Clinical Infectious Diseases最新文献

{"title":"Antiretroviral Therapy within Two Years of HIV Acquisition is Associated with Fewer Viral Blips: A Retrospective Analysis of Over 20 Years of Data from the U.S. Military HIV Natural History Study.","authors":"Trevor A Crowell, Hsing-Chuan Hsieh, Xun Wang, Xiuping Chu, Britt Gayle, Catherine M Berjohn, Jason M Blaylock, Joseph M Yabes, Derek T Larson, John H Powers, Robert J O'Connell, Anuradha Ganesan, Brian K Agan","doi":"10.1093/cid/ciaf103","DOIUrl":"https://doi.org/10.1093/cid/ciaf103","url":null,"abstract":"<p><strong>Introduction: </strong>Viral blips have been associated with larger reservoir size and slower decay. Earlier antiretroviral therapy (ART) initiation may decrease the risk of blips.</p><p><strong>Methods: </strong>We analyzed participants from the U.S. Military HIV Natural History Study with an estimated HIV seroconversion date, viral suppression ≤400 copies/mL within 1 year after starting ART, and at least 3 HIV RNA measurements after suppression. A blip was HIV RNA 401-1000 copies/mL preceded and followed by HIV RNA ≤400 copies/mL without changing ART. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for factors potentially associated with the time from viral suppression to first blip.</p><p><strong>Results: </strong>From 1996-2022, 1,413 participants on stable suppressive ART had a median age at HIV diagnosis of 29.2 years (interquartile range 24.9-35.4) and 1361 (96.3%) were males. Viral blips were observed in 88 (6.2%) participants, 68 (77.3%) of whom had a single blip. The overall incidence was 1.2 blips per 100 person-years (95% CI 0.9-1.4). In multivariable modeling, ART initiation within 24 months of estimated HIV acquisition was independently associated with decreased hazard of viral blips as compared to ART initiation after more than 24 months (0-6 months HR 0.29 [95% CI 0.18-0.48]; 6-12 months HR 0.43 [95% CI 0.31-0.59]; 12-24 months HR 0.46 [95% CI 0.35-0.60]).</p><p><strong>Conclusions: </strong>Participants who initiated ART within two years of HIV acquisition had lower hazard of blips, potentially reflecting smaller reservoir size and suggesting reservoir plasticity that extends beyond the acute phase of HIV.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the role of cytomegalovirus as a cause of stillbirths and child deaths in low and middle-income countries through postmortem minimally invasive tissue sampling.","authors":"Sithembiso Velaphi, Zachary J Madewell, Beth Tippett-Barr, Dianna M Blau, Emily A Rogena, Sanjay G Lala, Sana Mahtab, Peter J Swart, Victor Akelo, Dickens Onyango, Kephas Otieno, Emily A Rogena, Joyce A Were, Quique Bassat, Carla Carrilho, Inacio Mandomando, David Torres-Fernandez, Rosauro Varo, Ronita Luke, Francis Moses, Philip Nwajiobi-Princewill, Ikechukwu Udo Ogbuanu, Julius Ojulong, Shams El Arifeen, Emily S Gurley, Nega Assefa, Letta Gedefa, Lola Madrid, J Anthony G Scott, Henok Wale, Jane Juma, Adama Mamby Keita, Karen L Kotloff, Samba O Sow, Milagritos D Tapia, Portia Mutevedzi, Cynthia G Whitney, Shabir A Madhi","doi":"10.1093/cid/ciaf098","DOIUrl":"https://doi.org/10.1093/cid/ciaf098","url":null,"abstract":"<p><strong>Background: </strong>There is paucity of information on the role of cytomegalovirus (CMV) infection as a cause of stillbirths or childhood deaths in low-and middle-income countries (LMICs). We investigated attribution of CMV-disease in the causal pathway to stillbirths and deaths in children <5 years of age in seven LMICs participating in the Child Health and Mortality Prevention Surveillance (CHAMPS) network.</p><p><strong>Methods: </strong>We analyzed stillbirths and decedents enrolled between December 2016 and July 2023. Deaths were investigated using post-mortem minimally invasive tissue sampling with histopathology and molecular diagnostic investigations of tissues and body fluids, along with review of clinical records. Multi-disciplinary expert panels reviewed findings and reported on the causal pathway to death.