Journal articles on the topic 'HIV infections – Diagnosis – Asia'
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1
Bath, Rachel E., Lynsey Emmett, Neville Q. Verlander, and Mark Reacher. "Risk factors for late HIV diagnosis in the East of England: evidence from national surveillance data and policy implications." International Journal of STD & AIDS 30, no. 1 (August 31, 2018): 37–44. http://dx.doi.org/10.1177/0956462418793327.
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In 2014, 42% of all HIV diagnoses in the East of England were diagnosed late. Individuals unaware of their HIV status will not benefit from lifesaving and infectious-limiting antiretroviral therapy, and they remain at risk of decreased life expectancy and onward transmission of HIV. We sought to identify risk factors associated with late HIV diagnosis in the East of England to inform future HIV testing and prevention strategies relevant to the local population. Data on all HIV infected individuals aged ≥16 years and diagnosed between 2008 and 2014 in the East of England were obtained from the national HIV and AIDS Reporting System. Late diagnosis was defined as CD4 cell count below 350 cells/mm3 within 91 days of diagnosis. Logistic regression investigated risk factors for late HIV diagnosis. A total of 2469 people were included; 1342 (54%) were late HIV diagnoses. In multivariable analysis risk factors for late diagnosis were: age ≥30 years, originating from WHO regions of South-East Asia or Europe (excluding UK), heterosexual orientation and being diagnosed as an inpatient or by a general practitioner. The odds of late diagnosis significantly reduced every year (OR 0.95, 95% CI 0.90–0.99, p = 0.042). Despite this year-on-year reduction continued high rates suggest future HIV testing and prevention strategies should be informed by local regional epidemiology to allow those at greatest risk to be targeted appropriately.
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Papalini, Chiara, Barbara Belfiori, Giovanni Martino, Rita Papili, Lucia Pitzurra, Stefano Ascani, and Maria Bruna Pasticci. "An Italian Case of Disseminated Histoplasmosis Associated with HIV." Case Reports in Infectious Diseases 2019 (November 16, 2019): 1–5. http://dx.doi.org/10.1155/2019/7403878.
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Histoplasma capsulatum is a dimorphic fungus, endemic in the Americas, Africa (var. duboisii), India, and Southeast Asia. H. capsulatum infection is rarely diagnosed in Italy, while in Latin America, progressive disseminated histoplasmosis (PDH) is one of the most frequent AIDS-defining illnesses and causes of AIDS-related deaths. We report a case of PDH and new HIV infection diagnosis in a Cuban patient, who has been living in Italy for the past 10 years. Bone marrow aspirate and peripheral blood smear microscopy suggested H. capsulatum infection. The diagnosis was confirmed with the culture method identifying its thermal dimorphism. Liposomal amphotericin B was administered alone for 10 days and then for another 2 days, accompanied with voriconazole; the former was stopped for probable side effects (persistent fever and worsening thrombocytopenia), and voriconazole was continued to complete 4 weeks. PDH maintenance treatment consisted of itraconazole for one year. Antiretroviral therapy (ART) was started on the third week of antifungal treatment. At the 3-year follow-up, the patient is adherent on ART, the virus was suppressed, and she has an optimal immune recovery. This case highlights the need to suspect histoplasmosis in the differential diagnosis of opportunistic infections in immunocompromised persons, native to or who have traveled to endemic countries.
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Osakwe, Nonso, Diane Johnson, Natalie Klein, and Dalia Abdel Azim. "A Rare Case of HHV-8 Associated Hemophagocytic Lymphohistiocytosis in a Stable HIV Patient." Case Reports in Infectious Diseases 2019 (April 28, 2019): 1–3. http://dx.doi.org/10.1155/2019/3297463.
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Background. Hemophagocytic lymphohistiocytosis (HLH) is a rare condition associated with viral infections including HIV. Cases have been reported mainly in advanced HIV/AIDS. This is a rare case that reports HLH associated with human herpes virus-8 (HHV-8) associated multicentric Castleman disease in a stable HIV patient. Case Presentation. A 70-year-old Asian male patient with history of stable HIV on medications with CD 4 cell count above 200 presented with cough and fever and was initially treated for pneumonia as an outpatient. Persisting symptoms prompted presentation to the hospital. The patient was found to have anemia which persisted despite repeated transfusion of packed red cells. A bone marrow biopsy to investigate anemia revealed hemophagocytosis. A CT scan revealed multiple enlarged lymph nodes and hepatosplenomegaly. An excisional lymph node biopsy revealed HHV-8 associated multicentric Castleman disease. The patient deteriorated despite initiation of treatment. Conclusion. HLH can occur at any stage of HIV, rapid diagnosis to identify possible underlying reactive infectious etiology and prompt initiation of treatment is crucial to survival.
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Astiti, Cok Istri Sri Dharma, Anak Agung Sagung Sawitri, and Ketut Tuti Parwati Merati. "Factors associated to first line antiretroviral therapy (ART) failure among HIV/AIDS patients at Sanglah Hospital, Bali." Public Health and Preventive Medicine Archive 5, no. 1 (July 1, 2017): 3. http://dx.doi.org/10.15562/phpma.v5i1.33.
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Background and purpose: The incidence of first line ART failure is increasing in the South East Asia region. The main referral hospital in Bali has recorded an increased use of second line ART due to the first line ART failure. This study aims to explore risk factors associated to first line ART failure.Methods: A case control study was conducted among people living with HIV and AIDS at Sanglah Hospital Denpasar who started first line ART between 2004 and 2013. Cases were those who diagnosed as having clinical treatment failure and still on treatment in 2015. Controls were those with no treatment failure. Sex and year of ART initiation were matched between case and control. Data were obtained from medical records that include initial regiments, HIV mode of transmission, the WHO HIV clinical stage, CD4 count, opportunistic infections, body mass index, hemoglobin level, and drug substitution at the beginning and during treatment. Risk factors were analysed using logistic regression.Results: Out of 68 HIV/AIDS patients with clinical ART failure, 72.1% were confirmed with immunological and 36.8% were confirmed with virological failure. Median time before treatment failure was 3.5 years. Factors associated to ART failure were HIV clinical stage IV (AOR=3.43; 95%CI=1.65-7.13) and being widow/widower (AOR=4.85; 95%CI=1.52-15.53). Patients with TB co-infection have a lower risk for treatment failure due to early diagnosis and treatment through TB-HIV program (AOR=0.32; 95%CI=0.14-0.70).Conclusions: Higher HIV clinical stage at ART initiation increases the risk of treatment failure. HIV-TB co-infection indirectly reduces the risk of treatment failure.
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Oelrichs, Robert. "The subtypes of human immunodeficiency virus in Australia and Asia." Sexual Health 1, no. 1 (2004): 1. http://dx.doi.org/10.1071/sh03002.
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Worldwide, the human immunodeficiency virus exhibits a great genetic variability, with multiple circulating subtypes of the virus. This variability allows study of the movement of HIV strains within and between human populations but also has implications for diagnosis, treatment and monitoring. The type of HIV causing the epidemic in Australia is changing from being homogeneous subtype B, reflecting a greater regional diversity. In this paper the classification of HIV-1 subtypes and their distribution within the Australasian region are reviewed and the implications of these distribution patterns discussed.
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Lemoh, Chris, Rebecca Guy, Keflemariam Yohannes, Jenny Lewis, Alan Street, Bev Biggs, and Margaret Hellard. "Delayed diagnosis of HIV infection in Victoria 1994 to 2006." Sexual Health 6, no. 2 (2009): 117. http://dx.doi.org/10.1071/sh08028.
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Background: The identification of factors associated with delayed diagnosis of HIV infection in Victoria, Australia was the aim of the present study. Methods: Demographic and epidemiological characteristics of cases notified to the Victorian HIV surveillance database between 1 January 1994 and 31 December 2006 were analysed. Delayed diagnosis was defined as: CD4 count below 200 cells mm−3 at HIV diagnosis or diagnosis of AIDS earlier than 3 months after HIV diagnosis. Results: Diagnosis of HIV was delayed in 627 (22.6%) of 2779 cases. Of these, 528 (84.2%) had either a high-risk exposure or were born in a high-prevalence country. The most common exposure was male homosexual contact in 64.3% of cases. Independent risk factors for delayed diagnosis were: older age at diagnosis (30–39 years odds ratio [OR] 2.15, ≥ 50 years OR 7.50, P < 0.001), exposure via routes other than male homosexual sex or injecting drug use (heterosexual sex OR 2.51, P < 0.001, unknown/other route OR 4.24, P < 0.001); birth in Southern/Eastern Europe (OR 2.54), South-east Asia (OR 2.70) or the Horn of Africa/North Africa (OR 3.71, P < 0.001), and male gender (OR 0.47 for females, P < 0.001). Conclusion: Delay in the diagnosis of HIV infection is common in Victoria, but potentially avoidable in the majority of cases. Most people with delayed diagnosis had a history of male homosexual contact, injecting drug use, birth in a high-prevalence country or sexual contact with such individuals. An accurate sexual history, together with knowledge of their country of birth, should identify most individuals who should be offered an HIV test.
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Zijlstra, Eduard E. "Visceral leishmaniasis: a forgotten epidemic." Archives of Disease in Childhood 101, no. 6 (February 19, 2016): 561–67. http://dx.doi.org/10.1136/archdischild-2015-309302.
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Visceral leishmaniasis (VL or kala-azar) is most endemic in Asia and Africa and commonly affects young children. It is usually caused byLeishmania donovaniorLeishmania infantumthat are transmitted by Phlebotomine sand flies. Transmission may be anthroponotic or zoonotic or both, depending on the endemic area. Clinical features include fever, hepatosplenomegaly, weight loss and pancytopenia. Younger age, malnutrition and immunosuppression (HIV infection, use of immunosuppressive drugs) are risk factors. Many infections remain asymptomatic. Diagnosis is made by demonstration of theLeishmaniaparasite in aspirates of lymph node, bone marrow or spleen. Serological tests such as rK39 strip test are widely used but the sensitivity varies. qPCR is useful to detect low numbers of parasites and to monitor treatment. Treatment is with AmBisome monotherapy in most areas but with drug combinations elsewhere. HIV co-infected patients are most difficult to treat and often relapse. Control efforts focus on case finding, availability of diagnostic tools, reservoir control and protection from sand flies (insecticides, bed nets). There is no human vaccine.
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Combs, Barry C., and Carolien M. Giele. "An increase in overseas acquired HIV infections among heterosexual people in Western Australia." Sexual Health 6, no. 1 (2009): 35. http://dx.doi.org/10.1071/sh08010.
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Background: There has been a recent increase in the number of heterosexually acquired HIV infections among non-Aboriginal people in Western Australia (WA), which has not been reported in other Australian jurisdictions. This report describes the epidemiological features of this increase. Methods: A descriptive analysis was conducted of newly diagnosed HIV infections among non-Aboriginal WA residents notified to the Department of Health from 2002 to 2006. Analysis outcomes included demographics, exposure categories, and place of HIV acquisition. Results: From 2002 to 2006, 258 new HIV diagnoses were notified among non-Aboriginal WA residents. Over this period, the number of notifications increased from 41 cases in 2002 (2.2 cases/100 000 population) to 66 cases in 2006 (3.4 cases/100 000 population). Overall, 107 (42%) of the cases were heterosexually acquired, and the annual number increased threefold from 2002 to 2006 (12 to 36 cases, respectively). Of these cases, 64 (60%) were male and 43 (40%) were female. The majority (89%) of male cases acquired HIV overseas, mostly in countries other than their region of birth; South-east Asia was the most common place of acquisition reported. Over half (56%) of the female cases acquired HIV overseas, mainly in their region of birth (83%), and sub-Saharan Africa was the most common place of acquisition. Conclusion: There has been a recent increase in heterosexually acquired HIV infections among male and female WA residents, many of whom reported acquiring HIV overseas. Safe sex campaigns in WA should continue to reinforce safe sex messages among people travelling overseas.
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Shimizu, Kazuki, Hiroshi Nishiura, and Akifumi Imamura. "Investigation of the Proportion of Diagnosed People Living with HIV/AIDS among Foreign Residents in Japan." Journal of Clinical Medicine 8, no. 6 (June 5, 2019): 804. http://dx.doi.org/10.3390/jcm8060804.
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Foreign residents represent an increasing proportion of newly diagnosed human immunodeficiency virus (HIV) infections and acquired immunodeficiency syndrome (AIDS) cases in Japan, though scant research has addressed this. This study aimed to estimate the diagnosed proportion of people living with HIV/AIDS (PLWHA) among foreign residents in Japan, covering 1990–2017 and stratifying by geographic region of the country of origin. A balance equation model was employed to statistically estimate the diagnosed proportion as a single parameter. This used published estimates of HIV incidence and prevalence, population size, visit duration, travel volume, as well as surveillance data on HIV/AIDS in Japan. The proportion varied widely by region: People from Western Europe, East Asia and the Pacific, Australia and New Zealand, and North America were underdiagnosed, while those from sub-Saharan Africa, South and South-East Asia, and Latin America were more frequently diagnosed. Overall, the diagnosed proportion of PLWHA among foreign residents in Japan has increased, but the latest estimate in 2017 was as low as 55.3%; lower than the estimate among Japanese on the order of 80% and far below the quoted goal of 90%. This finding indicates a critical need to investigate the underlying mechanisms, including disparate access to HIV testing.
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Wipasa, Jiraprapa, Romanee Chaiwarith, Kriangkrai Chawansuntati, Jutarat Praparattanapan, Kritsadee Rattanathammethee, and Khuanchai Supparatpinyo. "Characterization of anti-interferon-γ antibodies in HIV-negative immunodeficient patients infected with unusual intracellular microorganisms." Experimental Biology and Medicine 243, no. 7 (March 7, 2018): 621–26. http://dx.doi.org/10.1177/1535370218764086.
