated rates of MRSA infections among HIV‐infected persons appear to be multifactorial, but may be mitigated with optimized HIV control and reductions in associated risk factors.

ObjectivesAs socioeconomic factors may impact the risk of chronic kidney disease (CKD), we evaluated the incidence and risk factors of incident CKD among an HIV-infected cohort with universal access to health care and minimal injecting drug use (IDU). MethodsIncident CKD was defined as an estimated glomerular filteration rate (eGFR) <60 ml/min/1.73 m 2 for Ն 90 days. eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Rates were calculated per 1000 person-years (PY). Associations with outcomes were assessed using two separate Cox proportional hazard models, adjusting for baseline and time-updated covariates. . Baseline factors associated with CKD included older age, lower CD4 count at HIV diagnosis [compared with CD4 count Ն 500 cells/mL, hazard ratio (HR) 2.1 (95% CI 1.2-3.8) for CD4 count 350-499 cells/mL; HR 3.6 (95% CI 2.0-6.3) for CD4 count 201-349 cells/mL; HR 4.3 (95% CI 2.0-9.4) for CD4 count Յ 200 cells/mL], and HIV diagnosis in the pre-highly active antiretroviral therapy (HAART) era. In the time-updated model, low nadir CD4 counts, diabetes, hepatitis B, hypertension and less HAART use were also associated with CKD. AA ethnicity was not associated with incident CKD in either model. Results Among ConclusionsThe low incidence of CKD and the lack of association with ethnicity observed in this study may in part be attributable to unique features of our cohort such as younger age, early HIV diagnosis, minimal IDU, and unrestricted access to care. Lower baseline CD4 counts were significantly associated with incident CKD, suggesting early HIV diagnosis and timely introduction of HAART may reduce the burden of CKD.

HIV and syphilis are often seen as co-infections since they share a common mode of transmission. During episodes of syphilis, CD4 counts transiently decrease and HIV viral loads increase; however, the effect of syphilis co-infection on HIV disease progression (time to AIDS or death) is unclear. We analysed prospectively collected information on 2239 persons with estimated dates of HIV seroconversion (205 [9.2%] with confirmed syphilis and 66 [2.9%] with probable syphilis) in order to determine the effect of syphilis co-infection on HIV disease progression. In multivariate models censored at highly active antiretroviral therapy (HAART) initiation or last visit, adjusting for CD4 count, age, race, gender, and hepatitis B and C status, syphilis (confirmed + probable) was not associated with increased hazard of AIDS or death (hazard ratio 0.99, 95% CI 0.73-1.33). Treating HAART as a time-varying covariate or limiting the analysis to only confirmed syphilis cases did not significantly alter the results. Despite transient changes in CD4 counts and viral loads, syphilis does not appear to affect HIV disease progression.