History Of Human Immunodeficiency Virus Research Articles

Venous intestinal ischemia of fungal origin as a cause of intestinal obstruction in immunocompromised patients: case report and literature review

BackgroundMucormycosis is a highly lethal opportunistic fungal disease caused by ubiquitous molds of the order Mucorales, with Rhizopus, Lichtheimia and Mucor being the most common genera. This rare disease primarily affects immunocompromised patients, with presentations ranging from rhino-orbito-cerebral infections to disseminated mucormycosis with angioinvasion, leading to thrombosis and tissue infarction. Gastrointestinal mucormycosis is the least common clinical presentation and is believed to be secondary to spore ingestion. It can involve multiple components of the gastrointestinal tract, such as the stomach, liver, ileum, and colon, with nonspecific manifestations, including pain, nausea, vomiting, and abdominal distension. The initial clinical presentation may even manifest as gastrointestinal bleeding due to gastric ulceration or intestinal perforation.Case presentationHere we present the case of a 48-year-old male patient with a 9-year history of human immunodeficiency virus (HIV) infection who was hospitalized in the context of febrile neutropenia and whose acute respiratory infection was documented; therefore, antibiotic treatment was initiated. However, due to persistent febrile peaks and peripheral blood showing documentation of multilineage cytopenias, a bone marrow biopsy was performed, compatible with presenting features of marrow myelodysplasia. During hospitalization, the patient presented left flank abdominal pain, and an abdominal computed tomography (CT) scan revealed signs of intussusception of a small bowel loop at the distal jejunum level, leading to intestinal obstruction with ischemic progression, requiring ileectomy (60 cm). Histopathological analysis of the resected intestine revealed severe transmural ischemic changes associated with venous thrombosis due to fungal structures, with histochemical studies demonstrating the presence of zygomycete (Mucor) fungal structures, leading to the initiation of treatment with amphotericin B. However, despite treatment, the patient experienced progressive clinical deterioration with persistent fever and ventilatory failure, with follow-up tests showing absolute neutropenia and blood cultures positive for yeast, leading to death 52 days after admission.ConclusionsThe diagnosis of intestinal mucormycosis may be delayed due to the lack of specificity of the signs and symptoms. Pathologists as well as histopathological studies are essential for timely treatment.

18F-FDG PET/CT in the Evaluation of Polyarteritis Nodosa.

A 61-year-old man with a medical history of human immunodeficiency virus well controlled on antiretroviral therapy presented for distal sensorimotor symptoms, fatigue, and recurrent fevers. Erythrocyte sedimentation rate and C-reactive protein were both elevated. Antineutrophilic cytoplasmic antibody and antinuclear antibodies were negative. Neurologic imaging workup was unremarkable. 18F-FDG PET/CT, which was crucial for diagnosis, demonstrated pathological tracer activity throughout the medium-sized vessels with sparing of the aorta. In view of presentation, comorbidities, and imaging findings, polyarteritis nodosa was diagnosed. The patient was treated appropriately with steroids and cyclophosphamide with significant symptomatic improvement.

6411 Ozempic - Oh no! Acute Renal Failure Associated with Initiation of Semaglutide

Abstract Disclosure: K. Barney: None. D. Tahir: None. A. Pannu: None. R. Saeed: None. Background: Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist which has been proven to reduce weight in those with obesity and improve glycemic control in patients with type II diabetes mellitus. The effect of semaglutide on kidney function has not been well established. The phase 3b SUSTAIN trials revealed that when compared with other GLP-1 agonists, semaglutide exhibited more frequent acute kidney injuries [1-3]. The SUSTAIN 6 trial reported two instances of acute renal failure (ARF) in patients with chronic kidney disease, and one case of ARF in a patient with normal kidney function who was treated with semaglutide [3]. Despite these reports, the SUSTAIN 1-9 trials report no significant decline in kidney function associated with semaglutide [3-6]. Case: We present the case of a 58-year-old male with a past medical history of human immunodeficiency virus (HIV), type II diabetes mellitus, and hypertension who presented to the hospital with ARF after initiation of Ozempic (semaglutide) two months prior to presentation. On admission, vitals were stable and physical examination was benign. His pertinent labs were blood urea nitrogen (BUN) 55 mg/dL, creatinine 5.94 mg/dL (baseline 1.2 mg/dL), and urinalysis with 2+ protein. To determine the cause of his renal failure, urine sodium and creatinine were obtained to calculate his fractional excretion of sodium, which was found to be consistent with intrinsic renal disease. Further workup, including renal ultrasound, urine protein, urine eosinophils, complement and free light chain levels, and creatinine kinase, were unrevealing for cause of intrinsic renal injury. He was managed with intravenous fluids and his creatinine improved to 2.03 mg/dL. Given the acute onset of the patient’s renal failure and recent initiation of Ozempic, it was determined that this medication was the cause of his renal failure, and it was discontinued on discharge. He has since followed up with nephrology and endocrinology. He remains off Ozempic and is doing well. Conclusions: Our case highlights a rare but significant adverse effect of semaglutide on renal function. As the use of semaglutide has increased due to its rising popularity for weight loss and glycemic control in type II diabetes mellitus, the potential for renal injury should be considered and discussed with patients. Furthermore, it is imperative that semaglutide associated renal injury be considered as a cause for ARF in patients taking this medication. This case demonstrates that instances of ARF associated with semaglutide treatment are a cause for concern and further exploration. Presentation: 6/1/2024

