Search

Editorial. Problemes lies au HIV pouvant concerner le gastroenterologue: lesions buccales, perte de poids, symptomes œsophagiens, diarrhee, cryptosporidiose, infection par Isosporidia belli, herpes, cytomegalovirus, Mycobacterium avium, microsporidies, infections bacteriennes et par protozoaires, sarcome de Kaposi. Roles de l'endoscopie et de la radiologie

Serum alpha-fetoprotein (AFP) levels have been measured sequentially by a radio-immunoassay method in 64 patients with fulminant hepatic failure. In 15 of the 64 patients (23%) AFP levels were raised but in only two did they exceed 500 ng/ml. Of the 23 survivors 11 (48%) had raised AFP levels compared with four of the 41 (9-8%) fatal cases (P less than 0-005). This rise in AFP levels was found early after the development of grade IV coma and constitutes an encouraging prognostic sign at a time when the liver function tests and EEG are unhelpful. A radioimmunoassay must be used if these small but significant rises in plasma concentration are to be detected. Twelve patients survived without showing a rise in plasma AFP at anytime during the illness. The four fatal cases who had raised AFP levels all had serious complications of fulminant hepatic failure. Charcoal haemoperfusion did not seem to increase the survival of AFP negative patients.

2 observations de pneumopathies a Pneumocystis carinii. Un des 2 mades est mort. Le diagnostic de SIDA est fait tardivement, a cause de l'âge avance des sujets (64 ans et 73 ans) qui cependant avaient eu des relations homosexuelles

Treatment of the coagulation disturbances developing with hepatic damage following a paracetamol overdose was assessed in a controlled trial of 22 patients, one half being given heparin and fresh frozen plasma and the other fresh frozen plasma alone. No significant difference was observed either in the speed of correction of the coagulation defect or in the clinical outcome. Two-thirds of the patients had evidence of disseminated intravascular coagulation, but despite the presence of a severe coagulation defect, significant bleeding occurred in only five patients. This may be because with paracetamol-induced hepatic necrosis both the coagulation defect (and possibly other features attributable to severe hepatic insufficiency) are of shorter duration than in hepatic necrosis due to causes such as viral hepatitis in which the liver damage may be a continuing process.

1. The ability of activated charcoal, treated in differing ways with poly(hydroxyethylmethacrylate), to adsorb paracetamol was studied. 2. Activated charcoal was coated with 2, 4 or 10% by weight of poly(hydroxyethylmethacrylate). Neither the percentage by weight (2, 4 or 10%) coating of activated charcoal by the polymer nor the procedure used to apply the coat affected the total adsorption of paracetamol at equilibrium, but these factors did influence the speed of adsorption. 3. The impregnated charcoals, and those with the lowest percentage by weight coating (2%), removed paracetamol from a stirred solution most rapidly. These charcoals also removed the drug most efficiently during column perfusion. 4. Biocompatibility studied in vivo in the dog revealed a smaller fall in blood platelets with haemoperfusion through 4% encapsulated charcoal than with 4% impregnated charcoal. 5. Dye-adsorption studies indicated that impregnation produced less complete coating of the charcoal, and that the lower percentage by weight coatings were the least complete. 6. The most acceptable compromise for clinical use appeared to be the 4% encapsulated charcoal, as the removal of paracetamol was reasonably rapid and the fall in blood platelet levels was acceptable.

Thirty patients with various types of chronic liver disease and a prothrombin time prolonged for four or more seconds who required needle liver biopsy for diagnostic purposes were given either fresh frozen plasma or a concentrate of clotting factors as a prophylactic measure. The prothrombin time returned to within normal limits in seven of the 15 patients given the concentrate and in three of those receiving fresh frozen plasma. Levels of factors II, IX, and X showed increases of about 30% following concentrate administration; corresponding rises in the group given fresh frozen plasma were less. This was because of the smaller quantity of clotting factors administered with fresh frozen plasma and the increase in factor II and IX activity/kg body weight/unit of clotting factor injected was greater when fresh frozen plasma was used. In neither group was there clinical evidence of bleeding, but it was of interest that most of the clotting factor levels, except in factor II, before biopsy were above those normally required for haemostasis. No evidence of disseminated intravascular coagulation was found with the concentrate injection, and the most worrying finding was the appearance of HBAg some months later in three patients, two from the concentrate group and one from those given fresh frozen plasma. However, the conversion of these patients to HBAg positive may be unrelated to the clotting factor replacement therapy.

51 patients infected with the human immunodeficiency virus (HIV) and with suspected Pneumocystis carinii pneumonia underwent sputum induction. Sputum specimens from 18 patients were positive for P carinii and patients were treated appropriately 25 of the 33 patients with negative specimens underwent bronchoscopy and bronchoalveolar lavage within 4 days of sputum induction, only 1 of whom had evidence of Pneumocystis infection. For diagnosis of Pneumocystis carinii pneumonia, sputum induction according to a strict protocol had a sensitivity of 94.7% and a negative predictive value of 96%, compared with bronchoalveolar lavage.

Summary A 33 year old man with acquired immunodeficiency syndrome developed a toxic megacolon. The patient was admitted with a two month history of diarrhoea. Cryptosporidia were isolated from all stool specimens. Clinically and radiographically he developed toxic dilatation of the colon which responded to conservative management.

Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg is being investigated in two Phase III trials, AMBER (NCT02431247; treatment-naive adults) and EMERALD (NCT02269917; treatment-experienced, virologically suppressed adults). Week 48 AMBER and EMERALD resistance analyses are presented. Postbaseline samples for genotyping/phenotyping were analyzed from protocol-defined virologic failures (PDVFs) with viral load (VL) ≥400 copies/mL at failure/later time points. Post hoc analyses were deep sequencing in AMBER, and HIV-1 proviral DNA from baseline samples (VL