Infectious Diseases Outpatient Clinic Research Articles

Improving influenza vaccination assessment and uptake, one step at a time in a cancer center.

280 Background: Influenza immunization has shown to decrease morbidity and mortality of influenza infections. From September to December 2022, at the infectious diseases (ID) clinic at our institution, 73% of the patients did not undergo influenza immunization assessment during their clinical encounters and only 3% of the patients had the influenza vaccine administered. Furthermore, documentation of vaccine discussion was done in 73% of cases. Our aim was to improve vaccination assessment from 73% noncompliant to 50%. Methods: A multidisciplinary team of nurses, nurse leaders, pharmacists, and quality specialists was assembled to analyze baseline data on influenza vaccination assessment, administration, and documentation at the ID clinic from Sept to Dec 2022 using The Model for Improvement. Quality tools were utilized including Cause and Effect Diagram, Current State Process Flow Chart and Prioritization Matrix, to identify and prioritize opportunities for improvement creating a worklist for improvement focus. Vaccine assessment measured via EPIC immunization tab marked as reviewed, discrete areas to document vaccination and their administration were not a part of nursing or provider’s workflow. Using the Plan, Do, Study, Act (PDSA) method, the following changes were tested: PDSA Cycle 1; A green sticker highlighted those patients needing vaccine assessment. PDSA Cycle 2; A smart phrase was created for documentation in nurses’ notes and PDSA Cycle 3; provider’s notes regarding vaccine recommendations. Results: Interventions were associated with an improvement of influenza assessment via the immunization tab marked as reviewed in the ID outpatient clinic from 73% noncompliance to 3% noncompliance from September 2023 to March 2024. Concurrent with improvement of our assessment process, our on-site vaccination rate increased from 97% error to 89% error (Table) and there was 50% improvement in provider’s documentation. Conclusions: The formation of a multidisciplinary working group and implementation of quality tools interventions resulted in timely significant improvement in vaccination assessment, documentation, and administration. Subsequently, we were granted institutional approval to add an EPIC clinical decision support tool to standardize influenza vaccination documentation. Future strategies include implementation and evaluation of the utilization of Health Maintenance tool in the ID clinic before expansion to other clinics in our institution. Influenza vaccine administration vs outpatient visits in the ID clinic. Month/Year # Outpatient visits # Vaccines administered in clinic % of vaccines administered Influenza Sep-Dec 2022 1827* 54 2.95% Influenza Sept 2023-March 2024 2682 251 9.36% *Includes video and telephone visits.

Prevalence and associated factors related to sarcopenia in people living with HIV/AIDS

BackgroundThe use of antiretrovirals has increased the survival of People Living with HIV/AIDS (PLWHA), resulting in an aging population and a rise in the incidence of sarcopenia. The lack of uniformity among the prevalences found in studies may be associated with the use of different diagnostic criteria, highlighting the need for local studies to determine the prevalence of sarcopenia.MethodsCross-sectional study to estimate the prevalence and associated factors of sarcopenia using the revised criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). This study included PLWHA of both sexes, aged 40 years or older, who were treated at the infectious disease outpatient clinic of a tertiary hospital from 2019 to 2021. Muscle mass was quantified through electrical bioimpedance, using resistance and reactance to calculate appendicular lean mass (ALM) in kg/m². Muscle strength, measured in kg, was assessed using a manual dynamometer, and muscle function was evaluated using the gait speed test (m/s). Numerical variables were analyzed using measures of central tendency and dispersion. The chi-square test was used to assess associations in categorical variables. Odds ratios (OR) and 95% Confidence Intervals (CI) were calculated to evaluate the strength of associations.ResultsAmong the 218 PLWHA, the prevalence of sarcopenia was 8.7% (95% CI: 5.6 to 13.3). The mean age of the study population was 51.8 ± 8.3 years; 53.7% were male, 72.9% were brown/Black, 97.7% reported not using illicit drugs, and 24.8% were classified as obese. Multivariate analysis showed that the time since HIV diagnosis (P = 0.022) and the use of illicit drugs were associated with the diagnosis of sarcopenia.ConclusionThe prevalence of sarcopenia using the EWGSOP2 criteria was low. People with a longer duration of HIV infection and those using illicit drugs were more likely to develop sarcopenia.