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A major characteristic of immunodeficiency associated with life-threatening intracellular infection in adults is the presence of anti-interferon-γ antibodies. Although little is known about the mechanism underlying this syndrome, it is believed that the antibodies inhibit the activity of downstream signaling pathway of interferon-γ. In this study, the characteristics of these antibodies in patients who presented, or have a history of, intracellular infection and were positive to anti-interferon-γ antibodies were investigated. The antibodies exhibited mainly the IgG1 and the IgG4 subtypes and recognized the C-terminal of the interferon-γ linear epitope containing the KRKR motif, which is required for the biological activity of interferon-γ. The antibodies bound to recombinant interferon-γ with significantly lower avidity than antibodies to a recall antigen, tetanus toxoid, suggesting that the antibodies might have not undergone affinity maturation. The data from this study may provide fundamental information to better understand the properties of anti-interferon-γ antibodies, which can be useful for future studies. Impact statement An increase in the number of immunodeficient patients related to autoantibodies to interferon (IFN)-γ has been observed particularly in East Asian adults. These patients are often presented with opportunistic infections caused by intracellular pathogens, including non-tuberculous mycobacteria (NTM), Cryptococcus neoformans, Penicillium marneffei (now called Talaromyces marneffei), and non-typhoidal Salmonella spp. The mortality rate for this syndrome is relatively high with 32% patients dying at the median time of 25 months after diagnosis. Characterization of these autoantibodies may promote better understanding of the syndrome, an emerging health problem affecting East Asia populations and impeding their welfare and economic development.
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DOUGAN, SARAH, LARA J. C. PAYNE, ALISON E. BROWN, BARRY G. EVANS, and O. NOEL GILL. "Past it? HIV and older people in England, Wales and Northern Ireland." Epidemiology and Infection 132, no. 6 (November 16, 2004): 1151–60. http://dx.doi.org/10.1017/s0950268804002961.
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The majority of those infected and affected by HIV are younger adults. The ability of highly active antiretroviral therapies (HAART) to extend survival means that those infected when younger may reach older age, and future increases in numbers of older individuals living with HIV in England, Wales and Northern Ireland (E,W&NI) are expected. Evidence that older individuals engage in risky sexual behaviours suggests potential for HIV transmission. Data from national HIV/AIDS surveillance systems were reviewed (1997–2001). An older individual is defined as aged 45 years or over. Between 1997 and 2001, 2290 older individuals were diagnosed with HIV; 361 in 1997, rising to 648 in 2001. Heterosexual acquisition accounted for 1073 (47%) infections; 662 were male. Where reported, 666 (65%) older heterosexuals were probably infected in Africa, 144 (14%) in the United Kingdom and 113 (11%) in Asia. There were 1020 (45%) new diagnoses acquired homosexually; white (92%), infected in the United Kingdom (78%). Numbers of older individuals accessing HIV-related services more than doubled between 1997 (2488) and 2001 (5175). In 2001, 2270 (53%) were London residents. Between 1997 and 2001, among HIV-infected older individuals attending genitourinary medicine (GUM) clinics, the proportions previously undiagnosed were 60% and 82% in heterosexual males and females respectively, and for men who have sex with men (MSM), 42%. Numbers of older individuals newly diagnosed with HIV have increased in recent years. The increase in numbers of older individuals accessing HIV-related services were in excess of younger adults. A significant proportion of older HIV-infected female heterosexuals and MSM were undiagnosed. Awareness must be raised among clinicians, and an ‘aged response’ to HIV is required.
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Amnuay, Kamalas, Chayatat Sirinawin, Nonthikorn Theerasuwipakorn, Pairoj Chattranukulchai, and Chusana Suankratay. "Native Valve Infective Endocarditis Caused by Histoplasma capsulatum in an Immunocompetent Host: The First Case in Asia and Literature Review in Asia and Australia." Case Reports in Infectious Diseases 2021 (June 21, 2021): 1–5. http://dx.doi.org/10.1155/2021/9981286.
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Background. Infective endocarditis caused by the dimorphic fungus Histoplasma capsulatum is extremely rare, occurring predominantly in individuals with prosthetic heart valves and HIV infection. To our knowledge, no case of H. capsulatum native valve endocarditis has been reported in Asia. Methodology. A descriptive study was carried out at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, in 2020. Results. A previously healthy 34-year-old man developed fever, umbilicated skin lesions, oral ulcers, hoarseness of voice, severe weight loss, and progressive dyspnea over the course of one week. Facial umbilicated papules, nodular ulcers in his tongue and palate, a diastolic rumbling murmur at the mitral valve, diffuse fine crackles in both lungs, and engorged neck veins were detected during the examination. Skin scraping of the facial lesion revealed both extracellular and intracellular yeasts with buddings, 2–4 μm in size on Wright’s stain. Transthoracic echocardiography demonstrated a left ventricular ejection fraction of 54 percent, severe rheumatic mitral stenosis, and multiple oscillating masses in the anterior mitral valve leaflet ranging in dimension from 1.5 to 2.4 cm. The HIV antibody test was negative. H. capsulatum endocarditis was diagnosed, and liposomal amphotericin B was administered. Due to cardiogenic shock, emergency open-heart surgery was conducted one day after admission. However, he died of multiorgan failure four days after the operation. The skin and vegetation cultures finally grew H. capsulatum after 1 week of incubation. Conclusions. To date, there has been handful of cases of H. capsulatum native valve endocarditis in non-HIV-infected patients. We report herein the first case in Thailand. Umbilicated skin lesions, especially combined with oral mucosal lesions, are a clinical clue that leads to the correct diagnosis of the causative organism.
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Kedar Mukthinuthalapati, V. V. Pavan, Vikash Sewram, Ntokozo Ndlovu, Stephen Kimani, Ashraf Omar Abdelaziz, Elizabeth Yu Chiao, and Ghassan K. Abou-Alfa. "Hepatocellular Carcinoma in Sub-Saharan Africa." JCO Global Oncology, no. 7 (May 2021): 756–66. http://dx.doi.org/10.1200/go.20.00425.
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More than 80% of global hepatocellular carcinoma (HCC) patients are estimated to occur in sub-Saharan Africa (SSA) and Eastern Asia. The most common risk factor of HCC in SSA is chronic hepatitis B virus (HBV) infection, with the incidence highest in West Africa. HBV is highly endemic in SSA and is perpetuated by incomplete adherence to birth dose immunization, lack of longitudinal follow-up care, and impaired access to antiviral therapy. HBV may directly cause HCC through somatic genetic alterations or indirectly through altered liver function and liver cirrhosis. Other risk factors of HCC in SSA include aflatoxins and, to a lesser extent, African iron overload. HIV plus HBV co-infection increases the risk of developing HCC and is increasingly becoming more common because of improving the survival of patients with HIV infection. Compared with the rest of the world, patients with HCC in SSA have the lowest survival. This is partly due to the late presentation of HCC with advanced symptomatic disease as a result of underdeveloped surveillance practices. Moreover, access to care and resource limitations further limit outcomes for the patients who receive a diagnosis in SSA. There is a need for multipronged strategies to decrease the incidence of HCC and improve its outcomes in SSA.
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Dethier, Divya, Natasha Rybak, Priya Hirway, Mariya Bachmaha, Jennifer Carroll, Andriy Sorokolit, Timothy Flanigan, and Maryana Sluzhynska. "The changing face of women living with HIV in western Ukraine." International Journal of STD & AIDS 29, no. 4 (August 3, 2017): 318–23. http://dx.doi.org/10.1177/0956462417724708.
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Ukraine has the second largest HIV epidemic in Eastern Europe/Central Asia. This study characterizes the demographics of HIV-infected women in the Lviv region of western Ukraine, patterns in their clinical presentation, and factors associated with delays in seeking care. A retrospective chart review was conducted of 622 HIV-infected women who registered for HIV treatment at the Lviv AIDS Center between 2008 and 2013. A total of 81.6% of women were infected through heterosexual transmission and the remaining 18.4% through intravenous drug use. Slightly less than half (45.4%) was between 26 and 35 years old. Slightly more than half (56.7%) listed their residence in a city, 22.6% in villages. One-third (30.0%) of all women presented with AIDS, and 37.7% presented with symptomatic conditions. Women diagnosed with HIV during antenatal care experienced a median delay of 34 days between diagnosis and registration, compared to 87.5 days for nonpregnant women tested in the context of intravenous drug use. Overall, HIV-infected women in western Ukraine experience time delays in care, and often present with advanced HIV disease and secondary complications. Linkage to care in a timely manner is a high priority and substantial challenge for women, particularly for intravenous drug users who may face stigma and other additional barriers.
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Demir, Tülin, Dilara Yıldıran, and Selçuk Kılıç. "Yeni HIV Tanı Algoritmasına Geçiş Sürecinde Ulusal HIV-AIDS Referans Merkezi’nin Deneyimi: Line-İmmunoassay Test ve Bio-Rad Geenius™ HIV-1/2 Antikor Ayırt Edici Hızlı Doğrulama Testleri Karşılaştırmalı Analizi." Mikrobiyoloji Bulteni 55, no. 1 (January 27, 2021): 17–29. http://dx.doi.org/10.5578/mb.20028.
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Shortly after the first detection of human immundeficiency virus (HIV) infection in USA in 1981, the number of cases have increased gradually from all around the world. Turkey’s high capacity for tourism and the unique geographic location extending between Europe and Asia, provides convenience for the passage of individuals across the countries and sexually transmitted infections including HIV, as well. According to the official data of the Ministry of Health; there are 25809 HIV positive and 1958 AIDS cases as of November 30, 2020, after the epidemic started in 1985 in Turkey. Despite the decrease in the number of newly detected HIV cases as a result of serious measures taken for the transmission of infection worldwide, the increase in the number of cases still continues in our country. Shortening the reporting period and starting treatment as soon as possible in the diagnosis of infection is critical for the control of the epidemic. For this purpose, Centers for Disease Control and Prevention (CDC) published a new test algorithm in 2010, which suggested the use of the Geenius™ HIV ½ supplemental assay test instead of western blot tests, which have been used for many years to verify HIV screening test positivity. In this study, we aimed to report the experience of the National HIV-Acquiner Immundeficiency Syndrome (AIDS) and Viral Hepatitis Reference Laboratories of Turkey in the first year of transition to the new HIV algorithm and to evaluate the diagnostic performance of Geenius™ HIV ½ and line immunassay (LIA) s. A total of 2090 anti-HIV positive patient sera sent to National HIV-AIDS and Viral Hepatitis Reference Laboratories of Turkey, Ankara for HIV confirmation were included in the study. All samples were retested with a fourth-generation enzyme linked immunosorbent assay (ELISA) test (VIDAS® HIV-1/2 Duo Ultra assay, BioMerieux, France) followed by the confirmatory tests; Geenius™ HIV 1/2 confirmatory assay (BioRad, Redmond, WA) and Line-immunoassay (INNO-LIA HIV ½ Score, Fujirebio, Belgium). Indeterminate/negative test results or discrepancies between the confirmatory tests were resolved with HIV-1 RNA reverse transcriptase polymerase chain reaction (RT-PCR) (artus HI Virus-1 RT-PCR, Qiagen, Germany) test and in-house HIV-2 RNA and proviral DNA PCR. The sensitivity, specificity, and the agreement of the each assay were compared. Cohen’s Kappa analysis was used for the evaluation of the agreement between the tests. According to the new algorithm which recommended Geenius™ test besides HIV-1 RNA test, 1707 (81.7%) HIV-1 positive samples were identified. Of these samples; 95.9% and 95.02% were identified as HIV-1 positive by GeeniusTM and INNO-LIA, respectively. However, 2.5% of the positive samples were negative with Geenius™ and 3.5% with INNO-LIA. One and a half percentage (1.5%) of these samples were detected with Geenius™ and 1.4% with INNO-LIA as indeterminant. When all the positive samples determined with ELISA were evaluated; it was detected that,1.3% were indeterminate by Geenius™ test and 2.4% by the INNO-LIA test. When the INNO-LIA test was regarded as the gold standard method; sensitivity, specificity, positive predictive and negative predictive values of the Geenius™ test were as follows; 99.7%, 96.1%, 98.9%, and 99.1%. The agreement between INNO-LIA and Geenius™ tests was found to be 98.95% (κ= 0.969; very good). When the Geenius™ and HIV-1 PCR tests were evaluated together for the confirmation; the sensitivities of Geenius™ and INNO-LIA tests were 99.8% and 98.3%, specificities were 89.8% and 85.3%, respectively. Slight positive bands were detected in the gp36 or gp140 bands, the HIV-2 specific envelope proteins, were detected in seven samples, However, the positivity disappeared after the dilution of the samples and it was accepted as false positivite reaction due to the absence of HIV-2 RNA and proviral DNA in these samples. In conclusion; we concluded that Geenius™ and INNO-LIA tests have a perfect agreement in HIV diagnosis and due to the rapid and reliable results provided for the HIV test protocol, Geenius™ test can be used safely as an alternative to the immunoblot tests. HIV-1 RNA testing must be performed in all HIV confirmation centers in order to detect acute HIV cases in the fast and early period which are the main reason for the updates in HIV diagnosis.
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Li, Kingbherly L., Jose Carlo B. Valencia, Florida F. Taladtad, Mary Grace T. Hernaez, Vivienne V. Luzentales, Cybele Lara R. Abad, and Edsel Maurice T. Salvana. "372. Prevalence of Urethral, Rectal, and Pharyngeal Gonorrhea and Chlamydia among Newly Diagnosed Filipino HIV Patients." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S195. http://dx.doi.org/10.1093/ofid/ofz360.445.
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Abstract Background The Philippines has the fastest-growing HIV epidemic in the Asia-Pacific. Concurrent sexually-transmitted infections increase the risk of HIV transmission and complications. The prevalence of Neisseria gonorrheae (NG) and Chlamydia trachomatis (CT) infection among Filipino HIV patients is unknown and screening is not universal. A symptom-based approach likely underestimates the prevalence of NG and CT among men who have sex with men (MSM). We determined the rectal, pharyngeal, and urethral prevalence of gonorrhea and chlamydia infection in our patient population using nucleic acid testing (NAT). Methods This is a single-center, prospective cross-sectional study at Philippine General Hospital. Following ethical approval and informed consent, pharyngeal, rectal, and urine samples from newly-diagnosed, treatment-naïve HIV adult patients were tested using the Xpert® CT/NG assay (Cepheid, Sunnydale, CA). Patients with recent (≤21 days) antibiotic use with activity against NG or CT were excluded. Demographic and clinical data were also collected. Results 46 subjects were enrolled. Mean age was 31 years (range 19–49), 83% (38/46) were male, 96% (44/46) were asymptomatic, and 92% (35/38) of the males were MSM. Median CD4 count was 225 cells/μL (range 0–1,335). The overall prevalence of CT/NG was 33% (15/46). Table 1 shows the prevalence of CT and NG by site. Four patients had both genital and rectal CT. More patients had rectal NG/CT compared with urethral and pharyngeal sites. No gonorrhea was found in the urine specimens; no chlamydia was found in the pharynx. Conclusion The prevalence of CT and NG among newly diagnosed Filipino HIV patients at 33% is sufficiently high to warrant routine NAT screening. Urine testing alone will miss a significant number of cases in an MSM-predominant population. We recommend NAT screening of both urethral and rectal sites for newly-diagnosed Filipino HIV patients. Disclosures All authors: No reported disclosures.
