Background. Invasive pneumococcal disease (IPD) is an important cause of morbidity among individuals infected with human immunodeficiency virus (HIV). We described incidence and risk factors for IPD ...in HIV-infected and uninfected individuals. Methods. Nationwide population-based cohort study of HIV-infected adults treated at all Danish HIV treatment centers during 1995–2012. Nineteen population-matched controls per HIV-infected individual were retrieved. The risk of IPD was assessed using Poisson regression. Results. The incidence of IPD was 304.7 cases per 100 000 person-years of follow-up (PYFU) in HIV-infected and 12.8 per 100 000 PYFU in HIV-uninfected individuals. After adjusting for confounders, HIV infection (relative risk RR, 24.4 95% confidence interval CI, 23.7–25.1), male sex (RR, 1.20 95% CI, 1.16–1.24), increasing age (per year) (RR, 1.03 95% CI, 1.03–1.04), and calendar period (pre-cART RR, 2.80 95% CI, 2.70–2.91 compared with late cART) were significantly associated with an increased risk of IPD. Among HIV-infected individuals, male sex (RR, 1.57 95% CI, 1.49–1.66), smoking (RR, 1.34 95% CI, 1.26–1.42), and injecting drug use (RR, 2.51 95% CI, 2.26–2.67) were associated with an increased risk of IPD. Detectable viral loads (RR, 1.88 95% CI, 1.79–1.98) and a relative fall in CD4 T-cell counts were also associated with an increased risk (≥500 to 350–500 CD4 T cells/μL: RR, 1.29 95% CI, 1.21–1.37 and <100 cells/μL: RR, 7.4 95% CI, 6.87–8.02). The risk of IPD declined over time, although this was not the case for IDUs where the risk remained unchanged. Conclusions. The incidence of IPD in HIV-infected individuals remained significantly higher than the incidence observed in non-HIV-infected subjects, despite the widespread use of cART. IDUs have a persistently high risk of IPD. Injecting drug use, smoking, and the receipt of cART are suitable targets for preventive measures in the future.
To estimate the health economic consequences of the recently introduced PPSV23 vaccination programme for persons aged 65+ in Denmark and of a potential extension of the programme to include persons ...aged 60-64 years.
A Markov model was adapted to the Danish healthcare setting to simulate the epidemiological and economic burden of invasive pneumococcal disease and non-bacteremic pneumococcal pneumonia using information from published sources and Danish databases.
We found that the recent introduction of an age-based vaccination programme offering PPSV23 vaccination to the population of persons aged 65+ in Denmark will lead to a societal gain of EUR 72.0 million and prevent 19,707 cases of pneumococcal disease and 1,308 deaths per 1 million persons during the five-year study period.
Similarly, we estimate that extending the programme to include persons aged 60-64 will lead to a gain of EUR 14.6 million per 1 million persons and prevent an additional 6,223 cases of pneumococcal disease and 185 deaths.
The recent introduction of the age-based vaccination programme offering PPSV23 vaccination to all persons aged 65+ in Denmark is cost-effective. This is also the case if the programme is extended to include persons aged 60-64.
More than 30,000 malaria cases are reported annually among international travellers. Despite improvements in malaria control, malaria continues to threaten travellers due to inaccurate perception of ...risk and sub-optimal pre-travel preparation.
Records with a confirmed malaria diagnosis after travel from January 2003 to July 2016 were obtained from GeoSentinel, a global surveillance network of travel and tropical medicine providers that monitors travel-related morbidity. Records were excluded if exposure country was missing or unascertainable or if there was a concomitant acute diagnosis unrelated to malaria. Records were analyzed to describe the demographic and clinical characteristics of international travellers with malaria.
