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Objective: To describe the clinical outcomes for all HIV-serodiscordant couples attending an assisted reproduction program., Design, Setting and Participants: Retrospective review of demographic, clinical and outcome data for all HIV-serodiscordant couples who attended an assisted reproduction program at a tertiary hospital in Melbourne, between its commencement in 2003 and June 2010., Main Outcome Measures: Pregnancies, miscarriages, births, HIV transmission to the HIV-negative partner, semen quality and detection of HIV (HIV RNA and HIV DNA) in semen., Results: As of June 2010, 39 HIV-positive clients had proceeded to assisted reproduction after the initial consultation in the program. There were 162 completed cycles, with 26 pregnancies (clinical pregnancy rate per cycle, 16.2% for HIV-positive men with an HIV-negative partner, and 15.4% for HIV-positive women). Of all 222 tested semen samples, 18 (8%) had HIV RNA detected despite these men receiving antiretroviral therapy and having an undetectable HIV viral load in plasma. Sperm velocity was significantly lower in HIV-positive clients receiving combination antiretroviral therapy than in a control group of recipient-recruited sperm donors (P = 0.01); there were no other significant differences in sperm quality between the two groups. No HIV transmission to babies or HIV-negative partners occurred., Conclusion: Our findings show detectable HIV in 8% of semen samples from men with an undetectable HIV viral load in plasma, but confirm the safety of assisted reproduction for HIV-serodiscordant couples within a program with strict protocols for HIV treatment and testing of all semen before use.

About one in three patients with advanced immune deficiency will develop disseminated MAC infection. This incidence can be reduced with prophylactic drug therapy, and established infections can be effectively treated, with improved quality of life and lengthened survival.

Objective: To assess the efficacy and tolerance of fluconazole (150 mg oral dose, once a week) in the prevention of recurrent oropharyngeal candidiasis in patients with moderate to severe human immunodeficiency virus (HIV) infection., Design: A randomised, double-blind, placebo-controlled trial., Patients: Eighty-four patients with moderate to severe HIV infection who had successfully completed two to four weeks treatment with fluconazole for oropharyngeal candidiasis were randomly allocated to receive either placebo or fluconazole. Pre-treatment clinical and laboratory characteristics were similar in the two groups., Outcome Measures: Success was classified as absence throughout the course of treatment of clinical evidence of oropharyngeal candidiasis, and failure as recurrence or relapse of symptomatic oropharyngeal candidiasis., Results: Of 73 evaluable patients the median time to relapse was > or = 168 days in the fluconazole group and 37 days in the placebo group (P < 0.0001). One patient in the placebo group and 18 patients in the fluconazole group completed six months' treatment without clinical relapse (P < 0.001)., Conclusion: Fluconazole was well tolerated and prevented clinical relapse of oropharyngeal candidiasis in 71% of patients who completed three months of treatment (95% confidence interval [CI], 55-86) and 58% (95% CI, 41-75) who completed six months of treatment.

Unexplained fever, usually self-limiting and often due to a viral infection, is commonly seen in many medical practices. When should a doctor consider HIV in relation to a patient's fever?

In the period from January 1971 to June 1983, 46 of 5477 patients (0.84%) admitted to Fairfield Hospital, Melbourne, with acute viral hepatitis died of fulminant hepatic failure. The case-fatality rate for patients with hepatitis A was 0.14%; for patients with hepatitis B, 0.84%; and for patients with non-A non-B (NANB) hepatitis, 2.29%. The highest case-fatality rates were observed in patients with post-transfusion hepatitis B (18.8%), and in patients with NANB hepatitis aged less than 5 years (50%) and 40 years and over (10%).