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3307 emner vises.
Clinical & Experimental Immunology, 29.03.2024
Tilføjet 29.03.2024
Abstract Oral rotavirus vaccines demonstrate diminished immunogenicity in low-income settings where human cytomegalovirus infection is aquired early in childhood and modulates immunity. We hypothesized that human cytomegalovirus infection around the time of vaccination may influence immunogenicity. We measured plasma human cytomegalovirus specific immunoglobulin M antibodies in rotavirus vaccinated infants from 6 weeks to 12 months old and compared rotavirus immunoglobulin A antibody titres between human cytomegalovirus seropositive and seronegative infants. There was no evidence of an association between human cytomegalovirus serostatus at 9 months and rotavirus specific antibody titres at 12 months (geometric mean ratio 1.01, 95%CI: 0.70,1.45; p=0.976) or fold-increase in RV-IgA titre between 9 and 12 months (risk ratio 0.999, 95%CI: 0.66,1.52; p=0.995) overall. However, HIV-exposed-uninfected infants who were seropositive for human cytomegalovirus at 9 months old had a 63% reduction in rotavirus antibody geometric mean titres at 12 months compared to HIV-exposed-uninfected infants who were seronegative for human cytomegalovirus (geometric mean ratio 0.37, 95%CI: 0.17, 0.77; p=0.008). While the broader implications of human cytomegalovirus infections on oral rotavirus vaccine response might be limited in the general infant population, the potential impact in the HIV-exposed-uninfected infants cannot be overlooked. This study highlights the complexity of immunological responses and the need for targeted interventions to ensure oral rotavirus vaccine efficacy, especially in vulnerable subpopulations.
Læs mere Tjek på PubMedBlock Ngaybe, M. G., Ravi, P., Rosales, A., Camarena, J. L., Madhivanan, P.
BMJ Open, 29.03.2024
Tilføjet 29.03.2024
BackgroundThere are currently over 38 million individuals around the globe living with the HIV and AIDS. As many HIV prevention and care services emerging for public use services become available to a wider audience, there is a growing need for more information about willingness to engage in these care and services. Stated preference research methods have been shown to be useful methods to help predict factors that influence health behaviours in the future. Research questionThis is a systematic review of findings from stated preference studies regarding the choices of people living with HIV or people at risk of contracting HIV to engage in HIV prevention or care. MethodsOur team plans to compile stated preference studies studying the choice to engage in HIV prevention or care services. Studies will be included from 1 January 2018 until 28 October 2022. There will be no restrictions on the language or location of the study. We will search databases including PubMed, PsycINFO, Embase, Scopus, Tufts CEA registry and CINAHL. Two researchers will review each article’s title, abstract, then full-text and finally extract relevant data based on a predetermined process. Data will be presented in a narrative review and in an exploratory meta-analysis by subgroups of studies. Ethics and dissemination of researchThere is no need for an ethical review process of this study since all data used is available publicly. The findings of this study will be reported in relevant conferences and submitted for publication in a peer-reviewed journal. PROSPERO registration numberCRD42023397785.
Læs mere Tjek på PubMedGarcia, C., Holbrook, A., Djiadeu, P., Alvarez, E., Matos Silva, J., Mbuagbaw, L.
BMJ Open, 29.03.2024
Tilføjet 29.03.2024
BackgroundAdequate surveillance of HIV drug resistance prevalence is challenged by heterogenous and inadequate data reporting. To address this issue, we recently published reporting guidance documentation for studies of HIV drug resistance prevalence and incidence. ObjectivesIn this study, we describe the methods used to develop this reporting guidance. DesignWe used a mixed-methods sequential explanatory design involving authors and users of studies of HIV drug resistance prevalence. In the quantitative phase, we conducted a cross-sectional electronic survey (n=51). Survey participants rated various reporting items on whether they are essential to report. Validity ratios were computed to determine the items to discuss in the qualitative phase. In the qualitative phase, two focus group discussions (n=9 in total) discussed this draft item checklist, providing a justification and examples for each item. We conducted a descriptive qualitative analysis of the group discussions to identify emergent themes regarding the qualities of an essential reporting item. ResultsWe identified 38 potential reporting items that better characterise the study participants, improve the interpretability of study results and clarify the methods used for HIV resistance testing. These items were synthesised to create the reporting item checklist. Qualitative insights formed the basis of the explanation, elaboration, and rationale components of the guidance document. ConclusionsWe generated a list of reporting items for studies on the incidence or prevalence of HIV drug resistance along with an explanation of why researchers believe these items are important. Mixed methods allowed for the simultaneous generation and integration of the item list and qualitative insights. The integrated findings were then further developed to become the subsequently published reporting guidance.
Læs mere Tjek på PubMedBMC Infectious Diseases, 29.03.2024
Tilføjet 29.03.2024
Abstract Background HIV virological failure is one of the main problems in HIV-infected patients, and identifying the main predictors of such treatment failure may help in combating HIV/AIDS. Methodology This cross-sectional study included 1800 HIV-infected patients with either virological failure or treatment response. HIV viral load, CD4 count, and other tests were performed. Statistical analysis was used to determine the predictors of virological failure. Results Clinical stage, treatment with reverse transcriptase inhibitors (RTIs), under therapy for three years or more, suboptimal adherence to antiretroviral treatment (ART), age > 40 years, CD4 count
Læs mere Tjek på PubMedJon Cohen
Science, 29.03.2024
Tilføjet 29.03.2024
Hareton Teixeira Vechi, Mônica Baumgardt Bay, Cláudio Henrique Silva de Freitas, Júlia Gomes Fernandes Costa de Sant’anna, Carlos Brites, Kenio Costa de Lima
PLoS One Infectious Diseases, 28.03.2024
Tilføjet 28.03.2024
by Hareton Teixeira Vechi, Mônica Baumgardt Bay, Cláudio Henrique Silva de Freitas, Júlia Gomes Fernandes Costa de Sant’anna, Carlos Brites, Kenio Costa de Lima Hepatitis A virus (HAV) infection has disproportionately affected more men who have sex with men (MSM), occurring in outbreaks, despite being vaccine-preventable. We determined the prevalence and factors associated with HAV susceptibility among cisgender MSM on HIV pre-exposure prophylaxis (PrEP) in Northeastern Brazil. From September 30, 2021 to June 19, 2023, 282 cisgender MSM receiving HIV PrEP were enrolled into this cross-sectional study. Sociodemographic and clinical information were collected. Blood samples were collected for screening of sexually transmitted infections (STIs) and serum samples were tested for IgM and total anti-HAV antibodies. Non-reactive results for total anti-HAV antibodies were found in 106 of 282 (37.6%) participants. Factors associated with HAV susceptibility included age
Læs mere Tjek på PubMedClinical Infectious Diseases, 28.03.2024
Tilføjet 28.03.2024
Abstract Background Improved epidemiologic and treatment data for active tuberculosis (TB) with chronic hepatitis B virus (cHBV) infection might inform and encourage screening and vaccination programs focused on persons at risk of having both conditions.Methods We matched the California Department of Public Health TB registry during 2016–2020 to the cHBV registry using probabilistic matching algorithms. We used chi-square analysis to compare the characteristics of persons with TB and cHBV with those with TB only. We compared TB treatment outcomes between these groups using modified Poisson regression models. We calculated the time between reporting of TB and cHBV diagnoses for those with both conditions.Results We identified 8,435 persons with TB, including 316 (3.7%) with cHBV. Among persons with TB and cHBV, 256 (81.0%) were non-U.S.-born Asian vs 4,186 (51.6%) with TB only (P 60 days after cHBV (median 3,411 days).Conclusion Persons with TB and cHBV were found more frequently in certain groups compared with TB only, and infrequently had their conditions diagnosed together. This highlights an opportunity to improve screening and treatment of TB and cHBV in those at high risk for coinfection.
Læs mere Tjek på PubMedClinical Infectious Diseases, 28.03.2024
Tilføjet 28.03.2024
Abstract Background There are little data on changes in insulin sensitivity during the first few years of life following in utero human immunodeficiency virus (HIV) and antiretroviral (ARV) exposure.Methods The Tshilo Dikotla study enrolled pregnant persons with HIV (PWH) (receiving tenofovir/emtricitabine or lamivudine plus dolutegravir or efavirenz) and pregnant individuals without HIV, as well as their liveborn children. Newborns were randomized to receive either zidovudine (AZT) or nevirapine (NVP) postnatal prophylaxis. Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) was assessed at birth and 1, 18, 24, and 36 months of life. We fit linear mixed-effects models to evaluate the association between in utero HIV/ARV exposure and average HOMA-IR from birth through 36 months of life, adjusting for confounders.Results A total of 419 children were included (287 with in utero HIV/ARV exposure and uninfected [CHEU] and 132 without in utero HIV/ARV exposure [CHUU]). CHEU were born to older women (29.6 vs 25.3 years of age) with higher gravidity (3 vs 1). HOMA-IR was persistently higher in CHEU versus CHUU in adjusted analyses (mean difference of 0.07 in log10 HOMA-IR, P = .02) from birth through 36 months of life. Among CHEU, no differences in HOMA-IR were observed from birth through 36 months by in utero ARV exposure status or between AZT and NVP infant prophylaxis arms.Conclusions In utero HIV/ARV exposure was associated with lower insulin sensitivity throughout the first 36 months of life, indicating persistent early life metabolic disturbances which may raise concern for poorer metabolic health later in life.
Læs mere Tjek på PubMedMinh Ha NgoJoshua PankracRyan C. Y. HoEmmanuel NdashimyeRahul PawaRenata CeccacciTsigereda BiruAbayomi S. OlabodeKatja KleinYue LiColin KovacsRobert AssadJeffrey M. JacobsonDavid H. CanadayStephen TomusangeSamiri JamiruAggrey AnokTaddeo KityamuweesiPaul BuuleRonald M. GaliwangoSteven J. ReynoldsThomas C. QuinnAndrew D. ReddJessica L. ProdgerJamie F. S. MannEric J. Artsa Department of Microbiology and Immunology, University of Western Ontario, London, Canadab College of Veterinary Medicine, Vietnam National University of Agriculture, Hanoi, Vietnamc Special Immunology Unit and Division of Infectious Diseases, Department of Medicine, Case Western Reserve University, Cleveland, OH, USAd Bristol Veterinary School, University of Bristol, Bristol, UKe Maple Leaf Medical Clinic and Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canadaf Rakai Health Sciences Program, Kalisizo, Ugandag Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USAh Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
Emerg Microbes Infect, 28.03.2024
Tilføjet 28.03.2024
BMC Infectious Diseases, 28.03.2024
Tilføjet 28.03.2024
Abstract Background The burden of cervical cancer in Ghana is high due to a lack of a national screening and vaccination program. Geographical variations in high-risk Human Papilloma Virus incidence and type should be considered for vaccine improvement and screening in LMICs. Methods A descriptive, multi-center cross-sectional study with purposive sampling of cases with cervical cancer diagnosed from January 2012 through to December 2018 was employed relying on archived Formalin Fixed Paraffin Embedded (FFPE) tissues from four (4) Teaching Hospitals. Cervical cancers were assessed for histopathological features following WHO guidelines. In addition, the novel Tumour Budding and Nest Size Grade (TBNS) for SCC, SILVA pattern of invasion for EAC and Tumour Infiltrating Lymphocytes (TILs) were assessed. High Risk HPV testing was performed using an isothermal, multiplex nucleic acid amplification method from ATILA biosystem (Mountain View California, USA). The FFPE blocks were tested for 15 hrHPV genotypes. Results were analyzed using SPSS v.26.0, with descriptive statistics and cross-tabulation and chi-square tests done with significance established at p
Læs mere Tjek på PubMedMaria Vittoria CossuAntonio D'AvolioCristina GervasoniAndrea GiacomelliDario CattaneoDavide Moschese1Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy2Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy, James E. Leggett
Antimicrobial Agents And Chemotherapy, 27.03.2024
Tilføjet 27.03.2024
Kelong Han1Clinical Pharmacology Modeling & Simulation, GSK, Collegeville, Pennsylvania, USA, James E. Leggett
Antimicrobial Agents And Chemotherapy, 27.03.2024
Tilføjet 27.03.2024
Karen O’Leary
Nature, 27.03.2024
Tilføjet 27.03.2024
Talha Burki
Lancet Respiratory Medicine, 27.03.2024
Tilføjet 27.03.2024
In places where conflict and displacement are a constant threat, Médecins Sans Frontières (MSF) has a straightforward way of ensuring that the people being treated for tuberculosis do not leave without their medication. MSF keeps a stock of so-called runaway kits containing sufficient drugs for each patient to finish their course. “If it seems likely that people are going to be displaced, we hand out the kits”, Animesh Sinha (HIV/TB/Hepatitis Advisor, MSF, London, UK) told The Lancet Respiratory Medicine.
Læs mere Tjek på PubMedThe PLOS ONE Editors
PLoS One Infectious Diseases, 27.03.2024
Tilføjet 27.03.2024
Journal of Infectious Diseases, 26.03.2024
Tilføjet 26.03.2024
Abstract Background The role of ribonucleases in tuberculosis (TB) among people with HIV (PWH) is unknown. We explored ribonuclease activity in plasma from PWH with and without TB.Methods Participants were identified from a cohort of treatment-naïve PWH in Ethiopia who had been classified for TB disease (HIV+/TB + or HIV+/TB-). Ribonuclease activity in plasma was investigated by quantification of synthetic spike-in RNAs using sequencing and qPCR, and by a specific ribonuclease activity assay. Quantification of ribonuclease 1, 2, 3, 6, 7 and T2 proteins was performed by ELISA. Ribonuclease activity and protein concentrations were correlated with markers of TB and HIV disease severity and with concentrations of inflammatory mediators.Results Ribonuclease activity was significantly higher in plasma of HIV+/TB + (n = 51) compared to HIV+/TB- (n = 78), causing reduced stability of synthetic spike-in RNAs. concentrations of ribonucleases 2, 3 and T2 were also significantly increased in HIV+/TB + compared to HIV+/TB-. Ribonuclease activity was correlated with HIV viral load, and inversely correlated with CD4 count, mid-upper arm circumference and body mass index. Moreover, ribonuclease activity correlated with concentrations of interleukin-27, kynurenine/tryptophan ratio and procalcitonin.Conclusion PWH with TB disease have elevated plasma ribonuclease activity, which is also associated with HIV severity and systemic inflammation.
Læs mere Tjek på PubMedClinical Infectious Diseases, 25.03.2024
Tilføjet 25.03.2024
Abstract A case of a male with human immunodeficiency virus with plasma genotyping detecting no resistance and a CRF02_AG subtype had a controlled HIV RNA on antiretroviral therapy since 2010. We introduced intramuscular therapy with cabotegravir and rilpivirine. One month later, his HIV RNA was 1500 copies/mL; genotyping found a subtype B with many mutations.
Læs mere Tjek på PubMedChimoyi, L., Ndini, P., Oladimeji, M., Seatlholo, N., Mawokomatanda, K., Charalambous, S., Setswe, G.
BMJ Open, 24.03.2024
Tilføjet 24.03.2024
ObjectiveTo explore the syndemic interaction between social, environmental, and structural contexts and HIV infection in peri-mining areas in South Africa. DesignMixed qualitative methods consisting of in-depth interviews (IDIs) and focus group discussions (FGDs) exploring the interaction between HIV infection and the social, environmental and structural factors affecting people living in the peri-mining areas of South Africa. Themes were analysed following the syndemic theoretical framework. SettingParticipants were recruited from three mining companies and locations in the peri-mining communities surrounding the mining companies in Limpopo, Mpumalanga, and Northern Cape provinces. ParticipantsInclusion criteria included mineworkers, healthcare workers, female sex workers (FSWs), injection drug users (IDUs), and other community members, ≥18 years, living in the peri-mining area at the time of participation. Three FGDs were conducted (n=30): 13 men and 17 women aged 18–55 years. IDIs were conducted with 45 participants: mineworkers (n=10), healthcare workers (n=11), FSWs (n=15), truck drivers (n=4) and IDUs (n=5). ResultsThe findings from this study indicate that a syndemic of four socio-behavioural factors is associated with HIV acquisition in peri-mining areas. These are migrancy, accessibility to alcohol and substance use, commercial and transactional sex, and uptake of HIV prevention services. ConclusionsOur findings have implications for HIV prevention programmes in mining companies, which rely on male condom usage promotion. More emphasis on better education about HIV prevalence, transmission and up-to-date prevention alternatives, such as pre-exposure prophylaxis for mineworkers is recommended. Furthermore, collaboration with community-based organisations is recommended to wholly address the syndemic factors influencing HIV transmission in peri-mining communities.
Læs mere Tjek på PubMedBurke, A., Davoren, M. P., Arensman, E., Harrington, J. M.
BMJ Open, 24.03.2024
Tilføjet 24.03.2024
ObjectivePsychoeducation is increasingly recognised for its value in facilitating adaption to a chronic disease diagnosis. This study aimed to synthesise available literature on the psychoeducation interventions available to adults living with chronic communicable disease. MethodsPubMed, CINAHL, Embase, SocINDEX, PsycINFO and PsycArticles were systematically searched up to May 2023. Peer-reviewed studies, published in English, investigating the impact of psychoeducational interventions on adults living with chronic communicable disease were included, across a range of outcome measures. Narrative synthesis was performed. The Effective Public Health Practice Project tool and Critical Appraisal Skills Programme tool were used to assess risk of bias. ResultsIn total, 22 studies were included in the review. The majority (n=16) of study populations focused on people living with HIV, followed by hepatitis C (n=5) and genital herpes (n=1). Interventions were delivered online (n=2), via telephone (n=1) and in-person (n=19). The majority of interventions were delivered in group sessions (n=16) and studies emphasised the value of group cohesion for social support, encouraging participants to share their own knowledge in addition to standard didactic presentations. Four studies facilitated peer-led delivery of the psychoeducation. Studies aiming to improve psychological well-being were beneficial in reducing depressive symptoms and/or emotional distress or showed improvement in the participant group overall. There was some evidence to suggest psychoeducation can improve readiness to attend treatment and medication adherence. ConclusionThe findings of this review highlight potential benefits of psychoeducation but indicate more robust clinical trials will be required to examine their effectiveness and elucidate the mechanisms by which they best operate. Future interventions incorporating a broader focus on resilience enhancement and coping skills specific to stigmatisation could more comprehensively serve the needs of adults living with chronic communicable disease, particularly with HIV. The role of peer support in group psychoeducation merits further exploration. PROSPERO registration numberCRD42021243058.
Læs mere Tjek på PubMedBMC Infectious Diseases, 24.03.2024
Tilføjet 24.03.2024
Abstract Background Men who have sex with men (MSM) are a key population group disproportionately affected by HIV and other sexually transmitted infections (STIs) worldwide. In Rwanda, the HIV epidemic remains a significant public health concern, and understanding the burden of HIV and hepatitis B and C coinfections among MSM is crucial for designing effective prevention and control strategies. This study aims to determine the prevalence of HIV, hepatitis B, and hepatitis C infections among MSM in Rwanda and identify correlates associated with HIV infection within this population. Methods We used respondent-driven sampling (RDS) to recruit participants between November and December 2021. A face-to-face, structured questionnaire was administered. Testing for HIV infection followed the national algorithm using two rapid tests: Alere Combo and STAT PAK as the first and second screening tests, respectively. Hepatitis B surface antigen (HBsAg) and anti-HCV tests were performed. All statistics were adjusted for RDS design, and a multivariable logistic regression model was constructed to identify factors associated with HIV infection. Results The prevalence of HIV among MSM was 6·9% (95% CI: 5·5–8·6), and among HIV-positive MSM, 12·9% (95% CI: 5·5–27·3) were recently infected. The prevalence of hepatitis B and C was 4·2% (95% CI: 3·0–5·7) and 0·7% (95% CI: 0·4–1·2), respectively. HIV and hepatitis B virus coinfection was 0·5% (95% CI: 0·2–1·1), whereas HIV and hepatitis C coinfection was 0·1% (95% CI: 0·0–0·5), and no coinfection for all three viruses was observed. MSM groups with an increased risk of HIV infection included those who ever suffered violence or abuse because of having sex with other men (AOR: 3·42; 95% CI: 1·87–6·25), those who refused to answer the question asking about ‘ever been paid money, goods, or services for sex’ (AOR: 10·4; 95% CI: 3·30–32·84), and those not consistently using condoms (AOR: 3·15; 95% CI: 1·31–7·60). Conclusion The findings suggest more targeted prevention and treatment approaches and underscore the importance of addressing structural and behavioral factors contributing to HIV vulnerability, setting interventions to reduce violence and abuse against MSM, promoting safe and consensual sexual practices, and expanding access to HIV prevention tools such as condoms and preexposure prophylaxis (PrEP).
Læs mere Tjek på PubMedZhengqiang Wang
Journal of Medical Virology, 23.03.2024
Tilføjet 23.03.2024
Paula Martínez de Aguirre, Silvia Carlos, Manuel Pina‐Sánchez, Samclide Mbikayi, Eduardo Burgueño, Céline Tendobi, Luis Chiva, África Holguín, Gabriel Reina
Journal of Medical Virology, 23.03.2024
Tilføjet 23.03.2024
Crowell, Trevor A.; Ritz, Justin; Zheng, Lu; Naqvi, Asma; Cyktor, Joshua C.; Puleo, Joseph; Clagett, Brian; Lama, Javier R.; Kanyama, Cecilia; Little, Susan J.; Cohn, Susan E.; Riddler, Sharon A.; Collier, Ann C.; Heath, Sonya L.; Tantivitayakul, Pornphen; Grinsztejn, Beatriz; Arduino, Roberto C.; Rooney, James F.; van Zyl, Gert U.; Coombs, Robert W.; Fox, Lawrence; Ananworanich, Jintanat; Eron, Joseph J.; Sieg, Scott F.; Mellors, John W.; Daar, Eric S.; for the AIDS Clinical Trials Group (ACTG) A5354/EARLIER Study Team
AIDS, 23.03.2024
Tilføjet 23.03.2024
Objective: To assess how antiretroviral therapy (ART) initiation during acute or early HIV infection (AEHI) affects the viral reservoir and host immune responses. Design: Single-arm trial of ART initiation during AEHI at 30 sites in the Americas, Africa, and Asia. Methods: HIV DNA was measured at week 48 of ART in 5 million CD4+ T cells by sensitive qPCR assays targeting HIV gag and pol. Peripheral blood mononuclear cells were stimulated with potential HIV T cell epitope peptide pools consisting of env, gag, nef, and pol peptides and stained for expression of CD3, CD4, CD8, and intracellular cytokines/chemokines. Results: From 2017 to 2019, 188 participants initiated ART during Fiebig stages I (n = 6), II (n = 43), III (n = 56), IV (n = 23), and V (n = 60). Median age was 27 years (interquartile range 23–38), 27 (14%) participants were female, and 180 (97%) cisgender. Among 154 virally suppressed participants at week 48, 100% had detectable HIV gag or pol DNA. Participants treated during Fiebig I had the lowest HIV DNA levels (P 0.025). At week 48, the magnitude, but not polyfunctionality, of HIV-specific T cell responses was moderately reduced among participants who initiated ART earliest. Conclusion: Earlier ART initiation during AEHI reduced but did not eliminate the persistence of HIV-infected cells in blood. These findings explain the rapid viral rebound observed after ART cessation in early-treated individuals with undetectable HIV DNA by less sensitive methods. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedColbrunn, Danielle K.; Jacks, Courtney; Curry, Scott R.; Gebregziabher, Mulugeta; Meissner, Eric G.
AIDS, 23.03.2024
Tilføjet 23.03.2024
Objective: The aim of this study was to examine outcomes of follow-up for persons with discordant fourth-generation HIV screening test results. Design: A retrospective chart review. Methods: We analyzed the electronic health record at the Medical University of South Carolina for a 10-year period spanning 2012–2022 to identify instances of discordant HIV screening test results, wherein initial antigen/antibody screening was positive, but reflex confirmatory testing for HIV-1 and HIV-2 antibodies was negative. We reviewed individual records to evaluate clinical follow-up and determine if the discordant test represented an acute HIV infection, a false-positive result, or was unresolved. Results: We identified 199 testing instances with discordant results. Most discordant results (n = 115) were subsequently determined to reflect a false-positive test, while 56 were unresolved without documented follow-up testing. Twenty-eight cases of acute HIV infection were identified of which 26 were linked to care within a month of initial testing. Two acute HIV cases were not identified in real time leading to delay in diagnosis and care. Testing done in the context of infectious symptoms and testing performed in the emergency department were associated with increased odds of a discordant test ultimately reflecting acute HIV infection. Conclusion: These results demonstrate the importance of appropriate and timely follow-up for discordant HIV screening test results. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedFilip, Iulia
AIDS, 23.03.2024
Tilføjet 23.03.2024
Neha Bhardwaj, Ashish Aggarwal, Harsimran Kaur, Shivaprakash M. Rudramurthy, Kirti Gupta
Clinical Microbiology and Infection, 23.03.2024
Tilføjet 23.03.2024
A 36-year-old drug abuser with chronic hepatitis C infection presented with headache due to raised intracranial pressure accompanied by vomiting for 2 days requiring ventriculoperitoneal shunting. Magnetic resonance imaging (MRI) revealed a ring-enhancing lesion in right cerebellar lobe with mass effect and hydrocephalus suggestive of tuberculoma (Figure 1A,B). An intra-operative frozen specimen grossly revealed a cavitatory lesion with a central necrosis. The frozen sections stained with toluidine blue and rapid hematoxylin & eosin demonstrated numerous scattered yeast and conidial forms admixed with segmented, bulbous, and pigmented fungal hyphae surrounding necrotic abscesses in the cerebellar folia.
Læs mere Tjek på PubMedMattia Trunfio, Bin Tang, Oluwakemi Okwuegbuna, Jennifer E. Iudicello, Ajay Bharti, David J. Moore, Benjamin B. Gelman, Susan Morgello, Payal B. Patel, Leah H. Rubin, Beau M. Ances, Sara Gianella, Robert K. Heaton, Ronald J. Ellis, Scott L. Letendre
Journal of Medical Virology, 22.03.2024
Tilføjet 22.03.2024
BMC Infectious Diseases, 22.03.2024
Tilføjet 22.03.2024
Abstract Background Tuberculous sepsis is uncommon in individuals without human immunodeficiency virus (HIV) infection, and some patients may not exhibit clinical signs and symptoms of suspected sepsis upon admission, leading to delayed diagnosis and treatment. Case presentation This report present the case of a 60-year-old female patient who presented with erythema, edema, and pain in her right upper limb accompanied by fever and chills. Further evaluation revealed multiple intermuscular abscesses caused by suspected gram-positive bacteria. Despite receiving anti-infection treatment, the patient rapidly progressed to septic shock and respiratory failure. Metagenomic next-generation sequencing (mNGS) analysis of blood samples detected Mycobacterium tuberculosis complex groups (11 reads). Additionally, mNGS analysis of fluid obtained from puncture of the abscess in the right upper extremity also suggested Mycobacterium tuberculosis complex groups (221 981 reads). Consequently, the patient was diagnosed with tuberculous sepsis resulting from hematogenous dissemination of Mycobacterium tuberculosis. Following the administration of anti-tuberculosis treatment, a gradual recovery was observed during the subsequent follow-up period. Conclusion It is noteworthy that atypical hematogenous disseminated tuberculosis can be prone to misdiagnosis or oversight, potentially leading to septic shock. This case illustrates the importance of early diagnosis and treatment of tuberculosis sepsis. Advanced diagnostic techniques such as mNGS can aid clinicians in the early identification of pathogens for definitive diagnosis.
Læs mere Tjek på PubMedBMC Infectious Diseases, 22.03.2024
Tilføjet 22.03.2024
Abstract Background Dolutegravir is an integrase strand transfer inhibitor that has been recommended for use in first-line antiretroviral regimens by the World Health Organisation and is currently being rolled out globally. There has been safety concerns with dolutegravir which has caused concern about its use in the general population. Dolutegravir first-line regimens have been used in South Africa since early 2020. Therefore, the aim of the present study was to assess the efficacy, safety, and tolerability of first-line dolutegravir-based antiretrovirals amongst adults living with HIV in Durban, South Africa. Methods This was a mixed-methods study, which comprised a cross-sectional survey and longitudinal retrospective follow-up of medical records. The study was conducted between October 2020 and January 2022. Data were described using descriptive and summary statistics. Bivariate logistic regression was applied to socio-demographic and clinical variables and crude odds ratios with a 95% confidence interval was calculated. Pearson chi-square tests, paired sample T-tests, and cross-tabulations were performed on selected variables. Results A total of 461 participants were enrolled in the study. There was a significant change in immunological outcomes (p
Læs mere Tjek på PubMedGeoff Watts
Lancet, 22.03.2024
Tilføjet 22.03.2024
“What I like about being a physician–scientist is that when you see people every day in clinic, and you\'re reminded of immense need, you also know that through research you can design and implement solutions that help to address some of the challenges”, says Andrew Kerkhoff. As Assistant Professor in the Department of Medicine at the University of California, San Francisco (UCSF) and Zuckerberg San Francisco General Hospital, CA, USA, Kerkhoff is well placed to tackle the challenges posed by tuberculosis, the infection which, along with HIV, has been the focus of his career.
Læs mere Tjek på PubMedClinical Infectious Diseases, 21.03.2024
Tilføjet 21.03.2024
Abstract Background Weight gain and associated metabolic complications are increasingly prevalent among people with HIV (PWH). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are incretin-based therapies for diabetes and weight management that have been shown to result in substantial weight loss; however, studies of their effects in PWH are limited.Methods A retrospective single-center cohort study was conducted among PWH who were taking GLP-1RAs at UC San Diego Owen Clinic between 2/1/2021 to 2/1/2023. Baseline clinical data were collected and changes in weight, body mass index (BMI), and hemoglobin A1C (A1C) before starting GLP-1RAs compared to the most recent clinic visit were calculated (with a minimum of 3 months follow-up time required). Logistic regression was performed to identify variables associated with >5% of total body weight loss.Results A total of 225 patients received on average 13 months of GLP-1RA therapy, with 85 (37.8%) achieving the maximum GLP-1RA dose. GLP-1RA therapy resulted, on average, in a loss of 5.4 kg, decrease in BMI by 1.8 kg/m2, and decrease in A1C by 0.6%. In the multivariable analysis, higher baseline BMI [OR 1.10 (1.03-1.16)], treatment duration of GLP-1RA therapy greater than 6 months [OR 3.12 (1.49-6.49], and use of tirzepatide [OR 5.46 (1.44-20.76)] were significantly more likely to be associated with >5% weight loss.Conclusions Use of GLP-1RAs led to declines in weight, BMI, and hemoglobin A1C among PWH and offers an additional strategy to address weight gain and diabetes.
Læs mere Tjek på PubMedAdah Tumwegamire, Robin Fatch, Nneka I. Emenyonu, Sara Lodi, Winnie R. Muyindike, Allen Kekibiina, Julian Adong, Christine Ngabirano, Brian Beesiga, Kara Marson, Nakisa Golabi, Moses Kamya, Gabriel Chamie, Judith A. Hahn
PLoS One Infectious Diseases, 21.03.2024
Tilføjet 21.03.2024
by Adah Tumwegamire, Robin Fatch, Nneka I. Emenyonu, Sara Lodi, Winnie R. Muyindike, Allen Kekibiina, Julian Adong, Christine Ngabirano, Brian Beesiga, Kara Marson, Nakisa Golabi, Moses Kamya, Gabriel Chamie, Judith A. Hahn Background Smoking and alcohol use frequently co-occur and are the leading causes of preventable death in sub-Saharan Africa (SSA) and are common among people living with HIV (PLWH). While alcohol use has been shown to be associated with reduced adherence to antiretroviral treatment (ART), which may affect HIV viral suppression, the independent effect of smoking on HIV outcomes in SSA is unknown. We aimed to 1) describe the prevalence of current smoking and correlates of smoking; 2) assess the association of smoking with viral suppression, adjusting for level of alcohol use; 3) explore the relationship between smoking and CD4 cell count
Læs mere Tjek på PubMedJournal of Infectious Diseases, 20.03.2024
Tilføjet 20.03.2024
Abstract HIV-1 RNA genetic diversity predicts time since infection which is important for clinical care and research. It\'s unclear, however, whether proviral DNA genetic diversity sampled under suppressive antiretroviral therapy can be used for this purpose. We tested whether proviral genetic diversity from NGS sequences predicts time since infection and recency in 221 people with HIV-1 with known infection time. Proviral diversity was significantly associated with time since infection (p
Læs mere Tjek på PubMedVan Hout, M.-C., Akugizibwe, M., Shayo, E. H., Namulundu, M., Kasujja, F. X., Namakoola, I., Birungi, J., Okebe, J., Murdoch, J., Mfinanga, S. G., Jaffar, S.
BMJ Open, 20.03.2024
Tilføjet 20.03.2024
IntroductionSub-Saharan Africa continues to experience a syndemic of HIV and non-communicable diseases (NCDs). Vertical (stand-alone) HIV programming has provided high-quality care in the region, with almost 80% of people living with HIV in regular care and 90% virally suppressed. While integrated health education and concurrent management of HIV, hypertension and diabetes are being scaled up in clinics, innovative, more efficient and cost-effective interventions that include decentralisation into the community are required to respond to the increased burden of comorbid HIV/NCD disease. Methods and analysisThis protocol describes procedures for a process evaluation running concurrently with a pragmatic cluster-randomised trial (INTE-COMM) in Tanzania and Uganda that will compare community-based integrated care (HIV, diabetes and hypertension) with standard facility-based integrated care. The INTE-COMM intervention will manage multiple conditions (HIV, hypertension and diabetes) in the community via health monitoring and adherence/lifestyle advice (medicine, diet and exercise) provided by community nurses and trained lay workers, as well as the devolvement of NCD drug dispensing to the community level. Based on Bronfenbrenner’s ecological systems theory, the process evaluation will use qualitative methods to investigate sociostructural factors shaping care delivery and outcomes in up to 10 standard care facilities and/or intervention community sites with linked healthcare facilities. Multistakeholder interviews (patients, community health workers and volunteers, healthcare providers, policymakers, clinical researchers and international and non-governmental organisations), focus group discussions (community leaders and members) and non-participant observations (community meetings and drug dispensing) will explore implementation from diverse perspectives at three timepoints in the trial implementation. Iterative sampling and analysis, moving between data collection points and data analysis to test emerging theories, will continue until saturation is reached. This process of analytic reflexivity and triangulation across methods and sources will provide findings to explain the main trial findings and offer clear directions for future efforts to sustain and scale up community-integrated care for HIV, diabetes and hypertension. Ethics and disseminationThe protocol has been approved by the University College of London (UK), the London School of Hygiene and Tropical Medicine Ethics Committee (UK), the Uganda National Council for Science and Technology and the Uganda Virus Research Institute Research and Ethics Committee (Uganda) and the Medical Research Coordinating Committee of the National Institute for Medical Research (Tanzania). The University College of London is the trial sponsor. Dissemination of findings will be done through journal publications and stakeholder meetings (with study participants, healthcare providers, policymakers and other stakeholders), local and international conferences, policy briefs, peer-reviewed journal articles and publications. Trial registration numberISRCTN15319595.
Læs mere Tjek på PubMedSarah May Johnson, Jhia Jiat Teh, Thomas Joshua Pasvol, Sara Ayres, Hermione Lyall, Sarah Fidler, Caroline Foster
PLoS One Infectious Diseases, 20.03.2024
Tilføjet 20.03.2024
by Sarah May Johnson, Jhia Jiat Teh, Thomas Joshua Pasvol, Sara Ayres, Hermione Lyall, Sarah Fidler, Caroline Foster Introduction Complex challenges amongst ageing cohorts of adolescents and adults living with perinatally acquired HIV (PaHIV) may impact on hospitalisation. We report hospitalisation rates and explored predictive factors for hospitalisation in adolescents and adults (10–35 years) living with PaHIV in England. Method Retrospective observational cohort study over a three-year period 2016–2019. Data collected included cause and duration of hospitalisation, HIV viral load and CD4 lymphocyte count. The primary outcome was overnight hospitalisation. Patients exited at study end/ transfer of care (TOC)/ loss to follow up (LTFU) or death. Maternity/hospital admissions at other centres were excluded. Admission rates per 100 person-years (95% CI) were calculated by age group. Negative binomial regression with generalized estimating equations was performed. Results 255 patients contributed 689 person-years of follow up. 56% were female and 83% were of a Black, Black British, Caribbean or African ethnicity. At baseline, the median age was 19 years (IQR 16–22). 36 individuals experienced a total of 62 admissions which resulted in 558 overnight stays (median stay was 5 nights). One person died (lymphoma), six had TOC and one was LTFU by the end of the three-year study period. Crude incidence of admission for the whole cohort was 9.0 per 100 PY (6.9–11.6). The respective crude incidence rates were 1.5 PY (0.0–8.2) in those aged 10–14 years and 3.5 PY (1.5–7.0) in the 15–19-year-olds. In those aged 20–24 years it was 14.5 PY (10.1–20.2) and in those >25 years the crude incidence rate was 11.7 PY (6.9–18.5). Factors significantly associated with admission were a CD4 lymphocyte count 20 years of age) compared to adolescents (10–19-year-olds). The continuing challenges experienced by PaHIV youth require enhanced multidisciplinary support throughout adulthood.
Læs mere Tjek på PubMedJournal of the American Medical Association, 19.03.2024
Tilføjet 19.03.2024
More than a decade after the approval of emtricitabine and tenofovir disoproxil fumarate (F/TDF) for HIV preexposure prophylaxis (PrEP), rates of new HIV infections remain high globally, with most occurring among cisgender women, and exceed the United Nations global targets. In the US, rates of PrEP use are substantially low in cisgender women, with disparities by race and ethnicity and across regions. Concerns about the effectiveness of F/TDF and limited PrEP alternatives complicate efforts to increase the use of PrEP in cisgender women.