</p><p><strong>Results: </strong>CMV was detected in 19.5%(1140/5841) of all evaluated deaths, including 5.0% (111/2204), 6.2% (139/2229), 41.2% (107/260), 68.1%(323/474) and 68.2%(460/674) of stillbirths, neonates (deaths 0-<28 days postnatal), young infants (28-<90 days), older infants (90-<365 days) and children (12-<60 months), respectively. CMV-disease was attributed in the causal pathway to death in 0.9%(20/2204) of stillbirths, 0.8%(17/2229) of neonates, 13.1% (34/260) of young infants, 9.7%(46/474) of older infants and 3.3%(22/674) of children. Decedents with CMV-disease compared with those without CMV-disease in the causal pathway, were more likely to have severe microcephaly (38.2% vs. 21.1%; aOR 2.2, 95%CI: 1.3-3.6) and HIV-infected (36.9% vs. 6.2%; aOR: 10.9, 95%CI: 6.5-18.5).</p><p><strong>Conclusions: </strong>CMV-disease is an important contributor to deaths during infancy and childhood and is often associated with severe microcephaly and HIV-infection. Improving management of CMV in HIV-infected children and a vaccine to prevent CMV are needed interventions.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of influenza antiviral prophylaxis for long-term care residents: a systematic review and meta-analysis","authors":"Ryan Hanula, Jessica Glugosh, Elise Van Leer, Émilie Bortolussi-Courval, Connor Prosty","doi":"10.1093/cid/ciaf101","DOIUrl":"https://doi.org/10.1093/cid/ciaf101","url":null,"abstract":"Background Influenza is a pervasive respiratory infection which disproportionately burdens long-term care residents. To limit outbreaks, guidelines recommend antiviral prophylaxis, particularly oseltamivir or zanamivir, despite acknowledging the inadequate supporting evidence. Therefore, we aimed to review the literature on the efficacy of oseltamivir, zanamivir, and baloxavir prophylaxis for influenza in long-term care. Methods Medline, Embase, PubMed, and several other databases were searched from inception to August 16, 2023. For inclusion, observational studies or randomized controlled trials (RCTs) had to report influenza-like illness (ILI) or infection rates amongst adult long-term care populations receiving prophylaxis. Outcome values were meta-analyzed as intervention-specific pooled proportions (PPs) and risk ratios (RRs) when applicable. Risk of bias was assessed via the Cochrane risk of bias tool 2.0 and Joanna Briggs Institute checklist. Results In total, 14 studies were included, comprising 12,672 residents. Individuals given oseltamivir or zanamivir experienced the fewest symptomatic, test-confirmed infections (oseltamivir PP: 0.7%, 95%CI: 0.1-4.7%, zanamivir PP: 3.0%, 95%CI: 0.9-9.4%) and ILIs (oseltamivir PP: 2.8%, 95%CI: 1.8-4.3%, zanamivir PP: 3.4%, 95%CI: 1.3-7.2%). However, no significant statistical differences were detected versus most other interventions (ILI PP range: 4.5-6.4%, infection PP range: 4.6-7.9%). Similarly, in studies directly comparing either antiviral to placebo, there were no associated benefits despite every RR being below 1 (0.51-0.75) due to expansive 95%CIs. Conclusions Oseltamivir or zanamivir could provide some benefit but low statistical power behind most estimates precluded definitive conclusions. Therefore, additional studies (RCTs) are needed to expand the evidence base and validate whether prophylaxis is beneficial in this setting.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"53 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143576238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decline of community-acquired alveolar pneumonia positive for respiratory syncytial virus in hospitalized children following implementation of PCV in Israel.","authors":"Ron Dagan, Bart Adriaan van der Beek, Tal Grupel, David Greenberg, Ayelet Keren-Naus, Shalom Ben-Shimol, Daniel M Weinberger","doi":"10.1093/cid/ciaf102","DOIUrl":"https://doi.org/10.1093/cid/ciaf102","url":null,"abstract":"<p><strong>Background: </strong>We assessed the impact of pneumococcal conjugate vaccine (PCV) implementation on respiratory syncytial virus-positive community-acquired alveolar pneumonia (RSV-CAAP) in young children in southern Israel.