Virus-positive Individuals Research Articles

Molecular epidemiology and distribution of Cryptococcus neoformans in human immunodeficiency-positive patients in China.

This study aims to inform the prevention and treatment of Cryptococcus neoformans infections in China by analyzing the molecular epidemiology and distribution patterns of the pathogen. A cross-sectional study was conducted involving a retrospective analysis of 64 clinical strains of Cryptococcus isolated from January 2018 to April 2023 across various domestic regions. Patient information was collected from human immunodeficiency virus-positive individuals in multiple hospitals located in 19 cities within China's southeastern coastal and southwestern regions. A VITEK MS mass spectrometer was employed for strain identification. Variants and mating types were amplified using polymerase chain reaction (PCR), while PCR multilocus sequence typing (MLST) was utilized for molecular genetic analysis of the strains. Evolutionary trees were constructed using MEGA software. The study identified a male predominance (2.37:1) among the 64 strains, with a median patient age of 38.5 years. Most strains (79.69%) were isolated from cerebrospinal fluid. All strains belonged to the Aα, VN I type, with MLST revealing three sequence types: ST5 (89.06%), ST32 (7.81%), and ST186 (3.13%). From 2018 to 2023, Cryptococcus neoformans infections in China were predominantly found in middle-aged men, and the VN I genotype was the most common among the isolated strains.

Prediction of Hepatocellular Carcinoma and Liver-related Events in Anti-hepatitis D Virus-positive Individuals

Chronic hepatitis D (CHD) is the most severe form of chronic viral hepatitis, with a high risk of developing hepatocellular carcinoma (HCC) and liver-related mortality. Risk stratification is needed to guide HCC surveillance strategies and to prioritize treatment with antiviral agents. We conducted a multicenter retrospective cohort of anti-hepatitis D virus (HDV)-positive individuals managed at sites in the Netherlands and the United Kingdom. We studied the 5-year cumulative incidences of HCC and liver-related events (first of HCC, liver transplantation, and liver-related mortality), in the overall cohort and among relevant subgroups. We analyzed 269 anti-HDV-positive individuals with a median follow-up of 4.3 years in which 47 first events occurred. The 5-year cumulative incidences of HCC and liver-related events were 3.8% and 15.6% in the overall cohort. The 5-year cumulative incidence of HCC and liver-related events for individuals without cirrhosis was 0% and 0.9% compared with 12% and 41.3% for individuals with cirrhosis (P < .001). The 5-year cumulative incidence of HCC and liver-related events was 0% and 2.1% among individuals with low PAGE-B scores, compared to 3.2% and 21.1% with intermediate and 25.4% and 45.5% with high-risk scores (P < .001). We found comparable results for the Fibrosis-4 score. Findings were consistent regardless of cirrhosis or detectable HDV RNA (P < .001). Anti-HDV-positive individuals are at high risk of adverse liver-related outcomes. The incidence of HCC was negligible among individuals without cirrhosis and among individuals with low baseline PAGE-B and/or Fibrosis-4 scores. Therefore, these scores can be used to guide HCC surveillance strategies and potentially also for treatment prioritization.

FibroScan® versus Biochemical Scores: A Study of Liver Fibrosis in HIV with HBV Co-Infection.

The study aimed to determine liver fibrosis in human immunodeficiency virus (HIV) positive individuals using transient elastography (FibroScan®), Fibrosis-4 (FIB-4) score, and aspartate aminotransferase (AST) to Platelet Ratio Index (APRI) in the HIV Department from Infectious Diseases Hospital "Victor Babeș" Craiova, Romania. Of the analyzed HIV-positive subjects (n = 161), 93 (57.76%) had HIV mono-infection, and 68 (42.24%) had Hepatitis B Virus (HBV) co-infection. The prevalence of advanced liver fibrosis was higher (F2: 11.76% and F3: 13.24%, F4: 4.41%) in the HIV-HBV co-infected group compared to the HIV mono-infected group. The univariate and multivariate analysis identified HBV co-infection (OR = 5.73) male sex (OR = 5.34), serum aspartate amino-transferase levels (Pearson's rho = 0.273), low platelet count (Pearson's rho = -0.149) and erythrocyte sedimentation rate (OR = 1.030) as risk factors for the presence of liver fibrosis. Body mass index (OR = 1.08), serum lipid levels (OR = 0.96), viral load at diagnosis (OR = 1.00005), and low CD4+ cell count (OR = 0.977) were also correlated with liver fibrosis. The FIB-4 and APRI scores were strongly correlated with each other. In conclusion, HBV co-infection seems to be a determinant factor for liver fibrosis development in people living with HIV, together with other risk factors.

