Mean Duration Of Infection Research Articles

A Survey of HBV Core/Pre-Core Mutations in Iraqi Patients with Chronic Hepatitis

Objectives: The present study was conducted to assess the pattern of HBV Core/Pre-Core mutations and HBV genotype in Iraqi patients with chronic hepatitis B virus (HBV) infection. Methods: In the current cross-sectional study in an Iraqi province, we evaluated 134 patients diagnosed with HBV hepatitis. We used PCR and, subsequently, Sanger sequencing to assess HBV Core/Pre-Core mutations. Sanger sequencing reads were further used for phylogenetic analysis and multiple sequence alignment. A phylogenetic tree was generated according to the neighbor-joining method. Results: The current study revealed that 58 (45%) of the patients were male, and 72 (55%) of them were female. The mean age of the patients was 36 ± 12.7 years, and the mean duration of infection was 5.2 ± 4.8 years. The results revealed 21 nucleic acid alterations in the samples analyzed. The generated phylogenetic tree divided samples into two genotypes. Pre-core/Core mutations were significantly associated with the treatment received (P = 0.0.001) but not with laboratory parameters. Most samples were matched with the genotype D clade, while only four samples were positioned adjacent to the genotype E clade. Direct nucleic acid translation disclosed five nucleic acid variants (73T>G, 347T>G, 364A>G, 365T>C, and 366A>G) on the core protein. Conclusions: This study has detected 21 nucleotide variants and 5 amino acid alterations within the coding sequences of the C gene. This study revealed that genotype D represents the primary genotype for the identified viral infections. The current study highlights the importance of these mutations evaluation for future, more comprehensive studies.

Neurocognitive Disorders in HIV-positive Patients.

(1) To know the prevalence of HAND in HIV-infected patients of a multi-ethnic population. (2) To describe various types of neurocognitive impairment among patients of HAND and study the factors affecting HAND. This study was a cross-sectional descriptive study conducted on 250 HIV-positive patients in outpatient department (OPD) of a tertiary care center in Mumbai, conducted over a period of 12 months. Patients with HIV-1 attending the OPD and having a minimal formal education of 4 years were included. Patients with concomitant delirium, any known central nervous system (CNS) disorder, any psychiatric disorder, and pregnant females were excluded. Outcome measures-the test batteries used were (1) International HIV Dementia Scale (IHDS) and (2) Addenbrookes cognitive examination-revised (ACE-R) scale. Of 250 subjects studied, 55.6% (139) were males and 44.4 % (111) were females. The mean age of study population was 39.42 years. The mean years of education were 8.32 years. The mean duration of infection (diagnosis of HIV-positive state) was 64.49 months and the mean duration of HAART intake in our patients was 52.30 months. The mean cluster of differentiation 4 (CD4) counts of our subjects were 527.13 per cumm [standard deviation (SD) of 234.13]. The mean nadir CD4 counts were 224.35 per cumm (SD of 115.09). Using the ACE-R scale, the prevalence of HAND was 71.60%, of which 37.20% had an asymptomatic neurological impairment, 29.60% had mild cognitive dysfunction, and 4.80% had HAD. Memory, verbal fluency and visuospatial abilities were the most affected domains on the ACE-R and memory recall and psychomotor speed were affected more on the IHDS. The prevalence of HAND was more with increasing age (p = 0.020), lesser education (p < 0.00) and lesser nadir CD4 counts (p < 0.00). However, it was not affected by the duration of the disease and the current CD4 counts (p > 0.05). Human immunodeficiency viruses (HIV) associated neurocognitive disorders HAND is common in HIV-positive patients, most of whom are asymptomatic. Older patients with less education and severe disease, having lower nadir counts are at the highest risk of HAND. Memory, verbal fluency, and visuospatial abilities were the most commonly affected domains.

