Open Forum Infectious Diseases最新文献

{"title":"Carbapenemase-Producing <i>Enterobacteriaceae</i> Colonization and the Risk of Carbapenemase-Producing <i>Enterobacteriaceae</i> Bacteremia in Hematopoietic Stem Cell Transplant Recipients.","authors":"Sung-Woon Kang, So Yun Lim, Euijin Chang, Jiwon Jung, Yong Pil Chong, Hyunkyung Park, Han-Seung Park, Yunsuk Choi, Jung-Hee Lee, Je-Hwan Lee, Sung-Han Kim","doi":"10.1093/ofid/ofaf516","DOIUrl":"10.1093/ofid/ofaf516","url":null,"abstract":"<p><strong>Background: </strong>Carbapenemase-producing <i>Enterobacteriaceae</i> (CPE) are globally concerning pathogens due to limited therapeutic options. Despite the increasing incidence of CPE infections, evidence supporting effective empirical treatments for individuals undergoing hematopoietic stem cell transplantation (HSCT) remains limited.</p><p><strong>Methods: </strong>From January 2019 to December 2023, individuals undergoing HSCT screened for CPE colonization via perianal swabs upon admission before HSCT were retrospectively analyzed. Culture-based identification and carbapenemase-specific polymerase chain reaction were performed. The occurrence of <i>Enterobacteriaceae</i> bacteremia within 100 days post-HSCT was monitored. Propensity-score (PS) matching and competing risk analyses were used to evaluate the relationship between CPE colonization and bacteremia risk.</p><p><strong>Results: </strong>Among 649 patients undergoing HSCT, 70 (11%) were colonized with CPE. <i>Enterobacteriaceae</i> bacteremia occurred in 20 (29%) CPE-colonized and 56 (10%) noncolonized individuals (<i>P</i> < .001). Among these cases, 17/20 (85%) in the colonized group and 12/56 (21%) in the noncolonized group were caused by CPE (<i>P</i> < .001). After 1:2 PS matching, these rates remained consistent (85% vs 22%, <i>P</i> = .004). All CPE isolates recovered from blood were identical in species and carbapenemase type to those detected in pre-HSCT swabs. Competing risk analyses showed that pre-HSCT CPE colonization was significantly associated with CPE bacteremia (subdistribution hazard ratio [sHR] 13.1, 95% confidence interval [CI] 6.27-27.3, <i>P</i> < .001; after matching: sHR 19.1, 95% CI 4.42-82.20, <i>P</i> < .001).</p><p><strong>Conclusions: </strong>Pre-HSCT CPE colonization increases <i>Enterobacteriaceae</i> bacteremia risk. Routine screening and empirical CPE-directed therapy are essential to improving clinical outcomes.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 9","pages":"ofaf516"},"PeriodicalIF":3.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV Oral Pre-exposure Prophylaxis Effectiveness, Adherence, and Discontinuation in an Italian Multicentric Access Program: ItaPrEP Study.","authors":"Valentina Mazzotta, Enrico Caruso, Alessandro Tavelli, Rozenn Esvan, Simone Lanini, Giulia Micheli, Davide Moschese, Anna De Bona, Sandro Mattioli, Daniele Calzavara, Federico De Zottis, Daniele Tesoro, Lorenzo Badia, Silvia Nozza, Antonella Cingolani, Alessandra Bianchi, Rita Bellagamba, Salvatore Cecere, Alessandro Giacinta, Nicoletta Frattini, Alessandra Oliva, Roberto Repossi, Roberto Rossotti, Marco Ridolfi, Claudio Maria Mastroianni, Carlo Torti, Giulia Marchetti, Antonella Castagna, Antonella d'Arminio Monforte, Massimo Cernuschi, Andrea Antinori","doi":"10.1093/ofid/ofaf539","DOIUrl":"10.1093/ofid/ofaf539","url":null,"abstract":"<p><strong>Background: </strong>Italian oral pre-exposure prophylaxis (PrEP) implementation faced challenges until the drug reimbursement approval in 2023. National real-life data on effectiveness are lacking. This study aimed to report incidence rates (IR) of HIV and other sexually transmitted infections (STIs), along with probabilities and predictors of poor adherence and PrEP discontinuation.</p><p><strong>Methods: </strong>Prospective national cohort study (ItaPrEP) on oral PrEP users (PrUs) in eight Italian centers (September 2017-November 2023) that could partially provide free drug supplies. IRs of HIV and STIs, and Kaplan-Meier estimated probabilities of poor adherence and discontinuation were evaluated. Mixed-effect logistic models with random intercept on the center were used to explore the association between risk factors and poor adherence and discontinuation.