Clinicoradiological Profile of Patients Having Drug-Sensitive Pulmonary Tuberculosis With and Without Diabetes Mellitus in a Tertiary Care Hospital in Ahmedabad, Gujarat, India.

Background A significant effect of diabetes mellitus (DM) on the clinical and radiological features of tuberculosis (TB) has been reported. However, conflicting results have also been reported. Hence, a conclusion is yet to be drawn. This study aimed to analyze and compare the clinical and radiological features of drug-sensitive pulmonary TB with DM and without DM. Methodology A comparative, observational study was conducted between August and October 2023. Patients with drug-resistant TB, extrapulmonary TB, those on immunosuppressive drugs, and human immunodeficiency virus-positive individuals were excluded from this study. Pulmonary TB patients with DM were classified as the case group and those without DM were classified as the control group. Demographic details, clinical symptoms, detailed past and family histories of comorbid conditions, laboratory investigations, sputum acid-fast bacilli results, and chest X-ray findings were noted. The diagnosis of TB and grading of sputum smear results were done by following the National Tuberculosis Elimination Program guidelines. Results A total of 40 patients, 20 (50%) cases and 20 (50%) controls, were enrolled in this study. Clinical symptoms were almost similar in both groups except for dyspnea (80% vs. 40%) and hemoptysis (75% vs. 35%), which were significantly predominant in the case group. Lower zone involvement in chest X-ray was significantly (p = 0.0079) more in the case group (75%) compared to the control group (40%). Cavitary lesions were also significantly higher in the TB with DM group (p = 0.031). Bilateral lesions and multiple zone involvement were also more common in the case group, although no statistically significant difference was seen. Additionally, thehematological parameters of the two groups differed; however, the findings were not statistically significant. Conclusions Based on our findings, we recommend screening all TB patients for DM. Similarly, all high-risk DM patients should be screened for TB for early diagnosis and management, thereby reducing morbidity and mortality. Physicians should be aware that people with DM may present with pulmonary TB in an atypical manner.

Diabetes mellitus and associated risk factors among HIV infected patients on HAART

BackgroundUnderstanding the impact of disease associations is becoming a priority in Kenya and other countries bearing the load of infectious diseases. With the increased incidences of non-communicable diseases and the endemicity of infectious diseases in Sub-Saharan Africa, their co-existence poses significant challenges to patients, health workers and an overwhelmed health sector. Classical risk factors for diabetes such as physical inactivity and unhealthy diet may not solely explain the current trends, suggesting the role of novel risk factors including infections/inflammation. HIV and its treatment have been identified as potential contributors especially to patients with family history of confirmed diabetes cases. Co-infections frequently observed during HIV infection also significantly influence both the epidemiological and pathophysiological of the link between HIV and diabetes. Understanding the correlates of HIV and diabetes is crucial to inform management and prevention strategies of the twin infections. We therefore aimed to determine the prevalence of diabetes mellitus and risk factors in a population of HIV infected patients on HAART. This study determined the association of diabetes/impaired glucose regulation in the context of HIV-1. A cross-sectional study was conducted at a comprehensive care clinic in Nairobi (Kenya). Participants were screened for diabetes and impaired glucose regulation using random blood glucose and glycated haemoglobin (HbA1c) This paper describes the prevalence of diabetes mellitus in Human Immunodeficiency Virus positive individuals and the associated risk factors. We have demonstrated that family history is a risk factor for diabetes. While age and BMI are known risk factors, they were not associated with diabetes in this study.

