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47 ud af 47 tidsskrifter valgt, søgeord (hiv) valgt, emner højest 180 dage gamle, sorteret efter nyeste først.
710 emner vises.
BMC Infectious Diseases, 14.02.2024
Tilføjet 14.02.2024
Abstract Background The World Health Organization endorsed Truenat MTB rapid molecular assay in 2020 and recommended additional in-country evaluation studies before uptake. We evaluated the accuracy and operational feasibility of Truenat MTB assay (Truenat) in comparison with GeneXpert Ultra and culture. Methods In a cross-sectional study of 250 presumptive TB patients, participants were requested to provide a sputum sample on the day of their visit to the clinic. The sputum sample was homogenized and a portion was tested using GeneXpert Ultra as per the routine standard procedure and the other portion was tested using Truenat assay at the clinic laboratory. The second sample portion was processed for Concentrated Fluorescent smear Microscopy (CFM), LJ, and MGIT cultures. Truenat sensitivity and specificity were compared to GeneXpert Ultra and culture. Test performance characteristics and operational feasibility assessment data through interview of the study laboratory staff were also collected and summarized as proportions and percentages. Results Of the 250 participants recruited in the study, the sensitivity and specificity of Truenat was n/N (%, 95%CI); 66/82 (80.5, 70.2–88.4) and 156/159 (98.1, 94.5–99.6) when compared with Ultra, 50/64 (89.3, 66.0-87.4) and 166/180 (92.2, 87.2–95.6) when compared with LJ, 58/71 (81.7,70.7–89.8) and 131/138 (94.9, 89.8–97.9) when compared to MGIT culture and 59/73 (80.8, 69.9–89.1) and 159/169 (94.1,89.3–97.1) when compared to LJ and/or MGIT culture. The sensitivity of Truenat was lower, 14/23 (60.9, 40.6–82.8) among smear-negative compared to 45/50 (90.0, 78.1–96.6) among smear-positive participants but not different by HIV status. There were no special training needs especially among laboratory personnel with previous GeneXpert /molecular test experience, 19/242 (7.8%) error/invalid, and 12 (17,4%) uninterpretable/indeterminate results mainly for rifampicin resistance determination. However, there were 3 (3.5%) of GeneXpert Ultra indeterminate results. Conclusion Among presumptive TB patients in Uganda, the Truenat assay has high sensitivity and specificity. The Truenat assay has acceptable operational feasibility attributes when compared with the GeneXpert Assay.
Læs mere Tjek på PubMedClinical Infectious Diseases, 13.02.2024
Tilføjet 13.02.2024
Abstract Background People with HIV (PWH) have an increased risk of cardiovascular disease (CVD). Cardiac magnetic resonance (CMR) has documented higher myocardial fibrosis, inflammation and steatosis in PWH, but studies have mostly relied on healthy volunteers as comparators and focused on men.Methods We investigated the associations of HIV and HIV-specific factors with CMR phenotypes in female participants enrolled in the Women’s Interagency HIV Study’s New York and San Francisco sites. Primary phenotypes included myocardial native (n) T1 (fibro-inflammation), extracellular volume fraction (ECV, fibrosis) and triglyceride content (steatosis). Associations were evaluated with multivariable linear regression, and results pooled or meta-analyzed across centers.Results Among 261 women with HIV (WWH, total n = 362), 76.2% had undetectable viremia at CMR. For the 82.8% receiving continuous antiretroviral therapy (ART) in the preceding 5 years, adherence was 51.7%, and 71.3% failed to achieve persistent viral suppression (42.2% with peak viral load
Læs mere Tjek på PubMedJournal of Infectious Diseases, 13.02.2024
Tilføjet 13.02.2024
Abstract Background Unlike influenza, information on the burden of human metapneumovirus (HMPV) as a cause of hospitalizations in adults with acute respiratory illness (ARI) is limited.Methods We compared the population-based incidence, seasonality, and clinical characteristics of these two viral infections among adults aged 20 years and over with ARI hospitalisations in Auckland, New Zealand, during 2012-2015 through the Southern Hemisphere Influenza Vaccine Effectiveness Research and Surveillance (SHIVERS) project.Results Of the 14,139 ARI hospitalisations, 276 (4.3%) of 6484 tested positive for HMPV and 1342 (19.1%) of 7027 tested positive for influenza. Crude rates of 9.8 (95% CI: 8.7-11.0) HMPV and 47.6 (95% CI: 45.1-50.1) influenza-associated ARI hospitalisations were estimated for every 100,000 adult residents annually. The highest rates for both viruses were in those aged 80 years or older, of Māori or Pacific ethnicity, or living in low socioeconomic status (SES) areas. HMPV infections were more common than influenza in those with chronic medical conditions.Conclusions Although HMPV infections accounted for fewer hospitalisations than influenza in adults aged 20 years and over, HMPV-associated ARI hospitalisation rates were higher than influenza in older adults, Maori and Pacific people and those of low SES. This highlighted a need for vaccine/antiviral development.
Læs mere Tjek på PubMedDada, D., Abu-Baare, G. R., Turner, D., Mashoud, I. W., Owusu-Dampare, F., Apreku, A., Ni, Z., Djiadeu, P., Aidoo-Frimpong, G., Zigah, E. Y., Nyhan, K., Nyblade, L., Nelson, L. E.
BMJ Open, 13.02.2024
Tilføjet 13.02.2024
ObjectivesSexual and gender minority (SGM) populations in sub-Saharan Africa (SSA) are disproportionately impacted by HIV and often face multiple HIV-related stigmas. Addressing these stigmas could reduce SGM HIV vulnerability but little is known about how the stigmas operate and intersect. Intersectional stigma offers a lens for understanding the experiences of stigmatised populations and refers to the synergistic negative health effects of various systems of oppression on individuals with multiple stigmatised identities, behaviours or conditions. This review aims to (1) assess how often and in what ways an intersectional lens is applied in HIV-related stigma research on SGM populations in SSA and (2) understand how intersectional stigma impacts HIV risk in these populations. DesignScoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Data sourcesPublic health and regional databases were searched in 2020 and 2022. Eligibility criteriaArticles in French and English on HIV-related stigma and HIV outcomes among men who have sex with men, women who have sex with women and/or transgender individuals in SSA. Data extraction and synthesisArticles were screened and extracted twice and categorised by use of an intersectional approach. Study designs and stigma types were described quantitatively and findings on intersectional stigma were thematically analysed. ResultsOf 173 articles on HIV-related stigma among SGM in SSA included in this review, 21 articles (12%) applied an intersectional lens. The most common intersectional stigmas investigated were HIV and same-sex attraction/behaviour stigma and HIV, same-sex attraction/behaviour and gender non-conformity stigma. Intersectional stigma drivers, facilitators and manifestations were identified across individual, interpersonal, institutional and societal socioecological levels. Intersectional stigma impacts HIV vulnerability by reducing HIV prevention and treatment service uptake, worsening mental health and increasing exposure to HIV risk factors. ConclusionIntersectional approaches are gaining traction in stigma research among SGM in SSA. Future research should prioritise quantitative and mixed methods investigations, diverse populations and intervention evaluation.
Læs mere Tjek på PubMedThe PLOS ONE Editors
PLoS One Infectious Diseases, 12.02.2024
Tilføjet 12.02.2024
Abraham Teka Ajema, Yilkal Simachew, Meiraf Daniel Meshesha, Taye Gari
PLoS One Infectious Diseases, 12.02.2024
Tilføjet 12.02.2024
by Abraham Teka Ajema, Yilkal Simachew, Meiraf Daniel Meshesha, Taye Gari Objectives To assess the incidence and predictors of time to Tuberculosis (TB) development among Human Immunodeficiency Virus (HIV) positive patients attending follow-up care in health facilities of Hawassa, Ethiopia. Methods We conducted a retrospective cohort study from April 1–30, 2023. A total of 422 participants were selected using a simple random sampling method. Data was collected from the medical records of patients enrolled between January 1, 2018 –December 31, 2022, using the Kobo toolbox. We used Statistical Package for Social Studies (SPSS) version 26.0 for data analysis. To estimate the duration of TB-free survival, we applied the Kaplan-Meier survival function and fitted Cox proportional hazard models to identify the predictors of time to TB development. Adjusted hazard ratios (AHR) with 95% confidence intervals were calculated and statistical significance was declared at a P-value of 0.05. Results The overall incidence rate of TB among HIV-positive patients was 6.26 (95% CI: 4.79–8.17) per 100 person-years (PYs). Patients who did not complete TB Preventive Therapy (TPT) were more likely to have TB than those who did (AHR = 6.2, 95% CI: 2.34–16.34). In comparison to those who began antiretroviral therapy (ART) within a week, those who began after a week of linkage had a lower risk of TB development (AHR = 0.44, 95% CI: 0.21–0.89). Patients who received ART for six to twelve months (AHR = 0.18, 95% CI: 0.05–0.61) and for twelve months or longer (AHR = 0.004, 95% CI: 0.001–0.02) exhibited a decreased risk of TB development in comparison to those who had ART for less than six months. Conclusion The incidence of TB among HIV-positive patients is still high. To alleviate this burden, special attention should be given to regimen optimization and provision of adherence support for better completion of TPT, sufficient patient preparation, thorough clinical evaluation for major (Opportunistic Infections) OIs prior to starting ART, and ensuring retention on ART.