Risk Factors for Pulmonary Mycosis in Immunocompromised Patients in Surakarta, Indonesia

<p><strong>Introduction: </strong>Recent evidence shows that there is an increase in the incidence of pulmonary mycosis globally. In clinical settings, pulmonary mycosis is commonly misdiagnosed as pulmonary tuberculosis (PTB). Identifying risk factors can ease the diagnosis of pulmonary mycosis. This study aimed to determine the risk factors for pulmonary mycosis in immunocompromised patients in Surakarta.</p><p><strong>Methods: </strong>This was an analytic observational study with a retrospective cohort study method. This study used purposive sampling technique on 218 medical records of immunocompromised patients during January 2019–September 2022 at a referral hospital in Surakarta. The correlation of sociodemographic, health status, health behavior, history of diseases, medications, and transplantations with the incidence of pulmonary mycosis was analyzed using Chi-Square test or Fisher’s exact test as its alternative.</p><p><strong>Results: </strong>There was a significant correlation between educational level (p=0.018), nutritional status (p=0.001), smoking habit (p=0.000), history of corticosteroid use (p=0.031), history of antibiotic use (p=0.006), history of chemotherapy (p=0.003), history of PTB (p=0.047), and history of chronic obstructive pulmonary disease (COPD) (p=0.001) with the incidence of pulmonary mycosis. Meanwhile, there was no significant correlation between occupation (p=0.057), neutrophil level (p=1.000), history of human immunodeficiency virus (HIV) infection (p=1.000), history of diabetes mellitus (DM) (p=0.070), and history of organ transplantation (p=1.000) with the incidence of pulmonary mycosis.</p><strong>Conclusion: </strong>Low educational level, malnutrition, smoking habit, history of pulmonary diseases, and medications are the risk factors for pulmonary mycosis in immunocompromised patients in Surakarta. It is important to identify these risk factors when examining patients with respiratory disorder symptoms.

Abstract PO2-20-11: Safety and efficacy of KEYNOTE-522 in combination with anti-retroviral therapy in a patient with HIV and triple-negative breast cancer