Plasmablastic Lymphoma in Epstein–Barr Virus-negative Patient

Plasmablastic lymphoma is a rare and aggressive variant of diffuse large B-cell lymphoma. It often develops in immunocompromised patients, particularly in human immunodeficiency virus-positive individuals. This report highlights the development of such a rare, aggressive malignancy in an immunocompetent adult male with negative Epstein–Barr virus serology. The patient was diagnosed 6 months after the onset of neck and submandibular swelling. A pan-computed tomography scan revealed nodal and extranodal involvement of the iliac bone and iliacus muscle. Chemotherapy was planned, but the patient’s condition deteriorated and he died. This case helps us to understand the clinicopathological features of this malignancy in the Saudi population and may help in early detection and better prognosis.

A dicistrovirus increases pupal mortality in Spodoptera frugiperda by suppressing protease activity and inhibiting larval diet consumption

Understanding interactions between viruses and their hosts is conducive to enabling better application of viruses as biocontrol agents. Certain viruses carried by parasitic wasps enhance the parasitic efficiency of wasp-larvae by protecting them against the immune system of their Lepidopteran host. However, the relationship between prey pests and viruses found in predatory natural enemies remains unclear. Herein, we report the interaction between Arma chinensis virus-1 (AcV-1), originally isolated from a predatory natural enemy, Arma chinensis (Hemiptera: Pentatomidae), and one of its prey species, Spodoptera frugiperda (Lepidoptera: Noctuidae). The results showed that the AcV-1 virus appeared harmful to the novel host S. frugiperda by inhibiting larval diet consumption and increasing pupal mortality. Meanwhile, sequencing data indicated that the virus altered the gene expression profiles of S. frugiperda. KEGG analysis showed that the proteasome and phagosome pathways related to protein degradation and immune response were significantly enriched. Although the expression levels of digestive enzyme genes did not change significantly, the total protease activity of AcV-1 virus-positive individuals was significantly decreased, suggesting that the virus inhibited diet consumption of S. frugiperda via the down-regulation of digestive enzyme activities. These results indicate that a virus initially isolated in a predatory natural enemy can decrease the fitness of its prey species. The virus was found to impact the host proteasome and phagosome pathways related to protein degradation and immunity, providing a potential mechanism to enhance controlling efficiency.

Some Coagulation and Haematological Parameters of Human Immunodeficiency Virus Positive Individuals Accessing Clinic in Haart Centers in Esan South-East Local Government Area of Edo State, Nigeria

Highly active antiretroviral therapy (HAART) has significantly reduced the scourge of Human Immunodeficiency Virus and its associated mortality, but systemic complications, haematological changes and other complications have been reported in patients receiving HAART (or ART).

Effect of aerobic and resistance exercise training on anthropometric parameters of human immunodeficiency virus-positive individuals

Background: The use of antiretroviral drugs has made human immunodeficiency virus (HIV)/AIDS a chronic disease with adverse anthropometric changes as one of its complications. Objectives: This study investigated the effects of aerobic and resistance exercise training on anthropometric parameters of HIV-positive individuals. The study examined the influence of aerobic and resistance exercises on body mass index (BMI), waist-to-hip ratio (WHR), percentage body fat and visceral fat of persons living with HIV/AIDS in a tertiary health institution in South–South zone of Nigeria. Methods: A randomised control trial design was employed in this study. Eighty-eight HIV-seropositive patients in stages 1 and 2 participated in the study. Randomisation was done into the control and aerobic exercise group and resistance exercise group. The experimental groups exercised thrice a week for 10 weeks and the non-experimental group received usual antiretroviral drugs and counselling. Initial intensity of the exercise was 60% HRmax and 1-RM and progression was by 10% every 3 weeks. Anthropometric parameters were recorded initially and on termination of 10 weeks for all three groups. Frequency, mean, standard deviation, and analysis of covariance (ANCOVA) were used for the data analysis. The Bonferroni pairwise comparison was used as post hoc test to identify the source of differences. Results: The outcome of this research showed that aerobic and resistance exercises resulted in significant alterations in anthropometric parameters of BMI (f = 13.617; Sig = 0.000), percentage body fat (f = 10.074; Sig = 0.000), WHR (f = 11.070; Sig = 0.000) and visceral fat (f = 10.286; Sig = 0.000). Conclusion: It was, therefore, concluded that aerobic and resistance are beneficial to HIV-seropositive persons and recommended that exercise should be prescribed for HIV-infected persons to enhance their anthropometric parameters resulting in improved health.

