We evaluated the impact of cytomegalovirus (CMV)-induced immune responses, autoimmune-induced immune responses, and microbial translocation on immune activation in 191 human immunodeficiency virus type 1-infected patients from the ANRS CO3 Aquitaine Cohort. All enrolled subjects had achieved long-term virological suppression during receipt of combination antiretroviral therapy (cART). HLA-DR(+)/CD38(+) expression was 16.8% among CD8(+) T cells. Independent of age, CD4(+) T-cell count, 16S ribosomal DNA load, and regulatory T-cell count, positive results of Quantiferon CMV analysis (P = .02), positive results of CMV-pp65 enzyme-linked immunosorbent spot analysis (P = .01), positive results of CMV-pp65-specific CD8(+) T-cell analysis (P = .05), and CMV seropositivity (P = .01) were associated with a higher percentage of CD8+ T cells that expressed HLA-DR+/CD38+. Autoimmune response and microbial translocation were not associated with immune activation. Therefore, the CMV-induced immune response seems to be associated with chronic immune activation in cART recipients with sustained virological suppression.

Hepatitis C virus (HCV) genotyping of samples from 184 patients with chronic HCV infection by the Trugene 5NC genotyping kit, based on sequence analysis of the 5 noncoding region (5 NCR), and the InnoLiPA assay was evaluated. In addition to these methods, the 184 samples were also analyzed by sequencing of part of the NS5B of the HCV genome after in-house PCR amplification, as a means of validating results obtained with the 5 NCR. The distribution of the genotypes typed by NS5B sequence analysis was as follows: 1a, 41 samples; 1b, 58 samples; 1d, 1 sample; 2a, 5 samples; 2b, 2 samples; 2c, 7 samples; 3a, 46 samples; 4a, 7 samples; 4c, 1 samples; 4e, 9 samples; 5a, 6 samples; 6a, 1 sample. The Trugene and InnoLiPA assays gave concordant results within HCV types in 100% of cases. The ability to discriminate at the subtype level was 76 and 74% for the Trugene and the InnoLiPA assays, respectively.Hepatitis C virus (HCV) is considered the major cause of posttransfusion non-A, non-B hepatitis. The viral genome, a positive-sense single-stranded RNA of about 9,400 nucleotides (5), is characterized by a high genetic heterogeneity like other RNA viruses. HCV isolates show four levels of genetic variability: types, subtypes, isolates, and quasispecies (3). An HCV genotype is therefore used with the histological results from liver biopsy and viral load for counseling individual patients about the risk-benefit ratio of therapy (17,21,22). HCV genotypes are distributed differently depending on geography and the etiology of infection (15,25). For the purpose of nomenclature, it has been proposed that HCV be classified into types, corresponding to the main branches in the phylogenetic tree, and subtypes, corresponding to the more related sequences within the major groups (23,24). HCV genotypes can be established by methods based on PCR typing and/or serological typing (2, 4, 16). The high degree of conservation in the 5Ј noncoding regions (5Ј NCR) has made it the target of choice for reverse transcriptase PCR-based detection assays. Moreover, several PCR typing methods, such as reverse dot blot (26), restriction fragment length polymorphism (10), cleavase fragment length polymorphism, dideoxy fingerprinting, heteroduplex mobility analysis (28), and hybridization to genotype-specific probes (18), exploit sequence-based differences and/or differences in secondary structure of the 5Ј NCR for HCV genotyping (9). Nucleotide sequence analysis is the reference method for identifying different genotypes of HCV (9, 13). However, because this method is expensive and timeconsuming and requires special equipment for sequencing, it has been restricted to the research setting and considered impractical for large clinical studies. A standardized sequencing assay has recently been developed for routine determination of HCV genotypes. In order to determine whether direct sequencing could be a routine tool for the determination of hepatitis C virus genotype, we assessed this first commercial type of HCV genotyping method (Trugene 5ЈNC HCV genot...

Hepatitis E virus (HEV) has been identified as a cause of chronic viral hepatitis in immunocompromised patients. Some glomerular diseases were found to be associated with this infection. We report the first case, to our knowledge, of a kidney transplant recipient who developed an HEV infection and de novo membranous nephropathy (MN) concomitantly. The patient displayed a hepatic cytolysis first and a nephrotic syndrome occurred 3 months later. HEV infection was diagnosed upon positive polymerase chain reaction on plasma and stool samples, and renal allograft biopsy revealed de novo MN. Typical causes of MN were definitively excluded. A 3-month course of ribavirin monotherapy allowed the patient to mount a sustained viral response that was rapidly followed by complete remission of the nephrotic syndrome. The chronology of the onset and remission of both diseases is highly suggestive of a causal relationship between hepatitis E and MN.

No abstract

Cannabis use is associated with a lower IR risk in HIV-HCV-coinfected patients. The benefits of cannabis-based pharmacotherapies for patients concerned with increased risk of IR and diabetes need to be evaluated in clinical research and practice.