To evaluate the effect of Nirmatrelvir‐ritonavir therapy and coronavirus disease 2019 (COVID‐19) vaccination on clinical outcomes of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) ...Omicron infection, we retrospectively analyzed the clinical data of 762 adult patients with confirmed Omicron BA2.2 variant infection, of them 488 patients received standard therapy and 274 patients received Nirmatrelvir‐ritonavir therapy. Subjects were matched by propensity score matching using R language, the baseline factors were balanced by the nearest‐neighbor matching method and were compared, together with the factors including progression to severe/critical disease, viral clearance time, length of hospital stay, and virological rebound of SARS‐CoV‐2 infection. Nirmatrelvir‐ritonavir therapy significantly accelerated viral clearance at Days 14 and 28 during hospitalization, but it had no impact on disease progression, length of hospital stay, or infection rebound. In contrast, COVID‐19 vaccination before admission was positively correlated with the viral clearance rate and negatively correlated with disease progression in a dose‐dependent way. COVID‐19 vaccination reduced the probability of infection rebound. Other factors such as the number of comorbidities, pneumonia on‐admission, and high D2 levels were positively correlated with disease progression. Our study strongly recommended booster COVID‐19 vaccination for the elderly population, particularly patients with comorbidities to prevent critical disease.
...the minimum sample size was found to be 108 individuals in each group by this calculation. ...we plotted cost-effectiveness acceptability curves (CEACs) which indicate the likelihood that the ...intervention is cost-effective for a given value of willingness to pay. With the improvement of antiretroviral drugs and patients' higher requirements for treatment effectiveness and quality of life, rapid ART has been effectively promoted among people living with HIV/AIDS (PLWHA). ...we estimated the direct individual costs of the two groups of patients in the
The correlation between HIV-1 DNA levels and plasma inflammatory cytokines was analyzed using Spearman correlation analysis and linear regression. Survival rates were evaluated using the Kaplan–Meier ...method, and differences were analyzed using a log-rank test. The results showed that IFN-γ levels were correlated with prognosis; patients with lower IFN-γ levels had better survival prognosis (hazard ratio HR = 0.193, 95% confidence interval CI 0.055–0.674; P = 0.019) Supplementary Figure 3, http://links.lww.com/CM9/B778. 5 Among the ART-experienced patients included in our study, CD8+ T cell counts in the lymphoma group were significantly lower than in the non-lymphoma group.
In light of this, our study endeavors to illuminate the distinctions in COVID-19 severity between ART-experienced and ART-naïve PLWH through a retrospective case–control analysis. The average age of ...the ART-naïve group was younger than that of the ART-experienced group (41.52 years old vs. 47.46 years old, t = 2.164, P = 0.032), while there was no significant difference in gender distribution between the two groups. ...the clinical classification of the two groups also showed significant differences, with a lower percentage of mild and asymptomatic cases (20 45.45% vs. 67 76.14%, χ2 = 12.38, P = 0.001) in ART-naïve group Supplementary Table 1, http://links.lww.com/CM9/B782. Ordinal logistic regression indicated that the absence of ART, but not age, SARS-CoV-2 vaccination, comorbidities, and low CD4+ T cell count was a risk factor for the severity of COVID-19 among PLWH, with an OR of 5.06 (95% confidence interval CI 1.71–14.92, P = 0.003) Figure 1A.
•Three-quarters (73.5%, 50/68) of central nervous system (CNS) infections were diagnosed by metagenomic next-generation sequencing (mNGS).•Multiple CNS infections are common in people living with ...human immunodeficiency virus.•The most common disease missed by mNGS tuberculous meningitis.
To evaluate the clinical utility of metagenomic next-generation sequencing (mNGS) for the diagnosis of central nervous system (CNS) infection in people living with human immunodeficiency virus (PLWH) in a real-world situation.
Cerebrospinal fluid (CSF) was sent for mNGS for PLWH who tested negative on all conventional tests but were still suspected to have CNS infection. A retrospective analysis was undertaken of the results and the clinical effect of mNGS on this cohort. The final diagnosis was adjudicated by a panel discussion following hospital discharge when the results of all tests and patients’ responses to the empiric therapy were available.
