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by Francis Creed Objective It is not clear why psychiatric disorders are more prevalent in the functional somatic syndromes than other general medical illnesses. This study assessed the correlates of psychiatric disorders in 3 functional syndromes and 3 general medical illnesses in a population-based sample. Methods The Lifelines cohort study included 122,366 adults with relevant data for 6 self-reported conditions: irritable bowel syndrome (IBS), fibromyalgia, chronic fatigue syndrome (CFS), inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and diabetes. For each condition the proportion with a DSM-IV psychiatric disorder was assessed. In a cross-sectional design, logistic regression identified at baseline the variables most closely associated with current psychiatric disorder in participants with a pre-existing medical or functional condition. In a separate analysis the prevalence of psychiatric disorder prior to onset of these conditions was assessed. This was a longitudinal study with psychiatric disorder assessed at baseline in participants who subsequently developed a general medical or functional condition between baseline and follow-up. Results The prevalence of psychiatric disorder was higher (17–27%) in the functional somatic syndromes than the general medical illnesses (10.4–11.7%). The variables closely associated with psychiatric disorder were similar in the functional syndromes and general medical illnesses: stressful life events, chronic personal health difficulties, neuroticism, poor perception of general health, impairment of function due to physical illness and reported previous (lifetime) psychiatric disorder. The prevalence of psychiatric disorder prior to development of these disorder was similar to that of established disorders. Conclusion Despite the difference in prevalence, the correlates of psychiatric disorders were similar in functional and general medical disorders and included predisposing and environmental factors. The increased rate of psychiatric disorder in functional somatic syndromes appears to be evident before onset of the syndrome. …

by Ye Ji Lee, Min A. Yuh, In Soo Kim, Byul Nym Hee Cho, Seon Hee Woo, Sungyoup Hong Background People experienced various stress and psychological responses to the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to examine the changes in emergency medical services (EMSs) utilization by self-harm patients in early pandemic and the impacts of physical distancing measures on the EMSs utilization by self-harm patients. Methods Data for all patients presenting to emergency departments (EDs) after self-harm injuries including self-poisoning were collected from the National ED Information System (NEDIS). Characteristics of patients in two study regions (urban versus rural) were compared. Weekly and annual ED visit rates after self-harm (VRSH) per 100,000 population were calculated. Mobile phone mobility index (MPMI) was calculated by dividing a region’s aggregated mobile phone mobility by mid-year population. Joinpoint regression analysis was conducted to assess changes in 2020 over pre-pandemic years. Test for presence of joinpoint at the end of 2019 was performed. A cross-correlation function was used to estimate the maximal morphological similarity and lag time between changes in MPMI and VRSH. Results In 2020, in early phases of the pandemic, there was a moderate decline in self-harm-related ED visits to 30,797 from a continuously increasing trend seen in previous years. However, proportions of young people (50.1%) and females (62.3%) increased over previous years. VRSHs among women and young people aged 15–34 years showed higher levels in 2020 than in previous five years. There was a significant decrease in the proportion of patients transported directly from the scene. In addition, there was a polarization of mental state upon ED arrival from alert and unresponsive. The median correlation coefficient between MPMI values and VRSH values was 0.601 (interquartile range [IQR]: 0.539–0.619) in urban regions and 0.531 (IQR: 0.454–0.595) in rural regions, showing no statistically significant difference between the two. Conclusion Physical distancing measures adopted to prevent the spread of transmittable diseases following the pandemic had the effect of decreasing ED visits due to self-harm. When the pandemic has ended, and daily life has been restored, it will be particularly important to pay attention to the increased numbers of self-harm patients expected to visit EDs compared to during the pandemic. …