Abstract Introduction: Triple-negative breast cancer (TNBC) is a subtype of breast cancer (BC) that does not express estrogen receptor (ER), progesterone receptor (PR), or human epidermal growth factor receptor 2 (HER-2), accounting for about 15% of all BC. TNBC is more aggressive than other BC with a higher risk of recurrence and mortality. The current standard of care for high-risk, early-stage TNBC based on the KEYNOTE-522 trial is neoadjuvant multidrug chemotherapy (paclitaxel and carboplatin [TCb] weekly x 12 weeks and doxorubicin and cyclophosphamide [AC] Q3 weeks) with pembrolizumab (P). The trial demonstrated patients who received chemotherapy plus P had a higher pathological complete response and event-free survival compared to patients who received chemotherapy plus placebo. However, the trial excluded patients with any autoimmune disease requiring treatment within 2 years, a diagnosis of immunodeficiency or steroids within 7 days before the first treatment, or a known history of human immunodeficiency virus (HIV). While limited data exist on immune checkpoint inhibitors (ICI) in patients with immunodeficiencies, subsequent data demonstrate that patients with HIV have similar efficacy and immune-related adverse events (irAE) compared to patients without HIV, and 2017 consensus recommendations encouraged broader eligibility in clinical trials to include patients with HIV. We present one of the first reported clinical cases of a patient with HIV diagnosed with stage IIB TNBC, treated per KEYNOTE-522 and anti-retroviral therapy (ART). Clinical Case: A 55-year-old female with a medical history significant for HIV, self-detected a mass in her left breast. Diagnostic imaging demonstrated a suspicious 4.0 cm mass in the left breast without adenopathy. An ultrasound-guided biopsy of the mass revealed grade 3 invasive ductal carcinoma with ER 0%, PR < 1%, and HER-2 1+. The clinical stage was cT2N0M0, prognostic stage IIB. Genetic testing was positive for germline BRCA2 pathogenic variant. HIV PCR < 20 copies/mL and CD4 count 1.298 K/uL prior to neoadjuvant chemotherapy. The patient was adherent to HIV ART with bictegravir, emtricitabine, and tenofovir alafenamide. The patient received KEYNOTE-522, including 11 cycles of TCb-P, followed by four cycles of AC-P. Following neoadjuvant treatment, the patient underwent a left segmental mastectomy and sentinel lymph node biopsy and achieved a pathological complete response. She completed left whole breast radiation (RT) with 3DCRT plus 3DCRT tumor bed boost to a total dose of 48.06 cGy and one-year of adjuvant P. Treatment-related adverse events included grade 4 febrile neutropenia after cycle one AC without growth factor, requiring a 5-day hospitalization; and grade 3 peripheral neuropathy, resulting in discontinuation of week 12 of TCb. The patient also developed paronychia, and a pulmonary embolism after week 11 of TCb. She had no irAE. Radiation-related adverse events included grade 1 left breast dermatitis and fatigue and mild left breast soreness. Discussion: Among the subset of patients diagnosed with TNBC, the percentage of patients with HIV or immunodeficiency receiving active BC treatment is low. Safety and efficacy data for novel cancer therapeutics including ICI are limited since historically patients with HIV and other immunodeficiency states were excluded from trials. Anti-PD-1 ICI has become a key part of the standard of care for the treatment of breast cancer. Patients with HIV experience rare infectious complications and have a life expectancy near the general population with ART. We support the inclusion of patients with HIV in future clinical trials for TNBC and/or ICI and recommend treatment of patients with HIV and TNBC per standard of care in multi-disciplinary collaboration with HIV clinicians. Citation Format: Stephanie Haddad, Stephanie Graff, Matthew Hadfield, Yihong Wang, Charu Taneja, Kara Leonard, Martha Sanchez, Robert Ward, Ana Lourenco, Mary Anne Fenton. Safety and efficacy of KEYNOTE-522 in combination with anti-retroviral therapy in a patient with HIV and triple-negative breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-20-11.

The unsolved problem of musculoskeletal hydatid disease: two case reports

BackgroundHydatidosis is a parasitic infection caused by Echinococcus granulosus and humans are usually an accidental intermediate host. Involvement of the musculoskeletal system is reported to occur in 0.5% to 4% of the cases.Case presentationWe present our experience with two cases of musculoskeletal hydatidosis in black African patients that required orthopaedic surgical intervention. A 51-year-old black African female presented with right hip hydatid disease and a 37-year-old black African female presented with the disease affecting the left shoulder. Both patients presented with joint pain and reduced range of motion. The patient with involvement of the shoulder had a background history of human immunodeficiency virus, this was not present with the other patient. Diagnostic work-up confirmed peri-articular hydatid disease and both patients were surgically managed with arthroplasty. Post-operative complications encountered include hardware loosening from bone lysis and hardware failure.DiscussionThe medical literature describes a limited number of cases of peri-articular musculoskeletal hydatid disease. Patients are often subjected to many investigations, prolonged treatment periods and multiple surgeries. Concurrent use of medical and surgical treatment is advocated however, the choice of surgery is individualised.ConclusionHydatid disease must always feature in the differential diagnosis of multiple lytic bone lesions and radical surgical intervention may be required from the outset.

Valley Fever: Pathogenesis and Evolving Treatment Options.

Coccidioidomycosis, also termed Valley fever, is a fungal infection caused by the inhalation of Coccidioides endospores. Once inhaled by a human host, the arthroconidia endospores travel to the lungs' alveoli to transform into spherules that grow and rupture to release more endospores. In the host immune response, macrophages, neutrophils, and dendritic cells will recognize the fungal antigen, producing pro-inflammatory cytokine. Th2 lymphocytes (type 2 helper T cells) are theorized to be the main human defense against Coccidioides given that Th2 deficiency is seen in patients with disseminated forms of the disease. A common triad of symptoms of coccidioidomycosis, also called "desert rheumatism," include fever, erythema nodosum, and arthralgia, often accompanied by a respiratory problem.In a clinical setting, along with the evaluation of symptoms, a medical provider may also test the patient's blood using antibody tests or perform microscopy to directly detect the presence of Coccidioides in a patient tissue sample for confirmation of a diagnosis.Imaging modalities may also be used to determine lung involvement and assess disease progression.A majority of coccidioidomycosis cases do not require specific treatment and will resolve on their own, so an approach with symptomatic treatment in mind is appropriate.If symptoms do not resolve, azoles or amphotericin B may be used, with the standard drug of choice being fluconazole (Diflucan, Pfizer, New York, New York, United States). Treatment varies depending on the immunocompetency of the patient.To name a few, pregnant patients and those with history of human immunodeficiency virus (HIV) or transplantation require special considerations.

Aspartate Aminotransferase to Platelet Ratio Index Before and After the Treatment of Chronic Hepatitis C Patients with Sofosbuvir/Daclatasvir

Background: The aspartate aminotransferase to platelet ratio index (APRI) is a non-invasive method used to investigate liver fibrosis in patients with hepatitis C virus (HCV). Objectives: This study aimed to determine the APRI before and after the treatment of HCV patients with sofosbuvir/daclatasvir (Sovodak) in the city of Rafsanjan, southeast Iran. Methods: This study was conducted on 45 patients with HCV from March 2021 to March 2022 in Rafsanjan. Demographic information, including age, gender, a history of human immunodeficiency virus (HIV) infection, and intravenous (IV) drug injection, was collected. Polymerase chain reaction (PCR) was performed after treatment with Sovodak to calculate sustained virological response (SVR). Also, the APRI was calculated before and after treatment. Results: Among 45 HCV patients (97.8% = male, 2.2% = female, age range = 26 to 59 years), the administration of Sovodak to all patients resulted in an efficacy of 100% in the assessment of SRV in 12 weeks (SVR12). Also, the APRI level decreased significantly after treatment with Sovodak (0.35 vs. 0.68, P-value: 0.000), even in HCV patients with a history of HIV (0.77 vs. 1.47, P-value: 0.028) or HCV patients with a history of injecting drugs in the last 12 months (0.38 vs. 0.66, P-value: 0.000). Conclusions: The present study indicated that the APRI level in HCV patients decreased significantly after treatment with Sovodak, regardless of having a history of HIV infection or a history of drug injection. Therefore, Sovodak in HCV patients can reduce the odds of liver fibrosis and subsequent hepatocellular carcinoma (HCC) by reducing the APRI level.

Abstract 15659: Bupropion Overdose Requiring Veno-Arterial Extracorporeal Membrane Oxygenation

Introduction: Bupropion is a monocyclic antidepressant that inhibits dopamine and norepinephrine reuptake, with significant risk cardiotoxicity in overdose cases. Case: A 32-year-old transgender man with a history of Human Immunodeficiency Virus (on anti-retroviral therapy), poly-substance use disorder, and depression presented with an intentional bupropion overdose. On arrival the patient was noted to have seizures and a decreased mental status. He was intubated and treated with anti-epileptic medication. Initial EKG was sinus tachycardia with a QTc of 456 milliseconds. Transthoracic echocardiogram (TTE) showed severely reduced left ventricular ejection fraction (LVEF) that worsened over a 6 hour period from 40% of 25%. Serial EKGs showed progressive QTc prolongation to 635 milliseconds. Cardiac catheterization demonstrated angiographically normal coronary arteries and a Cardiac Index of 2.5 L/min/m 2 . Due to the rapidly prolonging QTc and the significant risk of ventricular tachycardia (VT), the decision was to proceed with Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) cannulation after a multidisciplinary shock team discussion. A few hours after cannulation, patient suffered hemodynamically unstable VT, requiring electrical cardioversion (DCCV) with brief return to sinus rhythm (SR) and with subsequent VT recurrence, that responded to lidocaine and repeat DCCV. ECG normalized and the patient was decannulated from VA ECMO on hospital day 4. Repeat TTE showed recovery of LVEF to 60%. The patient was extubated and discharged to psychiatric rehabilitation. Conclusion: Cardiogenic shock and ventricular arrhythmias are well recognized complications from bupropion toxicity likely due to gap junction inhibition. VA ECMO cannulation should be considered as part of multidisciplinary team assessment for patients at high risk for hemodynamic or electrical collapse in toxidromes with marked cardiotoxicity.