Clinical features and treatment effect of HIV-associated immune thrombocytopenia—single center Ten-Years data summary

Thrombocytopenia represents one of the most prevalent hematologic complications observed in patients infected with the human immunodeficiency virus (HIV). In this study, we sought to analyze the clinical characteristics and treatment outcomes of patients with coexisting HIV and thrombocytopenia. Specifically, we retrospectively examined the medical records of 45 patients diagnosed with HIV/AIDS and thrombocytopenia at the Yunnan Infectious Diseases Specialist Hospital between January 2010 and December 2020, all of whom received highly active antiretroviral therapy (HAART) with/without glucocorticoids. The median follow-up period was 79 days, ranging between 14 and 368 days, the total platelet count was higher after receiving treatment than before (Z = −5.662, P < .001). Among the cohort, 27 patients (60.0%) responded to treatment, with 12 patients (44.44%) experiencing relapse during the follow-up period. The response rate (80.00%) of newly diagnosed ITP were significantly higher than of persistent ITP (28.57%) and chronic ITP (38.46%) ( \\x 2 = 9.560, P = .008) and the relapse rate of the newly diagnosed ITP (30.00%) was significantly lower than the persistent ITP and chronic ITP (100.00%, 80.00%) ( \\x 2 = 6.750, P = .034). Notably, we found that the number of CD4+ T cells, duration of HIV infection, selection of HAART and type of glucocorticoids administered displayed no statistically significant effect on platelet count, treatment response, or relapse rate. However, we observed a significant decrease in platelet count in hepatitis C virus-positive individuals coinfected with HIV compared to those with HIV alone (Z = −2.855, P = .003). Our findings suggest that patients diagnosed with HIV and thrombocytopenia exhibit a low response rate to treatment and have an increased likelihood of relapse.

Statistical Methods of Handling Ordinal Longitudinal Responses with Intermittent Missing Data

The rate of survival of human immunodeficiency virus (HIV) positive individuals resume to ameliorate with the usage of highly active antiretroviral therapy (HAART), yet pulmonary disease prevalence is growing unstopped amongst some of them. Handling missing data was a difficult challenge in the health data concept. We compared the effect of marginal to the proposed ordinal negative binomial models in handling intermittent missing observations for better numerical performance. The data used was characterised by monotone missing observations due to patients’ failure to declare their pulmonary conditions (lung infections and complications) and other vital health information. The use of multiple imputations is one of the latest techniques for handling missing observations, and this technique is relevant to different missing data mechanism assumptions, but occasionally profiles with the complication of the kind of parameters to be imputed and the mechanism underlying the incomplete data. This study focuses on the importance and application of the methods of handling missing health data. The proposed ordinal negative binomial model performs greatly than other models in adjusting for monotone missing data without imputation. In a real application, the proposed ordinal negative binomial model produces low estimates as against direct likelihood, mixed effects proportional odd, and MI-GEE models.

Effectiveness and safety of statins on outcomes in patients with HIV infection: a systematic review and meta-analysis

Statins are hypolipidaemic in human immunodeficiency virus (HIV) positive individuals. However, their effect on all-cause mortality and rate of discontinuation is unclear. We conducted a systematic review to evaluate the impact of statins on all-cause mortality, discontinuation rates, and risk of adverse effects among HIV patients on highly active antiretroviral therapy (HAART). We searched four electronic databases from inception until October 2021 for trials and cohort studies evaluating the effects of statin treatment versus placebo in HIV patients. Forty-seven studies involving 91,594 patients were included. Statins were associated with significantly lower risk of discontinuation (RR, 0.701; 95% CI 0.508–0.967; p = 0.031). The risk of all-cause mortality (RR, 0.994; 95% CI 0.561–1.588; p = 0.827), any adverse effects (RR, 0.780; 95% CI 0.564–1.077; p = 0.131) and, diabetes mellitus (RR, 0.272; 95% CI 0.031–2.393; p = 0.241) with statin treatment were lower but not statistically significant compared to placebo/control. Statin treatment was associated with a trend of higher but statistically insignificant risk of myalgia (RR, 1.341; 95% CI 0.770–2.333; p = 0.299), elevated creatine kinase (RR, 1.101; 95% CI 0.457–2.651; p = 0.830) and liver enzyme activities (RR, 1.709; 95% CI 0.605–4.831; p = 0.312). Clinicians should consider the nocebo effect in the effective management of PLWH on statins, who present with common adverse effects such as myalgia and, elevated levels of creatine kinase and liver enzymes.