Ocular Involvement in Patients with Brucellosis: A Single-Center Prospective Study

ABSTRACT Purpose The aim of this study was to evaluate the prevalence, type and treatment outcomes of ocular involvement in patients with brucellosis. Methods This prospective, single-center study enrolled patients admitted to the infectious disease outpatient clinic with diagnosed brucellosis between July 15, 2022 and July 15, 2023. Diagnosis was based on clinical symptoms and a standard Brucella tube agglutination test (≥1/160) or a positive blood culture. Ophthalmologic examinations were performed at baseline and in the first month of treatment. Third and sixth month follow-up examinations were also performed for patients with ocular findings. Results Ocular involvement occurred in 60 (24.8%) of 242 patients. Conjunctivitis was the most common ocular involvement and was observed in 39 patients (16.1%). Uveitis was the second most common ocular involvement in 14 patients (5.8%). Scleritis was the least common ocular involvement and was observed in only one patient. Patients with ocular involvement were older (p = 0.027) and had higher rates of weight loss and spondylodiscitis (p = 0.044 and 0.001, respectively). Among laboratory parameters, erythrocyte sedimentation rate and lactate dehydrogenase levels were significantly higher in patients with ocular involvement (p = 0.001 and 0.036, respectively). There were no significant differences in other demographic, clinical, and laboratory characteristics between patients with and without ocular involvement. In 56 (93.3%) patients, the ocular findings improved during the follow-up examination. Conclusion Brucellosis, a systemic infection, can manifest with ocular involvement. Early detection and treatment through ophthalmological examination are crucial in managing brucellosis.

Diagnostic approach of tuberculous lymphadenitis in a multicenter study.

Tuberculous lymphadenitis (TBLN) is the most common infectious etiology of peripheral lymphadenopathy in adults, in Turkiye. This study aimed to identify the demographic, clinical, and laboratory variables that differentiate TBLN from non-tuberculous lymphadenitis (NTBLN), as well as the etiology of lymphadenopathy in adults. Patients who were over 18 years old and were referred to the infectious disease outpatient clinics with complaints of swollen peripheral lymph nodes, and who underwent lymph node biopsy between 1 January 2010 and 1 March 2021, were included in this multicenter, nested case-control study. A total of 812 patients at 17 tertiary teaching and research hospitals in Turkiye were included in the study. TBLN was the most frequent diagnosis (53.69%). The proportion of patients diagnosed with TBLN was higher among females; and among those who had a higher erythrocyte sedimentation rate, positive purified protein derivative test, and positive interferon-gamma release test result (p < 0.05). However, TBLN was less frequent among patients with generalized lymphadenopathy, bilateral lymphadenopathy, axillary lymphadenopathy, inguinal lymphadenopathy, hepatomegaly, splenomegaly, leukocytosis, and moderately increased C reactive protein levels (p < 0.05). Identifying the variables that predict TBLN or discriminate TBLN from NTBLN will help clinicians establish optimal clinical strategies for the diagnosis of adult lymphadenopathy.

TOXOPLASMOSIS: SEROPREVALENCE IN WOMEN OF REPRODUCTIVE AGE AND APPROACH IN PREGNANCY

Objective: Toxoplasmosis is a parasitosis that is mostly asymptomatic or with mild symptoms. It can lead to severe clinical conditions in immunosuppressed patients who had infections that mostly develop through reactivation, or in congenital infections that develop in fetuses infected as a result of vertical transmission. Since it is possible to prevent congenital toxoplasmosis with appropriate follow-up and treatment, our study aimed to determine the susceptible population and seroprevalence of our region and to evaluate the course of infections in this group. Material and Method: Patients of childbearing age who were evaluated in the last five years in our tertiary hospital were included in our study, and Anti Toxoplasma gondii IgM and IgG results in these patients were evaluated. The course of pregnant women who were thought to have primary infection, the follow-up of these patients and the treatments applied were evaluated. In addition, the follow-up of non-pregnant patients examined were also evaluated. Results: The seropositivity rate was found to be 30.7% (n=1703) in 5545 women included in the study, and the seropositivity rate was 31% (n=1399) in 4503 pregnant women. After detailed evaluations, of 16 pregnant women who were thought to have primary infection during pregnancy and were followed up in our hospital; one underwent medical abortion at the request of the family, and only four used the recommended treatment until the end of pregnancy, and congenital toxoplasmosis was not detected in any newborn. Since the many of pregnant women with possible primary infection (n=28) were not referred to the infectious diseases outpatient clinic, this group was not evaluated in detail and could not be monitored. Of the patients included in the study, 26 (0.4%) were examined to investigate the etiology of fever, 37 (0.6%) were examined to investigate the etiology of lymphadenopathy (LAP), and 29 (0.5%) were examined to investigate the cause of elevated liver function tests. Among the patients monitored with LAP, four (10.8%) were diagnosed with acute toxoplasmosis. Conclusion: As a result, it is very important to determine the seroprevalence of toxoplasmosis, to detect possible primary infections, especially in pregnant women, and to prevent congenital toxoplasmosis by clinicians to guide patients correctly so that the follow-up and treatment of this group of patients is not interrupted.