A case report : 34 y.o male with incidental histopathological findings of Kaposi sarcoma without clinical history of human immunodeficiency virus (HIV)

Introduction: Kaposi sarcoma is a rare and challenging case especially in immunosuppressed patients that frequently doesn’t have specific manifestation. It usually caused by human herpes virus 8 virus infection and male patient with multiple lesion has high mortality rates. The aim of this study is to report 34 y.o Male with incidental histopathological findings of kaposi sarcoma without clinical history of Human Immunodeficiency Virus (HIV). Methodology: Descriptive study of the case report type, whose data were obtained from the patient's medical record. Result: This paper will report 34-year-old young adult male with clinically diagnosed with poroma and differential diagnosis of squamous cell carcinoma and pyogenic granuloma. The clinical sign was multiple skin lesion appear on his right nose and thumb in the last 6 months. The nodules are solitary with oval shape, erythema, firm borders and the nodule surface covered with brownish-yellow squama. In addition, imaging examination suspicious for soft tissue mass. The biopsy was performed, and histopathological finding exhibit a tumor mass consists of Kaposi sarcoma. Discussion: Furthermore, after pathological report revealed the diagnosis of Kaposi sarcoma then a provider-initiated HIV testing and counseling (PITC) examination is carried out and the test result showed reactive for HIV infection. So that, patient concluded to have predisposition of HIV infection with Kaposi sarcoma and treated for antiretrovirals (ARV), chemotherapy and routine clinical follow up. Conclusion : Kaposi sarcoma is a rare cancer caused by infection with the human herpesvirus 8 (HHV8). These lesions are often found in immunosuppressed patients such as HIV sufferers characterized by vascular proliferation. Through the incidental findings of Kaposi's sarcoma in patients who are not clinically suspected of having HIV, clinicopathological correlation is highly recommended. Therefore, the purpose of this writing can be a strong reference so that clinicians are more thorough in reviewing clinical patients and more detailed physical examinations.

A masquerade of recurrent anaphylaxis.

Background: We present a case of a 37 year old man with a history of human immunodeficiency virus, latent syphilis, anxiety, posttraumatic stress disorder. attention deficit/hyperactivity disorder, multiple drug intolerance syndrome who presented with concerns of recurrent episodes of rash and respiratory symptoms with questionable "anaphylaxis" episodes without clear etiology or known trigger. Methods: To evaluate some of the potential causes of recurrent anaphylaxis in our patient. Further evaluation through laboratory analysis and ultimately direct visualization of the patient's vocal cords by laryngoscopy assisted in the final diagnosis. Results: Inappropriate adduction of the vocal cords was observed during an acute reaction. Conclusion: The patient's presentation was consistent with inducible laryngeal obstruction and highlights the importance of confirming a suspected diagnosis of anaphylaxis and keeping a broad differential when establishing an etiology.

Large Conjunctival Ulceration from Ocular Monkeypox

Figure Description: A 34-year-old transgender female with history of human immunodeficiency virus (HIV) presented to the emergency department with complaint of a painful rash. Vesiculopapular lesions were present on the hands, face, and genitals raising clinical suspicion for monkeypox. The lesions were positive for monkeypox (orthopoxvirus) by polymerase chain reaction (PCR) and the patient's absolute CD4 count was 19 cells/uL. Tecovirimat was initiated for treatment of monkeypox as well as bictegravir-emtricitabine-tenofovir for newly diagnosed acquired immunodeficiency syndrome (AIDS). Two weeks later, the patient developed left eye pain. External examination findings (Figure 1) revealed a healing pox lesion present on the glabella (panel A), the left eye had temporal conjunctival injection, engorgement of the episcleral vessels, and a raised papule (panel B) that was PCR-positive for monkeypox. Higher magnification revealed conjunctival ulceration (panel C) with an epithelial defect demonstrated by green fluorescein staining under a cobalt blue light (panel D). The patient was started on erythromycin ointment and the lesion subsequently healed over the course of three weeks. As our understanding of ocular monkeypox evolves, it is apparent that the manifestations can be quite variable, ranging from classic papulovesicular eyelid lesions, conjunctivitis, keratitis, and subconjunctival nodules which can ulcerate as observed in this patient. Acknowledgement This study was supported by NIH/NEI grants EY029395 and EY034114 awarded to Dr. Edgar M. Espana.