</p><p><strong>Results: </strong>About 1758 PrUs were included, 98% MSM; five HIV seroconversions were observed with an IR 0.187/100 person-year follow-up (PYFU; 95% CI: 0.061-0.436). IR/100 PYFU were 13.1 (95%CI:11.7-14.5) for syphilis, 23.8 (95% CI: 22-25.7) for chlamydia, and 24.2 (95% CI: 22.4-26.1) for gonorrhea. The 2-year probability of poor adherence and discontinuation was 57.9% (95% CI: 54.8-61.0) and 37.1% (95% CI: 34.3-40.1), respectively.Chemsex and switching schedule were associated with poor adherence, unlike a high educational level. Age >40 years, free drug supplies, and laboratory monitoring were associated with a lower risk of discontinuation, while chemsex was associated with a higher risk.</p><p><strong>Conclusions: </strong>In this Italian oral PrEP program, the HIV incidence was lower than that observed in pivotal clinical trials in high-risk populations and close to that of observational real-life studies. Identifying fragile groups (youngest, low educational level, and chemsex users) and addressing barriers (free drugs and monitoring) are key to targeting strategies to improve oral PrEP implementation.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 9","pages":"ofaf539"},"PeriodicalIF":3.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethnic Disparities in Extrahepatic Manifestations Among People With HCV Infection: A Population-Based Study in British Columbia.","authors":"Dahn Jeong, Stanley Wong, Héctor A Velásquez García, Prince A Adu, Jean D Makuza, Sofia R Bartlett, Alnoor Ramji, Eric M Yoshida, Richard L Morrow, Amee R Manges, Mohammad E Karim, Amanda Yu, Georgine Cua, Mel Krajden, Naveed Z Janjua","doi":"10.1093/ofid/ofaf543","DOIUrl":"10.1093/ofid/ofaf543","url":null,"abstract":"<p><strong>Background: </strong>Ethnic disparities in extrahepatic manifestations (EHMs) among individuals with chronic hepatitis C virus (HCV) infection are poorly understood, especially in diverse populations. We aimed to examine ethnic disparities in EHMs among individuals diagnosed with HCV in British Columbia (BC), Canada.</p><p><strong>Methods: </strong>Using linked administrative health data from the BC Hepatitis Testers Cohort (1990-2015), we assessed EHMs incidence and risk by ethnicity (East Asian, South Asian, and Other) across 4 groups: individuals who remained untreated, pre-HCV treatment completion, post-HCV treatment completion, and those who spontaneously cleared HCV. EHMs included chronic kidney diseases (CKDs) and end-stage renal diseases (ESRDs), type 2 diabetes (T2DM), stroke, major adverse cardiac events (MACEs), and neurocognitive disorders. To assess the risk of EHMs by ethnicity, we used multivariable cause-specific proportional hazards models.</p><p><strong>Results: </strong>Among 41 874 individuals, South and East Asians had higher incidence rates of CKD and ESRD, T2DM, stroke, and MACE compared with other ethnicities, particularly among untreated individuals. Adjusted analyses showed that untreated South Asians had significantly higher risk of CKD and ESRD (adjusted hazard ratio [aHR] 1.27, 95% confidence interval [CI] 1.02-2.16) and T2DM (aHR 2.12, 95% CI 1.53-2.94). Following HCV treatment, these disparities largely disappeared except for diabetes.</p><p><strong>Conclusions: </strong>This study highlights the disproportionate burden of EHMs among Asians in BC and underscores the potential of HCV treatment to reduce ethnic disparities. Public health programming is needed to increase linkage to HCV treatment among those who remain untreated. Further research should focus on intra-ethnic differences and mechanisms underlying the impact of HCV treatment on mitigating these disparities.