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Objective: To determine rates of seroconversion after single vaccination with a novel split virion, inactivated, adjuvanted pandemic H1N1 influenza vaccine (A/California/7/2009) in HIV-1-infected patients (ClinicalTrials.gov Identifier: NCT01017172)., Design: Single center diagnostic study., Setting: Institutional HIV outpatient department of an urban university clinic., Participants: Adult HIV-1-infected individuals., Intervention: Serum samples were taken before and 21 days after vaccination., Main Outcome Measures: Antibody titers determined by hemagglutination inhibition assay. Seroconversion to vaccination was defined by either an antibody titer of 1: 10 or less before and of at least 1: 40 after or at least 1: 10 before and at least four-fold increase in antibody titer 21 days after single vaccination., Results: One hundred and sixty patients (125 men/35 women) were analyzed. Before vaccination, 23 patients (14.4%) had a hemagglutination inhibition assay titer of at least 1: 40. A median of 22 +/- 3 days after vaccination, 110 (69%) patients seroconverted. Seroconverters were younger (45.1 +/- 10.0 vs. 48.8 +/- 11.3 years; P = 0.04), had a higher CD4 cell count (532 +/- 227 vs. 475 +/- 281 cells/microl; P = 0.03) and were more likely to have received a previous H5N1 vaccination in 2009 (25 vs. 8%; P = 0.02) when compared to nonresponders. No other significant differences were found comparing the two groups (prevaccination hemagglutination inhibition assay titer of > or =1: 40, AIDS, HAART, HIV RNA PCR <50 copies/ml or CD4 nadir, CD4 and CD8 percentage, sex, BMI, chronic hepatitis B or C)., Conclusion: Seroconversion after one dose of a split virion, inactivated, adjuvanted pandemic H1N1 influenza vaccine of HIV-infected patients was 69%. Studies to investigate whether a second dose of the vaccine will increase seroconversion rate are needed.

Objective: To evaluate the interferon-gamma-releasing assays QuantiFERON-tuberculosis (TB) Gold and T-SPOT.TB in addition to tuberculin skin test (TST) for diagnosis of latent tuberculosis infection in HIV patients., Design, Setting and Participants: Prospective cross-sectional study for asymptomatic HIV-infected outpatients from a large University hospital., Intervention: Simultaneous performance of QuantiFERON-TB Gold, T-SPOT.TB and TST., Main Outcome Measures: Incidence and risk factors for a positive test reaction and the concordance (kappa) between the tests were investigated., Results: Of 286 enrolled patients, 81% were men; median age was 44 years, the median CD4 cell count 408/microl (range 7-1510) with a median nadir of 126/microl (range 0-749). A number of patients (63.8%) had undetectable HIV RNA (<50 copies/ml). Both T-SPOT.TB and QuantiFERON-TB showed more positive test results than TST: 25.2 and 20.0% (P = 0.133) compared with 12.8% (P < 0.001 and P = 0.008, respectively). Agreement between T-SPOT.TB and TST (kappa = 0.201) respectively QuantiFERON-TB and TST (kappa = 0.335) was fair, but only poor between the serological assays (kappa = 0.146). T-SPOT.TB provided more indeterminate results than QuantiFERON-TB (8 vs. 1/256, P < 0.01). Patients with a positive QuantiFERON-TB result had higher median CD4 cell counts (457 vs. 405 cells/microl for patients with negative result, P = 0.044); the amount of released interferon-gamma correlated with CD4 cell counts (rho = 0.199; P < 0.002). T-SPOT.TB results were independent from CD4 cell counts., Conclusion: In HIV-infected patients from a low prevalence TB country, both interferon-gamma assays are more sensitive than TST, but seem to be less sensitive than in immunocompetent patients. The blood tests show poor agreement and differ in their dependence on the CD4 cell count.

Objective: To determine the effect of Kaposi's sarcoma on survival of HIV-infected patients., Methods: Retrospective cohort study to compare the survival of 241 HIV-infected homosexual patients with Kaposi's sarcoma (cases) with that of 241 HIV-infected homosexual patients without Kaposi's sarcoma (control subjects) but with a similar level of immunosuppression (measured by the absolute CD4+ lymphocyte count)., Results: Cases and control subjects were similar in age, occurrence of previous opportunistic infections, and the use of antiretroviral therapy. The mean CD4+ lymphocyte counts were similar for cases and control subjects (185 x 10(6) versus 184 x 10(6)/l, respectively). Cases had a higher incidence of opportunistic infections (5.95 versus 3.88 infections, respectively, per 100 person-months of observation) and a greater number of infections typical of late-stage HIV infection. Cases had a shorter overall survival than did control subjects (P=0.0025). Kaposi's sarcoma was associated with an increased risk of death (odds ratio, 1.28), even when adjusting for age, previous opportunistic infection, baseline CD4+ lymphocyte count, and antiretroviral therapy., Conclusion: Kaposi's sarcoma appears to accelerate the clinical course of HIV infection. Opportunistic infections develop earlier and more often in patients with the disease than in control subjects. Survival was significantly shorter in patients with Kaposi's sarcoma.

Objective: To determine the incidence of AIDS-defining opportunistic infections and malignancies over a 5-year period from 1992 to 1996., Study Population: Subcohort of 1003 homosexual men with HIV infection and CD4 count less than 200 x 10(6) cells/l from the Frankfurt AIDS Cohort Study., Methods: Data including the earliest date that a CD4 T-lymphocyte count < 200 x 10(6)/l was reached and the dates of AIDS-defining events were compiled from medical records. Incidence analyses for AIDS-defining events and death during the subsequent 5 years (1992-1996) were performed using rates per 100 person-years of exposure., Results: During the observation period, the number of patients per year with CD4 T-lymphocyte counts < 200 x 10(6)/l varied between 402 and 511. In 1992, 56.7% of patients experienced at least one AIDS-defining illness, and 20.7% in 1996. The annual number of AIDS-defining events per 100 patient-years of observation declined from 143.5 in 1992 to 38.3 in 1996, and the number of AIDS-related deaths fell from 25.7 to 12.9. Analysis of the number of events confirmed this trend for malignancies and single opportunistic infections, with the exception of mycobacterial diseases., Conclusions: The incidence of AIDS-defining events in patients with advanced HIV infection at Frankfurt University Hospital has declined by more than 70% from 1992 to 1996.