Impact of Cytomegalovirus (CMV) on an Academic Pediatric Infectious Diseases Outpatient Clinic Referral Population, 2005-2020: Will the Advent of Universal Congenital CMV (cCMV) Screening Change Clinical Practice Referral Patterns?

Cytomegalovirus (CMV) infections exert a substantial impact on the practice of pediatric infectious diseases. Although most infections in children are minimally symptomatic, several populations are at risk for CMV-associated disease, including immunosuppressed children, children with HIV infection, and, most significantly, children with congenital CMV (cCMV) infection. In spite of the ubiquitous nature of CMV infection, few studies have quantified the impact of CMV-associated care in a pediatric outpatient clinic setting. We evaluated the impact of CMV on clinical care in an outpatient clinic setting over a fifteen-year period at the University of Minnesota (UMN) Masonic Children's Hospital Pediatric Infectious Diseases (PID) Clinic. A retrospective review of clinic appointments identified 253 unique patients specifically evaluated over this time period for consideration of CMV infection. Of these, 242 were pediatric patients. The majority of the pediatric patients evaluated in the PID clinic were referred for either confirmed or suspected cCMV infection, including children referred for consideration of CMV as a potential reason for a failed newborn hearing screen (NHS) and/or for evaluation of CMV as a possible etiology for documented hearing loss. In total, 116 of the children evaluated during this time period (48%) were unequivocally confirmed as having cCMV infection, with an additional 37 (15%) presenting with presumed, probable, or possible cCMV infection. A total of 16 (7%) of the pediatric CMV cases were confirmed to be post-natally acquired infections. Of the 253 total patients, 11 (4%) of the referrals were for pregnant patients seeking advice about potential therapies in the setting of a known or suspected primary maternal infection during their pregnancies, with an attendant risk of fetal CMV infection. This overview of the demographics and referral patterns for patients evaluated for known or suspected CMV infections in a tertiary care center outpatient PID clinic will serve as a useful baseline assessment, even as future patterns of outpatient care are highly likely to evolve. We predict that PID clinic referrals for newborns identified by universal cCMV screening programs will result in a shift of the CMV outpatient population to healthier infants with clinically inapparent infections, and care will need to be taken by practitioners not to over-medicalize management for these asymptomatic newborns.

Presentations for HIV post-exposure prophylaxis in emergency departments: guideline and recommendations

Patients often present to emergency departments after potential or confirmed exposure to human immunodeficiency virus (HIV) asking for recommendations concerning the initiation of post-exposure prophylaxis (PEP). These presentations may occur after occupational as well as non-occupational exposure. PEP entails taking atriple antiretroviral therapy for 28-30days. If taken early (ideally within 2 h, but no later than 72 h) and as indicated, HIV infection can be prevented with ahigh level of probability. Since these presentations occur around the clock, they require basic expertise on the part of the emergency department staff regarding its indication and its side effects as well as standardized procedures in the emergency department to not delay initiation. Patients should present to an infectious disease outpatient clinic or practice specialized in HIV in order to have the indication reviewed by aspecialist and, if necessary, adapted to complex cases with the aim of making individual case decisions. This review article aims to summarize core statements of the 2022 German-Austrian guideline on HIV post-exposure prophylaxis and to give emergency department staff necessary knowledge to safely and correctly begin PEP.

Investigation of SARS-CoV-2 antibody levels after COVID-19 vaccine in chronic hepatitis Bpatients.

