Suchergebnisse

Oral transmission of rabies virus has been observed by many authors and it seems that strain differences occur independant of their viral quantity. An experimental vaccine strain ERA/BHK (WIRAB) used in foxes by other authors was found to give satisfactory results as far as antibody response and protection is concerned. In this presentation, the isolation of a plaque from this ERA/BHK vaccine by using another cell system (Vero) and which plaque was subsequently multiplied in Vero cells, showed an extremely high pathogenicity in mice by oral route. The original strain (ERA/BHK) killed also by oral route, but to a lesser degree. In the application of these viruses, all precautions were taken not to provoke lesions during their administration. The importance of this finding warrants immediate prohi bition of the use of this strain ERA/BHK for oral or aerosol vaccination of foxes in control programmes. Its use should not be accepted, because the problem of rabies will be increased and more complicated than diminished, by applying this dangerous method. The authors give full consideration and warnings in respect of the inadequate legislation concerning rabies vaccines in France and other countries which will consider the use of such a vaccine or similar ones. In relation to this important finding of high oral pathogenicity, also public health aspects concerning the original vaccine strain ERA in primary pig kidney cells are mentioned. Government authorities who have licensed the vaccine ERA are invited to reconsider their autorization in relation to this finding of high oral pathogenicity, including France, particu larly in respect of the importation of vaccinated (by ERA-strain) domestic animals, frozen carcasses and their products for human consumption and other purposes. This equally applies to all other living rabies vaccines not yet examined for possible oral pathogenicity.

BackgroundRecent trials have shown the potential benefits of ritonavir‐boosted protease inhibitor (PI/r) monotherapy. As this alternative strategy has recently been included in European HIV treatment guidelines, its effectiveness needs to be assessed in routine practice.MethodsFrom 1st January to 31 December 2011, we identified all patients receiving a current PI/r monotherapy at a university‐based hospital setting using the Diamm database system. Antiretroviral‐naïve patients who directly initiated PI/r monotherapy were excluded. Patients who continued PI/r monotherapy after ending participation in a clinical trial were also included. We performed a retrospective, descriptive analysis of demographic, clinical and therapeutic characteristics of these patients. For biological variables, the last available value in 2011 was retained.ResultsIn 2011, among 3140 antiretroviral‐treated patients in our department, 107 (3.4%) received PI/r monotherapy (lopinavir/r n = 58, darunavir/r n= 49). Of them, 30 (28%) started during 2011 and 31 (29%) continued after a prior trial. Two patients switched to DRV/r due to intolerance. Eighty‐eight percent were male and median age at initiation was 45 years. The median time from starting multitherapy and switching to monotherapy was 30 months (range 2–117). At PI/r monotherapy initiation, median CD4 count was 567 cells/mm3 and HIV RNA was below 50 copies/mL in 90% of patients. The median duration under PI/r monotherapy was 25.4 months (range 0.5–93). At the end of follow‐up, median CD4 count was 643 cells/mm3 and HIV RNA was below 50 copies/mL in 89% of cases. During 2011, 11 patients discontinued PI/r monotherapy, of whom 8 presented viral rebound. Only one patient exhibited major protease mutations. All these 8 patients achieved an undetectable viral load 3 months after therapeutic intensification.ConclusionThis descriptive analysis shows that PI/r monotherapy in routine practice could be considered as an alternative and successful maintenance strategy, especially among patients who achieved an undetectable viral load while undergoing prior multitherapy.

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK