Chronic Coinfection Research Articles

The spectrum and outcome of metastatic hepatocellular carcinoma in a South African patient cohort.

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death globally, particularly in developing countries in Southeast Asia and sub-Saharan Africa (SSA), where chronic hepatitis B virus (HBV) dominates as a major aetiological factor. We conducted a retrospective cohort study to quantify the metastatic profile of HCC in a South African patient population managed at a tertiary centre. Demographic, clinical and treatment data were extracted from an institutional registry. Patients with and without metastases were compared to identify factors associated with an increased risk of developing metastases. Of 676 patients, 194 (28.7%) had metastases. Patients with metastases were younger (46.37 vs. 52.23 years; p<0.00001) and more frequently had chronic HBV, HIV co-infection and schistosomiasis compared to non-metastatic patients. The most common metastatic sites were lungs, skeletal, and peritoneum. For non-treated patients, skeletal metastases had the poorest survival. This study confirms a typical SSA disease profile of aggressive HCC in a young population. We reported on the metastatic profile of HCC and the impact of different metastases on survival. Future research should focus on defining the concept of oligometastatic disease in HCC to identify patients where intervention targeting metastatic disease may be of benefit.

HLA-G liver expression in chronically HIV/hepatitis C-coinfected individuals.

Hepatitis C-induced liver disease represents a significant threat to the survival of people living with HIV. HIV/HCV-coinfected individuals have a more rapid progression to cirrhosis and its complications than HCV monoinfected patients. Although the underlying mechanisms remain unclear, HLA-G, a non-classical class I HLA molecule, has a well-recognized property to down-regulate the immune response against viruses and may favor the progression of chronic hepatitis C. We analyzed HLA-G expression in 59 liver specimens of patients harboring chronic HCV and HIV coinfection and stratified the findings according to clinical and histopathological features. Genotype 1 was the most prevalent (88%); the HLA-G expression was observed in 38 (64%) liver specimens, and it was more frequent in more severe stages than in milder stages of chronic hepatitis (94,1% x 55%; p<0.01). HLA-G expression in the liver was not correlated to antiviral response to hepatitis C therapy with pegylated-IFN-α plus ribavirin. HLA-G expression in the context of HCV/HIV coinfection is a complex process modulated by many factors. HLA-G expression may play a role in the mechanisms that facilitate disease progression and may contribute to the deterioration of the immune response against HCV in individuals living with HIV.

Respiratory Syncytial Virus Risk Profile in Hospitalized Infants and Comparison with Influenza and COVID-19 Controls in Valladolid, Spain, 2010-2022.

We aimed to describe the risk profile of RSV infections among children aged ≤ 24months in Valladolid from January 2010 to August 2022 and to compare them with influenza and COVID-19 controls. We conducted a retrospective cohort study of all laboratory-confirmed RSV, influenza, and COVID-19 infections. We analyzed risk factors for RSV hospitalization and severity (length-of-stay ≥ 8 days, intensive-care-unit admission, in-hospital death or readmission < 30days) and compared severity between hospitalized RSV patients vs. influenza and COVID-19 controls using multivariable logistic regression models. We included 1507 patients with RSV (1274 inpatient), 32 with influenza, and 52 COVID-19 controls. Hospitalized RSV (mean age 5.3months) and COVID-19 (4months) were younger than influenza (9.1months) patients. Sixteen percent of patients had RSV within the first month of life. Most infants did not have comorbidities (74% RSV, 56% influenza, and 69% COVID-19). Forty-one percent of patients with RSV and influenza were coinfected vs. 27% COVID-19 (p = 0.04). Among RSV, hospitalization risk factors were prematurity (adjusted OR 3.11 [95% CI 1.66, 4.44]) and coinfection (2.03 [1.45, 2.85]). Risks for higher severity were maternal smoking (1.89 [1.07, 3.33]), prematurity (2.31 [1.59, 3.34]), chronic lung disease (2.20 [1.06, 4.58]), neurodevelopmental condition (4.28 [2.10, 8.73]), and coinfection (2.67 [2.09, 3.40]). Breastfeeding was protective against hospitalization (0.87 [0.80, 0.95]) and severity (0.81 [0.74, 0.88]), while complete vaccination schedule was protective against severity (0.51 [0.27, 0.97]). RSV had 2.47 (1.03, 5.96) higher risk of experiencing any severe outcome compared to influenza and did not show significant differences vs. COVID-19. RSV hospitalizations were more frequent and severe than influenza, while severity was comparable to the early pandemic COVID-19. Currently, both influenza and COVID-19 vaccines are included in the maternal and childhood Spanish immunization schedule between the ages of 6 and 59months. RSV monoclonal antibody is recommended for ≤ 6months but a third of patients were aged 6-24months. Maternal RSV vaccination can protect their children directly from birth and indirectly through breastfeeding.