Comparative analysis of Candida spp. isolated from complete denture wearers with and without an HIV diagnosis

Statement of problemDenture-related stomatitis (DRS), an inflammation frequently present in human immunodeficiency virus-positive (HIV+) individuals, can be attributable to colonization by Candida spp., which is considered a main factor. The virulence factors of these species are often modulated by the systemic condition of their hosts. PurposeThe purpose of this clinical study was to evaluate the incidence, virulence, and morphology of Candida spp. isolated from biofilms of complete denture wearers with DRS, with and without an HIV diagnosis. In addition, the interaction of the systemic condition with the ability of Candida spp. to colonize was evaluated. Material and methodsFifty-five complete denture wearers diagnosed with DRS were divided into 2 groups: experimental (HIV+) and control (human immunodeficiency virus-noninfected participants [HIV-]). Biofilm was collected by a standardized method of ultrasonification of prostheses. The incidence was evaluated by a chromogenic method and polymerase chain reaction (PCR). The virulence factors were assessed by using the capacity for biofilm formation by counting colony-forming units (CFUs/mL), biofilm metabolism by tetrazolium salt metabolization, and proteinase and phospholipase production by using a fluorimetric kit. Morphology was verified by using the hyphae-inducing test, and participants’ health data were collected with a form. Data were analyzed by using the Student t, Mann-Whitney U, Spearman, and Fisher tests (α=.05). ResultsThe results of incidence were related to 55 participants (22 experimental and 33 control); in total, 63 Candida spp. samples were isolated, showing 28 Candida albicans and 36 nonalbicans strains. No significant difference was found between groups in baseline CFU/mL counts, biofilm formation capacity, cell metabolism, and phospholipase production. Proteinase production was higher for C. albicans in the control (P=.031) and for nonalbicans in the experimental (P=.016) groups. Relative to health data, the experimental group showed a moderate negative correlation between the CFU count/mL at baseline for nonalbicans and DRS classification (P=.020). ConclusionsC. albicans was the most prevalent species. No difference was found in the Candida spp. of complete denture wearers with DRS, with and without an HIV diagnosis, with regard to virulence factors (except for proteinase production) and morphology.

Molecular transmission network of pretreatment drug resistance among human immunodeficiency virus-positive individuals and the impact of virological failure on those who received antiretroviral therapy in China.

ObjectivesWe investigated the prevalence of pretreatment drug resistance (PDR), the molecular transmission network among HIV-positive individuals, and the impact of virological failure on those who received antiretroviral therapy (ART) in China.MethodsBased on the World Health Organization (WHO) surveillance guidelines for PDR, a baseline survey and follow-up were conducted in 2018 and 2021, respectively. Demographic information and plasma samples were obtained from all participants. HIV pol gene region sequences were used to analyze the PDR and molecular transmission networks using the Stanford HIV database algorithm and HIV-TRACE, respectively. This study assessed the odds ratios (OR) of PDR to virological failure (viral load ≥ 50 copies/mL) after 3 years of ART using multivariable logistic regression.ResultsOf the 4,084 individuals, 370 (9.1%) had PDR. The prevalence of PDR to non-nucleoside reverse transcriptase inhibitors (5.2%) was notably higher than that to nucleoside reverse transcriptase inhibitors (0.7%, p < 0.001), protease inhibitors (3.0%, p < 0.001), and multidrug resistance (0.3%, p < 0.001). A total of 1,339 (32.8%) individuals from 361 clusters were enrolled in the molecular transmission network. Of the 361 clusters, 22 included two or more individuals with PDR. The prevalence of virological failure among HIV-positive individuals after 3 years of ART without PDR, those with PDR to Chinese listed drugs, and those with PDR to other drugs was 7.9, 14.3, and 12.6%, respectively. Compared with that in HIV-positive individuals without PDR, virological failure after 3 years of ART was significantly higher (OR: 2.02, 95% confidence interval (CI): 1.25–3.27) and not significantly different (OR: 1.72, 95% CI: 0.87–3.43) in individuals with PDR to Chinese listed drugs and those with PDR to other drugs, respectively. Missed doses in the past month were significantly associated with virological failure (OR, 2.82; 95% CI: 4.08–5.89).ConclusionThe overall prevalence of PDR was close to a high level and had an impact on virological failure after 3 years of ART. Moreover, HIV drug-resistant strains were transmitted in the molecular transmission network. These results illustrate the importance of monitoring PDR and ensuring virological suppression through drug adherence.