Histologic Features of Syphilitic Gastritis: A Rare but Resurging Imitator of Common Diseases.

The range of histopathologic features of gastric syphilis is not well described. Here we describe the clinicopathologic findings of eight patients with syphilitic gastritis. A search of our Pathology Data System (2003-2022) and multiple other institutions identified eight patients with syphilitic gastritis. Clinical information, pathology reports, and available slides were reviewed. Lesions predominated in middle-aged adults (mean age, 47.2 years; range, 23-61 years) with a propensity for men (n = 7). Three patients had a documented history of human immunodeficiency virus. Clinical presentations included weight loss, abdominal pain, hematochezia, fever, dyspepsia, nausea and vomiting, hematemesis, anemia, and early satiety. Endoscopic findings included ulcerations, erosions, abnormal mucosa, and nodularity. All specimens shared an active chronic gastritis pattern with intense lymphohistiocytic infiltrates, variable plasma cells, and gland loss. Prominent lymphoid aggregates were seen in four specimens. The diagnosis was confirmed either by immunostain for Treponema pallidum (n = 7) or by direct immunofluorescence staining and real-time polymerase chain reaction (n = 1). All patients with available follow-up data showed resolution of symptoms after antibiotic therapy (n = 4). Recognition of the histologic pattern of syphilitic gastritis facilitates timely treatment, prevents further transmission, and avoids unnecessarily aggressive treatment.

Diffuse large B-cell lymphoma and gastrointestinal Kaposi's sarcoma: a rare cause of upper gastrointestinal bleeding.

A 49-year-old man with a history of human immunodeficiency virus (HIV) infection, in a state of advanced immunosuppression and current antiretroviral therapy initiation. He was admitted to the hematology department after diagnosis of diffuse large B-cell lymphoma (DLBCL) associated with Epstein-Barr virus (EBV), disseminated cytomegalovirus (CMV) infection and cutaneous Kaposi's sarcoma (KS). During admission, he presented an episode of melena with anemization, so an urgent gastroscopy was performed. In the stomach there were multiple erythematous lesions, large and elevated, suggestive of subepithelial origin. Some of them presented an umbilicated center and other were ulcerated, covered with fibrin. The bulb and second duodenal portion showed similar involvement, large violaceous ulcerated lesions. Biopsies were taken and the anatomopathological diagnosis of the duodenal lesions was KS and of the gastric lesions KS and DLBCL associated with EBV. KS is an endothelial tumor associated with HIV. The stomach is the gastrointestinal organ most frequently affected and the typical endoscopic findings are nodular lesions. The stomach is the most common site of extranodal involvement in DLBCL. In both pathologies, the manifestation as upper gastrointestinal bleeding is exceptional and endoscopic biopsies can confirm the diagnosis.

Bartonella henselae Infective Endocarditis: A Rare Cause of Pauci-Immune Necrotizing Glomerulonephritis—A Case Report