Chronic Coinfection with Pseudomonas aeruginosa and Normal Colony Staphylococcus aureus Causes Lung Structural Damage in the Cystic Fibrosis Rat

Cystic fibrosis (CF) respiratory outcomes are heavily influenced by complications of infection. Pseudomonas aeruginosa and Staphylococcus aureus are the most common colonizers of the cystic fibrosis lung, and frequently overlap to cause chronic and persistent co-infections associated with severe disease. However, the dynamics of P. aeruginosa and S. aureus co-infection and its impacts on the development of CF lung structural damage are poorly understood. Additionally, small colony variants (SCVs) of S. aureus have been associated with P. aeruginosa infections in people with CF, but their role in disease progression is largely unknown. In this work, the CF rat was used to model chronic lung co-infection with P. aeruginosa and S. aureus, using clinical and laboratory derived normal colony and SCV strains of S. aureus to evaluate the impact of phenotype on clinical outcomes. Rats co-infected with clinically derived S. aureus of both phenotypes experienced increased inflammation in the lung, but only the combination of P. aeruginosa and clinical normal colony S. aureus led to lung structural decline, including mucus obstruction and bronchiectasis. In regression analyses, damage was associated with a higher burden of P. aeruginosa, indicating that chronic co-infection with normal colony S. aureus and P. aeruginosa may support the progression CF lung decline driven by P. aeruginosa, which might be avoided when co-infecting S. aureus exhibits the SCV phenotype.

Successful management of hepatitis B and C coinfection: a case report

We report the case of a patient with chronic hepatitis B and C managed with direct-acting antivirals in an outpatient setting. Chronic hepatitis B was first treated with entecavir before initiating treatment for chronic hepatitis C. The patient achieved viral suppression for hepatitis B and sustained virological response for hepatitis C. As direct-acting antivirals become more available, healthcare practitioners should be familiar with managing patients with chronic coinfection.

P205 Chronic coinfection of Staphylococcus aureus and Pseudomonas aeruginosa in people with cystic fibrosis – a retrospective 2 center study and investigation of the bacterial interaction status

P205 Chronic coinfection of Staphylococcus aureus and Pseudomonas aeruginosa in people with cystic fibrosis – a retrospective 2 center study and investigation of the bacterial interaction status

390. Corticosteroid Treatment in Severe Patients with SARS-CoV-2 and Chronic HBV Co-infection: A Retrospective Multicenter Study

Abstract Background The impact of corticosteroids on patients with severe coronavirus disease 2019 (COVID-19)/chronic hepatitis B virus (HBV) co-infection is currently unknown. We aimed to investigate the association of corticosteroids with these patients. Methods This retrospective multicenter study screened 5447 confirmed COVID-19 patients hospitalized between Jan 1, 2021, to December 1, 2022, in three centers in India, where the prevalence of chronic HBV infection is moderate to high. Severe patients who had chronic HBV and acute SARS-CoV-2 infection were potentially eligible. The diagnosis of chronic HBV infection was based on positive testing for hepatitis B surface antigen (HBsAg) or HBV DNA during hospitalization and a medical history of chronic HBV infection. Severe patients (meeting one of the following criteria: respiratory rate &amp;gt; 30 breaths/min; severe respiratory distress; or SpO2 ≤ 93% on room air; or oxygen index &amp;lt; 300 mmHg) with COVID-19/HBV co-infection were identified. The bias of confounding variables on corticosteroid effects was minimized using a multivariable logistic regression model and inverse probability of treatment weighting (IPTW) based on the propensity score. Results The prevalence of HBV co-infection in COVID-19 patients was 4.1%. There were 105 patients with severe COVID-19/HBV co-infections (median age 62 years, 57.1% male). Fifty-five patients received corticosteroid treatment and 50 patients did not. In the multivariable analysis, corticosteroid therapy (OR, 6.32, 95% CI 1.17-34.24, P = 0.033) was identified as an independent risk factor for 28-day mortality. With IPTW analysis, corticosteroid treatment was associated with delayed SARS-CoV-2 viral RNA clearance (OR, 2.95, 95% CI 1.63-5.32, P &amp;lt; 0.001), increased risk of 28-day and in-hospital mortality (OR, 4.90, 95% CI 1.68-14.28, P = 0.004; OR, 5.64, 95% CI 1.95-16.30, P = 0.001, respectively), and acute liver injury (OR, 4.50, 95% CI 2.57-7.85, P &amp;lt; 0.001). Methylprednisolone dose per day and cumulative dose in non-survivors were significantly higher than in survivors. Conclusion In patients with severe COVID-19/HBV co-infection, corticosteroid treatment may be associated with an increased risk of 28-day and in-hospital mortality. Disclosures All Authors: No reported disclosures