</p><p><strong>Methods: </strong>This study was nested within a prospective population-based active surveillance system during 2004-2019. All children <60 months residing in the region and served by the region's only hospital were included. A negative binomial regression model was used to evaluate the impact of PCV on the incidence of all-cause CAAP and RSV-CAAP and was the basis for estimating averted episodes.</p><p><strong>Results: </strong>7,640 all-cause CAAP episodes were observed; 50% were tested for RSV, of which 42% were positive. Shortly after PCV13 implementation, all-cause CAAP and RSV-CAAP rates markedly declined, stabilizing within 3-4 years. The mean annual hospitalization rates for all-cause CAAP and RSV-CAAP declined by 47% (95% CI: 40%; 53%) and 29% (95% CI: -2%; 51%), respectively, during the late-PCV period, compared with the expected rates. This translated to a reduction in the mean annual incidence of 3.73 cases of all-cause CAAP/1,000 children (95% CI: 2.98;4.58) and 0.50 cases of RSV-CAAP per 1,000 children (95% CI: -0.05;1.13). The highest incidences of averted cases occurred in children aged 12-23 months.</p><p><strong>Conclusions: </strong>The observed dynamics of hospitalizations due to all-cause CAAP and RSV-CAAP following PCV implementation are consistent with the notion of a synergistic role of RSV and pneumococcus in CAAP in young children.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dolutegravir/Lamivudine for Maintenance of Virological Suppression in Persons with Historical Suspected or Confirmed Resistance to Lamivudine: Week 48 Results of a Single-Arm, Open-Label, Multicentre, Phase IIA Clinical Trial.","authors":"Rosa De Miguel, María de Lagarde Sebastian, José Luis Blanco Arévalo, Adriana Pinto-Martinez, Rocío Montejano, Angela Gutiérrez Liarte, Roser Navarro-Soler, Esperanza Cañas-Ruano, Alexis Inciarte, Luz Martin-Carbonero, Arkaitz Imaz, Cristina Hernández Gutiérrez, Antonio Ocampo, Pedro Gil Divasson, Rafael Delgado, Federico Pulido, Jose R Arribas","doi":"10.1093/cid/ciaf100","DOIUrl":"https://doi.org/10.1093/cid/ciaf100","url":null,"abstract":"<p><strong>Background: </strong>We investigated the efficacy of dolutegravir/lamivudine for maintenance treatment for people with HIV and previous lamivudine resistance.</p><p><strong>Methods: </strong>Open-label, single arm, multicentric clinical trial including virologically suppressed PWH with historical lamivudine resistance (confirmed by genotypic testing or suspected based on clinical history), no integrase resistance and CD4+ >200 cells/mm3 whose ART was changed to dolutegravir/lamivudine if the M184V/I mutation was not detected in baseline proviral DNA population sequencing. Proviral DNA next-generation sequencing (NGS) was retrospectively performed in baseline samples. Primary endpoint was proportion of participants with HIV-1 RNA viral load (VL) ≥50 copies/mL at 48 weeks in the intention-to-treat-exposed (ITT-e) population using the Food and Drug Administration snapshot algorithm.</p><p><strong>Results: </strong>121 participants enrolled, 114 with a prior genotype with M184V/I, mean virological suppression of 9 years. 24 (19·8%) had the M184V/I in baseline proviral DNA NGS (>5% threshold). At 48 weeks, 4 participants had a VL ≥50 copies/mL (3·3%, 95% CI: 0·9%-8·2%, FDA-Snapshot ITT-e): 1 confirmed virologic withdrawal, 1 precautionary virologic withdrawal and 2 discontinued from study treatment for other reasons with last VL ≥ 50 copies/mL; none had M184V/I in baseline proviral DNA NGS and there was no emergent integrase resistance. 90·1% participants (109/121) had a VL<50 copies/mL (95% CI: 83·3%-94·8%) and there were no data for 6·6 % (8/121 participants) at 48 weeks.</p><p><strong>Conclusions: </strong>After excluding lamivudine mutations in proviral DNA by population sequencing, dolutegravir/lamivudine effectively maintained virological suppression in PWH with CD4+ >200 cells/mm3 and history of lamivudine resistance. Notably, no treatment-emergent resistance was observed.