Læs mere Tjek på PubMedNjoki, Carolyne; Simiyu, Nabukwangwa; Kaddu, Ronnie; Mwangi, Wambui; Sulemanji, Demet; Oduor, Peter; Dona, Dilanthi Gamage; Otieno, Dorothy; Abonyo, Teddy Thaddeus; Wangeci, Patricia; Kabanya, Thomas; Mutuku, Selina; Kioko, Annastacia; Muthoni, Joy; Kamau, Peter Mburu; Beane, Abigail; Haniffa, Rashan; Dondorp, Arjen; Misango, David; Pisani, Luigi; Waweru-Siika, Wangari
Critical Care Explorations, 11.02.2024
Tilføjet 11.02.2024
OBJECTIVES: To describe clinical, management, and outcome features of critically ill patients admitted to ICUs and high-dependency units (HDUs) in Kenya. DESIGN: Prospective registry-based observational study. SETTING: Three HDUs and eight ICUs in Kenya. PATIENTS: Consecutive adult patients admitted between January 2021 and June 2022. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data were entered in a cloud-based platform using a common data model. Study endpoints included case-mix variables, management features, and patient-centered outcomes. Patients with COVID-19 were reported separately. Of the 3892 of 4546 patients without COVID-19, 2445 patients (62.8%) were from HDUs, and 1447 patients (37.2%) were from ICUs. Patients had a median age of 53 years (interquartile range [IQR] 38–68), with HDU patients being older but with a lower severity (Acute Physiology and Chronic Health Evaluation II 6 [3–9] in HDUs vs. 12 [7–17] in ICUs; p < 0.001). One in four patients was postoperative with 604 (63.4%) receiving emergency surgery. Readmission rate was 4.8%. Hypertension and diabetes were prevalent comorbidities, with a 4.0% HIV/AIDS rate. Invasive mechanical ventilation was applied in 3.4% in HDUs versus 47.6% in ICUs (p < 0.001), with a duration of 7 days (IQR 3–21). There was a similar use of renal replacement therapy (4.0% vs. 4.7%; p < 0.001). Vasopressor use was infrequent while half of patients received antibiotics. Average length of stay was 2 days (IQR 1–5). Crude HDU mortality rate was 6.5% in HDUs versus 30.5% in the ICUs (p < 0.001). Of the 654 COVID-19 admissions, most were admitted in ICUs (72.3%) with a 33.2% mortality. CONCLUSIONS: We provide the first multicenter observational cohort study from an African ICU National Registry. Distinct management features and outcomes characterize HDU from ICU patients.
Læs mere Tjek på PubMedClemente, T., Galli, L., Lolatto, R., Gagliardini, R., Lagi, F., Ferrara, M., Cattelan, A. M., Foca, E., Di Biagio, A., Cervo, A., Calza, L., Maggiolo, F., Marchetti, G., Cenderello, G., Rusconi, S., Zazzi, M., Santoro, M. M., Spagnuolo, V., Castagna, A., On behalf of PRESTIGIO Study Group
BMJ Open, 10.02.2024
Tilføjet 10.02.2024
PurposeThe PRESTIGIO Registry was established in 2017 to collect clinical, virological and immunological monitoring data from people living with HIV (PLWH) with documented four-class drug resistance (4DR). Key research purposes include the evaluation of residual susceptibility to specific antiretrovirals and the validation of treatment and monitoring strategies in this population. ParticipantsThe PRESTIGIO Registry collects annual plasma and peripheral blood mononuclear cell samples and demographic, clinical, virological, treatment and laboratory data from PLWH followed at 39 Italian clinical centres and characterised by intermediate-to-high genotypic resistance to ≥1 nucleoside reverse transcriptase inhibitors, ≥1 non-nucleoside reverse transcriptase inhibitors, ≥1 protease inhibitors, plus either intermediate-to-high genotypic resistance to ≥1 integrase strand transfer inhibitors (INSTIs) or history of virological failure to an INSTI-containing regimen. To date, 229 people have been recorded in the cohort. Most of the data are collected from the date of the first evidence of 4DR (baseline), with some prebaseline information obtained retrospectively. Samples are collected from the date of enrollment in the registry. Findings to dateThe open-ended cohort has been used to assess (1) prognosis in terms of survival or development of AIDS-related or non-AIDS-related clinical events; (2) long-term efficacy and safety of different antiretroviral regimens and (3) virological and immunological factors predictive of clinical outcome and treatment efficacy, especially through analysis of plasma and cell samples. Future plansThe registry can provide new knowledge on how to implement an integrated approach to study PLWH with documented resistance to the four main antiretroviral classes, a population with a limited number of individuals characterised by a high degree of frailty and complexity in therapeutic management. Given the scheduled annual updates of PLWH data, the researchers who collaborate in the registry can send study proposals at any time to the steering committee of the registry, which evaluates every 3 months whether the research studies can be conducted on data and biosamples from the registry and whether they are aimed at a better understanding of a specific health condition, the emergence of comorbidities or the effect of potential treatments or experimental drugs that may have an impact on disease progression and quality of life. Finally, the research studies should aim to be inclusive, innovative and in touch with the communities and society as a whole. Trial registration numberNCT04098315.
Læs mere Tjek på PubMedShavuka, O., Iipumbu, E., Boois, L., Günther, G., Hoddinott, G., Lin, H.-H., Nepolo, E., Niemann, S., Ruswa, N., Seddon, J., Claassens, M. M.
BMJ Open, 10.02.2024
Tilføjet 10.02.2024
IntroductionNamibia is a high tuberculosis (TB)-burden country with an estimated incidence of 460/100 000 (around 12 000 cases) per year. Approximately 4.5% of new cases and 7.9% of previously treated TB cases are multidrug resistant (MDR) and 47% of patients with MDR-TB are HIV coinfected. Published data suggest a clustering of MDR-TB transmission in specific areas. Identifying transmission clusters is key to implementing high-yield and cost-effective interventions. This includes knowing the yield of finding TB cases in high-transmission zones (eg, community hotspots, hospitals or households) to deliver community-based interventions. We aim to identify such transmission zones for enhanced case finding and evaluate the effectiveness of this approach. Methods and analysisH3TB is an observational cross-sectional study evaluating MDR-TB active case finding strategies. Sputum samples from MDR-TB cases in three regions of Namibia will be evaluated by whole genome sequencing (WGS) in addition to routine sputum investigations (Xpert MTB/RIF, culture and drug susceptibility testing). We will collect information on household contacts, use of community spaces and geographical map intersections between participants, synthesising these data to identify transmission hotspots. We will look at the feasibility, acceptability, yield and cost of case finding strategies in these hotspots, and in households of patients with MDR-TB and visitors of hospitalised patients with MDR-TB. A compartmental transmission dynamic model will be constructed to evaluate the impact and cost-effectiveness of the strategies if scaled. Ethics and disseminationEthics approval was obtained. Participants will give informed consent. H3TB will capitalise on a partnership with the Ministry of Health and Social Services to follow up individuals diagnosed with MDR-TB and integrate WGS data with innovative contact network mapping, to allow enhanced case finding. Study data will contribute towards a systems approach to TB control. Equally important, it will serve as a role model for similar studies in other high-incidence settings.