The aim was to compare SARS-CoV-2 IgG antibody levels in chronic hepatitis Bpatients and healthcare personnel selected as the control group and to determine factors such as age, gender, vaccine type, and number of vaccines that may affect the antibody levels. 87 chronic hepatitis B(CHB) patients followed in Ankara Training and Research Hospital Infectious Diseases Clinic and Mamak State Hospital Infectious Diseases outpatient clinic and 89healthcare personnel selected as the control group were included in the study.SARS-CoV-2 IgG antibody levels in the serum samples of patients and healthcare personnel who received the COVID-19 vaccine were studied with the ELISA method in the Microbiology Laboratory of Ankara Training and Research Hospital, using acommercial ELISA kit (Abbott, USA) in line with the recommendations of the manufacturer. In the study, SARS-CoV-2 IgG levels were compared in CHB patients and healthcare personnel. In addition, the relationship between SARS-CoV-2 antibody level, gender, average age, natural history of the disease, number of vaccinations, vaccine type (Coronavac TM vaccine alone, BNT162b2 vaccine alone or Coronavac TM and BNT162b2 vaccine (heterologous vaccination)), treatment duration of CHB was investigated. Statistical analyses were made in the SPSS program. Avalue of p≤ 0.05 was considered statistically significant. Atotal of 167 people, including 87 CKD patients and 80 healthcare personnel as the control group, were included in the study. SARS-CoV-2 IgG antibody levels were detected above the cut-off level in the entire study group, regardless of the vaccine type. No difference was detected in SARS-CoV-2 IgG titers after COVID-19 vaccination between CHB patients and healthcare personnel. There was astatistically significant difference in SARS-CoV-2 IgG antibody levels among individuals participating in the study according to vaccine types. Compared to those who received Coronavac TM vaccine alone, the average SARS-CoV-2 IgG level was found to be statistically significantly higher in those who received BNT162b2 vaccine alone or heterologous vaccination with Coronavac TM + BNT162b2 vaccine. There was no difference between the groups in terms of age, gender, number of vaccinations, natural transmission of the disease, and duration of antiviral therapy in the CHD patient group. As aresult, SARS-CoV-2 IgG antibody levels above the cut-off value were achieved with Coronavac TM and BNT162b2 vaccines in both CHD patients and healthy control groups. however, both CHD patients and healthcare personnel had higher antibody levels than those who received BNT162b2 alone or those who received heterologous vaccination had higher antibody levels than those with Coronavac TM alone. Therefore, if there are no contraindications, BNT162b2 vaccine may be preferred in CHB and health personnel (Tab. 2, Ref. 14).

Prevalence and factors associated with hyperglycemia among persons living with HIV/AIDS on dolutegravir-based antiretroviral therapy in Uganda.

Dolutegravir-based (DTG) regimens are rapidly becoming the preferred first-line antiretroviral therapy (ART) for people living with HIV (PLHIV) in low and middle-income countries. However, there are rising concerns over the development of hyperglycemia and, in some cases, diabetes mellitus in patients switched to DTG. To determine the prevalence and factors associated with hyperglycemia among PLHIV receiving DTG-based ART at Kiruddu National Referral Hospital (KNRH), Uganda. Cross-sectional study. The study was conducted in the inpatient wards and the infectious disease outpatient clinic of KNRH from May to July 2022. Participants aged ⩾18 years on a DTG-based ART regimen for at least 3 months were consecutively enrolled and interviewed using a research assistant administered questionnaire for sociodemographic and clinical characteristics. HbA1c was measured using whole blood Architect Ci4100® (Abbott, Illinois, USA), with hyperglycemia defined using a cut-off of ⩾5.7% as per the Uganda Diabetes Association guidelines. Factors associated with hyperglycemia were examined through logistic regression, adjusting for pertinent confounders, in STATA 17. A significance level was set at p < 0.05. A total of 398 PLHIV with a median age of 40.5 years (IQR: 32-49) were enrolled. More than half were females (58.3%, n = 232) and the majority (90%) had a CD4 count above 200 cells/µL. About 16% had a family history of diabetes, 11.73% (n = 46) showed elevated blood pressure levels, and 16.7% (n = 64) had obesity. Hyperglycemia was present in 12.8% (n = 51), with 10.3% having pre-diabetes (n = 41) and 2.5% with diabetes mellitus (n = 10). At bivariate analysis, hyperglycemia was significantly associated with age >40 years (p < 0.001), herbal medicine use (p = 0.03), being widowed (p < 0.001), obesity (p = 0.042), hypertension (p = 0.002) and >3 since diagnosis with HIV (p = 0.030). At multivariable regression, only age >40 (AOR 2.55, 95% CI: 1.05-6.23, p = 0.039) and hypertension (AOR 2.93, 95% CI: 1.07-8.02, p = 0.036) remained significantly associated with hyperglycemia. More than 1 in 10 patients on DTG-based ART in our study had hyperglycemia. We recommend regular monitoring of plasma glucose, especially for patients >40 years old and those with other comorbidities, before starting/switching to DTG regimens. Longitudinal studies are recommended to determine the underlying mechanisms of hyperglycemia in this population.