JAK1 promotes HDV replication and is a potential target for antiviral therapy

Chronic co-infection with HBV and HDV leads to the most aggressive form of chronic viral hepatitis. To date, no treatment induces efficient viral clearance, and a better characterization of virus-host interactions is required to develop new therapeutic strategies. Using loss-of-function strategies, we validated the unexpected proviral activity of Janus kinase 1 (JAK1) - a key player in innate immunity - in the HDV life cycle and determined its mechanism of action on HDV through various functional analyses including co-immunoprecipitation assays. We confirmed the key role of JAK1 kinase activity in HDV infection. Moreover, our results suggest that JAK1 inhibition is associated with a modulation of ERK1/2 activation and S-HDAg phosphorylation, which is crucial for viral replication. Finally, we showed that FDA-approved JAK1-specific inhibitors are efficient antivirals in relevant invitro models including primary human hepatocytes. Taken together, we uncovered JAK1 as a key host factor for HDV replication and a potential target for new antiviral treatment. Chronic hepatitis D is the most aggressive form of chronic viral hepatitis. As no curative treatment is currently available, new therapeutic strategies based on host-targeting agents are urgently needed. Here, using loss-of-function strategies, we uncover an unexpected interaction between JAK1, a major player in the innate antiviral response, and HDV infection. We demonstrated that JAK1 kinase activity is crucial for both the phosphorylation of the delta antigen and the replication of the virus. By demonstrating the antiviral potential of several FDA-approved JAK1 inhibitors, our results could pave the way for the development of innovative therapeutic strategies to tackle this global health threat.

Seroprevalence of Hepatitis B and C co-infection in HIV seropositive and HIV seronegative cases in a Tertiary care hospital in Southern Haryana

HBV (Hepatitis B virus) and HCV (Hepatitis C virus) are the causative agents of acute as well as chronic hepatitis. Nearly, two billion people are suffering with HBV and approximately 170 million people are infected with HCV infection around the world. While patients who are infected with HIV (Human Immunodeficiency Virus) 2-4 million are found to be having chronic HBV co-infection and 4-5 million are having HCV coinfection. Due to common mode of transmission of HIV, HBV and HCV like using shared needles, syringes, other injectable devices, sexual intercourse, or even mother to baby transmission, it is common to see HBV and HCV co-infection in HIV positive individuals. This was a hospital based observational cross-sectional study. This study was conducted in Department of Microbiology, SHKM GMC, Nalhar, Nuh, Haryana. It was for one year. The sample size for HIV seropostive cases was 80 including 40 HIV positive and 40 HIV negative samples. Seroprevalence of HBV and HCV was identified on HIV positive and HIV negative samples. Seroprevalence of HBV and HCV was found to be higher in HIV positive individuals than HIV negative individuals. In HIV positive patients 10% individuals were HBsAg positive, 5% were HBeAg positive, 10% were positive by HBV RT-PCR. None of the HIV negative were coinfected with HBV. Similarly HCV-HIV coinfection was seen in 12.5% of individuals with Rapid test, ELISA and RT-PCR. None of the HIV negative were coinfected with HCV. In HIV positive individuals HBV and HCV coinfection was seen and Co-infection of HBV and HCV was absent in HIV negative individuals. Regular screening is recommended for HBV and HCV in HIV positive individuals.

WS03.02 Keep your enemies close: natural foes, Pseudomonas aeruginosa and Staphylococcus aureus are associated with fewer adverse clinical consequences when present in patients with chronic co-infection

Objectives: Pseudomonas aeruginosa (PA) has a reputation for predatory competition against neighbouring organisms like Staphylococcus aureus (SA) using toxins such as ExoS and cyanide. Despite this, we and others have reported high rates of chronic co-infection. We hypothesize that sustained co-existence occurs with less virulent strains which may limit collateral damage to the host. We explored a large, 20-year dataset to determine the impacts of PA and SA chronic mono- and co-infection on patient FEV1% and number of hospital IV days.