Bartonella sp. are the most common causes of culture-negative infective endocarditis (IE) cases in the United States. Although, infection-related glomerulonephritis can frequently mimic primary vasculitis due to pauci-immune pattern, majority of previously reported cases of Bartonella henselae-associated glomerulonephritis have immune-complex deposits on immunofluorescence. We present a rare case of B henselae IE-related pauci-immune necrotizing glomerulonephritis. Timely recognition of this atypical presentation led to appropriately directed medical therapy. A 33-year-old Caucasian male with a history of human immunodeficiency virus (HIV) on highly active antiretroviral therapy (HAART), alcohol abuse, previous subarachnoid hemorrhage (SAH), and recent wisdom tooth extraction (on amoxicillin) was transferred from an outside hospital for further evaluation of severe headache. He was diagnosed with an SAH and right anterior cerebral artery mycotic aneurysm. The serum creatinine at the outside hospital was 292 umol/L (3.3 mg/dL) with a previously normal baseline around 2 years ago. The serum creatinine at our institution was 256 umol/L (3.0 mg/dL). The urinalysis demonstrated +100 protein, +3 blood and 29 red blood cells/high power field. The urine protein creatinine ratio (UPC) was 1.7 g/g. Serologic evaluation was positive for a low C4 10.2 mg/dL, elevated rheumatoid factor 40 IU/mL and an elevated proteinase 3 (PR-3) antineutrophilic cytoplasmic antibodies (ANCA Ab) 4.0 U/mL. A transesophageal echocardiogram (TEE) showed echo densities on both mitral and aortic valve. Blood cultures were negative. Further serologic evaluation was positive for B henselae IgG titer of 1:2560 (normal <1:320) with a negative IgM titer. A percutaneous kidney biopsy revealed pauci-immune necrotizing glomerulonephritis, with 14/16 glomeruli globally sclerotic, and 2 glomeruli with active segmental necrotizing lesions. There was no evidence of immune-complex deposition on immunofluorescence or electron microscopy. Clinical findings were consistent with B henselae IE associated mycotic aneurysm and necrotizing glomerulonephritis. Empiric treatment for an active glomerulonephritis with immunosuppressive agents was deferred on admission, given concern for an underlying infectious process and mycotic aneurysms in an HIV-positive patient. He received antibiotic treatment with doxycycline and ceftriaxone with gentamicin for synergy. Despite this, the mitral and aortic valve regurgitation worsened, and he developed congestive heart failure requiring aortic valve replacement and mitral valve repair. The explanted aortic valve was positive for B henselae by polymerase chain reaction (PCR) confirming the diagnosis of B henselae IE. Immunosuppression was deferred due to timely identification of an atypical presentation of B henselae-associated ANCA antibodies-positive, pauci-immune necrotizing glomerulonephritis. A course of antibiotic treatment resulted in improved renal functions along with undetectable B henselae and PR3 Ab titers. The serum creatinine decreased to 176 umol/L (2 mg/dL) and remained stable 12 months after discharge. B henselae IE should be suspected in patients with pauci-immune necrotizing glomerulonephritis and culture-negative IE. This is imperative for optimal decision making in the management of such patients. Having high clinical suspicion can avoid unnecessary and potentially deleterious use of immunosuppressive agents.

HIV-associated multiple intracranial aneurysms and stroke in an adult patient: successful treatment with a combination of glucocorticoid and antiviral agents.

A 35-year-old Iranian man with an 18-year history of human immunodeficiency virus (HIV) infection developed sudden left-sided hemiparesis and mild dysarthria. Based on laboratory results, brain and neck computerized tomography angiography (CTA), echocardiography, hypercoagulability tests, and vasculitis tests, the patient was diagnosed with a stroke with multiple intracranial aneurysms secondary to HIV. Cerebral aneurysms and stroke are uncommon in HIV-infected patients, and the aneurysms' exact cause and risk factors are unknown. There is currently no effective regimen or definitive treatment for HIV-associated vasculitis. In the present study, the patient recovered without any neurological deficits following treatment with oral prednisolone, combined with combination antiretroviral therapy (cART), valacyclovir, and antiplatelet medication. Furthermore, after 2months of immunosuppressive treatment, all imaging abnormalities improved, and no new events were observed at the 20-month follow-up. To the best of our knowledge, this is the first case in which a patient with HIV-associated vasculopathy and stroke has survived successfully, and all angiographic abnormalities completely eliminated.

Global Transmission of Human Immunodeficiency Virus 1 Subtype C and Its Impact on the Circulation of B/C Recombination Strains in China

Abstract This study aimed to reconstruct the origin and worldwide epidemic history of human immunodeficiency virus (HIV) 1 subtype C and comprehend how HIV-1 subtype C was introduced into and spread throughout China in the form of B/C recombinant strains. Envelope sequences of HIV-1 subtype C and some other subtypes deposited before December 31, 2020 were downloaded from the Los Alamos HIV Database and the Chinese National Center for AIDS/STD Control and Prevention Database. The available sequences were screened for quality, and Bayesian analysis was used to build the maximum clade credibility evolutionary tree to analyze and judge the origin and spread of HIV-1 subtype C. HIV-1 subtype C originated in central Africa around 1952, then spread to southern Africa around 1969 and to eastern Africa around 1973. HIV-1 subtype C from southern Africa was introduced into India in 1977. HIV-1 subtype C of eastern Africa was introduced into Brazil in 1987. Indian HIV-1 subtype C was exported to China in three migration events during the period from 1986 to 1989. The two predominant recombinants in China (CRF07_BC and CRF08_BC) emerged in 1988 and 1990, respectively. Other B/C recombinants, namely, CRF64_BC, CRF61_BC and CRF62_BC, originated in 1993, 2002 and 2000, respectively. Our study has reconstructed the global origin and evolutionary history of HIV-1 subtype C. In addition, our study demonstrated that the Chinese HIV-1 subtype C originated from three related Indian lineages around the mid to late 1980s and, since then, has formed some B/C recombinants with subtype B that caused a widespread epidemic in China.