Eighty-eight eligible PLWH, including 51 (58%) patients suspected of encephalitis and 34 (46.7%) patients suspected of meningitis, were included in the analysis. Sixty-eight (77.3%) patients were diagnosed with CNS infection, of which 50 were based on the pathogens identified by mNGS. The most common disease missed by mNGS was clinically suspected tuberculous meningitis, followed by clinically suspected non-tuberculous mycobacterial meningitis. The results from mNGS led to modification of treatment in 21 (23.9%) patients, and increased confidence in continuation of original therapy in 30 (34.1%) patients. During hospitalization, two (2.3%) patients died and 66 (75%) patients improved.
mNGS of CSF is a useful tool for the diagnosis of CNS infection among PLWH. Further investigations are warranted to improve its sensitivity.
In the context of an aging global population, the aging of patients with HIV is an issue that society will have to face. Data indicate that between 2011 and 2019, the proportion of patients age 60 ...and over who were newly diagnosed with HIV in China increased from 12% to 25%. In contrast to younger groups, the special characteristics of older patients pose major challenges to the management of their disease. The current study examined the clinical outcomes and psychological status of patients age 50 and over who were diagnosed with HIV. Out of a total of 566 older patients from eastern China, viral suppression was achieved in 446 (78.8%), treatment was immunologically effective in 410 (72.4%), and treatment was effective in 324 (57.2%). Thirty-nine patients (6.9%) had significant anxiety and 143 (25.3%) exhibited depressive tendencies. Level of education and the time from diagnosis to treatment were associated with the effectiveness of treatment. Age, sleep quality, chronic illness, exercise, and travel time to medical appointments were associated with depressive symptoms. These findings suggest that the burden of HIV among the older population remains high in more economically developed areas. The urgent need for HIV education and screening programs, as well as follow-up visits and early initiation of treatment in older patients, is called for.
We investigated the clinical characteristics and outcomes of acquired immunodeficiency syndrome-related Burkitt lymphoma (AIDS-BL). A single-center retrospective study was performed of 78 cases over ...a 10-year period. The baseline characteristics of enrolled patients included the following: median age, 46 years; median CD4+ T lymphocyte count, 156 cells/μL; advanced stage, 74.3%; > 1 extranodal site, 55.1%; international prognostic index (IPI) > 1, 85.9%; and elevated serum lactate dehydrogenase, 82.1%. The 1-year and 2-year overall survival (OS) rates were 52.2 ± 5.9% and 42.7 ± 6.2%, respectively. A prognostic analysis of 65 patients who had undergone chemotherapy showed that B symptoms (with vs. without fever, night sweat or weight loss), number of extranodal sites (0, 1 vs. > 1), level of serum albumin (≥ 35 g/L vs. < 35 g/L), hemoglobin (≥ 110 g/L vs. < 110 g/L), and IPI score (≤ 2 vs. > 1) were all associated with OS. However, only B symptoms (HR = 4.036, 95% CI 1.821–8.948,
p
= 0.001), serum albumin level < 35 g/L (HR = 2.131, 95% CI 1.013–4.483,
p
= 0.046), and chemotherapy without rituximab (HR = 2.286, 95% CI 1.108–4.714,
p
= 0.025) were independent predictors of OS after multivariate adjustment. Patients with AIDS-BL were likely to present with high-risk features, and their clinical outcomes were relatively poor, especially those with B symptoms and lower serum albumin levels.
Background
Metabolic syndrome becomes a focus of clinical cares to people living with HIV (PLHIV) globally. This study aimed to explore the metabolic profiles in cerebrospinal fluid (CSF) of Chinese ...people living with HIV (PLHIV).
Methods
Cerebrospinal fluid samples from PLHIV and healthy controls were collected from our hospital. Then, the metabolic profiles of CSFs were analyzed PLHIV with healthy individual as the normal controls using the untargeted GC/TOFMS. Following this, kyoto encyclopedia of genes and genomes annotation and pathway analysis were performed to further explore the underlying mechanism of these metabolic alterations in cognitive impairment of PLHIV.