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Aye, Kyi-Phyu, Sabai Phyu, Thet-Su Mon, and Thwe-Zin Soe. "#21: Pattern and Outcome of Opportunistic Infections in Hospitalized HIV-Infected Patients in Specialist Hospital Waibargi, Myanmar." Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (March 1, 2021): S19. http://dx.doi.org/10.1093/jpids/piaa170.059.
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Abstract Background Human immunodeficiency virus/ acquired immune deficiency syndrome (HIV/AIDS) constitutes a major global public health concern. There are an estimated 237,000 people living with HIV in Myanmar with prevalence of 0.57%, the fourth highest in South East Asia region. Specialist Hospital Waibargi (SHW) is one of the 3 main hospitals in Myanmar for HIV care and support with a cohort of nearly 2000 patients. This study was performed in SHW to evaluate the pattern and hospital outcome of various opportunistic infections (OI) in HIV-infected patients which are the principal cause of morbidity and mortality. Methods We conducted a retrospective records review study involving 370 HIV-infected patients hospitalized from October 2018 to September 2019 (1-year period). Disseminated tuberculosis (TB) was defined by concurrent involvement in at least two noncontiguous organs or miliary TB in a chest radiograph. Suggested Mycobacterium avium complex (MAC) was defined by the presence of prolonged fever not responding to anti-TB treatment and presence of generalized lymphadenopathy, hepatosplenomegaly, and pancytopenia in patients with CD4 <50 cells/mm3. Invasive fungal infection was defined by the presence of diffuse infiltrates on chest radiograph and/or generalized lymphadenopathy, hepatosplenomegaly, and pancytopenia with a response to antifungal therapy. Frequencies of individual OI were expressed as percentages. Results Among 370 patients, antiretroviral therapy (ART) was initiated in 150 patients during admission, 153 patients were already on ART (first-line/second-line/third-line/ default and restart patients), 67 were about to be initiated at a follow-up visit and 9 were defaulters. The mean age was 38.2 ± 11 years, 224 male and 146 female patients were admitted (ratio 1.5:1). Mean CD4 is 111 cells/mm3 (range 4–627 cells/mm3). In total, 322 patients (87%) had CD4 <350 cells/mm3. A total of 823 OI occurred in 370 patients. One hundred and twenty-nine patients had ≥ 2 OI. Among 823 episodes, pulmonary TB accounted 32.8% (270 patients) with 13% confirmed cases including 12 multi-drug-resistant cases. Extrapulmonary TB was 22% including 48 TB meningitis cases. Disseminated TB was found in 15.3%. The rest were sepsis (19.6%), acute gastroenteritis (4%), cryptococcal meningitis/cryptococcaemia (3%), Pneumocystis jiroveci pneumonia (PCP) (3.2%), skin fungal infection (4%), invasive fungal infection (4%), esophageal candidiasis (2.3%), Cytomegalovirus retinitis (0.6%), suggested MAC (1.7%), cerebral toxoplasmosis (0.7%), progressive multifocal leukoencephalopathy (0.8%), encephalitis (0.7%), Herpes zoster infection (0.6%). Eighty-six hospitalized patients died with a mortality rate of 23.2% mostly due to disseminated TB or fungal infection, PCP, sepsis, cryptococcal meningitis, and immune reconstitution inflammatory syndrome. The mean duration of hospitalization was 14 ± 11 days. Sixteen children (age 12–22 years) with CD4 <350 cells/mm3 were included, half were infected congenitally and mortality was 50% mostly due to disseminated TB and sepsis. Conclusion Even in the test and treat era of ART, most HIV-infected patients in the study were late presenters with advanced disease. It highlights the importance of increasing testing awareness in the community and eliminating mother to child transmission. TB was the commonest OI among HIV-infected patients and early TB diagnosis, anti-TB treatment, good adherence, and latent TB prophylaxis are the major tools to improve HIV/TB-related morbidity and mortality.
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Bongomin, Kwizera, and Denning. "Getting Histoplasmosis on the Map of International Recommendations for Patients with Advanced HIV Disease." Journal of Fungi 5, no. 3 (September 2, 2019): 80. http://dx.doi.org/10.3390/jof5030080.
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Progressive disseminated histoplasmosis, caused by H. capsulatum, is a life-threatening illness and is an AIDS-defining opportunistic infection. It is neglected, worryingly under-diagnosed, and often misdiagnosed as cancer or tuberculosis with fatal consequences. Globally, over 100,000 cases of disseminated histoplasmosis have been estimated. In 2017, the World Health Organization (WHO) noted that disseminated histoplasmosis is a significant cause of mortality in AIDS patients. Through the rigorous efforts of the Global Action Fund for Fungal Infections (GAFFI) and partners, in 2019, the Histoplasma antigen test was included on the 2nd Edition of the WHO List of Essential Diagnostics. The drugs used in the treatment of histoplasmosis (amphotericin B and itraconazole) are on the WHO Essential Medicine List. The Manaus Declaration on histoplasmosis in the Americas and the Caribbean, where histoplasmosis kills more people with HIV than tuberculosis, advocates for universal access to rapid testing for histoplasmosis and availability of essential drugs for the treatment of histoplasmosis in every country by 2025. Hyperendemic areas are present in the Americas, Caribbean, Southeast Asia, and Latin America. In conclusion, histoplasmosis remains an important clinical and public health problem. To reduce HIV-associated mortality, disseminated histoplasmosis must be addressed through advocacy, increased awareness, and universal access to essential diagnostics and antifungal agents.
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Thapa, Priyenka, Kayla Mohr, Katelynn K. Campbell, and Michael Saccente. "Sweet Syndrome precipitated by Mycobacterium abscessus in a Laotian Man with Autoantibodies to Interferon Gamma." Journal of Investigative Medicine High Impact Case Reports 9 (January 2021): 232470962199077. http://dx.doi.org/10.1177/2324709621990771.
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Autoantibodies to interferon γ, part of the first line of defense in the human immune response, constitutes a rare form of an acquired immunodeficiency in HIV-uninfected adults that can predispose to disseminated atypical mycobacterial infection. Particularly, this has been described in people of Southeast Asian origin. In this case report, we describe a previously healthy, Laotian man who presented with skin lesions consistent with Sweet syndrome that were later found to be precipitated by disseminated atypical mycobacterial disease. Extensive immunological workup revealed the patient to have autoantibodies to interferon γ, rendering him susceptible to this infection. Our report demonstrates a complex case with a multilayered diagnosis, while inviting perspective from multiple specialties. This enigmatic case emphasizes the importance of a broad differential with special attention to demographics while demonstrating the difficulty in treating certain atypical infections that are inherently multidrug resistant.
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Alaei, Arash, Daniel J. Bromberg, Mary M. Tate, Saifuddin Karimov, Dilshod Saidi, and Kamiar Alaei. "HIV and associated factors among female sex workers in Tajikistan: Analysis from a national bio-behavioral survey." International Journal of STD & AIDS 32, no. 8 (March 26, 2021): 678–86. http://dx.doi.org/10.1177/0956462420984696.
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Tajikistan, a country of approximately nine million people, has a relatively small but quickly growing HIV epidemic. No peer-reviewed study has assessed factors associated with HIV, or associated risk factors, among female sex workers (FSWs) in Tajikistan. The purpose of the current study is to elucidate the factors associated with HIV status and risk factors in the Tajikistani context and add to the scant literature on risk factors among FSWs in Tajikistan and Central Asia. We used cross-sectional data from an HIV bio-behavioral survey (BBS) conducted among FSWs in the Republic of Tajikistan ( n = 2174) in 2017. Using Respondent Driven Sampling Analysis Tool software, we calculated the prevalence of HIV, diagnosed cases, linkage to antiretroviral therapy (ART), and the prevalence of syphilis for FSWs in Tajikistan. Prevalence data were adjusted for network size and any clustering effects in the network. Further, using univariate and multivariable logistic regression, we determined correlates of HIV-positive status. Results were as follows: Of all FSWs in Tajikistan, 2.6% (95% CI: 1.7–3.8%) are HIV positive, 2.3% (95% CI: 1.4–3.5%) are diagnosed and aware of their status, and 2.0% (95% CI: 1.2–3.1%) are on ART. About 5.7% (95% CI: 4.5–7.4%) of FSWs in Tajikistan have ever had syphilis, and 0.8% (95% CI: 0.4–1.3%) have active syphilis infections. The epidemic of injection drug use was found to be strongly synergistic with HIV infection as having had sex with a person who injects drugs was shown to be strongly associated with HIV-positive status (OR: 5.2; 95% CI: 2.6–10.2) in the multivariable model. While this study estimates that HIV prevalence among Tajikistani FSWs is relatively low, it is likely an underestimated due to selection and social desirability biases. To curb the small, but potentially volatile, HIV epidemic among FSWs, the government should consider targeted testing and linkage-to-care efforts for FSWs who inject drugs or who have people who inject drugs partners. Services should also be prioritized in Gorno-Badakhshan, which has a higher number of FSWs per capita relative to other regions. Additionally, the link between HIV and experiences of stigma, violence, and discrimination against FSWs should motivate advocates to protect Tajikistani FSWs from these experiences.
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Rajendran, Tara, and Krishna Prasad. "Primary extranodal non-Hodgkin lymphoma: Clinical characteristics and outcome." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e20027-e20027. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e20027.
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e20027 Background: According to the National Cancer Registry Program, the Indian Council of Medical Research reports that the estimated Incidence rate of Non-Hodgkins Lymphoma in India is 2-3 per 100,000 people. The incidence rate of extranodal Non-Hodgkins Lymphoma (NHL) in Asia is higher than that of the United States. We illustrate a single center review of the clinical characteristics of all the primary extranodal NHL. Methods: We retrospectively identified patients diagnosed with primary extranodal NHL out of 269 NHL patients diagnosed at the department of medical oncology, Kasturba Medical College hospital, Mangalore, India from August 1999 and September 2015. Results: A total of 43 patients(15.9%) with primary extranodal NHL were identified out of which 25 patients (58%) were male with a median age of 49 years (5-92). 11patients (25%) had tonsil as the extranodal location and 10 patients (23%) had musculoskeletal involvement. Lung, thyroid, ovary, nasopharynx, gastrointestinal, paranasal sinuses and central nervous system were the other sites. 17 patients (39.5%) were presented at stage 4. The most common subtype was diffuse large B cell Lymphoma (DLBCL)-25 patients (58%). 2 patients had HIV infection. Some CD 20+ patients could not afford the cost of Rituximab and hence resorted to the CHOP regimen for 6 cycles. Rest received RCHOP 6-8 cycles depending on the stage and response. Follicular Lymphoma patient received 6 cycles of RCHOP and Rituximab maintenance for 12 cycles once in 2 months. Burkitts lymphoma patient received MCP 842. 3 patients denied treatment. 6 patients had recurrence who received DHAP +/- Rituximab or ICE +/- Rituximab. 1 patient-reported progression treated with supportive care. 6 patients (14%) died and 22 (55%) patients attained complete remission. Conclusions: In our cohort, DLBCL was the most common subtype and tonsil, the most involved site. The prognosis was impacted by the stage at which the patient was presented, HIV infections and the higher cost of Rituximab. Primary extranodal NHL must be considered in the differential diagnosis as the current treatments can achieve complete remission.
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Zhou, J., N. I. Paton, and R. Ditangco. "AIDS-defining illness diagnosed within 90 days after starting highly active antiretroviral therapy among patients from the TREAT Asia HIV Observational Database." International Journal of STD & AIDS 18, no. 7 (July 1, 2007): 446–52. http://dx.doi.org/10.1258/095646207781147283.
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Using data from TREAT Asia HIV Observational Database (TAHOD), this paper aims to assess the rate of, and factors associated with the diagnosis of new AIDS-defining illness (ADI) within 90 days after antiretroviral treatment. Patients starting three or more antiretroviral combinations and having subsequent follow-up were included. New ADI cases were checked for evidence of immune reconstitution syndrome (IRS). Among the 1185 patients included, 75 (6.3%) were diagnosed with a new ADI within 90 days, giving a rate of 26.8/100 person-years, compared with a further 3.6% cumulative incidence of new ADI between 90 days to one year (4.2/100 person-years). Of the 75 patients, 21 were judged as definitive or presumptive IRS, giving a rate of 7.3/100 person-years. Patients with new ADI generally had lower CD4 counts before treatment started (median, 43 cells/μL). Lower CD4 count, lower body mass index and starting treatment in the same year as the first HIV-positive test done were associated with developing a new ADI. The higher rate of new ADI within 90 days may be partly explained by IRS occurring shortly after treatment. Although it is difficult to identify IRS from observational data, it appears that in TAHOD setting IRS was relatively uncommon.
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Nsenga, Lauryn, Jonathan Kajjimu, Ronald Olum, Sandra Ninsiima, Andrew Peter Kyazze, Phillip Ssekamatte, Davis Kibirige, Joseph Baruch Baluku, Irene Andia-Biraro, and Felix Bongomin. "Cryptococcosis complicating diabetes mellitus: a scoping review." Therapeutic Advances in Infectious Disease 8 (January 2021): 204993612110147. http://dx.doi.org/10.1177/20499361211014769.