Læs mere Tjek på PubMedMarie Armani-Tourret, Benjamin Bone, Toong Seng Tan, Weiwei Sun, Maxime Bellefroid, Tine Struyve, Michael Louella, Xu G. Yu, Mathias Lichterfeld
Nat Rev Microbiol, 10.02.2024
Tilføjet 10.02.2024
FEMS Microbiology Reviews, 10.02.2024
Tilføjet 10.02.2024
Abstract 20–41% of the world\'s population is either transiently or permanently colonized by the Gram-positive bacterium, Staphylococcus aureus. In 2017, the CDC designated methicillin resistant S. aureus (MRSA) as a serious threat, reporting ∼300 000 cases of MRSA-associated hospitalizations annually, resulting in over 19 000 deaths, surpassing that of HIV in the United States. S. aureus is a proficient biofilm-forming organism, which rapidly acquires resistance to antibiotics, most commonly methicillin (MRSA).This review focuses on a large group of (>30) S. aureus adhesins, either surface-associated or secreted that are designed to specifically bind to 15 or more of the proteins that form key components of the human extracellular matrix (hECM). Importantly, this includes hECM proteins that are pivotal to the homeostasis of almost every tissue environment (collagen (skin), proteoglycans (lung), hemoglobin (blood), elastin, laminin, fibrinogen, fibronectin, and fibrin (multiple organs). These adhesins offer S. aureus the potential to establish an infection in every sterile tissue niche. These infections often endure repeated immune onslaught, developing into chronic, biofilm-associated conditions that are tolerant to ∼1000 times the clinically prescribed dose of antibiotics. Depending on the infection and the immune response, this allows S. aureus to seamlessly transition from colonizer to pathogen by subtly manipulating the host against itself while providing the time and stealth that it requires to establish and persist as a biofilm. This is a comprehensive discussion of the interaction between S. aureus biofilms and the hECM. We provide particular focus on the role of these interactions in pathogenesis and consequently the clinical implications for the prevention and treatment of S. aureus biofilm infections.
Læs mere Tjek på PubMedClinical Infectious Diseases, 10.02.2024
Tilføjet 10.02.2024
Abstract Background Pre-diabetes is associated with proteinuria, a risk factor for chronic kidney disease. While people living with HIV (PWH) have a higher risk of proteinuria than people without HIV (PWOH), it is unknown whether incident proteinuria differs by HIV serostatus among pre-diabetic persons.Methods Urine protein-to-creatinine ratio (PCR) was measured at semi-annual visits among men in the Multicenter AIDS Cohort Study since April 2006. Men with pre-DM on or after April 2006 and no prevalent proteinuria or use of anti-diabetic medications were included. Pre-diabetes was defined as fasting glucose (FG) of 100-125 mg/dL confirmed within a year by a repeat FG or hemoglobin A1c 5.7–6.4%. Incident proteinuria was defined as PCR > 200 mg/g, confirmed within a year. We used Poisson regression models to determine whether incident proteinuria in participants with pre-diabetes differed by HIV serostatus and, among PWH, whether HIV-specific factors were related to incident proteinuria.Results Between 2006 and 2019, among 1276 men with pre-diabetes, 128/613 PWH (21%) and 50/663 PWOH (8%) developed proteinuria over a median 10-year follow-up. After multivariable adjustment, the incidence of proteinuria in PWH with pre-diabetes was 3.3 times [95% CI: 2.3–4.8 times] greater than in PWOH (p
Læs mere Tjek på PubMedClinical Infectious Diseases, 10.02.2024
Tilføjet 10.02.2024
Abstract Background Cryptococcal meningitis causes substantial mortality in high-HIV prevalence African countries despite advances in disease management and increasing antiretroviral therapy coverage. Reliable diagnosis of cryptococcal meningitis is cheap and more accessible than other indicators of AHD burden such as CD4 testing or investigation for disseminated tuberculosis; therefore, monitoring cryptococcal meningitis incidence has the potential to serve as a valuable metric of HIV programmatic success.Methods Botswana national meningitis surveillance data from 2015 to 2022 were obtained from electronic health records. All electronic laboratory records from cerebrospinal fluid samples analysed within government healthcare facilities in Botswana were extracted from a central online repository. Adjustments for missing data were made through triangulation with prospective cohort study datasets. Cryptococcal meningitis case frequency was enumerated using a case definition and incidence calculated using national census data.Results A total of 1,744 episodes of cryptococcal meningitis were identified; incidence declined from 15.0 (95% CI 13.4-16.7) cases/100,000 person-years in 2015 to 7.4 (95% CI 6.4-8.6) cases/100,000 person-years in 2022. However, the rate of decline slowed following the introduction of universal treatment in 2016. The highest incidence was observed in men and individuals aged 40-44. The proportion of cases diagnosed through cryptococcal antigen testing increased from 35.5% to 86.3%.Conclusion Cryptococcal meningitis incidence has decreased in Botswana following expansion of ART coverage but persists at a stubbornly high incidence. Most cases are now diagnosed through the cheap and easy-to-use cryptococcal antigen test highlighting the potential of using cryptococcal meningitis as key metric of programme success in the Treat All era.
Læs mere Tjek på PubMedAbere Woretaw Azagew, Hailemichael Kindie Abate, Yohannes Mulu Ferede, Chilot Kassa Mekonnen
PLoS One Infectious Diseases, 10.02.2024
Tilføjet 10.02.2024
by Abere Woretaw Azagew, Hailemichael Kindie Abate, Yohannes Mulu Ferede, Chilot Kassa Mekonnen Background cute kidney injury(AKI) is a rapid loss of the kidney’s excretory function, resulting in an accumulation of end products of nitrogen metabolism. The causes of AKI in HIV-positive patients are not well investigated, but it may be associated with antiretroviral drug side effects and HIV itself. Even though there were studies that reported the prevalence of AKI among HIV-positive patients in Africa, their findings were inconsistent across the studies. Methods We searched on PubMed, Embas, Ebsco, OVID, Cochrane Library, and other supplementary search engines, including Google and Google Scholar. Articles published upto July 2023 were included in this review study. The quality of the study was assessed using the Newcastle-Ottawa Scale for cross-sectional, case-control, and cohort studies. The data were extracted using a Microsoft Excel spreadsheet and exported to Stata version 14 for analysis. A random effect meta-analysis model was used to estimate the pooled prevalence of AKI among HIV-positive patients. Heterogeneity was evaluated using Cochrane Q statistics and I squared (I2). Furthermore, the graphic asymmetric test of the funnel plot and/or Egger’s tests were computed to detect publication bias. Sensitivity analysis was computed to see the effect of a single study on the summary effects. To treat the publication bias, a trim and fill analysis was carried out. The protocol of this review has been registered in an international database, the Prospective Register of Systematic Reviews (PROSPERO),with reference number CRD42023446078. Results A total of twenty-four original articles comprising 7913HIV-positive patients were included in the study. The pooled prevalence of AKI among HI-positive patients was found to be 23.35% (95% CI: 18.14–28.56%, I2 = 97.7%, p-value
Læs mere Tjek på PubMedSivaprakasam T. Selvavinayagam, Suvaiyarasan Suvaithenamudhan, Yean K. Yong, Kannan Hemashree, Manivannan Rajeshkumar, Anandhazhvar Kumaresan, Parthiban Arthydevi, Meganathan Kannan, Natarajan Gopalan, Ramachandran Vignesh, Amudhan Murugesan, Munusamy P. Sivasankaran, Sathish Sankar, Narayanaiah Cheedarla, Abdul R. Anshad, Sakthivel Govindaraj, Ying Zhang, Hong Y. Tan, Marie Larsson, Shanmugam Saravanan, Pachamuthu Balakrishnan, Langeswaran Kulanthaivel, Kamalendra Singh, Narcisse Joseph, Vijayakumar Velu, Siddappa N. Byrareddy, Esaki M. Shankar, Sivadoss Raju
Journal of Medical Virology, 9.02.2024
Tilføjet 9.02.2024
Journal of Infectious Diseases, 9.02.2024
Tilføjet 9.02.2024
Abstract In Lusaka, Zambia, we introduced liver fine needle aspiration (FNA) into a research cohort of adults with treatment-naïve chronic hepatitis B virus (HBV) infection, with and without HIV coinfection, as well as with acute HBV infection. Over 117 enrollment and 47 longitudinal FNAs (at 1 year follow-up), we established participant acceptability and safety. We also demonstrated the quality of the material through single cell RNA sequencing of selected enrollment FNAs, which revealed a range of immune cells. This approach can drive new insights into HBV immunology, informing cure strategies, and can improve our understanding of HBV natural history in Africa.