Effect of iron deficiency anemia on blood levels of interleukin 6 and infection rates in children: a pilot study

Introduction: Iron deficiency is the most common micronutrient deficiency worldwide. Iron activates the growth and differentiation of immune cells and cytokine actions. Interleukin 6 is a pro-inflammatory cytokine that stimulates the differentiation of B lymphocytes into plasma cells and activates T lymphocytes. Our study aimed to evaluate the correlation between blood levels of iron and interleukin-6 (IL-6) and its impact on infection rates in children. Materials and methods: The study included 36 children. The serum concentration of IL-6, iron, and morphology parameters from a venous blood sample were assessed. An anonymous survey of children’s parents was conducted regarding the frequency of infections before and after the diagnosis of anemia. Results: In the study group, the levels of IL-6 were higher than in the control group and showed greater variability between individual patients. There was a statistically significant, negative correlation between IL-6 and iron levels within the study group (p = 0.012), and a decrease in the number of viral diarrheas after the diagnosis of anemia compared to the state before diagnosis (p = 0.041). There was no statistically significant change in the number of colds or the mean duration of infection (p = 0.144, p = 0.498), nor in the incidence of other infectious diseases and antibiotics intake in the study group before and after iron deficiency anemia diagnosis (p = 0.500, p = 0.219). Conclusions: IL-6 might play a role in iron deficiency anemia. Increased levels of IL-6 were shown not to correspond with visible changes in rates and the course of colds, but did result in a reduction in the frequency of viral diarrhea. Further research on a larger group of carefully selected patients is required to determine the effect of anemia on the immune system.

Capillaroscopy, microangiopathy, and HIV. Descriptive study of capillaroscopy findings in HIV positive patients

In this study, we aim to evaluate microangiopathy in HIV positive patients by using capillaroscopy. To date, few studies have been published on the topic. Capillaroscopy may be a tool for early diagnosis of cardiovascular involvement in this patient population. Cross-sectional study with HIV positive patients >18 years. The enrolment period was set from January to June 2018. The following data were collected: demographic (sex, age), laboratory tests (duration of infection, CD4 cell count, CD4:CD8 ratio, coinfection with other viruses), antiretroviral treatment, dyslipidemia, and comorbidities (active smoking, alcoholism, high blood pressure, dyslipidaemia, diabetes, cardiopathy). The capillaroscopy and blood tests were performed simultaneously. The following alterations were evaluated in the capillaroscopy: congestion, tortuosity, haemorrhage, dilations, capillary loss, and presence of megacapillaries. One hundred and two patients were included; 73.5% were male, mean age was 40 years (SD: 10), and mean duration of infection 4.5 years (SD: 3.1). At diagnosis, mean CD4 cell count was 408/mm3 and CD4/CD8 ratio 0.4. A number of patients (14.7%) were coinfected with the hepatitis B virus; 31.3% were active smokers and 13.7% alcoholics. Capillaroscopy alterations were found in most study patients (93.1%): congestion (78.5%), tortuosity (77.5%), haemorrhage (13.8%), dilations (11.8%), capillary loss (5%), and megacapillaries (1%). Capillary tortuosity was associated with age and smoking; and haemorrhage with age, CD4, antiretroviral treatment, and hypertension. Prevalence of capillaroscopy alterations is high in HIV positive patients, particularly tortuosity and congestion. To the best of our knowledge, the later alteration has not been previously reported in this group of patients.

Helicobacter Pylori Infection in Children with Idiopathic Thrombocytopenic Purpura

Background: Today Helicobacter pylori is the most common bacterial infection worldwide and is associated with some extra-gastrointestinal diseases such as blood disorders including idiopathic thrombocytopenic purpura (ITP). Therefore, this study was designed and performed to determine the status of Helicobacter pylori infection in children with idiopathic thrombocytopenic purpura referred to Dr. Mohammad Kermanshahi Hospital in 2019. Materials and Methods: In this cross-sectional study, 68 children with ITP were evaluated for Helicobacter pylori infection using stool antigen test. Information on Helicobacter pylori was collected using a checklist along with data on gender, age, type of ITP (acute / chronic), primary platelet counts, duration of ITP, and history of receiving treatment for H. pylori infection. Data were analyzed by SPSS-20 using descriptive statistics and the Chi-square test. Results: The mean age of all subjects was 6.35 ± 3.44 years with an age range of 1 to 13 years. The mean duration of the disease was 9.73. ± 9.04 months. Among patients, 63.24% (43 patients) were boys. Regarding the type of ITP, the highest percentage was the Acute type of disease (72/06%). Also, based on the analytical results, there was no significant relationship between Helicobacter pylori infection and gender, mean duration of infection and type of ITP (p <0.05). Conclusion: According to the results of this study, half of the ITP patients had Helicobacter pylori infection, but there was no significant relationship between the type of ITP and its duration with Helicobacter pylori infection. Therefore, it is recommended to conduct similar studies with a larger sample size and perform follow-ups to achieve more accurate results