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Background: A better understanding of the epidemiology of cryptococcal infection in HIV-negative individuals is an international research interest. Immune dysfunction in diabetes mellitus (DM) significantly increases the risk of acquiring and reactivation of infection due to Cryptococcus neoformans. Risk factors and outcomes of cryptococcosis in DM are not well documented. Objective: The objective of this study was to determine the clinical characteristics and outcomes of cryptococcal infections in persons living with DM. Methods: MEDLINE (via PubMed), EMBASE, and the Cochrane Library databases were searched in November 2020. The searches covered the period between 1980 and 2020.We included studies that reported confirmed cryptococcosis in patients with DM. Reference lists of included articles were also searched, and additional studies were included if appropriate. No language restriction was applied. Single case reports, case series and original articles were included whereas review articles were excluded. Results: A total of 28 studies (24 single case reports, 4 retrospectives) were included involving 47 unique patients from Asia (17 cases), North America (six cases), South America (three cases) and Africa (two cases). Men constituted 75% ( n = 18) of the cases. Median age was 60.5 (range: 27–79) years. The majority of the patients had cryptococcal meningitis (68.1%, n = 32) followed by disseminated cryptococcosis (6.4%, n = 7), and others (isolated cutaneous disease one, peritonitis one, pleural one, thyroid one, adrenal one). Diagnosis was achieved through either culture and microscopy (38/47), cryptococcal antigen tests (9/47) or histopathology (9/47) singly or in a combination. All-cause mortality was 38.3% ( n = 18). Among those with meningitis mortality was 36.2%. Conclusion: A wide spectrum of cryptococcal infections with varying severity occurs in DM. Mortality remains unacceptably high. There is a need for more studies to characterize better cryptococcal disease in DM.
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Dovgopolyuk, E. S., L. I. Levakhina, A. T. Tyumentsev, and O. A. Pasechnik. "Dispanserization monitoring for HIV-infected patients in the Siberian Federal District in 2013–2017." Medical Almanac, no. 3-4 (October 14, 2019): 44–48. http://dx.doi.org/10.21145/2499-9954-2019-3-44-48.
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According to UNAIDS, 1.4 million people are living with HIV in Eastern Europe and Central Asia, 75% of them in Russia. International guidelines recommend regular clinical evaluation of HIV-infected patients, which is achieved through follow-up. Purpose of the study: to characterize the quality of follow-up observation of HIV patients in the Siberian Federal District for the five-year period from 2013 to 2017. Materials and methods. A retrospective descriptive-assessment epidemiological study for the period 2013–2017 was conducted in the Siberian Federal District, in which dispensary observation indicators were most affected by improving the epidemiological situation associated with the spread of HIV infection. Results. The HIV infection in the Siberian Federal District increased during the period under review by 62,4% and reached 1328,5 per 100 thousand population. The prevalence of HIV infection at the beginning of 2018 was 679.0 per 100 thousand population (with an average Russian indicator of 430,2). The SFO accounted for 20,7% of all HIV cases (n = 130 595), which were registered at specialized medical organizations in the Russian Federation. The coverage of HIVinfected patients with clinical observation reached the target value and amounted to 88,2%. The number of patients who were examined to determine the immune status and viral load increased almost 2 times. At the same time, the proportion of HIV-infected people receiving antiretroviral therapy was at the level of 39,8%, which is 4,2% lower than the target values. The proportion of patients surveyed for tuberculosis among those who underwent medical examination in 2017 remains at the level of 87,8%, which does not stabilize the incidence of tuberculosis infection. The number of HIV-infected patients with a diagnosis of active tuberculosis increased 1,4 times to 17 610 in 2017 (10,9% of the number of patients). Conclusion. In the context of the continuing increase in the incidence of HIV infection in the population and an increase in the number of patients in need of various types of medical care, additional measures are needed to improve the quality and effectiveness of follow-up observation of patients with HIV infection.
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Vannier, Edouard, and Peter J. Krause. "Update on Babesiosis." Interdisciplinary Perspectives on Infectious Diseases 2009 (2009): 1–9. http://dx.doi.org/10.1155/2009/984568.
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Human babesiosis is an emerging tick-borne infectious disease caused by intraerythrocytic protozoan species of the genusBabesiawith many clinical features similar to those of malaria. Over the last 50 years, the epidemiology of human babesiosis has changed from a few isolated cases to the establishment of endemic areas in the northeastern and midwestern United States. Episodic cases are reported in Europe, Asia, Africa, and South America. The severity of infection ranges from asymptomatic infection to fulminant disease resulting in death, although the majority of healthy adults experience a mild-to-moderate illness. People over the age of 50 years and immunocompromised individuals are at the highest risk of severe disease, including those with malignancy, HIV, lacking a spleen, or receiving immunosuppressive drugs. Asymptomatic carriers present a blood safety risk when they donate blood. Definitive diagnosis of babesial infection generally is made by microscopic identification of the organism on thin blood smear, amplification ofBabesiaDNA using PCR, and detection ofBabesiaantibody in acute and convalescent sera. Specific antimicrobial therapy consists of atovaquone and azithromycin or clindamycin and quinine. Exchange transfusion is used in severe cases. The use of multiple prevention strategies is recommended and consists of personal, residential, and community approaches.
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Brassard, Paul, Travis Salway Hottes, Richard G. Lalonde, and Marina B. Klein. "Tuberculosis Screening and Active Tuberculosis among HIV-Infected Persons in a Canadian Tertiary Care Centre." Canadian Journal of Infectious Diseases and Medical Microbiology 20, no. 2 (2009): 51–57. http://dx.doi.org/10.1155/2009/658382.
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RATIONALE: HIV infection increases the risk of reactivation of latent tuberculosis (TB). The present study evaluates how latent TB is detected and treated to determine the effectiveness of screening in HIV-infected patients with diverse risk profiles.METHOD: A retrospective medical record database review (1988 to 2007) was conducted at a tertiary care HIV clinic. The proportion of patients receiving tuberculin skin tests (TSTs) and the rate of active TB at each stage of screening and prevention were estimated. Predictors of receiving a TST at baseline, testing positive by TST and developing active TB were evaluated.RESULTS: In the present study, 2123 patients were observed for a total of 9412 person-years. Four hundred seventy-six (22.4%) patients were tested by TST within 90 days of first clinic visit. Having a first clinic visit during the highly active antiretroviral therapy era (OR 3.64; 95% CI 2.66 to 4.99), country of birth (ORs: Africa 3.11, Asia 2.79, Haiti 3.14, and Latin America and the Caribbean 2.38), time between HIV diagnosis and first visit (OR per one-year change 0.97; 95% CI 0.94 to 0.99) and previous antiretroviral exposure (OR 0.61; 95% CI 0.45 to 0.81) were independent predictors of receiving a TST at baseline. Of the 17 patients who developed active TB during follow-up, nine (53%) had no documented TSTs at baseline or during follow-up. Forty-one per cent of all TB patients and 56% of TB patients who were not screened were born in Canada.CONCLUSION: The administration of TSTs to newly diagnosed HIV patients was inconsistent and differential according to country of birth, among other factors, resulting in missed opportunities for TB prevention.
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Lanjewar, Dhaneshwar Namdeorao. "The Spectrum of Clinical and Pathological Manifestations of AIDS in a Consecutive Series of 236 Autopsied Cases in Mumbai, India." Pathology Research International 2011 (May 23, 2011): 1–12. http://dx.doi.org/10.4061/2011/547618.
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The HIV epidemic in the Asian subcontinent has a significant impact on India. The AIDS associated pathology has not been well evaluated in a representative study hence very little is known about the spectrum of HIV/AIDS associated diseases in Indian subcontinent. To determine the important postmortem findings in HIV infected individuals in Mumbai, autopsy study was carried out. The patient population included patients with AIDS who died at the tertiary care hospital over a 20 year period from 1988 to 2007. A total of 236 (182; 77% males and 54; 23%) females) patients with AIDS were autopsied. The main risk factor for HIV transmission was heterosexual contact (226 patients; 96%) and 223/236 (94%) patients died of HIV-related diseases. Tuberculosis was the prime cause of death in 149 (63%) patients, followed by bacterial pneumonia 33 (14%), cryptococcosis 18 (8%), toxoplasmosis of brain 15 (6%), pneumocystis jiroveci (PCJ) 1 (0.5%) and Non-Hodgkin's lymphoma 7 (3%) cases. The major underlying pathologies are either preventable or treatable conditions. There is an urgent need for attention towards the diagnosis, issue of therapy, and care of HIV disease in developing countries. Reducing mortality in patients with AIDS from infections must be highest public health policy in India.
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Harper, Eugene P., Justin Oring, Harry Powers, Courtney E. Sherman, Benjamin Wilke, Jane Hata, Aziza Nassar, Julio C. Mendez, and Claudia R. Libertin. "317. Case Series of Echinococcus Infections at Mayo Clinic Florida." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S230—S231. http://dx.doi.org/10.1093/ofid/ofaa439.513.
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Abstract Background Echinococcus multilocularis is a destructive zoonotic cestode with low human incidence. Hydatid disease classically presents with hepatic or lung involvement with infrequent extrahepatic bone destruction. Diagnosis is challenging due to its latency and mimicry. Fig.1: Case 1 - X-ray imaging of the pelvis shows osseous destruction of the iliac crest secondary to known osteomyelitis status post left ilium debridement. Fig.2: Case 1 - Magnetic resonance imaging demonstrates extensive osteomyelitis throughout left ilium. Stable scattered focal fluid collections seen throughout the left lower quadrant. Methods CASE 1: A 57 year-old Albanian male with diabetes, latent TB, and left iliac lytic lesion presented with 4 weeks of left flank pain and was treated with 6 weeks of IV Ceftriaxone and Flagyl. 2 years later he returned with flank pain and purulent lumbar drainage. Hip x-ray suggested chronic osteomyelitis, with left psoas fluid collections on CT. Bartonella, Q fever, Brucella, HIV, AFB and fungal serologies were negative. Hemipelvis debridement revealed structures concerning for hydatid disease. Echinococcus IgG was equivocal. Histopathology was consistent with Echinococcus multilocularis species, and albendazole was started. On follow-up, he presented with left hip tenderness and toe extensor weakness. Labs showed mild leukocytosis. CT revealed progressive destruction of the left iliac with sacroiliac extension concerning for abscess. CASE 2: A 36 year-old female presented with lung and liver cysts, progressive dyspnea, and non-productive cough. She lived in Africa, Asia, and Europe and consumed local street food and unpasteurized milk. Hobbies included spelunking and swimming in freshwater lakes. She had exposure to stray animals, but denied bites or scratches. Over 4 years dyspnea progressed to orthopnea. MR abdomen revealed a 10x6x12cm liver cyst and chest CT showed 2 fluid-attenuating lesions in the LLL and RLL, measuring 4.9 x 6.0 cm and 6.8 x 4.3 cm respectively. Echinococcus, Bartonella, Q fever, Brucella, HIV, AFB and fungal serologies were negative. Schistosomiasis serology was equivocal. Fig. 3: Case 2 - MRI abdomen demonstrating 10x6x12cm liver cyst Fig. 4: Case 2 - Chest CT showed 2 dominant fluid attenuating lesions within the LLL and RLL. The larger lesion in RLL measures 6.8 x 4.3 cm. The left lower lobe lesion measures 4.9 x 6.0 cm. Results Patient 1 underwent type I hemipelvectomy. Patient 2 underwent pulmonary segmentectomy and liver lobectomy. Both were continued on albendazole. Fig. 5: Case 1 - Photo taken during debridement of left ileac and hip. Note presence of white cysts discovered intraoperatively. Fig. 6: Case 1 - Histopathologic slides (H&E stain) demonstrating hooks and scolices consistent with Echinococcus multilocularis. A. Hooklet (100x magnification). B. Hydatid cyst with black-staining structures suggestive of degenerating hooklets. C. Zoomed detail of cyst wall. D. Degenerating hydatid cyst and hooklets. Conclusion Equivocal IgG serology does not exclude infection. History and clinical presentation are key to diagnosis, but histopathology remains the gold standard. Hydatid bone infection progresses insidiously and frequently recurs, depending upon excision and debridement. Finally, echinococcosis demands aggressive long-term therapy and surveillance. Disclosures Claudia R. Libertin, MD, Pfizer, Inc. (Grant/Research Support, Research Grant or Support)
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Jou, Erin, Carmen KM Cheung, Ryan CY Ho, Diwakar Mohan, Uriel Felsen, Henny H. Billett, Anthony T. C. Chan, Edwin P. Hui, and Radha Raghupathy. "Retrospective Study of the Incidence and Risk Factors for Hematological Malignancies in Patients with Hepatitis B Virus Infection." Blood 124, no. 21 (December 6, 2014): 5403. http://dx.doi.org/10.1182/blood.v124.21.5403.5403.
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Abstract Background: Hepatitis B infection may be associated with an increased risk of non hodgkins lymphoma, especially diffuse large B cell lymphoma. Whether an intact immune system is required hepatitis B mediated lymphomagenesis and if factors such as other viral co infections and paraproteins may further compound this risk remains unclear. We retrospectively studied our large database of HBsAg positive patients for diagnoses of hematological malignancies or premalignant disorders (HM) and the risk factors for their development. Methods: Patients over the age of 18 with at least one positive HBsAg test between Jan 1st 2001 and Dec 31st 2011 were identified using the medical center database, clinical looking glass. Data were collected regarding demographics, HIV and hepatitis C status. Serum protein electrophoresis tests done after the HBsAg test were reviewed. Results of all biopsies performed for each patient, ICD9 and cancer registry diagnoses were reviewed for biopsy confirmed diagnoses of a HM. Liver biopsy results were reviewed for evidence of chronic hepatitis changes. Results: 3177 of 216,522 patients (1.5%) tested were HBsAg positive. Mean age of the HBsAg positive group was 43 years, 56% were male. 44% were black, 8% white and 7.4% were Asian. 33.6% of these patients had two positive HBsAg tests 6 months apart. 10.3% of patients underwent a liver biopsy and 9.4% of patients had biopsy changes consistent with chronic hepatitis. Of the 3177 patients, 4.9% (155 patients) had a biopsy of any lymphatic tissue or bone marrow performed. 2.2 % (71 patients) had a hematological malignancy or premalignant disorder diagnosed. 0.4% (12 patients) had an insufficient specimen for diagnosis and were excluded from further analysis. Of the 71 patients with a HM, 30 (42.3%) had a high grade B or T cell lymphoma; 12 (16.9%) had myeloma or smoldering myeloma; 11 (15.5%) had a low grade lymphoma; 6 (8.4%) had myelodysplasia, myeloproliferative disorder or acute leukemia and 11 (15.5%) had a premalignant disorder including multicentric castleman, MGUS or NK cell lymphocytosis. 47% of high grade lymphomas occurred in an extranodal location. Within the HBsAg positive population, HM positive patients (n=71) compared to HM negative controls (n=3094) were significantly older (52.5 vs 43 yrs, p<0.001) and more likely to be male (73.2% vs 55.5% p:0.003) HM positive patients were tested for other viral coinfections more often and were more likely to be seropositive for HIV (62.7% vs 31.4%, p<0.001) and Hepatitis C (20% vs 10.7%, p:0.014) . HM positive patients were also tested for paraprotein more frequently and had a significantly higher prevalence of paraproteinemia than their HM negative counterparts. (58.1% vs. 15.4%, p<0.0001) On multivariate analysis, male gender (OR: 2.4, 95% CI:1.1-4.9), paraprotein positivity (OR:16.3, 8.0-33.7) and HIV positivity (OR:2.6, 1.4-4.9) but not Hepatitis C positivity emerged as independent risk factors for development of HM. (Table 1) Of those patients with HBsAg positivity diagnosed with hematological malignancies, patients co-infected with HIV and hepatitis B had a significantly higher proportion of DLBCL cases as compared to those with hepatitis B alone (46.9% vs 10.5%, p:0.013). Conclusions: Concurrent HIV infection and paraproteinemia were associated with increased risk of HM in our HBsAg positive patients. Of those who develop HM, HIV and Hepatitis B co-infected patients have a higher proportion of DLBCL. These data suggest synergistic mechanisms of Hepatitis B and HIV in abnormal B cell proliferation. Being a retrospective study, inherent biases exist in terms of which patients get certain tests. Further work is required to confirm these findings and to elucidate the mechanisms of lymphomagenesis in this population. Abstract 5403. Table 1: Risk factors for the development of HM in HBsAg positive patients HM positive (n=71) HM negative (n=3094) p value Mean age in years (SE) 52.5 (12.9) 42.9 (13.6) <0.0001* Male gender (n,%) 52 (73.2%) 1716 (55.5%) 0.003* HIV serology or viral load tested (n,%) 51 (71.8%) 1787 (57.8%) 0.017* HIV positive of tested patients (n,%) 32/51 (62.7%) 561/1787 (31.4%) <0.0001* HCV serology done (n,%) 70 (98.6%) 2660 (86%) 0.001* HCV seropositive of those tested (n,%) 14 /70 (20%) 285 / 2660 (10.7%) 0.014* SPEP test done (n,%) 31 (43.6%) 311 (10.1%) 0.0001* SPEP positive of tested patients (n,%) 18/31 (58.1%) 48/311 (15.4%) <0.0001* Disclosures No relevant conflicts of interest to declare.