Læs mere Tjek på PubMedRaquel Martín-Iguacel, Sergio Moreno-Fornés, Andreu Bruguera, Jordi Aceitón, Daniel Kwakye Nomah, Ana González-Cordón, Pere Domingo, Adrian Curran, Arkaitz Imaz, David Dalmau Juanola, Joaquim Peraire, Beatriz Borjabad, Laia Arbones Fernandez, Isik Somuncu Johansen, José M. Miró, Jordi Casabona, Josep M. Llibre, the PISCIS study group
Clinical Microbiology and Infection, 9.02.2024
Tilføjet 9.02.2024
To assess the impact of COVID-19 on the post-acute risk of cardiovascular events (CVE) among people with HIV (PWH).
Læs mere Tjek på PubMedJulia Blaauw, Jessica Chikwana, David Chaima, Stanley Khoswe, Lyson Samikwa, Isabelle de Vries, Wieger Voskuijl
PLoS One Infectious Diseases, 9.02.2024
Tilføjet 9.02.2024
by Julia Blaauw, Jessica Chikwana, David Chaima, Stanley Khoswe, Lyson Samikwa, Isabelle de Vries, Wieger Voskuijl Background Undernutrition and malnutrition in children in low- and middle-income countries contribute to high mortality rates. Stunting, a prevalent form of malnutrition, is associated with educational and productivity losses. Environmental enteric dysfunction (EED) and human immunodeficiency virus (HIV) infection worsen these conditions. This study seeks to investigate the presence of enteropathy using EED fecal biomarkers in HIV-infected children who are stable on antiretroviral therapy (ART) across various nutritional statuses. By understanding the interplay between EED, HIV, and nutritional status, this study aims to provide insights that can inform targeted interventions to optimize nutritional outcomes in HIV infected children. Methods/Principal findings This study evaluated the levels of alpha-1-antitrypsin, calprotectin and myeloperoxidase in frozen fecal samples from 61 HIV infected (mean age 9.16 ±3.08 years) and 31 HIV uninfected (6.65 ±3.41 years) children in Malawi. Anthropometric measurements and clinical data were collected. The height-for-age z-score (-1.66 vs -1.27, p = 0.040) and BMI-for-age z-score (-0.36 vs 0.01, p = 0.037) were lower in HIV infected children. Enzyme-linked immunosorbent assays were used to measure biomarker concentrations. Statistical tests were applied to compare biomarker levels based on HIV status and anthropometric parameters. Myeloperoxidase, alpha-1-antitrypsin, and calprotectin concentrations did not differ between HIV infected and HIV uninfected children of different age groups. In HIV infected children from 5–15 years, there is no difference in biomarker concentration between the stunted and non-stunted groups. Conclusion/Significance Our study found a higher prevalence of stunting in HIV infected children compared to uninfected children, but no significant differences in biomarker concentrations. This suggests no causal relationship between enteropathy and stunting in HIV infected children. These results contribute to the understanding of growth impairment in HIV infected children and emphasize the need for further research, particularly a longitudinal, biopsy-controlled study.
Læs mere Tjek på PubMedThi Vu, Jasmine Manalel, Kate Nyhan, Katie Wang, Joan Monin
PLoS One Infectious Diseases, 9.02.2024
Tilføjet 9.02.2024
by Thi Vu, Jasmine Manalel, Kate Nyhan, Katie Wang, Joan Monin Introduction The population of women aged 50 years and older living with HIV is increasing. Older women face unique challenges in the prevention and management of HIV; however, they are often under engaged in HIV/AIDS research. One such challenge is gender-based stigma, which can be manifested through harmful gendered stereotypes, discrimination, prejudice, and sexism that could potentially hinder HIV care engagement among this population. We propose a scoping review to identify and synthesize evidence pertaining to how experiences of gender-based stigma impacts HIV prevention and care among older women. Materials and methods We will use the framework by Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) to conduct this scoping review. We will search MEDLINE/PubMed, Web of Science, PsycINFO, CINAHL and Scopus for empirical literature published between January 1981 and the date of search commencement. Supplementary screening will be conducted using backwards citation chaining of the final list of included full-text articles. Two reviewers will independently screen all titles and abstracts for articles that meet the predetermined inclusion criteria. Two reviewers will also screen full-text articles and chart data using a standardized data collection form. Results We will synthesize the findings through tables, charts, and narrative summaries. We will also identify gaps in the current literature and provide recommendations for future research. Findings will be shared at conferences and submitted to a peer-reviewed publication. Discussion To our knowledge, this will be the first scoping review to examine gender-based stigma in relation to HIV prevention and care among older women. We anticipate that our results will be of interest to older women living with HIV, healthcare providers, policy makers, and community activists working to improve quality of life and care experiences for older women living with HIV.
Læs mere Tjek på PubMedKroeze, Stefanie; Kootstra, Neeltje A.; van Nuenen, Ad C.; Rossouw, Theresa M.; Kityo, Cissy M.; Siwale, Margaret; Akanmu, Sulaimon; Mandaliya, Kishor; de Jager, Marleen; Ondoa, Pascale; Wit, Ferdinand W.; Reiss, Peter; Rinke de Wit, Tobias F.; Hamers, Raph L.
AIDS, 9.02.2024
Tilføjet 9.02.2024
Objective: This study investigated the association of plasma microRNAs before and during antiretroviral therapy (ART) with poor CD4+ T-cell recovery during the first year of ART. Design: MicroRNAs were retrospectively measured in stored plasma samples from people with HIV (PWH) in sub-Saharan Africa who were enrolled in a longitudinal multicountry cohort and who had plasma viral-load less than 50 copies/ml after 12 months of ART. Methods: First, the levels of 179 microRNAs were screened in a subset of participants from the lowest and highest tertiles of CD4+ T-cell recovery (ΔCD4) (N = 12 each). Next, 11 discordant microRNAs, were validated in 113 participants (lowest tertile ΔCD4: n = 61, highest tertile ΔCD4: n = 52). For discordant microRNAs in the validation, a pathway analysis was conducted. Lastly, we compared microRNA levels of PWH to HIV-negative controls. Results: Poor CD4+ T-cell recovery was associated with higher levels of hsa-miR-199a-3p and hsa-miR-200c-3p before ART, and of hsa-miR-17-5p and hsa-miR-501-3p during ART. Signaling by VEGF and MET, and RNA polymerase II transcription pathways were identified as possible targets of hsa-miR-199a-3p, hsa-200c-3p, and hsa-miR-17-5p. Compared with HIV-negative controls, we observed lower hsa-miR-326, hsa-miR-497-5p, and hsa-miR-501-3p levels before and during ART in all PWH, and higher hsa-miR-199a-3p and hsa-miR-200c-3p levels before ART in all PWH, and during ART in PWH with poor CD4+ T-cell recovery only. Conclusion: These findings add to the understanding of pathways involved in persistent HIV-induced immune dysregulation during suppressive ART. Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedGergen, Margaretta; Hewitt, Austin; Sanger, Cristina B.; Striker, Rob
AIDS, 9.02.2024
Tilføjet 9.02.2024
An infographic is available for this article at:http://links.lww.com/QAD/D115. An infographic is available for this article at:http://links.lww.com/QAD/D115. Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedNoor, M. N., Shaw, S. Y., Linton, J., Lorway, R.
BMJ Open, 8.02.2024
Tilføjet 8.02.2024
IntroductionSexually diverse Muslim men are seen to be at a higher risk for HIV and other sexually transmitted infections due to their limited access to sexual healthcare services. We outline a protocol to conduct a scoping review of research on the barriers that may impede these men’s access to sexual healthcare. Methods and analysisTo conduct this scoping review, we will follow the methodological framework developed by Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses’ extension for scoping reviews. To classify the barriers to sexual healthcare, we will employ Bronfenbrenner’s socioecological model as a conceptual framework. We will conduct a literature search via Medline, Embase and Global Health (OVID); Scopus; CINAHL on EBSCOhost along with several other EBSCOhost databases (Academic Search Complete, Canadian Reference Centre, Alternative Press Index, Family & Society Studies Worldwide, Social Work Abstracts) and Google Scholar, published until November 2023. Journal articles, published in the English language, describing quantitative and qualitative research on sexual healthcare access barriers for sexually diverse Muslim men will be included in the review. Commentaries and correspondences, along with grey literature including research reports and conference abstracts, as well as studies that do not include men with the Muslim faith, will be considered ineligible. Following screening of titles and abstracts, we will conduct a full-text screening to determine the final number of studies to be included in the review. A Microsoft Excel spreadsheet will be used to extract study characteristics, and information on sexual healthcare access barriers will be classified according to the socioecological model’s core concepts. Ethics and disseminationOur review does not require ethics approval. We will disseminate the review findings through peer-reviewed academic journals, seminars and conference presentations.