There were 5689 travellers included; 325 were children <18 years. More than half (53%) were visiting friends and relatives (VFRs). Most (83%) were exposed in sub-Saharan Africa. The median trip duration was 32 days (interquartile range 20-75); 53% did not have a pre-travel visit. More than half (62%) were hospitalized; children were hospitalized more frequently than adults (73 and 62%, respectively). Ninety-two per cent had a single Plasmodium species diagnosis, most frequently Plasmodium falciparum (4011; 76%). Travellers with P. falciparum were most frequently VFRs (60%). More than 40% of travellers with a trip duration ≤7 days had Plasmodium vivax. There were 444 (8%) travellers with severe malaria; 31 children had severe malaria. Twelve travellers died.
Malaria remains a serious threat to international travellers. Efforts must focus on preventive strategies aimed on children and VFRs, and chemoprophylaxis access and preventive measure adherence should be emphasized.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Summary Background The global spread of multi-resistant Enterobacteriaceae is a new challenge in health care. Travelling in high endemic areas has been associated with colonisation. This study was ...performed among patients hospitalised for any reason, with recent travel abroad to identify the rate for colonisation with multi-resistant bacteria. Methods In a 3-month period (2011) all patients admitted to a the Department of Infectious Diseases, Aarhus University Hospital, Denmark with a travel history within the last three months were screened for multi-drug resistant bacteria by a rectal swab. Results A total of 88 adult patients were included. None were carriers of carbapenemase-producing bacilli. 12.5% were colonised with extended spectrum beta-lactamase producing Escherichia coli (ESBL-EC). Diarrhoea during travel was significantly associated with colonisation. More than 80% of the ESBL-EC colonised patients had been abroad longer than two weeks ( P < 0.05). Less than 40% of patients with ESBL-EC had self-limiting diarrhoea at the time of admission. Conclusions A significant proportion of patients with a recent travel history was colonised with ESBL-EC at hospitalisation (12.5%). Less than half of the travellers with ESBL-EC had gastrointestinal symptoms. Diarrhoea during travel and travelling time > two weeks were associated with colonisation with ESBL-EC.
Primary antibody deficiencies (PAD) make up more than half of primary immunodeficiencies. PAD is characterized by low levels of one or more immunoglobulin (Ig) classes or impaired vaccine response. ...Recurrent infections are the predominant presenting symptoms, but autoimmune disorders are also frequent. Onset of symptoms is often after the age of six. Screening for PAD with measurement of the levels of serum IgG, IgM, and IgA is simple and can be done in general practice. Replacement therapy with Ig is the cornerstone in treatment of PAD and reduces the frequency of infections and mortality.
•Destinations, travel demographics, and travel plans were found to be similar among Nordic citizens responding to an online questionnaire Au? rephrase.•Overall, 37% of respondents had traveled to ...countries with a higher risk of acquiring travel-related diseases.•Older individuals were found to travel almost as much as younger ones.•One-third of the 60–74-year-olds had visited destinations outside Europe and North America.
Despite the high frequency of international travel from Nordic countries annually, data describing demographics, patterns, and plans of travel among Nordic inhabitants are scarce.
In 2018, an online questionnaire covering travel patterns, plans, and knowledge about travel-related diseases was sent to Nordic inhabitants 18–74 years of age. At-risk travelers were defined as those who had traveled outside Europe and North America during the previous 2 years.
Of the 5407 respondents included, 4371 (80.8%) had traveled abroad within the past 2 years. Among the respondents, 37.0% (n = 1999) were at-risk travelers. The most frequent travel destinations were Europe (n = 3907, 89.4%) and Asia (n = 1019, 23.3%). Russia/Eurasia was a more common destination for Finnish travelers than the other travelers (10.6% vs 2.3–4.1%). Most at-risk travelers had traveled for leisure/tourism (n = 1329, 66.5%). Visiting friends and relatives was more frequent among Norwegian and Swedish travelers (n = 105, 22.0% and n = 98, 19.4%, respectively) than Finnish travelers (n = 74, 12.7%). The elderly traveled often and made up 21.4% of at-risk travelers.