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Bourne, Adam, Beatrice Alba, Alex Garner, Gianfranco Spiteri, Anastasia Pharris, and Teymur Noori. "Use of, and likelihood of using, HIV pre-exposure prophylaxis among men who have sex with men in Europe and Central Asia: findings from a 2017 large geosocial networking application survey." Sexually Transmitted Infections 95, no. 3 (January 5, 2019): 187–92. http://dx.doi.org/10.1136/sextrans-2018-053705.
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ObjectiveCurrently, seven European countries provide HIV pre-exposure prophylaxis (PrEP) through public health services, although there are numerous reports of off-licence use. The objective of this study was to examine current use of PrEP, likelihood of future use and indicators of potential PrEP candidacy among an opportunistic sample of men who have sex with men in Europe and Central Asia.MethodsA survey was sent out in eight languages to users of the Hornet gay networking application in July and August 2017. Descriptive statistics present proportions of PrEP use, while factors associated with PrEP use are examined using logistic and linear regressions.ResultsOf 12 053 participants whose responses came from 55 European and Central Asian countries, 10 764 (89%) were not living with diagnosed HIV. Among these HIV-negative/untested men, 10.1% (n=1071) were currently taking PrEP or had done so within the previous 3 months. Current or recent PrEP users were significantly more likely to have taken postexposure prophylaxis (adjusted OR (AOR)=16.22 (95% CI 13.53 to 19.45)) or received an STI diagnosis (AOR=4.53 (95% CI 3.77 to 5.44)) in the previous 12 months than those who had not. Most commonly, these men obtained PrEP from a physician (28.1%) or the internet (24.8%), while 33.6% had not disclosed PrEP use to their doctor. Men reporting happiness with their sex life were more likely to have taken PrEP (AOR=1.73 (95% CI 1.59 to 1.89)). Nearly a quarter (21.5%) of those not on PrEP said they were likely to use it in the next 6 months.ConclusionsThe majority of men using, or intending to use, PrEP appear to have a risk profile consistent with emerging guidance. A large proportion of these men are accessing PrEP outside of traditional healthcare settings, posing a challenge for routine monitoring.
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Lemaitre, Marine, Pauline Brice, Marco Frigeni, Catherine Thieblemont, Luca Arcaini, and Caroline Besson. "Hepatitis B Virus Associated B-Cell Non-Hodgkin Lymphoma in Non-Endemic Areas." Blood 132, Supplement 1 (November 29, 2018): 4228. http://dx.doi.org/10.1182/blood-2018-99-120349.
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Abstract Introduction Hepatitis B virus (HBV) is a hepatotropic virus accounting for chronic hepatitis and cirrhosis. HBV is also known as oncogenic, leading to increased risks of not only hepatocellular carcinoma but also other cancers including B-cell non-Hodgkin lymphoma (NHL) (Odd-ratio: 1.9-2.0). According to the World Health Organization, 257 million people in the world have an active HBV infection, areas of high prevalence being in Africa, Western Pacific, and Southeast Asia. While some studies were performed in endemic area, little is known concerning the characteristics of HBV-related NHL in Occident. Moreover, although the need for antivirals to prevent HBV reactivation is well known in patients with HBV receiving chemo or immunotherapy, their impact on their prognosis is unknown. Our aim is to describe the characteristics and outcomes of patients with NHL and active HBV in non-endemic areas. Methods Thirty-nine consecutive patients diagnosed with active HBV infection and B-cell NHL between 2002 and 2017 were enrolled retrospectively in France and Italy. Active HBV infection was defined by positive antigen HbS (AgHbs) and/or positive HBV-DNA in serum. HCV or HIV positive patients were excluded. Their characteristics and outcomes were analyzed and, for Diffuse Large B-cell Lymphoma (DLBCL), compared with those of HBV-negative patients enrolled in R-CHOP arms of LYSA trials. Results Most patients were men (29/39), and median age at NHL diagnosis was 59 years ranging from 29 to 88 years. Twenty-two patients (57%) were born in Europe, 13 in Africa (33%), 4 in Asia (10%). Thirty-three patients had positive AgHbs and 28, positive viral load. The histological subtype distribution was: 23 (59%) DLBCL; 13 low-grade NHL (LG-NHL) including 4 follicular lymphoma (FL), 3 spleen marginal zone lymphoma (SMZL), 3 mucosa associated lymphoid tissue lymphoma and 3 not otherwise specified LG-NHL; 2 mantle cell and one Burkitt lymphoma. Of note, none of the primary DLBCL had a low-grade component but 2 FL and one LG-NHL transformed to DLBCL during follow-up. Five patients had a monoclonal immunoglobulin component. Overall, 26 patients (67%) had an extra-nodal involvement (bone marrow (10), liver (8), digestive (6), and bone (5)). All but one DLBCL patients were treated with R-CHOP/R-CHOP-like regimen leading to complete remission in 19 out of 22 (84%). Treatment of LG-NHL patients was diverse: Rituximab monotherapy, immuno-chemotherapy (R-CHOP, R-Chlorambucil, R-Bendamustine), corticosteroids alone or with radiotherapy, Helicobacter pylori treatment or wait and watch. After front-line therapy, 20 DLBCL patients (87%) and 9 LG-NHL (69%) patients achieved complete remission (CR). Thirty-six patients received antiviral treatment following NHL diagnosis while 3 did not (one DLBCL, 2 LG-NHL). Seven patients (18%) died during follow-up: 4 due to progression of lymphoma (3 DLBCL and one LG-NHL), 2 to hepatocellular carcinoma, one to infection. Median overall survival was 81 months without difference between DLBCL and LG-NHL patients. Lastly, the comparison of the outcomes of the 23 DLBCL patients with those of HBV-negative patients did not show significant difference. Conclusions To our knowledge, this is the first study exploring HBV-related NHL in non-endemic areas. Interestingly, more than 40% of patients were born in high-endemic areas. The strong predominance of DLBCL (59%) is concordant with studies performed in high-incidence areas. Strikingly, it contrasts with the peculiar distribution of HCV-related NHL supporting that some different pathophysiological mechanisms contribute to NHL in HBV. However, as in HCV-related NHL, frequent hepatic or digestive involvement raises the hypothesis of home privileged lymphomagenesis favored by viral induced inflammation or by infection of B-cells. No difference was detected when comparing HBV DLBCL outcomes with non HBV patients. Remarkably, all patients, except one, received antiviral therapy combined with chemotherapy. In endemic areas, while some studies reported that patients with HBV NHL had a poorer prognostic, others suggested that antivirals could overcome this pejorative impact. This study, performed in Western Europe, area of low HBV prevalence, underlines the predominance of DLBCL among patients with active HBV infection and the similar outcomes of DLBCL patients to non-HBV patients when treated with a combination of R-CHOP and antivirals. Disclosures No relevant conflicts of interest to declare.
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Liu, Yi-Chang, Yi-Hsin Yang, Hui-Hua Hsiao, Ming-Yu Yang, Wen-Chi Yang, and Sheng-Fung Lin. "Herpes Zoster Is Associated with An Increased Risk of Subsequent Lymphoid Malignancies — A Population-Based Matched-Control Study in Taiwan." Blood 118, no. 21 (November 18, 2011): 1599. http://dx.doi.org/10.1182/blood.v118.21.1599.1599.
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Abstract Abstract 1599 Infectious agents have been shown to contribute to the development of certain lymphoid malignancies. The different distribution of lymphoid malignancies in Asian and Western populations suggests possibly different etiologies in lymphomagenesis in Asian populations. Herpes zoster infection, commonly seen in immunocompromised persons, has been reported to be associated with lymphoid malignancies, but the results are controversial and large-scale studies from Asian populations are lacking. In this study we performed a population-based matched-controlled prospective study on Taiwanese patients using the National Health Insurance Research Database which provided 1,000,000 random subjects from 1996 to 2007. We defined herpes zoster by compatible ICD-9-CM (International Classification of Disease, 9th Revision, Clinical Modification) codes of herpes zoster (053.0–053.9) on at least one service claim for inpatient or outpatient care. The cases were identified by compatible ICD-9-CM codes including Hodgkin's disease (code 201.0–201.9), non-Hodgkin's lymphoma (code 200.0–200.8, 202.0–202.9), multiple myeloma (code 203.0–203.1), and lymphoid leukemia (code 204.0–204.9). Patients who had been diagnosed with any lymphoid malignancies or any cancers (code 140.0–199.1) before herpes zoster, and who had been diagnosed with other viral infections (code 045.0–052.9, 054.0–066.9, 071–079.9) and HIV infection (code 042) before the diagnosis of lymphoid malignancies were excluded. We randomly selected 169,983 control subjects (4 for every herpes zoster patient), matched with the study group in terms of age, sex and the year and month of index visit. Of 42,498 patients with herpes zoster prior to the diagnosis of any malignancies, the mean age was 48.92 years (± 20.67 years), with a mild female predominance (52.4%). Patients with herpes zoster infection had a lower monthly income (p < 0.001), and tended to live in urban areas (p < 0.001). Among the patients with herpes zoster, 2.42% subsequently developed cancer, and 0.11% lymphoid malignancy. Among the controls, 2.26% of the patients subsequently developed cancer, and 0.06% lymphoid malignancy. Patients with herpes zoster had a significantly increased risk of developing any cancers (excluding lymphoid malignancies, crude HR: 1.07, 95% CI: 1.01–1.15), and lymphoid malignancies (crude HR: 1.82, 95% CI: 1.29–2.55) compared with the control group. After adjusting for Charlson disease index, income category, and residence using Cox proportional hazard regressions, patients with herpes zoster had an increased risk of developing lymphoid malignancies (adjusted HR: 1.72, 95% CI: 1.22–2.42, p = 0.0019), but did not have an increased risk of developing non-lymphoid malignancies (adjusted HR: 1.00, 95% CI: 0.93–1.07, p = 0.895). These data suggest that preceding herpes zoster infection is an independent risk factor for the subsequent development of lymphoid malignancies in Taiwanese subjects. Further studies are warranted to explore the role of herpes zoster in the pathogenesis. Disclosures: No relevant conflicts of interest to declare.
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Mijovic, Hana, Yossef Al-Nasser, Ghada Al-Rawahi, and Ashley Roberts. "EXPERIENCE WITH USING RAPID MOLECULAR TESTING IN DIAGNOSING PULMONARY AND EXTRA-PULMONARY PEDIATRIC TUBERCULOSIS IN A NON-ENDEMIC SETTING - A RETROSPECTIVE CASE SERIES." Paediatrics & Child Health 23, suppl_1 (May 18, 2018): e44-e45. http://dx.doi.org/10.1093/pch/pxy054.114.
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Abstract BACKGROUND Tuberculosis (TB) is a rare but potentially devastating infection among Canadian children. Accurate diagnosis and initiation of treatment are limited in part by the fact that it takes 2–6 weeks for culture results to be confirmed. Xpert MTB/RIF (Xpert) is a rapid, automated molecular assay that has been validated for diagnosing pulmonary but not extra-pulmonary TB in children. OBJECTIVES This was a retrospective study of children investigated for active TB at our facility in order to: 1.Outline demographic characteristics and describe clinical presentations of children diagnosed with active TB. 2.Compare performance of molecular testing (Xpert) to stain and Mycobacterium tuberculosis culture on pulmonary and extra-pulmonary specimens. DESIGN/METHODS We conducted a retrospective chart review of all paediatric patients investigated for active TB at our facility with stain, culture and molecular (Xpert) testing between January 2015 and August 2017. Due to a small number of patients, our data analysis was limited to narrative summary and descriptive statistics. RESULTS A total of 10 children were diagnosed with active TB, including 3 cases of pulmonary, 4 extra-pulmonary and 3 disseminated disease. Age range at diagnosis was 2 months to 16 years, with 3 children younger than 1 year. Most children contracted TB while travelling to and/or being exposed to an index case from endemic areas, including East Asia/Western Pacific (5), South Asia (2) and Africa (1). All children were HIV negative. Time from symptom onset to TB diagnosis and treatment ranged from approximately 4 days to 5 months. Multi-drug resistant TB was confirmed in 1 child. Sadly, 1 child passed away from TB related complications. AFB stain was positive on at least one specimen in 4/10 cases, cultures were positive in 8/10 and molecular testing (Xpert) in 7/10 cases. Time to positive cultures ranged from 10 to 35 days, with an average of 19 days. All cases positive on Xpert were also culture positive. Xpert test diagnosed TB in 5/6 of extra-pulmonary specimens submitted, including pericardial fluid, lymph node tissues and cerebrospinal fluid. CONCLUSION Many paediatric TB patients at our facility are children who have traveled to/have contacts from TB endemic regions, emphasizing the need for obtaining thorough exposure and travel history. Culture and molecular testing demonstrated similar TB detection rates, albeit based on a small patient population. While cultures remain the most reliable diagnostic method, molecular testing may facilitate rapid diagnosis and treatment of pulmonary and extra-pulmonary paediatric TB in a non-endemic setting.
