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Many HIV-infected persons travel from temperate zones to (sub)tropical destinations. HIV-specific immigration issues, medical resources abroad and problems regarding travel with multiple medication need to be anticipated. When prescribing immunisations and specific chemoprophylaxis, the stage of immunodeficiency as well as drug interactions with antiretrovirals must be taken into account. Live vaccines may be contraindicated. With good pretravel advice the risk of severe health problems is low for most HIV-infected travellers.

We report the case of a 46-year-old HIV-1 infected patient who acquired a Cyclopsora cayetanensis infection during travel to southeast Asia. He developed excessive watery diarrhoea and pronounced fatigue, which resolved after treatment with cotrimoxazole. The term Cyclospora cayetanensis was first suggested in 1993 for the infectious agent of diarrhoea in tropical and subtropical regions. The infection is usually self-limiting. However, in HIV-1 infected persons the symptoms are often more severe and protracted. Microbiological diagnosis is performed by light microscopy and at X400 magnification of faeces fixed in SAF medium or 10% formalin preservatives.

Surrogate endpoints are used extensively in clinical studies to evaluate the efficacy of therapy. The effect of a treatment on surrogate endpoints should predict efficacy with regard to clinical endpoints such as morbidity and death. Benefits and risks in the use of surrogate endpoints in clinical trials and daily practice are discussed using the example of HIV infection. CD4-lymphocyte counts and plasma HIV-RNA are powerful markers of disease progression in HIV infection. They are also increasingly used as surrogate endpoints to evaluate the efficacy of antiretroviral treatments. Surrogate endpoints should be biologically plausible and must be validated statistically. However, clinical endpoints are still of paramount importance in assessing the value of treatments for chronic diseases.

Sulfadiazine-nephropathy and -nephrolithiasis were well known complications of high dose sulfadiazine therapy 50 years ago. In the last few years high dose sulfadiazine therapy has been widely used for treatment of toxoplasmic encephalitis in AIDS patients. As a consequence sulfadiazine-nephropathy and -nephrolithiasis have become increasingly common. We describe 2 patients with the typical picture of these complications. Therapy is based on the fact that the solubility of sulfadiazine and its acetylated metabolite are markedly improved at higher urine-pH levels. Urine alkalinization is also effective for prophylaxis during sulfadiazine treatment. We present our guidelines for prophylaxis and treatment of these complications.

Disseminated nontuberculous mycobacteriosis is a frequent and late complication of HIV infection. All the 13 patients described here had CD4-lymphocyte counts < 20/mm3. The causative agent was mainly M. avium complex. But we also found, for the first time, a double infection with M. avium complex and M. "genavense" and one patient with growth of M. shimoidei in the blood culture. Clinical signs are nonspecific (fever, reduced performance, anemia). Positive cultures of blood or tissue biopsies are diagnostic. The therapeutic approach is the combination of new macrolides with other antimycobacterial agents. Prognosis is poor, mainly due to advanced immunodeficiency, but two of our patients survived more than one year after diagnosis. Prophylactic treatment should be considered in patients with CD4-counts less than 50/mm3.

Accidental exposure to blood carries with it a definite risk for the health care worker of infection by various bloodborne pathogens, especially the hepatitis B, hepatitis C, and human immunodeficiency virus. The risk of transmission from exposure to HIV is lower than that associated with exposure to HBV and HCV. Should HIV infection occur, however, the outcome is likely to be fatal. Although general infection control precautions, safer use of needles, gloves, and other procedures may substantially reduce the incidence of occupational exposures, they cannot eliminate the risk completely. The post-exposure management is discussed. Neither the efficacy nor the safety of AZT (zidovudine) for use as a chemoprophylactic agent following occupational exposures to HIV has been established. Nevertheless in selected cases it can be proposed to health care workers.

We report the case of a patient with AIDS, Kaposi's sarcoma and persistent herpes simplex type 2 proctitis who died of herpes simplex 2 pneumonitis following an episode of nonspecific interstitial pneumonitis. This rare complication of persistent herpes simplex mucosal infection must be considered in patients with AIDS suffering from severe pneumonitis with negative bronchoalveolar lavage.