Læs mere Tjek på PubMedMeehan, S.-A., Hesseling, A. C., von Delft, A., Marx, F. M., Hughes, J. A., Bock, P., Banke-Thomas, A., Dunbar, R., Phelanyane, F., Smith, M., Osman, M.
BMJ Open, 8.02.2024
Tilføjet 8.02.2024
BackgroundTuberculosis (TB) remains a leading cause of mortality among women of childbearing age and a significant contributor to maternal mortality. Pregnant women with TB are at high risk of adverse pregnancy outcomes. This study aimed to determine risk factors for an adverse pregnancy outcome among pregnant women diagnosed with TB. MethodsUsing TB programmatic data, this retrospective cohort analysis included all women who were routinely diagnosed with TB in the public sector between October 2018 and March 2020 in two health subdistricts of Cape Town, and who were documented to be pregnant during their TB episode. Adverse pregnancy outcome was defined as either a live birth of an infant weighing
Læs mere Tjek på PubMedYang, X., Olatosi, B., Weissman, S., Li, X., Zhang, J.
BMJ Open, 8.02.2024
Tilføjet 8.02.2024
IntroductionThe measure of sexual orientation and gender identity (SOGI) data in electronic health records (EHR) has been critical for addressing health disparities and inequalities, especially for HIV care. Given that gender and sexual minorities (eg, transgender, men who have sex with men and intersex) are key groups in people living with HIV (PLWH), SOGI data can facilitate a more accurate understanding about the HIV outcomes (eg, viral suppression) among this key group and then lead to tailored therapeutic services. The two-step SOGI collection method as an emerging gender measurement can be used to measure SOGI status in medical settings. Using the statewide cohort of PLWH in South Carolina (SC), this project aims to: (1) integrate statewide PLWH cohort data with their birth certificate data to evaluate SOGI measurements from multiple EHR sources; and (2) examine differences in viral suppression based on SOGI measurements. Methods and analysisOur EHR database includes several HIV data sources with patients’ gender information, such as SC Department of Health and Environmental Control Centre (DHEC), Health Sciences South Carolina (HSSC) and Prisma as well as birth certificate data to retrieve the sex at birth. The SC Enhanced HIV/AIDS Reporting System (e-HARS) from DHEC will provide longitudinal viral load information to define a variety of viral suppression status. Datasources like the SC office of Revenue and Fiscal Affairs (RFA) will extract longitudinal EHR clinical data of all PLWH in SC from multiple health systems; obtain data from other state agencies and link the patient-level data with county-level data from multiple publicly available data sources. Ethics and disseminationThe study was approved by the Institutional Review Board at the University of South Carolina (Pro00129906) as a Non-Human Subject study. The study’s findings will be published in peer-reviewed journals and disseminated at national and international conferences and through social media.
Læs mere Tjek på PubMedShade, Starley B.; Gutin, Sarah A.; Agnew, Emily; Grignon, Jessica S.; Gilmore, Hailey; Ratlhagana, Mary-Jane; Sumitani, Jeri; Steward, Wayne T.; Lippman, Sheri A.
Journal of Acquired Immune Deficiency Syndromes, 8.02.2024
Tilføjet 8.02.2024
Introduction: Large proportions of people living with HIV (PLHIV) in sub-Saharan Africa are not linked to or retained in HIV care. There is a critical need for cost-effective interventions to improve engagement and retention in care and inform optimal allocation of resources. Methods: We estimated costs associated with: a short message service (SMS) plus peer navigation (SMS+PN) intervention; an SMS-only intervention; and standard of care (SOC), within the I-Care cluster-randomized trial to improve HIV care engagement for recently diagnosed PLHIV. We employed a uniform cost data-collection protocol to quantify resources used and associated costs for each intervention. Results: Compared to SOC, the SMS+PN intervention cost $1284 ($828-$2859) more per additional patient linked to care within 30 days and $1904 ($1158-$5343) more per additional patient retained in care at 12 months, while improving linkage by 24% (95% CI=11%,36%) and retention by 16% (95% CI=6%,26%). In contrast, the SMS-only intervention cost $198 ($93-dominated) more per additional patient linked to care and $697 ($171-dominated) more per additional patient retained in care, but was not significantly associated with improvements in linkage (12%; 95% CI=-1,25) or retention (3%; 95% CI=-7,14) compared to SOC. The efficiency of the SMS+PN intervention could be improved by 46%, to $690 more per additional patient linked and $1023 more per additional patient retained in care, if implemented within the Department of Health (DoH) using more efficient distribution of staff resources. Discussion: Findings suggest scale-up of the SMS+PN intervention could benefit patients, improving care and health outcomes while being cost-effective. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedPoku, Ohemaa; Attoh-Okine, Naa-Djama; Corbeil, Thomas; Chen, Ying; Kluisza, Luke; Ahmed, Afifa; Liotta, Lucy; Morrison, Corey; Dolezal, Curtis; Robbins, Reuben N.; Mellins, Claude A.
Journal of Acquired Immune Deficiency Syndromes, 8.02.2024
Tilføjet 8.02.2024
Background: With few psychometrically evaluated HIV related stigma measures for adolescents and young adults (AYA) living with HIV, we examined the developmental applicability (i.e., validity) of two subscales of the commonly used stigma measure, the Social Impact Scale (SIS), among a cohort of adolescents and young adults with perinatally-acquired HIV. Setting: Data came from a New York City longitudinal study (N=340). This study primarily comprises Black and Latinx AYA with either perinatally-acquired HIV (PHIV) or those with perinatal exposure but who are uninfected. Data for this analysis came from the PHIV population and spanned approximately a 15-year survey period (2003-2018). Methods: A confirmatory factor analysis was used at seven time points to assess if the Social Rejection and Internalized Shame subscales were consistent in this cohort over time. Overall and individual Cronbach’s alphas were reported to show the strength of the internal consistency. Results: Mean age from Baseline to Follow-Up 6 ranged from 12-23 years over the study period. The Social Rejection subscale was acceptably valid across follow-up periods with strong factor loadings and Cronbach’s alphas higher than 0.70. However, the Internalized Shame subscale was less valid among younger adolescents. Starting at Follow-Up 2, we observed better validity with the Internalized Shame subscale performance. Conclusion: Future research must consider mechanisms for developing and adapting measures from a developmental perspective to best measure the experiences of HIV-related stigma among younger populations. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedTurk, Teja; Labarile, Marco; Braun, Dominique L.; Rauch, Andri; Stöckle, Marcel; Cavassini, Matthias; Hoffmann, Matthias; Calmy, Alexandra; Bernasconi, Enos; Notter, Julia; Pasin, Chloé; Günthard, Huldrych F.; Kouyos, Roger D.; the Swiss HIV Cohort Study
Journal of Acquired Immune Deficiency Syndromes, 8.02.2024
Tilføjet 8.02.2024
Objective. We developed a robust characterization of immune recovery trajectories in people living with HIV (PWH) on antiretroviral treatment (ART) and relate our findings to epidemiological risk factors and bacterial pneumonia. Methods. Using data from the Swiss HIV Cohort Study and the Zurich Primary HIV Infection Cohort Study (n = 5907), we analyzed the long-term trajectories of CD4 cell and CD8 cell counts and their ratio in PWH on ART for at least eight years by fitting nonlinear mixed effects models. The determinants of long-term immune recovery were investigated using generalized additive models. In addition, prediction accuracy of the modeled trajectories and their impact on the fit of a model for bacterial pneumonia was assessed. Results. Overall, our population showed good immune recovery (median plateau [IQR]-CD4: 718 [555, 900] cells/µl, CD8: 709 [547, 893] cells/µl, CD4/CD8: 1.01 [0.76, 1.37]). The following factors were predictive of recovery: Age, sex, nadir/zenith value, pre-ART HIV-1 viral load, Hepatitis C, ethnicity, acquisition risk and timing of ART-initiation. The fitted models proved to be an accurate and efficient way of predicting future CD4+ and CD8+ cell recovery dynamics: Compared to carrying forward the last observation, mean squared errors of the fitted values were lower by 1.3% to 18.3% across outcomes. When modeling future episodes of bacterial pneumonia, using model-derived predictors improved most model fits. Conclusion. We described and validated a method to characterize individual immune recovery trajectories of PWH on suppressive ART. These trajectories accurately predict long-term immune recovery and the occurrence of bacterial pneumonia. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedNguyen, Vu-Thuy; Nagavedu, Kshema; Morrison, Monica; Chen, Tom; Randall, Liisa M.; Landazabal, Claudia; John, Betsey; Klompas, Michael; Cocoros, Noelle M.
