Updates

By Carol A. Kemper, MD, FACP

KS Fails to Respond to Cidofovir

Source: Little RF, et al. J Infect Dis. 2003;187:149-153.

Anecdotal reports have suggested that Kaposi sarcoma (KS), which is believed to be, in part, due to the presence of human herpes virus 8, may respond to antiherpes drugs. Cidofovir, which is one of the most active agents in vitro against HHV-8, was administered to 7 patients with severe KS. Five of the patients had HIV-related KS, and 2 had classical KS (6 of the patients had 50 or more lesions). Sadly, all 7 patients had progression of their disease at a median of 2 months of therapy (range, 5-27 weeks). No decrease in HHV-8 viral load was detected in peripheral blood mononuclear cells. Progression of disease occurred in the 5 patients despite fairly good CD4 cell counts (mean CD4 count, 214 cells/mm3 with a range of 66-1041), and 4 were receiving highly active antiretroviral therapy.


MRSA Hits Big City Gays Hard

Source: ProMED-mail post. February 27, 2003; promed@promedmail.org.

Physicians and local health authorities in the San Francisco Bay Area, Los Angeles, and Boston are reporting an epidemic of methicillin-resistant Staphylococcus aureus (MRSA) infections, predominantly in gay men. Notices have been posted in bathhouses and other locations throughout San Francisco, warning that the resistant bacteria may be acquired through close contact and sexual activity. One man interviewed for the local nightly newscast disclosed that he acquired his infection after having sex with a man with an abscess.

While current surveillance techniques make it difficult to get an accurate count of the number of individuals affected, physicians in San Francisco estimate that about 150 cases have occurred, some of which have required parenterally administered antibiotics or hospitalization. While most of the cases are mild-to-moderate skin infections, more serious infections, such as post-operative infection and osteomyelitis, have occurred. Although several clones appear to be circulating in the various communities, many are additionally resistant to quinolones. This is hardly surprising since quinolones have become one of the most popular antibiotics prescribed.

Authorities in the Bay Area have wondered if this new strain possesses unique virulence factors, and epidemiologic studies are under way. In the meantime, gay men should be advised to avoid contact with other men with active skin infection or colonization with MRSA, cover any open sores, seek medical assistance for any boils or skin lesions, and wash their hands as frequently as possible.


CCR5 Genotype and HIV Risk in Women

Source: Philpott S, et al. J Infect Dis. 2003;187:569-575.

The cc chemokine receptor 5 (CCR5) acts as a coreceptor for HIV-1 transmission. Earlier studies of predominantly gay men found that homozygous, but not heterozygous, gene deletion (D32) was protective against transmission of HIV. Philpott and colleagues extended this work to an all-female cohort of 2605 women enrolled in the Women’s Interagency HIV Study (WIHS). The cohort was largely black and latina, and women were recruited in New York, Los Angeles, Washington, and San Francisco. The D32 gene frequency was 0.026 for HIV-positive women compared with 0.040 for HIV-negative women (odd ratio, 0.63), suggesting that even the heterozygous state was partially protective against HIV infection. D32 was 4-5 times more common in uninfected white women (0.116) compared with uninfected blacks (0.022) and latinas (0.029), while it was more than 20 times more common than in white women with HIV infection (0.057). The relative infrequency of CCR5 D32 in blacks and other minorities may contribute to the higher rates of HIV infection in these groups.


Off-Road Driving and Cocci?

Source: ProMED-mail post. February 20, 2003; promed@promedmail.org.

One astute reader suggests that the recent increase in popularity of off-road vehicles (ORVs) may be to blame for the recent increased incidence of coccidioidomycosis, especially in places like Mariposa County, Arizona. ORVs are literally tearing up the desert in certain areas of Arizona, and residents are complaining of clouds of dust that hang in the air for hours, potentially exposing both drivers and residents to the organism. Should drivers of ORVs be warned of the potential risk to their health when purchasing a vehicle?