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 9","pages":"ofaf543"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Comprehensive Program for the Early Diagnosis and Treatment of Severe Infections in a Tertiary Hospital in Spain.","authors":"Guillermo Martín-Gutiérrez, José Molina, Carlos Martín-Pérez, Manuela Aguilar-Guisado, María Solla, Belén Ramos-Morán, Teresa Aldabó, Rosario Amaya-Villar, Adelina Gimeno, Pilar Egea, Rocío Álvarez-Marín, José Antonio Lepe, José Miguel Cisneros","doi":"10.1093/ofid/ofaf532","DOIUrl":"10.1093/ofid/ofaf532","url":null,"abstract":"<p><strong>Background: </strong>To assess the impact of the rapid diagnosis and treatment of severe infections (rDTSI) program on diagnostic and clinical outcomes in patients with severe infections.</p><p><strong>Method: </strong>We conducted a pre-post quasi-experimental study evaluating patients with severe pneumonia or sepsis before (October 2019-February 2020) and after (March 2022-March 2023) rDTSI implementation. The program integrated rapid molecular diagnostics, a 24/7 laboratory workflow, and multidisciplinary training. Primary outcomes included time from clinical diagnosis to pathogen-directed therapy and targeted therapy within 48 h. Secondary outcomes assessed antimicrobial appropriateness (DOOR-MAT), length of stay, and mortality.</p><p><strong>Results: </strong>The rDTSI program significantly reduced the median time to pathogen-directed therapy in pneumonia (48.8 vs 23.6 h, <i>P</i> < .001) and increased targeted therapy within 48 h (36.17% to 58.14%, <i>P</i> = .049). Hospital stays decreased (38.9 to 22.2 days, <i>P</i> < .001). In sepsis, diagnostic times (19.4 vs 18.1 h, <i>P</i> = .028) and DOOR-MAT scores (80.4 vs 88.0, <i>P</i> = .024) improved, while other clinical outcomes remained unchanged.</p><p><strong>Conclusions: </strong>The rDTSI program accelerated microbiological diagnosis, optimized antimicrobial therapy, and improved hospital efficiency in severe infections. These findings support integrating rapid diagnostics into antimicrobial stewardship programs to enhance severe infection management.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 9","pages":"ofaf532"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anal Cancer Incidence Rates Among Men and Women With and Without HIV in South Africa.","authors":"Nathalie Verónica Fernández Villalobos, Yann Ruffieux, Chido Chinogurei, Andreas D Haas, Nicola Low, Matthias Egger, Jenni Noble, Gary Maartens, Naomi Folb, Eliane Rohner","doi":"10.1093/ofid/ofaf537","DOIUrl":"10.1093/ofid/ofaf537","url":null,"abstract":"<p><strong>Background: </strong>More than 7.5 million people in South Africa have HIV, but little is known about the association of HIV and anal cancer incidence. We examined anal cancer incidence in a large South African cohort of insured men and women.</p><p><strong>Methods: </strong>We conducted a cohort study using reimbursement claims data from a South African medical insurance scheme (01/2011-07/2020) to assess anal cancer rates among people with and without HIV aged ≥18 years. We estimated adjusted hazard ratios (aHRs) for the association of HIV and incident anal cancer using flexible parametric survival models. Covariates included sex, age, calendar year, a history of genital warts and other sexually transmitted infections, and in women, cervical precancer.</p><p><strong>Results: </strong>We included 1 068 915 people of whom 69 985 (7%) were living with HIV. Over 3 933 145 person-years, 122 anal cancers were diagnosed (crude rate: 3.1/100 000 person-years; 95% confidence intervals [CI] 2.6-3.7). People with HIV had a 4-fold higher anal cancer risk than people without HIV (aHR 4.43; 95% CI 2.44-8.04). While anal cancer rates were similar among men and women, older age (≥65 vs 45-54 years; aHR 5.01; 95% CI: 2.94-8.53), a history of genital warts (aHR 7.56; 95% CI: 2.28-25.07), and among women, a prior cervical precancer diagnosis (aHR 5.70; 95% CI 1.75-18.58) were associated with a higher anal cancer risk.</p><p><strong>Conclusions: </strong>In South Africa, men and women with HIV, older individuals, people with a history of genital warts, and women with a prior cervical precancer diagnosis might benefit from prioritized access to anal cancer screening.