In This Issue Free

Genetic polymorphisms associated with greater shedding of severe acute respiratory syndrome—associated coronavirus (SARS-CoV) (Chen et al., pp. 1561–9).

Patients who shed high titers of SARS-CoV were found to have a higher mortality rate than patients who shed lower titers. To determine whether differences in innate immunity contributed to the shedding of high titers of virus, infected patients were screened to detect genetic polymorphisms. Four polymorphisms of genes involved in innate immunity were found to be associated with higher titers of shed virus.

Directly administered antiretroviral therapy (DAART) in methadone clinics (Lucas et al., pp. 1628–35).

Patients who received DAART at urban methadone clinics achieved better viral suppression (viral suppression rate, 56%) than did various groups of control patients with or without a history of intravenous drug use who had self-administered HAART (viral suppression rates, 32%–44%). Integrating DAART into methadone clinics may lead to improved virologic and immunologic outcomes.

Community-based antiretroviral therapy adherence-support trial (Wohl et al., pp. 1619–27).

A randomized trial found no difference in viral load or CD4⁺ cell count between directly administered antiretroviral therapy, an intensive adherence case-management intervention, and standard care. Adherence-support interventions may be most beneficial to patients with documented adherence problems.

Improvement of hepatitis B— or hepatitis C—related chronic hepatitis with concomitant hepatitis A (Sagnelli et al., pp. 1536–43).

Patients with chronic hepatitis B or C and concomitant hepatitis A were compared with control groups of patients with acute hepatitis A alone or chronic hepatitis B or C alone. Two case patients had severe courses of hepatitis A; both patients recovered. The remainder of the case patients had normal, self-limited courses of hepatitis A. No difference was found in the course of hepatitis A between patients with or without preexisting hepatitis B or C. However, after 6 months, one-half of the patients with chronic hepatitis B or C and concomitant hepatitis A experienced improvement in the preexisting condition. Concomitant hepatitis A seems to be self-limited and may induce remission from chronic hepatitis by inhibiting hepatitis B and C genomes.

Outbreak of enterotoxigenic Escherichia coli (ETEC) with an unusually long duration of illness (Yoder et al., pp. 1513–7).

A foodborne outbreak of ETEC in which 3 serotypes were detected by PCR was associated with a median duration of diarrhea that was 3 days longer than had been observed in most previous ETEC outbreaks. Consumption of carbonated beverages was associated with prolonged duration of diarrhea.

Apparent absence of Pneumocystis jirovecii in healthy subjects (Nevez et al., pp. e99–101).

PCR testing for the presence of P. jirovecii was conducted on sputum specimens from 30 healthy subjects with no pulmonary disorders and 50 patients with chronic obstructive pulmonary disease (COPD). None of the healthy subjects had positive test results, but the fungus was detected in 16% of patients with COPD. Immunocompetent people with normal respiratory function appear to play a minor role in P. jirovecii epidemiology.

HIV-2 demyelinating encephalomyelitis (Moulignier et al., pp. e89–91).

An HIV-2—infected patient presented with decreased visual acuity in the right eye and weakness in the left leg. His CD4⁺ cell count was 30 cells/mm³, and an MRI of the brain showed a right peduncular lesion. Subsequent MRIs indicated disseminated spinal cord lesions and right optic nerve atrophy. The neurological complications of HIV-2 infection may be extensive and may overlap with those of HIV-1 infection. Inflammatory demyelinating encephalomyelitis should be considered in HIV-2—infected patients with focal brain lesions.