Pangenotypic and Genotype-Specific Antivirals in the Treatment of HCV Genotype 4 Infected Patients with HCV Monoinfection and HIV/HCV Coinfection

The introduction of the direct-acting antivirals (DAA) has substantially improved the effectiveness of the therapy in patients with chronic hepatitis C. We aimed to compare the efficacy of pangenotypic and genotype-specific DAA in the cohort of genotype (GT) four patients with HCV monoinfection and HIV coinfection. A total of 662 GT4-infected patients treated in 2015–2020—of whom 168 (25.3%) were coinfected with HIV, selected from the retrospective EpiTer-2 database—were enrolled in the analysis. Among HIV-coinfected patients, 54% (90) were treated with genotype-specific regimens and 46% (78) with pangenotypic options, while among HCV-monoinfected patients, the rates were 72% and 28%, respectively. Significantly higher rate of males (67.9% vs. 57.7%, p = 0.01), a lower rate of liver cirrhosis (10.2% vs. 18.1%, p = 0.02), and higher of treatment-naïve patients (87.5% vs. 76.7%, p = 0.003) were documented in the HIV coinfected population. The overall sustained virologic response after exclusion of non-virologic failures was achieved in 98% with no significant difference between HIV-positive and HIV-negative patients, 96.2% vs. 98.5%, respectively. While the genotype-specific regimens resulted in a similar cure rate regardless of the HIV status, the pangenotypic options were more efficacious in patients with HCV monoinfection (99.3% vs. 94.4%, p = 0.05). Hereby, we demonstrated the high effectiveness and good safety profile of the DAA therapy in the population of HCV GT4 infected patients with HIV coinfection supporting the current recommendations to treat HCV/HIV coinfected patients with the same options as those with HCV monoinfection.

Tuberculosis Situation in Volga Federal District in 2016-2020

The objective of the study: to assess changes in the incidence and prevalence of multiple drug resistant tuberculosis (MDR TB) and TB/HIV coinfection (TB/HIV) in Volga Federal District (VFD) and its regions during 2016-2020.Subjects and Methods. Data from FGSN Forms No. 8, 33, and 61, and analytical reviews of main statistical TB rates in the Russian Federation have been studied. The number of those died is presented as per the Rosstat data.Results. An increase in the incidence and prevalence of MDR TB and TB/HIV coinfection has been detected in certain region of Volga Federal District. Perm Region, the Republic of Bashkortostan, the Republic of Udmurtia, and Orenburg and Samara Regions have the highest prevalence of MDR TB and TB/HIV coinfection. In 2020, the Republic of Bashkortostan was the only region where the incidence and prevalence of MDR TB were growing (164.7% and 47.3%, respectively). The highest incidence and prevalence of TB/HIV coinfection was reported in the Republic of Bashkortostan, Perm Kray, Orenburg Region, the Chuvash and Udmurt Republics. Over the last 5 years, the maximum increase in TB/HIV incidence and prevalence was observed in the Republic of Bashkortostan (38.8% and 41.3%, respectively).

Respiratory symptoms and lung function in patients treated for pulmonary tuberculosis in Malawi: a prospective cohort study

RationalePulmonary tuberculosis (PTB) can cause post-TB lung disease (PTLD) associated with respiratory symptoms, spirometric and radiological abnormalities. Understanding of the predictors and natural history of PTLD is limited.ObjectivesTo describe the symptoms and lung function of Malawian adults up to 3 years following PTB-treatment completion, and to determine the evolution of PTLD over this period.MethodsAdults successfully completing PTB treatment in Blantyre, Malawi were followed up for 3 years and assessed using questionnaires, post-bronchodilator spirometry, 6 min walk tests, chest X-ray and high-resolution CT. Predictors of lung function at 3 years were identified by mixed effects regression modelling.Measurement and main resultsWe recruited 405 participants of whom 301 completed 3 years follow-up (mean (SD) age 35 years (10.2); 66.6% males; 60.4% HIV-positive). At 3 years, 59/301 (19.6%) reported respiratory symptoms and 76/272 (27.9%) had abnormal spirometry. The proportions with low FVC fell from 57/285 (20.0%) at TB treatment completion to 33/272 (12.1%), while obstruction increased from and 41/285 (14.4%) to 43/272 (15.8%) at 3 years. Absolute FEV1 and FVC increased by mean 0.03 L and 0.1 L over this period, but FEV1 decline of more than 0.1 L was seen in 73/246 (29.7%). Higher spirometry values at 3 years were associated with higher body mass index and HIV coinfection at TB-treatment completion.ConclusionSpirometric measures improved over the 3 years following treatment, mostly in the first year. However, a third of PTB survivors experienced ongoing respiratory symptoms and abnormal spirometry (with accelerated FEV1 decline). Effective interventions are needed to improve the care of this group of patients.