Læs mere Tjek på PubMedJournal of the American Medical Association, 19.03.2024
Tilføjet 19.03.2024
This pooled analysis of postapproval studies examines the association between baseline demographics and other characteristics and PrEP adherence trajectories with HIV incidence in women.
Læs mere Tjek på PubMedBMC Infectious Diseases, 19.03.2024
Tilføjet 19.03.2024
Abstract Background The burden of herpes zoster (shingles) virus and associated complications, such as post-herpetic neuralgia, is higher in older adults and has a significant impact on quality of life. The incidence of herpes zoster and post-herpetic neuralgia is increased in people living with HIV (PLWH) compared to an age-matched general population, including PLWH on long-term antiretroviral therapy (ART) with no detectable viremia and normal CD4 counts. PLWH – even on effective ART may- exhibit sustained immune dysfunction, as well as defects in cells involved in the response to vaccines. In the context of herpes zoster, it is therefore important to assess the immune response to varicella zoster virus vaccination in older PLWH and to determine whether it significantly differs to that of HIV-uninfected healthy adults or younger PLWH. We aim at bridging these knowledge gaps by conducting a multicentric, international, non-randomised clinical study (SHINGR’HIV) with prospective data collection after vaccination with an adjuvant recombinant zoster vaccine (RZV) in two distinct populations: in PLWH on long-term ART (> 10 years) over 50 years of and age/gender matched controls. Methods We will recruit participants from two large established HIV cohorts in Switzerland and in France in addition to age-/gender-matched HIV-uninfected controls. Participants will receive two doses of RZV two months apart. In depth-evaluation of the humoral, cellular, and innate immune responses and safety profile of the RZV will be performed to address the combined effect of aging and potential immune deficiencies due to chronic HIV infection. The primary study outcome will compare the geometric mean titer (GMT) of gE-specific total IgG measured 1 month after the second dose of RZV between different age groups of PLWH and between PLWH and age-/gender-matched HIV-uninfected controls. Discussion The SHINGR’HIV trial will provide robust data on the immunogenicity and safety profile of RZV in older PLWH to support vaccination guidelines in this population. Trial registration ClinicalTrials.gov NCT05575830. Registered on 12 October 2022. Eu Clinical Trial Register (EUCT number 2023-504482-23-00).
Læs mere Tjek på PubMedBMC Infectious Diseases, 19.03.2024
Tilføjet 19.03.2024
Abstract Background Over one-third of people living with HIV (PLH) in Ukraine are not on treatment. Index testing services, which link potentially exposed partners (named partners) of known PLH (index patients) with testing and treatment services, are being scaled in Ukraine and could potentially close this gap. Methods This retrospective study included patient data from 14,554 adult PLH who initiated antiretroviral treatment (ART) between October 2018 and May 2021 at one of 35 facilities participating in an intervention to strengthen index testing services. Mixed effects modified Poisson models were used to assess differences between named partners and other ART initiators, and an interrupted time series (ITS) analysis was used to assess changes in ART initiation over time. Results Compared to other ART initiators, named partners were significantly less likely to have a confirmed TB diagnosis (aRR = 0.56, 95% CI = 0.40, 0.77, p
Læs mere Tjek på PubMedRathbone, A., Cartwright, N., Cummings, L., Noble, R., Budaiova, K., Ashton, M., Foster, J., Payne, B., Duncan, S.
BMJ Open, 19.03.2024
Tilføjet 19.03.2024
IntroductionYoung people aged 18–24 years old are a key demographic target for eliminating HIV transmission globally. Pre-exposure prophylaxis (PrEP), a prevention medication, reduces HIV transmission. Despite good uptake by gay and bisexual men who have sex with men, hesitancy to use PrEP has been observed in other groups, such as young people and people from ethnic minority backgrounds. The aim of this study was to explore young people’s perceptions and attitudes to using PrEP. DesignA qualitative transcendental phenomenological design was used. Participants and settingA convenience sample of 24 young people aged between 18 and 24 years was recruited from England. MethodsSemistructured interviews and graphical elicitation were used to collect data including questions about current experiences of HIV care, awareness of using PrEP and decision-making about accessing PrEP. Thematic and visual analyses were used to identify findings. ResultsYoung people had good levels of knowledge about HIV but poor understanding of using PrEP. In this information vacuum, negative stigma and stereotypes about HIV and homosexuality were transferred to using PrEP, which were reinforced by cultural norms portrayed on social media, television and film—such as an association between using PrEP and being a promiscuous, white, gay male. In addition, young people from ethnic minority communities appeared to have negative attitudes to PrEP use, compared with ethnic majority counterparts. This meant these young people in our study were unable to make decisions about when and how to use PrEP. ConclusionFindings indicate an information vacuum for young people regarding PrEP. A strength of the study is that theoretical data saturation was reached. A limitation of the study is participants were largely from Northern England, which has low prevalence of HIV. Further work is required to explore the information needs of young people in relation to PrEP.
Læs mere Tjek på PubMedBMC Infectious Diseases, 18.03.2024
Tilføjet 18.03.2024
Abstract Background Our aim was to examine the prevalence and characteristics of difficult-to-treat HIV in the current Swedish HIV cohort and to compare treatment outcomes between people with difficult and non-difficult-to-treat HIV. Methods In this cross-sectional analysis of the Swedish HIV cohort, we identified all people with HIV currently in active care in 2023 from the national register InfCareHIV. We defined five categories of difficult-to-treat HIV: 1) advanced resistance, 2) four-drug regimen, 3) salvage therapy, 4) virologic failure within the past 12 months, and 5) ≥ 2 regimen switches following virologic failure since 2008. People classified as having difficult-to-treat HIV were compared with non-difficult for background characteristics as well as treatment outcomes (viral suppression and self-reported physical and psychological health). Results Nine percent of the Swedish HIV cohort in 2023 (n = 8531) met at least one criterion for difficult-to-treat HIV. Most of them had ≥ 2 regimen switches (6%), and the other categories of difficult-to-treat HIV were rare (1–2% of the entire cohort). Compared with non-difficult, people with difficult-to-treat HIV were older, had an earlier first year of positive HIV test and lower CD4 counts, and were more often female. The viral suppression rate among people with difficult-to-treat HIV was 84% compared with 95% for non-difficult (p = 0.001). People with difficult-to-treat HIV reported worse physical (but not psychological) health, and this remained statistically significant after adjustment for age, sex, and transmission group. Conclusions Although 9% of the HIV cohort in Sweden in 2023 were classified as having difficult-to-treat HIV, a large proportion of these were virally suppressed, and challenges such as advanced resistance and need for salvage therapy are rare in the current Swedish cohort.