Clinical, Laboratory, and Epidemiological Characteristics of Patients Diagnosed with Brucellosis: A Comprehensive Analysis

Introduction: This study aims to evaluate the demographic characteristics, clinical manifestations, laboratory findings, radiological features, and the relationship between brucella capture titers and blood culture positivity in patients followed up due to brucellosis.&#x0D; Methods: The medical records of 214 patients diagnosed with brucellosis, who were followed up at the infectious diseases clinic and/or outpatient clinic between January 2017 and December 2018, were retrospectively reviewed. Demographic and clinical characteristics of 118 included patients were recorded. Brucella capture tests and blood cultures were processed at bacteriology department of Dicle University Hospital Laboratory.&#x0D; Results: The mean age of the patients was 39.54±17.123 years. Fifty percent of the patients were male and 58.5% of the patients resided in rural areas. The most common complaints at presentation were fever (89%) and bone-joint pain (73.7%). The most frequent physical examination findings were fever (89%) and tenderness in bones and joints (73.7%). Elevated erythrocyte sedimentation rate was observed in 29.6% of patients, while elevated c-reactive protein levels were seen in 55.9% of the patients. The two most common hematological findings at the time of diagnosis were anemia with 45.8% and lymphomonocytosis with 26.3%. A statistically significant disparity was observed in the incidence of complications among patients displaying hematological manifestations, including anemia, leukopenia, and thrombocytopenia, associated with brucellosis (p

2500. An Audit of Hepatocellular Carcinoma Surveillance amongst Patients with Chronic Hepatitis B Attending an Irish Tertiary Centre

Abstract Background The association between chronic hepatitis B (CHB) and hepatocellular carcinoma (HCC) is well established, however it can be challenging to identify those who require surveillance. The European Association for the Study of the Liver (EASL) guidelines recommend 6-monthly liver ultrasound (US) as the optimal surveillance method and using the PAGE-B score for HCC risk stratification. This score offers good predictability for HCC whilst on nucleoside analogue therapy, and it also appears reliable in untreated patients. It has also been validated for individuals with HIV/HBV coinfection. We aimed to assess the compliance of an Irish tertiary hospital with the EASL guidelines for HCC surveillance. Methods We carried out a retrospective review of electronic medical records of patients with CHB attending the infectious diseases outpatient clinic in Beaumont Hospital, Dublin, Ireland. Results 70 patients were included, of which 20 were co-infected with HIV. Of the 50 patients with CHB monoinfection, 4% (n=2) had cirrhosis and 20% (n=10) were on treatment. 98% (n=49) were undergoing surveillance with 90% undergoing 12-monthly US. We analysed each patient's PAGE-B score from their most recent clinic data and 6 (12%) were stratified as high risk, 24 (48%) as medium risk and 20 (40%) as low risk. Of those coinfected with HIV, 15% (n=3) patients had cirrhosis and all patients were on anti-viral therapy. 7 patients (35%) were undergoing HCC surveillance. PAGE-B scores stratified 5 patients (25%) as high risk, 10 (50%) as medium risk and 5 (25%) as low risk. [Table 1 and 2] Conclusion The majority of patients with CHB monoinfection are receiving HCC surveillance with annual US. Using the PAGE-B score we identified 40% that are low risk and for which regular surveillance may be deferred. Those who were stratified as medium or high risk would benefit from more frequent 6-monthly US. This audit highlights the benefit of risk stratification in the allocation of resources. There was a lack of surveillance in our coinfected population despite 15 patients (75%) being stratified as medium or high risk. This may be due to clinicians focusing on HIV-associated issues during clinic visits and highlights the importance of addressing both infections when reviewing these patients. Disclosures All Authors: No reported disclosures

A retrospective study: Can dual ART mitigate the risk of potential drug-drug interactions among PLWH under stable ART?