The Impact of Chronic Pulmonary Aspergillosis Co-infection on the Health-Related Quality of Life of Patients with Pulmonary Tuberculosis in Uganda.

Both pulmonary tuberculosis (PTB) and chronic pulmonary aspergillosis (CPA) significantly affect health-related quality of life (HR-QoL). We aimed to determine the impact of CPA co-infection on the HR-QoL of Ugandans with PTB. We conducted a prospective study as part of a larger study among participants with PTB with persistent pulmonary symptoms after 2months of anti-TB treatment at Mulago Hospital, Kampala, Uganda between July 2020 and June 2021. HR-QoL was assessed using St. George Respiratory Questionnaire (SGRQ) at enrollment and at the end of PTB treatment (4months apart). SGRQ scores range from 0 to 100, with higher score representing a poorer HR-QoL. Of the 162 participants enrolled in the larger study, 32 (19.8%) had PTB + CPA and 130 (80.2%) had PTB. The baseline characteristics of the two groups were comparable. Regarding overall health, a higher proportion of the PTB group rated their HR-QoL as "very good" compared to those who had PTB + CPA (68 [54.0%] versus 8 [25.8%]). At enrollment, both groups had comparable median SGRQ scores. However, at follow up, the PTB group had statistically significantly better SGRQ scores (interquartile range); symptoms (0 [0-12.4] versus 14.4 [0-42.9], p < 0.001), activity ((0 [0-17.1] versus 12.2 [0-35.5], p = .03), impact (0 [0-4.0] versus 3.1 [0-22.5], p = 0.004), and total scores ((0 [0-8.5] versus 7.6[(0-27.4], p = 0.005). CPA co-infection impairs HR-QoL of people with PTB. Active screening and management of CPA in patients with PTB is recommended to improve HR-QoL of these individuals.

Coagulation Profiles of Patients with Chronic Liver Disease

Background: The liver has a vital role in the hemostatic system. It is the site of synthesis of proteins responsible for clotting factors and their inhibitors. Liver infections/ diseases pose the effective functioning of the liver enzymes and clotting profiles. Objective of Study: This retrospective study aims to determine the plasma level of APTT, PT, in patients with chronic disease state in the University of Abuja Teaching Hospital, Gwagwalada, Nigeria. Materials and Methods: A total of 144 participants were enrolled for this study; both PT and APTT were analyzed using Quick and kaolin methods, respectively. Results: 144 candidates who met the inclusion criteria were recruited for this study. table 1.0 and 2.0 showed relationship between PT and APTT in liver infections/ diseases respectively, among the subjects, 81 subjects had Asymptomatic HBV Infection with mean ± SD of 15.3704± 3.0391, 18 Asymptomatic HCV infection, 2 HBV and HCV coinfection, 34 Chronic HBV, 6 Chronic HCV, 1 HCV/HIV coinfection, 1 Chronic HCV /HIV coinfection, 1 HBV/HIV coinfection, and Liver cirrhosis. They was non-statistically significant decrease in the level of PT among patients with both asymptomatic and chronic HBV, HCV, HBV and HCV co-infection, HBV co-infection with HIV, HCV co-infection with HIV and patients with liver cirrhosis with P-value of 0.229. Conclusion: Findings from this study demonstrated that coagulation profile has an association with liver disease.

Functional HIV-1/HCV cross-reactive antibodies isolated from a chronically co-infected donor.

Despite prolific efforts to characterize the antibody response to human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV) mono-infections, the response to chronic co-infection with these two ever-evolving viruses is poorly understood. Here, we investigate the antibody repertoire of a chronically HIV-1/HCV co-infected individual using linking B cell receptor to antigen specificity through sequencing (LIBRA-seq). We identify five HIV-1/HCV cross-reactive antibodies demonstrating binding and functional cross-reactivity between HIV-1 and HCV envelope glycoproteins. All five antibodies show exceptional HCV neutralization breadth and effector functions against both HIV-1 and HCV. One antibody, mAb688, also cross-reacts with influenza and coronaviruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We examine the development of these antibodies using next-generation sequencing analysis and lineage tracing and find that somatic hypermutation established and enhanced this reactivity. These antibodies provide a potential future direction for therapeutic and vaccine development against current and emerging infectious diseases. More broadly, chronic co-infection represents a complex immunological challenge that can provide insights into the fundamental rules that underly antibody-antigen specificity.