Recurrent pneumothorax in a human immunodeficiency virus-positive patient with multidrug-resistant tuberculosis: a rare case of bronchopleural fistula: a case report

BackgroundHuman immunodeficiency virus/tuberculosis coinfections have amplified the multidrug-resistant tuberculosis pandemic in many countries in Sub-Saharan Africa, and multidrug-resistant tuberculosis has become a major public health threat. There is a paucity of data on severe complications of multidrug-resistant tuberculosis in the context of human immunodeficiency virus coinfection despite the increasing prevalence of multidrug-resistant tuberculosis/human immunodeficiency virus coinfection and the complexity of multidrug-resistant tuberculosis treatment. This report describes a rare case of complicated multidrug-resistant tuberculosis in a human immunodeficiency virus-positive individual.Case presentationA 39-year-old human immunodeficiency virus-positive Ugandan male on anti-retroviral therapy for 6 years, who had recently completed treatment for drug-susceptible tuberculosis from a public hospital, presented to the tuberculosis ward of Mulago National Referral Hospital with worsening respiratory symptoms including persistent cough with purulent sputum, fever, right chest pain, and shortness of breath. On admission, a diagnosis of drug-resistant tuberculosis was made following a positive sputum Xpert MTB/Rif test with rifampicin resistance. Culture-based tuberculosis tests and line probe assay confirmed multidrug-resistant tuberculosis. The patient was given multidrug-resistant tuberculosis treatment that included bedaquiline, isoniazid, prothionamide, clofazimine, ethambutol, levofloxacin, and pyrazinamide and switched to second-line anti-retroviral therapy that included tenofovir/lamivudine/lopinavir/ritonavir. Chest X-ray revealed a hydro-pneumothorax, following which a chest tube was inserted. With persistent bubbling from the chest tube weeks later and a check chest X-ray that showed increasing pleural airspace (pneumothorax) and appearance of a new air–fluid level, chest computed tomography scan was performed, revealing a bronchopleural fistula in the right hemithorax. The computed tomography scan also revealed a pyo-pneumothorax and lung collapse involving the right middle and lower lobes as well as a thick-walled cavity in the right upper lobe. With the pulmonary complications, particularly the recurrent pneumothorax, bronchopleural fistula, and empyema thoracis, cardiothoracic surgeons were involved, who managed the patient conservatively and maintained the chest tube. The patient continued to be ill with recurrent pneumothorax despite the chest tube, until relatives opted for discharge against medical advice.ConclusionsComplicated human immunodeficiency virus-related multidrug-resistant tuberculosis is not uncommon in settings of high human immunodeficiency virus/tuberculosis prevalence and is often associated with significant morbidity and mortality. Early diagnosis and treatment of multidrug-resistant tuberculosis, with rigorous monitoring for human immunodeficiency virus-positive individuals, is necessary to prevent debilitating complications.

The Body Fat Percentage Rather Than the BMI Is Associated with the CD4 Count among HIV Positive Japanese Individuals.