Journal of Acquired Immune Deficiency Syndromes, 8.02.2024
Tilføjet 8.02.2024
Background: People with HIV (PWH) may be at risk for more severe COVID-19 outcomes. We compared risk for severe COVID-19 in PWH to matched individuals without HIV. Methods: We identified adults in Massachusetts with a positive SARS-CoV-2 test, March 2020-July 2022, using electronic medical record data from three large clinical practice groups. We then used regression models to compare outcomes among PWH versus propensity score-matched people without HIV (matched 20:1) for severe COVID-19 (pneumonia or acute respiratory distress syndrome), hospitalization, and hospital length-of-stay (LOS). Results: We identified 171,058 individuals with COVID-19; among them, 768 PWH were matched to 15,360 individuals without HIV. Overall, severe COVID-19 and hospitalization was similar in PWH and those without HIV (severe COVID-19: 3.8% vs 3.0%, adjusted OR 1.27, 95% CI 0.86-1.87; hospitalization:12.1% vs 11.3%, adjusted OR 1.08, 95% CI 0.87-1.35). Compared to people without HIV, PWH with low CD4 T-cell counts (
Læs mere Tjek på PubMedJournal of the American Medical Association, 8.02.2024
Tilføjet 8.02.2024
Receiving doxycycline after sex did not lead to fewer chlamydia or gonorrhea infections among cisgender women compared with standard care, according to results from a randomized clinical trial involving 449 participants aged 18 to 30 years in Kenya who were also receiving preexposure prophylaxis against HIV. These findings contrast previous research that showed taking doxycycline within 72 hours after a sexual encounter protects cisgender men who have sex with men and transgender women from sexually transmitted infections (STIs).
Læs mere Tjek på PubMedAmerican Journal of Tropical Medicine and Hygiene, 8.02.2024
Tilføjet 8.02.2024
Journal Name: The American Journal of Tropical Medicine and Hygiene Volume: 110 Issue: 2 Pages: 228-233
Læs mere Tjek på PubMedAmerican Journal of Tropical Medicine and Hygiene, 8.02.2024
Tilføjet 8.02.2024
Journal Name: The American Journal of Tropical Medicine and Hygiene Volume: 110 Issue: 2 Pages: 387-390
Læs mere Tjek på PubMedBMC Infectious Diseases, 7.02.2024
Tilføjet 7.02.2024
Abstract Background Diagnosis of tuberculous meningitis (TBM) is hampered by the lack of a gold standard. Current microbiological tests lack sensitivity and clinical diagnostic approaches are subjective. We therefore built a diagnostic model that can be used before microbiological test results are known. Methods We included 659 individuals aged (ge 16) years with suspected brain infections from a prospective observational study conducted in Vietnam. We fitted a logistic regression diagnostic model for TBM status, with unknown values estimated via a latent class model on three mycobacterial tests: Ziehl–Neelsen smear, Mycobacterial culture, and GeneXpert. We additionally re-evaluated mycobacterial test performance, estimated individual mycobacillary burden, and quantified the reduction in TBM risk after confirmatory tests were negative. We also fitted a simplified model and developed a scoring table for early screening. All models were compared and validated internally. Results Participants with HIV, miliary TB, long symptom duration, and high cerebrospinal fluid (CSF) lymphocyte count were more likely to have TBM. HIV and higher CSF protein were associated with higher mycobacillary burden. In the simplified model, HIV infection, clinical symptoms with long duration, and clinical or radiological evidence of extra-neural TB were associated with TBM At the cutpoints based on Youden’s Index, the sensitivity and specificity in diagnosing TBM for our full and simplified models were 86.0% and 79.0%, and 88.0% and 75.0% respectively. Conclusion Our diagnostic model shows reliable performance and can be developed as a decision assistant for clinicians to detect patients at high risk of TBM. Summary Diagnosis of tuberculous meningitis is hampered by the lack of gold standard. We developed a diagnostic model using latent class analysis, combining confirmatory test results and risk factors. Models were accurate, well-calibrated, and can support both clinical practice and research.
Læs mere Tjek på PubMedClinical Infectious Diseases, 7.02.2024
Tilføjet 7.02.2024
Abstract A 32-year-old female with advanced HIV infection presented to an Australian hospital with subacute but worsening symptoms of encephalitis. Metagenomic sequencing and Dengue NS3 antigen staining of brain tissue confirmed active Dengue virus (DENV) encephalitis. The most recent possible DENV exposure was months prior in West Africa, indicating chronicity.
Læs mere Tjek på PubMedInfection, 6.02.2024
Tilføjet 6.02.2024
Abstract Background Little is known about the etiology, clinical presentation, management, and outcome of central nervous system (CNS) infections in Indonesia, a country with a high burden of infectious diseases and a rising prevalence of HIV. Methods We included adult patients with suspected CNS infections at two referral hospitals in a prospective cohort between April 2019 and December 2021. Clinical, laboratory, and radiological assessments were standardized. We recorded initial and final diagnoses, treatments, and outcomes during 6 months of follow-up. Results Of 1051 patients screened, 793 were diagnosed with a CNS infection. Patients (median age 33 years, 62% male, 38% HIV-infected) presented a median of 14 days (IQR 7–30) after symptom onset, often with altered consciousness (63%), motor deficits (73%), and seizures (21%). Among HIV-uninfected patients, CNS tuberculosis (TB) was most common (60%), while viral (8%) and bacterial (4%) disease were uncommon. Among HIV-infected patients, cerebral toxoplasmosis (41%) was most common, followed by CNS TB (19%), neurosyphilis (15%), and cryptococcal meningitis (10%). A microbiologically confirmed diagnosis was achieved in 25% of cases, and initial diagnoses were revised in 46% of cases. In-hospital mortality was 30%, and at six months, 45% of patients had died, and 12% suffered from severe disability. Six-month mortality was associated with older age, HIV, and severe clinical, radiological and CSF markers at presentation. Conclusion CNS infections in Indonesia are characterized by late presentation, severe disease, frequent HIV coinfection, low microbiological confirmation and high mortality. These findings highlight the need for earlier disease recognition, faster and more accurate diagnosis, and optimized treatment, coupled with wider efforts to improve the uptake of HIV services.
Læs mere Tjek på PubMedRiley M. HorvathZabrina L. BrummeIvan Sadowski1Department of Biochemistry and Molecular Biology Molecular Epigenetics Group, LSI, University of British Columbia, Vancouver, British Columbia, Canada2Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada3British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada, Miguel Angel Martinez
Antimicrobial Agents And Chemotherapy, 6.02.2024
Tilføjet 6.02.2024
Infection, 5.02.2024
Tilføjet 5.02.2024
Abstract Background Little is known about the etiology, clinical presentation, management, and outcome of central nervous system (CNS) infections in Indonesia, a country with a high burden of infectious diseases and a rising prevalence of HIV. Methods We included adult patients with suspected CNS infections at two referral hospitals in a prospective cohort between April 2019 and December 2021. Clinical, laboratory, and radiological assessments were standardized. We recorded initial and final diagnoses, treatments, and outcomes during 6 months of follow-up. Results Of 1051 patients screened, 793 were diagnosed with a CNS infection. Patients (median age 33 years, 62% male, 38% HIV-infected) presented a median of 14 days (IQR 7–30) after symptom onset, often with altered consciousness (63%), motor deficits (73%), and seizures (21%). Among HIV-uninfected patients, CNS tuberculosis (TB) was most common (60%), while viral (8%) and bacterial (4%) disease were uncommon. Among HIV-infected patients, cerebral toxoplasmosis (41%) was most common, followed by CNS TB (19%), neurosyphilis (15%), and cryptococcal meningitis (10%). A microbiologically confirmed diagnosis was achieved in 25% of cases, and initial diagnoses were revised in 46% of cases. In-hospital mortality was 30%, and at six months, 45% of patients had died, and 12% suffered from severe disability. Six-month mortality was associated with older age, HIV, and severe clinical, radiological and CSF markers at presentation. Conclusion CNS infections in Indonesia are characterized by late presentation, severe disease, frequent HIV coinfection, low microbiological confirmation and high mortality. These findings highlight the need for earlier disease recognition, faster and more accurate diagnosis, and optimized treatment, coupled with wider efforts to improve the uptake of HIV services.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 5.02.2024
Tilføjet 5.02.2024
Abstract Background Abnormal cervical cytology is commonly observed in women living with HIV (WLWH).Methods A cross-sectional study was conducted with 130 WLWH and 147 age-matched healthy controls, who underwent gynecological examinations at Beijing Ditan Hospital. The presence of abnormal cervical cytology in WLWH was predicted after performing a logistic regression analysis.Results Multivariate logistic regression revealed three independent factors, among which CD4 cell counts of more than 350 cells/μL was the protective factor, while human papillomavirus infection and abnormal vaginal pH were the risk factors.Conclusions Vaginal microecological disorders can increase the risk of abnormal cervical cytology in WLWH.