Metagenomic Analysis Identifying a Rare Leishmania Infection in an Adult With AIDS

Leishmania belongs to a genus of the protozoan parasites that causes leishmaniasis, and includes cutaneous leishmaniasis (CL) and visceral leishmaniasis (VL). In this case, Leishmania amastigotes were found on cytomorphology examination of the bone marrow specimen, followed by 1,076 Leishmania donovani reads using metagenomic next generation sequencing (mNGS). Since being definitely diagnosed with VL/HIV coinfection, the patient was treated with liposomal amphotericin B as the parasite-resistant therapy and was discharged after clinical cure. But nearly a year later, on the mNGS follow-up, L. donovani was detected in the patient’s blood plasma specimen with 941 reads, suggesting that a relapse of leishmaniasis had occurred. These results indicate that leishmaniasis still exists in China and may represent a public health concern. This case could be helpful in the differential diagnosis of leishmaniasis, and for determining disease progression, prevention, and control of vectors and reservoir hosts.

STI epidemic re-emergence, socio-epidemiological clusters characterisation and HIV coinfection in Catalonia, Spain, during 2017–2019: a retrospective population-based cohort study

ObjectivesTo describe the epidemiology of sexually transmitted infections (STIs), identify and characterise socio-epidemiological clusters and determine factors associated with HIV coinfection.DesignRetrospective population-based cohort.SettingCatalonia, Spain.Participants42 283 confirmed syphilis, gonorrhoea, chlamydia and lymphogranuloma venereum cases, among 34 600 individuals, reported to the Catalan HIV/STI Registry in 2017–2019.Primary and secondary outcomesDescriptive analysis of confirmed STI cases and incidence rates. Factors associated with HIV coinfection were determined using logistic regression. We identified and characterized socio-epidemiological STI clusters by Basic Health Area (BHA) using K-means clustering.ResultsThe incidence rate of STIs increased by 91.3% from 128.2 to 248.9 cases per 100 000 population between 2017 and 2019 (p<0.001), primarily driven by increase among women (132%) and individuals below 30 years old (125%). During 2017–2019, 50.1% of STIs were chlamydia and 31.6% gonorrhoea. Reinfections accounted for 10.8% of all cases and 6% of cases affected HIV-positive individuals. Factors associated with the greatest likelihood of HIV coinfection were male sex (adjusted OR (aOR) 23.69; 95% CI 16.67 to 35.13), age 30–39 years (versus <20 years, aOR 18.58; 95% CI 8.56 to 52.13), having 5–7 STI episodes (vs 1 episode, aOR 5.96; 95% CI 4.26 to 8.24) and living in urban areas (aOR 1.32; 95% CI 1.04 to 1.69). Living in the most deprived BHAs (aOR 0.60; 95% CI 0.50 to 0.72) was associated with the least likelihood of HIV coinfection. K-means clustering identified three distinct clusters, showing that young women in rural and more deprived areas were more affected by chlamydia, while men who have sex with men in urban and less deprived areas showed higher rates of STI incidence, multiple STI episodes and HIV coinfection.ConclusionsWe recommend socio-epidemiological identification and characterisation of STI clusters and factors associated with HIV coinfection to identify at-risk populations at a small health area level to design effective interventions.