Clinical characteristics of COVID-19 infection in polyhandicapped persons in France

AimLittle is known about the clinical profile of COVID-19 infection in polyhandicapped persons. This study aimed to describe the characteristics of this infection among individuals with polyhandicap. MethodThis was a retrospective observational study. Polyhandicap was defined by the combination of motor deficiency, profound mental retardation, and age at onset of cerebral lesion younger than 6 years. A positive COVID-19 status was considered for patients with a positive COVID-19 laboratory test result, or patients presenting with compatible symptoms and living in an institution or at home with other patients or relatives who had laboratory-confirmed COVID-19 infection. Data collection included sociodemographic data, clinical and paraclinical characteristics, as well as the management and treatment for COVID-19 infection. ResultsWe collected 98 cases, with a sex ratio of 0.98 and a mean age of 38.5 years (3 months to 73 years). COVID-19 infection was paucisymptomatic in 46% of patients, 20.6% of patients presented with dyspnea, while the most frequent extra-respiratory symptoms were digestive (26.5%) and neurological changes (24.5%); 18 patients required hospital admission, four adults died. The mean duration of infection was longer for adults than for children, and the proportion of taste and smell disorders was higher in older patients. ConclusionThese findings suggest that PLH persons often develop paucisymptomatic forms of COVID-19 infection, although they may also experience severe outcomes, including death. Clinicians should be aware that COVID-19 symptoms in PLH persons are often extra-respiratory signs, mostly digestive and neurologic, which may help in the earlier identification of COVID-19 infection in this particular population of patients.

Epidemiological Trends and Clinicomycological Profile of Chronic Dermatophytosis: A Descriptive Study From South India.

Background:Chronic dermatophytosis refers to persistent or recurrent episodes of dermatophytosis lasting for more than 1 year despite adequate treatment with topical and systemic antifungal agents. The rise in the number of these cases is alarming over the past 5 to 6 years, and a thorough knowledge about the reasons for chronicity of dermatophytosis may go a long way in the treatment and prevention of this infection.Aims and Objectives:The aim of this study was to investigate the epidemiology, various clinical types, and factors associated with chronicity in patients with chronic dermatophytosis, and to isolate the etiological agents and study the clinicomycological correlation.Materials and Methods:Detailed history and clinical details of all patients with chronic dermatophytosis who presented to our tertiary care center over a span of 1 year were recorded. Skin scrapings from these patients were subjected to potassium hydroxide mount and culture in modified Sabouraud's dextrose agar medium.Results:Sixty-four patients were enrolled in this study with a mean age of 44.5 years. The mean duration of infection was 3.14 years. Tinea corporis was the most common clinical type seen in 46 (71.9%) patients, affecting commonly the waist area in females and the back in males. Bronchial asthma was the most frequent systemic association affecting 20 (31.3%) patients followed by diabetes mellitus, which was present in 13 (20.3%) patients. About 34% patients had a history of long-term steroid use. Among the 28 isolates, Trichophyton mentagrophytes was the most frequent species isolated (46.4%), followed by Trichophyton rubrum (39.3%). Trichophyton tonsurans and Trichophyton verrucosum were isolated from two patients each.Conclusion:Extensive area of involvement, atopy, diabetes, and long-term use of systemic corticosteroids were associated with chronicity. Unlike in the yesteryears, T. mentagrophytes has emerged as the most common etiological agent of chronic dermatophytosis.

Duration of Human Immunodef iciency Virus Infection at Diagnosis among New Human Immunodef iciency Virus Cases in Dehong, Yunnan, China, 2008-2015.