Antibiotic Prescribing Patterns and Guideline Concordance for Uncomplicated Urinary Tract Infections Among Adult Women in the US Military Health System

Urinary tract infections (UTIs) are one of the most commonly diagnosed infections, and prior studies have reported discordance in antibiotic treatment with the Infectious Diseases Society of America (IDSA) guidelines. To assess IDSA guideline concordance rates for women with uncomplicated UTIs treated with antibiotics, and compare concordance rates between different specialty field. Retrospective cross-sectional study of health care claims data from the US Military Health System Data Repository, which contains comprehensive health care encounter and claims data for all military beneficiaries. Participants were adult women between the ages of 18 to 50 years with uncomplicated UTIs from October 1, 2017, to September 30, 2019. Data extraction and analysis were performed in 2022. Patients with diagnosis of UTI in the preceding 6 months, current pregnancy, history of pyelonephritis, history of diabetes, history of organ transplant, history of human immunodeficiency virus, immunosuppression, renal insufficiency, urinary tract abnormalities, or history of urologic procedures were excluded. Antibiotic treatment for uncomplicated UTIs. Only antibiotics received within 1 day after the diagnosis were analyzed. The IDSA recommends the following antibiotics as first-line therapy: nitrofurantoin, trimethoprim-sulfamethoxazole, fosfomycin, pivmecillinam. The IDSA guideline concordance rates were calculated as the number of patients receiving first-line antibiotic therapy divided by the total number of cases for uncomplicated UTIs. A total of 46 793 adult women (67.3% [31 475 of 46 793] aged 18-34 years; 38.2% [31 475 of 46 793] of White race) were diagnosed with uncomplicated UTIs with 91.0% receiving guideline-concordant antibiotic treatment. In comparison with obstetrics and gynecology, IDSA guideline-concordant treatment was more likely in internal medicine (adjusted odds ratio [aOR], 2.87; 95% CI, 2.73-3.03), family medicine (aOR, 1.81; 95% CI, 1.76-1.87), surgery (aOR, 1.51; 95% CI, 1.36-1.67), and emergency medicine (aOR, 1.36; 95% CI, 1.32-1.39) and less likely in urology (aOR, 0.40; 95% CI, 0.38-0.43). Compared with direct military care, private sector care had lower concordance rates (aOR, 0.63; 95% CI, 0.62-0.64). In this cross-sectional study of antibiotic treatments for uncomplicated UTIs in a universally insured population, the IDSA guideline-concordance rate was high at 91.0% with higher rates in direct military care compared with private sector care. There were higher rates in general medical specialties, surgery, and emergency medicine and lower rates in urology and obstetrics and gynecology. These results further enhance the literature on current antibiotic prescribing practices for uncomplicated UTIs in adult women.

Abstract OT2-24-02: ZEST: Randomized phase III study evaluating efficacy and safety of niraparib in patients with HER2-negative BRCA-mutated or triple-negative breast cancer with detectable circulating tumor DNA after definitive therapy

Abstract OT2-24-02: ZEST: Randomized phase III study evaluating efficacy and safety of niraparib in patients with HER2-negative BRCA-mutated or triple-negative breast cancer with detectable circulating tumor DNA after definitive therapy

Rituximab as a treatment for human immunodeficiency virus-associated nemaline myopathy: What does the literature have to tell us?

We presented a letter about a case of a 37-year-old Black female with a history of human immunodeficiency virus and an undetectable viral load. She was evaluated with weakness in the scapular (grade III) and pelvic girdles (grade II), elevation of creatine phosphokinase levels and muscle biopsy compatible with nemaline myopathy. She was treated with rituximab showing improvement of the condition.