Læs mere Tjek på PubMedInfection, 16.03.2024
Tilføjet 16.03.2024
Abstract Purpose The risk of developing active tuberculosis (TB) is considerably increased in people living with HIV/AIDS (PLWH). However, incidence of HIV/TB coinfection is difficult to assess as surveillance data are lacking in many countries. Here, we aimed to perform a quantitative analysis of HIV/TB coinfections within the Cologne/Bonn HIV cohort and to determine risk factors for active TB. Methods We systematically evaluated data of patients with HIV/TB coinfection between 2006 and 2017. In this retrospective analysis, we compared HIV/TB-coinfected patients with a cohort of HIV-positive patients. The incidence density rate (IDR) was calculated for active TB cases at different time points. Results During 2006–2017, 60 out of 4673 PLWH were diagnosed with active TB. Overall IDR was 0.181 cases/100 patient-years and ranged from 0.266 in 2006–2009 to 0.133 in 2014–2017. Patients originating from Sub-Saharan Africa had a significantly (p
Læs mere Tjek på PubMedClinical Infectious Diseases, 16.03.2024
Tilføjet 16.03.2024
Abstract Background Oral pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir disoproxil fumarate (F/TDF) has high efficacy against HIV-1 acquisition. Seventy-two prospective studies of daily oral F/TDF PrEP were conducted to evaluate HIV-1 incidence, drug resistance, adherence, and bone and renal safety in diverse settings.Methods HIV-1 incidence was calculated from incident HIV-1 diagnoses after PrEP initiation and within 60 days of discontinuation. Tenofovir concentration in dried blood spots (DBS), drug resistance, and bone/renal safety indicators were evaluated in a subset of studies.Results Among 17,274 participants, there were 101 cases with new HIV-1 diagnosis (0.77 per 100 person-years; 95% CI 0.63–0.94). In 78 cases with resistance data, 18 (23%) had M184I or V, one (1.3%) had K65R, and three (3.8%) had both mutations. In 54 cases with tenofovir concentration data from DBS, 45 (83.3%), 2 (3.7%), 6 (11.1%), and 1 (1.9%) had average adherence of
Læs mere Tjek på PubMedRumbidzai Chireshe, Tawanda Manyangadze, Keshena Naidoo
PLoS One Infectious Diseases, 15.03.2024
Tilføjet 15.03.2024
by Rumbidzai Chireshe, Tawanda Manyangadze, Keshena Naidoo Background Integrated health care is an approach characterized by a high degree of collaboration and communication among health professionals. Integration of HIV/NCD is recommended to enhance the quality of healthcare services being provided. Duplication of limited resources is minimized, and a holistic care approach is promoted by shifting from acute and reactive care to care that embraces patient-centredness that includes promotive health and disease surveillance. The high burden of HIV disease in sub-Saharan Africa (SSA) combined with the increasing prevalence of chronic non-communicable diseases (NCDs) necessitates a review of how health systems has been doing to deliver quality integrated care for people living with HIV (PLWH) and comorbid chronic NCDs. Methods A scoping review was conducted to identify and describe all publications on integrated chronic care management models at the primary care level in the SSA context, particularly those that addressed the care of PLHIV with co-morbid chronic NCDs. The inclusion and exclusion criteria were applied, and duplicates were removed. Results A total of twenty-one articles were included in the final review. Integrated healthcare systems were reported in only eight SSA countries–(South Africa, Uganda, Kenya, the United Republic of Tanzania, Zambia, Malawi, Zimbabwe and Swaziland). Integrated care systems adopted one of three health models. These included added-on NCD services to previously dedicated HIV care facilities, expansion of primary care facilities to include HIV care and establishment of integrated care services. Short-term benefits included staff capacitation, improved retention of patients and improved screening and detection of NCDs. However, the expansion of existing services resulted in an increased workload with no additional staff. A significant positive change noted by communities was that there was less or no stigmatisation of people living with HIV when attending dedicated HIV clinics. Conclusion Evidence of integrated healthcare services for PLWH and co-morbid of NCDs in SSA is scanty. Data on some short-term benefits of integrated care was available, but evidence was absent on the long-term outcomes. Randomized clinical trials with clearly defined comparator groups and standardized measures of HIV and NCD outcomes are needed to demonstrate non-inferiority of integrated against non-integrated care.
Læs mere Tjek på PubMedWeiser, John; Tie, Yunfeng; Crim, Stacy M.; Riedel, David J.; Shouse, R. Luke; Dasgupta, Sharoda
Journal of Acquired Immune Deficiency Syndromes, 15.03.2024
Tilføjet 15.03.2024
Background: We compared HIV care outcomes by HIV provider type to inform efforts to strengthen the HIV provider workforce. Setting: U.S. Methods: We analyzed data from CDC’s Medical Monitoring Project collected during 6/2019-5/2021 from 6,323 adults receiving HIV medical care. Provider types were infectious disease physicians only (ID physicians), non-ID physicians only (non-ID physicians), nurse practitioners only (NPs), physician assistants only (PAs), and ID physicians plus NPs and/or PAs (mixed providers). We measured patient characteristics, social determinants of health (SDOH), and clinical outcomes including retention in care; antiretroviral therapy prescription; antiretroviral therapy adherence; viral suppression; gonorrhea, chlamydia, and syphilis testing; satisfaction with HIV care; and HIV provider trust. Results: Compared with patients of ID physicians, higher percentages of patients of other provider types had characteristics and SDOH associated with poor health outcomes and received HIV care at Ryan White HIV/AIDS Program-funded facilities. After accounting for these differences, most outcomes were not meaningfully different, however higher percentages of patients of non-ID physicians, NPs, and mixed providers were retained in care (6.5, 5.6, and 12.7 percentage points, respectively) and had STI testing in the past 12 months, if sexually active (6.9, 7.4, and 13.5 percentage points, respectively). Conclusion: Most HIV outcomes were equivalent across provider types. However, patients of non-ID physicians, NPs, and mixed providers were more likely to be retained in care and have recommended STI testing. Increasing delivery of comprehensive primary care by ID physicians and including primary care providers in ID practices could improve HIV primary care outcomes. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedMadlala, Hlengiwe P.; Myer, Landon; Geffen, Hayli; Rusch, Jody; Shey, Muki S.; Meyer, Demi; Goedecke, Julia H.; Malaba, Thokozile R.; Gray, Clive M.; Newell, Marie-Louise; Jao, Jennifer
Journal of Acquired Immune Deficiency Syndromes, 15.03.2024
Tilføjet 15.03.2024
Background: Postpartum weight (PPW) contributes to long-term obesity, a growing concern in persons with HIV (PWH). We investigated whether inflammatory markers in pregnancy may be involved in postpartum (PP) obesity in PWH. Setting: A total of 57 pregnant PWH enrolled at ≤14 weeks gestation (T1) in Gugulethu antenatal care clinic in Cape Town and followed through 48 weeks PP were included. Methods: Plasma soluble (s) CD14, sCD163, leptin, tumour necrosis factor receptor 1 (TNFR-1), resistin, adiponectin, and interleukin-6 (IL-6) were assayed in duplicate using the Luminex platform. We considered each inflammatory marker at T1 (n=57) and T3 (29-36 weeks gestation, n=31) as a separate exposure of interest. Linear mixed effects models were fit to examine whether each exposure was associated with average PPW and PPW trajectories; linear regression was used for associations with PPW change between T1 and 48 weeks. Results: Median age was 32 years (IQR, 29-35), 98% were multigravida, and 49% had a BMI≥30 kg/m2. Higher T1 sCD14 levels were associated with higher average weight through 48 weeks PP (ß = 0.002, p=0.04), and T3 sCD14 with higher PPW gain (ß = 0.007, p=0.04). Leptin (ß = 0.414, p
Læs mere Tjek på PubMedNúñez, Isaac; Ceballos-Liceaga, Santa E.; Torre, Alethse de la; García-Rodríguez, Gabriel; López-Martínez, Irma; López-Gatell, Hugo; Mosqueda-Gómez, Juan L.; Valdés-Ferrer, Sergio Iván
Journal of Acquired Immune Deficiency Syndromes, 15.03.2024
Tilføjet 15.03.2024