Background:On diagnosis of human immunodeficiency virus (HIV) infection, a person may have been infected already for many years. This study aimed to estimate the duration of HIV infection at the time of diagnosis.Methods:Newly diagnosed HIV cases in Dehong, China, from 2008 to 2015 were studied. Duration of infection at the time of diagnosis was calculated using the first CD4 cell count result after diagnosis and a CD4 depletion model of disease progression. Multiple linear regression analysis was used to investigate the associated risk factors.Results:A total of 5867 new HIV cases were enrolled. Overall, mean duration of infection was 6.3 years (95% confidence interval [CI]: 6.2, 6.5). After adjusting for confounding, significantly shorter durations of infection were observed among participants who were female (beta: −0.37, 95% CI: −0.64, −0.09), Dai ethnicity (beta: −0.28, 95% CI: −0.57, 0.01), and infected through injecting drug use (beta: −1.82, 95% CI: −2.25, −1.39). Compared to the hospital setting, durations were shorter for those diagnosed in any other settings, and compared to 2008, durations were shorter for those diagnosed all years after 2010.Results:A total of 5867 new HIV cases were enrolled. Overall, mean duration of infection was 6.3 years (95% confidence interval [CI]: 6.2, 6.5). After adjusting for confounding, significantly shorter durations of infection were observed among participants who were female (beta: −0.37, 95% CI: −0.64, −0.09), Dai ethnicity (beta: −0.28, 95% CI: −0.57, 0.01), and infected through injecting drug use (beta: −1.82, 95% CI: −2.25, −1.39). Compared to the hospital setting, durations were shorter for those diagnosed in any other settings, and compared to 2008, durations were shorter for those diagnosed all years after 2010.Conclusion:Although the reduction in duration of infection at the time of diagnosis observed in Dehong was significant, it may not have had a meaningful impact.

Dynamics of mammary infections in organic dairy farms in Northern Spain

The objective of this paper is to evaluate the microbiological state and the dynamics of the mammary infections of organic farms in North Spain to discover if the high somatic cell count (SCC) observed in these farms is associated to a high incidence of mastitis. Microbiological cultures and SCC were performed in 8,496 foremilk samples collected from 160 cows in five representative organic farms from February 2006 to January 2008. Even though 79.3% of cultures were positive, only 21.2% of the total fit our diagnosis of mastitis (clinical, subclinical and chronic). The great prevalence of Corynebacterium bovis (teat canal-region pathogen) in the positive cultures that did not fit the mastitis diagnosis criteria (nearly 70%) compared with those that did (27%) was found to be related to lack of post-milking teat disinfection. The study prevalence of mastitis was 69.2% (66.7% subclinical mastitis, 27.8% clinical mastitis); the mean monthly prevalence was 47.4%; the mean monthly incidence was 12.9% and the mean duration of infection was 3.84 ± 3.98 months The high SCC in foremilk samples from old cows (three or more lactations) not diagnosed as mastitis compared to the heifers, reflects a worsening health status of the animals over time. When compared with the conventional sector in Northern Spain, these parameters indicate a poorer udder health in the studied organic herds with a high presence of chronic subclinical processes.

Predictors of Liver Disease Severity in Children with Chronic Hepatitis B.

Evaluation of the liver histology is essential for the management of chronic hepatitis B (CHB) in children. The aim of this study was to analyze the histopathological features in children with CHB and compare them with clinical and laboratory data. The study comprised 30 treatment-naïve children (mean age: 12.8 ± 2.4; mean duration of infection: 11.7 ± 2.5 years; 16/30 HBeAg-positive and 14/30 HBeAg-negative), who underwent a liver biopsy due to CHB. Liver biopsies were evaluated according to the modified Knodell score. A histopathological evaluation revealed mild to severe necroinflammatory activity (mean grading: 5.4 ± 3.2) and fibrosis (mean staging: 1.7 ± 0.9), irrespective of the HBeAg-status, viral load and duration of infection. One case of cirrhosis was observed. A multiple regression analysis revealed that alanine and aspartate aminotransferase (ALT and AST) levels were associated with the necroinflammatory activity (p = 0.001 for ALT, and p = 0.006 for AST). No such correlation for fibrosis was observed; however, children with elevated AST were prone to more advanced fibrosis compared to children with normal AST level (p = 0.01). Children with CHB presented a wide range of liver changes over a decade after the infection. The severity of liver lesions did not differ according to the HBeAg status, viral load and duration of the infection. ALT and AST levels correlated positively with the inflammatory activity. AST seems to be a better predictor of fibrosis compared to ALT. Liver biopsy is a useful tool in evaluating the severity of liver disease in children with chronic hepatitis B, whereas clinical and laboratory parameters are weak predictors of liver injury.