People living with human immunodeficiency virus (PLWH) are getting older. Age-related comorbidities in PLWH result in polypharmacy and increase the risk for potential drug-drug interactions (pDDIs). This study aimed to evaluate how the rate of pDDIs would change if the treatment of patients receiving different combined antiretroviral therapies (ARTs) were theoretically changed with dolutegravir/lamivudine (DTG+3TC) or cabotegravir/rilpivirine (CAB+RPV). This study was conducted at the infectious disease outpatient clinic of a university hospital as a follow-up of a previous study. The data of PLWH receiving at least 1 comedication other than antiretrovirals (ARVs) were retrospectively reviewed and analyzed. The Drugs.com/Drug Interactions Checker and University of Liverpool HIV Drug Interactions Checker databases were used to identify pDDIs and their severities. A total of 75 PLWH, of whom 83% were male, with a mean age (± standard deviation) of 46.5 (±12.98) years were included. Polypharmacy was observed in 59 (79%) of the participants; however, with dual ARV options, the probability of polypharmacy was 35 (47%) (p < 0.001). In the Drugs.com database, no significant difference was found in terms of pDDIs between the treatment of current ARTs (64%) and DTG/3TC (%44) (p = 0.06) or CAB/RPV (%64) (p = 0.521). However, in the University of Liverpool database, the current rate of pDDIs (55%) was significantly higher compared to the theoretical treatment of DTG/3TC (40%) (p = 0.029), oral CAB/RPV (48%) (p = 0.003), and injectable CAB/RPV (31%) use (p = 0.006). The results suggest that dual treatment regimens can reduce pDDIs, resulting in better tolerance and probably higher quality of life among PLWH.

Screening for Neglected Tropical Diseases and other infections in African refugees and asylum seekers in Rome and Lazio region, Italy

BackgroundFew reliable data are available on Neglected Tropical Diseases (NTDs) and other infections among African refugees and asylum seekers in Italy.We aimed to estimate the prevalence of NTDs and other infections in a large cohort of African refugees and asylum seekers living in reception centers in Lazio, Italy. Material and methodsThis is an observational, prospective prevalence study on infectious diseases in a large population of African refugees and asylum seekers (936 overall) consecutively enrolled for screening purpose at the Infectious and Tropical diseases outpatient clinic of the National Institute of Migrant and Poverty (INMP), Rome from August 2019 to December 2020. ResultsWe found a prevalence of 8.8 % and 31 % for Strongyloides and schistosoma infection, respectively, while the prevalence of human immunodeficiency virus (HIV) infection was 0.7 %, HCV antibodies2.5%, hepatitis B virus surface antigen 10.8 % and syphilis serological tests 2.9 %. ConclusionStrongyloidiasis and schistosomiasis are highly prevalent among African refugees and asylum seekers in Italy, in contrast to communicable diseases (with the exception of hepatitis B).Raising awareness of NTDs among health professionals and implementing guidelines seems to be of paramount importance to prevent these diseases and their sufferers from becoming even more “neglected”.

Implementing a peer-supported, integrated strategy for substance use disorder care in an outpatient infectious disease clinic is associated with improved patient outcomes

Substance use disorder (SUD) and infectious disease (ID) care integration may lead to improvements in SUD and ID outcomes. We assessed implementation of integrating peer-supported SUD care in an outpatient ID setting. In this implementation study, we describe REcovery in Specialty care Through medication and OutREach (RESTORE), a low-threshold SUD program implemented in a Baltimore outpatient ID clinic. Key program components were clinician training and support in SUD care, prescription of SUD treatment medications, and peer-based psychosocial support provided by peer recovery specialists. We assessed clinician adoption of RESTORE and compared patient outcomes from baseline to 6 months. Between January 2019 and January 2022, the number of ID clinicians (N=61) who prescribed buprenorphine increased eightfold from 3 (5%) to 24 (39%). Of 258 ID patients referred to RESTORE, 182 (71%) engaged, 137 consented to study participation. Mean age in the study sample was 52.1 (SD=10.4), 63% were male, 84% were Black/African-American. Among 127 (93%) who completed 6-month follow-up, fewer participants reported illicit/non-prescribed opioid use in the past 30 days at follow-up (32%) compared to baseline (52%; p<0.001). Similar reductions were noted for cocaine use (47% to 34%; p=0.006), emergency department visits (23% to 9%; p=0.002), and inpatient hospitalizations (15% to 7%; p=0.025). SUD care integration into an outpatient ID care setting using a peer-supported implementation strategy was adopted by clinicians and improved clinical outcomes for patients. This strategy is a promising approach to treating people with infectious diseases and SUD.