by Kathleen Subramoney, Nkhensani Mtileni, Ashlyn Davis, Jennifer Giandhari, Houriiyah Tegally, Eduan Wilkinson, Yeshnee Naidoo, Yajna Ramphal, Sureshnee Pillay, Upasana Ramphal, Andiswa Simane, Bhaveshan Reddy, Bonolo Mashishi, Nonhlanhla Mbenenge, Tulio de Oliveira, Burtram C. Fielding, Florette K. Treurnicht Intra-host diversity studies are used to characterise the mutational heterogeneity of SARS-CoV-2 infections in order to understand the impact of virus-host adaptations. This study investigated the frequency and diversity of the spike (S) protein mutations within SARS-CoV-2 infected South African individuals. The study included SARS-CoV-2 respiratory samples, from individuals of all ages, received at the National Health Laboratory Service at Charlotte Maxeke Johannesburg Academic hospital, Gauteng, South Africa, from June 2020 to May 2022. Single nucleotide polymorphism (SNP) assays and whole genome sequencing were performed on a random selection of SARS-CoV-2 positive samples. The allele frequency (AF) was determined using TaqMan Genotyper software for SNP PCR analysis and galaxy.eu for analysis of FASTQ reads from sequencing. The SNP assays identified 5.3% (50/948) of Delta cases with heterogeneity at delY144 (4%; 2/50), E484Q (6%; 3/50), N501Y (2%; 1/50) and P681H (88%; 44/50), however only heterogeneity for E484Q and delY144 were confirmed by sequencing. From sequencing we identified 9% (210/2381) of cases with Beta, Delta, Omicron BA.1, BA.2.15, and BA.4 lineages that had heterogeneity in the S protein. Heterogeneity was primarily identified at positions 19 (1.4%) with T19IR (AF 0.2–0.7), 371 (92.3%) with S371FP (AF 0.1–1.0), and 484 (1.9%) with E484AK (0.2–0.7), E484AQ (AF 0.4–0.5) and E484KQ (AF 0.1–0.4). Mutations at heterozygous amino acid positions 19, 371 and 484 are known antibody escape mutations, however the impact of the combination of multiple substitutions identified at the same position is unknown. Therefore, we hypothesise that intra-host SARS-CoV-2 quasispecies with heterogeneity in the S protein facilitate competitive advantage of variants that can completely/partially evade host’s natural and vaccine-induced immune responses.

by Yingjun Nie, Yuanyan Ma, Xiaozhi Yao, Yijia Gao, Xiangping Zheng Background COVID-19 caused severe effects on the psychological well-being of Chinese students overseas (COS). Physical activity (PA) is critical to strengthen immunity, prevent infection, and reduce the psychological burden caused by COVID-19. However, there is a severe lack of effective PA intervention for mental health in most countries, and COS have limited access to mental healthcare during the pandemic. Objective We aim to examine the effects of PA on COS’ mental health during the pandemic abroad and to better understand that certain types of PA might be associated with a greater reduction in psychological burdens during the pandemic. Methods and results In a multi-country cross-sectional analysis, a questionnaire was distributed to COS living in 37 foreign countries via WeChat Subscription using a snowball sampling strategy. A total of 10,846 participants were included. Descriptive statistics and Binary logistic regression analysis were used for statistical analysis. We found that COS had negative psychology during the pandemic, especially with fear (2.90, 95% CI 2.88−2.92), anxiety (2.84, 95% CI 2.82−2.85), and stress (2.71, 95% CI 2.69−2.73). PA had meaningful effects on reducing COS self-reported mental health burdens (3.42, 95% CI 3.41–3.44) during the pandemic. The largest associations were seen for recreational and home-based PA (i.e., family games, home aerobic exercise), individual outdoor PA (i.e., walking or running, rope skipping), and PA with a duration of 30 to 70 min per session at frequencies of 4 to 6 times and a total of 150 to 330 min of moderate and vigorous intensity per week tends to be an optimal choice during social distancing times. Conclusions COS had several poor mental health conditions during the pandemic. The improvement of PA on COS’ psychology was positively effective during the pandemic. Specific types, intensities, durations, and frequencies of PA might have advantages over others for improving COS’ mental health during periods of public health emergencies, and the topic may merit interventional study to reveal multiple factors causing COS’ psychological burdens and enrich the PA forms for all COS’ mental health improvement (i.e., infected, recovered, and asymptomatic COS). …