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are We Being Gaslit? A Primer for Recognizing Corporate Jargon to Overcome Gaslighting for the Infectious Disease Workforce.","authors":"Gonzalo Bearman, Priya Nori","doi":"10.1093/cid/ciaf097","DOIUrl":"https://doi.org/10.1093/cid/ciaf097","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Definitions in Encephalitis.","authors":"Ralph Habis, Anna Kolchinski, Ashley N Heck, Paris Bean, John C Probasco, Rodrigo Hasbun, Arun Venkatesan","doi":"10.1093/cid/ciaf099","DOIUrl":"https://doi.org/10.1093/cid/ciaf099","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low diagnostic accuracy of encephalitis criteria hinders interpretation of the absence of CSF pleiocytosis.","authors":"Steven L Staal, Sabine E Olie, Diederik van de Beek, Matthijs C Brouwer","doi":"10.1093/cid/ciaf096","DOIUrl":"https://doi.org/10.1093/cid/ciaf096","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of electrocautery, topical cidofovir and topical sinecatechins for the Treatment of Anal High-grade Squamous Intraepithelial Lesions in Persons with HIV: an open-label, randomized controlled trial","authors":"Joaquin Burgos, Adrià Curran, Jorge Garcia, David Campany, Vicente Descalzo, Paula Suanzes, Jordi Navarro, Bibiana Planas, Marta Sanchiz, Stefania Landolfi, Carme Dinares, Javier Hernádez-Losa, Vicenç Falcó","doi":"10.1093/cid/ciaf086","DOIUrl":"https://doi.org/10.1093/cid/ciaf086","url":null,"abstract":"Background Doubts remain about the best treatment for managing premalignant lesions (HSIL) associated with anal cancer. Methods The TREATAIN trial was an open-label, randomized study conducted at Hospital Vall d’Hebron (Spain). Persons with HIV and anal HSIL were randomly assigned 1:1:1 to receive treatment with electrocautery, topical cidofovir 1% ointment, or topical sinecatechins 10%. The primary outcome was histological resolution of HSIL. Secondary outcomes included adverse events, participant satisfaction, HPV clearance, and HSIL recurrence. EudraCT: 2018-001730-18. ClinicalTrials.gov: NCT04055142. Results Between October 2020 and November 2022, 100 participants were enrolled (36 in the electrocautery arm, 28 in cidofovir arm, and 36 in the sinecatechins arm). Modified intention-to-treat analysis showed a response rate of 69·4% [95% CI; 54·4-84·5] of patients in the electrocautery group, 82·1% [95% CI; 67·9-96·3] in the cidofovir group, and 61·1% [95% CI; 45·2-77] in the sinecatechins group (p=0.189). During the 48-weeks follow-up period, recurrence was observed in 7 participants (28%) in the electrocautery group, 7 (30·4%) in the cidofovir group, and 8 (36·4%) in the sinecatechins group (Log-rank test p=0·811). Side effects were reported by 97·2% of patients in the electrocautery group, 85·7% in the cidofovir group, and 33% in the sinecatechins group (p&amp;lt;0·001). Patients were more satisfied with the sinecatechins treatment (5·6 ± 0·4), followed by electrocautery (5·1 ± 0·8), while lower satisfaction was reported with cidofovir treatment (4·77 ± 0·96), p&amp;lt;0.001. Conclusion No statistically significant difference was observed in efficacy between treatments; in contrast, sinecatechins was the most accepted and well-tolerated treatment.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"59 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143547075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tuberculosis preventive treatment for household contacts at health facility and community settings in Pakistan","authors":"Maria R Jaswal, Leonardo Martinez, Meredith Brooks, Saira Farooq, Nauman Safdar, Jinsar Ali Shah, Zafar Islam, Kumail Nasir, Usama Fareed, Shadab Manzar, Rabia Maniar, Sara Siddiqui, Saira Khowaja, Aamir J Khan, Hamidah Hussain, Amyn A Malik","doi":"10.1093/cid/ciaf088","DOIUrl":"https://doi.org/10.1093/cid/ciaf088","url":null,"abstract":"We assessed incremental completion of tuberculosis preventive treatment cascade in household contacts by offering services in community settings. This improved clinical evaluation by 12.4 (95% CI:11.7–13.0) percentage points (pp), treatment completion by 11.6 (95% CI: 10.6–12.7) pp, and cascade completion by 5.9 (95% CI: 5.1–6.7) pp.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"32 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143546622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}