73 Impact of community-acquired MRSA and hospital-acquired MRSA on pulmonary function of CF patients

Objective Persistent methicillin-resistant Staphylococcus aureus (MRSA) infection affects both pulmonary function and survival of CF patients. Few reports have investigated the genetic background of MRSA strains involved in persistent lung infection. This study compares lung function decline in CF patients persistently infected by community-acquired MRSA (CA-MRSA) and hospital-acquired MRSA (HA-MRSA). Methods Seventy-five patients attending five Italian CF centers and persistently infected by MRSA were studied. One strain/year/patient was analyzed. SCCmec analysis was performed as previously described in order to characterize CA- and HA-MRSA strains. The mean annual FEV 1 decline was evaluated for each patient. Results Forty-nine out of 75 (65%) patients maintained the same SCCmec type over time and the mean duration of infection was 3.1 years. Twenty-five patients (mean age 20.6 years) were persistently infected by HA-MRSA and 24 (mean age 18.4 years) by CA-MRSA. The prevalence of chronic P. aeruginosa infection was 52% and 29% in the HA- and CA-MRSA group respectively. The yearly mean FEV 1 decline for patients harboring HA-MRSA and CA-MRSA was –1.12±4.7 and –2.2±4 respectively. Conclusion Most of the studied patients maintained the same SCCmec type for several years. Patients infected by CA-MRSA showed more FEV1 decline in comparison with HA-MRSA infected patients. However this difference is not statistically significant. The knowledge of genetic background of MRSA strains should be improved in order to understand the clinical impact of persistent MRSA infection and optimize prevention and treatment strategies. Grant RF-2010-2316176 Bando Ricerca Finalizzata

PIN7 - Epidemiology, Treatment Outcomes and Costs of Treating Hepatitis C in Routine Care – Results from a Large Multicenter Trial

Estimates assume that 400,000 to 500,000 people are chronically infected with Hepatitis C in Germany. About 27% of end-stage liver cirrhosis and 25% of hepatocellular carcinoma are associated with HCV. The economic relevance of hepatitis C results from high costs for antiviral treatment as well as accompanying and secondary diseases. The aim of the study was to gain information on epidemiological characteristics, treatment outcomes and costs. Underlying data were collected in a non-interventional trial between 2008 and 2011. Inclusion criteria were a confirmed HCV diagnosis and need for antiviral treatment. Besides sociodemographic and clinical parameters, HCV related resource utilization was gathered for a subgroup of patients. Data presented are mean values. Data on 7,637 patients receiving antiviral treatment with peginterferon-α-2a and ribavirin were collected. This analysis relates on 3,708 patients without HIV coinfection and/or drug substitution treatment. Mean age was 43.7 years, 60.3% were male. Most patients had a genotype-1 (61.3%) or genotype-3 infection (28.5%). The majority of patients was treatment-naïve (86.5%), 7.3% were relapser and 5.6% non-responder. Main sources of infection were injection drug use (34.8%) and blood products (14.2%). Mean duration of infection was 13.6 years. In average 48.9% of treatment-naïve GT-1(4-6) and 63.0% of GT-2/3 patients achieved SVR. For prior relapse patients and non-responder SVR-rates were: GT-1(4-6): 35.4%; GT-2/3: 58.5 and GT-1(4-6): 23.3% GT-2/3: 37.9%, respectively. Costs for antiviral treatment amount for €20,889 in GT-1(4-6) patients and €13,610 in GT-2/3 patients. Costs for the management of adverse events or HCV-related diseases sum up for €11.70. Ambulatory care, diagnostics procedures and hospital care amount for a small proportion of total costs. This study provides an overview on epidemiologic characteristics, treatment outcomes and treating costs in routine care. Treatment of HCV is costly and mainly affected by length of antiviral therapy.