Hepatitis D virus interferes with hepatitis B virus RNA production via interferon-dependent and -independent mechanisms

Chronic coinfection with HBV and HDV leads to the most aggressive form of chronic viral hepatitis. Herein, we aimed to elucidate the molecular mechanisms underlying the widely reported observation that HDV interferes with HBV in most coinfected patients. Patient liver tissues, primary human hepatocytes, HepaRG cells and human liver chimeric mice were used to analyze the effect of HDV on HBV using virological and RNA-sequencing analyses, as well as RNA synthesis, stability and association assays. Transcriptomic analyses in cell culture and mouse models of coinfection enabled us to define an HDV-induced signature, mainly composed of interferon (IFN)-stimulated genes (ISGs). We also provide evidence that ISGs are upregulated in chronically HDV/HBV-coinfected patients but not in cells that only express HDV antigen (HDAg). Inhibition of the hepatocyte IFN response partially rescued the levels of HBV parameters. We observed less HBV RNA synthesis upon HDV infection or HDV protein expression. Additionally, HDV infection or expression of HDAg alone specifically accelerated the decay of HBV RNA, and HDAg was associated with HBV RNAs. On the contrary, HDAg expression did not affect other viruses such as HCV or SARS-CoV-2. Our data indicate that HDV interferes with HBV through both IFN-dependent and IFN-independent mechanisms. Specifically, we uncover a new viral interference mechanism in which proteins of a satellite virus affect the RNA production of its helper virus. Exploiting these findings could pave the way to the development of new therapeutic strategies against HBV. Although the molecular mechanisms remained unexplored, it has long been known that despite its dependency, HDV decreases HBV viremia in patients. Herein, using invitro and invivo models, we showed that HDV interferes with HBV through both IFN-dependent and IFN-independent mechanisms affecting HBV RNA metabolism, and we defined the HDV-induced modulation signature. The mechanisms we uncovered could pave the way for the development of new therapeutic strategies against HBV by mimicking and/or increasing the effect of HDAg on HBV RNA. Additionally, the HDV-induced modulation signature could potentially be correlated with responsiveness to IFN-α treatment, thereby helping to guide management of HBV/HDV-coinfected patients.

HCV-HIV Chronic Coinfection Prevalence in Amazon Region.

Hepatitis C virus (HCV) infection is an important public health problem, especially in areas with a low human development index such as the Amazon region. This study aimed to identify the prevalence and genotypes of HCV among people living with HIV (PLWH), both neglected chronic diseases in the Amazon region. From March 2016 to June 2017, 433 PWLH were attended to at two sexually transmitted infection referral centers in the city of Belém, in the Brazilian state of Pará in the Amazon region. All individuals were submitted to testing via the rapid immunochromatographic assay (RIA) for the qualitative detection of anti-HCV antibodies. Samples with anti-HCV antibodies were evaluated by reverse transcriptase polymerase chain reaction (RT-PCR), and samples with HCV RNA were subjected to nucleotide sequencing and phylogenetic analysis. Three (0.7%) PLWH had anti-HCV antibodies, and only one (0.2%) had HCV RNA (genotype 2); of these, 31 (7.1%) self-declared to have used drugs at least one time, and 12 (2.7%) regularly use injected drugs. One participant was elderly, single, heterosexual, with a history of unprotected sex and multiple sexual partners. This study detected a low prevalence of HCV infection and recorded the presence of HCV genotype 2 for the first time among PLWH in the Brazilian Amazon.

Corticosteroid treatment in severe patients with SARS-CoV-2 and chronic HBV co-infection: a retrospective multicenter study