Læs mere Tjek på PubMedClinical Infectious Diseases, 5.02.2024
Tilføjet 5.02.2024
Abstract Background Obesity is increasingly prevalent among people with HIV (PWH). Obesity can reduce drug exposure; however, limited data are available for long-acting (LA) antiretrovirals. We performed in-silico trials using physiologically based pharmacokinetic (PBPK) modelling to determine the effect of obesity on the exposure of LA cabotegravir and rilpivirine after the initial injection and after multiple injections.Methods Our PBPK model was verified against available clinical data for LA cabotegravir and rilpivirine in normal weight/overweight (body mass index (BMI) 35% for BMI >35 kg/m2 and in rilpivirine AUC and Cmin of >18% for BMI >40 kg/m2 at steady-state. A significant proportion of morbidly obese individuals were predicted to have both cabotegravir and rilpivirine Cmin below the target concentration at steady-state with the bimonthly administration but this was less frequent with the monthly administration.Conclusions Morbidly obese PWH are at risk of presenting suboptimal Cmin for cabotegravir/rilpivirine after the first injection but also at steady-state particularly with the bimonthly administration. Therapeutic drug monitoring is advised to guide dosing interval adjustment.
Læs mere Tjek på PubMedClinical Infectious Diseases, 5.02.2024
Tilføjet 5.02.2024
Abstract Background HIV-related opportunistic infections (OIs) cause substantial morbidity and mortality among people with HIV (PWH). US hospitalization and in-hospital mortality rates associated with OIs have not been published using data from the past decade.Methods We analyzed the National Inpatient Sample (NIS) for the years 2011 through 2018. We used sociodemographic, financial, and hospital-level variables and identified hospitalizations for PWH and OI diagnoses. Using survey-weighted methods, we estimated all OI-related US hospitalization rates and in-hospital mortality per 100,000 PWH and modeled associated factors using survey-based multivariable logistic regression techniques.Findings From 2011-2018, there were an estimated 1,710,164 (95% CI 1,659,566-1,760,762) hospital discharges for PWH with 154,430 (95% CI 148,669-159,717; 9.2%) associated with an OI, of which 9,336 (95% CI 8,813-9,857; 6.0%) resulted in in-hospital mortality. Variables associated with higher odds of OI-related hospitalizations (compared to without an OI) included younger age (Likelihood Ratio (LR) p
Læs mere Tjek på PubMedClinical Infectious Diseases, 5.02.2024
Tilføjet 5.02.2024
Abstract Background Reliance on sputum-based testing is a key barrier to increasing access to molecular diagnostics for tuberculosis (TB). Many people with TB are unable to produce sputum, and sputum processing increases the complexity and cost of molecular assays. Tongue swabs are emerging as an alternative to sputum, but performance limits are uncertain.Methods From June 2022 to July 2023, we enrolled 397 consecutive adults with cough >2 weeks at two health centers in Kampala, Uganda. We collected routine demographic and clinical information, sputum for routine TB testing (Xpert MTB/RIF Ultra® and two liquid cultures), and up to four tongue swabs for same-day qPCR. We evaluated tongue swab qPCR diagnostic accuracy in reference to sputum TB test results, quantified TB targets per swab, assessed the impact of serial swabbing, and compared two swab types (Copan FLOQSWAB® and Steripack® spun polyester).Results Among 397 participants, 43.1% were female, median age was 33 years, 23.5% were living with HIV (PLHIV) and 32.0% had confirmed TB. Sputum Xpert Ultra and tongue swab qPCR results were concordant for 98.2% [96.2-99.1] of participants. Tongue swab qPCR sensitivity was 92.6% [95%CI: 86.5, 96.0] and specificity 99.1% [96.9-99.8] vs. microbiological reference standard (MRS). A single tongue swab recovered a seven-log range of TB copies, with a decreasing recovery trend among four serial swabs. We found no difference between swab types.Conclusions Tongue swabs are a promising alternative to sputum for molecular diagnosis of TB, with sensitivity approaching sputum-based molecular tests. Our results provide valuable insights for developing successful tongue swab-based TB diagnostics.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 4.02.2024
Tilføjet 4.02.2024
Abstract Research on infectious diseases (ID) is crucial for enhancing public health worldwide. Often, it is physician-scientists who spearhead these medical breakthroughs. However, the current workforce in infectious diseases faces significant challenges. In this perspective, we address these challenges and propose strategies to bolster the physician-scientist workforce in ID. Tracing the history of ID research from the dawn of the modern era to the present, we highlight the unique contributions of physician-scientists and groundbreaking discoveries that have shaped human health. We underscore the role of ID research in unraveling disease mechanisms and developing treatments and vaccines that promote public health and prevention measures. We emphasize the ongoing need for ID research due to the persistence of emerging and re-emerging infectious diseases, the development of antimicrobial resistance, and longstanding infectious threats such as HIV and influenza. By analyzing the current landscape and challenges of the physician-scientist workforce in ID, we shed light on existing gaps and economic realities in academic medicine. We draw attention to the status of the ID field, which is often overshadowed by other medical specialties. We advocate for a shift in focus from intervention in response to outbreaks to sustained prevention and preparedness efforts. We delve into hurdles physician-scientists face, such as limited funding opportunities, inadequate training and mentorship programs, and insufficient research and clinical practice integration. To strengthen the physician-scientist workforce, we present a comprehensive roadmap. This includes increasing funding opportunities, developing robust training programs, enhancing mentorship and career development, promoting collaboration and interdisciplinary research, broadening the definition of research, identifying unmet needs, and improving recognition and reward systems. Here, we highlight the critical importance of a well-supported physician-scientist workforce in ID research. We call for immediate action to implement the proposed strategies and ensure the continuous advancement of infectious diseases research and patient care.
Læs mere Tjek på PubMedNathan Ford, Peter Ehrenkranz, Joseph Jarvis
New England Journal of Medicine, 4.02.2024
Tilføjet 4.02.2024
Rodrigo Volmir Anderle, Robson Bruniera de Oliveira, Felipe Alves Rubio, James Macinko, Ines Dourado, Davide Rasella
PLoS One Infectious Diseases, 3.02.2024
Tilføjet 3.02.2024
by Rodrigo Volmir Anderle, Robson Bruniera de Oliveira, Felipe Alves Rubio, James Macinko, Ines Dourado, Davide Rasella Objective To end the AIDS epidemic by 2030, despite the increasing poverty and inequalities, policies should be designed to deal with population heterogeneity and environmental changes. Bottom-up designs, such as the Agent-Based Model (ABM), can model these features, dealing with such complexity. HIV/AIDS has a complex dynamic of structural factors, risk behaviors, biomedical characteristics and interventions. All embedded in unequal, stigmatized and heterogeneous social structure. To understand how ABMs can model this complexity, we performed a scoping review of HIV applications, highlighting their potentialities. Methods We searched on PubMed, Web of Science, and Scopus repositories following the PRISMA extension for scoping reviews. Our inclusion criteria were HIV/AIDS studies with an ABM application. We identified the main articles using a local co-citation analysis and categorized the overall literature aims, (sub)populations, regions, and if the papers declared the use of ODD protocol and limitations. Results We found 154 articles. We identified eleven main papers, and discussed them using the overall category results. Most studies model Transmission Dynamics (37/154), about Men who have sex with Men (MSM) (41/154), or individuals living in the US or South Africa (84/154). Recent studies applied ABM to model PrEP interventions (17/154) and Racial Disparities (12/154). Only six papers declared the use of ODD Protocol (6/154), and 34/154 didn’t mention the study limitations. Conclusions While ABM is among the most sophisticated techniques available to model HIV/AIDS complexity. Their applications are still restricted to some realities. However, researchers are challenged to think about social structure due model characteristics, the inclusion of these features is still restricted to case-specific. Data and computational power availability can enhance this feature providing insightful results.