The clinical diagnosis of HIV-infection in a specialized hospital

Aim. To assess the structure of opportunistic infections and concomitant diseases, including the stage of infection, in patients hospitalized with HIV-infection. Methods. 40 cases of in-patient treatment of patients diagnosed with HIV aged 25 to 42 (mean age 34.26±1.22), male - 26, female - 14, with mean duration of infection 6,7±0,6 years were analyzed. Results. The patients were admitted to the hospital on 17±3.24 day of the disease, including cases of pulmonary diseases (on 23±3.6 day), cases of chronic hepatitis reactivation and liver cirrhosis decompensation (on 30±10.09 day), cases of acute infections (on 7±1.16 day). Previous psychoactive drug use was confirmed in 28 (70.0%) of patients. 13 (32.5%) patients received treatment with antiretroviral drugs, 3 (7.5%) have abandoned it, the rest had never been offered an antiretroviral treatment. According to the classification by V.I. Pokrovsky, the patient were staged as: stage III - 4 (10.0%) patients, stage IVA - 8 (20.0%), IVB - 11 (27.5)%, IVC - 17 (42.5%) patients. Pulmonary diseases were the most prevalent and were diagnosed in 17 (42,5%) patients, including cases of community-acquired pneumonia (focal, multisegmental, interstitial, lobular) in 8 (47.1%) patients, pulmonary tuberculosis (infiltrative, military, intrathoracic lymph nodes tuberculosis) in 9 (52.9)% patients. Liver diseases (chronic hepatitis B, chronic hepatitis B + C, liver cirrhosis) were the most frequent concomitant diseases and were found in 21 (52.5%) patients. Conclusion. Herpes zoster and liver diseases are the most predominant concomitant diseases at the early stages of HIV-infection, whereas ooportunistic infections, tuberculosis, community-acquired pneumonia and sepsis are typical in patients with late stages of HIV-infection.

Stable bone mineral density over 6 years in HIV-infected men treated with highly active antiretroviral therapy (HAART)

Most longitudinal studies of bone mineral density (BMD) in HIV-infected cohorts have been of short duration, typically 1-2 years. Some studies, especially of cohorts treated with highly active antiretroviral therapy (HAART), report short-term stable or increasing BMD, but other studies, often in cohorts initiating HAART, report short-term losses in BMD. We assessed BMD changes over the medium term in HIV-infected men already established on HAART at baseline. Six-year, prospective, longitudinal study. Forty-four HIV-infected men treated with HAART and 37 uninfected, healthy controls. Participants had measurements of BMD at baseline, 2 and 6 years. In the HIV-infected men at baseline, the mean age was 49 years, the mean duration of infection was 8 years, and the mean duration of HAART was 50 months. Over 6 years of follow-up, there was a greater increase in lumbar spine BMD (5·3%, 95% CI 3·8-6·5%) in the HIV-infected men compared with controls (0·3%, 95% CI -1·0 to 1·6%), P < 0·001. There was no difference between the groups in the change in BMD over time at the total hip (HIV group: -0·6%, 95% CI -1·7 to 0·4%, controls -1·0%, 95% CI -2·2 to 0%, P = 0·8) or at the total body (HIV group, 0·3%, 95% CI -0·3 to 1·0%; controls, 0·5%, 95% CI -0·2 to 1·1%, P = 0·15). Lean mass increased in the HIV group, but not in the controls. There was no evidence of accelerated bone loss over 6 years in middle-aged, HIV-infected men treated with HAART. For such patients, routine monitoring of BMD is not necessary over the short/medium term.

6. Reconsidering the Framing of Clinical Messages to Patients Concerning HPV: Further Evaluation of the Natural History of HPV Infection

Purpose: Counseling young women about abnormal pap smears often emphasizes the high likelihood for spontaneous clearance of HPV infection. However, in some women, HPV may cause persistent or even lifelong infection. Messages emphasizing clearance may trivialize the importance of oncogenic HPV infections. In this study, periods of prolonged non-detection within a type-specific infection were identified for common oncogenic, high risk (HR) HPV types. The goal of the study was to gain insights into possible low-level persistence and re-activation of HR-HPV. Methods:WeevaluatedHPV infections of 150unvaccinatedwomen using a longitudinal cohort recruited from 3 Indianapolis clinics. Quarterly vaginal swabs were analyzed for HPV using Roche Linear ArrayHPVGenotyping. The analysis focused onHPV typesmost often detected in cervical cancer (16, 18, 31, 33, 45, 52, and 58). Infection was defined as type specific HPV detection in two consecutive quarterly swabs. Infection duration was defined as the time between first and last type-specific HPV positive swabs. Periods of non-detection were defined as at least two sequential negative swabs interrupting a type specific infection. Survival analysis was used to determine duration of HPV infection. Results: Data from 146 of 150 women (ages 14-17; mean 15.4 years at enrollment) were included based on sufficient data. Most women were Black (94.5%). Duration of follow up was 3.94-9.18 years (average 5.6 years). Twenty-one of 70 women (30%) with HPV 16 infections (mean duration of infection of 794.6 days) had at least one period of non-detection that averaged 24.9 months (SD 22.7). Seven of 35 women (30%) with HPV 18 infections (mean duration of infection of 680.8 days) had at least one period of non-detection that averaged 22.1months (SD 5.4). Three of 30women (10%)with HPV 31 infections (mean duration of infection of 460.8 days) had at least one period of non-detection that averaged 12.3 months (SD 2.9). One of 7 women (14%) with HPV 33 (mean duration of infection of 501.6 days) had at least one period of non-detection that averaged 11 months. Seven of 34 women (21%) with HPV 45 infections (mean duration of infection of 449.0days) had at least one period of non-detection that averaged 11.3 months (SD 3.6). Fourteen of 57 women (25%) with HPV 52 infections (average duration of 613.6 days) had at least one period of non-detection that averaged 26.7 months (SD 24.0). Nine of 33 women (27%) with HPV 58 infections (mean duration of infection of 587.6 days) had at least one period of non-detection that lasted 11.67 months (SD 3.97 months). Conclusions: Prolonged follow-up of adolescentwomenwith highrisk HPV infections reveals that non-detection does not mean resolution. During a HPV type specific infection, many women in our study had prolonged periods of non-detection. This suggests that what might have been traditionally considered clearance of HPV infection,may in fact be periods of non-detection. Accordingly, counseling women with HPV and HPV related diseases needs to consider the potential for disease persistence. Sources of Support: Source of Funding: NIH RO1 A107202001A2