BackgroundThe impact of corticosteroids on patients with severe coronavirus disease 2019 (COVID-19)/chronic hepatitis B virus (HBV) co-infection is currently unknown. We aimed to investigate the association of corticosteroids on these patients.MethodsThis retrospective multicenter study screened 5447 confirmed COVID-19 patients hospitalized between Jan 1, 2020 to Apr 18, 2020 in seven centers in China, where the prevalence of chronic HBV infection is moderate to high. Severe patients who had chronic HBV and acute SARS-cov-2 infection were potentially eligible. The diagnosis of chronic HBV infection was based on positive testing for hepatitis B surface antigen (HBsAg) or HBV DNA during hospitalization and a medical history of chronic HBV infection. Severe patients (meeting one of following criteria: respiratory rate > 30 breaths/min; severe respiratory distress; or SpO2 ≤ 93% on room air; or oxygen index < 300 mmHg) with COVID-19/HBV co-infection were identified. The bias of confounding variables on corticosteroids effects was minimized using multivariable logistic regression model and inverse probability of treatment weighting (IPTW) based on propensity score.ResultsThe prevalence of HBV co-infection in COVID-19 patients was 4.1%. There were 105 patients with severe COVID-19/HBV co-infections (median age 62 years, 57.1% male). Fifty-five patients received corticosteroid treatment and 50 patients did not. In the multivariable analysis, corticosteroid therapy (OR, 6.32, 95% CI 1.17–34.24, P = 0.033) was identified as an independent risk factor for 28-day mortality. With IPTW analysis, corticosteroid treatment was associated with delayed SARS-CoV-2 viral RNA clearance (OR, 2.95, 95% CI 1.63–5.32, P < 0.001), increased risk of 28-day and in-hospital mortality (OR, 4.90, 95% CI 1.68–14.28, P = 0.004; OR, 5.64, 95% CI 1.95–16.30, P = 0.001, respectively), and acute liver injury (OR, 4.50, 95% CI 2.57–7.85, P < 0.001). Methylprednisolone dose per day and cumulative dose in non-survivors were significantly higher than in survivors.ConclusionsIn patients with severe COVID-19/HBV co-infection, corticosteroid treatment may be associated with increased risk of 28-day and in-hospital mortality.

Hepatitis E in a Portuguese cohort of human immunodeficiency virus positive patients: High seroprevalence but no chronic infections.

IntroductionHepatitis E virus (HEV) infection causes zoonotic hepatitis in Europe, with a higher risk of complications in immunocompromised hosts. HEV natural history in human immunodeficiency virus (HIV) positive patients is not fully understood, and its prevalence is unknown.ObjectivesTo study the seroprevalence of HEV and prevalence of chronic HEV in HIV‐positive patients from Porto, Portugal.MethodsWe randomly selected patients from the cohort of HIV‐positive patients followed in our hospital. We performed an enzyme‐linked immunosorbent assay to search for immunoglobulin G for HEV. When the absorbance/cut‐off was inferior to 3.5, the test was repeated, and a confirmatory test executed in that sample. For reactive tests and for immunosuppressed patients (CD4 count < 200/mm3) with nonreactive test, a polymerase chain reaction (PCR) test was also performed.ResultsWe included 299 patients. The mean age was 48 and 75.3% were men. Regarding HIV infection, the median follow‐up time was 10 years, the acquisition was mainly heterosexual contact, and 94% were on antiretroviral therapy. Seventy‐six patients (25.4%) had reactive immunoglobulin G (IgG) hepatitis E serology. Patients with a reactive test were older (statistically significant difference). Otherwise, there was no difference between groups concerning birthplace, rural residence, chronic viral hepatitis coinfection, or cirrhosis. Nadir and actual TCD4+ lymphocyte counts did not differ significantly from patients with HEV reactive and nonreactive serology. Gamma‐glutamyl‐transferase (GGT) was higher in patients with reactive IgG HEV. All serum HEV PCR tests were negative.ConclusionsSeroprevalence of HEV was 25.4% in HIV‐positive patients. Older age and higher GGT correlated to HEV reactive IgG test. No cases of current hepatitis E were found.

Impact of chronic co-infection in pulmonary Mycobacterium avium complex disease after treatment initiation

BackgroundThe impact of co-infection with other pathogenic microorganisms after initiation of treatment for Mycobacterium avium complex pulmonary disease (MAC-PD) has not been clearly described. This study sought to clarify the clinical outcomes of co-infection with MAC after antimycobacterial therapy for MAC.MethodsCo-infection status was defined as the detection of pathogenic microorganisms other than MAC in at least two consecutive sputum cultures 6–24 months after initiation of treatment. Chest computed tomography (CT) findings and culture results were compared between co-infection and MAC alone groups.ResultsThe co-infection and MAC alone groups comprised 12 and 36 patients, respectively. The proportion of patients with sputum culture positive for MAC after 24 months of therapy did not differ significantly between the two groups [25% (3/12) vs. 16.7% (6/36); p = 0.671]. The proportion of patients with improved chest CT score after 24 months of starting treatment compared to baseline was significantly lower for the co-infection group than for the MAC alone group [16.7% (2/12) vs. 79.4% (27/34); p < 0.001]. In the co-infection group, median CT score values at 12 and 24 months did not differ from baseline. However, the MAC alone group showed significant improvement at 12 and 24 months compared with baseline.ConclusionsIn the patient group with co-infection of other pathogenic microorganisms after treatment initiation for MAC there was no impact on therapeutic efficacy compared to the MAC alone group. However, therapeutic intervention interfered with improvement in chest CT findings such as nodule formation, bronchiectasis, infiltration, and cavitary lesions.