Travel demographics, destinations, and future travel plans were similar across the Nordic countries. More than one third had traveled outside Europe/North America. One third were either elderly or visiting friends or relatives.
Background: Survival among people with HIV (PWH) has vastly improved globally over the last few decades but remains lower than among the general population. We aimed to estimate time trends of ...survival among PWH and their families from 1995 to 2021. Methods: We conducted a registry-based, nationwide, population-based, matched cohort study. We included all Danish-born PWH from 1995 to 2021 who had been on antiretroviral therapy for 90 days, did not report intravenous drug use, and were not co-infected with hepatitis C (n = 4168). We matched population controls from the general population 10:1 to PWH by date of birth and sex (n = 41,680). For family cohorts, we identified siblings, mothers, and fathers of PWH and population controls. From Kaplan–Meier tables with age as time scale, we estimated survival from age 25. We compared PWH with population controls and families of PWH with families of population controls to calculate mortality rate ratios adjusted for sex, age, comorbidities, and education (aMRR). Findings: The median age of death among PWH increased from 27.5 years in 1995–1997 to 73.9 years (2010–2014), but thereafter survival increased only marginally. From 2015 to 2021, mortality was increased among PWH (aMRR 1.87 (95% CI: 1.65–2.11)) and siblings (aMRR: 1.25 (95% CI: 1.07–1.47)), mothers (aMRR: 1.30 (95% CI: 1.17–1.43)), and fathers (aMRR: 1.15 (95% CI: 1.03–1.29)) of PWH compared to their respective control cohorts. Mortality among siblings of PWH who reported heterosexual route of HIV transmission (aMRR: 1.51 (95% CI: 1.16–1.96)) was higher than for siblings of PWH who reported men who have sex with men as route of HIV transmission (aMRR 1.19 (95% CI: 0.98–1.46)). Interpretation: Survival among PWH improved substantially until 2010, after which it increased only marginally. This may partly be due to social and behavioural factors as PWH families also had higher mortality. Funding: Preben and Anna Simonsen’s Foundation and Independent Research Fund Denmark.
Survival among people with HIV (PWH) has vastly improved globally over the last few decades but remains lower than among the general population. We aimed to estimate time trends of survival among PWH ...and their families from 1995 to 2021.
We conducted a registry-based, nationwide, population-based, matched cohort study. We included all Danish-born PWH from 1995 to 2021 who had been on antiretroviral therapy for 90 days, did not report intravenous drug use, and were not co-infected with hepatitis C (n = 4168). We matched population controls from the general population 10:1 to PWH by date of birth and sex (n = 41,680). For family cohorts, we identified siblings, mothers, and fathers of PWH and population controls. From Kaplan–Meier tables with age as time scale, we estimated survival from age 25. We compared PWH with population controls and families of PWH with families of population controls to calculate mortality rate ratios adjusted for sex, age, comorbidities, and education (aMRR).
The median age of death among PWH increased from 27.5 years in 1995–1997 to 73.9 years (2010–2014), but thereafter survival increased only marginally. From 2015 to 2021, mortality was increased among PWH (aMRR 1.87 (95% CI: 1.65–2.11)) and siblings (aMRR: 1.25 (95% CI: 1.07–1.47)), mothers (aMRR: 1.30 (95% CI: 1.17–1.43)), and fathers (aMRR: 1.15 (95% CI: 1.03–1.29)) of PWH compared to their respective control cohorts. Mortality among siblings of PWH who reported heterosexual route of HIV transmission (aMRR: 1.51 (95% CI: 1.16–1.96)) was higher than for siblings of PWH who reported men who have sex with men as route of HIV transmission (aMRR 1.19 (95% CI: 0.98–1.46)).
Survival among PWH improved substantially until 2010, after which it increased only marginally. This may partly be due to social and behavioural factors as PWH families also had higher mortality.