by Tomomitsu Tahara, Kazuya Takahama, Sayumi Tahara, Noriyuki Horiguchi, Kohei Funasaka, Yoshihito Nakagawa, Tomoyuki Shibata, Tetsuya Tsukamoto, Hiro-o Ieda, Toshiro Fukui, Makoto Naganuma, Naoki Ohmiya Background/Aim Lymphoid follicles hyperplasia (LH) is sometimes observed in the normal colon as small, round, yellowish-white nodules. LH is associated with food hypersensitivity and bowel symptoms and histologically characterized as intense infiltration of lymphocytes or plasmacytes. It is suggested that LH represents inflammatory immune response in the colonic mucosa. We investigated the presence of LH in the normal colonic mucosa and its association with incidence of colorectal lesions including colorectal cancer, adenoma and hyperplastic polyp. Patients/Methods 605 participants undergoing colonoscopy for various indications were enrolled. Presence of LH in the proximal colon (appendix, cecum and the ascending colon) was observed using the blue laser imaging (BLI) endoscopy, a new generation image enhanced endoscopy (IEE) system. LH was defined as well demarcated white nodules. Elevated LH with erythema was distinguished as LH severe. Association between presence of LH and occurrence of colorectal lesions was investigated. Results Prevalence of all colorectal lesions and adenoma were significantly lower in LH severe group compared to the LH negative group (P = 0.0008, 0.0009, respectively). Mean number of all colorectal lesions and adenoma were also lower in LH severe group compared to the LH negative group (P = 0.005, 0.003 respectively). The logistic regression with adjustment for gender and age demonstrated that presence of LH severe held significantly lower risk of all colorectal lesions (OR = 0.48, 95%CI = 0.27–0.86) and adenoma (OR = 0.47, 95%CI = 0.26–0.86). Conclusion LH in the colonic mucosa visualized by IEE is useful endoscopic finding to predict risk of colorectal adenoma. …

by Amir Hossein Khoshakhlagh, Saeid Yazdanirad, Hamid Reza Saberi, Masoud Motalebi Kashani, Fatemeh Ghanaei Khaledabadi, Fazel Mohammadi-Moghadam, Muhammet Gul The need for a biological disease risk assessment method to prevent the contagion of these diseases, particularly among healthcare personnel, is crucial. Therefore, this study aimed to develop and validate a biological risk assessment tool for biological agents among hospital personnel under COVID-19 conditions. This cross-sectional study was performed on 301 employees in two hospitals. Firstly, we identified the items affecting the contagion of biological agents. Then, we computed the weight of the items using the Fuzzy Analytical Hierarchy Process (FAHP) method. We used the identified items and the estimated weights in the next step to develop a predictive equation. The outcome of this tool was the risk score of biological disease contagion. After that, we used the developed method to evaluate the biological risk of the participants. The ROC curve was also used to reveal accuracy of developed method. In this study, 29 items were identified and categorized into five dimensions, including environmental items, ventilation items, job items, equipment-related items, and organizational items. The weights of these dimensions were estimated at 0.172, 0.196, 0.255, 0.233, and 0.144, respectively. The final weight of items was used to develop a predictive equation. The area under ROC curves (AUC) was also calculated as 0.762 (95% CI: 0.704, 0.820) (p…