Experience of Using a Mobile App to Improve Adherence to Treatment in Patients with TB/HIV Coinfection

The objective of the study: to summarize experience of using a mobile technology to improve adherence in patients with tuberculosis and HIV infection (TB/HIV) who are psychoactive substance users.Subjects and Methods. A smartphone app was used, it included daily patient inquiries about mood, stress levels, and medication intake; periodic reminders about outpatient appointments; and anonymous chats with the coordinating physician and other patients. Treatment results were evaluated in Group 1 (n = 54) and Group 2 (n = 50), where this technology was used and not used, respectively.Results. The number of patients cured of tuberculosis was not significantly different between Groups 1 and 2 (32/51 vs. 27/48; χ2 = 0.61, p = 0.48). Patients from Group 2 died significantly more often during the follow-up period (14/48 vs. 3/51; χ2 = 7.86, p = 0.006) associated with antiretroviral therapy interruption or withdrawal. Increased CD4 count by 6 months of follow-up was found in both groups, most pronounced among those who started ART (W = 6.0, p = 0.004 – in Group 1 and W = 15.0, p = 0.004 – in Group 2). The total number of patients with viral suppression was greater in Group 1 than in Group 2 (34/47 vs. 20/39; χ2 = 4.05, p = 0.04).Conclusion. The mobile app used is suitable for supporting the outpatient management of patients with TB/HIV coinfection but its direct impact was reflected only in the formation of ART adherence and lower number of deaths.

Historical analysis of leishmaniasis cases in the transamazonian region: from 2009 to 2019

Objective: To determine the total number of notified cases, new cases and recurrence of American Tegumentary Leishmaniasis (ATL), to investigate the association between HIV coinfection and the presence of cutaneous lesion, as well to assess the concordance of two different laboratorial procedures: parasitological and histopathological in this region. Methods: This is a cross-sectional study. The research used data from the Information System for Notifiable Diseases, hence forth designated as SINAN (Sistema de Informação de Agravos de Notificação) that contained 6,183 cases of leishmaniasis in 9 municipalities. Results: As results, 5795 were of new cases and 351 recurrence cases. Among the cases 1,146 patients were tested for HIV, 16 presented coinfection from these 15 developed cutaneous lesion. In the overall studied population 5,690 subjects manifested cutaneous lesion. There was no agreement of the results regarding the quality of the parasitological and histopathological exams, demonstrating that they are poorly replicable (p <0.005). Conclusion: The ATL is endemic in the transamazonian region posing as a major public health problem. All patients with leishmaniasis must be tested for HIV and health professionals must register on the notification form. The tests to diagnose leishmaniasis need to be more specific and sensitive.

Survival and predictors of death in tuberculosis/HIV coinfection cases in Porto Alegre, Brazil: A historical cohort from 2009 to 2013

Background Tuberculosis is a curable disease, which remains the leading cause of death among infectious diseases worldwide, and it is the leading cause of death in people living with HIV. The purpose is to examine survival and predictors of death in Tuberculosis/HIV coinfection cases from 2009 to 2013. Methods We estimated the survival of 2,417 TB/HIV coinfection cases in Porto Alegre, from diagnosis up to 85 months of follow-up. We estimated hazard ratios and survival curves. Results The adjusted risk ratio (aRR) for death, by age, hospitalization, and Directly Observed Treatment was 4.58 for new cases (95% CI: 1.14–18.4), 4.51 for recurrence (95% CI: 1.11–18.4) and 4.53 for return after abandonment (95% CI: 1.12–18.4). The average survival time was 72.56 ± 1.57 months for those who underwent Directly Observed Treatment and 62.61 ± 0.77 for those who did not. Conclusions Case classification, age, and hospitalization are predictors of death. The occurrence of Directly Observed Treatment was a protective factor that increased the probability of survival. Policies aimed at reducing the mortality of patients with TB/HIV coinfection are needed.

Possibilities of specific immunological tests in patients with TB/HIV coinfection

The objective of the study: to study the possibilities of skin tests with tuberculosis recombinant allergen (TRA) in the diagnosis of tuberculosis in HIV-positive patients in the region with a high prevalence of tuberculosis.Subjects and Methods. Medical files of 85 patients were retrospectively analyzed, all the patients suffered from TB/HIV coinfection and underwent the skin test with TRA.Results. The skin test with TRA was found to be significantly valuable for the diagnosis of tuberculosis in patients with TB/HIV coinfection. The correlation between the intensity of response to the TRA test and CD4+ count was detected (p = 0.011). The lowest values were observed for CD4+ counts below 100 cells/μL. The direct correlation between the intensity of response to TRA and the stage of HIV infection was proved. No effect of the form of tuberculosis, the phase of the tuberculosis disease, or drug sensitivity on the intensity of response to TRA was found. Among tuberculosis patients with bacterial excretion (n = 48), 68.8% of patients responded positively to the TRA test, and in those with no bacterial excretion, the positive reaction was observed in 81.1%.