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 9","pages":"ofaf537"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uptake and 24-month Outcomes of Dolutegravir- Versus Lopinavir-based Second-line Antiretroviral Therapy for People With HIV in South Africa: A Retrospective Cohort Study and Emulated Target Trial.","authors":"Jennifer Anne Brown, Lara Lewis, Yukteshwar Sookrajh, Lungile Hobe, Thulani Ngwenya, Johan van der Molen, Kwabena Asare, Kwena Tlhaku, Mlungisi Khanyile, Thokozani Khubone, Christian Bottomley, Nigel Garrett, Jienchi Dorward","doi":"10.1093/ofid/ofaf530","DOIUrl":"10.1093/ofid/ofaf530","url":null,"abstract":"<p><strong>Background: </strong>Aligning with the World Health Organization, South Africa has replaced ritonavir-boosted lopinavir (LPV/r) with dolutegravir (DTG) in second-line antiretroviral therapy (ART) after treatment failure with tenofovir disoproxil fumarate (TDF)/lamivudine or emtricitabine (XTC)/efavirenz (EFV). Initial guidance included special considerations for DTG use among women.</p><p><strong>Methods: </strong>We analyzed routine deidentified data of adults switched from TDF/XTC/EFV to second-line AZT/XTC/LPV/r, AZT/XTC/DTG, or TDF/XTC/DTG between December 2019 and December 2023 at 108 healthcare facilities in KwaZulu-Natal, South Africa. Among people switched before July 2021, we emulated a target trial comparing 24-month death or loss to follow-up (LTFU), and viremia (>50 copies/mL). We conducted intention-to-treat and per-protocol analyses using weighted logistic regression with bootstrapped CIs.</p><p><strong>Results: </strong>Overall, women were less likely than men to switch to DTG (RR: 0.92 [95% CI: .88, .96]; <i>N</i> = 3649). Of 2321 people switched before July 2021, 915 (39%) switched to AZT/XTC/LPV/r, 415 (18%) to zidovudine (AZT)/XTC/DTG, and 991 (43%) to TDF/XTC/DTG. Median age was 36 years (IQR: 30, 43) and 1364 (59%) were women. In intention-to-treat analyses, the standardized 24-month risk of death or LTFU was similar with AZT/XTC/LPV/r (31%), AZT/XTC/DTG (30%), and TDF/XTC/DTG (34%). The standardized risk of 24-month viremia among those retained in care with a viral load result (<i>N</i> = 1270) was higher with AZT/XTC/LPV/r (50%) than with AZT/XTC/DTG (40%; aRD: -10% [95% CI -19%, -2%]) or TDF/XTC/DTG (39%; aRD: -11% [95% CI -18%, -5%]). Per-protocol analyses gave similar results.</p><p><strong>Conclusions: </strong>While retention was similar across regimens, viremia was less common on DTG-based ART, supporting current guidelines.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 9","pages":"ofaf530"},"PeriodicalIF":3.8,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibody Responses are Sustained 2 Years Post-Mpox Infection but not Following Modified Vaccinia Ankara-Bavarian Nordic Vaccination.","authors":"Joanne Byrne, Alejandro Garcia-Leon, Aisling Murphy, Gurvin Saini, Ishan Banik, Alan Landay, Liem Binh Luong Nguyen, Stefano Savinelli, Cathal O'Broin, Mary Horgan, Christine Kelly, Carlos Mejia-Chew, Corinna Sadlier, Eoghan de Barra, Jane A O'Halloran, Virginie Gautier, Patrick W G Mallon, Eoin R Feeney","doi":"10.1093/ofid/ofaf536","DOIUrl":"10.1093/ofid/ofaf536","url":null,"abstract":"<p><strong>Background: </strong>Clade IIb mpox cases have declined globally, likely due to behavioral changes alongside vaccine- and infection-induced immunity. However, infections in vaccinated individuals raise concerns about immunity durability. We compared the longevity of antibody responses following mpox infection and modified vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccination.</p><p><strong>Methods: </strong>In a multicenter, prospective cohort, we measured plasma IgG titers to vaccinia virus (VACV) B5 antigen in adults with prior mpox, MVA-BN vaccination, and historical controls, sampled up to 2 years postexposure. Receiver operating characteristic analysis determined the seropositivity threshold. Generalized additive mixed models compared antibody kinetics, and logistic regression identified factors associated with seropositivity. The results are median (interquartile range) unless specified.