We assessed relationships between early peripheral blood type I interferons (IFN) levels, clinical new early warning scores (NEWS), and clinical outcomes in hospitalized coronavirus ...disease‐19 (COVID‐19) adult patients. Early IFN‐β levels were lower among patients who further required intensive care unit (ICU) admission than those measured in patients who did not require an ICU admission during severe acute respiratory syndrome coronavirus type 2 infection. IFN‐β levels were inversely correlated with NEWS only in the subgroup of patients who further required ICU admission. To assess whether peripheral blood IFN‐β levels could be a potential relevant biomarker to predict further need for ICU admission, we performed receiver operating characteristic (ROC) curve analyses that showed for all study patients an area under ROC curve of 0.77 growing to 0.86 (p = 0.003) when the analysis was restricted to a subset of patients with NEWS ≥5 at the time of hospital admission. Overall, our findings indicated that early peripheral blood IFN‐β levels might be a relevant predictive marker of further need for an ICU admission in hospitalized COVID‐19 adult patients, specifically when clinical score (NEWS) was graded as upper than 5 at the time of hospital admission.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
We compared invasive cervical cancer (ICC) incidence rates in Europe, South Africa, Latin and North America among women living with HIV who initiated antiretroviral therapy (ART) between 1996 and ...2014. We analyzed cohort data from the International Epidemiology Databases to Evaluate AIDS (IeDEA) and the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) in EuroCoord. We used flexible parametric survival models to determine regional ICC rates and risk factors for incident ICC. We included 64,231 women from 45 countries. During 320,141 person‐years (pys), 356 incident ICC cases were diagnosed (Europe 164, South Africa 156, North America 19 and Latin America 17). Raw ICC incidence rates per 100,000 pys were 447 in South Africa (95% confidence interval CI: 382–523), 136 in Latin America (95% CI: 85–219), 76 in North America (95% CI: 48–119) and 66 in Europe (95% CI: 57–77). Compared to European women ICC rates at 5 years after ART initiation were more than double in Latin America (adjusted hazard ratio aHR: 2.43, 95% CI: 1.27–4.68) and 11 times higher in South Africa (aHR: 10.66, 95% CI: 6.73–16.88), but similar in North America (aHR: 0.79, 95% CI: 0.37–1.71). Overall, ICC rates increased with age (>50 years vs. 16–30 years, aHR: 1.57, 95% CI: 1.03–2.40) and lower CD4 cell counts at ART initiation (per 100 cell/μl decrease, aHR: 1.25, 95% CI: 1.15–1.36). Improving access to early ART initiation and effective cervical cancer screening in women living with HIV should be key parts of global efforts to reduce cancer‐related health inequities.
What's new?
Invasive cervical cancer (ICC) is a significant burden among women living with human immunodeficiency virus (HIV). Little is known, however, about geographical differences in ICC rates in women living with HIV. Here, ICC incidence rates in women who received antiretroviral therapy (ART) were compared across geographic regions. ICC incidence was notably high among women living with HIV in South Africa and Latin America. Five years after ART initiation, ICC incidence remained elevated for women in these two regions, compared with women in Europe and North America. Reduced CD4 cell count and older age at ART initiation were associated with increased ICC risk.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Objective
To perform an external validation of the Dat'AIDS score for predicting 5‐year overall mortality among people with HIV (PWH) aged 60 years or older.
Methods
This was a multi‐centre ...prospective cohort study at all sites participating in the Swiss HIV Cohort Study (SHCS). We calculated the Dat'AIDS score in PWH aged 60 years or older at their first visit between 1 January 2015 and 1 January 2020. People living with HIV‐2 and those whose Dat'AIDS score could not be calculated were excluded. Patients were followed until 1 January 2020. The primary endpoint was all‐cause mortality. Vital status was collected throughout the study period. We obtained population and score descriptive statistics and assessed the score's discrimination and calibration.
Results
We included 2205 participants (82% male) of median interquartile range (IQR) age 62.0 (60.3–67.0) years, mostly with viraemia <50 copies/mL (92.7%). Median follow‐up time was 15.9 years and median (IQR) CD4 cell count at enrolment was 586 (420–782) cells/μL. In all, 152 deaths were recorded during a total follow‐up period of 7147 patient‐years. The median (IQR) observed Dat'AIDS score was 3 (0–8). Discriminative capacities were good as the C‐statistic was 0.73 (95% CI: 0.69–0.77) and consistent across all subgroups. Comparison of observed and expected survival probabilities showed good calibration.
Conclusions
External validation of the Dat'AIDS score in patients aged 60 years or older showed that it could be a useful tool not only for research purposes, but also to identify older patients at a higher mortality risk and to tailor the most appropriate interventions.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Objectives
Sustained virological response (SVR) decreases the risk of hepatitis C virus (HCV)‐related events. Nevertheless, a substantial risk of events persists. We estimated incidences and ...identified factors associated with severe clinical events after SVR following treatment with a direct‐acting antiviral (DAA) in HIV/HCV‐coinfected patients.