Background: People who live with HIV (PWLH) have been one of the most affected groups during the current mpox outbreak. They are hypothesized to have a more severe clinical course than people without HIV but comparative data is scarce. We aimed to compare clinical features and outcomes of mpox in people with and without HIV in Mexico. Setting: Country-wide study in Mexico. Methods: We performed an observational study using nation-wide epidemiological data. We included all people with confirmed mpox diagnosed between May and November 2022 in Mexico. Clinical and sociodemographic characteristics were compared between people with and without HIV. Multivariable logistic regression models were preformed to determine the association between HIV, clinical features, and outcomes and reported with odds ratios (ORs) and 95% confidence intervals (95% CI). ORs for rare outcomes were interpreted as risk ratios. Results: Among 3291 people with mpox, 59% were PWLH. PWLH had an increased risk of severe mpox (OR 2.6, 2.4-2.9) and death (OR 10.8, 9.7-11.9). They also had a higher risk of otalgia, proctitis, and urethritis. Eleven individuals died, of whom ten were PWLH. All deaths were directly attributed to mpox. Conclusion: People with HIV have a higher risk of severe mpox and death due to mpox. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedBMC Infectious Diseases, 15.03.2024
Tilføjet 15.03.2024
Abstract Introduction In 2022, the WHO reported that 29.8 million people around the world were living with HIV (PLHIV) and receiving antiretroviral treatment (ART), including 25 375 people in Gabon (54% of all those living with HIV in the country). The literature reports a frequency of therapeutic failure with first-line antiretrovirals (ARVs) of between 20% and 82%. Unfortunately, data relating to the failure of second-line ARVs are scarce in Gabon. This study aims to determine the profiles of HIV drug resistance mutations related to protease inhibitors in Gabon. Methodology Plasma from 84 PLHIV receiving ARVs was collected from 2019 to 2021, followed by RNA extraction, amplification, and sequencing of the protease gene. ARV resistance profiles were generated using the Stanford interpretation algorithm version 8.9-1 (https://hivdb.stanford.edu) and statistical analyses were performed using EpiInfo software version 7.2.1.0 (CDC, USA). Results Of 84 HIV plasma samples collected from 45 men and 39 women, 342 mutations were detected. Of these, 43.3% (148/342) were associated with nucleoside reverse transcriptase inhibitors (NRTIs), 30.4% (104/342) with non-nucleoside reverse transcriptase inhibitors (NNRTIs), and 26.3% (90/342) with protease inhibitors (PIs). Most NRTI mutations were associated with thymidine analogues (TAMs) (50.7%; 75/148), including T215F/V (14.9%; 22/148), D67DN/E/G/N/T (10.1%; 15/148), M41L (9.5%; 14/148), and K70E/KN/S/R (9.5%; 14/148). Resistance mutations related to non-TAM NRTIs (33.1%; 49/148) were M184V (29.1%; 43/148), and L74I/V (8.1%; 12/148). NNRTI mutations were predominantly K103N/S (32.7%; 34/104), V108I (10.6%; 11/104), A98G (10.6%; 11/104), and P225H (9.6%; 10/104). Minor mutations associated with PIs (60.0%; 54/90) were predominantly K20I (15.6%; 14/90) and L10F/I/V (14.5%; 13/90). The major mutations associated with PIs (40.0%; 36/90) were M41L (12.2%; 11/90), I84V (6.7%; 06/90), and V82A (6.7%; 06/90). The four most prescribed therapeutic regimens were TDF + 3TC + LPV/r (20.3%; 17/84), ABC + DDI + LPV/r (17.9%; 15/84), TDF + FTC + LPV/r (11.9%; 10/84), and ABC + 3TC + LPV/r (11.9%; 10/84). Conclusion This study revealed that HIV drug resistance mutations are common in Gabon. The major mutations associated with PIs were M41L, I84V, and V82A. There is a need for access to new NRTIs, NNRTIs, and PIs for a better therapeutic management of PLHIV in Gabon.
Læs mere Tjek på PubMedKim, J.-H., Tack, B., Fiorino, F., Pettini, E., Marchello, C., Jacobs, J., Crump, J., Marks, F., Vacc-iNTS Consortium
BMJ Open, 15.03.2024
Tilføjet 15.03.2024
BackgroundInvasive non-typhoidal Salmonella (iNTS) disease is a significant health concern in sub-Saharan Africa. While our knowledge of a larger-scale variation is growing, understanding of the subnational variation in iNTS disease occurrence is lacking, yet crucial for targeted intervention. MethodWe performed a systematic review of reported occurrences of iNTS disease in sub-Saharan Africa, consulting literature from PubMed, Embase and Web of Science published since 2000. Eligibility for inclusion was not limited by study type but required that studies reported original data on human iNTS diseases based on the culture of a normally sterile site, specifying subnational locations and the year, and were available as full-text articles. We excluded studies that diagnosed iNTS disease based on clinical indications, cultures from non-sterile sites or serological testing. We estimated the probability of occurrence of iNTS disease for sub-Saharan Africa on 20 km x 20 km grids by exploring the association with geospatial covariates such as malaria, HIV, childhood growth failure, access to improved water, and sanitation using a boosted regression tree. ResultsWe identified 130 unique references reporting human iNTS disease in 21 countries published from 2000 through 2020. The estimated probability of iNTS occurrence grids showed significant spatial heterogeneity at all levels (20 km x 20 km grids, subnational, country and subregional levels) and temporal heterogeneity by year. For 2020, the probability of occurrence was higher in Middle Africa (0.34, 95% CI: 0.25 to 0.46), followed by Western Africa (0.33, 95% CI: 0.23 to 0.44), Eastern Africa (0.24, 95% CI: 0.17 to 0.33) and Southern Africa (0.08, 95% CI: 0.03 to 0.11). Temporal heterogeneity indicated that the probability of occurrence increased between 2000 and 2020 in countries such as the Republic of the Congo (0.05 to 0.59) and Democratic Republic of the Congo (0.10 to 0.48) whereas it decreased in countries such as Uganda (0.65 to 0.23) or Zimbabwe (0.61 to 0.37). ConclusionThe iNTS disease occurrence varied greatly across sub-Saharan Africa, with certain regions being disproportionately affected. Exploring regions at high risk for iNTS disease, despite the limitations in our data, may inform focused resource allocation. This targeted approach may enhance efforts to combat iNTS disease in more affected areas.
Læs mere Tjek på PubMedSamantha A. Devlin, Amy K. Johnson, Kimberly A. Stanford, Sadia Haider, Jessica P. Ridgway
PLoS One Infectious Diseases, 15.03.2024
Tilføjet 15.03.2024
by Samantha A. Devlin, Amy K. Johnson, Kimberly A. Stanford, Sadia Haider, Jessica P. Ridgway Automated algorithms for identifying potential pre-exposure prophylaxis (PrEP) candidates are effective among men, yet often fail to detect cisgender women (hereafter referred to as “women”) who would most benefit from PrEP. The emergency department (ED) is an opportune setting for implementing automated identification of PrEP candidates, but there are logistical and practical challenges at the individual, provider, and system level. In this study, we aimed to understand existing processes for identifying PrEP candidates and to explore determinants for incorporating automated identification of PrEP candidates within the ED, with specific considerations for ciswomen, through a focus group and individual interviews with ED staff. From May to July 2021, we conducted semi-structured qualitative interviews with 4 physicians and a focus group with 4 patient advocates working in a high-volume ED in Chicago. Transcripts were coded using Dedoose software and analyzed for common themes. In our exploratory study, we found three major themes: 1) Limited PrEP knowledge among ED staff, particularly regarding its use in women; 2) The ED does not have a standardized process for assessing HIV risk; and 3) Perspectives on and barriers/facilitators to utilizing an automated algorithm for identifying ideal PrEP candidates. Overall, ED staff had minimal understanding of the need for PrEP among women. However, participants recognized the utility of an electronic medical record (EMR)-based automated algorithm to identify PrEP candidates in the ED. Facilitators to an automated algorithm included organizational support/staff buy-in, patient trust, and dedicated support staff for follow-up/referral to PrEP care. Barriers reported by participants included time constraints, hesitancy among providers to prescribe PrEP due to follow-up concerns, and potential biases or oversight resulting from missing or inaccurate information within the EMR. Further research is needed to determine the feasibility and acceptability of an EMR-based predictive HIV risk algorithm within the ED setting.
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