</p><p><strong>Results: </strong>A total of 122 vaccinated participants (100% male, aged 36 [32.5-43.5], 25% people with HIV [PWH]) were sampled at 22.0 (20.0-23.5) months post-MVA-BN vaccination, 72 of whom had a paired sample 12.5 (8.0-15.5) months prior, alongside 13 participants post-mpox (100% male, aged 32.5 [30.5-40], 23% PWH) sampled 25.0 (22.5-29.0) months postinfection, 12 with a paired sample 12.5 (8.5-15.5) months prior. At follow-up, 85% (11/13) of the post-mpox group remained seropositive, versus 32% (39/122) of the vaccinated group. Predicted geometric-mean anti-VACV-B5 titers fell below the seropositivity threshold at 15.5 (95% confidence interval [CI]: 13.0-19.5) months postvaccine. PWH had significantly lower odds of retaining seropositivity (odds ratio: 0.18; 95% CI: .04-.60; <i>P</i> = .01).</p><p><strong>Conclusions: </strong>Antibody titers declined more rapidly postvaccination than post-mpox, with most vaccinated recipients, particularly PWH, losing seropositivity at 2 years. How these data relate to reinfection risk or the need for boosters remains to be determined.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 9","pages":"ofaf536"},"PeriodicalIF":3.8,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes in Military Blood Donors at Joint Base San Antonio With Reactive <i>Trypanosoma cruzi</i> Antibody Screening Results.","authors":"Michael J Wells, Brian G Casleton, Melita M Gella, Glorimar Z Rivera, Megan L Phelps, Theresa M Casey, Angela B Osuna, Ga On Jung, Erin L Winkler, Heather C Yun, Joseph E Marcus","doi":"10.1093/ofid/ofaf522","DOIUrl":"10.1093/ofid/ofaf522","url":null,"abstract":"<p><strong>Background: </strong>All blood donors in the United States are universally screened once for <i>Trypanosoma cruzi</i> antibodies to prevent transfusion-transmitted Chagas disease, but military donors are screened with every donation. Previous studies of military blood donors demonstrated that reactive <i>T cruzi</i> antibodies were a common reason for postdonation deferral, but follow-up is unclear. This study evaluated the diagnostic evaluation of blood donors with reactive <i>T cruzi</i> screening results.</p><p><strong>Methods: </strong>Medical records of all blood donors at the Armed Services Blood Bank Center at Joint Base San Antonio-Lackland with reactive screening results for <i>T cruzi</i> antibodies between January 2017 to December 2022 were evaluated after chemiluminescent immunoassay or chemiluminescent microparticle immunoassay screening and enzyme strip assay supplementary testing. Records were assessed to determine the diagnostic evaluation and final diagnosis of each case following initial reactive screening results.</p><p><strong>Results: </strong>Of 89,459 blood donors during the study period, 49 (0.055%) screened reactive for <i>T cruzi</i> antibodies on initial blood donation. Of those, 4 (8%) had positive and 18 (36%) had indeterminate supplementary test results. No donors met criteria for Chagas disease on clinical diagnostic testing. Of the 8 with repeated screening testing ordered in the weeks after their original reactive result, only 1 (13%) had a repeated reactive screening test result but negative confirmatory serologic results.</p><p><strong>Conclusions: </strong>While reactive <i>T cruzi</i> screening results occurred in this cohort, there were no cases of Chagas disease. This study demonstrates that some military blood donors have transient reactivity with screening assays, and future work should determine ways to safely bring these donors without Chagas disease back into the donor pool.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 9","pages":"ofaf522"},"PeriodicalIF":3.8,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-Year Outcomes After Programmatic Transitioning to Dolutegravir in the Context of Severe Civil Unrest in Haiti.","authors":"Bernard Liautaud, Ana Sanchez Chico, Youry Macius, Sosina Abuhay, Patrice Joseph, Harrison T Reeder, Theo Bolas, Adias Marcelin, Colette Guiteau Moïse, Alexandra Apollon, Pierre Cremieux, Jean W Pape, Serena P Koenig","doi":"10.1093/ofid/ofaf526","DOIUrl":"10.1093/ofid/ofaf526","url":null,"abstract":"<p><strong>Background: </strong>Tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD) is widely prescribed in low and middle-income countries. Data on long-term outcomes are limited.