Prevalence and Risk Factors of HBV and HCV Co-Infection Among People Living with HIV in an Egyptian Setting.

Human Immune Deficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infections constitute a global health concern. They share common modes of transmission, increasing the likelihood of co-infection. Co-infection accelerates viral replication, promotes the progression of chronic liver diseases and challenges antiviral therapy. There are no available data addressing the magnitude of chronic viral hepatitis co-infection in people living with HIV in Egypt. Nor is there a mandate for HCV/HBV screening. This cross-sectional study provides needed data on HBV and/or HCV co-infection in Egyptian people living with HIV. The study was conducted at the HIV clinic in Alexandria Fever Hospital. The investigation included 168 confirmed HIV cases. All cases were interviewed and tested for HCV-Ab and HBsAg by ELISA. There were 52 (31%) persons who were anti-HCV positive. 40 of them had detectable HCV RNA (76.9%). HIV/HCV co-infection was significantly higher among males (40.7%) compared to only (10.9%) among females (OR = 3). History of imprisonment (OR = 4.84, CI: 1.33-17.62), accidental puncture with protruding needle contaminated with blood (OR = 3.35, CI: 0.99-11.72), alcohol use (OR = 3.03, CI: 1.13-8.09) and male gender (OR = 2.96, CI: 0.99-8.88) were all significant predictors for HIV/HCV co-infection. On the other hand, HIV/HCV co-infection was inversely associated with high education level (OR = 0.28, CI: 0.10-0.76). HBsAg was detected in 4 (2.4%), and anti-HBc in 49 (29.2%) of HIV patients. Previous HBV infection (positive anti-HBc/negative anti-HBs) was significantly associated with a history of female genital mutilation circumcision, injection drug use, invasive procedures, non-specific fatigue and HCV-Ab seropositivity. Egyptian people living with HIV have an increased frequency of HCV antibody and HCV infection compared to the general population indicating a higher risk of infection and suggest a higher risk of HCV exposure. Past or present HBV co-infections are also elevated. Routine screening of these viruses in the management protocol of people living with HIV in Egypt is recommended.

The impact of outbreeding on the immune function and disease status of eight hybrid Chinook salmon crosses after Vibrio anguillarum challenge

Aquaculture in North America is currently dominated by Atlantic salmon, but there has been an increasing interest in the production of species native to the Pacific coast. Chinook salmon is relatively new to production; therefore, the selection of appropriate stocks is critical. Often genes from wild populations are incorporated into farmed stocks to avoid performance decreases associated with inbreeding. The present study focuses on assessing the immunological performance of one inbred stock and seven outbred/hybrid crosses after challenge with the marine pathogen, Vibrio anguillarum. Throughout exposure challenge to both pathogen and sterile PBS, significant differences in mortality were observed between crosses. Fish were also assessed for major histocompatibility complex (MHC) class II β1 genotype, and although particular alleles did not confer resistance, crosses with better survival had more individuals presenting a heterozygous genotype. The stress induced during infection resulted in several individuals presenting signs of Bacterial Kidney Disease (Renibacterium salmoninarum) indicating that chronic co-infection may have contributed to susceptibility. When spleen samples from the highest and lowest performing hybrid crosses were assessed for cytokine and respiratory burst gene expression throughout bacterial challenge, high surviving crosses presented lower expression of inflammatory cytokine transcripts (IL-1β, IL-6 and TNFα) when compared to low performing crosses. Interestingly, microsatellite analysis revealed no significant differences in inbreeding coefficient or allelic richness between crosses despite observed variation in immune performance. Understanding the impact of outbreeding on the immune function of farmed, and often inbred, Chinook salmon could aid in future development of high-quality aquaculture stocks for this species.