by Francis Hassard, Milan Vu, Shadi Rahimzadeh, Victor Castro-Gutierrez, Isobel Stanton, Beata Burczynska, Dirk Wildeboer, Gianluca Baio, Mathew R. Brown, Hemda Garelick, Jan Hofman, Barbara Kasprzyk-Hordern, Azeem Majeed, Sally Priest, Hubert Denise, Mohammad Khalifa, Irene Bassano, Matthew J. Wade, Jasmine Grimsley, Lian Lundy, Andrew C. Singer, Mariachiara Di Cesare Background Schools are high-risk settings for infectious disease transmission. Wastewater monitoring for infectious diseases has been used to identify and mitigate outbreaks in many near-source settings during the COVID-19 pandemic, including universities and hospitals but less is known about the technology when applied for school health protection. This study aimed to implement a wastewater surveillance system to detect SARS-CoV-2 and other public health markers from wastewater in schools in England. Methods A total of 855 wastewater samples were collected from 16 schools (10 primary, 5 secondary and 1 post-16 and further education) over 10 months of school term time. Wastewater was analysed for SARS-CoV-2 genomic copies of N1 and E genes by RT-qPCR. A subset of wastewater samples was sent for genomic sequencing, enabling determination of the presence of SARS-CoV-2 and emergence of variant(s) contributing to COVID-19 infections within schools. In total, >280 microbial pathogens and >1200 AMR genes were screened using RT-qPCR and metagenomics to consider the utility of these additional targets to further inform on health threats within the schools. Results We report on wastewater-based surveillance for COVID-19 within English primary, secondary and further education schools over a full academic year (October 2020 to July 2021). The highest positivity rate (80.4%) was observed in the week commencing 30th November 2020 during the emergence of the Alpha variant, indicating most schools contained people who were shedding the virus. There was high SARS-CoV-2 amplicon concentration (up to 9.2x106 GC/L) detected over the summer term (8th June - 6th July 2021) during Delta variant prevalence. The summer increase of SARS-CoV-2 in school wastewater was reflected in age-specific clinical COVID-19 cases. Alpha variant and Delta variant were identified in the wastewater by sequencing of samples collected from December to March and June to July, respectively. Lead/lag analysis between SARS-CoV-2 concentrations in school and WWTP data sets show a maximum correlation between the two-time series when school data are lagged by two weeks. Furthermore, wastewater sample enrichment coupled with metagenomic sequencing and rapid informatics enabled the detection of other clinically relevant viral and bacterial pathogens and AMR. Conclusions Passive wastewater monitoring surveillance in schools can identify cases of COVID-19. Samples can be sequenced to monitor for emerging and current variants of concern at the resolution of school catchments. Wastewater based monitoring for SARS-CoV-2 is a useful tool for SARS-CoV-2 passive surveillance and could be applied for case identification and containment, and mitigation in schools and other congregate settings with high risks of transmission. Wastewater monitoring enables public health authorities to develop targeted prevention and education programmes for hygiene measures within undertested communities across a broad range of use cases. …

by Günter Schneckenreither, Lukas Herrmann, Rafael Reisenhofer, Niki Popper, Philipp Grohs Structural features and the heterogeneity of disease transmissions play an essential role in the dynamics of epidemic spread. But these aspects can not completely be assessed from aggregate data or macroscopic indicators such as the effective reproduction number. We propose in this paper an index of effective aggregate dispersion (EffDI) that indicates the significance of infection clusters and superspreading events in the progression of outbreaks by carefully measuring the level of relative stochasticity in time series of reported case numbers using a specially crafted statistical model for reproduction. This allows to detect potential transitions from predominantly clustered spreading to a diffusive regime with diminishing significance of singular clusters, which can be a decisive turning point in the progression of outbreaks and relevant in the planning of containment measures. We evaluate EffDI for SARS-CoV-2 case data in different countries and compare the results with a quantifier for the socio-demographic heterogeneity in disease transmissions in a case study to substantiate that EffDI qualifies as a measure for the heterogeneity in transmission dynamics.

Influenza is an acute respiratory infection caused by influenza viruses that circulate worldwide. The annual epidemics are estimated to result in about 3 to 5 million cases of severe illness, and about 290 000 to 650 000 respiratory deaths in the world [1]. In addition, 4.8%-18.9% of children with influenza develop various neurologic complications, including febrile seizure, influenza-associated encephalopathy/encephalitis, transverse myelitis, Guillain-Barré syndrome, and Reye\'s syndrome [2, 3].