Depression, psychosocial factors, and laboratory routine testing in people living with HIV in Northeastern Mexico: prevalence, correlations, and its associations

Introduction: Depression is up to five times more prevalent in people living with HIV (PLWHIV). There are neurohormonal, virological and psychosocial factors involved and it is associated with antiretroviral treatment non-adherence, decreased life expectancy, faster progression to AIDS and premature death. Studies support that with lower CD4 levels, and the higher viral load (VL), depression increases. Objective: To establish whether there is a correlation and association between the VL and CD4 count with depression and its symptoms in PLWHIV. Method: Under follow-up in the Infectious Disease outpatient clinic a survey of sociodemographic variables, and a Beck's Depression Inventory (BDI) was applied to the study subjects, whose results were analyzed using Rho Spearman (rs) and Chi Squared test (X2) with VL and CD4 levels. Results: 137 individuals were included, from 18-73 years, which 97 (70.8%) were male assigned at birth. The prevalence of depression reported, was 25.5%. A positive correlation was found between VL and BDI score, and a negative correlation between BDI score and CD4. In addition, correlation was found between VL, and depressive symptoms such as guilt, discouragement and self-image perception. These symptoms were strongly associated with death wishes, previous suicide attempts, and treatment non-dherence. Conclusion: VL may have implication in depression and its symptoms in this population, so their control is extremely important to prevent depressive episodes and suicidal behavior and prolong treatment adherence.

The efficacy of integrated hepatitis C virus treatment in relieving fatigue in people who inject drugs: a randomized controlled trial

BackgroundMost people who inject drugs (PWIDs) suffer from severe fatigue, and chronic hepatitis C virus (HCV) infection may play a role in this. However, there is scarce evidence about interventions that alleviate fatigue among PWIDs. The present study investigated the effect of integrated HCV treatment on fatigue in this population compared to the effect of standard HCV treatment, adjusted for sustained virological response of the HCV treatment.MethodsThis multi-center, randomized controlled trial evaluated fatigue as a secondary outcome of integrated HCV treatment (the INTRO-HCV trial). From May 2017 to June 2019, 276 participants in Bergen and Stavanger, Norway, were randomly assigned to receive integrated and standard HCV treatment. Integrated treatment was delivered in eight decentralized outpatient opioid agonist therapy clinics and two community care centers; standard treatment was delivered in specialized infectious disease outpatient clinics at referral hospitals. Fatigue was assessed prior to treatment and 12 weeks after treatment using the nine-item Fatigue Severity Scale (FSS-9). We applied a linear mixed model to evaluate the impact of integrated HCV treatment on changes in FSS-9 (ΔFSS-9) sum scores.ResultsAt baseline, the mean FSS-9 sum score was 46 (standard deviation (SD): 15) for participants on integrated HCV treatment and 41 (SD: 16) for those on standard treatment. Twelve weeks after completed HCV treatment, the mean FSS-9 sum score for participants receiving integrated HCV treatment was 42 (SD: 15) and 40 (SD: 14) for those receiving standard HCV treatment. Integrated HCV treatment did not reduce the FSS-9 scores compared to standard HCV treatment (ΔFSS-9: -3.0, 95% confidence interval (CI): -6.4;0.4).ConclusionsFatigue is a common symptom among PWIDs. Integrated HCV treatment is at least equal to standard HCV treatment in improving fatigue.Trial registrationClinicalTrials.gov.no NCT03155906, 16/05/2017.

Retention and Overdose Risk among Patients Receiving Substance Use Disorder Treatment, Mental Health Care and Peer Recovery Support: A Longitudinal Analysis.

Drug overdose remains a major crisis in the United States. Expanding substance use disorder (SUD) treatment and recovery support services is critical for reducing overdose risk during disasters such as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic. We evaluated the outcomes of an innovative multicomponent service, inclusive of medications for SUD, and peer support, colocated in an outpatient infectious disease clinic in Baltimore City. Our goal was to examine whether a multicomponent SUD program can support patients in recovery during a pandemic. One hundred five patients in the RESTORE service between 2019-2020 completed baseline, 3-month, and 6-month surveys. Telemedicine and phone-based support groups were implemented in March 2020 after statewide restrictions on face-to-face services due to SARS-CoV2. Data from surveys and electronic medical records were integrated and analyzed using mixed-effects regression models. At baseline, most patients (88%) reported using drugs/alcohol in the preceding 30 days; 48% of patients reported a history of drug overdose, as well anxiety (23%) and depression (28%) symptoms. Despite pandemic-related disruptions and procedural changes, retention in RESTORE was high (83% after 3 months, 76% after 6 months). Mixed-effects regression models indicated decreased anxiety, alcohol use, heroin use, and nonfatal overdose after 6 months of enrollment (all P < 0.05). Multicomponent SUD services that are colocated within infectious disease specialty services could help patients to successfully manage their overdose risk and mental health even during future disasters. This model of care could be implemented in other specialty settings that see high rates of SUD.

