Clinical Impact of GB Virus C Viremia on Patients with HIV Type 1 Infection in the Era of Highly Active Antiretroviral Therapy

BACKGROUND

The influence of GB virus C (GBV-C) viremia on clinical outcomes of patients with human immunodeficiency virus type 1 (HIV-1) infection remains controversial in the era of highly active antiretroviral therapy (HAART).

METHODS

A prospective observational study was conducted to describe the epidemiology of GBV-C viremia and assess its clinical impact on treatment responses to HAART in 385 HIV-1-infected patients during the period from January 1999 through June 2004.

RESULTS

A total of 59 patients (15.3%) had detectable GBV-C RNA viremia during a median observation of 3.6 years (range, 1.0-7.0 years); 47 patients (12.2%) had GBV-C viremia at enrollment, and 12 (3.1%) acquired GBV-C infection during follow-up. Thirty-two (68.1%) of the 47 patients with baseline GBV-C viremia had persistent GBV-C viremia. Compared with patients with clearance of GBV-C viremia (n=15) and patients without detectable GBV-C viremia (n=326), patients with persistent GBV-C viremia were more likely to be men who have sex with men (81.3% vs. 60.4%; P=.02), tended to have lower baseline plasma HIV RNA load (HIV RNA load > or =5 log(10) copies/mL, 31.3% vs. 49.4%; P=.05), and had a higher proportion of isolated anti-hepatitis B core antibody (37.5% vs. 17.2%; P=.005). There was no statistically significant difference in terms of virologic, immunologic, and clinical responses to HAART; occurrence of hepatic events; and mortality among the 3 groups.

CONCLUSIONS

Persistent GBV-C viremia is significantly associated with male-male sex in HIV-infected patients with advanced immunodeficiency, and persistent GBV-C viremia does not confer short-term benefit in patients receiving HAART.

[A clinical analysis of 10 cases of adult respiratory distress syndrome]

Adult respiratory distress syndrome (ARDS) is a special type of acute respiratory failure. 10 cases with ARDS were reported. Severe trauma, major abdominal operation and shock were the most common causative factors (9 of ten). All of six conscious patients felt chest dullness, shortness of breath, respiratory distress and accelerated respiratory rate. Rales in lungs were heard in 8 cases. Monitoring results: PaO2(FiO2 = 1) < 40kPa, P(A-a)O2 > 40kPa, PaO2/FiO2 < 300 in all cases; Qs/Qt > 30% in seven. In 5 of seven patients, chest X-ray showed abnormal shadows in the lung fields. PCWP 1.47-1.87kPa. 8 patients, whose failure organs were more than four, died, mortality rate was 80%. Clinical course of this group showed that ARDS and MOSF were two different kinds of syndromes, though they based on similar pathophysiologic mechanism. The insertion of a Swan-Ganz catheter and hemodynamic monitoring are helpful to the diagnosis of ARDS and the selection of the optimal PEEP.