Infection and Immunity, Ahead of Print.

Publication date: Available online 30 May 2023 Source: Infectious Disease Modelling Author(s): Sheng-Tao Wang, Yong-Ping Wu, Li Li, Yong Li, Gui-Quan Sun …

Publication date: Available online 29 May 2023 Source: International Journal for Parasitology Author(s): Raffi Aroian, Alex Loukas, Richard Martin …

Volume 14, Issue 1, December 2023 .

Journal of Medical Virology, Volume 95, Issue 6, June 2023.

Journal of Medical Virology, Volume 95, Issue 6, June 2023.

Journal of Medical Virology, Volume 95, Issue 6, June 2023.

For thousands of years, humans have mass-reared domesticated insects such as honeybees and silkworms. The mass rearing of insects on an industrial scale, however, is a relatively new concept, and this burgeoning industry is vital in producing insects for research, pollination services, and biological control of pests and vectors [1,2]. The most recent development is the production of insects, such as flies, mealworms, crickets, and locusts, as a protein source for aquaculture, livestock, and human consumption [1,3,4].

AbstractBackgroundHigh-dose (HD) influenza vaccine offers improved protection from influenza virus infection among older adults compared with standard-dose (SD) vaccine. Here we explored whether HD vaccine attenuates disease severity among older adults with breakthrough influenza.MethodsRetrospective cohort study among adults ≥65 years from U.S. claims data, for seasons 2016-17, 2017-18 and 2018-19 defined as October 1st through April 30th. After adjusting the different cohorts for the probability of vaccination conditional on patients’ characteristics, we compared 30-day mortality rate post-influenza among older adults experiencing breakthrough infection after receipt of HD or SD influenza vaccines and among those not vaccinated (NV).ResultsWe evaluated 44,456 influenza cases: 23,109 (52%) were unvaccinated, 15,037 (33.8%) received HD vaccine and 6,310 (14.2%) received SD vaccine. Significant reductions in mortality rates among breakthrough cases were observed across all three seasons for HD vs NV, ranging from 17-29% reductions. A significant mortality reduction of 25% was associated with SD vaccination vs. NV in the 2016-17 season, when there was a good match between circulating influenza viruses and selected vaccine strains. When comparing HD vs. SD cohorts, mortality reductions were higher among those receiving HD in the last two seasons, when mismatch between vaccine strains and circulating H3N2 viruses were documented, albeit not significant.ConclusionHD vaccination was associated with lower post-influenza mortality among older adults with breakthrough influenza, even during seasons where antigenically drifted H3N2 circulated. Improved understanding of the impact of different vaccines on attenuating disease severity is warrant when assessing vaccine policy recommendations.

Journal of Medical Virology, Volume 95, Issue 6, June 2023.

Journal of Medical Virology, Volume 95, Issue 6, June 2023.

Journal of Medical Virology, Volume 95, Issue 6, June 2023.

AbstractBackgroundImmunity to Streptococcus pyogenes in high burden settings is poorly understood. We explored S. pyogenes nasopharyngeal colonization after intranasal live attenuated influenza vaccine (LAIV) among Gambian children aged 24-59 months, and resulting serological response to 7 antigens.MethodsA post-hoc analysis was performed in 320 children randomized to receive LAIV at baseline (LAIV group) or not (control). S. pyogenes colonization was determined by quantitative Polymerase Chain Reaction (qPCR) on nasopharyngeal swabs from baseline (D0), day 7 (D7) and day 21 (D21). Anti-streptococcal IgG was quantified, including a subset with paired serum pre/post S. pyogenes acquisition.ResultsThe point prevalence of S. pyogenes colonization ranged from 7-13%. In children negative at D0, S. pyogenes was detected at D7 or D21 in 18% of LAIV group and 11% of control group participants (p=0.12). The odds ratio (OR) for colonization over time was significantly increased in the LAIV group (D21 vs D0 OR 3.18, p=0.003) but not in the control group (OR 0.86, p=0.79). The highest IgG increases following asymptomatic colonization were seen for M1 and SpyCEP proteins.ConclusionsAsymptomatic S. pyogenes colonization appears modestly increased by LAIV, and may be immunologically significant. LAIV could be used to study influenza-S. pyogenes interactions.