Maintenance of the cluster of differentiation 4 (CD4) positive lymphocyte count (CD4 count) is important for human immunodeficiency virus (HIV) positive individuals. Although a higher body mass index (BMI) is shown to be associated with a higher CD4 count, BMI itself does not reflect body composition. Therefore, we examined the association of body weight, body composition and the CD4 count, and determined the optimal ranges of CD4 count associated factors in Japanese HIV positive individuals. This cross-sectional study included 338 male patients treated with antiretroviral therapy for ≥12 months. Multiple logistic regression analysis was used to identify factors significantly associated with a CD4 count of ≥500 cells (mm3)−1. The cutoff values of factors for a CD4 ≥ 500 cells (mm3)−1 and cardiovascular disease risk were obtained by receiver operating characteristic curves. Age, body fat percentage (BF%), nadir CD4 count, duration of antiretroviral therapy (ART), years since the HIV-positive diagnosis and cholesterol intake showed significant associations with the CD4 count. The cutoff value of BF% for a CD4 ≥ 500 cells (mm3)−1 and lower cardiovascular disease risk were ≥25.1% and ≤25.5%, respectively. The BF%, but not the BMI, was associated with CD4 count. For the management of HIV positive individuals, 25% appears to be the optimal BF% when considering the balance between CD4 count management and cardiovascular disease risk.

Development of an intervention system for linkage-to-care and follow-up for hepatitis B and C virus carriers.

BackgroundPoor connections in the cascade of viral hepatitis care have been discussed around the world. In 2011 in Japan, 500,000 to 1.25 million hepatitis B and C virus carriers needed to consult with hepatologists, so linkage-to-care (LTC) needs to be promoted. Therefore, in this study, to improve LTC and care-seeking behaviors, we attempted to establish a community-based intervention system and evaluate its effectiveness by analyzing behavior modifications.MethodsIn a model city, Okazaki (population: 387,887 as of 2019), LTC was encouraged among HBV and HCV carriers by annually mailed brochures, and their care-seeking behaviors were followed up through questionnaires for 8 years (2012–2019). Their behavior modifications and demographic characteristics were analyzed anonymously in cooperation with community health workers, hepatologists, and researchers.ResultsThrough regional HBsAg and anti-HCV screening, 333 HBV and 208 HCV carriers were identified. Before the intervention, only 34.7% (25/72) of HBV- and 34.3% (24/70) of HCV-positive individuals had consulted with hepatologists. However, in 2019, after the intervention, these proportions increased to 79.8% (91/114) and 91.2% (52/57), respectively. Access to outpatient care and treatment uptake also continuously improved. However, individuals over 70 years of age were significantly less likely to engage in care-seeking behaviors (p < 0.05), and significantly fewer HCV-positive females received treatment (p = 0.03).ConclusionsA paper-based reiterative intervention encouraging LTC and follow-up successfully improved the care-seeking behaviors of hepatitis virus-positive individuals and enabled their behavior modifications to be monitored. Further trials are required to advance the system by age- and gender-specific interventions.Graphical Supplementary InformationThe online version contains supplementary material available at 10.1007/s12072-021-10269-5.

Factors associated with immunological and virological discordant responses to highly active antiretroviral therapy among adult HIV positive individuals in Ethiopia: A cross-sectional study.

In clinical practice, not all human immune deficiency virus (HIV) positive individuals who received highly active antiretroviral therapy (HAART) achieve the desired concordant response characterized by a sustained viral suppression or immune recovery. The expected success of HAART doesn’t occur in all treated patients and a discordant response between CD4 count and the viral load (VL) has been a major concern in the treatment of HIV patients. Thus, this study is designed to describe the factors associated with immunological and virological discordant responses to HAART among adult HIV positive individuals.A hospital-based cross-sectional study with secondary data review was conducted on 423 HIV positive individuals on HAART from February 1 to April 30, 2017. Socio-demographic characteristics, clinical data and about 10 mL of blood specimen for HIV VL, and CD4 count measurement were collected. The data was entered into SPSS version 20 and descriptive, bivariate, and multivariate logistic regression analysis was employed.The mean age of the patients at study time was 39 (±9.8). The average follow-up duration of patients on antiretroviral therapy (ART) was 7 (±3) years. The prevalence of immunological discordance and virological discordance to HAART were 13.2% and 47%, respectively. With multivariate logistic regression analysis duration of follow-up on ART ≤ 6 years (adjusted odds ratio [AOR] = 3.29 (1.80–6.03), P ≤ .001) and VL ≥20 copies/mm3 (AOR = 3.08 [1.70–5.61], P ≤ .001) were significant factors for immunological discordance conversely the patients who switched drug as a result of TB (AOR = 3.33 [1.10–10.08], P = .03) was significant factors for virological discordance.The prevalence of immunological discordance and virological discordance to HAART among HIV patients is high. Patients with the duration of follow-up on ART ≤ 6 years, VL ≥ 20 copies/mm3 and patients who switched drugs as a result of TB were significant factors for discordance. Hence, intensive adherence support and counseling should be provided to achieve the UNAIDS 90 target. HIV positive individuals co-infected with TB, who have had VL ≥ 20 copies/mm3 and who are ≤6 years duration of follow-up on ART need to be carefully monitored. In addition, national based study of discordant groups is recommended.