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Spacek, Lisa A., Dana Higgins, and Kathleen Brady. "956. Delayed HIV diagnosis in Philadelphia." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S509. http://dx.doi.org/10.1093/ofid/ofaa439.1142.
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Abstract Background Ending the HIV Epidemic (EHE) requires prompt diagnosis and treatment of HIV to reduce transmission. Delayed HIV diagnosis and late entry into care remain challenging. Strategic deployment of testing resources may leverage both targeted and universal testing to accomplish the timely diagnosis of HIV infection. Methods We extracted data from the City of Philadelphia’s Enhanced HIV/AIDS Reporting System for 3,856 individuals diagnosed with HIV infection in Philadelphia, PA from 2012-2018, to determine characteristics associated with delayed diagnosis, defined as: AIDS diagnosed within 90 days of HIV or date of AIDS diagnosis prior to HIV diagnosis. Independent variables included: time since HIV diagnosis, age category, birth sex, current gender, race/ethnicity, transmission risk, insurance status, and receipt of care from Ryan White medical provider. We used Chi-square and multivariate logistic regression to assess factors associated with delayed diagnosis. Results From 2012 to 2018, the number of HIV diagnoses declined from 731 to 422; those with delayed diagnosis declined from 28% to 18%. Age category of 25-34 years comprised the majority of HIV diagnoses N=1402 (36%). The majority were: born male (78%), current gender male (76%), black (69%), MSM (51%), insured (54%), and participating in Ryan White care (71%). In multivariate regression, current gender male, heterosexual transmission, race/ethnicity Asian, American Indian, Alaska Native, or Multi-race, unknown insurance status, and receipt of care from a Ryan White medical provider were 3.7 (95%CI, 1.2-11.4), 1.3 (1.0-1.7), 1.8 (1.2-2.8), 5.9 (4.9-7.1), and 1.4 (1.2-1.7) times as likely to have delayed diagnosis, respectively, after adjustment for time since diagnosis, age category, and birth sex. Participants’ Characteristics and Logistic Regression Results Conclusion EHE will only be successful by reaching all people living with HIV and creating opportunities for early diagnosis. Routine opt-out universal screening combined with repeated, targeted testing will allow for identification and early treatment of HIV infection. As a medical care safety net, Ryan White program provides care to a disproportionate number of people with delayed diagnosis of HIV. By diagnosing HIV as early as possible, we may eliminate delayed diagnosis and reduce the risk of AIDS-related events or death. Disclosures All Authors: No reported disclosures
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Mohammed Alhassan, Hussaini, Saudetu Haruna Shinkafi, Ibrahim Yakubu, Hamisu Abdullahi, Ahmad Hamidu Marafa, Abdullahi Isiyaku, and Mustapha Umar Kalgo. "Profile of Hepatitis B Sero Markers Among Blood Donors Attending Usmanu Danfodiyo University Teaching Hospital, Sokoto-Nigeria." Journal of Biomedical Research & Environmental Sciences 2, no. 5 (May 2021): 412–17. http://dx.doi.org/10.37871/jbres1251.
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Introduction: Hepatitis B Virus (HBV) is a double-stranded circular DNA virus, it is one of the major blood transmissible infections. The prevalence of HBV is highest in sub-Saharan Africa and East Asia, where 5-20% of the adult population are infected. In Africa, up to 15 to 60% of the population are positive for at least one of the serological markers of HBV. This study aimed to determine the prevalence markers of HBV among prospective blood donors in Sokoto. Materials/methods: About 170 blood donors were randomly recruited into this research study and 5ml of blood was aseptically collected from each of the research participants, the sample was screened for Hepatitis B virus, using a rapid step-wise HBV-5 panel immunoassay of Combo Cassette Manufactured by Lusys Laboratories Inc U.S.A. The HBV-5 is capable of detecting HBsAg, HBsAb, HBeAg, HBeAb and HBcAb simultaneously. The test component was opened from the notch, and the device was removed, 2-3 drops (60-90µl) plasma sample was added into the sample wells in the device. The result was read within 15 minutes. Results: The prevalence rates of the markers are HBsAg 8(4.7%), HBeAg 1(0.6%), HBsAb 7(4.1%), HbeAb 8(4.7%), and HBcAb 9(5.3%). Donors aged (20-30) years had the highest prevalence rate of HBV infection compared to other age groups. Male blood donors had higher seropositivity for the five markers than their female counterpart. The prevalence of HBV markers was high among the First time donors (non-vaccinated donors) who have a higher prevalence than other donors (vaccinated donors). Conclusion: This study has shown that screening for HBsAg alone may not be sufficient for the diagnosis of hepatitis B virus infection, and thus other markers should be included in the routine screening.
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Utami, Sri, Anak Agung Sagung Sawitri, Luh Putu Lila Wulandari, I. wayan Gede Artawan Eka Putra, Putu Ayu Swandewi Astuti, Dewa Nyoman Wirawan, Louise Causer, and Bradley Mathers. "Mortality among people living with HIV on antiretroviral treatment in Bali, Indonesia: incidence and predictors." International Journal of STD & AIDS 28, no. 12 (February 15, 2017): 1199–207. http://dx.doi.org/10.1177/0956462417692942.
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Indonesia has the third highest number of people living with HIV/AIDS (PLWH) and the greatest increase in proportion of AIDS-related mortality in the Asia Pacific region between 2005 and 2013. Longitudinal mortality data among PLWH in Indonesia are limited. We conducted a retrospective cohort study from medical records of antiretroviral treatment (ART) recipients attending Badung General Hospital (BGH) and Bali Medica Clinic (BMC) between 2006 and 2014. We explored incidence of mortality by Kaplan–Meier analysis and identified predictors using a Cox proportional hazard model. In total, 575 patients were included in the analysis; the majority were male. The overall mortality rate was 10% per year. Multivariate analysis suggested that being male (adjusted hazard ratio [aHR]: 2.74; 95% confidence interval [CI]: 1.34–5.59), having a lower education (aHR: 2.17; 95%CI: 1.31–3.61), having heterosexual (aHR: 7.40; 95% CI: 2.61–21.00) or injecting drug use (aHR: 13.20; 95% CI: 3.17–55.00) as the likely transmission risk category, starting treatment with low CD4 cell counts (aHR: 3.18; 95% CI: 1.16–8.69), and not having a treatment supervisor (aHR: 4.02; 95% CI: 2.44–6.65) were independent predictors of mortality. The mortality was high, particularly in the first three months after initiating ART. These findings highlight the need to encourage HIV testing and early diagnosis and prompt treatment. Applying aspects of BMCs targeted HIV services model in more generalised services such as BGH may be beneficial. Providing adherence support as part of ART services is key to promoting adherence to ART.
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Al-khazraji, A., H. Alkhawam, and B. Garrido. "ID: 29: INVASIVE LIVER ABSCESS SYNDROME IN NORTH AMERICA." Journal of Investigative Medicine 64, no. 4 (March 22, 2016): 938.2–939. http://dx.doi.org/10.1136/jim-2016-000120.55.
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Case presentationThis is a 25 years old Pilipino male with no past medical history who presented with fever, rigors, fatigue and night sweats for 3 days. His symptoms progressively getting worse which made him seek medical attention. Patient travelled to Philippines five months ago which he stayed for a month.Upon presentation, patient was febrile with Temp 104 F and tachycardic 139 BPM, BP113/76. He appeared to be diaphoretic and tachypnic on physical exam. Abdomen was soft and non-tender, no hepatomegaly or splenomegaly on palpation.Pertinent laboratory findings included leukocytosis of 14,000 and bandemia 12, lactate of 3.6, Liver function tests – AST 62/ALT 61/ ALK 52 GGT 48 LDH 347 Total bilirubin 2.5 and direct Bilirubin 1.6 – Hepatitis serology revealed immunity against Hepatitis B (HBV). Coagulation panel and renal function were normal. Abdominal imaging revealed diffuse hepatic changes suggestive of cirrhosis and complex avascular slightly lobulated hypoechoic mass with mild posterior enhancement measuring 7.2×6.8 cm noted in the anteromedial portion of posterior segment of the right lobe (figure 1A and B).Further tests including HIV testing, urine analysis, blood and urine cultures, Echinococcosis and Amoebic serology were none revealing. Empirical broad spectrum antibiotics with 3rd generation cephalosporin and metronidazole for possible amoebic verus pyogenic liver abscess.After 3–4 days from admission date, he developed persistent rigors, tachycardia, and appeared to have respiratory distress which required an urgent intubation for acute respiratory failure and transferred to ICU. Urgent drainage attempted for pyogenic liver abscess. Abscess fluid culture was positive for Klebsiella pneumonia.Patient received an intravenous ceftriaxone 2 gm daily with continuous Jackson-Pratt liver drain suction for 3–4 weeks which was curative with resolution and decrease in the size of liver abscess on repeat imaging (figure 1c).DiscussionKlebsiella pneumoniae, a member of the Enterobacteriaceae family, is a pathogen with worldwide distribution. Most community-acquired Klebsilla pneumoniae infections cause pneumonia or urinary tract infections. Invasive liver abscess syndrome is very rare in western countries. For the past 2 decades, a distinct clinical syndrome has been emerging in Southeast Asia that is characterized by bacteremia, liver abscesses, and metastatic infections. In the past decade, few patients were diagnosed as having a liver abscess caused by K pneumoniae in two case series in the USA.Most community-acquired Klebsilla pneumoniae infections cause pneumonia or urinary tract infections. Invasive liver abscess syndrome is very rare in western countries. Clinicians should be aware about invasive klebsiella pneumonia liver abscess especially in patients with Asian background presented with liver abscess failed the treatment with antibiotics. Treatment of invasive klebsiella pneumonia liver abscess requires dual approach medical and surgical as we approached our patient which he subsequently improved after CT-guided liver abscess drainage and four weeks of antibiotics therapy.Abstract ID: 29 Figure 1
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Herath, Samantha, and Christopher Lewis. "Pulmonary involvement in patients presenting with extra-pulmonary tuberculosis: thinking beyond a normal chest x-ray." Journal of Primary Health Care 6, no. 1 (2014): 64. http://dx.doi.org/10.1071/hc14064.
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INTRODUCTION: Recognition of pulmonary involvement in extra-pulmonary tuberculosis (TB) may be an important public health issue, as smear-negative pulmonary TB is responsible for about 17% of new infections. Pulmonary TB can be present despite a normal chest x-ray (CXR), even in human immunodeficiency virus (HIV)negative patients. In this retrospective clinical audit, we reviewed a case series of HIV-negative patients with extra-pulmonary tuberculosis to identify the proportion with concurrent pulmonary TB despite an unremarkable CXR. METHODS: Clinical notes, microbiology results and CXR reports were reviewed from consecutive patients treated at Auckland City Hospital for extra-pulmonary TB from January 2007 to July 2010. RESULTS: Of the sample of 103 patients with extra-pulmonary TB, the majority of patients were born in an Asian country (n=70; 68%). The commonest presentation of extra-pulmonary TB was lymphadenopathy (n=51; 50%), followed by pleural (n=24; 23%) and bone (n=6; 6%) disease. Extra-pulmonary TB was diagnosed by biopsy or excision of the extra-pulmonary site in the majority (n=74; 72%), and by sputum testing alone in 26 (25%). The majority had CXR abnormalities (n=76; 74%). In the group with a normal CXR (n=27), 55% (n=15) had sputum cultures performed. In total, 18% (n=5) of patients with extra-pulmonary TB and a normal CXR had pulmonary TB, of whom two were smear positive. DISCUSSION: In patients with extra-pulmonary TB, sputum testing should be considered to detect concurrent pulmonary TB even if a CXR is normal, especially in immunosuppressed or symptomatic patients. This may aid diagnosis and determine infectivity and consequent public health action. KEYWORDS: Chest x-ray; sputum; tuberculosis; tuberculosis, pulmonary
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Wisniewski, Piotr, Evan C. Ewers, and Ryan C. Maves. "1179. Septic shock in Coccidioides immitis Infection." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S614—S615. http://dx.doi.org/10.1093/ofid/ofaa439.1365.