Publication date: Available online 28 May 2023 Source: Infectious Disease Modelling Author(s): Sittisede Polwiang …

Tropical Medicine &International Health, EarlyView.

Journal of Medical Virology, Volume 95, Issue 6, June 2023.

Background: Kenya’s HIV epidemic is heterogeneously distributed. Although HIV incidence in Kenya has shown signs of recent decline, focused interventions are still needed for female sex workers (FSWs). Geo-spatially-informed approaches have been advocated for targeted HIV prevention. We quantified heterogeneity in HIV burden in Nairobi-based FSWs by place of origin within Kenya, and hotspots and residence within Nairobi. Methods: Data were collected as part of enrolment in the Sex Workers Outreach Program (SWOP) in Nairobi between 2014 to 2017. Prevalence ratios (PRs) were used to quantify the risk of HIV by high prevalence counties (HPC) using modified Poisson regression analyses. Crude and fully adjusted models were fitted to the data. In heterogeneity analyses, hotspots and residences were aggregated to the Nairobi constituency level (n=17). Inequality in the geographic distribution of HIV prevalence was measured using the Gini coefficient. Results: A total of 11,899 FSWs were included. Overall HIV prevalence was 16%. FSWs originating from HPC were at 2-fold increased risk of living with HIV in adjusted analysis (PR 1.95, 95% CI: 1.76-2.17). HIV prevalence was also highly heterogeneous by hotspot, ranging from 7% to 52% by hotspot (Gini coefficient: 0.37; 95% CI: 0.23-0.50). In contrast, constituency of residence had a Gini coefficient of 0.08 (95% CI: 0.06-0.10), suggesting minimal heterogeneity by residence. Conclusion: HIV prevalence in FSW is heterogeneous by place of work within Nairobi, and by county of birth within Kenya. As HIV incidence declines and financial commitments flatline, tailoring interventions to FSWs at highest HIV risk becomes increasingly important. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Background: People with schizophrenia experience unique barriers to routine HIV testing, despite increased risk of HIV compared to the general US population. Little is known about how healthcare delivery system factors impact testing rates or whether there are testing differences for people with schizophrenia. Setting: Nationally representative sample of Medicaid enrollees with and without schizophrenia. Methods: Using retrospective longitudinal data, we examined whether state-level factors were associated with differences in HIV testing among Medicaid enrollees with schizophrenia compared to frequency matched controls during 2002–2012. Multivariable logistic regression estimated testing rate differences between and within cohorts. Results: Higher HIV testing rates for enrollees with schizophrenia was associated with higher state-level Medicaid spending per enrollee, efforts to reduce Medicaid fragmentation, and higher federal prevention funding. State-level AIDS epidemiology predicted more frequent HIV testing for enrollees with schizophrenia versus controls. Living in rural settings predicted lower HIV testing, especially for people with schizophrenia. Conclusion: Overall, state-level predictors of HIV testing rates varied among Medicaid enrollees, though rates were generally higher for those with schizophrenia than controls. Increased HIV testing for people with schizophrenia was associated with coverage of HIV testing when medically necessary, higher CDC prevention funding, and higher AIDS incidence, prevalence, and mortality when compared to controls. This analysis suggests that state policymaking has an important role to play in advancing that effort. Overcoming fragmented care systems, sustaining robust prevention funding, and consolidating funding streams in innovative and flexible ways to support more comprehensive systems of care delivery deserve attention. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Background: Sodium glucose transporter inhibitors have been approved for treatment of diabetes mellitus (DM), chronic kidney disease (CKD), and heart failure (HF), but little is known about prescription levels and safety profiles among PWH. Methods: We leveraged data from the U.S. Mass General Brigham (MGB) electronic healthcare database to determine the use/uptake of SGLT2 inhibitors among PWH with DM2 (with or without CKD, proteinuria, or HF) and to assess rates of adverse events among PWH with DM2 taking SGLT2 inhibitors. Results: Among eligible PWH with DM2 receiving care at MGB (N=907), SGLT2 inhibitors were prescribed to 8.8%. SGLT2 inhibitors were prescribed to a fraction of eligible PWH with DM2 and a concomitant diagnosis of either CKD (3.8%), proteinuria (13.2%), or HF (8.2%). PWH with DM2 on SGLT2 inhibitors experienced side effects (urinary tract infection, diabetic ketoacidosis, acute kidney injury) at rates comparable to PWH with DM2 prescribed GLP-1 agonists. Rates of mycotic genitourinary infections were higher among those prescribed SGLT2 inhibitors (5% vs. 1%, P = 0.17), but no cases of necrotizing fasciitis ensued. Conclusions: Additional studies are needed to characterize population-specific salutary and adverse effects of SGLT2 inhibitors among PWH and potentially augment prescription rates when guideline indicated. Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

