Any immunocompromised HIV patient developing clinical HSV lesions despite adequate doses of aciclovir, valaciclovir or famciclovir must have a sample taken for viral culture and testing for antiviral sensitivity. If new lesions are forming after 5 days, PCI-32765 molecular weight despite increasing the doses of antiviral drugs then therapy should be reviewed and changed (category IV recommendation). Topical 1% foscarnet cream or 1% cidofovir gel have been reported to increase lesion healing, reduce symptom score and virological effect [78–80]. In the UK 1% foscarnet cream is not commercially available; however, a 2% formulation is available from Idis Pharmaceuticals. Systemic therapy with either iv foscarnet 40 mg/kg
bd or tid iv has been shown to be effective for aciclovir resistant strains with the length of therapy depending on treatment response [81] and [82], (category Ib recommendation). In rare cases with aciclovir and foscarnet resistance cidofovir topically [83] or iv 5 mg/kg weekly infusion is the preferred agent [84] (category III recommendation). In patients with prolonged cutaneous
ulceration or who have systemic disease, consideration should be given to initiating combination antiretroviral therapy or changing therapy in those experiencing virological failure [category IV recommendation]. “
“The aim of this study was to estimate the relative risk of cardiovascular disease (CVD) among people living with HIV (PLHIV) compared with the HIV-uninfected population. We LEE011 in vitro conducted a systematic review and meta-analysis of studies from the peer-reviewed literature. We searched the Medline database for relevant journal articles published before August
2010. Eligible studies were observational and randomized controlled trials, reporting CVD, defined as myocardial infarction (MI), ischaemic heart disease, cardiovascular and cerebrovascular events or coronary heart disease among Coproporphyrinogen III oxidase HIV-positive adults. Pooled relative risks were calculated for various groupings, including different classes of antiretroviral therapy (ART). The relative risk of CVD was 1.61 [95% confidence interval (CI) 1.43–1.81] among PLHIV without ART compared with HIV-uninfected people. The relative risk of CVD was 2.00 (95% CI 1.70–2.37) among PLHIV on ART compared with HIV-uninfected people and 1.52 (95% CI 1.35–1.70) compared with treatment-naïve PLHIV. We estimate the relative risk of CVD associated with protease inhibitor (PI)-, nucleoside reverse transcriptase inhibitor- and nonnucleoside reverse transcriptase inhibitor-based ART to be 1.11 (95% CI 1.05–1.17), 1.05 (95% CI 1.01–1.10) and 1.04 (95% CI 0.99–1.09) per year of exposure, respectively. Not all ART was associated with increased risk; specifically, lopinavir/ritonavir and abacavir were associated with the greater risk and the relative risk of MI for PI-based versus non-PI-based ART was 1.41 (95% CI 1.20–1.65). PLHIV are at increased risk of cardiovascular disease.