</p><p><strong>Methods: </strong>We included all persons with HIV (PWH) ≥15 years of age who initiated or switched to TLD in Port-au-Prince, Haiti. We described treatment outcomes by pre-switch viral load and assessed predictors of virologic failure using multivariable logistic regression.</p><p><strong>Results: </strong>A total of 10 354 PWH initiated or switched to TLD from November 2018 to March 2021, and were included in the analyses. Of these, 2217 (21.4%) were ART-naïve and 8137 (78.6%) switched from an non-nucleoside reverse transcriptase inhibitor (NNTRI)-based regimen. Median follow-up time on TLD was 2.8 years (IQR: 2.3, 3.1). HIV-1 RNA <1000 copies/mL was achieved at the latest measurement in 92.7% of recipients of care (RoC) with pre-switch suppression, 88.5% without pre-switch viral load, 58.3% with pre-switch failure, and 81.8% of RoC ART-naïve at TLD initiation. Among treatment-experienced RoC, predictors of ≥1000 copies/mL at latest test included younger age (adjusted odds ratio [aOR]: 0.44; 95% CI: 0.34, 0.57 for age ≥50 vs <30 years), shorter time on ART (aOR: 0.91; 95% CI: 0.89, 0.93/year), lower education (aOR: 1.31; 95% CI: 1.13, 1.52), and higher pre-switch viral load: (aOR: 7.23; 95% CI: 6.06, 8.63 for ≥10 000 vs < 1000 copies/mL).</p><p><strong>Conclusions: </strong>Virologic outcomes on TLD are outstanding for PWH with pre-switch suppression. However, rates of virologic suppression are suboptimal among PWH who were ART-naïve at TLD initiation, and among those with a history of pre-switch failure, additional interventions are necessary, including access to long-acting treatment regimens.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 9","pages":"ofaf526"},"PeriodicalIF":3.8,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-emergence of Diphtheria in Guinea: An Outbreak Analysis of Vaccination and Disease Control Perspectives.","authors":"Alpha Kabiné Keita, Abdoul Karim Soumah, Thibaut Armel Chérif Gnimadi, Abass Kande, Kadio Jean Jacques Olivier Kadio, Haby Diallo, Mariama Cisse, Joel Ballè Koivogui, Djiba Kaba, Salifou Talassone Bangoura, Abdoulaye Toure, Florence Fenollar, Oleg Mediannikov, Alpha Kabinet Keita","doi":"10.1093/ofid/ofaf527","DOIUrl":"10.1093/ofid/ofaf527","url":null,"abstract":"<p><strong>Background: </strong>This study presented the key characteristics of patients who tested positive for diphtheria during the outbreak in the Republic of Guinea in 2023 and assessed the influence of some risk factors on disease development.</p><p><strong>Methods: </strong>The clinical diagnosis of diphtheria was confirmed by detecting diphtheria toxin genes in nasopharyngeal samples collected from suspected patients via 2 reverse transcription-quantitative polymerase chain reaction tests. Bivariate analyses with the χ² test and the Fisher's exact test were conducted to explore possible associations between diphtheria positivity and various sociodemographic, clinical, and exposure factors.</p><p><strong>Results: </strong>In total, 444 samples obtained from suspected cases were analyzed. In 90 (20.3%) cases, the condition was confirmed using quantitative polymerase chain reaction, with an overall fatality rate of 8.9% (<i>n</i> = 8). On average, deaths occurred 2 days after admission, with 6 (75.0%) of 8 (6 girls and 2 boys) deaths recorded within the first 3 months after the epidemic onset. The clinical characteristics included sore throat (91%), fever (90%), whitish throat membrane (83%), throat redness (81%), and dyspnea (28%). The risk factors were age <15 years, no prior vaccination, and contact with a patient with diphtheria. A whitish throat membrane and dyspnea were significantly associated with diphtheria positivity.</p><p><strong>Conclusions: </strong>This study emphasized that diphtheria remains a major and potentially fatal disease, despite vaccination and early symptom recognition. The identification of characteristic signs-particularly a whitish throat membrane and dyspnea-is important for reducing disease severity and mortality.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 9","pages":"ofaf527"},"PeriodicalIF":3.8,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}