Le parcours de santé de l’enfant polyhandicapé

Little is known about the clinical profile of COVID-19 infection in polyhandicapped persons. This study aimed to describe the characteristics of this infection among individuals with polyhandicap.This was a retrospective observational study. Polyhandicap was defined by the combination of motor deficiency, profound mental retardation, and age at onset of cerebral lesion younger than 6 years. A positive COVID-19 status was considered for patients with a positive COVID-19 laboratory test result, or patients presenting with compatible symptoms and living in an institution or at home with other patients or relatives who had laboratory-confirmed COVID-19 infection. Data collection included sociodemographic data, clinical and paraclinical characteristics, as well as the management and treatment for COVID-19 infection.We collected 98 cases, with a sex ratio of 0.98 and a mean age of 38.5 years (3 months to 73 years). COVID-19 infection was paucisymptomatic in 46% of patients, 20.6% of patients presented with dyspnea, while the most frequent extra-respiratory symptoms were digestive (26.5%) and neurological changes (24.5%); 18 patients required hospital admission, four adults died. The mean duration of infection was longer for adults than for children, and the proportion of taste and smell disorders was higher in older patients.These findings suggest that PLH persons often develop paucisymptomatic forms of COVID-19 infection, although they may also experience severe outcomes, including death. Clinicians should be aware that COVID-19 symptoms in PLH persons are often extra-respiratory signs, mostly digestive and neurologic, which may help in the earlier identification of COVID-19 infection in this particular population of patients.

Confirmation of high SVR rates after shortening duration of treatment with Peginterferon alfa–2a (PEG) and Ribavirin (RBV) in Chronic Hepatitis C (CHC) Patients with RVR in Real Life

Studies showed that SVR in patients with low viral load (LVL) is high and treatment duration can be reduced while maintaining high SVR rates. But is this true under real life conditions? Methods: Between 2008 and 2011 data of 3810 patients completing a treatment period of 6 months for GT 2/3 or 12 months for GT 1 plus 6 months follow-up were recorded in a noninterventional study. This analysis included 745 naïve patients of G–1/2/3 with RVR and achievement of planned end of therapy, 165 patients of them got shortened treatment: GT 1 20–28 wks (n=110) and GT 2/3 (n=55) 14–18 wks in comparison to standard duration of 40–52 wks in GT 1 and 22–26 wks in GT 2/3. Results: 64.8% male, 38.7 yrs old, BMI 24.8kg/m², mean duration of infection 10.5 yrs. There were no major differences between genotypes or patient demographics with shorter vs. standard therapy. Standard treatment duration were 47.8 and 24.0 wks in GT 1 and GT 2/3 patients whereas shortened therapies were 24.4 and 15.9 wks, respectively.110/278 patients (39.6%) with GT1 and 55/467 patients with GT 2/3 (11.8%) got a shorter treatment. 91.7% of GT 1 and 96.4% of GT 2/3 patients with shortened treatment had LVL ( 800,000 IU/ml). Patients with standard treatment duration and RVR had low viral load in 59.5% of GT 1 and 61.1% of GT 2/3 patients. Rates of AEs and SAEs were 68.2%, 1.8% in GT 1 and 58.2%, 1.8% in GT 2/3 with shorter therapy and 70.2%, 3.6% in GT 1 and 62.1%, 0.7% in GT 2/3 with standard therapy. Conclusion: In real life patients with RVR were considered eligible for shorter therapy only with LVL in the majority of cases. These patients achieved high rates of SVR, similar to standard therapy in patients with RVR. Shorter treatment duration led to better tolerability especially in GT 1 patients. This analysis with very high SVR rates particular in GT 1 patients argues for a 4 week lead-in PEG/RBV period to identify RVR patients before starting triple therapy with protease inhibitors.

