http://www.biomedcentral.com/bmcinfectdis/ The editor's pick of recent articles published by BMC Infectious Diseases 2012-04-26T00:00:00Z Detection of Mycobacterium tuberculosis antigens in urine is attractive as a potential meansof diagnosing tuberculosis (TB) regardless of the anatomical site of disease. The mostpromising candidate antigen is the cell wall lipopolysaccharide antigen lipoarabinomannan(LAM), which has been used to develop commercially available enzyme-linkedimmunosorbent assays. Although highly variable diagnostic accuracy has been observed indifferent clinical populations, it is now clear that this assay has useful sensitivity fordiagnosis of HIV-associated TB in patients with advanced immunodeficiency and low CD4cell counts. Thus, this assay is particularly useful when selectively used among patientsenrolling in antiretroviral treatment services or in HIV-infected patients requiring admissionto hospital medical wards. These are the very patients who have the highest mortality risk andwho stand to gain the most from rapid diagnosis, permitting immediate initiation of TBtreatment. A recently developed low-cost, lateral-flow (urine 'dip-stick') format of the assayprovides a result within 30 minutes and is potentially a major step forward as it can be used atthe point-of-care, making the possibility of immediate diagnosis and treatment a reality. Thispaper discusses the likely utility of this point-of-care assay and how it might best be used incombination with other TB diagnostic assays for TB. The many further research studies thatare needed on this assay are described. Consideration is particularly given to potential reasonsfor the variable specificity observed in existing field evaluations of LAM ELISAs. Whetherthis might be related to the assay itself or to the challenges associated with study design isdiscussed. http://www.biomedcentral.com/1471-2334/12/103 Stephen D Lawn BMC Infectious Diseases 2012, 12:103 2012-04-26T00:00:00Z 10.1186/1471-2334-12-103 LAM for diagnosis of HIV-associated TB Stephen Lawn reviews recent advances in lipoarabinomannan (LAM) detection in urine for rapid point-of-care diagnosis of HIV-associated tuberculosis (TB), which would enable immediate initiation of TB treatment in patients with the highest mortality risk. /content/figures/1471-2334-12-103-toc.gif BMC Infectious Diseases 1471-2334 12 103 2012-04-26T00:00:00Z PDF Background: Increased risk of fractures and osteoporosis have been associated with the use of antiretroviral drugs. There is a paucity of prospective evaluations of bone markers after the initiation of drugs currently recommended to treat HIV infection and results on the evolution of these markers are conflicting. Lastly, the effect of tenofovir on 1,25-(OH)2 vitamin D is uncertain. Methods: We performed a prospective study on the evolution of bone markers, parathormone and 1,25-(OH)2 vitamin D before and after standard antiretroviral regimens. This was a sub-study of a trial conducted in antiretroviral-naïve patients randomized to tenofovir + emtricitabine in combination with either atazanavir/ritonavir (ATV/r) or efavirenz (EFV). Follow-up lasted 48 weeks. The following bone markers were analyzed: C-terminal cross-laps (CTx), osteocalcin (OC), osteoprotegerin (OPG), and receptor activator of nuclear factor κB ligand (RANKL). Mixed-factorial analysis of variance with random-coefficient general linear model was used to compare their trends over time and linear multivariable regression was performed with a backward selection method to assess predictors of their variations from baseline to week 48. Trends of parathormone and 1,25-(OH)2 vitamin D were also evaluated. Results: Seventy-five patients were studied: 33 received EFV and 42 ATV/r. Significant increases were found for all markers except for RANKL. There was a significant direct association between CTx and OC increases. Multivariable analysis showed that higher glomerular filtration rate (estimated through cystatin C clearance) predicted greater OPG increase, while older age, higher HIV RNA at baseline and use of ATV/r predicted greater CTx increase. A significant increase of parathormone accompanied the evolution of the study markers. 1,25-(OH)2 vitamin D remained stable, though a seasonality variation was demonstrated. Conclusions: These data demonstrate CTx increase (bone resorption marker) corresponding to OC increase (bone formation marker) early upon HAART initiation. Moreover, predictors of bone marker increases have been suggested, possibly indicating that a stricter monitoring of bone health and pro-active interventions are needed in older patients, those with higher HIV RNA, prescribed ATV/r rather than EFV, and with decreased renal function at baseline. Further studies are needed to clarify the mechanisms responsible for up-regulation of bone turnover markers, as well as to understand if and what markers are best correlated or predictive of pathological fractures. http://www.biomedcentral.com/1471-2334/12/38 Emanuele Focà Davide Motta Marco Borderi Daria Gotti Laura Albini Alessandra Calabresi Ilaria Izzo Rita Bellagamba Pasquale Narciso Laura Sighinolfi Alberto Clò Davide Gibellini Eugenia Quiros-Roldan Nigritella Brianese Bruno Cesana Maria Re Carlo Torti BMC Infectious Diseases 2012, 12:38 2012-02-14T00:00:00Z 10.1186/1471-2334-12-38 Bone health in HIV-positive patients Bone markers C-terminal cross-laps (CTx) and osteocalcin (OC) indicate that antiretroviral drugs could affect bone health, necessitating stricter monitoring in patients who are older, have higher HIV load, or are prescribed certain drugs. /content/figures/1471-2334-12-38-toc.gif BMC Infectious Diseases 1471-2334 12 38 2012-02-14T00:00:00Z XML Background: A substantial prevalence of mild neurocognitive disorders has been reported in HIV, also in patients treated with combination antiretroviral therapy (cART). This includes a new disorder that has been termed asymptomatic neurocognitive impairment (ANI).DiscussionANI is identified by performance on formal neuropsychological testing that is at least 1 SD below the mean of normative scores in at least two cognitive domains out of at least five examined in patients without associated symptoms or evident functional impairment in daily living. While two tests are recommended to assess each domain, only one is required to fulfill this diagnostic criterion. Unfortunately, this definition necessitates that about 20% of the cognitively normal HIV-infected population is classified as suffering ANI. This liberal definition raises important ethical concerns and has as well diagnostic and therapeutic implications. Since neither its biological substrate, prognostic significance nor therapeutic implications are clearly established, we recommend that this diagnosis be modified or applied cautiously.SummaryThe diagnoses of less severe forms of neurocognitive disorders in HIV relies on the outcomes of neuropsychological testing, and a high proportion of HIV-infected patients with effective cART may be classified as neurocognitively abnormal using the current criteria. The definition of ANI is not stringent, and results in approximately 20% of the population being classified as abnormal. To us this seems an unacceptable false-positive rate.Please see related article: http://www.biomedcentral.com/1741-7015/9/138 http://www.biomedcentral.com/1471-2334/11/356 Magnus Gisslén Richard W Price Staffan Nilsson BMC Infectious Diseases 2011, 11:356 2011-12-28T00:00:00Z 10.1186/1471-2334-11-356 Defining HIV-associated neurocognitive disorders Magnus Gisslen and colleagues discuss the potential overestimation of asymptomatic neurocognitive impairment (ANI) in HIV patients, arguing that the current definition could lead to a high false-positive rate. This debate is discussed further by Carlo Torti and colleagues in BMC Medicine. /content/figures/1471-2334-11-356-toc.gif BMC Infectious Diseases 1471-2334 11 356 2011-12-28T00:00:00Z XML