Bir Üniversite Hastanesinde HIV Pozitif Hastalarda Antiretroviral Tedavi Değişikliklerine Etki Eden Faktörlerin Değerlendirilmesi

Introduction: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is the leading cause of death from infectious diseases in the world. With the antiretroviral treatments developed over the years, viral replication is suppressed even though the disease cannot be cured yet. However, antiretroviral therapy (ART), like all drugs, has brought with it undesirable side effects as well as positive effects. In addition, demographic characteristics, accompanying comorbidities, organ dysfunctions, viral load, CD4 T lymphocyte count, ART resistance status, coinfections, pregnancy are also effective factors in the initial ART decision and change. In this study, we aimed to show the treatment status of HIV-positive patients followed in the infectious diseases outpatient clinic of our hospital and to determine the factors that affect ART change. Materials and Methods: Demographic data of HIV-positive patients followed in the infectious diseases outpatient clinic between January 2016 and May 2021, HIV-RNA and CD4 T lymphocyte results obtained before and after antiretroviral therapy, and the reasons for changing treatment were evaluated retrospectively. Results: The mean age of the patients included in the study was 40.0 ± 13.9 (min: 20-max: 76), and 16 (18%) were female and 71 (82%) were male. Treatment was changed in 32% of the patients. Changes were made due to drug-related side effects in 43%, patient-related reasons (such as single tablet request, non-compliance with treatment) in 25%, and virological unresponsiveness in 18% of patients who underwent treatment change. The most common cause of drug changes due to side effects was hyperlipidemia. The treatment regimens that changed the initial treatment were most frequently TDF/FTC/LPV/r and TDF/FTC/EFV, respectively. Conclusion: As a result of our study, we found that the most common cause of ART change in HIV-positive patients in our hospital was drug-related side effects, and patient non-compliance was the second most common. It is important to know the factors that cause these changes in advance and to make choices accordingly when starting the treatment, in order to increase patient compliance and facilitate follow-up.

Determination of Serum Differential Carnitine Ester Levels in HIV [+] Patients: A Cross-sectional Study.

It has been reported that carnitine deficiency is observed in various viral infections and in the follow-up of the prognosis of some diseases. In this cross-sectional study, we aimed to determine how carnitine ester derivatives change in HIV-positive patients. In this study, 25 HIV-infected patients who applied to Harran University Faculty of Medicine Education Research and Practice Hospital Infectious Diseases and Clinical Microbiology Outpatient Clinic and who did not receive any antiretroviral treatment, as well as 25 healthy volunteers were included in the study. Carnitine ester levels in serum samples were measured by Liquid Chromatography-Mass Spectrometry/Mass Spectrometry (LC-MS/MS) method (Shimadzu North America, Columbia, MD, USA). While suberoylcarnitine (C8DC), myristoleylcarnitine (C14:1), tetradecadienoylcarnitine (C14:2), palmitoleylcarnitine (C16:1), and linoleylcarnitine (C18:2) levels in HIV+ patients were quite low compared to the control group, tiglylcarnitine (C5:1) levels were high (p ≤ 0.05). In addition, C5:1 and C14:2 index parameters according to VIP score, and C5:1 and C14:1/C16 index parameters according to ROC analysis were determined as markers with high potential to distinguish HIV+ patients from healthy volunteers. This study showed that acylcarnitine derivatives might be altered in HIV+ patients, and the results obtained may contribute to a better understanding of carnitine metabolism.

Cutaneous Polyarteritis Nodosa: A Rare but Severely Debilitating Disease

Cutaneous polyarteritis nodosa is a rare cause of ulcerations of the lower extremities. Inflammation and occlusion of small and medium sized cutaneous vessels results in painful nodules and skin ulcerations. Mild cases can be treated with topical corticosteroids or oral nonsteroidal anti-inflammatory medications. Severe cases require corticosteroids and other immunosuppressive therapies. A 47-year-old female patient presented to the infectious diseases outpatient clinic with multiple skin lesions of her lower extremities that failed to respond to courses of oral antibiotics. A deep tissue biopsy confirmed findings of vasculitis and she was initiated on corticosteroids. She developed progressive necrotic lesions as soon as corticosteroids were tapered. Angiography of the lower extremities revealed extensive abnormalities of bilateral tibial arteries and she was advised amputation. The patient sought a second opinion and underwent limb salvage therapy with surgical debridement, skin grafting and hyperbaric oxygen therapy along with systemic corticosteroids. She continues experiencing slow healing and has successfully avoided limb amputations. This case highlights the need to have a high index of suspicion of this rare but highly debilitating form of cutaneous vasculitis. Corticosteroids or other immune-modulating agents along with expert care at a specialized wound center can help patients avoid limb amputation.