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Abstract Background Coccidiodes can cause severe or disseminated disease in a minority of patients, but coccidioidomycosis resulting in septic shock is rare. We describe a case of fulminant C. immitis infection whose diagnosis was delayed by a markedly elevated serum procalcitonin. We review the published literature of coccidioidomycosis complicated by septic shock. Case Report A 74-year-old man presented with cough, fever, and three weeks of progressive decline. He was febrile at 39.1°C, tachycardic, and tachypneic with crackles in the left lung; an initial procalcitonin (PCT) was 1.73 ng/mL. Broad-spectrum antibacterials were administered. His condition worsened on the 2nd day, requiring vasopressors, endotracheal intubation, and hemodialysis. PCT rose to > 400 ng/mL. Respiratory cultures grew fungi consistent with Coccidioides. Liposomal amphotericin B (AmB) was initiated. His shock progressed, and he died on hospital day 6. Methods We performed a MEDLINE and Google Scholar search using the terms “coccidioidomycosis”, “Coccidioides”, “sepsis”, and “septic shock”. Indexed articles and conference abstracts were included if the patient had confirmed coccidioidomycosis and vasopressor-dependent shock with no alternate cause. Data on age, sex, ethnicity, comorbidities, antifungal therapy, and outcome were tabulated. Results We identified 18 reports describing 31 patients with vasopressor-dependent septic shock due to Coccidioides since 1993 (table 1). Of these cases, 23/31 (74.2%) died. Of those with reported race/ethnicity, 20/23 were Latino, 4/23 of African descent, 5/23 Asian-Pacific Islander, and 3/23 white. 27/31 (87.1%) were male. All but two were adults (median age 51.5 years). 21/31 (67.7%) had reported comorbid conditions. 20/31 patients (64.5%) and all of the survivors received AmB-based therapy. Table 1 - Published cases of coccidioidomycosis complicated by septic shock. All ages are in years. Abbreviations: HIV/AIDS = human immunodeficiency virus/acquired immunodeficiency syndrome; CAD = coronary artery disease; COPD = chronic obstructive pulmonary disease; ESRD = End stage renal disease; SLE = Systemic Lupus Erythematosus; APC = recombinant human activated protein C (drotrecogin alfa). Conclusion Coccidioidomycosis is an elusive diagnosis in critically-ill patients due to its rarity, the lack of rapid diagnostics, and its propensity to mimic other infections. Mortality is high, potentially due to delays in diagnosis. The marked elevation in PCT has not been previously noted in coccidioidomycosis and may further confound diagnosis. Improved diagnostics and the rapid institution of AmB may reduce mortality in patients with coccidioidal sepsis. Disclosures All Authors: No reported disclosures
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Leumi, Steve, Jean Joel Bigna, Marie A. Amougou, Anderson Ngouo, Ulrich Flore Nyaga, and Jean Jacques Noubiap. "Global Burden of Hepatitis B Infection in People Living With Human Immunodeficiency Virus: A Systematic Review and Meta-analysis." Clinical Infectious Diseases 71, no. 11 (December 9, 2019): 2799–806. http://dx.doi.org/10.1093/cid/ciz1170.
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Abstract Background This meta-analysis was conducted to estimate the global burden of hepatitis B virus (HBV) infection in people living with human immunodeficiency virus (PLWH). Methods We searched multiple databases for studies published between January 1990 and December 2017. HBV infection (hepatitis B surface antigen) was diagnosed with serological assays. A random-effects meta-analysis served to pool data. Results We included 358 studies (834 544 PLWH from 87 countries). The pooled prevalence of HBV infection was 8.4% (95% confidence interval [CI], 7.9%–8.8%), among which 26.8% (95% CI, 22.0%–31.9%) was positive to hepatitis B e antigen. HBV prevalence (with 95% CIs) differed according to region: West and Central Africa, 12.4% (11.0%–13.8%); Middle East and North Africa, 9.9% (6.0%–14.6%); Asia and the Pacific, 9.8% (8.7%–11.0%); Eastern and Southern Africa, 7.4% (6.4%–8.4%); Western and Central Europe and North America, 6.0% (5.5%–6.7%); and Latin America and the Caribbean, 5.1% (4.2%–6.2%) (P < .0001). The prevalence decreased from 10.4% in low-developed to 6.6% in highly developed countries (P < .0001) and increased from 7.3% in countries with HIV prevalence ≤1% to 9.7% in countries with HIV prevalence >1% (P < .0001). Globally, we estimated that there were 3 136 500 (95% CI, 2 952 000–3 284 100) cases of HBV in PLWH, with 73.8% of estimated regional cases from sub-Saharan Africa and 17.1% from Asia and the Pacific. Conclusions This study suggests a high burden of HBV infection in PLWH, with disparities according to region, level of development, and country HIV prevalence.
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van Griensven, Frits, Jan Willem de Lind van Wijngaarden, Patrick Castillo Eustaquio, Stephen Wignall, Iskandar Azwa, Vanessa Veronese, Laurent Ferradini, Nittaya Phanuphak, and Stephen Mills. "The continuing HIV epidemic among men who have sex with men and transgender women in the ASEAN region: implications for HIV policy and service programming." Sexual Health 18, no. 1 (2021): 21. http://dx.doi.org/10.1071/sh20134.
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Men who have sex with men (MSM) in Western urban areas have seen substantive decreases in new diagnoses of HIV infection. This paper explores whether such declines are present among MSM and transgender women (TGW) in Southeast Asia and discusses implications for HIV policies and programming. A scoping review was conducted of scientific publications and selected documents regarding the spread of HIV infection among MSM and TGW in major urban centres of the Association of Southeast Asian Nations (ASEAN) region. Continued high HIV prevalence and incidence among MSM are found in integrated behavioural and biological surveillance (IBBS) and research studies. HIV prevalence among MSM under IBBS decreased only in Bangkok from 28.6% in 2014 to 10.3% in 2018, whereas it was increasing in Kuala Lumpur, Ho Chi Minh City, Vientiane, and Phnom Penh. HIV/AIDS case reports regarding new HIV infection diagnoses among MSM have started to decrease in Singapore since 2011 and have been plateauing in Metropolitan Manila since 2017. Where data were available, it was found that HIV prevalence among TGW was high and if IBBS was conducted, it was increasing. HIV prevalence among TGW under IBBS in Jakarta had risen to 34.0% (2015) and 14.0% (2019) in Phnom Penh. These findings suggest that most ASEAN member states have so far failed to effectively implement and scale-up scientifically proven biomedical HIV prevention measures and counter stigma and discrimination that impedes access to appropriate HIV prevention and treatment services for MSM and TGW.
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Cheng, Chieh-Lung, Erin Huang, Ming-Kai Chuang, Wen-Chien Chou, and Hwei-Fang Tien. "Hepatitis B Surface Antigen Positivity Is an Independent Unfavorable Prognostic Factor for Overall Survival in Patients with Diffuse Large B-Cell Lymphoma Treated with Standard Chemoimmunotherapy." Blood 132, Supplement 1 (November 29, 2018): 4235. http://dx.doi.org/10.1182/blood-2018-99-114982.
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Abstract Introduction Hepatitis B virus (HBV) is one of the most common viral infections in humans. Global prevalence of chronic HBV infection is heterogeneous, with 2-20% of a given population being infected with HBV. In some parts of Africa, Asia and South America, HBV infection is endemic and remains to be a significant public health issue.Previous studies have shown a positive association between hepatitis B surface antigen (HBsAg)-positive HBV infection and B-cell non-Hodgkin lymphoma (NHL), such as diffuse large B-cell lymphoma (DLBCL), the most common subtype of B-cell NHL. Nevertheless, the clinical characteristics of HBsAg positivity and negativity, as well as their prognostic implications in DLBCL patients treated with frontline standard chemoimmunotherapy remain to be clarified. Methods We conducted a single-institution retrospective study in a tertiary referral hospital in Taiwan, an HBV prevalent country in Asia. From January 2001 to December 2015, patients aged ≥20 years with newly diagnosed DLBCL treated with standard rituximab plus combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) were selected. Retrospective chart review was performed to collect data on clinical features, laboratory profiles, serum markers for HBV infection such as HBsAg and HBV-DNA loads before chemotherapy, as well as data on treatment response and outcome. The cohort was followed up until the cutoff date of June 30, 2018. Results A total of 393 DLBCL patients were analyzed in this study, with a median age of 60.5 years (range, 23.5 years to 90.9 years) and the sex ratio of 1.38 to 1.The 5-year overall survival (OS) rates were 65.2% after a median follow-up time of 68.8 months. In this cohort, 100 patients (25.4%) were found to have HBsAg positivity before treatment.Eighty-two of them had received prophylactic antiviral therapy, including 28 with lamivudine, 44 with entecavir and 10 with others. Besides, forty-five of HBsAg-positive patients had data of serum HBV-DNA loads before treatment, and 44 of them had received prophylactic anti-HBV therapy. Compared to HBsAg-negative patients, HBsAg-positive patients had a younger median onset age (55.9 years vs. 61.4 years, P=0.004), a trend of more advanced stage (stage III/IV: 62% vs. 51.2%, P=0.064), higher serum LDH levels at diagnosis (62% vs. 50.2%, P=0.048), and a trend of higher National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI) score (high-intermediate/high: 50% vs. 41.6%, P=0.162). Regarding to treatment response and outcome, HBsAg-positive patients, compared to HBsAg-negative patients, had a trend of lower overall response rates (78% vs. 84.3%, P=0.169) and complete remission rates (73% vs. 79.9%, P=0.163). Furthermore, compared to HBsAg-negative patients, HBsAg-positive patientshad a poorer median OS (median OS, not reached vs. 95.8 months, P=0.001, Figure 1) and a shorter median progression-free survival (PFS) (median PFS, not reached vs. 34.3 months, P=0.031), respectively. By multivariate analysis, HBsAg positivity is an independent poor prognostic factor for OS irrespective of NCCN-IPI score, serum albumin levels and B symptoms. No significant difference was found in outcome between patients with high HBV-DNA loads (> 2000 IU/mL, n=21) and those with low HBV-DNA loads (≤2000 IU/mL, n=24). With respect to prophylactic anti-HBV treatment, patients without prophylactic therapy (n=18), compared to those with prophylactic therapy (n=82), had a trend of shorter median OS (27.9 months vs. 96.2 months, P=0.346). Moreover, no significant difference was found in median OS between HBsAg-positive patients when administrated with anti-HBV lamivudine and those when administrated with anti-HBV entecavir. Conclusions This study demonstrated that HBsAg positivity has unique clinical relevance to patients with DLBCL, as well as its impact in the efficacy of treatment. HBsAg positivity may serve as a relevant biomarker to predict clinical outcome in DLBCL patients treated with R-CHOP. Prophylactic anti-HBV therapy may be of great importance in HBsAg-positive DLBCL patients. Further studies to explore the etiopathogenesis of HBV infection in DLBCL may help to discovery new treatment targets to improve the outcome of this group of patients. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.
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Assoumou, Sabrina A., Jianing Wang, Shayla Nolen, Golnaz Eftekhari Yazdi, Kenneth H. Mayer, Jon Puro, Joshua A. Salomon, and Benjamin P. Linas. "302. HCV Care in Federally Qualified Health Centers During the Opioid Epidemic: A Retrospective Cohort Study." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S163. http://dx.doi.org/10.1093/ofid/ofz360.375.
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Abstract Background Federally qualified health centers (FQHCs) serve diverse communities in the United States (US) and could function as important venues to manage hepatitis C virus (HCV) infections. Little is known on HCV outcomes in underserved communities as most of the current data are derived from clinical trials, commercially insured patients, or small health center samples. We aimed to determine the proportion of HCV testing, factors associated with treatment initiation, and real-world treatment outcomes in a large, national diverse sample of US FQHCs during the opioid epidemic. Methods We created a retrospective cohort of adults seen at 341 participating FQHCs in 19 US states. Inclusion criteria were: (1) clinical visit between January 01, 2012 and June 30, 2017; (2) ≥18 years of age. Outcomes included HCV testing proportion, stratified by diagnosis of opioid use disorder (OUD); treatment initiation rates; and sustained virologic response (SVR), defined as undetectable HCV RNA 3 months after treatment completion. We identified factors associated with testing, treatment initiation, and SVR using logistic regression. Results Of the 1,508,525 patients meeting inclusion criteria, 88,384 (5.9%) were tested for HCV, and 8,694 (9.8%) of individuals tested had reactive results. Of the 6,357 with HCV RNA testing, 4,092 (64.4%) had detectable RNA. Twelve percent of individuals with chronic HCV and evaluable data initiated treatment. Of those, 86% reached SVR. Having commercial insurance (aOR, 2.10, 95% CI, 1.45–3.02), older age (aOR, 1.07, 95% CI, 1.06–1.09) and being Hispanic/Latino (aOR, 1.35, 95% CI, 1.33–1.38) or Asian/Pacific Islander (aOR, 1.84, 95% CI, 1.79–1.90) were independently associated with higher odds of treatment initiation after multivariable adjustment. Only 8% of individuals with chronic HCV were tested for HIV, and 15% of individuals with identified OUD were tested for HCV. Conclusion During the opioid epidemic, fewer than 20% of individuals with identified OUD were tested for HCV at evaluated FQHCs. In addition, approximately 10% of patients initiated treatment and SVR was lower than expected. Expansion of HCV management into community clinics must consider measures to monitor and evaluate treatment effectiveness, and to improve outcomes if cure rates are low. Disclosures All authors: No reported disclosures.
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Pandey, Anita, Susan Ezemenari, Maksim Liaukovich, Ivan Richard, and Avezbakiyev Boris. "A Rare Case of Pembrolizumab-Induced Reactivation of Hepatitis B." Case Reports in Oncological Medicine 2018 (October 17, 2018): 1–3. http://dx.doi.org/10.1155/2018/5985131.
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Hepatitis B virus (HBV) infection is common across the world, especially in Asia, Africa, Southern Europe, and Latin America. The association of HBV infection in patients suffering from different oncological conditions is well established. Many cases of HBV reactivation have been reported in patients on immunosuppressive chemotherapy and in patients undergoing hematopoietic bone marrow transplantations. Only one case has been reported so far of HBV reactivation in a patient treated with programmed cell death receptor 1 (PD-1) checkpoint inhibitors in the setting of HIV status. We report a case of a 51-year-old male, former smoker, diagnosed with stage IV poorly differentiated adenocarcinoma of the lung, and started on pembrolizumab, who developed reactivation of chronic hepatitis requiring antiviral therapy.
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Peach, Elizabeth, Chris Lemoh, Mark Stoove, Paul Agius, Carol El Hayek, Nasra Higgins, and Margaret Hellard. "Aiming for 90–90–90 – the importance of understanding the risk factors for HIV exposure and advanced HIV infection in migrant populations and other groups who do not report male-to-male sex." Sexual Health 15, no. 5 (2018): 441. http://dx.doi.org/10.1071/sh17192.
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Background In Australia, new HIV diagnoses increasingly occur among people who do not report male-to-male sex. Among migrants, it is not clear what proportion acquired infection before migration. Similarly, among Australian-born people, it is not clear what proportion acquired infection in-country. There is a need to better understand the epidemiology of HIV in people who do not report male-to-male sex. Methods: Victorian public health surveillance data were used to classify migrants as having likely acquired HIV before or after arrival to Australia using a CD4 cell count decline method to estimate date of infection. Place of exposure for Australian-born people was estimated based on self-report. Factors associated with place of HIV acquisition, advanced infection and newly acquired infection were explored among migrants and among Australian-born people. Results: Between July 1996 and June 2014, there were 821 new non-MSM HIV diagnoses. Most (58%) were migrants, and of these, half (54%) were estimated to have acquired HIV before migration. Among Australian-born people, 27% reported exposure likely occurring abroad; the majority of these were men who reported exposure in South-East Asia. Advanced infection was common in migrants (45%) and Australian-born people (35%). Among migrants, birth in South-East Asia was associated with increased odds of advanced infection. Conclusion: These results highlight the potential vulnerability of migrants after arrival in Australia, especially those from South-East Asia and Sub-Saharan Africa, and that of Australian-born men travelling to these regions. Public health practice must be strengthened to meet prevention needs of these populations in line with Australian policy.