Methods
Participants from the ANRS CO13 HEPAVIH were included if they reached SVR. Incidence rates of overall mortality, liver‐related events, AIDS‐defining events, ischaemic events and non‐liver non‐AIDS‐defining cancers (NLNA) were estimated. Factors associated with the risk of those events were identified using Poisson models adjusted on age at SVR and sex.
Results
In all, 775 participants were included. Incidence rates (95% confidence interval) of liver‐related events, overall mortality, AIDS‐defining events, ischaemic events and NLNA cancers per 1000 person‐years were 5.9 (3.3–10.3), 22.2 (16.8–29.5), 0.6 (0.1–4.5), 7.3 (4.4–12.2) and 13.7 (9.4–20.0), respectively. For all events, incidence rates were higher in cirrhotic than in non‐cirrhotic participants. Cirrhosis, liver stiffness and CD4 count were associated with liver‐related events. Factors associated with overall mortality were age, cirrhosis, liver stiffness and gamma‐glutamyl transferase (GGT). For ischaemic events and NLNA cancers, associated factors were total cholesterol and CD4 count, respectively.
Conclusions
After SVR following a DAA treatment, liver‐related and AIDS‐defining events were observed less frequently than NLNA cancers. Severity of liver disease was associated with the risk of liver‐related events and of overall mortality but not with ischaemic events and NLNA cancers. Factors reflecting HIV infection were associated with NLNA cancers and liver‐related events.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
The objective of this study was to evaluate antimicrobial therapy outcomes of bone and joint infections (BJI) caused by
Clostridium perfringens
. We investigated remission of symptoms and the absence ...of relapse or reinfection during follow-up. Among the 8 patients with
C. perfringens
BJI, the type of infection was early prosthesis infection (
n
= 2), osteosynthetic device infection (
n
= 4), and chronic osteomyeletis (
n
= 2). Clindamycin-rifampicin combination was given in 4 cases and metronidazole in 4 cases. The overall success rate was 87.5%. Among the 7 patients who completed antibiotic treatment, the success rate was 100%. The clindamycin-rifampicin combination appeared to be effective in patients with
C. perfringens
BJI.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
After emergency valve replacement surgery and renal replacement therapy, she recovered well and was discharged home in October, 2013, without further renal replacement therapy, and with improving ...renal function. Amoxicillin crystalluria can be asymptomatic or can be responsible for haematuria or acute renal failure attributable to intratubular precipitation or urinary tract obstruction.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Paget's disease of bone (PDB) has rarely been reported in people with HIV (PWH). We describe the prevalence and characteristics of patients with PDB in the French multicenter Dat'AIDS cohort. Among ...49 698 PWH actively followed in 2022, 9 had a diagnosis of PDB. The overall prevalence of PDB was 0.02% 95% confidence interval (CI) 0.01-0.03. The prevalence of PDB in PWH is very low and does not appear to differ from the non-HIV population.
•Severe COVID-19 patients present overwhelming inflammatory reactions leading to lung injury.•Corticosteroids may beneficially modulate the host immune response to COVID-19 pneumonia.•Before–after ...study evaluating the effect of corticosteroid addition to COVID-19 pneumonia treatment on hospital mortality.•In multivariate analysis, the ‘after’ period was associated with an adjusted lower risk of death (aHR = 0.47; P = 0.04).•‘After’ period was also associated with lower risk of ICU admission or death before ICU admission (aHR = 0.37; P < 0.001).
Anti-inflammatory drugs such as corticosteroids may beneficially modulate the host inflammatory response to coronavirus disease 2019 (COVID-19) pneumonia. The aim of this study was to evaluate the impact of addition of corticosteroids to the hospital protocol for treatment of suspected or confirmed COVID-19 pneumonia on rates of death or intensive care unit (ICU) admission. A before–after study was performed to evaluate the effect of addition of corticosteroids to our institution's COVID-19 treatment protocol on hospital mortality. A total of 257 patients with a COVID-19 diagnosis were included in this study between 3 March 2020 and 14 April 2020. As corticosteroids were widely used after 27 March 2020, two periods were considered for the purposes of this study: the ‘before’ period from 3–20 March 2020 (n = 85); and the ‘after’ period from 26 March–14 April 2020 (n = 172). The ‘after’ period was associated with a lower risk of death adjusted hazard ratio (aHR) = 0.47, 95% confidence interval (CI) 0.23–0.97; P = 0.04 and a lower risk of ICU admission or of death before ICU admission (aHR = 0.37, 95% CI 0.21–0.64; P = 0.0005) by multivariate analysis adjusted for age, National Early Warning score and institutionalisation status. In conclusion, addition of corticosteroids to our institution's COVID-19 treatment protocol was associated with a significant reduction in hospital mortality in the ‘after’ period.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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