Arthrodesis with Internal Fixation of the Infected Ankle

Arthrodesis may be necessary to avoid amputation when treating an infected tibiotalar joint. In such cases, external or hybrid fixation is usually used. In this retrospective study, we report our experience in treating tibiotalar joint infection by arthrodesis with internal fixation. From March 1992 to October 2005 (13 years, 7 months), 20 patients underwent septic ankle arthrodesis with internal fixation. The mean duration of infection before fusion was 2.5 ± 6.7 years. Arthrodesis was performed with the Méary technique in 9 (45%) cases and with the Crawford-Adams technique in 11 (55%) cases. Internal fixation consisted of screw fixation, staple fixation, or a combination of both. The mean duration of antibiotic treatment was 97.5 ± 37.5 days, and the mean follow-up was 64 ± 36 months, with no patient lost to follow-up. Patients were considered cured if no clinical, biological, or radiologic signs of infection were present at a minimum of 2 years follow-up. The incidence of cure was 85.0% (91.0% with Crawford-Adams and 77.8% with Méary techniques). Radiographic fusion was identified in 89.5% of the cases (91.0% with Crawford-Adams and 87.5% with Méary techniques) at a mean of 4.8 ± 2.4 (range 3 to 11) months postoperative. Tibiotalar arthrodesis in the presence of sepsis can be performed with internal osteosynthesis only under certain conditions. In our experience, this treatment produced satisfactory fusion in 89.5% of patients and eradicated infection in 85.0% of cases.

Vastus lateralis muscle flap for infected hips after resection arthroplasty

We evaluated the potential of a vastus lateralis muscle flap in controlling infection after resection arthroplasty of the hip. We retrospectively reviewed 119 patients with 120 chronic infections after resection arthroplasty treated with this procedure. The flap was fixed with Mitek anchors in the acetabular cavity. The mean duration of infection after resection before the muscle flap procedure was 6.5 months (2 to 13). The patients had previously undergone a mean of 4.9 operations (2 to 25). In all patients the infected cavity was the origin of the persistent infection. The mean follow-up was for 2.6 years (1.0 to 4.7). No patient had recurrent infection post-operatively and all had an improvement in the pain and better quality of life.

The natural history of hepatitis C infection acquired through injection drug use: Meta-analysis and meta-regression

Our aim was to estimate the rate of progression to cirrhosis for those infected with hepatitis C virus (HCV) through injection drug use. We searched the published literature for articles assessing cirrhosis in this population and abstracted data on cirrhosis prevalence, mean duration of infection, mean age, mean alanine aminotransferase (ALT) enzyme levels, proportion of males, proportion HIV co-infected, proportion consuming excessive alcohol, and study setting. Summary progression rates were estimated using weighted averages and random effects Poisson meta-regression. The impact of co-variates was assessed by estimating the posterior probability that the relative risk (RR) of progression exceeded 1.0. A total of 47 published articles were identified. After adjusting for covariates in 44 studies representing 6457 patients, the estimated rate of progression to cirrhosis, was 8.1 per 1000 person-years (95% credible region (CR), 3.9-14.7). This corresponds to a 20-year cirrhosis prevalence of 14.8% (95% CR, 7.5-25.5). A 5% increase in the proportion of male participants and a 5% increase in the proportion consuming excessive alcohol were associated with faster progression (probability RR>1=0.97 and 0.92, respectively). A 5% increase in the proportion of HIV co-infected, an increase in ALT of 5 IU/L and studies in settings with a high risk of referral bias were not associated with faster progression (probability RR>1=0.42, 0.65, and 0.43, respectively). Analysis of aggregate level data suggests that for patients who contracted HCV through injection drug use prognosis is poor in populations with many male patients and high levels of alcohol consumption.