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Upadhyay Banskota, Shristi, Andres E. Mendez-Hernandez, Hafeez Shaka, Prasanth Lingamaneni, Binav Baral, Garima Pudasaini, and Maryam Zia. "Adult Hemophagocytic Lymphohistiocytosis(HLH): Experience of an Urban, Public Hospital over Two Decades." Blood 136, Supplement 1 (November 5, 2020): 19. http://dx.doi.org/10.1182/blood-2020-141947.
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Introduction:HLH is a rare, life-threatening disorder, characterized by hyperstimulation of immune system leading to systemic inflammation and multi-organ failure. It is categorized as primary and secondary HLH. Secondary HLH usually affects adolescents and adults. It results from acquired immune dysregulation secondary to a number of etiologies, including infections, malignancy, and autoimmune diseases. Owing to less epidemiological data, adult HLH is thought to be underdiagnosed, making a true assessment difficult, however, some observational data suggest 40% of HLH cases occurs in adults. Disease presentation includes fever, cytopenias, organomegaly, liver function anomalies, elevated ferritin levels, and/or demonstration of macrophage activation in hematopoietic organs. In 2014, Fardet et al proposed the H-Score, a novel diagnostic score derived from 162 adult patients with HLH.We aim to report a retrospective review of Adult HLH in an urban safety-net hospital over the course of two decades along with predictive value of H-score in our patient population. Methods:We conducted a retrospective review of patients diagnosed with HLH at Cook County Health, Chicago between January 2000 and January 2019 after approval by the Institutional Review Board. Patients were identified from electronic records using ICD-10 codes D76.1, D76.2, and ICD-9 code 288.4. Patients under 18 years were excluded. MS excel was used for data collection and further descriptive statistics were calculated with frequencies and percentage. Results:After initial review, 12 confirmed and eligible cases were included in the study. Mean age at diagnosis of adult HLH at our center was 37, with male predominance(7 males, 4 females, and 1 female transgender). 5 were African-American, 6 were Hispanic, and 1 was Asian. Most common presentation was fever, seen in 10 out of 12 cases, along with variety of symptoms like fatigue, sore throat and jaundice.4 out of 12 patients (33%) had HIV/AIDS, with CD4 counts between 79 to 180. 3 were already receiving anti-retroviral therapy at the time of HLH diagnosis, while 1 was diagnosed with HIV/AIDS at the time of HLH diagnosis. Etiologic spectrum mainly included infectious (4 HIV and 3 EBV) and autoimmune (2 systemic lupus erythematous, 1 cold immune hemolytic anemia with immune thrombocytopenic purpura) causes. 1 patient had an underlying malignancy (diffuse large B-cell lymphoma). Etiology was not established in 1patient with no familial associations found in subsequent genetic evaluation. All patients had elevated liver enzymes. The mean ferritin level in our cohort was 19,198 ng/ml. Leucopenia was seen among most cases, 11 out of 12. The 1 patient noted to have a high white cell count was actually receiving corticosteroid therapy for cold immune hemolytic anemia. Most common bone marrow findings were hemophagocytosis (9 patients) and hypocellularity (7 patients). 2 had hypercelullar marrow and 1 had normal marrow. Genetic testing was performed in 4 patients; chromosomal abnormalities were not observed in any. Specific lab parameters in our cohort as included in HLH-2004 criteria is shown in Table 1. Calculated H scores in our cohort is shown in table 2. 11 patients fall under high probability for HLH. Conclusion:The most widely used diagnostic criteria for HLH is the HLH-2004 diagnostic criteria, derived from pediatric HLH study. It is often extrapolated for use in adults. There are several limitations to the HLH-2004 diagnostic criteria. sIL2r and NK function testing is not available in all centers, and many of the manifestations of HLH in adults are not included in the criteria. When using H score, a cutoff value of 169, corresponds to sensitivity of 93% and specificity of 86% in diagnosing HLH. In our study, 11 out of 12 patients (91.66) scored higher than 169, which is highly suggestive of HLH. The remaining 1 patient with H score of only 118, however, met the diagnosis of HLH by HLH-2004 criteria (score: 5/8). Therefore, although our study population was small, results of our study were in favor of using H-score as an appropriate diagnostic tool in adult-onset HLH, which also helps mitigate the restrictions of HLH-2004 criteria in adult population. Disclosures No relevant conflicts of interest to declare.
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Wang, Chia-Ching J., Paige M. Bracci, and James L. Rubenstein. "Obesity and Hepatitis B Infection and Risk Of Primary CNS Lymphoma." Blood 122, no. 21 (November 15, 2013): 4298. http://dx.doi.org/10.1182/blood.v122.21.4298.4298.
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Abstract Introduction The incidence of primary central nervous system lymphoma (PCNSL) has markedly increased during the past three decades. Advanced HIV disease, as well as congenital and iatrogenic immunodeficiency states are the only established risk factors. While the incidence of PCNSL continues to rise among older patients (>60), the vast majority of newly-diagnosed PCNSL patients are not overtly immune suppressed. The goal of this study is to identify novel risk factors for PCNSL that may explain the continued rise in incidence among non-HIV infected, immunocompetent populations. Methods A cohort of 72 HIV-negative patients diagnosed with primary and secondary CNS lymphoma who received ambulatory follow-up evaluation at University of California at San Francisco between 2009-2013 were frequency-matched to Bay Area population-based controls by age-group, sex and race with 1:4 case:control ratio. We regarded HBsAg positivity at baseline as evidence of chronic HBV infection, and HBcAb positivity at baseline as prior HBV infection. Body mass index (BMI) was modeled as normal (reference,<25), overweight (25-30) and obese (30+). Multivariable unconditional logistic regression was used to compute odds ratios (OR) as estimates of relative risk. Models were adjusted for matching factors and statistical significance was based on a two-sided p<0.05. Having been born in a country with a high prevalence of HBV was assessed as a potential confounder. Results 64 patients with PCNSL were identified. Among these, 28 (44%) were male, 69% Caucasian, median age at diagnosis was 61.5 years, 6 (10%) died during the follow-up period, and 7 (11%) had intraocular involvement. HBV infection (chronic or prior) and increased BMI were independently associated with increased risk of PCNSL; HBV infection: OR=14.8 (5.0-44), p<0.0001; BMI: obese vs. normal, OR=2.8 (1.2-6.5), p for trend=0.04. There was no evidence of confounding and no statistical interaction between HBV and BMI (p=0.72). HCV positivity also was assessed but analysis was constrained as only 3 patients were HCV antibody positive (1 also HBV positive). Results from descriptive analyses of intraocular involvement provided some evidence that these PCNSL patients were more likely to have been born in a country with moderate/high HBV prevalence (chi-square p=0.006). Obese PCNSL patients were statistically significantly younger (median age 54) than other patients (overweight median age 64.5, normal 63). Interestingly the Asian patients were younger (median age 57) than Caucasian (median age 62). Hep B patients were older (median age 66) compared with non Hep B (median age 56) but the difference was not statistically significant. All PCNSL patients were treated with high dose methotrexate-based systemic chemotherapy. 37 (58%) were determined to be in complete remission at the end of the follow-up period. For B-cell PCNSL patients who were treated with high-dose methotrexate (n=55), those who were obese had improved progression-free survival (PFS) compared to non-obese (P<0.04; HR 0.3). In contrast, a history of hepatitis B infection was associated with shorter PFS (P=0.04; HR 2.7). Notably, the apparent risk factors of obesity and/or hepatitis B impact approximately half of the 55 non-HIV-infected PCNSL patients in this analysis. Conclusions We believe this to be the first report of associations among obesity, hepatitis B infection and PCNSL. These findings may partly explain the increasing incidence of this subtype of NHL. We hypothesize that both hepatitis B infection as well as obesity may each promote inflammatory states that contribute to CNS lymphomagenesis. Further studies are warranted to confirm these findings and to explore underlying mechanisms of pathogenesis. Supported by Leukemia and Lymphoma Society and NIH R01CA139-83-01A1. Disclosures: Rubenstein: Genentech: Research Funding; Celgene: Research Funding.
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Wang, Melinda, Sin How Lim, Britton A. Gibson, Iskandar Azwa, Thomas E. Guadamuz, Frederick L. Altice, Adeeba Kamarulzaman, and Jeffrey A. Wickersham. "Correlates of newly diagnosed HIV infection among cisgender women sex workers and transgender women sex workers in Greater Kuala Lumpur, Malaysia." International Journal of STD & AIDS 32, no. 7 (March 22, 2021): 609–19. http://dx.doi.org/10.1177/0956462420970417.
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Globally, cisgender women sex workers (CWSWs) and transgender women sex workers (TWSWs) experience increased vulnerabilities to HIV infection. Unfortunately, there is limited data on the drivers of HIV infection in these two understudied populations, particularly in Southeast Asia. To better understand factors associated with HIV infection, we evaluated correlates of newly diagnosed HIV infection in these two populations in Greater Kuala Lumpur, Malaysia. A total of 469 women (CWSW: n = 283; TWSW: n = 186) were included in this study. Most participants who tested HIV+ were unaware of their infection (59.6%; n = 34/57). Separate binary and multivariable logistic regressions were conducted to identify correlates of newly diagnosed HIV in CWSWs and TWSWs. Among CWSWs, Chlamydia trachomatis (aOR = 5.66; p = 0.007) and lifetime use of ecstasy/MDMA (aOR = 5.34; p = 0.03) were associated with newly diagnosed HIV, while condomless vaginal sex with clients was associated with lower likelihood of HIV infection (aOR = 0.98; p = 0.01). Among TWSWs, being single (aOR = 6.76; p = 0.03), using mobile application to solicit clients (aOR = 25.33; p = 0.006), and having C. trachomatis infection (aOR = 88.22, p = 0.02) were associated with newly diagnosed HIV. Expansion of HIV/sexually transmitted infection screening is needed to increase detection of HIV and linkage to care for sex workers. Interventions to reduce HIV infection among CWSWs and TWSWs should be tailored to these populations’ unique vulnerabilities.
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Tan, Wu Meng, Soo Yong Tan, Tat Ming Ng, Summer Pan, Richard Hong Hui Quek, Miriam Tao, Wai Meng David Tai, et al. "AIDS-related lymphoma (ARL) in Asians in the era of HAART and rituximab." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e18546-e18546. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e18546.
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e18546 Background: We described EBV & HHV8 co-infection rates, histology subtypes (particularly T-cell), prognosticators and outcomes of Asian ARL and compared them to Western series. Methods: We studied clinicopathologic features of 46 HAART-era ARL diagnosed from 1998-2011 in an Asian Tertiary Cancer Centre. To study HIV effect on survival, we applied multivariate analysis to HIV-DLBCL matched against 453 de novo DLBCL from 2000-2008. Results: The 46 patients’ characteristics are presented in the table below. Of note, germinal centre B-cell (GCB) subtype predominated in HIV-DLBCL with evaluable tissue. In multivariate analysis of HIV-DLBCL and matched de novo DLBCL, HIV status did not predict survival (HR1.33, p=0.63); CR was the only significant prognosticator (HR0.30, p=0.048). Conclusions: 1. EBV+ rates appeared to surpass prior Western ARL series. Although concomitant EBV infection appeared to correlate with inferior survival (HR34.5), it was not statistically significant. 2. Alb<30 (p=0.02) & Hb<10 (p=0.003) significantly predicted worse OS, but not CD4 or concurrent HIV&ARL diagnosis. 3. In this predominantly EPOCH-treated population, BL (HR 2.27) non-significantly trended to worse OS than DLBCL. 4. T-cell ARL (2/46, 4%) was rarer than the expected Asian de novo rate. 5. In multivariate analysis, HIV-DLBCL OS was similar to matched de novo DLBCL, suggesting they should be similarly treated with curative intent. CR rates and 5yr OS were comparable to de novo DLBCL. [Table: see text]
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Tajima, Katsushi. "High Incidence of Hepatitis B or C Virus Infection in Lymphoma." Blood 114, no. 22 (November 20, 2009): 3934. http://dx.doi.org/10.1182/blood.v114.22.3934.3934.
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Abstract Abstract 3934 Poster Board III-870 Introduction In lymphoma, several reports from different countries have shown that patients with lymphoma have a higher prevalence of HCV or HBV infection. The infection rates were very different even in virus endemic areas as Asia-Pacific countries including Japan. However, an association between virus infection and lymphoma should be evaluated and discussed with the background of virus prevalence in the community. This study aimed to investigate the prevalence of HBV or HCV infection status in lymphoma patients in Tohoku distinct in Japan. Patients and Methods The study, designed by the Tohoku Hematology Forum Group, was conducted in 9 clinical centers in Tohoku Distinct in Japan. This study included 1331 newly diagnosed consecutive series of lymphoma patients admitted in Tohoku Hematology Forum Group Hospital (Japan) and 848 non-lymphoma control patients enrolled from January 2005 to October 2008. We evaluated the prevalence of HBV (as indicated by hepatitis B surface antigen) or HCV infection in both group patients and compared the clinic-pathological characteristics of HBV- or HCV-positive and its negative lymphoma cases. Results The carrier rate of HBsAg was higher in lymphoma patients (57 of 1331, 4.3%) than control group (1.7%, p <0.001) The higher prevalence was observed in both sexes and especially diffuse large B cell lymphoma. Compared with HBV negative lymphoma group, the positive group displayed more liver or spleen involvement (p=0.002). The rate of HCV infection was higher than those in control group In HCV-infected case, more liver involvement was indicated (p<0.004). No difference in HBV or HCV prevalence was found between B-cell and T/NK-cell lymphoma. Conclusions The present study, so far the largest trial of incidence of HBV or HCV infection in lymphoma patients, demonstrated that patients with lymphoma in Japan had higher prevalence of HBV and HCV infection. These appears to be a possible role for HBV or HCV in the induction of malignant transformation, resulting in the development of lymphoma. However, the precise role of HBV or HCV in the pathogenesis of lymphoma remains to be elucidated and warrants further research. Disclosures: No relevant conflicts of interest to declare.