Preben and Anna Simonsen’s Foundation and Independent Research Fund Denmark.
Introduction. HIV infected individuals have an increased risk of developing lymphoma compared to sex- and age matched non-immunocompromised control population and approximately 2% of HIV infected ...individuals developed lymphoma (Gopal et al, J Natl cancer Inst 2013). Our group has been among the first who identified novel serum protein markers present at time of HIV diagnosis, which were predictive of subsequent lymphoma development (Vase et al, AIDS 2016). Galectins are important regulators of cell adhesion, apoptosis, cell cycle, and mRNA processing. Galectin-1 (Gal-1) is a known lectin-binding protein able to mediate Th2 skewed microenvironment in lymphomas (Juszczynski et al, Proc Natl Acad Sci U S A 2007; Cedeno-Laurent et al, Blood 2012), and facilitates HIV-infection (Sato et al, Ann N Y Acad Sci 2012). Increased serum Gal-1 levels were correlated to increased tumor burden and adverse clinical features in Hodgkin lymphoma (HL) (Kamper et al, Blood 2011; Ouyang et al, Blood 2013) and low Gal-1 levels were associated with an increased risk of chronic graft-versus-host disease in patients with hematologic malignancies treated with non-myeloablative hematopoietic stem cell transplantation (Petruskevicius et al, BMT 2016). In this study, we investigated whether the serum level of Gal-1 at the time of HIV diagnosis was predictive for subsequent lymphoma development.
Methods. We determined the serum levels of Gal-1 in serum samples from19 HIV infected patients collected at the time of HIV diagnosis. Measurements were performed using a time-resolved immunofluorometric assay, as previously described (Petruskevicius et al, BMT 2016). Patients were grouped based on clinical outcomes in (i) future HIV-associated lymphoma (HIV/lymphoma), (ii) future HIV-associated benign lymphadenopathy (HIV/adenopathy), and (iii) no future neoplasia (HIV/no neoplasia), Table 1. Furthermore, serum Gal-1 levels were compared to those of a healthy control group (n=30), as previously reported (Petruskevicius et al, BMT 2016). Gal-1 sample concentrations were calculated by regression anaysis on basis of a standard curve of recombinant Gal-1 at concentrations of 100 to 0.78 ng/mL with 1:4 sample dilutions. Gal-1 levels > 400ng/mL was included in the analyses with a value of 400ng/mL. Estimates of differences between groups were evaluated using Student’s t-test or ANOVA on log transformed data. A ROC analysis was computed to establish cut-off values for serum galectin-1, with respect to development of lymphoma.
Results. Overall, the serum Gal-1 level in the HIV cohort was lower than in the healthy control group (p<0.001), Figure 1A. At HIV diagnosis, those HIV patients who would subsequently develop lymphoma had significantly lower levels of serum Gal-1 compared to the remaining cohort, Figure 1B (p=0.017). There was no gender-related difference (p=0.436) and Gal-1 serum levels did not correlate with either CD4 count (p=0.553) or viral load (p=0.600) at time of HIV diagnosis. In this size-limited study population, it was not possible to show any significant difference between HIV/lymphoma, HIV/adenopathy, and HIV/no neoplasia. ROC calculated cut-off of 2.6 ng/mL was able to separate HIV patients with future lymphoma from the remaining HIV patients and controls with a specificity of 78% and sensitivity of 100%. At this cut-off 13 (31%) patients were allocated to the low Gal-1 group, including all future lymphoma patients.
Conclusion. HIV infected patients had significant lower serum Gal-1 levels than compared to a healthy control cohort. All HIV infected patients that later developed lymphoma belonged to the subset with lowest serum Gal-1 levels. If confirmed in independent cohorts of HIV patients from the cART era, this observation will support the use of low serum levels of Gal-1 as an early predictive biomarker for subsequent lymphoma development in HIV infected individuals. This may in turn have potential implications on the clinical monitoring strategy of these patients.
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