Objective: Determine if patient-centered, streamlined HIV care achieves higher ART uptake and viral suppression than the standard treatment model for people with HIV (PWH) reporting hazardous alcohol use. Design: Community cluster-randomized trial Methods: The SEARCH trial (NCT01864603) compared an intervention of annual population HIV testing, universal ART, and patient-centered care to a control of baseline population testing with ART by country standard in 32 Kenyan and Ugandan communities. Adults (≥15 years) completed a baseline Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and were classified as no/non-hazardous (AUDIT-C 0-2 women/0-3 men) or hazardous alcohol use (≥3 women/≥4 men). We compared year 3 ART uptake and viral suppression of PWH reporting hazardous use between intervention and control arms. We compared alcohol use as a predictor of year 3 ART uptake and viral suppression among PWH, by arm. Results: Of 11,070 PWH with AUDIT-C measured, 1723 (16%) reported any alcohol use; 893 (8%) reported hazardous use. Among PWH reporting hazardous use, the intervention arm had higher ART uptake (96%) and suppression (87%) compared to control (74%, aRR=1.28, 95%CI:1.19-1.38; and 72%, aRR=1.20, 95%CI:1.10-1.31, respectively). Within arm, hazardous alcohol use predicted lower ART uptake in control (aRR=0.86, 95%CI:0.78-0.96), but not intervention (aRR=1.02, 95%CI:1.00-1.04); use was not predictive of suppression in either arm. Conclusion: The SEARCH intervention improved ART uptake and viral suppression among PWH reporting hazardous alcohol use and eliminated gaps in ART uptake between PWH with hazardous and no/non-hazardous use. Patient-centered HIV care may decrease barriers to HIV care for PWH with hazardous alcohol use. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Background: The COVID-19 pandemic led to an increase in the number of deaths among all populations, including people with diagnosed HIV (PWDH). The aim of this study was to analyze the top causes of death (COD) among PWDH prior to the start of the COVID-19 pandemic, during the start of the COVID-19 pandemic, and a year later, to determine changes in the leading COD among PWDH, as well as determine if the historical trend of decreasing deaths related to HIV continued through the pandemic. Methods: To examine mortality among PWDH in New York State (NYS), records for PWDH who died from 2015-2021 were extracted from the NYS HIV registry and Vital Statistics Death Data. Results: The number of deaths among PWDH in New York State (NYS) increased 32% from 2019 to 2020 and continued in 2021. COVID-19 was one of the most common underlying COD among PWDH in 2020. In 2021, COVID-19 related deaths decreased while HIV and diseases of the circulatory system remained the top COD. HIV listed as either the underlying or contributing COD showed a consistent downward trend in the percentage of HIV related deaths among PWDH, from 45% in 2015 to 32% in 2021. Conclusions: There was a large increase in deaths among PWDH in 2020, with a substantial percent related to COVID-19. However, even with the introduction of COVID-19 in 2020, the percentage of deaths related to HIV— one of the goals of the Ending the Epidemic Initiative in NYS—continued to decrease. Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