Results
Both PCA analysis and OPLS‐DA had presented that most samples were localized in 95% CI and the gap between control and HIV could significantly separate from each other. Upon this quality control, a total of 82 known metabolites were identified in CSF between PLHIV and healthy controls. Clustering of these metabolites presented that these differentially expressed metabolites could markedly distinguish HIV from healthy controls. Further pathway analyses showed that TCA cycle (citric acid, fumaric acid, lactate, et al.), amino acid (arginine, proline, alanine, aspartate, glutamine, et al.), lipid (cholesterol, butyrate, et al.) metabolisms were significantly changed in CSF of PLHIV, which might affect the cognitive status of PLHIV via affecting neuron energy support, signaling transduction, and neuroinflammation.
Conclusion
Metabolic profiles were significantly altered in CSF and might play key roles in the etiology of cognitive impairment of PHLIV. Further explore the exact mechanism for these metabolic changes might be useful for cognitive impairment management of PHLIV.
CSF samples from 10 HIV‐infected patients and 10 healthy controls were collected. Then, the metabolic profiles of PLHIV CSFs were analyzed with healthy individual as the normal controls using the untargeted GC/TOFMS. Following this, KEGG annotation and pathway analysis were performed to further explore the underlying mechanism of these metabolic alterations in cognitive impairment of PLHIV.
Talaromyces marneffei (TM) bloodstream infection is common in Acquired Immunodeficiency Syndrome (AIDS) patients with extreme immunodeficiency in Southeast Asia and South China, however, clinical ...case study on TM bloodstream infection is scarce. We retrospectively analyzed the clinical characteristics of TM bloodstream infection in hospitalized AIDS patients and determined the outcomes of hospitalization after diagnosis in our hospital over the past 5 years. From January 2015 to July 2020, 87 cases of TM detected by blood culture in patients admitted to our center were collected. The admission complaints, blood cells, biochemistry, CD4 and CD8 cell counts and 1,3-beta-D-glucan (BDG), procalcitonin (PCT), CRP level on the day of blood culture test, and outcomes during hospitalization were analyzed. Logistic regression analysis was performed for the risk factors for poor prognosis (60 cases). Spearman correlation analysis was used to analyze the correlation between peripheral blood cells, albumin and the time required for TM turnaround in blood culture. The difference was statistically significant when the P value was < 0.05. A total of 87 patients were collected, with a median age of 34 years, a median hemoglobin of 94 g/L and CD4 count of 7/mul. The rate of TM bloodstream infection among all in-hospital patients increased from 0.99% in 2015 to 2.09% in 2020(half year). Patients with TM bloodstream infection with CD8 count < 200/mul had a 12.6-fold higher risk of poor prognosis than those with CD8 count > 200/mul (p = 0.04), and those with BDG < 100 pg/mL had a 34.9-fold higher risk of poor prognosis than those with BDG > 100 pg/mL (p = 0.01). TM bloodstream infection is becoming more common in advanced AIDS patients in endemic areas. For those patients with extremely low CD4 and CD8 cell counts below 200/mul is with an increased risk of poor prognosis.
Men who have sex with men (MSM) is a key population for preventing HIV in China, yet pre-exposure prophylaxis (PrEP) is not widely accepted in this population. The objective of this manuscript was to ...assessed the barriers in the acknowledgement and uptake focusing the demand side.
An online questionnaire survey was conducted from December 2018 to January 2019. All participants were required to scan two-dimensional code which was the online crowdsourcing survey platform to complete the electronic questionnaire anonymously.
Among 1915 MSM from thirty-four cities of China, 512 (26.7%) versus 1617 (84.4%) had an objective or subjective need of PrEP, respectively. One hundred and six (5.5%) reported affordability and only 23 (1.2%) had ever taken it. Age, living alone and occupation were associated with the objective needs. Age, income, sexual behavior were associated with actual usage. The participants who they had objective need to use PrEP are the population which we should focus on.
A wide disconnect exists among the objective need, willingness, affordability and uptake of PrEP. Cost was the most prevalent barrier, accounting for 78.22% of individuals who needed and wished for PrEP but finally failed to receive it. The findings might facilitate optimizing future allocation of resources to better promote PrEP in Chinese MSM.
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