Testing, diagnosis of viral hepatitis, and the follow-up policy in Japan.

Viral hepatitis is one of the major infectious diseases in Japan and causes liver cirrhosis and liver cancer. Therefore, screening for hepatitis viruses was started in 2002, based on the geriatric health care program. The screening plan has now been transferred to the Health Promotion Project and it is estimated that more than half of the population has been tested for hepatitis viruses. The Basic Act on Hepatitis Measures was enacted in 2009 and the Basic Guidelines for Promotion of Control Measures for hepatitis was issued in 2011. It reported that there were about 770,000 positive people who were unaware that they were infected, and about 0.5 to 1.2 million positive people who knew they were infected but did not continue to receive medical examinations. Ten years have passed since that report and it is estimated that the number of hepatitis virus-positive individuals who need medical examination/treatment is decreasing. Therefore, in order to eradicate viral hepatitis, it is essential to identify areas and age groups in which hepatitis virus testing is inadequate, to encourage people to undergo testing and to promptly send positive patients to hepatologists for continued medical care. This review describes the current status and challenges of hepatitis virus testing measures in Japan, led by the Ministry of Health, Labour and Welfare, and the promotion of visits to medical institutions by positive patients.

POECIVIRUS IS PRESENT IN INDIVIDUALS WITH BEAK DEFORMITIES IN SEVEN SPECIES OF NORTH AMERICAN BIRDS.

Avian keratin disorder (AKD), a disease of unknown etiology characterized by debilitating beak overgrowth, has increasingly affected wild bird populations since the 1990s. A novel picornavirus, poecivirus, is closely correlated with disease status in Black-capped Chickadees (Poecile atricapillus) in Alaska, US. However, our knowledge of the relationship between poecivirus and beak deformities in other species and other geographic areas remains limited. The growing geographic scope and number of species affected by AKD-like beak deformities require a better understanding of the causative agent to evaluate the population-level impacts of this epizootic. Here, we tested eight individuals from six avian species with AKD-consistent deformities for the presence of poecivirus: Mew Gull (Larus canus), Hairy Woodpecker (Picoides villosus), Black-billed Magpie (Pica hudsonia), American Crow (Corvus brachyrhynchos), Red-breasted Nuthatch (Sitta canadensis), and Blackpoll Warbler (Setophaga striata). The birds were sampled in Alaska and Maine (1999-2016). We used targeted PCR followed by Sanger sequencing to test for the presence of poecivirus in each specimen and to obtain viral genome sequence from virus-positive host individuals. We detected poecivirus in all individuals tested, but not in negative controls (water and tissue samples). Furthermore, we used unbiased metagenomic sequencing to test for the presence of other pathogens in six of these specimens (Hairy Woodpecker, two American Crows, two Red-breasted Nuthatches, Blackpoll Warbler). This analysis yielded additional viral sequences from several specimens, including the complete coding region of poecivirus from one Red-breasted Nuthatch, which we confirmed via targeted PCR followed by Sanger sequencing. This study demonstrates that poecivirus is present in individuals with AKD-consistent deformities from six avian species other than Black-capped Chickadee. While further investigation will be required to explore whether there exists a causal link between this virus and AKD, this study demonstrates that poecivirus is not geographically restricted to Alaska, but rather occurs elsewhere in North America.