Background: We evaluated factors associated with lack of triple vaccination (hepatitis A (HAV), hepatitis B (HBV), human papilloma virus (HPV)] among men who have sex with men (MSM) using pre-exposure prophylaxis (PrEP). Setting: PrEP users at San Raffaele Scientific Institute, Italy, with ≥1 follow-up visit (May 2017-2022). Methods: Participants were considered protected if: i) prior to PrEP access: positive serology (IgG-HAV+, HbsAb>10mUI/ml) or vaccination history were recorded; ii) after starting PrEP: ≥1 dose of each vaccination was administered. Individuals were considered fully protected if they received before/during PrEP access: HAV vaccination/infection, HBV vaccination/infection and HPV vaccination. Chi-square and Kruskal-Wallis tests were used to compare characteristics of those fully, partially and not protected. Factors associated with lack of triple vaccination were assessed by multivariable logistic regression and classification tree analysis. Results: Overall, 473 MSM were considered: 146 (31%) were fully protected, 231 (48%) partially and 96 (20%) not. Daily-based PrEP users (fully:93, 63.7%; partially:107, 46.3%; not protected:40, 41.7%; p=0.001) and those with a sexually transmitted infection (STI) at first visit (43, 29.5%; 55, 23.8%; 15, 15.6%; p=0.048) were more frequently fully protected. At multivariable analysis, the odds of lack of triple vaccination was lower among daily-based users (adjusted odds ratio=0.47, 95%CI=0.31-0.70, p…

Objectives: To determine the impact of high doses of corticosteroids (HDCT) in critically ill COVID-19 patients with nonresolving acute respiratory distress syndrome (ARDS) who had been previously treated with dexamethasone as a standard of care. Design: Prospective observational cohort study. Eligible patients presented nonresolving ARDS related to severe acute respiratory syndrome coronavirus 2 infection and had received initial treatment with dexamethasone. We compared patients who had received or not HDCT during ICU stay, consisting of greater than or equal to 1 mg/kg of methylprednisolone or equivalent for treatment of nonresolving ARDS. The primary outcome was 90-day mortality. We assessed the impact of HDCT on 90-day mortality using univariable and multivariable Cox regression analysis. Further adjustment for confounding variables was performed using overlap weighting propensity score. The association between HDCT and the risk of ventilator-associated pneumonia was estimated using multivariable cause-specific Cox proportional hazard model adjusting for pre-specified confounders. Setting: We included consecutive patients admitted in 11 ICUs of Great Paris area from September 2020 to February 2021. Patients: Three hundred eighty-three patients were included (59 in the HDCT group, 324 in the no HDCT group). Interventions: None. Measurements and Main Results: At day 90, 30 of 59 patients (51%) in the HDCT group and 116 of 324 patients (35.8%) in the no HDCT group had died. HDCT was significantly associated with 90-day mortality in unadjusted (hazard ratio [HR], 1.60; 95% CI, 1.04–2.47; p = 0.033) and adjusted analysis with overlap weighting (adjusted HR, 1.65; 95% CI, 1.03–2.63; p = 0.036). HDCT was not associated with an increased risk of ventilator-associated pneumonia (adjusted cause-specific HR, 0.42; 95% CI, 0.15–1.16; p = 0.09). Conclusions: In critically ill COVID-19 patients with nonresolving ARDS, HDCT result in a higher 90-day mortality.