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.02.2024
Tilføjet 3.02.2024
Abstract The pathological consequences of inflammation persist in people living with the human immunodeficiency virus (PLWH), regardless of the positive outcomes of highly active antiretroviral therapy (HAART). The current systematic review and meta-analysis aims to understand and explore the levels of high-sensitivity C-reactive protein (hs-CRP) and other cardiovascular disease (CVD)-risk factors including lipid profiles among PLWH on HAART. Major electronic databases including PubMed, Scopus, and Web of Science were searched to retrieve relevant global literature reporting on hs-CRP levels in PLWH on HAART. A total of twenty-two studies with an average participant age of 40 years were eligible for this systematic review and meta-analysis. Majority of the included studies were from Africa (n = 11), the United States (n = 6), and Europe (n = 5). Our systemic review showed that most studies reported increased levels of hs-CRP among PLWH on HAART when compared to controls (PLWH not on HAART or those without HIV), especially in studies from Africa. This was supported by a meta-analysis showing significantly elevated levels of hs-CRP in PLWH on HAART when compared to PLWH not on HAART (standardised mean difference [SMD] = 0.56; 95% CI = 0.10‑1.01, z = 2.41; p = 0.02) or those without HIV (SMD = 1.19; 95% CI = 0.76‑1.63, z = 5.35; p
Læs mere Tjek på PubMedAshley L. Bennett, Robert Edwards, Irina Kosheleva, Carrie Saunders, Yishak Bililign, Ashliegh Williams, Pimthada Bubphamala, Katayoun Manosouri, Kara Anasti, Kevin O. Saunders, S. Munir Alam, Barton F. Haynes, Priyamvada Acharya, Rory Henderson
Science Advances, 2.02.2024
Tilføjet 2.02.2024
Aaloke Mody, Annette H Sohn, Collins Iwuji, Rayner K J Tan, Francois Venter, Elvin H Geng
Lancet, 2.02.2024
Tilføjet 2.02.2024
The global HIV response has made tremendous progress but is entering a new phase with additional challenges. Scientific innovations have led to multiple safe, effective, and durable options for treatment and prevention, and long-acting formulations for 2-monthly and 6-monthly dosing are becoming available with even longer dosing intervals possible on the horizon. The scientific agenda for HIV cure and remission strategies is moving forward but faces uncertain thresholds for success and acceptability.
Læs mere Tjek på PubMedBMC Infectious Diseases, 2.02.2024
Tilføjet 2.02.2024
Abstract Background objective This study aimed to understand the basic situation of adults with human immunodeficiency virus (HIV) receiving antiretroviral therapy (ART) in Meigu County, Liangshan Yi Autonomous Prefecture. The information of patients who had been on ART for more than 6 months, the effect of ART, the possible reasons for ART failure, knowledge of drug resistance among patients with ART failure and the possible reasons for the emergence of drug resistance were analyzed. Methods A total of 2753 people living with HIV (PLWH) were collected for HIV-1 RNA virus nucleic acid testing. Plasma specimens with HIV-1 RNA ≥ 1000 copies/mL were sent to the laboratory for nucleic acid extraction, PCR, electrophoresis and sequencing, and the sequencing results were submitted to the HIV drug resistance database of Stanford University for subtyping to determine the drug resistance mutation sites and drug sensitivity levels. Results A total of 2753 patients were enrolled in this study. Antiviral therapy failed in 288 patients and was successfully amplified in 245, of which 111 had resistance genes. The resistance rate to failure of viral suppression was 45.3% (111/245). The highest rates of resistance to NNRTIs were found for efavirenz (EFV) and nevirapine (NVP) (42.9%), and the highest rates of resistance to NRTIs were found for 3TC and emtricitabine (FTC) (15.9%). The most common NNRTI resistance mutation site was K103N (20.8%), followed by V179D (9.4%) and V106M (7.8%); the most common NRTI resistance mutation site was M184V/I/MV (14.3%), followed by K65R (6.9%); three PI-associated resistance mutation sites were identified. The subtype of the resistant strain was CRF07-BC in almost all patients (98.9%). Conclusions Compared with the previous low ART efficacy in the county, this study showed that the overall virological failure (VF) resistance rate in the county is still low, dominated by resistance to EFV, NVP, 3TC, FTC, and didanosine (DDI). Due to economic constraints, the core regimen is still 3TC + TDF, but before initiating ART, testing for HIV-1 subtypes and resistance should be conducted to avoid resistance that can lead to VF, especially for patients with high risk factors for resistance as shown by epidemiologic investigations.
Læs mere Tjek på PubMedBMC Infectious Diseases, 2.02.2024
Tilføjet 2.02.2024
Abstract Background Previous studies show increased morbidity in children who are HIV-exposed but uninfected (HEU) compared to children who are HIV-unexposed uninfected (HUU). We sought to evaluate the effects of prenatal HIV exposure on clinical and immunological outcomes in the first 24 months of life. Methods Eighty-five HEU and 168 HUU children from Kenya were followed from birth to 24 months. All mothers living with HIV received combination antiretroviral therapy. Children who were HEU received standard-of-care cotrimoxazole prophylaxis through 18 months. Episodes of acute illness were identified through a combination of active and passive follow up. Trajectories of plasma cytokines, vaccine-specific antibodies, and antimalarial antibodies were examined. Results Children who were HEU and children who were HUU had similar growth curves. Children who were HEU had lower rates of malaria (rate ratio 0.54, 95% CI 0.38, 0.77) and respiratory illness (rate ratio 0.80, 95% CI 0.68, 0.93). Trajectories of plasma cytokines and vaccine-specific antibodies were similar in children who were HEU and HUU. There were subtle differences in antimalarial antibody dynamics, in which children who were HEU had overall lower antibody levels against five of the 14 malaria antigens tested. Conclusions Children who were HEU and born to optimally treated mothers living with HIV had similar growth characteristics and immune profiles compared to children who were HUU. Children who were HEU had reduced risk for malaria and respiratory illness, which may be secondary to cotrimoxazole prophylaxis.
Læs mere Tjek på PubMedIlana NazariMatthew J. Feinstein1Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA2Division of Cardiology in the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA3Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA, Graeme N. Forrest
Clinical Microbiology Reviews, 1.02.2024
Tilføjet 1.02.2024
BMC Infectious Diseases, 1.02.2024
Tilføjet 1.02.2024
Abstract Background Pneumocystis jirovecii pneumonia (PJP) is a life-threatening and severe disease in immunocompromised hosts. A synergistic regimen based on the combination of sulfamethoxazole-trimethoprim (SMX-TMP) with caspofungin and glucocorticosteroids (GCSs) may be a potential first-line therapy for PJP. Therefore, it is important to explore the efficacy and safety of this synergistic therapy for treating non-HIV-related PJP patients. Methods We retrospectively analysed the data of 38 patients with non-HIV-related PJP at the First Affiliated Hospital of Xi’an Jiaotong University. Patients were divided into two groups: the synergistic therapy group (ST group, n = 20) and the monotherapy group (MT group, n = 18). All patients were from the ICU and were diagnosed with severe PJP. In the ST group, all patients were treated with SMX-TMP (TMP 15–20 mg/kg per day) combined with caspofungin (70 mg as the loading dose and 50 mg/day as the maintenance dose) and a GCS (methylprednisolone 40–80 mg/day). Patients in the MT group were treated only with SMX-TMP (TMP 15–20 mg/kg per day). The clinical response, adverse events and mortality were compared between the two groups. Results The percentage of patients with a positive clinical response in the ST group was significantly greater than that in the MT group (100.00% vs. 66.70%, P = 0.005). The incidence of adverse events in the MT group was greater than that in the ST group (50.00% vs. 15.00%, P = 0.022). Furthermore, the dose of TMP and duration of fever in the ST group were markedly lower than those in the MT group (15.71 mg/kg/day vs. 18.35 mg/kg/day (P = 0.001) and 7.00 days vs. 11.50 days (P = 0.029), respectively). However, there were no significant differences in all-cause mortality or duration of hospital stay between the MT group and the ST group. Conclusions Compared with SMZ/TMP monotherapy, synergistic therapy (SMZ-TMP combined with caspofungin and a GCS) for the treatment of non-HIV-related PJP can increase the clinical response rate, decrease the incidence of adverse events and shorten the duration of fever. These results indicate that synergistic therapy is effective and safe for treating severe non-HIV-related PJP.
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