To ensure correct diagnosis in such cases, a multidisciplinary approach should be adopted: where local expertise and laboratory facilities are available, the diagnosis can be confirmed locally; where they are not available, photographs and samples can be sent off for a remote consultation. Physicians should be encouraged to obtain advice at an early stage in order that such patients with several comorbidities can be offered optimal treatment that provides the best
chance of success. As cases of chronic herpes are not common even in the largest HIV centres, therapeutic prospective and controlled clinical studies have not been conducted. KU-60019 order A new expert consensus on HSV and HIV coinfection would be welcome, 16 years after the first algorithms were proposed during the pre-HAART era [16]. In Z-VAD-FMK nmr particular, such an updated consensus could
integrate the influence of HAART and the immune restoration syndrome. To conclude, chronic mucocutaneous HSV-2 infection in HIV-positive patients remains uncommon in the HAART era. We describe its two main clinical forms, ulcerative and pseudo-tumoral, and emphasize the importance of laboratory confirmation tests not only for diagnosis but also for treatment and follow-up using culture and in vitro HSV sensitivity testing. The long evolution and active viral replication of HSV-2 are linked to dysimmunity and the development of viral resistance to anti-herpetic drugs, and patients with HIV and HSV-2 coinfection therefore require careful and specialized management. We thank Drs Véronique Schiffer, Christian Junet and Joëlle Wintsch for their clinical collaboration in the patient follow-up; Dr Thomas Mckee, Department of Pathology, for his help with the cutaneous biopsies and PCR analyses; and Mrs Delphine Garcia, Laboratory Evodiamine of Virology, for her technical help with the viral
cultures and resistance screening. Conflict of interest: None of the authors has a commercial or other association that might pose a conflict of interest. No funding was obtained for this study. “
“We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the overall efficacy of new antiretroviral drugs, as well as the factors associated with increased efficacy. We compared CD4 cell count increases associated with chemokine (C-C motif) receptor 5 (CCR5) inhibitors or other new drugs, using indirect comparison. We included RCTs published in 2003–2010 that assessed the 48-week immunological and virological efficacy of adding new antiretroviral drugs vs. placebo to optimized background therapy (OBT) in treatment-experienced subjects. These drugs included maraviroc, vicriviroc, enfuvirtide, raltegravir, etravirine, tipranavir and darunavir. We collected baseline descriptive characteristics, CD4 cell count changes and virological suppression proportions (percentage with HIV RNA <50 HIV-1 RNA copies/mL). We identified 10 studies which included a total of 6401 patients.